|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$417.85
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$355.17 |
| Rate for Payer: AlohaCare Medicaid |
$58.12
|
| Rate for Payer: AlohaCare Medicare |
$54.96
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Devoted Health Medicare |
$60.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$88.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.21
|
| Rate for Payer: Health Management Network Commercial |
$355.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.96
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$73.27
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$62.28 |
| Rate for Payer: AlohaCare Medicaid |
$27.76
|
| Rate for Payer: AlohaCare Medicare |
$24.78
|
| Rate for Payer: Cash Price |
$43.96
|
| Rate for Payer: Cash Price |
$43.96
|
| Rate for Payer: Devoted Health Medicare |
$27.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.20
|
| Rate for Payer: Health Management Network Commercial |
$62.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.78
|
|
|
PR CAST SUP GAUNTLET FIBERGLASS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS Q4014
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: AlohaCare Medicaid |
$18.88
|
| Rate for Payer: AlohaCare Medicare |
$33.84
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Devoted Health Medicare |
$37.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.25
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.84
|
|
|
PR CAST SUP GAUNTLET PED FBRGLS
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS Q4016
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: AlohaCare Medicaid |
$9.44
|
| Rate for Payer: AlohaCare Medicare |
$16.91
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Devoted Health Medicare |
$18.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.12
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.91
|
|
|
PR CAST SUP HIP SPICA FIBERGLAS
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS Q4026
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$219.30 |
| Rate for Payer: AlohaCare Medicare |
$150.32
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Devoted Health Medicare |
$165.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.60
|
| Rate for Payer: Health Management Network Commercial |
$219.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.32
|
|
|
PR CAST SUP HIP SPICA PED FBRGL
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS Q4028
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: AlohaCare Medicaid |
$24.00
|
| Rate for Payer: AlohaCare Medicare |
$75.20
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Devoted Health Medicare |
$82.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.33
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.20
|
|
|
PR CAST SUP HIP SPICA PLASTER
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS Q4025
|
| Min. Negotiated Rate |
$37.34 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: AlohaCare Medicare |
$48.12
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Devoted Health Medicare |
$52.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.34
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.12
|
|
|
PR CAST SUP LNG ARM SPLINT FBRG
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: AlohaCare Medicaid |
$10.32
|
| Rate for Payer: AlohaCare Medicare |
$18.48
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$20.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.34
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.48
|
|
|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: AlohaCare Medicaid |
$5.16
|
| Rate for Payer: AlohaCare Medicare |
$9.28
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$10.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.19
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.28
|
|
|
PR CAST SUP LNG LEG CYLINDER FB
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: AlohaCare Medicare |
$85.39
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Devoted Health Medicare |
$93.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.25
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.39
|
|
|
PR CAST SUP LNGLEG CYLNDR PED F
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS Q4036
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$62.05 |
| Rate for Payer: AlohaCare Medicare |
$42.73
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$47.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.14
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.73
|
|
|
PR CAST SUP LNG LEG PED FBRGLS
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS Q4032
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: AlohaCare Medicare |
$48.46
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Devoted Health Medicare |
$53.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.59
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.46
|
|
|
PR CAST SUP LNG LEG SPLNT FBRGL
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS Q4042
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: AlohaCare Medicare |
$43.49
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Devoted Health Medicare |
$47.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.73
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.49
|
|
|
PR CAST SUP LNG LEG SPLNT PED F
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS Q4044
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: AlohaCare Medicare |
$21.78
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Devoted Health Medicare |
$23.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.87
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.78
|
|
|
PR CAST SUP LNG LEG SPLNT PED P
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS Q4043
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: AlohaCare Medicare |
$12.74
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Devoted Health Medicare |
$14.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.89
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.74
|
|
|
PR CAST SUP LNG LEG SPLNT PLSTR
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS Q4041
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: AlohaCare Medicare |
$25.48
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$28.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.76
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.48
|
|
|
PR CAST SUP LONG ARM ADULT FBRG
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$37.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Devoted Health Medicare |
$40.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.86
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.20
|
|
|
PR CAST SUP LONG ARM PED FBRGLS
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: AlohaCare Medicaid |
$10.36
|
| Rate for Payer: AlohaCare Medicare |
$18.59
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$20.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.42
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.59
|
|
|
PR CAST SUP LONG LEG FIBERGLASS
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS Q4030
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: AlohaCare Medicaid |
$38.92
|
| Rate for Payer: AlohaCare Medicare |
$96.92
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Devoted Health Medicare |
$106.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.18
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.92
|
|
|
PR CAST SUP SHRT LEG FIBERGLASS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$52.48
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$57.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.71
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.48
|
|
|
PR CAST SUP SHRT LEG PED FBRGLS
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS Q4040
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: AlohaCare Medicaid |
$14.20
|
| Rate for Payer: AlohaCare Medicare |
$26.23
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Devoted Health Medicare |
$28.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.35
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.23
|
|
|
PR CAST SUP SHT ARM ADULT FBRGL
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS Q4010
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$36.55 |
| Rate for Payer: AlohaCare Medicaid |
$14.20
|
| Rate for Payer: AlohaCare Medicare |
$24.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$27.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.25
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.80
|
|
|
PR CAST SUP SHT ARM ADULT PLSTR
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS Q4009
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: AlohaCare Medicaid |
$6.14
|
| Rate for Payer: AlohaCare Medicare |
$11.03
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$12.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.56
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.03
|
|
|
PR CAST SUP SHT ARM PED FBRGLAS
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS Q4012
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: AlohaCare Medicaid |
$6.92
|
| Rate for Payer: AlohaCare Medicare |
$12.43
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Devoted Health Medicare |
$13.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.63
|
| Rate for Payer: Health Management Network Commercial |
$17.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.43
|
|
|
PR CAST SUP SHT ARM SPLINT FBRG
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: AlohaCare Medicaid |
$8.64
|
| Rate for Payer: AlohaCare Medicare |
$15.50
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$17.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.02
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.50
|
|
