|
29105-Long Arm
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
8080071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$266.50
|
| Rate for Payer: AlohaCare Medicare |
$266.50
|
| Rate for Payer: Cash Price |
$346.45
|
| Rate for Payer: Cash Price |
$346.45
|
| Rate for Payer: Devoted Health Medicare |
$293.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$506.35
|
| Rate for Payer: Health Management Network Commercial |
$453.05
|
| Rate for Payer: Humana Medicare |
$266.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$479.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.50
|
| Rate for Payer: MDX Hawaii PPO |
$517.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.50
|
| Rate for Payer: University Health Alliance Commercial |
$388.50
|
|
|
29105-Long Arm
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
8080071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$453.05 |
| Max. Negotiated Rate |
$517.01 |
| Rate for Payer: Cash Price |
$346.45
|
| Rate for Payer: Health Management Network Commercial |
$453.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$479.70
|
| Rate for Payer: MDX Hawaii PPO |
$517.01
|
|
|
29125 Application of short arm splint (forearm to hand) static
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
8038440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$42.42
|
| Rate for Payer: AlohaCare Medicare |
$42.79
|
| Rate for Payer: Cash Price |
$168.35
|
| Rate for Payer: Cash Price |
$168.35
|
| Rate for Payer: Cash Price |
$168.35
|
| Rate for Payer: Devoted Health Medicare |
$47.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$63.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$220.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: University Health Alliance Commercial |
$53.06
|
|
|
29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
8023337
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Health Management Network Commercial |
$382.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.00
|
| Rate for Payer: MDX Hawaii PPO |
$436.50
|
|
|
29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
8023337
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$225.00
|
| Rate for Payer: AlohaCare Medicare |
$225.00
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Devoted Health Medicare |
$247.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$225.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$427.50
|
| Rate for Payer: Health Management Network Commercial |
$382.50
|
| Rate for Payer: Humana Medicare |
$225.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$225.00
|
| Rate for Payer: MDX Hawaii PPO |
$436.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$225.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$225.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$225.00
|
| Rate for Payer: University Health Alliance Commercial |
$328.00
|
|
|
29125 Apply Forearm Splint Bilat
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
HCPCS 29125 50
|
| Hospital Charge Code |
8222655
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$423.89 |
| Rate for Payer: AlohaCare Medicaid |
$218.50
|
| Rate for Payer: AlohaCare Medicare |
$218.50
|
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Devoted Health Medicare |
$240.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$218.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$415.15
|
| Rate for Payer: Health Management Network Commercial |
$371.45
|
| Rate for Payer: Humana Medicare |
$218.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$222.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.50
|
| Rate for Payer: MDX Hawaii PPO |
$423.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$218.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$218.50
|
| Rate for Payer: University Health Alliance Commercial |
$244.72
|
|
|
29125 Apply Forearm Splint Bilat
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
HCPCS 29125 50
|
| Hospital Charge Code |
8222655
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$371.45 |
| Max. Negotiated Rate |
$423.89 |
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Health Management Network Commercial |
$371.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.30
|
| Rate for Payer: MDX Hawaii PPO |
$423.89
|
|
|
29125 Apply Forearm Splint LT
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
HCPCS 29125 LT
|
| Hospital Charge Code |
8222656
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$371.45 |
| Max. Negotiated Rate |
$423.89 |
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Health Management Network Commercial |
$371.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.30
|
| Rate for Payer: MDX Hawaii PPO |
$423.89
|
|
|
29125 Apply Forearm Splint LT
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
HCPCS 29125 LT
|
| Hospital Charge Code |
8222656
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$423.89 |
| Rate for Payer: AlohaCare Medicaid |
$218.50
|
| Rate for Payer: AlohaCare Medicare |
$218.50
|
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Devoted Health Medicare |
$240.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$218.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$415.15
|
| Rate for Payer: Health Management Network Commercial |
$371.45
|
| Rate for Payer: Humana Medicare |
$218.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$222.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.50
|
| Rate for Payer: MDX Hawaii PPO |
$423.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$218.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$218.50
|
| Rate for Payer: University Health Alliance Commercial |
$244.72
|
|
|
29125 Apply Forearm Splint RT
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
HCPCS 29125 RT
|
| Hospital Charge Code |
8222657
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$371.45 |
| Max. Negotiated Rate |
$423.89 |
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Health Management Network Commercial |
$371.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.30
|
| Rate for Payer: MDX Hawaii PPO |
$423.89
|
|
|
29125 Apply Forearm Splint RT
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
HCPCS 29125 RT
|
| Hospital Charge Code |
8222657
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$423.89 |
| Rate for Payer: AlohaCare Medicaid |
$218.50
|
| Rate for Payer: AlohaCare Medicare |
$218.50
|
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Devoted Health Medicare |
$240.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$218.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$415.15
|
| Rate for Payer: Health Management Network Commercial |
$371.45
|
| Rate for Payer: Humana Medicare |
$218.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$222.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.50
|
| Rate for Payer: MDX Hawaii PPO |
$423.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$218.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$218.50
|
| Rate for Payer: University Health Alliance Commercial |
$244.72
|
|
|
29125-Short Arm
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
8080072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$194.50
|
| Rate for Payer: AlohaCare Medicare |
$194.50
|
| Rate for Payer: Cash Price |
$252.85
|
| Rate for Payer: Cash Price |
$252.85
|
| Rate for Payer: Devoted Health Medicare |
$213.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$194.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$369.55
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Humana Medicare |
$194.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.50
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$194.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$194.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$194.50
|
| Rate for Payer: University Health Alliance Commercial |
$283.54
|
|
|
29125-Short Arm
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
