|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/MNPJ
|
Professional
|
Both
|
$1,022.74
|
|
|
Service Code
|
HCPCS 25624
|
| Min. Negotiated Rate |
$280.54 |
| Max. Negotiated Rate |
$869.33 |
| Rate for Payer: AlohaCare Medicaid |
$487.07
|
| Rate for Payer: AlohaCare Medicare |
$467.45
|
| Rate for Payer: Cash Price |
$613.64
|
| Rate for Payer: Cash Price |
$613.64
|
| Rate for Payer: Devoted Health Medicare |
$514.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$487.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$467.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$487.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$280.54
|
| Rate for Payer: Health Management Network Commercial |
$869.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$560.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$560.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$560.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$487.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$467.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$487.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$467.45
|
| Rate for Payer: University Health Alliance Commercial |
$623.90
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ
|
Professional
|
Both
|
$658.44
|
|
|
Service Code
|
HCPCS 25622
|
| Min. Negotiated Rate |
$228.28 |
| Max. Negotiated Rate |
$559.67 |
| Rate for Payer: AlohaCare Medicaid |
$316.95
|
| Rate for Payer: AlohaCare Medicare |
$313.96
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Devoted Health Medicare |
$345.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$316.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$313.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$316.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$228.28
|
| Rate for Payer: Health Management Network Commercial |
$559.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$376.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$376.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$376.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$313.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$313.96
|
| Rate for Payer: University Health Alliance Commercial |
$420.00
|
|
|
PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,052.20
|
|
|
Service Code
|
HCPCS 27500
|
| Min. Negotiated Rate |
$397.28 |
| Max. Negotiated Rate |
$894.37 |
| Rate for Payer: AlohaCare Medicaid |
$507.27
|
| Rate for Payer: AlohaCare Medicare |
$476.13
|
| Rate for Payer: Cash Price |
$631.32
|
| Rate for Payer: Cash Price |
$631.32
|
| Rate for Payer: Devoted Health Medicare |
$523.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$507.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$476.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$507.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$397.28
|
| Rate for Payer: Health Management Network Commercial |
$894.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$571.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$571.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$571.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$507.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$476.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$507.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$476.13
|
| Rate for Payer: University Health Alliance Commercial |
$657.92
|
|
|
PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 27552
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$977.50 |
| Rate for Payer: AlohaCare Medicaid |
$669.12
|
| Rate for Payer: AlohaCare Medicare |
$621.45
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Devoted Health Medicare |
$683.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$621.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$977.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$745.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$745.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$745.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$669.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$621.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$669.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$621.45
|
|
|
PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$2,146.60
|
|
|
Service Code
|
HCPCS 21453
|
| Min. Negotiated Rate |
$483.86 |
| Max. Negotiated Rate |
$1,824.61 |
| Rate for Payer: AlohaCare Medicaid |
$1,017.50
|
| Rate for Payer: AlohaCare Medicare |
$966.11
|
| Rate for Payer: Cash Price |
$1,287.96
|
| Rate for Payer: Cash Price |
$1,287.96
|
| Rate for Payer: Devoted Health Medicare |
$1,062.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,017.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,364.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$966.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,017.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$483.86
|
| Rate for Payer: Health Management Network Commercial |
$1,824.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,159.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,159.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,159.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,017.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$966.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,017.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$966.11
|
| Rate for Payer: University Health Alliance Commercial |
$1,225.12
|
|
|
PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$446.55
|
|
|
Service Code
|
HCPCS 28470
|
| Min. Negotiated Rate |
$184.86 |
| Max. Negotiated Rate |
$379.57 |
| Rate for Payer: AlohaCare Medicaid |
$228.27
|
| Rate for Payer: AlohaCare Medicare |
$222.89
|
| Rate for Payer: Cash Price |
$267.93
|
| Rate for Payer: Cash Price |
$267.93
|
| Rate for Payer: Devoted Health Medicare |
$245.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$228.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$222.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$228.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.86
|
| Rate for Payer: Health Management Network Commercial |
$379.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$267.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$228.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$222.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$228.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$222.89
