|
APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 97010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: AlohaCare Medicaid |
$6.77
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.76
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.77
|
|
|
APPLICATION MODALITY 1/> AREAS INFRARED
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 97026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$26.35 |
| Rate for Payer: AlohaCare Medicaid |
$7.16
|
| Rate for Payer: AlohaCare Medicare |
$7.13
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Devoted Health Medicare |
$7.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.42
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.13
|
|
|
APPLICATION MODALITY 1/> AREAS WHIRLPOOL
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 97022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: AlohaCare Medicaid |
$18.47
|
| Rate for Payer: AlohaCare Medicare |
$16.88
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Devoted Health Medicare |
$16.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.09
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.88
|
|
|
APPLICATION SHORT ARM SPLINT DYNAMIC
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 29126
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$256.70 |
| Rate for Payer: AlohaCare Medicaid |
$51.66
|
| Rate for Payer: AlohaCare Medicare |
$46.95
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Devoted Health Medicare |
$46.95
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$51.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$78.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$256.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.95
|
| Rate for Payer: University Health Alliance Commercial |
$66.31
|
|
|
APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 29125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: AlohaCare Medicaid |
$42.42
|
| Rate for Payer: AlohaCare Medicare |
$42.79
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Devoted Health Medicare |
$42.79
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$42.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$63.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$165.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.79
|
| Rate for Payer: University Health Alliance Commercial |
$53.06
|
|
|
APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 29405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.43 |
| Max. Negotiated Rate |
$256.70 |
| Rate for Payer: AlohaCare Medicaid |
$61.19
|
| Rate for Payer: AlohaCare Medicare |
$57.43
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Devoted Health Medicare |
$57.43
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$61.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$92.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.46
|
| Rate for Payer: Health Management Network Commercial |
$256.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.43
|
| Rate for Payer: University Health Alliance Commercial |
$76.45
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 29425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.86 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: AlohaCare Medicaid |
$56.42
|
| Rate for Payer: AlohaCare Medicare |
$52.86
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Devoted Health Medicare |
$52.86
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$56.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$93.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.86
|
| Rate for Payer: University Health Alliance Commercial |
$70.57
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 29515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: AlohaCare Medicaid |
$51.60
|
| Rate for Payer: AlohaCare Medicare |
$51.10
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Devoted Health Medicare |
$51.10
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$51.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.04
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.10
|
| Rate for Payer: University Health Alliance Commercial |
$65.81
|
|
|
APPL MODALITY 1+ AREAS CONTRAST BATHS EA 15 MIN
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 97034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: AlohaCare Medicaid |
$14.83
|
| Rate for Payer: AlohaCare Medicare |
$14.80
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Devoted Health Medicare |
$14.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.33
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.80
|
|
|
APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 97014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$135.15 |
| Rate for Payer: AlohaCare Medicaid |
$13.06
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.68
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.06
|
|
|
APPL MODALITY 1+ AREAS ESTIM EA 15 MIN
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 97032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: AlohaCare Medicaid |
$15.01
|
| Rate for Payer: AlohaCare Medicare |
$15.38
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Devoted Health Medicare |
$15.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.72
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.38
|
|
|
APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 97033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: AlohaCare Medicaid |
$20.70
|
| Rate for Payer: AlohaCare Medicare |
$20.27
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Devoted Health Medicare |
$20.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.62
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.27
|
|
|
APPL MODALITY 1/> AREAS PARAFFIN BATH
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 97018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AlohaCare Medicaid |
$6.01
|
| Rate for Payer: AlohaCare Medicare |
$6.37
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Devoted Health Medicare |
$6.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.81
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.37
|
|
|
APPL MODALITY 1/> AREAS TRACTION MECHANICAL
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 97012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: AlohaCare Medicaid |
$14.63
|
| Rate for Payer: AlohaCare Medicare |
$15.05
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Devoted Health Medicare |
$15.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.70
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.05
|
|
|
APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 97035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: AlohaCare Medicaid |
$14.83
|
| Rate for Payer: AlohaCare Medicare |
$15.18
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Devoted Health Medicare |
$15.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.61
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.18
|
|
|
APPL MODALITY 1/> AREAS VASOPNEUMATIC DEVICES
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 97016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: AlohaCare Medicaid |
$12.30
|
| Rate for Payer: AlohaCare Medicare |
$12.66
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$12.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.09
|
| Rate for Payer: Health Management Network Commercial |
$71.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.66
|
|
|
APPL-SHORT ARM SPLINT DYNAMIC Charge
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
440291260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
APPL-SHORT ARM SPLINT DYNAMIC Charge
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
440291260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$215.46
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$471.96
|
| Rate for Payer: Devoted Health Medicare |
$215.46
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$215.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.46
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.46
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
APPLY CAST HAND/LOWER FOREARM CHARGE
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
440290850
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$215.46
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$471.96
|
| Rate for Payer: Devoted Health Medicare |
$215.46
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$215.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.46
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.46
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
APPLY CAST HAND/LOWER FOREARM CHARGE
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
440290850
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
APPLY FINGER SPLINT (STATIC) CHARGE
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
440291300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$277.42 |
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
|
|
APPLY FINGER SPLINT (STATIC) CHARGE
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
440291300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$143.00
|
| Rate for Payer: AlohaCare Medicare |
$120.12
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$263.12
|
| Rate for Payer: Devoted Health Medicare |
$120.12
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$271.70
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Humana Medicare |
$120.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.12
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.12
|
| Rate for Payer: University Health Alliance Commercial |
$208.47
|
|
|
APPLY LONG ARM CAST CHARGE
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
440290650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$297.36
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$651.36
|
| Rate for Payer: Devoted Health Medicare |
$297.36
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$672.60
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$297.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$297.36
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$297.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.36
|
| Rate for Payer: University Health Alliance Commercial |
$516.06
|
|
|
APPLY LONG ARM CAST CHARGE
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
440290650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
APPLY LONG ARM SPLINT CHARGE
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
440291050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
