|
PR CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$1,711.00
|
|
|
Service Code
|
HCPCS 44625
|
| Min. Negotiated Rate |
$674.96 |
| Max. Negotiated Rate |
$1,454.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,000.48
|
| Rate for Payer: AlohaCare Medicare |
$919.49
|
| Rate for Payer: Cash Price |
$1,026.60
|
| Rate for Payer: Cash Price |
$1,026.60
|
| Rate for Payer: Devoted Health Medicare |
$1,011.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$919.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$674.96
|
| Rate for Payer: Health Management Network Commercial |
$1,454.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,103.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,103.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,103.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,000.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$919.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,000.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$919.49
|
|
|
PR CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$2,656.00
|
|
|
Service Code
|
HCPCS 44626
|
| Min. Negotiated Rate |
$1,301.30 |
| Max. Negotiated Rate |
$2,257.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,553.00
|
| Rate for Payer: AlohaCare Medicare |
$1,415.40
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Devoted Health Medicare |
$1,556.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,415.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,301.30
|
| Rate for Payer: Health Management Network Commercial |
$2,257.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,698.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,698.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,698.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,553.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,415.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,553.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,415.40
|
|
|
PR CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$1,732.00
|
|
|
Service Code
|
HCPCS 27222
|
| Min. Negotiated Rate |
$579.28 |
| Max. Negotiated Rate |
$1,472.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,007.49
|
| Rate for Payer: AlohaCare Medicare |
$922.63
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Devoted Health Medicare |
$1,014.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$922.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$579.28
|
| Rate for Payer: Health Management Network Commercial |
$1,472.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,107.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,107.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,107.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,007.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$922.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,007.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$922.63
|
|
|
PR CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
HCPCS 27842
|
| Min. Negotiated Rate |
$230.62 |
| Max. Negotiated Rate |
$759.90 |
| Rate for Payer: AlohaCare Medicaid |
$521.61
|
| Rate for Payer: AlohaCare Medicare |
$505.02
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Devoted Health Medicare |
$555.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$505.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$230.62
|
| Rate for Payer: Health Management Network Commercial |
$759.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$606.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$606.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$606.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$521.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$505.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$505.02
|
|
|
PR CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ
|
Professional
|
Both
|
$782.81
|
|
|
Service Code
|
HCPCS 26742
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$665.39 |
| Rate for Payer: AlohaCare Medicaid |
$364.25
|
| Rate for Payer: AlohaCare Medicare |
$354.65
|
| Rate for Payer: Cash Price |
$469.69
|
| Rate for Payer: Cash Price |
$469.69
|
| Rate for Payer: Devoted Health Medicare |
$390.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$364.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$364.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.88
|
| Rate for Payer: Health Management Network Commercial |
$665.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$425.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$425.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$425.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$364.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$364.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.65
|
| Rate for Payer: University Health Alliance Commercial |
$468.92
|
|
|
PR CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ
|
Professional
|
Both
|
$492.82
|
|
|
Service Code
|
HCPCS 26740
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$418.90 |
| Rate for Payer: AlohaCare Medicaid |
$247.54
|
| Rate for Payer: AlohaCare Medicare |
$240.59
|
| Rate for Payer: Cash Price |
$295.69
|
| Rate for Payer: Cash Price |
$295.69
|
| Rate for Payer: Devoted Health Medicare |
$264.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$247.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$247.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.22
|
| Rate for Payer: Health Management Network Commercial |
$418.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$288.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.59
|
| Rate for Payer: University Health Alliance Commercial |
$312.94
|
|
|
PR CLTX CARPAL BONE FX W/MNPJ EACH BONE
|
Professional
|
Both
|
$968.84
|
|
|
Service Code
|
HCPCS 25635
|
| Min. Negotiated Rate |
$351.26 |
| Max. Negotiated Rate |
$823.51 |
| Rate for Payer: AlohaCare Medicaid |
$462.44
|
| Rate for Payer: AlohaCare Medicare |
$442.73
|
| Rate for Payer: Cash Price |
$581.30
|
| Rate for Payer: Cash Price |
$581.30
|
| Rate for Payer: Devoted Health Medicare |
$487.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$462.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$442.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$462.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$351.26
