|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$734.30
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$198.95 |
| Max. Negotiated Rate |
$624.15 |
| Rate for Payer: AlohaCare Medicaid |
$224.51
|
| Rate for Payer: AlohaCare Medicare |
$198.95
|
| Rate for Payer: Cash Price |
$440.58
|
| Rate for Payer: Cash Price |
$440.58
|
| Rate for Payer: Devoted Health Medicare |
$218.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$224.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$368.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$224.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$237.64
|
| Rate for Payer: Health Management Network Commercial |
$624.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$224.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$224.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.95
|
| Rate for Payer: University Health Alliance Commercial |
$253.49
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$850.38
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$174.46 |
| Max. Negotiated Rate |
$722.82 |
| Rate for Payer: AlohaCare Medicaid |
$282.29
|
| Rate for Payer: AlohaCare Medicare |
$275.54
|
| Rate for Payer: Cash Price |
$510.23
|
| Rate for Payer: Cash Price |
$510.23
|
| Rate for Payer: Devoted Health Medicare |
$303.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$282.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$450.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$282.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.46
|
| Rate for Payer: Health Management Network Commercial |
$722.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$330.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$330.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$282.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.54
|
| Rate for Payer: University Health Alliance Commercial |
$319.52
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$498.47
|
|
|
Service Code
|
HCPCS 12041
|
| Min. Negotiated Rate |
$132.93 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: AlohaCare Medicaid |
$150.87
|
| Rate for Payer: AlohaCare Medicare |
$132.93
|
| Rate for Payer: Cash Price |
$299.08
|
| Rate for Payer: Cash Price |
$299.08
|
| Rate for Payer: Devoted Health Medicare |
$146.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$150.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$246.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$150.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.72
|
| Rate for Payer: Health Management Network Commercial |
$423.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$150.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.93
|
| Rate for Payer: University Health Alliance Commercial |
$164.58
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$575.21
|
|
|
Service Code
|
HCPCS 12042
|
| Min. Negotiated Rate |
$159.64 |
| Max. Negotiated Rate |
$488.93 |
| Rate for Payer: AlohaCare Medicaid |
$203.83
|
| Rate for Payer: AlohaCare Medicare |
$173.37
|
| Rate for Payer: Cash Price |
$345.13
|
| Rate for Payer: Cash Price |
$345.13
|
| Rate for Payer: Devoted Health Medicare |
$190.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$203.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$335.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$203.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$159.64
|
| Rate for Payer: Health Management Network Commercial |
$488.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$208.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$208.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$203.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.37
|
| Rate for Payer: University Health Alliance Commercial |
$221.92
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM
|
Professional
|
Both
|
$1,134.12
|
|
|
Service Code
|
HCPCS 12047
|
| Min. Negotiated Rate |
$269.36 |
| Max. Negotiated Rate |
$964.00 |
| Rate for Payer: AlohaCare Medicaid |
$356.78
|
| Rate for Payer: AlohaCare Medicare |
$346.92
|
| Rate for Payer: Cash Price |
$680.47
|
| Rate for Payer: Cash Price |
$680.47
|
| Rate for Payer: Devoted Health Medicare |
$381.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$356.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$569.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$346.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$356.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$269.36
|
| Rate for Payer: Health Management Network Commercial |
$964.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$416.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$416.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$416.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$356.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$346.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$356.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$346.92
|
| Rate for Payer: University Health Alliance Commercial |
$413.69
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
HCPCS 12044
|
| Min. Negotiated Rate |
$190.32 |
| Max. Negotiated Rate |
$623.05 |
| Rate for Payer: AlohaCare Medicaid |
$220.92
|
| Rate for Payer: AlohaCare Medicare |
$194.42
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Devoted Health Medicare |
$213.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$220.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$363.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$194.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$220.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.32
|
| Rate for Payer: Health Management Network Commercial |
$623.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$233.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$233.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$233.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$220.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$194.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$220.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$194.42
|
| Rate for Payer: University Health Alliance Commercial |
$249.95
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$776.56
|
|
|
Service Code
|
HCPCS 12035
|
| Min. Negotiated Rate |
$210.86 |
| Max. Negotiated Rate |
$660.08 |
| Rate for Payer: AlohaCare Medicaid |
$247.22
|
| Rate for Payer: AlohaCare Medicare |
$228.04
|
| Rate for Payer: Cash Price |
$465.94
|
| Rate for Payer: Cash Price |
$465.94
|
| Rate for Payer: Devoted Health Medicare |
$250.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$247.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$409.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$228.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$247.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$210.86
|
| Rate for Payer: Health Management Network Commercial |
$660.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$228.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$228.04
|
| Rate for Payer: University Health Alliance Commercial |
$269.13
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$892.68
|
|
|
Service Code
|
HCPCS 12036
|
| Min. Negotiated Rate |
$265.72 |
| Max. Negotiated Rate |
$758.78 |
| Rate for Payer: AlohaCare Medicaid |
$285.75
|
| Rate for Payer: AlohaCare Medicare |
$271.61
|
| Rate for Payer: Cash Price |
$535.61
|
| Rate for Payer: Cash Price |
$535.61
|
| Rate for Payer: Devoted Health Medicare |
$298.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$285.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$478.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$271.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$285.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$265.72
|
| Rate for Payer: Health Management Network Commercial |
