|
PR OPEN TX CARPAL SCAPHOID NAVICULAR FX W/INT FIXJ
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 25628
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$1,104.15 |
| Rate for Payer: AlohaCare Medicaid |
$754.61
|
| Rate for Payer: AlohaCare Medicare |
$683.98
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Devoted Health Medicare |
$752.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$683.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$477.36
|
| Rate for Payer: Health Management Network Commercial |
$1,104.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$820.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$820.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$820.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$754.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$683.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$754.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$683.98
|
|
|
PR OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION
|
Professional
|
Both
|
$1,293.00
|
|
|
Service Code
|
HCPCS 23515
|
| Min. Negotiated Rate |
$437.06 |
| Max. Negotiated Rate |
$1,099.05 |
| Rate for Payer: AlohaCare Medicaid |
$752.93
|
| Rate for Payer: AlohaCare Medicare |
$692.67
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Devoted Health Medicare |
$761.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$692.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$437.06
|
| Rate for Payer: Health Management Network Commercial |
$1,099.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$831.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$831.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$752.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$692.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$752.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$692.67
|
|
|
PR OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG
|
Professional
|
Both
|
$1,910.00
|
|
|
Service Code
|
HCPCS 21365
|
| Min. Negotiated Rate |
$971.40 |
| Max. Negotiated Rate |
$1,623.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,107.50
|
| Rate for Payer: AlohaCare Medicare |
$971.40
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Devoted Health Medicare |
$1,068.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$971.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,074.32
|
| Rate for Payer: Health Management Network Commercial |
$1,623.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,165.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,165.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,165.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,107.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$971.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,107.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$971.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,555.00
|
|
|
PR OPEN TX DEPRESSED FRONTAL SINUS FRACTURE
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 21343
|
| Min. Negotiated Rate |
$661.70 |
| Max. Negotiated Rate |
$1,652.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,141.05
|
| Rate for Payer: AlohaCare Medicare |
$1,006.08
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Devoted Health Medicare |
$1,106.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,006.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$661.70
|
| Rate for Payer: Health Management Network Commercial |
$1,652.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,207.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,207.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,207.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,141.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,006.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,141.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,006.08
|
|
|
PR OPEN TX DEPRESSED MALAR FRACTURE
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
HCPCS 21360
|
| Min. Negotiated Rate |
$481.35 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: AlohaCare Medicaid |
$552.87
|
| Rate for Payer: AlohaCare Medicare |
$481.35
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Devoted Health Medicare |
$529.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$481.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$551.20
|
| Rate for Payer: Health Management Network Commercial |
$801.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$577.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$577.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$577.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$552.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$481.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$552.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$481.35
|
| Rate for Payer: University Health Alliance Commercial |
$735.00
|
|
|
PR OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 27792
|
| Min. Negotiated Rate |
$598.78 |
| Max. Negotiated Rate |
$982.60 |
| Rate for Payer: AlohaCare Medicaid |
$675.31
|
| Rate for Payer: AlohaCare Medicare |
$622.14
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Devoted Health Medicare |
$684.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$622.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$598.78
|
| Rate for Payer: Health Management Network Commercial |
$982.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$746.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$746.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$746.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$675.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$622.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$675.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$622.14
|
|
|
PR OPEN TX DISTAL PHALANGEAL FRACTURE EACH
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 26765
|
| Min. Negotiated Rate |
$293.80 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: AlohaCare Medicaid |
$540.89
|
| Rate for Payer: AlohaCare Medicare |
$506.32
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Devoted Health Medicare |
$556.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$506.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$293.80
|
| Rate for Payer: Health Management Network Commercial |
$790.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$607.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$607.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$607.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$540.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$506.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$540.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$506.32
|
|
|
PR OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION
|
Professional
|
Both
|
$1,271.00
|
|
|
Service Code
|
HCPCS 27829
|
| Min. Negotiated Rate |
$505.70 |
| Max. Negotiated Rate |
$1,080.35 |
| Rate for Payer: AlohaCare Medicaid |
$745.81
|
| Rate for Payer: AlohaCare Medicare |
$695.59
|
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Devoted Health Medicare |
$765.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$695.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$505.70
|
| Rate for Payer: Health Management Network Commercial |
$1,080.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$834.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$834.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$834.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$745.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$695.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$745.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$695.59
|
|
|
PR OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE
|
Professional
|
Both
|
$1,685.00
|
|
|
Service Code
|
HCPCS 27514
|
| Min. Negotiated Rate |
$873.92 |
| Max. Negotiated Rate |
$1,432.25 |
| Rate for Payer: AlohaCare Medicaid |
$981.69
|
| Rate for Payer: AlohaCare Medicare |
$873.92
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Devoted Health Medicare |
$961.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$873.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$989.30
|
