|
PR APPLICATION LONG ARM SPLINT SHOULDER HAND
|
Professional
|
Both
|
$181.60
|
|
|
Service Code
|
HCPCS 29105
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$154.36 |
| Rate for Payer: AlohaCare Medicaid |
$40.71
|
| Rate for Payer: AlohaCare Medicare |
$36.18
|
| Rate for Payer: Cash Price |
$108.96
|
| Rate for Payer: Cash Price |
$108.96
|
| Rate for Payer: Devoted Health Medicare |
$39.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$82.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$154.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.18
|
| Rate for Payer: University Health Alliance Commercial |
$50.24
|
|
|
PR APPLICATION LONG LEG CAST THIGH-TOE
|
Professional
|
Both
|
$276.96
|
|
|
Service Code
|
HCPCS 29345
|
| Min. Negotiated Rate |
$92.94 |
| Max. Negotiated Rate |
$235.42 |
| Rate for Payer: AlohaCare Medicaid |
$101.94
|
| Rate for Payer: AlohaCare Medicare |
$92.94
|
| Rate for Payer: Cash Price |
$166.18
|
| Rate for Payer: Cash Price |
$166.18
|
| Rate for Payer: Devoted Health Medicare |
$102.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$157.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.38
|
| Rate for Payer: Health Management Network Commercial |
$235.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.94
|
| Rate for Payer: University Health Alliance Commercial |
$127.46
|
|
|
PR APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE
|
Professional
|
Both
|
$286.65
|
|
|
Service Code
|
HCPCS 29355
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: AlohaCare Medicaid |
$108.93
|
| Rate for Payer: AlohaCare Medicare |
$98.10
|
| Rate for Payer: Cash Price |
$171.99
|
| Rate for Payer: Cash Price |
$171.99
|
| Rate for Payer: Devoted Health Medicare |
$107.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$108.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$167.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$108.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.30
|
| Rate for Payer: Health Management Network Commercial |
$243.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.10
|
| Rate for Payer: University Health Alliance Commercial |
$141.82
|
|
|
PR APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES
|
Professional
|
Both
|
$208.39
|
|
|
Service Code
|
HCPCS 29505
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$177.13 |
| Rate for Payer: AlohaCare Medicaid |
$54.66
|
| Rate for Payer: AlohaCare Medicare |
$56.79
|
| Rate for Payer: Cash Price |
$125.03
|
| Rate for Payer: Cash Price |
$125.03
|
| Rate for Payer: Devoted Health Medicare |
$62.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$81.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.26
|
| Rate for Payer: Health Management Network Commercial |
$177.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.79
|
| Rate for Payer: University Health Alliance Commercial |
$69.05
|
|
|
PR APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 97010
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: AlohaCare Medicaid |
$6.77
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.76
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.77
|
|
|
PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$2,007.00
|
|
|
Service Code
|
HCPCS 20692
|
| Min. Negotiated Rate |
$347.10 |
| Max. Negotiated Rate |
$1,705.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,166.78
|
| Rate for Payer: AlohaCare Medicare |
$1,063.39
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Devoted Health Medicare |
$1,169.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,063.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$347.10
|
| Rate for Payer: Health Management Network Commercial |
$1,705.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,276.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,276.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,276.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,166.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,063.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,166.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,063.39
|
|
|
PR APPLICATION SHORT ARM SPLINT DYNAMIC
|
Professional
|
Both
|
$161.91
|
|
|
Service Code
|
HCPCS 29126
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$137.62 |
| Rate for Payer: AlohaCare Medicaid |
$51.66
|
| Rate for Payer: AlohaCare Medicare |
$46.95
|
| Rate for Payer: Cash Price |
$97.15
|
| Rate for Payer: Cash Price |
$97.15
|
| Rate for Payer: Devoted Health Medicare |
$51.65
|
| Rate for Payer: Hawaii Medical Service Association 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 Medical Service Association Non-ABD |
$51.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$137.62
|
| 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
|
|
|
PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC
|
Professional
|
Both
|
$150.66
|
|
|
Service Code
|
HCPCS 29125
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: AlohaCare Medicaid |
$42.42
|
| Rate for Payer: AlohaCare Medicare |
$42.79
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Devoted Health Medicare |
$47.07
|
| Rate for Payer: Hawaii Medical Service Association 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 Medical Service Association Non-ABD |
$42.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$128.06
|
| 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
|
|
|
PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Professional
|
Both
|
$164.31
|
|
|
Service Code
|
HCPCS 29405
|
| Min. Negotiated Rate |
$57.43 |
| Max. Negotiated Rate |
$139.66 |
| Rate for Payer: AlohaCare Medicaid |
$61.19
|
| Rate for Payer: AlohaCare Medicare |
$57.43
|
| Rate for Payer: Cash Price |
$98.59
|
| Rate for Payer: Cash Price |
$98.59
|
| Rate for Payer: Devoted Health Medicare |
$63.17
|