|
| Rate for Payer: Health Management Network Commercial |
$823.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$531.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$531.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$462.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$462.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.73
|
| Rate for Payer: University Health Alliance Commercial |
$592.49
|
|
|
PR CLTX CARPAL BONE FX W/O MNPJ EACH BONE
|
Professional
|
Both
|
$644.65
|
|
|
Service Code
|
HCPCS 25630
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$547.95 |
| Rate for Payer: AlohaCare Medicaid |
$314.40
|
| Rate for Payer: AlohaCare Medicare |
$306.09
|
| Rate for Payer: Cash Price |
$386.79
|
| Rate for Payer: Cash Price |
$386.79
|
| Rate for Payer: Devoted Health Medicare |
$336.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$314.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$306.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$314.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$235.04
|
| Rate for Payer: Health Management Network Commercial |
$547.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$367.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$367.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$367.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$314.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$306.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$314.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$306.09
|
| Rate for Payer: University Health Alliance Commercial |
$400.08
|
|
|
PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 26675
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: AlohaCare Medicaid |
$458.46
|
| Rate for Payer: AlohaCare Medicare |
$436.05
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Devoted Health Medicare |
$479.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$458.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$436.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$458.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$810.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$523.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$523.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$523.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$458.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$436.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$458.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$436.05
|
| Rate for Payer: University Health Alliance Commercial |
$588.68
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ
|
Professional
|
Both
|
$924.42
|
|
|
Service Code
|
HCPCS 27788
|
| Min. Negotiated Rate |
$262.60 |
| Max. Negotiated Rate |
$785.76 |
| Rate for Payer: AlohaCare Medicaid |
$416.23
|
| Rate for Payer: AlohaCare Medicare |
$431.78
|
| Rate for Payer: Cash Price |
$554.65
|
| Rate for Payer: Cash Price |
$554.65
|
| Rate for Payer: Devoted Health Medicare |
$474.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$416.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$431.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$416.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$262.60
|
| Rate for Payer: Health Management Network Commercial |
$785.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$518.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$518.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$518.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$416.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$431.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$416.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$431.78
|
| Rate for Payer: University Health Alliance Commercial |
$535.08
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$655.34
|
|
|
Service Code
|
HCPCS 27786
|
| Min. Negotiated Rate |
$163.54 |
| Max. Negotiated Rate |
$557.04 |
| Rate for Payer: AlohaCare Medicaid |
$317.53
|
| Rate for Payer: AlohaCare Medicare |
$310.30
|
| Rate for Payer: Cash Price |
$393.20
|
| Rate for Payer: Cash Price |
$393.20
|
| Rate for Payer: Devoted Health Medicare |
$341.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$317.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$310.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$317.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$163.54
|
| Rate for Payer: Health Management Network Commercial |
$557.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$317.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$317.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.30
|
| Rate for Payer: University Health Alliance Commercial |
$406.87
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Professional
|
Both
|
$711.57
|
|
|
Service Code
|
HCPCS 26755
|
| Min. Negotiated Rate |
$138.84 |
| Max. Negotiated Rate |
$604.83 |
| Rate for Payer: AlohaCare Medicaid |
$299.23
|
| Rate for Payer: AlohaCare Medicare |
$313.18
|
| Rate for Payer: Cash Price |
$426.94
|
| Rate for Payer: Cash Price |
$426.94
|
| Rate for Payer: Devoted Health Medicare |
$344.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$299.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$486.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$313.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$299.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.84
|
| Rate for Payer: Health Management Network Commercial |
$604.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$375.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$375.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$375.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$299.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$313.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$299.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$313.18
|
| Rate for Payer: University Health Alliance Commercial |
$381.00
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA
|
Professional
|
Both
|
$413.14
|
|
|
Service Code
|
HCPCS 26750
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$351.17 |
| Rate for Payer: AlohaCare Medicaid |
$213.71
|
| Rate for Payer: AlohaCare Medicare |
$222.03
|
| Rate for Payer: Cash Price |
$247.88
|
| Rate for Payer: Cash Price |
$247.88
|
