|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL
|
Professional
|
Both
|
$2,355.34
|
|
|
Service Code
|
HCPCS 37237
|
| Min. Negotiated Rate |
$175.85 |
| Max. Negotiated Rate |
$2,878.72 |
| Rate for Payer: AlohaCare Medicaid |
$195.35
|
| Rate for Payer: AlohaCare Medicare |
$175.85
|
| Rate for Payer: Cash Price |
$1,413.20
|
| Rate for Payer: Cash Price |
$1,413.20
|
| Rate for Payer: Devoted Health Medicare |
$193.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$195.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$337.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$195.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,878.72
|
| Rate for Payer: Health Management Network Commercial |
$2,002.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$195.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$195.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.85
|
| Rate for Payer: University Health Alliance Commercial |
$265.57
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL
|
Professional
|
Both
|
$5,043.31
|
|
|
Service Code
|
HCPCS 37236
|
| Min. Negotiated Rate |
$367.82 |
| Max. Negotiated Rate |
$4,801.68 |
| Rate for Payer: AlohaCare Medicaid |
$410.31
|
| Rate for Payer: AlohaCare Medicare |
$367.82
|
| Rate for Payer: Cash Price |
$3,025.99
|
| Rate for Payer: Cash Price |
$3,025.99
|
| Rate for Payer: Devoted Health Medicare |
$404.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$410.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$715.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$367.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$410.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,801.68
|
| Rate for Payer: Health Management Network Commercial |
$4,286.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$441.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$441.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$367.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$410.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$367.82
|
| Rate for Payer: University Health Alliance Commercial |
$667.00
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST
|
Professional
|
Both
|
$6,433.38
|
|
|
Service Code
|
HCPCS 37238
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$5,468.37 |
| Rate for Payer: AlohaCare Medicaid |
$288.49
|
| Rate for Payer: AlohaCare Medicare |
$257.93
|
| Rate for Payer: Cash Price |
$3,860.03
|
| Rate for Payer: Cash Price |
$3,860.03
|
| Rate for Payer: Devoted Health Medicare |
$283.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$288.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$501.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$257.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$288.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,924.66
|
| Rate for Payer: Health Management Network Commercial |
$5,468.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$309.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$309.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$309.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$288.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$257.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$288.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$257.93
|
| Rate for Payer: University Health Alliance Commercial |
$466.88
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 23410
|
| Min. Negotiated Rate |
$708.76 |
| Max. Negotiated Rate |
$1,241.00 |
| Rate for Payer: AlohaCare Medicaid |
$849.71
|
| Rate for Payer: AlohaCare Medicare |
$775.96
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Devoted Health Medicare |
$853.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$775.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$708.76
|
| Rate for Payer: Health Management Network Commercial |
$1,241.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$931.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$931.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$931.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$849.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$775.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$849.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$775.96
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$1,514.00
|
|
|
Service Code
|
HCPCS 23412
|
| Min. Negotiated Rate |
$414.44 |
| Max. Negotiated Rate |
$1,286.90 |
| Rate for Payer: AlohaCare Medicaid |
$882.17
|
| Rate for Payer: AlohaCare Medicare |
$801.92
|
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Devoted Health Medicare |
$882.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$801.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$414.44
|
| Rate for Payer: Health Management Network Commercial |
$1,286.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$962.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$962.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$962.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$882.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$801.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$882.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$801.92
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 27814
|
| Min. Negotiated Rate |
$726.94 |
| Max. Negotiated Rate |
$1,156.85 |
| Rate for Payer: AlohaCare Medicaid |
$794.35
|
| Rate for Payer: AlohaCare Medicare |
$726.94
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Devoted Health Medicare |
$799.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$726.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$821.08
|
| Rate for Payer: Health Management Network Commercial |
$1,156.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$872.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$872.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$872.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$794.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$726.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$794.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$726.94
|
|
|
PR OPEN TREATMENT CALCANEAL FRACTURE
|
Professional
|
Both
|
$1,990.00
|
|
|
Service Code
|
HCPCS 28415
|
| Min. Negotiated Rate |
$859.56 |
| Max. Negotiated Rate |
$1,691.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,162.68
|
| Rate for Payer: AlohaCare Medicare |
$1,069.71
|
| Rate for Payer: Cash Price |
$1,194.00
|
| Rate for Payer: Cash Price |
$1,194.00
|
| Rate for Payer: Devoted Health Medicare |
$1,176.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,069.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$859.56
|
| Rate for Payer: Health Management Network Commercial |
$1,691.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,283.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,283.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,283.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,162.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,069.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,162.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,069.71
|
|
|
PR OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA
|
Professional
|
Both
|
$2,339.00
|
|
|
Service Code
|
HCPCS 27828
|
| Min. Negotiated Rate |
$1,054.56 |
| Max. Negotiated Rate |
$1,988.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,369.54
|
| Rate for Payer: AlohaCare Medicare |
$1,248.62
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Devoted Health Medicare |
$1,373.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,248.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,054.56
|
| Rate for Payer: Health Management Network Commercial |
$1,988.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,498.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,498.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,498.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,369.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,248.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,369.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,248.62
