|
PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$805.88
|
|
|
Service Code
|
HCPCS 21337
|
| Min. Negotiated Rate |
$244.14 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: AlohaCare Medicaid |
$322.59
|
| Rate for Payer: AlohaCare Medicare |
$296.06
|
| Rate for Payer: Cash Price |
$483.53
|
| Rate for Payer: Cash Price |
$483.53
|
| Rate for Payer: Devoted Health Medicare |
$325.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$322.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$490.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$322.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$244.14
|
| Rate for Payer: Health Management Network Commercial |
$685.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$355.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$355.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$322.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$322.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.06
|
| Rate for Payer: University Health Alliance Commercial |
$415.57
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 27560
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: AlohaCare Medicaid |
$371.11
|
| Rate for Payer: AlohaCare Medicare |
$417.92
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Devoted Health Medicare |
$459.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$371.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$417.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$371.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$737.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$501.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$501.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$501.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$371.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$417.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$371.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$417.92
|
| Rate for Payer: University Health Alliance Commercial |
$468.81
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$692.77
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: AlohaCare Medicaid |
$333.47
|
| Rate for Payer: AlohaCare Medicare |
$328.65
|
| Rate for Payer: Cash Price |
$415.66
|
| Rate for Payer: Cash Price |
$415.66
|
| Rate for Payer: Devoted Health Medicare |
$361.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$333.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$328.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$333.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$208.00
|
| Rate for Payer: Health Management Network Commercial |
$588.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$394.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$394.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$333.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$328.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$333.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$328.65
|
| Rate for Payer: University Health Alliance Commercial |
$425.02
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$990.40
|
|
|
Service Code
|
HCPCS 24655
|
| Min. Negotiated Rate |
$258.44 |
| Max. Negotiated Rate |
$841.84 |
| Rate for Payer: AlohaCare Medicaid |
$442.70
|
| Rate for Payer: AlohaCare Medicare |
$462.64
|
| Rate for Payer: Cash Price |
$594.24
|
| Rate for Payer: Cash Price |
$594.24
|
| Rate for Payer: Devoted Health Medicare |
$508.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$442.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$462.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$442.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$258.44
|
| Rate for Payer: Health Management Network Commercial |
$841.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$555.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$555.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$555.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$442.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$462.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$442.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$462.64
|
| Rate for Payer: University Health Alliance Commercial |
$563.21
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$568.10
|
|
|
Service Code
|
HCPCS 24650
|
| Min. Negotiated Rate |
$212.42 |
| Max. Negotiated Rate |
$482.88 |
| Rate for Payer: AlohaCare Medicaid |
$275.77
|
| Rate for Payer: AlohaCare Medicare |
$275.26
|
| Rate for Payer: Cash Price |
$340.86
|
| Rate for Payer: Cash Price |
$340.86
|
| Rate for Payer: Devoted Health Medicare |
$302.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$275.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$275.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.42
|
| Rate for Payer: Health Management Network Commercial |
$482.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$330.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$330.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$275.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$275.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.26
|
| Rate for Payer: University Health Alliance Commercial |
$350.00
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,092.68
|
|
|
Service Code
|
HCPCS 25505
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$928.78 |
| Rate for Payer: AlohaCare Medicaid |
$498.94
|
| Rate for Payer: AlohaCare Medicare |
$511.22
|
| Rate for Payer: Cash Price |
$655.61
|
| Rate for Payer: Cash Price |
$655.61
|
| Rate for Payer: Devoted Health Medicare |
$562.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$498.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$511.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$498.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$296.40
|
| Rate for Payer: Health Management Network Commercial |
$928.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$613.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$613.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$613.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$511.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$498.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$511.22
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$613.01
|
|
|
Service Code
|
HCPCS 25500