|
| Rate for Payer: University Health Alliance Commercial |
$320.00
|
|
|
PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ
|
Professional
|
Both
|
$1,078.00
|
|
|
Service Code
|
HCPCS 24620
|
| Min. Negotiated Rate |
$327.86 |
| Max. Negotiated Rate |
$916.30 |
| Rate for Payer: AlohaCare Medicaid |
$626.72
|
| Rate for Payer: AlohaCare Medicare |
$585.62
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Devoted Health Medicare |
$644.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$585.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$327.86
|
| Rate for Payer: Health Management Network Commercial |
$916.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$702.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$702.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$702.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$626.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$585.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$626.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$585.62
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$305.60
|
|
|
Service Code
|
HCPCS 21315
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$259.76 |
| Rate for Payer: AlohaCare Medicaid |
$60.57
|
| Rate for Payer: AlohaCare Medicare |
$53.86
|
| Rate for Payer: Cash Price |
$183.36
|
| Rate for Payer: Cash Price |
$183.36
|
| Rate for Payer: Devoted Health Medicare |
$59.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$60.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$200.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$60.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.26
|
| Rate for Payer: Health Management Network Commercial |
$259.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.86
|
| Rate for Payer: University Health Alliance Commercial |
$78.92
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$419.39
|
|
|
Service Code
|
HCPCS 21320
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$356.48 |
| Rate for Payer: AlohaCare Medicaid |
$96.42
|
| Rate for Payer: AlohaCare Medicare |
$81.66
|
| Rate for Payer: Cash Price |
$251.63
|
| Rate for Payer: Cash Price |
$251.63
|
| Rate for Payer: Devoted Health Medicare |
$89.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$96.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$180.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$96.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$186.94
|
| Rate for Payer: Health Management Network Commercial |
$356.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$96.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.66
|
| Rate for Payer: University Health Alliance Commercial |
$200.00
|
|
|
PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$805.88
|
|
|
Service Code
|
HCPCS 21337
|
| Min. Negotiated Rate |
$244.14 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: AlohaCare Medicaid |
$322.59
|
| Rate for Payer: AlohaCare Medicare |
$296.06
|
| Rate for Payer: Cash Price |
$483.53
|
| Rate for Payer: Cash Price |
$483.53
|
| Rate for Payer: Devoted Health Medicare |
$325.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$322.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$490.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$322.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$244.14
|
| Rate for Payer: Health Management Network Commercial |
$685.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$355.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$355.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$322.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$322.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.06
|
| Rate for Payer: University Health Alliance Commercial |
$415.57
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 27560
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: AlohaCare Medicaid |
$371.11
|
| Rate for Payer: AlohaCare Medicare |
$417.92
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Devoted Health Medicare |
$459.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$371.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$417.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$371.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$737.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$501.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$501.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$501.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$371.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$417.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$371.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$417.92
|
| Rate for Payer: University Health Alliance Commercial |
$468.81
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$692.77
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: AlohaCare Medicaid |
$333.47
|
| Rate for Payer: AlohaCare Medicare |
$328.65
|
| Rate for Payer: Cash Price |
$415.66
|
| Rate for Payer: Cash Price |
$415.66
|
| Rate for Payer: Devoted Health Medicare |
$361.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$333.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$328.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$333.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$208.00
|
| Rate for Payer: Health Management Network Commercial |
$588.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$394.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$394.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$333.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$328.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$333.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$328.65
|
| Rate for Payer: University Health Alliance Commercial |
$425.02
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$990.40
|
|
|
Service Code
|
HCPCS 24655
|
| Min. Negotiated Rate |
$258.44 |
| Max. Negotiated Rate |
$841.84 |
| Rate for Payer: AlohaCare Medicaid |
$442.70
|
| Rate for Payer: AlohaCare Medicare |
$462.64
|
| Rate for Payer: Cash Price |
$594.24
|
| Rate for Payer: Cash Price |
$594.24
|
| Rate for Payer: Devoted Health Medicare |