| Rate for Payer: Hawaii Medical Service Association 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 Medical Service Association Non-ABD |
$61.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.46
|
| Rate for Payer: Health Management Network Commercial |
$139.66
|
| 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
|
|
|
PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Professional
|
Both
|
$151.66
|
|
|
Service Code
|
HCPCS 29425
|
| Min. Negotiated Rate |
$52.86 |
| Max. Negotiated Rate |
$128.91 |
| Rate for Payer: AlohaCare Medicaid |
$56.42
|
| Rate for Payer: AlohaCare Medicare |
$52.86
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Devoted Health Medicare |
$58.15
|
| Rate for Payer: Hawaii Medical Service Association 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 Medical Service Association Non-ABD |
$56.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$128.91
|
| 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
|
|
|
PR APPLICATION SHORT LEG SPLINT CALF FOOT
|
Professional
|
Both
|
$155.22
|
|
|
Service Code
|
HCPCS 29515
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$131.94 |
| Rate for Payer: AlohaCare Medicaid |
$51.60
|
| Rate for Payer: AlohaCare Medicare |
$51.10
|
| Rate for Payer: Cash Price |
$93.13
|
| Rate for Payer: Cash Price |
$93.13
|
| Rate for Payer: Devoted Health Medicare |
$56.21
|
| Rate for Payer: Hawaii Medical Service Association 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 Medical Service Association Non-ABD |
$51.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.04
|
| Rate for Payer: Health Management Network Commercial |
$131.94
|
| 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
|
|
|
PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 99188
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: AlohaCare Medicaid |
$9.90
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.90
|
| Rate for Payer: Health Management Network Commercial |
$17.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.90
|
|
|
PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,053.00
|
|
|
Service Code
|
HCPCS 20690
|
| Min. Negotiated Rate |
$207.48 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: AlohaCare Medicaid |
$612.77
|
| Rate for Payer: AlohaCare Medicare |
$549.13
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Devoted Health Medicare |
$604.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$549.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.48
|
| Rate for Payer: Health Management Network Commercial |
$895.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$658.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$658.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$658.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$612.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$549.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$612.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$549.13
|
|
|
PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$139.40 |
| Rate for Payer: AlohaCare Medicaid |
$27.04
|
| Rate for Payer: AlohaCare Medicare |
$23.32
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Devoted Health Medicare |
$25.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.80
|
| Rate for Payer: Health Management Network Commercial |
$139.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.32
|
| Rate for Payer: University Health Alliance Commercial |
$36.27
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 15274
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: AlohaCare Medicaid |
$43.19
|
| Rate for Payer: AlohaCare Medicare |
$37.70
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Devoted Health Medicare |
$41.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$43.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$73.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$43.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.70
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.70
|
| Rate for Payer: University Health Alliance Commercial |
$51.52
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$593.14
|
|
|
Service Code
|
HCPCS 15273
|
| Min. Negotiated Rate |
$168.04 |
| Max. Negotiated Rate |
$504.17 |
| Rate for Payer: AlohaCare Medicaid |
$191.95
|
| Rate for Payer: AlohaCare Medicare |
$168.04
|
| Rate for Payer: Cash Price |
$355.88
|
| Rate for Payer: Cash Price |
$355.88
|
| Rate for Payer: Devoted Health Medicare |
$184.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$191.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$323.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$191.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$319.54
|
| Rate for Payer: Health Management Network Commercial |
$504.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$191.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.04
|
| Rate for Payer: University Health Alliance Commercial |
$225.96
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$295.82
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$74.85 |
| Max. Negotiated Rate |
$251.45 |
| Rate for Payer: AlohaCare Medicaid |
$83.87
|
| Rate for Payer: AlohaCare Medicare |
$74.85
|
| Rate for Payer: Cash Price |
$177.49
|
| Rate for Payer: Cash Price |
$177.49
|
| Rate for Payer: Devoted Health Medicare |
$82.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$130.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$153.40
|
| Rate for Payer: Health Management Network Commercial |
$251.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.85
|
| Rate for Payer: University Health Alliance Commercial |
$91.51
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Professional
|
Both
|
$46.99
|
|
|
Service Code
|
HCPCS 15272
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$39.94 |
| Rate for Payer: AlohaCare Medicaid |
$16.51
|
| Rate for Payer: AlohaCare Medicare |