| Rate for Payer: Devoted Health Medicare |
$244.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$213.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$222.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$213.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.06
|
| Rate for Payer: Health Management Network Commercial |
$351.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$222.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$222.03
|
| Rate for Payer: University Health Alliance Commercial |
$268.21
|
|
|
PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ
|
Professional
|
Both
|
$727.30
|
|
|
Service Code
|
HCPCS 25600
|
| Min. Negotiated Rate |
$249.86 |
| Max. Negotiated Rate |
$618.21 |
| Rate for Payer: AlohaCare Medicaid |
$365.00
|
| Rate for Payer: AlohaCare Medicare |
$366.23
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Devoted Health Medicare |
$402.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$365.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$366.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$365.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$249.86
|
| Rate for Payer: Health Management Network Commercial |
$618.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$439.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$439.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$439.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$365.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$366.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$365.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$366.23
|
| Rate for Payer: University Health Alliance Commercial |
$470.00
|
|
|
PR CLTX DSTL RDL FX/EPIPHYSL SEP W/MNPJ
|
Professional
|
Both
|
$1,169.94
|
|
|
Service Code
|
HCPCS 25605
|
| Min. Negotiated Rate |
$357.50 |
| Max. Negotiated Rate |
$994.45 |
| Rate for Payer: AlohaCare Medicaid |
$549.02
|
| Rate for Payer: AlohaCare Medicare |
$571.32
|
| Rate for Payer: Cash Price |
$701.96
|
| Rate for Payer: Cash Price |
$701.96
|
| Rate for Payer: Devoted Health Medicare |
$628.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$549.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$571.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$549.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$357.50
|
| Rate for Payer: Health Management Network Commercial |
$994.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$685.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$685.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$685.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$549.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$571.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$549.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$571.32
|
| Rate for Payer: University Health Alliance Commercial |
$715.00
|
|
|
PR CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Professional
|
Both
|
$1,022.02
|
|
|
Service Code
|
HCPCS 26432
|
| Min. Negotiated Rate |
$268.06 |
| Max. Negotiated Rate |
$868.72 |
| Rate for Payer: AlohaCare Medicaid |
$597.86
|
| Rate for Payer: AlohaCare Medicare |
$583.82
|
| Rate for Payer: Cash Price |
$613.21
|
| Rate for Payer: Cash Price |
$613.21
|
| Rate for Payer: Devoted Health Medicare |
$642.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$583.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$268.06
|
| Rate for Payer: Health Management Network Commercial |
$868.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$700.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$700.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$700.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$597.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$583.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$597.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$583.82
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 28490
|
| Min. Negotiated Rate |
$66.82 |
| Max. Negotiated Rate |
$255.85 |
| Rate for Payer: AlohaCare Medicaid |
$139.08
|
| Rate for Payer: AlohaCare Medicare |
$142.00
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Devoted Health Medicare |
$156.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$139.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$139.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.82
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$170.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.00
|
| Rate for Payer: University Health Alliance Commercial |
$205.00
|
|
|
PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Professional
|
Both
|
$328.88
|
|
|
Service Code
|
HCPCS 28515
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$279.55 |
| Rate for Payer: AlohaCare Medicaid |
$159.14
|
| Rate for Payer: AlohaCare Medicare |
$154.51
|
| Rate for Payer: Cash Price |
$197.33
|
| Rate for Payer: Cash Price |
$197.33
|
| Rate for Payer: Devoted Health Medicare |
$169.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$159.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$252.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.16
|
| Rate for Payer: Health Management Network Commercial |
$279.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$185.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$185.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$159.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.51
|
| Rate for Payer: University Health Alliance Commercial |
$198.04
|
|
|
PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ
|
Professional
|
Both
|
$246.50
|
|
|
Service Code
|
HCPCS 28510
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$209.53 |
| Rate for Payer: AlohaCare Medicaid |
$134.88
|
| Rate for Payer: AlohaCare Medicare |
$134.02
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Devoted Health Medicare |
$147.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$134.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$209.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$134.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.02
|
|
|
PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ
|
Professional
|
Both
|
$663.39
|
|
|
Service Code
|
HCPCS 27824
|
| Min. Negotiated Rate |
$224.90 |
| Max. Negotiated Rate |
$563.88 |
| Rate for Payer: AlohaCare Medicaid |
$335.38
|
| Rate for Payer: AlohaCare Medicare |