$508.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$442.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$462.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$442.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$258.44
|
| Rate for Payer: Health Management Network Commercial |
$841.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$555.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$555.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$555.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$442.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$462.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$442.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$462.64
|
| Rate for Payer: University Health Alliance Commercial |
$563.21
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$568.10
|
|
|
Service Code
|
HCPCS 24650
|
| Min. Negotiated Rate |
$212.42 |
| Max. Negotiated Rate |
$482.88 |
| Rate for Payer: AlohaCare Medicaid |
$275.77
|
| Rate for Payer: AlohaCare Medicare |
$275.26
|
| Rate for Payer: Cash Price |
$340.86
|
| Rate for Payer: Cash Price |
$340.86
|
| Rate for Payer: Devoted Health Medicare |
$302.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$275.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$275.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.42
|
| Rate for Payer: Health Management Network Commercial |
$482.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$330.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$330.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$275.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$275.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.26
|
| Rate for Payer: University Health Alliance Commercial |
$350.00
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,092.68
|
|
|
Service Code
|
HCPCS 25505
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$928.78 |
| Rate for Payer: AlohaCare Medicaid |
$498.94
|
| Rate for Payer: AlohaCare Medicare |
$511.22
|
| Rate for Payer: Cash Price |
$655.61
|
| Rate for Payer: Cash Price |
$655.61
|
| Rate for Payer: Devoted Health Medicare |
$562.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$498.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$511.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$498.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$296.40
|
| Rate for Payer: Health Management Network Commercial |
$928.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$613.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$613.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$613.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$511.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$498.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$511.22
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$613.01
|
|
|
Service Code
|
HCPCS 25500
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$521.06 |
| Rate for Payer: AlohaCare Medicaid |
$287.50
|
| Rate for Payer: AlohaCare Medicare |
$289.14
|
| Rate for Payer: Cash Price |
$367.81
|
| Rate for Payer: Cash Price |
$367.81
|
| Rate for Payer: Devoted Health Medicare |
$318.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$287.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$289.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$287.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$219.96
|
| Rate for Payer: Health Management Network Commercial |
$521.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$346.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$346.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$346.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$287.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$287.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.14
|
| Rate for Payer: University Health Alliance Commercial |
$363.33
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ
|
Professional
|
Both
|
$1,152.76
|
|
|
Service Code
|
HCPCS 25565
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$979.85 |
| Rate for Payer: AlohaCare Medicaid |
$498.45
|
| Rate for Payer: AlohaCare Medicare |
$529.03
|
| Rate for Payer: Cash Price |
$691.66
|
| Rate for Payer: Cash Price |
$691.66
|
| Rate for Payer: Devoted Health Medicare |
$581.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$498.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$529.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$498.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$446.16
|
| Rate for Payer: Health Management Network Commercial |
$979.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$634.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$634.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$634.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$529.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$498.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$529.03
|
| Rate for Payer: University Health Alliance Commercial |
$643.90
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MNPJ
|
Professional
|
Both
|
$623.72
|
|
|
Service Code
|
HCPCS 25560
|
| Min. Negotiated Rate |
$165.62 |
| Max. Negotiated Rate |
$530.16 |
| Rate for Payer: AlohaCare Medicaid |
$288.89
|
| Rate for Payer: AlohaCare Medicare |
$289.95
|
| Rate for Payer: Cash Price |
$374.23
|
| Rate for Payer: Cash Price |
$374.23
|
| Rate for Payer: Devoted Health Medicare |
$318.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$288.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$289.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$288.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.62
|
| Rate for Payer: Health Management Network Commercial |
$530.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$347.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$347.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$347.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$288.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$288.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.95
|
| Rate for Payer: University Health Alliance Commercial |
$365.70
|
|
|
PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$495.93
|
|
|
Service Code
|
HCPCS 23570
|
| Min. Negotiated Rate |
$126.62 |
| Max. Negotiated Rate |
$421.54 |
| Rate for Payer: AlohaCare Medicaid |
$270.54
|
| Rate for Payer: AlohaCare Medicare |
$268.20
|
| Rate for Payer: Cash Price |