|
|
|
PR OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY
|
Professional
|
Both
|
$1,995.00
|
|
|
Service Code
|
HCPCS 27827
|
| Min. Negotiated Rate |
$970.06 |
| Max. Negotiated Rate |
$1,695.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,166.08
|
| Rate for Payer: AlohaCare Medicare |
$1,076.63
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Devoted Health Medicare |
$1,184.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,076.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$970.06
|
| Rate for Payer: Health Management Network Commercial |
$1,695.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,291.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,291.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,291.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,166.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,076.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,166.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,076.63
|
|
|
PR OPEN TREATMENT GREATER TROCHANTERIC FRACTURE
|
Professional
|
Both
|
$1,314.00
|
|
|
Service Code
|
HCPCS 27248
|
| Min. Negotiated Rate |
$610.22 |
| Max. Negotiated Rate |
$1,116.90 |
| Rate for Payer: AlohaCare Medicaid |
$765.37
|
| Rate for Payer: AlohaCare Medicare |
$690.38
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Devoted Health Medicare |
$759.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$690.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$610.22
|
| Rate for Payer: Health Management Network Commercial |
$1,116.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$828.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$828.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$828.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$765.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$690.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$765.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$690.38
|
|
|
PR OPEN TREATMENT HUMERAL CONDYLAR FRACTURE
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
HCPCS 24579
|
| Min. Negotiated Rate |
$606.84 |
| Max. Negotiated Rate |
$1,271.60 |
| Rate for Payer: AlohaCare Medicaid |
$869.16
|
| Rate for Payer: AlohaCare Medicare |
$793.25
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Devoted Health Medicare |
$872.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$793.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$606.84
|
| Rate for Payer: Health Management Network Commercial |
$1,271.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$951.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$951.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$869.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$793.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$869.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$793.25
|
|
|
PR OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE
|
Professional
|
Both
|
$1,438.00
|
|
|
Service Code
|
HCPCS 21465
|
| Min. Negotiated Rate |
$600.86 |
| Max. Negotiated Rate |
$1,222.30 |
| Rate for Payer: AlohaCare Medicaid |
$825.52
|
| Rate for Payer: AlohaCare Medicare |
$737.22
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Devoted Health Medicare |
$810.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$737.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$600.86
|
| Rate for Payer: Health Management Network Commercial |
$1,222.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$884.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$884.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$884.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$825.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$737.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$825.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$737.22
|
|
|
PR OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE
|
Professional
|
Both
|
$1,094.00
|
|
|
Service Code
|
HCPCS 27766
|
| Min. Negotiated Rate |
$596.32 |
| Max. Negotiated Rate |
$929.90 |
| Rate for Payer: AlohaCare Medicaid |
$636.22
|
| Rate for Payer: AlohaCare Medicare |
$596.32
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Devoted Health Medicare |
$655.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$596.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$644.28
|
| Rate for Payer: Health Management Network Commercial |
$929.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$715.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$715.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$715.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$636.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$596.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$636.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$596.32
|
|
|
PR OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 26715
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$893.35 |
| Rate for Payer: AlohaCare Medicaid |
$610.71
|
| Rate for Payer: AlohaCare Medicare |
$563.83
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Devoted Health Medicare |
$620.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$563.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$893.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$676.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$676.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$676.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$610.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$563.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$610.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$563.83
|
|
|
PR OPEN TREATMENT METATARSAL FRACTURE EACH
|
Professional
|
Both
|
$1,023.00
|
|
|
Service Code
|
HCPCS 28485
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: AlohaCare Medicaid |
$599.48
|
| Rate for Payer: AlohaCare Medicare |
$564.18
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Devoted Health Medicare |
$620.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$564.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$424.32
|
| Rate for Payer: Health Management Network Commercial |
$869.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$677.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$677.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$677.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$599.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$564.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$599.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$564.18
|
| Rate for Payer: University Health Alliance Commercial |
$775.00
|
|
|
PR OPEN TREATMENT PALATAL/MAXILLARY FRACTURE
|
Professional
|
Both
|
$1,131.00
|
|
|
Service Code
|
HCPCS 21422
|
| Min. Negotiated Rate |
$527.02 |
| Max. Negotiated Rate |
$961.35 |
| Rate for Payer: AlohaCare Medicaid |
$650.15
|
| Rate for Payer: AlohaCare Medicare |
$609.00
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Devoted Health Medicare |
$669.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$609.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$527.02
|
| Rate for Payer: Health Management Network Commercial |
$961.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$730.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$730.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$730.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$650.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$609.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$650.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$609.00
|
| Rate for Payer: University Health Alliance Commercial |
$895.00
|
|
|
PR OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 27769
|
| Min. Negotiated Rate |
$686.30 |
| Max. Negotiated Rate |
$1,100.75 |
| Rate for Payer: AlohaCare Medicaid |
$754.31
|
| Rate for Payer: AlohaCare Medicare |
$686.30
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Devoted Health Medicare |
$754.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$686.30
|
| Rate for Payer: Health Management Network Commercial |
