|
PR ANN BREAST EXAM
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS S0613
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
|
|
PR ANNUAL GYNECOLOGICAL EXAMINA
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS S0612
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$64.63 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
|
|
PR ANNUAL GYNECOLOGICAL EXAMINA
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS S0610
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$64.63 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
|
|
PR ANOSCOPY ABLATION LESION
|
Professional
|
Both
|
$363.60
|
|
|
Service Code
|
HCPCS 46615
|
| Min. Negotiated Rate |
$84.73 |
| Max. Negotiated Rate |
$309.06 |
| Rate for Payer: AlohaCare Medicaid |
$92.10
|
| Rate for Payer: AlohaCare Medicare |
$84.73
|
| Rate for Payer: Cash Price |
$218.16
|
| Rate for Payer: Cash Price |
$218.16
|
| Rate for Payer: Devoted Health Medicare |
$93.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$92.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$92.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.06
|
| Rate for Payer: Health Management Network Commercial |
$309.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.73
|
| Rate for Payer: University Health Alliance Commercial |
$122.25
|
|
|
PR ANOSCOPY CONTROL BLEEDING
|
Professional
|
Both
|
$351.80
|
|
|
Service Code
|
HCPCS 46614
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$299.03 |
| Rate for Payer: AlohaCare Medicaid |
$65.73
|
| Rate for Payer: AlohaCare Medicare |
$62.41
|
| Rate for Payer: Cash Price |
$211.08
|
| Rate for Payer: Cash Price |
$211.08
|
| Rate for Payer: Devoted Health Medicare |
$68.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$152.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.58
|
| Rate for Payer: Health Management Network Commercial |
$299.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.41
|
| Rate for Payer: University Health Alliance Commercial |
$87.24
|
|
|
PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Professional
|
Both
|
$249.60
|
|
|
Service Code
|
HCPCS 46600
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: AlohaCare Medicaid |
$42.94
|
| Rate for Payer: AlohaCare Medicare |
$41.99
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Devoted Health Medicare |
$46.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$63.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.28
|
| Rate for Payer: Health Management Network Commercial |
$212.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.99
|
| Rate for Payer: University Health Alliance Commercial |
$55.80
|
|
|
PR ANOSCOPY W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$594.88
|
|
|
Service Code
|
HCPCS 46606
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$505.65 |
| Rate for Payer: AlohaCare Medicaid |
$76.38
|
| Rate for Payer: AlohaCare Medicare |
$71.81
|
| Rate for Payer: Cash Price |
$356.93
|
| Rate for Payer: Cash Price |
$356.93
|
| Rate for Payer: Devoted Health Medicare |
$78.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$76.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$94.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$76.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.66
|
| Rate for Payer: Health Management Network Commercial |
$505.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.81
|
| Rate for Payer: University Health Alliance Commercial |
$100.19
|
|
|
PR ANOSCOPY W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$620.41
|
|
|
Service Code
|
HCPCS 46608
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$527.35 |
| Rate for Payer: AlohaCare Medicaid |
$84.05
|
| Rate for Payer: AlohaCare Medicare |
$80.33
|
| Rate for Payer: Cash Price |
$372.25
|
| Rate for Payer: Cash Price |
$372.25
|
| Rate for Payer: Devoted Health Medicare |
$88.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$84.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$131.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$84.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$527.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.33
|
| Rate for Payer: University Health Alliance Commercial |
$111.20
|
|
|
PR ANOSCOPY W/RMVL LESION CAUTERY
|
Professional
|
Both
|
$591.92
|
|
|
Service Code
|
HCPCS 46610
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$503.13 |
| Rate for Payer: AlohaCare Medicaid |
$80.75
|
| Rate for Payer: AlohaCare Medicare |
$76.58
|
| Rate for Payer: Cash Price |
$355.15
|
| Rate for Payer: Cash Price |
$355.15
|
| Rate for Payer: Devoted Health Medicare |
$84.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$80.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$125.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$80.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.60
|
| Rate for Payer: Health Management Network Commercial |
$503.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.58
|
| Rate for Payer: University Health Alliance Commercial |
$106.43
|
|
|
PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 45990
|
| Min. Negotiated Rate |
$98.59 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: AlohaCare Medicaid |
$105.67
|
| Rate for Payer: AlohaCare Medicare |
$98.59
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Devoted Health Medicare |
$108.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.58
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.59
|
|
|
PR ANTEPARTUM CARE ONLY 4-6 VISITS
|
Professional
|
Both
|
$1,008.58
|
|
|
Service Code
|
HCPCS 59425
