|
PR CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,014.16
|
|
|
Service Code
|
HCPCS 25535
|
| Min. Negotiated Rate |
$291.98 |
| Max. Negotiated Rate |
$862.04 |
| Rate for Payer: AlohaCare Medicaid |
$495.58
|
| Rate for Payer: AlohaCare Medicare |
$471.28
|
| Rate for Payer: Cash Price |
$608.50
|
| Rate for Payer: Cash Price |
$608.50
|
| Rate for Payer: Devoted Health Medicare |
$518.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$495.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$471.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$495.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.98
|
| Rate for Payer: Health Management Network Commercial |
$862.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$565.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$565.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$495.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$471.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$495.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$471.28
|
| Rate for Payer: University Health Alliance Commercial |
$636.99
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$568.98
|
|
|
Service Code
|
HCPCS 25530
|
| Min. Negotiated Rate |
$162.76 |
| Max. Negotiated Rate |
$483.63 |
| Rate for Payer: AlohaCare Medicaid |
$273.07
|
| Rate for Payer: AlohaCare Medicare |
$270.83
|
| Rate for Payer: Cash Price |
$341.39
|
| Rate for Payer: Cash Price |
$341.39
|
| Rate for Payer: Devoted Health Medicare |
$297.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$273.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$270.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$273.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$162.76
|
| Rate for Payer: Health Management Network Commercial |
$483.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$325.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$325.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$325.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$273.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$270.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$273.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$270.83
|
| Rate for Payer: University Health Alliance Commercial |
$355.00
|
|
|
PR CLOSURE ENTEROSTOMY LG/SMALL INTESTINE
|
Professional
|
Both
|
$1,468.00
|
|
|
Service Code
|
HCPCS 44620
|
| Min. Negotiated Rate |
$652.60 |
| Max. Negotiated Rate |
$1,247.80 |
| Rate for Payer: AlohaCare Medicaid |
$857.42
|
| Rate for Payer: AlohaCare Medicare |
$793.06
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Devoted Health Medicare |
$872.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$793.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$652.60
|
| Rate for Payer: Health Management Network Commercial |
$1,247.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$951.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$951.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$857.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$793.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$857.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$793.06
|
|
|
PR CLOSURE GASTROSTOMY SURG
|
Professional
|
Both
|
$1,209.00
|
|
|
Service Code
|
HCPCS 43870
|
| Min. Negotiated Rate |
$388.96 |
| Max. Negotiated Rate |
$1,027.65 |
| Rate for Payer: AlohaCare Medicaid |
$706.02
|
| Rate for Payer: AlohaCare Medicare |
$664.28
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Devoted Health Medicare |
$730.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$664.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$388.96
|
| Rate for Payer: Health Management Network Commercial |
$1,027.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$797.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$797.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$797.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$706.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$664.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$706.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$664.28
|
|
|
PR CLOSURE INTESTINAL CUTANEOUS FISTULA
|
Professional
|
Both
|
$2,338.00
|
|
|
Service Code
|
HCPCS 44640
|
| Min. Negotiated Rate |
$632.58 |
| Max. Negotiated Rate |
$1,987.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,366.89
|
| Rate for Payer: AlohaCare Medicare |
$1,250.63
|
| Rate for Payer: Cash Price |
$1,402.80
|
| Rate for Payer: Cash Price |
$1,402.80
|
| Rate for Payer: Devoted Health Medicare |
$1,375.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,250.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$632.58
|
| Rate for Payer: Health Management Network Commercial |
$1,987.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,500.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,500.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,500.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,366.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,250.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,366.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,250.63
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL
|
Professional
|
Both
|
$590.87
|
|
|
Service Code
|
HCPCS 40831
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$502.24 |
| Rate for Payer: AlohaCare Medicaid |
$212.21
|
| Rate for Payer: AlohaCare Medicare |
$202.06
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Devoted Health Medicare |
$222.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$212.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$339.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$202.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$212.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$148.46
|
| Rate for Payer: Health Management Network Commercial |
$502.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.06
|
| Rate for Payer: University Health Alliance Commercial |
$287.13
|
|
|
PR CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 23540
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$438.60 |
| Rate for Payer: AlohaCare Medicaid |
$263.27
|
| Rate for Payer: AlohaCare Medicare |
$272.38
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Devoted Health Medicare |
