|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$785.82
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$218.90 |
| Max. Negotiated Rate |
$667.95 |
| Rate for Payer: AlohaCare Medicaid |
$264.70
|
| Rate for Payer: AlohaCare Medicare |
$218.90
|
| Rate for Payer: Cash Price |
$471.49
|
| Rate for Payer: Cash Price |
$471.49
|
| Rate for Payer: Devoted Health Medicare |
$240.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$264.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$434.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$218.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$264.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$274.82
|
| Rate for Payer: Health Management Network Commercial |
$667.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$262.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$262.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$262.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$264.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$218.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$264.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$218.90
|
| Rate for Payer: University Health Alliance Commercial |
$301.31
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$237.14
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$66.77 |
| Max. Negotiated Rate |
$201.57 |
| Rate for Payer: AlohaCare Medicaid |
$82.26
|
| Rate for Payer: AlohaCare Medicare |
$66.77
|
| Rate for Payer: Cash Price |
$142.28
|
| Rate for Payer: Cash Price |
$142.28
|
| Rate for Payer: Devoted Health Medicare |
$73.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.48
|
| Rate for Payer: Health Management Network Commercial |
$201.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.77
|
| Rate for Payer: University Health Alliance Commercial |
$94.86
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$637.37
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$166.92 |
| Max. Negotiated Rate |
$541.76 |
| Rate for Payer: AlohaCare Medicaid |
$206.40
|
| Rate for Payer: AlohaCare Medicare |
$174.70
|
| Rate for Payer: Cash Price |
$382.42
|
| Rate for Payer: Cash Price |
$382.42
|
| Rate for Payer: Devoted Health Medicare |
$192.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$206.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$317.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$206.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.92
|
| Rate for Payer: Health Management Network Commercial |
$541.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$209.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$206.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$206.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.70
|
| Rate for Payer: University Health Alliance Commercial |
$235.23
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$736.56
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$215.82 |
| Max. Negotiated Rate |
$626.08 |
| Rate for Payer: AlohaCare Medicaid |
$255.92
|
| Rate for Payer: AlohaCare Medicare |
$215.82
|
| Rate for Payer: Cash Price |
$441.94
|
| Rate for Payer: Cash Price |
$441.94
|
| Rate for Payer: Devoted Health Medicare |
$237.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$255.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$396.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$255.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$237.12
|
| Rate for Payer: Health Management Network Commercial |
$626.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$258.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$255.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.82
|
| Rate for Payer: University Health Alliance Commercial |
$300.06
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$223.04
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$58.71 |
| Max. Negotiated Rate |
$189.58 |
| Rate for Payer: AlohaCare Medicaid |
$71.40
|
| Rate for Payer: AlohaCare Medicare |
$58.71
|
| Rate for Payer: Cash Price |
$133.82
|
| Rate for Payer: Cash Price |
$133.82
|
| Rate for Payer: Devoted Health Medicare |
$64.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$112.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$73.32
|
| Rate for Payer: Health Management Network Commercial |
$189.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.71
|
| Rate for Payer: University Health Alliance Commercial |
$83.15
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$345.84
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$293.96 |
| Rate for Payer: AlohaCare Medicaid |
$135.86
|
| Rate for Payer: AlohaCare Medicare |
$111.80
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Devoted Health Medicare |
$122.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$135.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$212.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$135.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$137.28
|
| Rate for Payer: Health Management Network Commercial |
$293.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$135.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.80
|
| Rate for Payer: University Health Alliance Commercial |
$157.35
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,182.84
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$393.38 |
| Max. Negotiated Rate |
$1,005.41 |
| Rate for Payer: AlohaCare Medicaid |
$479.63
|
| Rate for Payer: AlohaCare Medicare |
$410.45
|
| Rate for Payer: Cash Price |
$709.70
|
| Rate for Payer: Cash Price |
$709.70
|
| Rate for Payer: Devoted Health Medicare |
$451.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$479.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$730.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$410.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$479.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.38
|
| Rate for Payer: Health Management Network Commercial |
$1,005.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$492.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$492.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$492.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$479.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$410.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$479.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$410.45
|
| Rate for Payer: University Health Alliance Commercial |
$618.15
|
|
|
PR REPAIR ENTROPION EXTENSIVE
|
Professional
|
Both
|
$1,234.34
|
|
|
Service Code
|
HCPCS 67924
|
| Min. Negotiated Rate |
$410.64 |
| Max. Negotiated Rate |
$1,049.19 |
| Rate for Payer: AlohaCare Medicaid |
$479.83
|
| Rate for Payer: AlohaCare Medicare |
$410.64
|
| Rate for Payer: Cash Price |
$740.60
|
| Rate for Payer: Cash Price |
$740.60
|
| Rate for Payer: Devoted Health Medicare |
$451.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$479.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$723.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$410.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$479.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$495.04
|
| Rate for Payer: Health Management Network Commercial |
$1,049.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$492.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$492.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$492.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$479.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$410.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$479.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$410.64
|
| Rate for Payer: University Health Alliance Commercial |
$617.77
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,064.77
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$905.05 |
| Rate for Payer: AlohaCare Medicaid |
$625.15
|
| Rate for Payer: AlohaCare Medicare |
$608.06
|
| Rate for Payer: Cash Price |
$638.86
|
| Rate for Payer: Cash Price |
$638.86
|
| Rate for Payer: Devoted Health Medicare |