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: AlohaCare Medicaid |
$417.21
|
| Rate for Payer: AlohaCare Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Devoted Health Medicare |
$405.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$417.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$368.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$417.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$197.60
|
| Rate for Payer: Health Management Network Commercial |
$857.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$441.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$441.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$417.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$368.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$417.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$368.21
|
|
|
PR ANTEPARTUM CARE ONLY 7/> VISITS
|
Professional
|
Both
|
$1,851.88
|
|
|
Service Code
|
HCPCS 59426
|
| Min. Negotiated Rate |
$395.20 |
| Max. Negotiated Rate |
$1,574.10 |
| Rate for Payer: AlohaCare Medicaid |
$765.67
|
| Rate for Payer: AlohaCare Medicare |
$675.03
|
| Rate for Payer: Cash Price |
$1,111.13
|
| Rate for Payer: Cash Price |
$1,111.13
|
| Rate for Payer: Devoted Health Medicare |
$742.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$765.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$675.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$765.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$395.20
|
| Rate for Payer: Health Management Network Commercial |
$1,574.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$810.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$810.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$810.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$765.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$675.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$765.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$675.03
|
|
|
PR APLIGRAF
|
Professional
|
Both
|
$253.21
|
|
|
Service Code
|
HCPCS Q4101
|
| Min. Negotiated Rate |
$144.69 |
| Max. Negotiated Rate |
$215.23 |
| Rate for Payer: AlohaCare Medicare |
$144.69
|
| Rate for Payer: Cash Price |
$151.93
|
| Rate for Payer: Cash Price |
$151.93
|
| Rate for Payer: Devoted Health Medicare |
$159.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.69
|
| Rate for Payer: Health Management Network Commercial |
$215.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.69
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 44955
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: AlohaCare Medicaid |
$80.61
|
| Rate for Payer: AlohaCare Medicare |
$71.54
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Devoted Health Medicare |
$78.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.76
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.54
|
|
|
PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
HCPCS 44960
|
| Min. Negotiated Rate |
$645.84 |
| Max. Negotiated Rate |
$1,258.85 |
| Rate for Payer: AlohaCare Medicaid |
$864.85
|
| Rate for Payer: AlohaCare Medicare |
$804.74
|
| Rate for Payer: Cash Price |
$888.60
|
| Rate for Payer: Cash Price |
$888.60
|
| Rate for Payer: Devoted Health Medicare |
$885.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$804.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.84
|
| Rate for Payer: Health Management Network Commercial |
$1,258.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$965.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$965.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$965.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$864.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$804.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$864.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$804.74
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 44950
|
| Min. Negotiated Rate |
$525.20 |
| Max. Negotiated Rate |
$924.80 |
| Rate for Payer: AlohaCare Medicaid |
$635.28
|
| Rate for Payer: AlohaCare Medicare |
$592.56
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Devoted Health Medicare |
$651.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$592.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$525.20
|
| Rate for Payer: Health Management Network Commercial |
$924.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$711.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$711.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$635.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$592.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$635.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$592.56
|
|
|
PR APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG
|
Professional
|
Both
|
$266.67
|
|
|
Service Code
|
HCPCS 29450
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$226.67 |
| Rate for Payer: AlohaCare Medicaid |
$114.08
|
| Rate for Payer: AlohaCare Medicare |
$100.35
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Devoted Health Medicare |
$110.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$178.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$114.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.22
|
| Rate for Payer: Health Management Network Commercial |
$226.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.35
|
| Rate for Payer: University Health Alliance Commercial |
$150.99
|
|
|
PR APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS
|
Professional
|
Both
|
$590.62
|
|
|
Service Code
|
HCPCS 29325
|
| Min. Negotiated Rate |
$172.30 |
| Max. Negotiated Rate |