$334.26
|
| Rate for Payer: Cash Price |
$398.03
|
| Rate for Payer: Cash Price |
$398.03
|
| Rate for Payer: Devoted Health Medicare |
$367.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$335.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$334.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$335.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.90
|
| Rate for Payer: Health Management Network Commercial |
$563.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$401.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$401.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$401.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$335.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$334.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$335.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$334.26
|
| Rate for Payer: University Health Alliance Commercial |
$427.75
|
|
|
PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Professional
|
Both
|
$1,106.00
|
|
|
Service Code
|
HCPCS 27825
|
| Min. Negotiated Rate |
$411.58 |
| Max. Negotiated Rate |
$940.10 |
| Rate for Payer: AlohaCare Medicaid |
$519.66
|
| Rate for Payer: AlohaCare Medicare |
$489.59
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Devoted Health Medicare |
$538.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$519.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$489.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$519.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$411.58
|
| Rate for Payer: Health Management Network Commercial |
$940.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$587.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$587.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$587.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$489.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$519.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$489.59
|
| Rate for Payer: University Health Alliance Commercial |
$675.77
|
|
|
PR CLTX GREATER HUMERAL TUBEROSITY FX W/O MNPJ
|
Professional
|
Both
|
$579.83
|
|
|
Service Code
|
HCPCS 23620
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$492.86 |
| Rate for Payer: AlohaCare Medicaid |
$289.28
|
| Rate for Payer: AlohaCare Medicare |
$288.04
|
| Rate for Payer: Cash Price |
$347.90
|
| Rate for Payer: Cash Price |
$347.90
|
| Rate for Payer: Devoted Health Medicare |
$316.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$289.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$288.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$289.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.78
|
| Rate for Payer: Health Management Network Commercial |
$492.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$345.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$345.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$345.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$288.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$289.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$288.04
|
| Rate for Payer: University Health Alliance Commercial |
$395.00
|
|
|
PR CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Professional
|
Both
|
$1,314.00
|
|
|
Service Code
|
HCPCS 27252
|
| Min. Negotiated Rate |
$381.42 |
| Max. Negotiated Rate |
$1,116.90 |
| Rate for Payer: AlohaCare Medicaid |
$769.27
|
| Rate for Payer: AlohaCare Medicare |
$723.71
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Devoted Health Medicare |
$796.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$723.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$381.42
|
| Rate for Payer: Health Management Network Commercial |
$1,116.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$868.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$868.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$868.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$769.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$723.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$769.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$723.71
|
|
|
PR CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$771.38
|
|
|
Service Code
|
HCPCS 24576
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$655.67 |
| Rate for Payer: AlohaCare Medicaid |
$349.62
|
| Rate for Payer: AlohaCare Medicare |
$358.38
|
| Rate for Payer: Cash Price |
$462.83
|
| Rate for Payer: Cash Price |
$462.83
|
| Rate for Payer: Devoted Health Medicare |
$394.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$349.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$358.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$349.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.88
|
| Rate for Payer: Health Management Network Commercial |
$655.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$430.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$349.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$358.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$349.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$358.38
|
| Rate for Payer: University Health Alliance Commercial |
$465.00
|
|
|
PR CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$734.72
|
|
|
Service Code
|
HCPCS 24560
|
| Min. Negotiated Rate |
$176.54 |
| Max. Negotiated Rate |
$624.51 |
| Rate for Payer: AlohaCare Medicaid |
$327.08
|
| Rate for Payer: AlohaCare Medicare |
$338.95
|
| Rate for Payer: Cash Price |
$440.83
|
| Rate for Payer: Cash Price |
$440.83
|
| Rate for Payer: Devoted Health Medicare |
$372.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$327.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$338.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$327.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$176.54
|
| Rate for Payer: Health Management Network Commercial |
$624.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$406.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$406.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$406.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$327.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$338.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$327.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$338.95
|
| Rate for Payer: University Health Alliance Commercial |
$428.00
|
|