8080072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$330.65 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: Cash Price |
$252.85
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
|
|
29126 Appl Forearm Splint Dynamc Bil
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 29126 50
|
| Hospital Charge Code |
8222627
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: AlohaCare Medicaid |
$380.00
|
| Rate for Payer: AlohaCare Medicare |
$380.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Devoted Health Medicare |
$418.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$380.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$722.00
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Humana Medicare |
$380.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$684.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$387.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$380.00
|
| Rate for Payer: MDX Hawaii PPO |
$737.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$380.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$380.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$380.00
|
| Rate for Payer: University Health Alliance Commercial |
$425.60
|
|
|
29126 Appl Forearm Splint Dynamc Bil
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 29126 50
|
| Hospital Charge Code |
8222627
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$684.00
|
| Rate for Payer: MDX Hawaii PPO |
$737.20
|
|
|
29126 Appl Forearm Splint Dynamic LT
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 29126 LT
|
| Hospital Charge Code |
8222628
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: AlohaCare Medicaid |
$380.00
|
| Rate for Payer: AlohaCare Medicare |
$380.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Devoted Health Medicare |
$418.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$380.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$722.00
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Humana Medicare |
$380.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$684.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$387.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$380.00
|
| Rate for Payer: MDX Hawaii PPO |
$737.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$380.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$380.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$380.00
|
| Rate for Payer: University Health Alliance Commercial |
$425.60
|
|
|
29126 Appl Forearm Splint Dynamic LT
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 29126 LT
|
| Hospital Charge Code |
8222628
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$684.00
|
| Rate for Payer: MDX Hawaii PPO |
$737.20
|
|
|
29126 Appl Forearm Splint Dynamic RT
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 29126 RT
|
| Hospital Charge Code |
8222629
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: AlohaCare Medicaid |
$380.00
|
| Rate for Payer: AlohaCare Medicare |
$380.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Devoted Health Medicare |
$418.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$380.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$722.00
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Humana Medicare |
$380.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$684.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$387.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$380.00
|
| Rate for Payer: MDX Hawaii PPO |
$737.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$380.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$380.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$380.00
|
| Rate for Payer: University Health Alliance Commercial |
$425.60
|
|
|
29126 Appl Forearm Splint Dynamic RT
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 29126 RT
|
| Hospital Charge Code |
8222629
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$684.00
|
| Rate for Payer: MDX Hawaii PPO |
$737.20
|
|
|
29126 Application of short arm splint (forearm to hand) dynamic
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
8038441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$51.66
|
| Rate for Payer: AlohaCare Medicare |
$46.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Devoted Health Medicare |
$51.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$78.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$66.31
|
|
|
29126 Application of short arm splint (forearm to hand) dynamic
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
8038441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: AlohaCare Medicaid |
$51.66
|
| Rate for Payer: AlohaCare Medicare |
$46.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Devoted Health Medicare |
$51.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$78.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.95
|
| Rate for Payer: University Health Alliance Commercial |
$66.31
|
|
|
29130 Application Finger Splint LT
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
HCPCS 29130 LT
|
| Hospital Charge Code |
8222651
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$544.85 |
| Max. Negotiated Rate |
$621.77 |
| Rate for Payer: Cash Price |
$416.65
|
| Rate for Payer: Health Management Network Commercial |
$544.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$576.90
|
| Rate for Payer: MDX Hawaii PPO |
$621.77
|
|
|
29130 Application Finger Splint LT
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
HCPCS 29130 LT
|
| Hospital Charge Code |
8222651
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$621.77 |
| Rate for Payer: AlohaCare Medicaid |
$320.50
|
| Rate for Payer: AlohaCare Medicare |
$320.50
|
| Rate for Payer: Cash Price |
$416.65
|
| Rate for Payer: Cash Price |
$416.65
|
| Rate for Payer: Devoted Health Medicare |
$352.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$320.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$608.95
|
| Rate for Payer: Health Management Network Commercial |
$544.85
|
| Rate for Payer: Humana Medicare |
$320.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$576.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$326.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$320.50
|
| Rate for Payer: MDX Hawaii PPO |
$621.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$320.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$320.50
|
| Rate for Payer: University Health Alliance Commercial |
$358.96
|
|
|
29130 Application Finger Splint RT
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
HCPCS 29130 RT
|
| Hospital Charge Code |
8222652
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$544.85 |
| Max. Negotiated Rate |
$621.77 |
| Rate for Payer: Cash Price |
$416.65
|
| Rate for Payer: Health Management Network Commercial |
$544.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$576.90
|
| Rate for Payer: MDX Hawaii PPO |
$621.77
|
|
|
29130 Application Finger Splint RT
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
HCPCS 29130 RT
|
| Hospital Charge Code |
8222652
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$621.77 |
| Rate for Payer: AlohaCare Medicaid |
$320.50
|
| Rate for Payer: AlohaCare Medicare |
$320.50
|
| Rate for Payer: Cash Price |
$416.65
|
| Rate for Payer: Cash Price |
$416.65
|
| Rate for Payer: Devoted Health Medicare |
$352.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$320.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$608.95
|
| Rate for Payer: Health Management Network Commercial |
$544.85
|
| Rate for Payer: Humana Medicare |
$320.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$576.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$326.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$320.50
|
| Rate for Payer: MDX Hawaii PPO |
$621.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$320.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$320.50
|
| Rate for Payer: University Health Alliance Commercial |
$358.96
|
|