$502.03 |
| Rate for Payer: AlohaCare Medicaid |
$183.92
|
| Rate for Payer: AlohaCare Medicare |
$172.30
|
| Rate for Payer: Cash Price |
$354.37
|
| Rate for Payer: Cash Price |
$354.37
|
| Rate for Payer: Devoted Health Medicare |
$189.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$183.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$183.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$502.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$183.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$183.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.30
|
| Rate for Payer: University Health Alliance Commercial |
$236.98
|
|
|
PR APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$183.49
|
|
|
Service Code
|
HCPCS 29075
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$155.97 |
| Rate for Payer: AlohaCare Medicaid |
$65.53
|
| Rate for Payer: AlohaCare Medicare |
$60.80
|
| Rate for Payer: Cash Price |
$110.09
|
| Rate for Payer: Cash Price |
$110.09
|
| Rate for Payer: Devoted Health Medicare |
$66.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$155.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.80
|
| Rate for Payer: University Health Alliance Commercial |
$82.52
|
|
|
PR APPLICATION CAST HAND & LOWER FOREARM GAUNTLET
|
Professional
|
Both
|
$200.64
|
|
|
Service Code
|
HCPCS 29085
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$170.54 |
| Rate for Payer: AlohaCare Medicaid |
$70.58
|
| Rate for Payer: AlohaCare Medicare |
$65.28
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Devoted Health Medicare |
$71.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$70.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$107.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$70.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$170.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.28
|
| Rate for Payer: University Health Alliance Commercial |
$88.52
|
|
|
PR APPLICATION CAST SHOULDER HAND LONG ARM
|
Professional
|
Both
|
$202.98
|
|
|
Service Code
|
HCPCS 29065
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$172.53 |
| Rate for Payer: AlohaCare Medicaid |
$71.15
|
| Rate for Payer: AlohaCare Medicare |
$66.24
|
| Rate for Payer: Cash Price |
$121.79
|
| Rate for Payer: Cash Price |
$121.79
|
| Rate for Payer: Devoted Health Medicare |
$72.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$108.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.46
|
| Rate for Payer: Health Management Network Commercial |
$172.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.24
|
| Rate for Payer: University Health Alliance Commercial |
$92.19
|
|
|
PR APPLICATION CYLINDER CAST THIGH ANKLE
|
Professional
|
Both
|
$259.75
|
|
|
Service Code
|
HCPCS 29365
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$220.79 |
| Rate for Payer: AlohaCare Medicaid |
$90.81
|
| Rate for Payer: AlohaCare Medicare |
$83.87
|
| Rate for Payer: Cash Price |
$155.85
|
| Rate for Payer: Cash Price |
$155.85
|
| Rate for Payer: Devoted Health Medicare |
$92.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$137.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$90.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.44
|
| Rate for Payer: Health Management Network Commercial |
$220.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.87
|
| Rate for Payer: University Health Alliance Commercial |
$116.76
|
|
|
PR APPLICATION FINGER SPLINT DYNAMIC
|
Professional
|
Both
|
$111.37
|
|
|
Service Code
|
HCPCS 29131
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$94.66 |
| Rate for Payer: AlohaCare Medicaid |
$35.29
|
| Rate for Payer: AlohaCare Medicare |
$31.36
|
| Rate for Payer: Cash Price |
$66.82
|
| Rate for Payer: Cash Price |
$66.82
|
| Rate for Payer: Devoted Health Medicare |
$34.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$53.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.28
|
| Rate for Payer: Health Management Network Commercial |
$94.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.36
|
| Rate for Payer: University Health Alliance Commercial |
$45.67
|
|
|
PR APPLICATION FINGER SPLINT STATIC
|
Professional
|
Both
|
$85.17
|
|
|
Service Code
|
HCPCS 29130
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$72.39 |
| Rate for Payer: AlohaCare Medicaid |
$29.03
|
| Rate for Payer: AlohaCare Medicare |
$25.51
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Devoted Health Medicare |
$28.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.92
|
| Rate for Payer: Health Management Network Commercial |
$72.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.51
|
| Rate for Payer: University Health Alliance Commercial |
$36.07
|
|
|
PR APPLICATION HIP SPICA CAST 1 LEG
|
Professional
|
Both
|
$536.67
|
|
|
Service Code
|
HCPCS 29305
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$456.17 |
| Rate for Payer: AlohaCare Medicaid |
$164.73
|
| Rate for Payer: AlohaCare Medicare |
$155.53
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Devoted Health Medicare |
$171.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$164.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$250.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$164.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$152.36
|
| Rate for Payer: Health Management Network Commercial |
$456.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$164.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$164.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.53
|
| Rate for Payer: University Health Alliance Commercial |
$211.79
|
|