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$521.06 |
| Rate for Payer: AlohaCare Medicaid |
$287.50
|
| Rate for Payer: AlohaCare Medicare |
$289.14
|
| Rate for Payer: Cash Price |
$367.81
|
| Rate for Payer: Cash Price |
$367.81
|
| Rate for Payer: Devoted Health Medicare |
$318.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$287.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$289.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$287.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$219.96
|
| Rate for Payer: Health Management Network Commercial |
$521.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$346.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$346.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$346.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$287.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$287.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.14
|
| Rate for Payer: University Health Alliance Commercial |
$363.33
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ
|
Professional
|
Both
|
$1,152.76
|
|
|
Service Code
|
HCPCS 25565
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$979.85 |
| Rate for Payer: AlohaCare Medicaid |
$498.45
|
| Rate for Payer: AlohaCare Medicare |
$529.03
|
| Rate for Payer: Cash Price |
$691.66
|
| Rate for Payer: Cash Price |
$691.66
|
| Rate for Payer: Devoted Health Medicare |
$581.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$498.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$529.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$498.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$446.16
|
| Rate for Payer: Health Management Network Commercial |
$979.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$634.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$634.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$634.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$529.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$498.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$529.03
|
| Rate for Payer: University Health Alliance Commercial |
$643.90
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MNPJ
|
Professional
|
Both
|
$623.72
|
|
|
Service Code
|
HCPCS 25560
|
| Min. Negotiated Rate |
$165.62 |
| Max. Negotiated Rate |
$530.16 |
| Rate for Payer: AlohaCare Medicaid |
$288.89
|
| Rate for Payer: AlohaCare Medicare |
$289.95
|
| Rate for Payer: Cash Price |
$374.23
|
| Rate for Payer: Cash Price |
$374.23
|
| Rate for Payer: Devoted Health Medicare |
$318.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$288.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$289.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$288.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.62
|
| Rate for Payer: Health Management Network Commercial |
$530.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$347.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$347.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$347.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$288.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$288.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.95
|
| Rate for Payer: University Health Alliance Commercial |
$365.70
|
|
|
PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$495.93
|
|
|
Service Code
|
HCPCS 23570
|
| Min. Negotiated Rate |
$126.62 |
| Max. Negotiated Rate |
$421.54 |
| Rate for Payer: AlohaCare Medicaid |
$270.54
|
| Rate for Payer: AlohaCare Medicare |
$268.20
|
| Rate for Payer: Cash Price |
$297.56
|
| Rate for Payer: Cash Price |
$297.56
|
| Rate for Payer: Devoted Health Medicare |
$295.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$270.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$268.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$270.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.62
|
| Rate for Payer: Health Management Network Commercial |
$421.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$321.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$270.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$268.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$270.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$268.20
|
| Rate for Payer: University Health Alliance Commercial |
$342.66
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES
|
Professional
|
Both
|
$790.67
|
|
|
Service Code
|
HCPCS 28575
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$672.07 |
| Rate for Payer: AlohaCare Medicaid |
$371.72
|
| Rate for Payer: AlohaCare Medicare |
$359.53
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Devoted Health Medicare |
$395.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$371.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$359.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$371.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$672.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$431.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$431.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$371.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$359.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$371.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$359.53
|
| Rate for Payer: University Health Alliance Commercial |
$474.47
|
|
|
PR CLOSED TX TALUS FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$499.66
|
|
|
Service Code
|
HCPCS 28430
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$424.71 |
| Rate for Payer: AlohaCare Medicaid |
$232.46
|
| Rate for Payer: AlohaCare Medicare |
$229.69
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Devoted Health Medicare |
$252.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$232.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$229.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$232.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.40
|
| Rate for Payer: Health Management Network Commercial |
$424.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$275.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$275.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$229.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$229.69
|
| Rate for Payer: University Health Alliance Commercial |
$296.30
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 28600