$297.56
|
| Rate for Payer: Cash Price |
$297.56
|
| Rate for Payer: Devoted Health Medicare |
$295.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$270.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$268.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$270.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.62
|
| Rate for Payer: Health Management Network Commercial |
$421.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$321.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$270.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$268.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$270.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$268.20
|
| Rate for Payer: University Health Alliance Commercial |
$342.66
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES
|
Professional
|
Both
|
$790.67
|
|
|
Service Code
|
HCPCS 28575
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$672.07 |
| Rate for Payer: AlohaCare Medicaid |
$371.72
|
| Rate for Payer: AlohaCare Medicare |
$359.53
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Devoted Health Medicare |
$395.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$371.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$359.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$371.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$672.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$431.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$431.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$371.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$359.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$371.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$359.53
|
| Rate for Payer: University Health Alliance Commercial |
$474.47
|
|
|
PR CLOSED TX TALUS FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$499.66
|
|
|
Service Code
|
HCPCS 28430
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$424.71 |
| Rate for Payer: AlohaCare Medicaid |
$232.46
|
| Rate for Payer: AlohaCare Medicare |
$229.69
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Devoted Health Medicare |
$252.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$232.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$229.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$232.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.40
|
| Rate for Payer: Health Management Network Commercial |
$424.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$275.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$275.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$229.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$229.69
|
| Rate for Payer: University Health Alliance Commercial |
$296.30
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 28600
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: AlohaCare Medicaid |
$176.17
|
| Rate for Payer: AlohaCare Medicare |
$167.45
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Devoted Health Medicare |
$184.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$176.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$305.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$176.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.84
|
| Rate for Payer: Health Management Network Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.45
|
| Rate for Payer: University Health Alliance Commercial |
$258.33
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$333.97
|
|
|
Service Code
|
HCPCS 21480
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$283.87 |
| Rate for Payer: AlohaCare Medicaid |
$30.20
|
| Rate for Payer: AlohaCare Medicare |
$29.44
|
| Rate for Payer: Cash Price |
$200.38
|
| Rate for Payer: Cash Price |
$200.38
|
| Rate for Payer: Devoted Health Medicare |
$32.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.00
|
| Rate for Payer: Health Management Network Commercial |
$283.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.44
|
| Rate for Payer: University Health Alliance Commercial |
$39.89
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ
|
Professional
|
Both
|
$956.83
|
|
|
Service Code
|
HCPCS 24675
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$813.31 |
| Rate for Payer: AlohaCare Medicaid |
$452.34
|
| Rate for Payer: AlohaCare Medicare |
$440.80
|
| Rate for Payer: Cash Price |
$574.10
|
| Rate for Payer: Cash Price |
$574.10
|
| Rate for Payer: Devoted Health Medicare |
$484.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$452.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$440.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$452.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$228.80
|
| Rate for Payer: Health Management Network Commercial |
$813.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$528.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$528.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$528.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$452.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$440.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$452.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$440.80
|
| Rate for Payer: University Health Alliance Commercial |
$586.19
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ
|
Professional
|
Both
|
$631.98
|
|
|
Service Code
|
HCPCS 24670
|
| Min. Negotiated Rate |
$213.72 |
| Max. Negotiated Rate |
$537.18 |
| Rate for Payer: AlohaCare Medicaid |
$297.56
|
| Rate for Payer: AlohaCare Medicare |
$298.09
|
| Rate for Payer: Cash Price |
$379.19
|
| Rate for Payer: Cash Price |
$379.19
|
| Rate for Payer: Devoted Health Medicare |
$327.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$297.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$298.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$297.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$213.72
|
| Rate for Payer: Health Management Network Commercial |
$537.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$357.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$357.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$297.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$298.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$297.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$298.09
|
| Rate for Payer: University Health Alliance Commercial |
$378.56
|
|