$299.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$263.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$272.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$263.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.74
|
| Rate for Payer: Health Management Network Commercial |
$438.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$326.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$326.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$263.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$272.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$263.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$272.38
|
| Rate for Payer: University Health Alliance Commercial |
$332.19
|
|
|
PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$481.84
|
|
|
Service Code
|
HCPCS 23500
|
| Min. Negotiated Rate |
$154.96 |
| Max. Negotiated Rate |
$409.56 |
| Rate for Payer: AlohaCare Medicaid |
$255.04
|
| Rate for Payer: AlohaCare Medicare |
$260.52
|
| Rate for Payer: Cash Price |
$289.10
|
| Rate for Payer: Cash Price |
$289.10
|
| Rate for Payer: Devoted Health Medicare |
$286.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$255.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$260.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$255.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.96
|
| Rate for Payer: Health Management Network Commercial |
$409.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$312.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$312.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$312.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$260.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$255.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$260.52
|
| Rate for Payer: University Health Alliance Commercial |
$321.55
|
|
|
PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$776.67
|
|
|
Service Code
|
HCPCS 24500
|
| Min. Negotiated Rate |
$200.46 |
| Max. Negotiated Rate |
$660.17 |
| Rate for Payer: AlohaCare Medicaid |
$370.41
|
| Rate for Payer: AlohaCare Medicare |
$368.24
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Devoted Health Medicare |
$405.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$370.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$368.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$370.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.46
|
| Rate for Payer: Health Management Network Commercial |
$660.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$441.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$441.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$370.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$368.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$370.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$368.24
|
| Rate for Payer: University Health Alliance Commercial |
$471.14
|
|
|
PR CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES
|
Professional
|
Both
|
$763.65
|
|
|
Service Code
|
HCPCS 23655
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$649.10 |
| Rate for Payer: AlohaCare Medicaid |
$439.32
|
| Rate for Payer: AlohaCare Medicare |
$435.99
|
| Rate for Payer: Cash Price |
$458.19
|
| Rate for Payer: Cash Price |
$458.19
|
| Rate for Payer: Devoted Health Medicare |
$479.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$435.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$649.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$523.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$523.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$523.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$439.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$435.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$439.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$435.99
|
|
|
PR CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Professional
|
Both
|
$809.67
|
|
|
Service Code
|
HCPCS 23650
|
| Min. Negotiated Rate |
$190.58 |
| Max. Negotiated Rate |
$688.22 |
| Rate for Payer: AlohaCare Medicaid |
$327.73
|
| Rate for Payer: AlohaCare Medicare |
$387.10
|
| Rate for Payer: Cash Price |
$485.80
|
| Rate for Payer: Cash Price |
$485.80
|
| Rate for Payer: Devoted Health Medicare |
$425.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$327.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$387.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$327.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.58
|
| Rate for Payer: Health Management Network Commercial |
$688.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$464.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$464.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$464.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$327.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$387.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$327.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$387.10
|
| Rate for Payer: University Health Alliance Commercial |
$410.93
|
|
|
PR CLSR ANAL FSTL W/RCT ADVMNT FLAP
|
Professional
|
Both
|
$996.00
|
|
|
Service Code
|
HCPCS 46288
|
| Min. Negotiated Rate |
$375.96 |
| Max. Negotiated Rate |
$846.60 |
| Rate for Payer: AlohaCare Medicaid |
$580.46
|
| Rate for Payer: AlohaCare Medicare |
$566.66
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Devoted Health Medicare |
$623.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$566.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$375.96
|
| Rate for Payer: Health Management Network Commercial |
$846.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$679.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$679.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$679.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$580.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$566.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$580.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$566.66
|
|
|
PR CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ
|
Professional
|
Both
|
$2,590.00
|
|
|
Service Code
|
HCPCS 44661
|
| Min. Negotiated Rate |
$899.86 |
| Max. Negotiated Rate |
$2,201.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,509.49
|
| Rate for Payer: AlohaCare Medicare |
$1,377.43
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Devoted Health Medicare |
$1,515.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,377.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$899.86