$668.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$608.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$228.80
|
| Rate for Payer: Health Management Network Commercial |
$905.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$729.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$729.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$625.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$608.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$625.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$608.06
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,354.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$380.90 |
| Max. Negotiated Rate |
$1,150.90 |
| Rate for Payer: AlohaCare Medicaid |
$803.37
|
| Rate for Payer: AlohaCare Medicare |
$761.67
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Devoted Health Medicare |
$837.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$761.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.90
|
| Rate for Payer: Health Management Network Commercial |
$1,150.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$914.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$914.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$914.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$803.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$761.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$803.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$761.67
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH
|
Professional
|
Both
|
$1,186.13
|
|
|
Service Code
|
HCPCS 26418
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,008.21 |
| Rate for Payer: AlohaCare Medicaid |
$689.23
|
| Rate for Payer: AlohaCare Medicare |
$677.79
|
| Rate for Payer: Cash Price |
$711.68
|
| Rate for Payer: Cash Price |
$711.68
|
| Rate for Payer: Devoted Health Medicare |
$745.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$677.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$1,008.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$813.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$813.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$813.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$689.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$677.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$689.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$677.79
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,125.02
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$642.49 |
| Max. Negotiated Rate |
$956.27 |
| Rate for Payer: AlohaCare Medicaid |
$658.64
|
| Rate for Payer: AlohaCare Medicare |
$642.49
|
| Rate for Payer: Cash Price |
$675.01
|
| Rate for Payer: Cash Price |
$675.01
|
| Rate for Payer: Devoted Health Medicare |
$706.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$642.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$670.28
|
| Rate for Payer: Health Management Network Commercial |
$956.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$770.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$770.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$770.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$658.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$642.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$658.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$642.49
|
|
|
PR REPAIR FISTULA OROMAXILLARY
|
Professional
|
Both
|
$1,163.00
|
|
|
Service Code
|
HCPCS 30580
|
| Min. Negotiated Rate |
$370.50 |
| Max. Negotiated Rate |
$988.55 |
| Rate for Payer: AlohaCare Medicaid |
$480.93
|
| Rate for Payer: AlohaCare Medicare |
$430.64
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Devoted Health Medicare |
$473.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$480.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$742.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$430.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$480.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$370.50
|
| Rate for Payer: Health Management Network Commercial |
$988.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$516.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$516.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$516.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$480.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$430.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$480.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$430.64
|
| Rate for Payer: University Health Alliance Commercial |
$628.69
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$294.58 |
| Max. Negotiated Rate |
$572.05 |
| Rate for Payer: AlohaCare Medicaid |
$390.22
|
| Rate for Payer: AlohaCare Medicare |
$368.97
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Devoted Health Medicare |
$405.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$368.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$294.58
|
| Rate for Payer: Health Management Network Commercial |
$572.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$442.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$442.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$442.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$390.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$368.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$390.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$368.97
|
|
|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$333.20 |
| Rate for Payer: AlohaCare Medicaid |
$228.52
|
| Rate for Payer: AlohaCare Medicare |
$212.80
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Devoted Health Medicare |
$234.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$212.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.50
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$255.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$255.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$228.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$212.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$228.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$212.80
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM
|
Professional
|
Both
|
$1,022.09
|
|
|
Service Code
|
HCPCS 12055
|
| Min. Negotiated Rate |
$298.09 |
| Max. Negotiated Rate |
$868.78 |
| Rate for Payer: AlohaCare Medicaid |
$307.96
|
| Rate for Payer: AlohaCare Medicare |
$298.09
|
| Rate for Payer: Cash Price |
$613.25
|
| Rate for Payer: Cash Price |
$613.25
|
| Rate for Payer: Devoted Health Medicare |
$327.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$307.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$470.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$298.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$307.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$301.60
|
| Rate for Payer: Health Management Network Commercial |
$868.78
|
| 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 |
$307.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$298.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$307.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$298.09
|
| Rate for Payer: University Health Alliance Commercial |
$347.86
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM
|
Professional
|
Both
|
$1,168.76
|
|
|
Service Code
|
HCPCS 12056
|
| Min. Negotiated Rate |
$301.86 |
| Max. Negotiated Rate |
$993.45 |
| Rate for Payer: AlohaCare Medicaid |
$395.14
|
| Rate for Payer: AlohaCare Medicare |
$354.93
|
| Rate for Payer: Cash Price |
$701.26
|
| Rate for Payer: Cash Price |
$701.26
|
| Rate for Payer: Devoted Health Medicare |
$390.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$395.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$558.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$395.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$301.86
|
| Rate for Payer: Health Management Network Commercial |
