|
PR CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR
|
Professional
|
Both
|
$1,709.00
|
|
|
Service Code
|
HCPCS 23455
|
| Min. Negotiated Rate |
$884.75 |
| Max. Negotiated Rate |
$1,452.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,010.44
|
| Rate for Payer: AlohaCare Medicare |
$884.75
|
| Rate for Payer: Cash Price |
$1,025.40
|
| Rate for Payer: Cash Price |
$1,025.40
|
| Rate for Payer: Devoted Health Medicare |
$973.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$884.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,174.16
|
| Rate for Payer: Health Management Network Commercial |
$1,452.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,061.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,061.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,061.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,010.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$884.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,010.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$884.75
|
|
|
PR CARDIOPULMONARY RESUSCITATION
|
Professional
|
Both
|
$708.73
|
|
|
Service Code
|
HCPCS 92950
|
| Min. Negotiated Rate |
$167.64 |
| Max. Negotiated Rate |
$602.42 |
| Rate for Payer: AlohaCare Medicaid |
$179.25
|
| Rate for Payer: AlohaCare Medicare |
$167.64
|
| Rate for Payer: Cash Price |
$425.24
|
| Rate for Payer: Cash Price |
$425.24
|
| Rate for Payer: Devoted Health Medicare |
$184.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$179.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$179.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$213.90
|
| Rate for Payer: Health Management Network Commercial |
$602.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$179.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.64
|
| Rate for Payer: University Health Alliance Commercial |
$218.44
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$287.19
|
|
|
Service Code
|
HCPCS 92960
|
| Min. Negotiated Rate |
$96.14 |
| Max. Negotiated Rate |
$244.11 |
| Rate for Payer: AlohaCare Medicaid |
$108.77
|
| Rate for Payer: AlohaCare Medicare |
$96.14
|
| Rate for Payer: Cash Price |
$172.31
|
| Rate for Payer: Cash Price |
$172.31
|
| Rate for Payer: Devoted Health Medicare |
$105.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$108.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$108.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$155.52
|
| Rate for Payer: Health Management Network Commercial |
$244.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.14
|
| Rate for Payer: University Health Alliance Commercial |
$135.15
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 92961
|
| Min. Negotiated Rate |
$207.33 |
| Max. Negotiated Rate |
$337.45 |
| Rate for Payer: AlohaCare Medicaid |
$233.54
|
| Rate for Payer: AlohaCare Medicare |
$207.33
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Devoted Health Medicare |
$228.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.33
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$248.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$233.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$233.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.33
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 25210
|
| Min. Negotiated Rate |
$345.54 |
| Max. Negotiated Rate |
$769.25 |
| Rate for Payer: AlohaCare Medicaid |
$525.81
|
| Rate for Payer: AlohaCare Medicare |
$482.54
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Devoted Health Medicare |
$530.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$482.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$345.54
|
| Rate for Payer: Health Management Network Commercial |
$769.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$579.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$579.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$579.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$525.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$482.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$525.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$482.54
|
|
|
PR CARPECTOMY ALL BONES PROXIMAL ROW
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
HCPCS 25215
|
| Min. Negotiated Rate |
$525.72 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: AlohaCare Medicaid |
$653.51
|
| Rate for Payer: AlohaCare Medicare |
$592.52
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Devoted Health Medicare |
$651.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$592.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$525.72
|
| Rate for Payer: Health Management Network Commercial |
$956.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$711.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$711.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$653.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$592.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$653.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$592.52
|
|
|
PR CAR SEAT/BED TEST INFT THRU 12 MO 60 MIN
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 94780
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: AlohaCare Medicaid |
$23.42
|
| Rate for Payer: AlohaCare Medicare |
$20.41
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$22.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.42
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.41
|
| Rate for Payer: University Health Alliance Commercial |
$28.80
|
|
|
PR CAR SEAT/BED TEST INFT THRU 12 MO EA ADDL 30 MIN
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 94781
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: AlohaCare Medicaid |
$8.14
|
| Rate for Payer: AlohaCare Medicare |
$7.01
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$7.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.14
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.01
|
| Rate for Payer: University Health Alliance Commercial |
$9.92
|
|
|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$441.22 |
| Max. Negotiated Rate |
$735.25 |
| Rate for Payer: AlohaCare Medicaid |
$506.58
|
| Rate for Payer: AlohaCare Medicare |
$447.01
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Devoted Health Medicare |
$491.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$447.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$441.22
|
| Rate for Payer: Health Management Network Commercial |