$1,100.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$823.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$823.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$823.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$754.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$686.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$754.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$686.30
|
|
|
PR OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE
|
Professional
|
Both
|
$1,271.00
|
|
|
Service Code
|
HCPCS 27784
|
| Min. Negotiated Rate |
$393.90 |
| Max. Negotiated Rate |
$1,080.35 |
| Rate for Payer: AlohaCare Medicaid |
$747.31
|
| Rate for Payer: AlohaCare Medicare |
$687.42
|
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Devoted Health Medicare |
$756.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$687.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.90
|
| Rate for Payer: Health Management Network Commercial |
$1,080.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$824.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$824.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$824.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$747.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$687.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$747.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$687.42
|
|
|
PR OPEN TREATMENT RADIAL SHAFT FRACTURE W/INT FIXJ
|
Professional
|
Both
|
$1,213.00
|
|
|
Service Code
|
HCPCS 25515
|
| Min. Negotiated Rate |
$504.92 |
| Max. Negotiated Rate |
$1,031.05 |
| Rate for Payer: AlohaCare Medicaid |
$705.98
|
| Rate for Payer: AlohaCare Medicare |
$649.11
|
| Rate for Payer: Cash Price |
$727.80
|
| Rate for Payer: Cash Price |
$727.80
|
| Rate for Payer: Devoted Health Medicare |
$714.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$649.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$504.92
|
| Rate for Payer: Health Management Network Commercial |
$1,031.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$778.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$778.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$778.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$649.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$705.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$649.11
|
|
|
PR OPEN TREATMENT TALUS FRACTURE
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
HCPCS 28445
|
| Min. Negotiated Rate |
$553.28 |
| Max. Negotiated Rate |
$1,569.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,081.23
|
| Rate for Payer: AlohaCare Medicare |
$987.92
|
| Rate for Payer: Cash Price |
$1,108.20
|
| Rate for Payer: Cash Price |
$1,108.20
|
| Rate for Payer: Devoted Health Medicare |
$1,086.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$987.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$553.28
|
| Rate for Payer: Health Management Network Commercial |
$1,569.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,185.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,185.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,185.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,081.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$987.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,081.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$987.92
|
|
|
PR OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,494.00
|
|
|
Service Code
|
HCPCS 28615
|
| Min. Negotiated Rate |
$514.80 |
| Max. Negotiated Rate |
$1,269.90 |
| Rate for Payer: AlohaCare Medicaid |
$873.82
|
| Rate for Payer: AlohaCare Medicare |
$819.93
|
| Rate for Payer: Cash Price |
$896.40
|
| Rate for Payer: Cash Price |
$896.40
|
| Rate for Payer: Devoted Health Medicare |
$901.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$819.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.80
|
| Rate for Payer: Health Management Network Commercial |
$1,269.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$983.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$983.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$983.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$873.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$819.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$873.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$819.93
|
|
|
PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END
|
Professional
|
Both
|
$1,184.00
|
|
|
Service Code
|
HCPCS 24685
|
| Min. Negotiated Rate |
$639.04 |
| Max. Negotiated Rate |
$1,006.40 |
| Rate for Payer: AlohaCare Medicaid |
$689.60
|
| Rate for Payer: AlohaCare Medicare |
$639.04
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Devoted Health Medicare |
$702.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$639.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$686.92
|
| Rate for Payer: Health Management Network Commercial |
$1,006.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$766.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$766.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$766.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$689.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$639.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$689.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$639.04
|
|
|
PR OPEN TREATMENT ULNAR SHAFT FRACTURE W/INT FIXJ
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
HCPCS 25545
|
| Min. Negotiated Rate |
$503.36 |
| Max. Negotiated Rate |
$967.30 |
| Rate for Payer: AlohaCare Medicaid |
$661.37
|
| Rate for Payer: AlohaCare Medicare |
$611.87
|
| Rate for Payer: Cash Price |
$682.80
|
| Rate for Payer: Cash Price |
$682.80
|
| Rate for Payer: Devoted Health Medicare |
$673.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$611.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$503.36
|
| Rate for Payer: Health Management Network Commercial |
$967.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$734.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$734.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$661.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$611.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$661.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$611.87
|
|
|
PR OPEN TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
HCPCS 25652
|
| Min. Negotiated Rate |
$542.36 |
| Max. Negotiated Rate |
$964.75 |
| Rate for Payer: AlohaCare Medicaid |
$657.90
|
| Rate for Payer: AlohaCare Medicare |
$606.58
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Devoted Health Medicare |
$667.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$606.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$542.36
|
| Rate for Payer: Health Management Network Commercial |
$964.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$727.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$727.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$727.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$657.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$606.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$657.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$606.58
|
|
|
PR OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 23550
|
| Min. Negotiated Rate |
$463.84 |
| Max. Negotiated Rate |
$876.35 |
| Rate for Payer: AlohaCare Medicaid |
$600.98
|
| Rate for Payer: AlohaCare Medicare |
$553.77
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Devoted Health Medicare |
$609.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$553.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$463.84
|
| Rate for Payer: Health Management Network Commercial |
$876.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$664.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$664.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$664.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$600.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$553.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$600.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$553.77
|
|