$993.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$425.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$425.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$425.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.93
|
| Rate for Payer: University Health Alliance Commercial |
$452.68
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$535.27
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$144.82 |
| Max. Negotiated Rate |
$454.98 |
| Rate for Payer: AlohaCare Medicaid |
$176.67
|
| Rate for Payer: AlohaCare Medicare |
$153.96
|
| Rate for Payer: Cash Price |
$321.16
|
| Rate for Payer: Cash Price |
$321.16
|
| Rate for Payer: Devoted Health Medicare |
$169.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$176.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$269.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$176.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.82
|
| Rate for Payer: Health Management Network Commercial |
$454.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$184.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.96
|
| Rate for Payer: University Health Alliance Commercial |
$191.81
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$587.21
|
|
|
Service Code
|
HCPCS 12052
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$499.13 |
| Rate for Payer: AlohaCare Medicaid |
$207.25
|
| Rate for Payer: AlohaCare Medicare |
$177.19
|
| Rate for Payer: Cash Price |
$352.33
|
| Rate for Payer: Cash Price |
$352.33
|
| Rate for Payer: Devoted Health Medicare |
$194.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$207.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$316.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$207.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$170.56
|
| Rate for Payer: Health Management Network Commercial |
$499.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$212.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$212.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.19
|
| Rate for Payer: University Health Alliance Commercial |
$225.61
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM
|
Professional
|
Both
|
$1,208.25
|
|
|
Service Code
|
HCPCS 12057
|
| Min. Negotiated Rate |
$336.96 |
| Max. Negotiated Rate |
$1,027.01 |
| Rate for Payer: AlohaCare Medicaid |
$429.09
|
| Rate for Payer: AlohaCare Medicare |
$387.75
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Devoted Health Medicare |
$426.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$429.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$637.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$387.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$429.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$336.96
|
| Rate for Payer: Health Management Network Commercial |
$1,027.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$465.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$465.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$465.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$429.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$387.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$429.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$387.75
|
| Rate for Payer: University Health Alliance Commercial |
$491.55
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$680.96
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$191.26 |
| Max. Negotiated Rate |
$578.82 |
| Rate for Payer: AlohaCare Medicaid |
$222.76
|
| Rate for Payer: AlohaCare Medicare |
$191.26
|
| Rate for Payer: Cash Price |
$408.58
|
| Rate for Payer: Cash Price |
$408.58
|
| Rate for Payer: Devoted Health Medicare |
$210.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$222.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$339.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$222.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$193.44
|
| Rate for Payer: Health Management Network Commercial |
$578.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$229.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$229.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$222.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$222.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.26
|
| Rate for Payer: University Health Alliance Commercial |
$242.55
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$734.30
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$198.95 |
| Max. Negotiated Rate |
$624.15 |
| Rate for Payer: AlohaCare Medicaid |
$224.51
|
| Rate for Payer: AlohaCare Medicare |
$198.95
|
| Rate for Payer: Cash Price |
$440.58
|
| Rate for Payer: Cash Price |
$440.58
|
| Rate for Payer: Devoted Health Medicare |
$218.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$224.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$342.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$224.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$237.64
|
| Rate for Payer: Health Management Network Commercial |
$624.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$224.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$224.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.95
|
| Rate for Payer: University Health Alliance Commercial |
$253.49
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$850.38
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$174.46 |
| Max. Negotiated Rate |
$722.82 |
| Rate for Payer: AlohaCare Medicaid |
$282.29
|
| Rate for Payer: AlohaCare Medicare |
$275.54
|
| Rate for Payer: Cash Price |
$510.23
|
| Rate for Payer: Cash Price |
$510.23
|
| Rate for Payer: Devoted Health Medicare |
$303.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$282.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$419.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$282.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.46
|
| Rate for Payer: Health Management Network Commercial |
$722.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$330.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$330.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$282.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.54
|
| Rate for Payer: University Health Alliance Commercial |
$319.52
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$498.47
|
|
|
Service Code
|
HCPCS 12041
|
| Min. Negotiated Rate |
$132.93 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: AlohaCare Medicaid |
$150.87
|
| Rate for Payer: AlohaCare Medicare |
$132.93
|
| Rate for Payer: Cash Price |
$299.08
|
| Rate for Payer: Cash Price |
$299.08
|
| Rate for Payer: Devoted Health Medicare |
$146.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$150.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$229.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$150.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.72
|
| Rate for Payer: Health Management Network Commercial |
$423.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$150.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.93
|
| Rate for Payer: University Health Alliance Commercial |
$164.58
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$575.21
|
|
|
Service Code
|
HCPCS 12042
|
| Min. Negotiated Rate |
$159.64 |
| Max. Negotiated Rate |
$488.93 |
| Rate for Payer: AlohaCare Medicaid |
$203.83
|
| Rate for Payer: AlohaCare Medicare |
$173.37
|
| Rate for Payer: Cash Price |
$345.13
|
| Rate for Payer: Cash Price |
$345.13
|
| Rate for Payer: Devoted Health Medicare |
$190.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$203.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$311.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$203.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$159.64
|
| Rate for Payer: Health Management Network Commercial |
$488.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$208.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$208.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$203.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.37
|
| Rate for Payer: University Health Alliance Commercial |
$221.92
|
|