$735.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$536.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$536.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$536.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$447.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$506.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$447.01
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$417.85
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$355.17 |
| Rate for Payer: AlohaCare Medicaid |
$58.12
|
| Rate for Payer: AlohaCare Medicare |
$54.96
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Devoted Health Medicare |
$60.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$88.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.21
|
| Rate for Payer: Health Management Network Commercial |
$355.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.96
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$73.27
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$62.28 |
| Rate for Payer: AlohaCare Medicaid |
$27.76
|
| Rate for Payer: AlohaCare Medicare |
$24.78
|
| Rate for Payer: Cash Price |
$43.96
|
| Rate for Payer: Cash Price |
$43.96
|
| Rate for Payer: Devoted Health Medicare |
$27.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.20
|
| Rate for Payer: Health Management Network Commercial |
$62.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.78
|
|
|
PR CAST SUP GAUNTLET FIBERGLASS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS Q4014
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: AlohaCare Medicaid |
$18.88
|
| Rate for Payer: AlohaCare Medicare |
$33.84
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Devoted Health Medicare |
$37.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.25
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.84
|
|
|
PR CAST SUP GAUNTLET PED FBRGLS
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS Q4016
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: AlohaCare Medicaid |
$9.44
|
| Rate for Payer: AlohaCare Medicare |
$16.91
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Devoted Health Medicare |
$18.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.12
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.91
|
|
|
PR CAST SUP HIP SPICA FIBERGLAS
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS Q4026
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$219.30 |
| Rate for Payer: AlohaCare Medicare |
$150.32
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Devoted Health Medicare |
$165.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.60
|
| Rate for Payer: Health Management Network Commercial |
$219.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.32
|
|
|
PR CAST SUP HIP SPICA PED FBRGL
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS Q4028
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: AlohaCare Medicaid |
$24.00
|
| Rate for Payer: AlohaCare Medicare |
$75.20
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Devoted Health Medicare |
$82.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.33
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.20
|
|
|
PR CAST SUP HIP SPICA PLASTER
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS Q4025
|
| Min. Negotiated Rate |
$37.34 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: AlohaCare Medicare |
$48.12
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Devoted Health Medicare |
$52.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.34
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.12
|
|
|
PR CAST SUP LNG ARM SPLINT FBRG
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: AlohaCare Medicaid |
$10.32
|
| Rate for Payer: AlohaCare Medicare |
$18.48
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$20.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.34
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.48
|
|
|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: AlohaCare Medicaid |
$5.16
|
| Rate for Payer: AlohaCare Medicare |
$9.28
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$10.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.19
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.28
|
|
|
PR CAST SUP LNG LEG CYLINDER FB
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: AlohaCare Medicare |
$85.39
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Devoted Health Medicare |
$93.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.25
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.39
|
|
|
PR CAST SUP LNGLEG CYLNDR PED F
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS Q4036
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$62.05 |
| Rate for Payer: AlohaCare Medicare |
$42.73
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$47.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.14
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.73
|
|
|
PR CAST SUP LNG LEG PED FBRGLS
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS Q4032
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: AlohaCare Medicare |
$48.46
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Devoted Health Medicare |
$53.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.59
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.46
|
|
|
PR CAST SUP LNG LEG SPLNT FBRGL
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS Q4042
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: AlohaCare Medicare |
$43.49
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Devoted Health Medicare |
$47.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.73
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.49
|
|
|
PR CAST SUP LNG LEG SPLNT PED F
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS Q4044
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: AlohaCare Medicare |
$21.78
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Devoted Health Medicare |
$23.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.87
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.78
|
|
|
PR CAST SUP LNG LEG SPLNT PED P
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS Q4043
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: AlohaCare Medicare |
$12.74
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Devoted Health Medicare |
$14.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.89
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.74
|
|
|
PR CAST SUP LNG LEG SPLNT PLSTR
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS Q4041
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: AlohaCare Medicare |
$25.48
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$28.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.76
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.48
|
|