| Rate for Payer: Health Management Network Commercial |
$1,432.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,048.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,048.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,048.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$981.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$873.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$981.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$873.92
|
|
|
PR OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD
|
Professional
|
Both
|
$2,160.00
|
|
|
Service Code
|
HCPCS 27269
|
| Min. Negotiated Rate |
$1,118.09 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,256.80
|
| Rate for Payer: AlohaCare Medicare |
$1,118.09
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Devoted Health Medicare |
$1,229.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,118.09
|
| Rate for Payer: Health Management Network Commercial |
$1,836.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,341.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,341.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,341.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,256.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,118.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,256.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,118.09
|
|
|
PR OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN
|
Professional
|
Both
|
$1,733.00
|
|
|
Service Code
|
HCPCS 27511
|
| Min. Negotiated Rate |
$866.32 |
| Max. Negotiated Rate |
$1,473.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,011.42
|
| Rate for Payer: AlohaCare Medicare |
$898.87
|
| Rate for Payer: Cash Price |
$1,039.80
|
| Rate for Payer: Cash Price |
$1,039.80
|
| Rate for Payer: Devoted Health Medicare |
$988.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$898.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$866.32
|
| Rate for Payer: Health Management Network Commercial |
$1,473.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,078.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,078.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,078.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,011.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$898.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,011.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$898.87
|
|
|
PR OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/XTN
|
Professional
|
Both
|
$2,136.00
|
|
|
Service Code
|
HCPCS 27513
|
| Min. Negotiated Rate |
$1,019.20 |
| Max. Negotiated Rate |
$1,815.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,246.00
|
| Rate for Payer: AlohaCare Medicare |
$1,098.86
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Devoted Health Medicare |
$1,208.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,098.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,019.20
|
| Rate for Payer: Health Management Network Commercial |
$1,815.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,318.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,318.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,318.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,246.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,098.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,246.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,098.86
|
|
|
PR OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES
|
Professional
|
Both
|
$1,240.47
|
|
|
Service Code
|
HCPCS 28505
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,054.40 |
| Rate for Payer: AlohaCare Medicaid |
$520.71
|
| Rate for Payer: AlohaCare Medicare |
$484.21
|
| Rate for Payer: Cash Price |
$744.28
|
| Rate for Payer: Cash Price |
$744.28
|
| Rate for Payer: Devoted Health Medicare |
$532.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$520.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$537.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$484.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$1,054.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$581.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$581.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$581.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$520.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$484.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$520.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$484.21
|
| Rate for Payer: University Health Alliance Commercial |
$676.63
|
|
|
PR OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE
|
Professional
|
Both
|
$1,075.39
|
|
|
Service Code
|
HCPCS 28525
|
| Min. Negotiated Rate |
$297.96 |
| Max. Negotiated Rate |
$914.08 |
| Rate for Payer: AlohaCare Medicaid |
$432.50
|
| Rate for Payer: AlohaCare Medicare |
$400.70
|
| Rate for Payer: Cash Price |
$645.23
|
| Rate for Payer: Cash Price |
$645.23
|
| Rate for Payer: Devoted Health Medicare |
$440.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$432.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$472.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$432.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$297.96
|
| Rate for Payer: Health Management Network Commercial |
$914.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$480.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$480.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$432.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$432.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.70
|
| Rate for Payer: University Health Alliance Commercial |
$553.55
|
|
|
PR OPEN TX HUMERAL EPICONDYLAR FRACTURE
|
Professional
|
Both
|
$1,323.00
|
|
|
Service Code
|
HCPCS 24575
|
| Min. Negotiated Rate |
$601.64 |
| Max. Negotiated Rate |
$1,124.55 |
| Rate for Payer: AlohaCare Medicaid |
$768.51
|
| Rate for Payer: AlohaCare Medicare |
$710.43
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Devoted Health Medicare |
$781.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$710.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$601.64
|
| Rate for Payer: Health Management Network Commercial |
$1,124.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$852.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$852.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$852.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$768.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$710.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$768.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$710.43
|
|
|
PR OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN
|
Professional
|
Both
|
$1,649.00
|
|
|
Service Code
|
HCPCS 24545
|
| Min. Negotiated Rate |
$614.90 |
| Max. Negotiated Rate |
$1,401.65 |
| Rate for Payer: AlohaCare Medicaid |
$959.19
|
| Rate for Payer: AlohaCare Medicare |
$869.86
|
| Rate for Payer: Cash Price |
$989.40
|
| Rate for Payer: Cash Price |
$989.40
|
| Rate for Payer: Devoted Health Medicare |
$956.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$869.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$614.90
|
| Rate for Payer: Health Management Network Commercial |
$1,401.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,043.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,043.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,043.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$959.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$869.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$959.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$869.86
|
|
|
PR OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 24546
|
| Min. Negotiated Rate |
$772.46 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,067.54
|
| Rate for Payer: AlohaCare Medicare |
$961.79
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Devoted Health Medicare |
$1,057.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$961.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$772.46
|
| Rate for Payer: Health Management Network Commercial |
$1,560.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,154.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,154.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,154.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,067.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$961.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,067.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$961.79