|
| Rate for Payer: Health Management Network Commercial |
$2,201.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,652.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,652.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,652.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,509.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,377.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,509.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,377.43
|
|
|
PR CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$1,711.00
|
|
|
Service Code
|
HCPCS 44625
|
| Min. Negotiated Rate |
$674.96 |
| Max. Negotiated Rate |
$1,454.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,000.48
|
| Rate for Payer: AlohaCare Medicare |
$919.49
|
| Rate for Payer: Cash Price |
$1,026.60
|
| Rate for Payer: Cash Price |
$1,026.60
|
| Rate for Payer: Devoted Health Medicare |
$1,011.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$919.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$674.96
|
| Rate for Payer: Health Management Network Commercial |
$1,454.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,103.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,103.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,103.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,000.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$919.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,000.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$919.49
|
|
|
PR CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$2,656.00
|
|
|
Service Code
|
HCPCS 44626
|
| Min. Negotiated Rate |
$1,301.30 |
| Max. Negotiated Rate |
$2,257.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,553.00
|
| Rate for Payer: AlohaCare Medicare |
$1,415.40
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Devoted Health Medicare |
$1,556.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,415.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,301.30
|
| Rate for Payer: Health Management Network Commercial |
$2,257.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,698.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,698.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,698.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,553.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,415.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,553.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,415.40
|
|
|
PR CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$1,732.00
|
|
|
Service Code
|
HCPCS 27222
|
| Min. Negotiated Rate |
$579.28 |
| Max. Negotiated Rate |
$1,472.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,007.49
|
| Rate for Payer: AlohaCare Medicare |
$922.63
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Devoted Health Medicare |
$1,014.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$922.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$579.28
|
| Rate for Payer: Health Management Network Commercial |
$1,472.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,107.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,107.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,107.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,007.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$922.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,007.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$922.63
|
|
|
PR CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
HCPCS 27842
|
| Min. Negotiated Rate |
$230.62 |
| Max. Negotiated Rate |
$759.90 |
| Rate for Payer: AlohaCare Medicaid |
$521.61
|
| Rate for Payer: AlohaCare Medicare |
$505.02
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Devoted Health Medicare |
$555.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$505.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$230.62
|
| Rate for Payer: Health Management Network Commercial |
$759.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$606.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$606.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$606.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$521.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$505.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$505.02
|
|
|
PR CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ
|
Professional
|
Both
|
$782.81
|
|
|
Service Code
|
HCPCS 26742
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$665.39 |
| Rate for Payer: AlohaCare Medicaid |
$364.25
|
| Rate for Payer: AlohaCare Medicare |
$354.65
|
| Rate for Payer: Cash Price |
$469.69
|
| Rate for Payer: Cash Price |
$469.69
|
| Rate for Payer: Devoted Health Medicare |
$390.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$364.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$364.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.88
|
| Rate for Payer: Health Management Network Commercial |
$665.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$425.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$425.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$425.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$364.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$364.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.65
|
| Rate for Payer: University Health Alliance Commercial |
$468.92
|
|
|
PR CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ
|
Professional
|
Both
|
$492.82
|
|
|
Service Code
|
HCPCS 26740
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$418.90 |
| Rate for Payer: AlohaCare Medicaid |
$247.54
|
| Rate for Payer: AlohaCare Medicare |
$240.59
|
| Rate for Payer: Cash Price |
$295.69
|
| Rate for Payer: Cash Price |
$295.69
|
| Rate for Payer: Devoted Health Medicare |
$264.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$247.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$247.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.22
|
| Rate for Payer: Health Management Network Commercial |
$418.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$288.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.59
|
| Rate for Payer: University Health Alliance Commercial |
$312.94
|
|
|
PR CLTX CARPAL BONE FX W/MNPJ EACH BONE
|
Professional
|
Both
|
$968.84
|
|
|
Service Code
|
HCPCS 25635
|
| Min. Negotiated Rate |
$351.26 |
| Max. Negotiated Rate |
$823.51 |
| Rate for Payer: AlohaCare Medicaid |