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: AlohaCare Medicaid |
$176.17
|
| Rate for Payer: AlohaCare Medicare |
$167.45
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Devoted Health Medicare |
$184.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$176.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$305.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$176.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.84
|
| Rate for Payer: Health Management Network Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.45
|
| Rate for Payer: University Health Alliance Commercial |
$258.33
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$333.97
|
|
|
Service Code
|
HCPCS 21480
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$283.87 |
| Rate for Payer: AlohaCare Medicaid |
$30.20
|
| Rate for Payer: AlohaCare Medicare |
$29.44
|
| Rate for Payer: Cash Price |
$200.38
|
| Rate for Payer: Cash Price |
$200.38
|
| Rate for Payer: Devoted Health Medicare |
$32.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.00
|
| Rate for Payer: Health Management Network Commercial |
$283.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.44
|
| Rate for Payer: University Health Alliance Commercial |
$39.89
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ
|
Professional
|
Both
|
$956.83
|
|
|
Service Code
|
HCPCS 24675
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$813.31 |
| Rate for Payer: AlohaCare Medicaid |
$452.34
|
| Rate for Payer: AlohaCare Medicare |
$440.80
|
| Rate for Payer: Cash Price |
$574.10
|
| Rate for Payer: Cash Price |
$574.10
|
| Rate for Payer: Devoted Health Medicare |
$484.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$452.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$440.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$452.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$228.80
|
| Rate for Payer: Health Management Network Commercial |
$813.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$528.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$528.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$528.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$452.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$440.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$452.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$440.80
|
| Rate for Payer: University Health Alliance Commercial |
$586.19
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ
|
Professional
|
Both
|
$631.98
|
|
|
Service Code
|
HCPCS 24670
|
| Min. Negotiated Rate |
$213.72 |
| Max. Negotiated Rate |
$537.18 |
| Rate for Payer: AlohaCare Medicaid |
$297.56
|
| Rate for Payer: AlohaCare Medicare |
$298.09
|
| Rate for Payer: Cash Price |
$379.19
|
| Rate for Payer: Cash Price |
$379.19
|
| Rate for Payer: Devoted Health Medicare |
$327.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$297.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$298.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$297.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$213.72
|
| Rate for Payer: Health Management Network Commercial |
$537.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$357.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$357.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$297.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$298.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$297.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$298.09
|
| Rate for Payer: University Health Alliance Commercial |
$378.56
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,014.16
|
|
|
Service Code
|
HCPCS 25535
|
| Min. Negotiated Rate |
$291.98 |
| Max. Negotiated Rate |
$862.04 |
| Rate for Payer: AlohaCare Medicaid |
$495.58
|
| Rate for Payer: AlohaCare Medicare |
$471.28
|
| Rate for Payer: Cash Price |
$608.50
|
| Rate for Payer: Cash Price |
$608.50
|
| Rate for Payer: Devoted Health Medicare |
$518.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$495.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$471.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$495.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.98
|
| Rate for Payer: Health Management Network Commercial |
$862.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$565.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$565.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$495.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$471.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$495.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$471.28
|
| Rate for Payer: University Health Alliance Commercial |
$636.99
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$568.98
|
|
|
Service Code
|
HCPCS 25530
|
| Min. Negotiated Rate |
$162.76 |
| Max. Negotiated Rate |
$483.63 |
| Rate for Payer: AlohaCare Medicaid |
$273.07
|
| Rate for Payer: AlohaCare Medicare |
$270.83
|
| Rate for Payer: Cash Price |
$341.39
|
| Rate for Payer: Cash Price |
$341.39
|
| Rate for Payer: Devoted Health Medicare |
$297.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$273.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$270.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$273.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$162.76
|
| Rate for Payer: Health Management Network Commercial |
$483.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$325.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$325.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$325.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$273.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$270.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$273.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$270.83
|
| Rate for Payer: University Health Alliance Commercial |
$355.00
|
|
|
PR CLOSURE ENTEROSTOMY LG/SMALL INTESTINE
|
Professional
|
Both
|
$1,468.00
|
|
|
Service Code
|
HCPCS 44620
|
| Min. Negotiated Rate |
$652.60 |
| Max. Negotiated Rate |
$1,247.80 |
| Rate for Payer: AlohaCare Medicaid |
$857.42
|
| Rate for Payer: AlohaCare Medicare |
$793.06
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Devoted Health Medicare |
$872.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$793.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$652.60
|
| Rate for Payer: Health Management Network Commercial |