|
|
|
PR OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE
|
Professional
|
Both
|
$1,451.00
|
|
|
Service Code
|
HCPCS 27540
|
| Min. Negotiated Rate |
$715.26 |
| Max. Negotiated Rate |
$1,233.35 |
| Rate for Payer: AlohaCare Medicaid |
$843.26
|
| Rate for Payer: AlohaCare Medicare |
$773.16
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Devoted Health Medicare |
$850.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$773.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$715.26
|
| Rate for Payer: Health Management Network Commercial |
$1,233.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$927.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$927.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$927.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$843.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$773.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$843.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$773.16
|
|
|
PR OPEN TX INTERPHALANGEAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 26785
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$857.65 |
| Rate for Payer: AlohaCare Medicaid |
$584.78
|
| Rate for Payer: AlohaCare Medicare |
$543.47
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Devoted Health Medicare |
$597.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$543.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$233.74
|
| Rate for Payer: Health Management Network Commercial |
$857.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$652.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$652.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$652.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$584.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$543.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$584.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.47
|
|
|
PR OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$3,911.60
|
|
|
Service Code
|
HCPCS 21462
|
| Min. Negotiated Rate |
$807.04 |
| Max. Negotiated Rate |
$3,324.86 |
| Rate for Payer: AlohaCare Medicaid |
$1,248.21
|
| Rate for Payer: AlohaCare Medicare |
$1,179.07
|
| Rate for Payer: Cash Price |
$2,346.96
|
| Rate for Payer: Cash Price |
$2,346.96
|
| Rate for Payer: Devoted Health Medicare |
$1,296.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,248.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,800.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,179.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,248.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$807.04
|
| Rate for Payer: Health Management Network Commercial |
$3,324.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,414.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,414.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,414.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,248.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,179.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,248.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,179.07
|
| Rate for Payer: University Health Alliance Commercial |
$1,681.34
|
|
|
PR OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION
|
Professional
|
Both
|
$3,450.46
|
|
|
Service Code
|
HCPCS 21461
|
| Min. Negotiated Rate |
$514.54 |
| Max. Negotiated Rate |
$2,932.89 |
| Rate for Payer: AlohaCare Medicaid |
$1,149.43
|
| Rate for Payer: AlohaCare Medicare |
$1,037.26
|
| Rate for Payer: Cash Price |
$2,070.28
|
| Rate for Payer: Cash Price |
$2,070.28
|
| Rate for Payer: Devoted Health Medicare |
$1,140.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,630.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,037.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,149.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.54
|
| Rate for Payer: Health Management Network Commercial |
$2,932.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,244.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,244.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,244.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,149.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,037.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,149.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,037.26
|
| Rate for Payer: University Health Alliance Commercial |
$1,512.63
|
|
|
PR OPEN TX METACARPAL FRACTURE SINGLE EA BONE
|
Professional
|
Both
|
$1,055.00
|
|
|
Service Code
|
HCPCS 26615
|
| Min. Negotiated Rate |
$421.46 |
| Max. Negotiated Rate |
$896.75 |
| Rate for Payer: AlohaCare Medicaid |
$612.81
|
| Rate for Payer: AlohaCare Medicare |
$566.50
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Devoted Health Medicare |
$623.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$566.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$421.46
|
| Rate for Payer: Health Management Network Commercial |
$896.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$679.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$679.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$679.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$612.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$566.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$612.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$566.50
|
|
|
PR OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 24635
|
| Min. Negotiated Rate |
$655.94 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: AlohaCare Medicaid |
$710.57
|
| Rate for Payer: AlohaCare Medicare |
$655.94
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Devoted Health Medicare |
$721.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$655.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$795.08
|
| Rate for Payer: Health Management Network Commercial |
$1,042.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$787.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$787.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$787.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$655.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$710.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$655.94
|
|
|
PR OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR
|
Professional
|
Both
|
$1,409.00
|
|
|
Service Code
|
HCPCS 21423
|
| Min. Negotiated Rate |
$600.86 |
| Max. Negotiated Rate |
$1,197.65 |
| Rate for Payer: AlohaCare Medicaid |
$822.87
|
| Rate for Payer: AlohaCare Medicare |
$735.74
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Devoted Health Medicare |
$809.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$735.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$600.86
|
| Rate for Payer: Health Management Network Commercial |
$1,197.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$882.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$882.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$882.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$822.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$735.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$822.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$735.74
|
|
|
PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 26735
|
| Min. Negotiated Rate |
$402.74 |
| Max. Negotiated Rate |
$923.95 |
| Rate for Payer: AlohaCare Medicaid |
$632.08
|
| Rate for Payer: AlohaCare Medicare |
$582.63
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Devoted Health Medicare |
$640.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$582.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$402.74
|
| Rate for Payer: Health Management Network Commercial |
$923.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$699.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$699.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$699.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$632.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$582.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$632.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$582.63
|
|