$758.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$325.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$325.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$325.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$285.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$271.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$285.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$271.61
|
| Rate for Payer: University Health Alliance Commercial |
$329.45
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$493.94
|
|
|
Service Code
|
HCPCS 12031
|
| Min. Negotiated Rate |
$117.26 |
| Max. Negotiated Rate |
$419.85 |
| Rate for Payer: AlohaCare Medicaid |
$158.83
|
| Rate for Payer: AlohaCare Medicare |
$138.32
|
| Rate for Payer: Cash Price |
$296.36
|
| Rate for Payer: Cash Price |
$296.36
|
| Rate for Payer: Devoted Health Medicare |
$152.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$158.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$260.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$158.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.26
|
| Rate for Payer: Health Management Network Commercial |
$419.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$158.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.32
|
| Rate for Payer: University Health Alliance Commercial |
$172.77
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$567.96
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$482.77 |
| Rate for Payer: AlohaCare Medicaid |
$199.83
|
| Rate for Payer: AlohaCare Medicare |
$171.50
|
| Rate for Payer: Cash Price |
$340.78
|
| Rate for Payer: Cash Price |
$340.78
|
| Rate for Payer: Devoted Health Medicare |
$188.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$199.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$326.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$199.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.30
|
| Rate for Payer: Health Management Network Commercial |
$482.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$205.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$205.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$199.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.50
|
| Rate for Payer: University Health Alliance Commercial |
$217.60
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E >30.0 CM
|
Professional
|
Both
|
$993.35
|
|
|
Service Code
|
HCPCS 12037
|
| Min. Negotiated Rate |
$307.49 |
| Max. Negotiated Rate |
$844.35 |
| Rate for Payer: AlohaCare Medicaid |
$330.81
|
| Rate for Payer: AlohaCare Medicare |
$307.49
|
| Rate for Payer: Cash Price |
$596.01
|
| Rate for Payer: Cash Price |
$596.01
|
| Rate for Payer: Devoted Health Medicare |
$338.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$330.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$553.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$330.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$318.50
|
| Rate for Payer: Health Management Network Commercial |
$844.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$368.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$368.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$368.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$330.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$330.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.49
|
| Rate for Payer: University Health Alliance Commercial |
$380.76
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$629.98
|
|
|
Service Code
|
HCPCS 12034
|
| Min. Negotiated Rate |
$176.54 |
| Max. Negotiated Rate |
$535.48 |
| Rate for Payer: AlohaCare Medicaid |
$212.66
|
| Rate for Payer: AlohaCare Medicare |
$184.16
|
| Rate for Payer: Cash Price |
$377.99
|
| Rate for Payer: Cash Price |
$377.99
|
| Rate for Payer: Devoted Health Medicare |
$202.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$212.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$350.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$184.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$212.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$176.54
|
| Rate for Payer: Health Management Network Commercial |
$535.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$220.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$220.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$184.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$184.16
|
| Rate for Payer: University Health Alliance Commercial |
$231.25
|
|
|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$1,439.00
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$713.18 |
| Max. Negotiated Rate |
$1,223.15 |
| Rate for Payer: AlohaCare Medicaid |
$842.31
|
| Rate for Payer: AlohaCare Medicare |
$796.88
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Devoted Health Medicare |
$876.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$796.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$713.18
|
| Rate for Payer: Health Management Network Commercial |
$1,223.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$956.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$956.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$956.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$842.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$796.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$842.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$796.88
|
|
|
PR REPAIR LACERATION PALATE <2 CM
|
Professional
|
Both
|
$476.07
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$404.66 |
| Rate for Payer: AlohaCare Medicaid |
$196.97
|
| Rate for Payer: AlohaCare Medicare |
$173.68
|
| Rate for Payer: Cash Price |
$285.64
|
| Rate for Payer: Cash Price |
$285.64
|
| Rate for Payer: Devoted Health Medicare |
$191.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$196.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$323.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$196.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.04
|
| Rate for Payer: Health Management Network Commercial |
$404.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$208.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$208.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$196.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$196.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.68
|
| Rate for Payer: University Health Alliance Commercial |
$254.69
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$622.44 |
| Max. Negotiated Rate |
$1,104.15 |
| Rate for Payer: AlohaCare Medicaid |
$753.71
|
| Rate for Payer: AlohaCare Medicare |
$695.37
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Devoted Health Medicare |
$764.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$695.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$622.44
|
| Rate for Payer: Health Management Network Commercial |
$1,104.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$834.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$834.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$834.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$753.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$695.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$753.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$695.37
|
|
|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,153.00
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$415.74 |
| Max. Negotiated Rate |
$980.05 |
| Rate for Payer: AlohaCare Medicaid |
$670.34
|
| Rate for Payer: AlohaCare Medicare |
$633.58
|
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Devoted Health Medicare |
$696.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$633.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$415.74
|
| Rate for Payer: Health Management Network Commercial |
$980.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$760.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$760.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$760.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$670.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$633.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$670.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$633.58