$1,247.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$951.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$951.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$857.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$793.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$857.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$793.06
|
|
|
PR CLOSURE GASTROSTOMY SURG
|
Professional
|
Both
|
$1,209.00
|
|
|
Service Code
|
HCPCS 43870
|
| Min. Negotiated Rate |
$388.96 |
| Max. Negotiated Rate |
$1,027.65 |
| Rate for Payer: AlohaCare Medicaid |
$706.02
|
| Rate for Payer: AlohaCare Medicare |
$664.28
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Devoted Health Medicare |
$730.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$664.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$388.96
|
| Rate for Payer: Health Management Network Commercial |
$1,027.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$797.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$797.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$797.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$706.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$664.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$706.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$664.28
|
|
|
PR CLOSURE INTESTINAL CUTANEOUS FISTULA
|
Professional
|
Both
|
$2,338.00
|
|
|
Service Code
|
HCPCS 44640
|
| Min. Negotiated Rate |
$632.58 |
| Max. Negotiated Rate |
$1,987.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,366.89
|
| Rate for Payer: AlohaCare Medicare |
$1,250.63
|
| Rate for Payer: Cash Price |
$1,402.80
|
| Rate for Payer: Cash Price |
$1,402.80
|
| Rate for Payer: Devoted Health Medicare |
$1,375.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,250.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$632.58
|
| Rate for Payer: Health Management Network Commercial |
$1,987.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,500.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,500.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,500.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,366.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,250.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,366.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,250.63
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL
|
Professional
|
Both
|
$590.87
|
|
|
Service Code
|
HCPCS 40831
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$502.24 |
| Rate for Payer: AlohaCare Medicaid |
$212.21
|
| Rate for Payer: AlohaCare Medicare |
$202.06
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Devoted Health Medicare |
$222.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$212.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$339.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$202.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$212.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$148.46
|
| Rate for Payer: Health Management Network Commercial |
$502.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.06
|
| Rate for Payer: University Health Alliance Commercial |
$287.13
|
|
|
PR CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 23540
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$438.60 |
| Rate for Payer: AlohaCare Medicaid |
$263.27
|
| Rate for Payer: AlohaCare Medicare |
$272.38
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Devoted Health Medicare |
$299.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$263.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$272.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$263.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.74
|
| Rate for Payer: Health Management Network Commercial |
$438.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$326.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$326.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$263.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$272.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$263.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$272.38
|
| Rate for Payer: University Health Alliance Commercial |
$332.19
|
|
|
PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$481.84
|
|
|
Service Code
|
HCPCS 23500
|
| Min. Negotiated Rate |
$154.96 |
| Max. Negotiated Rate |
$409.56 |
| Rate for Payer: AlohaCare Medicaid |
$255.04
|
| Rate for Payer: AlohaCare Medicare |
$260.52
|
| Rate for Payer: Cash Price |
$289.10
|
| Rate for Payer: Cash Price |
$289.10
|
| Rate for Payer: Devoted Health Medicare |
$286.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$255.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$260.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$255.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.96
|
| Rate for Payer: Health Management Network Commercial |
$409.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$312.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$312.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$312.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$260.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$255.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$260.52
|
| Rate for Payer: University Health Alliance Commercial |
$321.55
|
|
|
PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$776.67
|
|
|
Service Code
|
HCPCS 24500
|
| Min. Negotiated Rate |
$200.46 |
| Max. Negotiated Rate |
$660.17 |
| Rate for Payer: AlohaCare Medicaid |
$370.41
|
| Rate for Payer: AlohaCare Medicare |
$368.24
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Devoted Health Medicare |
$405.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$370.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$368.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$370.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.46
|
| Rate for Payer: Health Management Network Commercial |
$660.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$441.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$441.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$370.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$368.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$370.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$368.24
|
| Rate for Payer: University Health Alliance Commercial |
$471.14
|
|