$462.44
|
| Rate for Payer: AlohaCare Medicare |
$442.73
|
| Rate for Payer: Cash Price |
$581.30
|
| Rate for Payer: Cash Price |
$581.30
|
| Rate for Payer: Devoted Health Medicare |
$487.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$462.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$442.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$462.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$351.26
|
| Rate for Payer: Health Management Network Commercial |
$823.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$531.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$531.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$462.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$462.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.73
|
| Rate for Payer: University Health Alliance Commercial |
$592.49
|
|
|
PR CLTX CARPAL BONE FX W/O MNPJ EACH BONE
|
Professional
|
Both
|
$644.65
|
|
|
Service Code
|
HCPCS 25630
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$547.95 |
| Rate for Payer: AlohaCare Medicaid |
$314.40
|
| Rate for Payer: AlohaCare Medicare |
$306.09
|
| Rate for Payer: Cash Price |
$386.79
|
| Rate for Payer: Cash Price |
$386.79
|
| Rate for Payer: Devoted Health Medicare |
$336.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$314.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$306.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$314.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$235.04
|
| Rate for Payer: Health Management Network Commercial |
$547.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$367.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$367.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$367.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$314.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$306.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$314.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$306.09
|
| Rate for Payer: University Health Alliance Commercial |
$400.08
|
|
|
PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 26675
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: AlohaCare Medicaid |
$458.46
|
| Rate for Payer: AlohaCare Medicare |
$436.05
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Devoted Health Medicare |
$479.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$458.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$436.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$458.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$810.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$523.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$523.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$523.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$458.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$436.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$458.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$436.05
|
| Rate for Payer: University Health Alliance Commercial |
$588.68
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ
|
Professional
|
Both
|
$924.42
|
|
|
Service Code
|
HCPCS 27788
|
| Min. Negotiated Rate |
$262.60 |
| Max. Negotiated Rate |
$785.76 |
| Rate for Payer: AlohaCare Medicaid |
$416.23
|
| Rate for Payer: AlohaCare Medicare |
$431.78
|
| Rate for Payer: Cash Price |
$554.65
|
| Rate for Payer: Cash Price |
$554.65
|
| Rate for Payer: Devoted Health Medicare |
$474.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$416.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$431.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$416.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$262.60
|
| Rate for Payer: Health Management Network Commercial |
$785.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$518.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$518.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$518.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$416.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$431.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$416.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$431.78
|
| Rate for Payer: University Health Alliance Commercial |
$535.08
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$655.34
|
|
|
Service Code
|
HCPCS 27786
|
| Min. Negotiated Rate |
$163.54 |
| Max. Negotiated Rate |
$557.04 |
| Rate for Payer: AlohaCare Medicaid |
$317.53
|
| Rate for Payer: AlohaCare Medicare |
$310.30
|
| Rate for Payer: Cash Price |
$393.20
|
| Rate for Payer: Cash Price |
$393.20
|
| Rate for Payer: Devoted Health Medicare |
$341.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$317.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$310.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$317.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$163.54
|
| Rate for Payer: Health Management Network Commercial |
$557.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$317.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$317.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.30
|
| Rate for Payer: University Health Alliance Commercial |
$406.87
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Professional
|
Both
|
$711.57
|
|
|
Service Code
|
HCPCS 26755
|
| Min. Negotiated Rate |
$138.84 |
| Max. Negotiated Rate |
$604.83 |
| Rate for Payer: AlohaCare Medicaid |
$299.23
|
| Rate for Payer: AlohaCare Medicare |
$313.18
|
| Rate for Payer: Cash Price |
$426.94
|
| Rate for Payer: Cash Price |
$426.94
|
| Rate for Payer: Devoted Health Medicare |
$344.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$299.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$452.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$313.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$299.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.84
|
| Rate for Payer: Health Management Network Commercial |
$604.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$375.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$375.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$375.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$299.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$313.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$299.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$313.18
|
| Rate for Payer: University Health Alliance Commercial |
$381.00
|
|