$14.31
|
| Rate for Payer: Cash Price |
$28.19
|
| Rate for Payer: Cash Price |
$28.19
|
| Rate for Payer: Devoted Health Medicare |
$15.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.12
|
| Rate for Payer: Health Management Network Commercial |
$39.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.31
|
| Rate for Payer: University Health Alliance Commercial |
$18.02
|
|
|
PR ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB
|
Professional
|
Both
|
$1,624.00
|
|
|
Service Code
|
HCPCS 27479
|
| Min. Negotiated Rate |
$730.34 |
| Max. Negotiated Rate |
$1,380.40 |
| Rate for Payer: AlohaCare Medicaid |
$945.34
|
| Rate for Payer: AlohaCare Medicare |
$856.16
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Devoted Health Medicare |
$941.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$856.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$730.34
|
| Rate for Payer: Health Management Network Commercial |
$1,380.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,027.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,027.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,027.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$945.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$856.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$945.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$856.16
|
|
|
PR ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 27485
|
| Min. Negotiated Rate |
$514.02 |
| Max. Negotiated Rate |
$1,023.40 |
| Rate for Payer: AlohaCare Medicaid |
$700.66
|
| Rate for Payer: AlohaCare Medicare |
$643.90
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Devoted Health Medicare |
$708.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$643.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.02
|
| Rate for Payer: Health Management Network Commercial |
$1,023.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$772.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$772.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$772.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$700.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$643.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$700.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$643.90
|
|
|
PR ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
HCPCS 36821
|
| Min. Negotiated Rate |
$575.14 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: AlohaCare Medicaid |
$625.24
|
| Rate for Payer: AlohaCare Medicare |
$575.14
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Devoted Health Medicare |
$632.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$575.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$623.48
|
| Rate for Payer: Health Management Network Commercial |
$906.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$690.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$690.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$690.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$625.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$575.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$625.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$575.14
|
| Rate for Payer: University Health Alliance Commercial |
$920.00
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$105.75
|
|
|
Service Code
|
HCPCS 20605
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$89.89 |
| Rate for Payer: AlohaCare Medicaid |
$36.94
|
| Rate for Payer: AlohaCare Medicare |
$31.95
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Devoted Health Medicare |
$35.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$89.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.95
|
| Rate for Payer: University Health Alliance Commercial |
$48.93
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Professional
|
Both
|
$175.65
|
|
|
Service Code
|
HCPCS 20606
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$149.30 |
| Rate for Payer: AlohaCare Medicaid |
$51.78
|
| Rate for Payer: AlohaCare Medicare |
$44.17
|
| Rate for Payer: Cash Price |
$105.39
|
| Rate for Payer: Cash Price |
$105.39
|
| Rate for Payer: Devoted Health Medicare |
$48.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.32
|
| Rate for Payer: Health Management Network Commercial |
$149.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.17
|
| Rate for Payer: University Health Alliance Commercial |
$68.25
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$126.51
|
|
|
Service Code
|
HCPCS 20610
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$107.53 |
| Rate for Payer: AlohaCare Medicaid |
$45.55
|
| Rate for Payer: AlohaCare Medicare |
$39.25
|
| Rate for Payer: Cash Price |
$75.91
|
| Rate for Payer: Cash Price |
$75.91
|
| Rate for Payer: Devoted Health Medicare |
$43.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$45.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$45.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.76
|
| Rate for Payer: Health Management Network Commercial |
$107.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.25
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Professional
|
Both
|
$194.22
|
|
|
Service Code
|
HCPCS 20611
|
| Min. Negotiated Rate |
$49.46 |
| Max. Negotiated Rate |
$165.09 |
| Rate for Payer: AlohaCare Medicaid |
$58.92
|
| Rate for Payer: AlohaCare Medicare |
$49.46
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Devoted Health Medicare |
$54.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$92.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$49.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.32
|
| Rate for Payer: Health Management Network Commercial |
$165.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$59.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.46
|
| Rate for Payer: University Health Alliance Commercial |
$138.00
|
|