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$647.40 |
| Max. Negotiated Rate |
$1,092.25 |
| Rate for Payer: AlohaCare Medicaid |
$749.69
|
| Rate for Payer: AlohaCare Medicare |
$692.35
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Devoted Health Medicare |
$761.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$692.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$647.40
|
| Rate for Payer: Health Management Network Commercial |
$1,092.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$830.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$830.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$830.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$749.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$692.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$749.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$692.35
|
|
|
PR REPAIR NAIL BED
|
Professional
|
Both
|
$352.57
|
|
|
Service Code
|
HCPCS 11760
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$299.68 |
| Rate for Payer: AlohaCare Medicaid |
$114.03
|
| Rate for Payer: AlohaCare Medicare |
$107.29
|
| Rate for Payer: Cash Price |
$211.54
|
| Rate for Payer: Cash Price |
$211.54
|
| Rate for Payer: Devoted Health Medicare |
$118.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$191.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$114.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.84
|
| Rate for Payer: Health Management Network Commercial |
$299.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.29
|
| Rate for Payer: University Health Alliance Commercial |
$123.62
|
|
|
PR REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$1,208.00
|
|
|
Service Code
|
HCPCS 30630
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$1,026.80 |
| Rate for Payer: AlohaCare Medicaid |
$716.63
|
| Rate for Payer: AlohaCare Medicare |
$638.70
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Devoted Health Medicare |
$702.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$638.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$404.30
|
| Rate for Payer: Health Management Network Commercial |
$1,026.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$766.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$766.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$766.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$716.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$638.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$716.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$638.70
|
|
|
PR REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$1,835.00
|
|
|
Service Code
|
HCPCS 30465
|
| Min. Negotiated Rate |
$755.56 |
| Max. Negotiated Rate |
$1,559.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,088.74
|
| Rate for Payer: AlohaCare Medicare |
$960.80
|
| Rate for Payer: Cash Price |
$1,101.00
|
| Rate for Payer: Cash Price |
$1,101.00
|
| Rate for Payer: Devoted Health Medicare |
$1,056.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$960.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$755.56
|
| Rate for Payer: Health Management Network Commercial |
$1,559.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,152.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,152.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,152.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,088.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$960.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,088.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$960.80
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$1,864.00
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$809.64 |
| Max. Negotiated Rate |
$1,584.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,084.94
|
| Rate for Payer: AlohaCare Medicare |
$977.39
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Devoted Health Medicare |
$1,075.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$977.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$809.64
|
| Rate for Payer: Health Management Network Commercial |
$1,584.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,172.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,172.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,172.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,084.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$977.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,084.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$977.39
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$757.12 |
| Max. Negotiated Rate |
$1,317.50 |
| Rate for Payer: AlohaCare Medicaid |
$902.22
|
| Rate for Payer: AlohaCare Medicare |
$822.40
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Devoted Health Medicare |
$904.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$822.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$757.12
|
| Rate for Payer: Health Management Network Commercial |
$1,317.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$986.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$986.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$902.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$822.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$902.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$822.40
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 27722
|
| Min. Negotiated Rate |
$684.32 |
| Max. Negotiated Rate |
$1,351.50 |
| Rate for Payer: AlohaCare Medicaid |
$925.98
|
| Rate for Payer: AlohaCare Medicare |
$843.70
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$928.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$843.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$684.32
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,012.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,012.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,012.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$925.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$843.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$925.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$843.70
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$1,186.00
|
|
|
Service Code
|
HCPCS 27650
|
| Min. Negotiated Rate |
$641.67 |
| Max. Negotiated Rate |
$1,008.10 |
| Rate for Payer: AlohaCare Medicaid |
$688.98
|
| Rate for Payer: AlohaCare Medicare |
$641.67
|
| Rate for Payer: Cash Price |
$711.60
|
| Rate for Payer: Cash Price |
$711.60
|
| Rate for Payer: Devoted Health Medicare |
$705.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$738.66
|
| Rate for Payer: Health Management Network Commercial |
$1,008.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$770.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$770.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$770.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$688.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$688.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.67
|
|
|
PR REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
HCPCS 27407
|
| Min. Negotiated Rate |
$625.56 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: AlohaCare Medicaid |
$829.27
|
| Rate for Payer: AlohaCare Medicare |
$760.33
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Devoted Health Medicare |
$836.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$760.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$625.56
|
| Rate for Payer: Health Management Network Commercial |
$1,211.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$912.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$912.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$912.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$829.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$760.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$829.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$760.33
|
|
