|
PR KO ELAS W/ CONDYLE PADS OTF
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS L1821
|
| Min. Negotiated Rate |
$194.23 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: AlohaCare Medicare |
$194.23
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Devoted Health Medicare |
$213.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$194.23
|
| Rate for Payer: Health Management Network Commercial |
$289.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$233.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$233.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$233.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$194.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$194.23
|
|
|
PR KO IMMOB CANVAS LONG PRE OTS
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS L1830
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$218.45 |
| Rate for Payer: AlohaCare Medicaid |
$87.51
|
| Rate for Payer: AlohaCare Medicare |
$149.93
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Devoted Health Medicare |
$164.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.00
|
| Rate for Payer: Health Management Network Commercial |
$218.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.93
|
|
|
PR LABYRINTHOTOMY TRANSCANAL
|
Professional
|
Both
|
$418.39
|
|
|
Service Code
|
HCPCS 69801
|
| Min. Negotiated Rate |
$107.68 |
| Max. Negotiated Rate |
$355.63 |
| Rate for Payer: AlohaCare Medicaid |
$126.57
|
| Rate for Payer: AlohaCare Medicare |
$107.68
|
| Rate for Payer: Cash Price |
$251.03
|
| Rate for Payer: Cash Price |
$251.03
|
| Rate for Payer: Devoted Health Medicare |
$118.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$126.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$126.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$355.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.68
|
| Rate for Payer: University Health Alliance Commercial |
$157.39
|
|
|
PR LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$1,033.00
|
|
|
Service Code
|
HCPCS 44970
|
| Min. Negotiated Rate |
$485.68 |
| Max. Negotiated Rate |
$878.05 |
| Rate for Payer: AlohaCare Medicaid |
$602.67
|
| Rate for Payer: AlohaCare Medicare |
$570.88
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Devoted Health Medicare |
$627.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$570.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$485.68
|
| Rate for Payer: Health Management Network Commercial |
$878.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$685.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$685.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$685.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$602.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$570.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$602.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$570.88
|
|
|
PR LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 60650
|
| Min. Negotiated Rate |
$1,071.46 |
| Max. Negotiated Rate |
$1,712.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,174.36
|
| Rate for Payer: AlohaCare Medicare |
$1,076.92
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Devoted Health Medicare |
$1,184.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,076.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,071.46
|
| Rate for Payer: Health Management Network Commercial |
$1,712.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,292.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,292.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,292.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,174.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,076.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,174.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,076.92
|
|
|
PR LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$2,581.00
|
|
|
Service Code
|
HCPCS 44204
|
| Min. Negotiated Rate |
$1,359.80 |
| Max. Negotiated Rate |
$2,193.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,508.54
|
| Rate for Payer: AlohaCare Medicare |
$1,381.76
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Devoted Health Medicare |
$1,519.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,381.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,359.80
|
| Rate for Payer: Health Management Network Commercial |
$2,193.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,658.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,658.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,658.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,508.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,381.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,508.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,381.76
|
|
|
PR LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX
|
Professional
|
Both
|
$1,671.00
|
|
|
Service Code
|
HCPCS 57425
|
| Min. Negotiated Rate |
$850.69 |
| Max. Negotiated Rate |
$1,420.35 |
| Rate for Payer: AlohaCare Medicaid |
$982.39
|
| Rate for Payer: AlohaCare Medicare |
$850.69
|
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Devoted Health Medicare |
$935.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$850.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$924.30
|
| Rate for Payer: Health Management Network Commercial |
$1,420.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,020.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,020.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,020.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$982.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$850.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$982.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$850.69
|
|
|
PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 44180
|
| Min. Negotiated Rate |
$806.26 |
| Max. Negotiated Rate |
$1,322.60 |
| Rate for Payer: AlohaCare Medicaid |
$907.45
|
| Rate for Payer: AlohaCare Medicare |
$844.07
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Devoted Health Medicare |
$928.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$844.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$806.26
|
| Rate for Payer: Health Management Network Commercial |
$1,322.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,012.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,012.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,012.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$907.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$844.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$907.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$844.07
|
|
|
PR LAPAROSCOPY FULGURATION OVIDUCTS
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 58670
|
| Min. Negotiated Rate |
$333.26 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: AlohaCare Medicaid |
$381.20
|
| Rate for Payer: AlohaCare Medicare |
$333.26
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Devoted Health Medicare |
$366.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$333.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.78
|
| Rate for Payer: Health Management Network Commercial |
$549.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$399.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$399.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$399.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$381.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$333.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$381.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$333.26
|
|
|
PR LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 50546
|
| Min. Negotiated Rate |
$1,074.30 |
| Max. Negotiated Rate |
$1,753.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,204.21
|
| Rate for Payer: AlohaCare Medicare |
$1,074.30
|
| Rate for Payer: Cash Price |
$1,237.80
|
| Rate for Payer: Cash Price |
$1,237.80
|
| Rate for Payer: Devoted Health Medicare |
$1,181.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,074.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,079.26
|
| Rate for Payer: Health Management Network Commercial |
$1,753.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,289.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,289.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,289.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,204.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,074.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,204.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,074.30
|
|
|
PR LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 50548
|
| Min. Negotiated Rate |
$1,181.08 |
| Max. Negotiated Rate |
$1,943.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,335.57
|
| Rate for Payer: AlohaCare Medicare |
$1,181.08
|
| Rate for Payer: Cash Price |
$1,372.20
|
| Rate for Payer: Cash Price |
$1,372.20
|
| Rate for Payer: Devoted Health Medicare |
$1,299.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,181.08
|
| Rate for Payer: Health Management Network Commercial |
$1,943.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,417.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,417.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,417.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,335.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,181.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,335.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,181.08
|
|
|
PR LAPAROSCOPY RADICAL NEPHRECTOMY
|
Professional
|
Both
|
$2,278.00
|
|
|
Service Code
|
HCPCS 50545
|
| Min. Negotiated Rate |
$1,177.88 |
| Max. Negotiated Rate |
$1,936.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,329.81
|
| Rate for Payer: AlohaCare Medicare |
$1,177.88
|
| Rate for Payer: Cash Price |
$1,366.80
|
| Rate for Payer: Cash Price |
$1,366.80
|
| Rate for Payer: Devoted Health Medicare |
$1,295.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,177.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.60
|
| Rate for Payer: Health Management Network Commercial |
$1,936.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,413.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,413.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,413.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,329.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,177.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,329.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,177.88
|
|
|
PR LAPAROSCOPY SMALL INTESTINE RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 44203
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$334.05 |
| Rate for Payer: AlohaCare Medicaid |
$229.75
|
| Rate for Payer: AlohaCare Medicare |
$205.95
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Devoted Health Medicare |
$226.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$205.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.08
|
| Rate for Payer: Health Management Network Commercial |
$334.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$247.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$205.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$229.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$205.95
|
|
|
PR LAPAROSCOPY SURG ABLATION RENAL CYSTS
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 50541
|
| Min. Negotiated Rate |
$818.17 |
| Max. Negotiated Rate |
$1,338.75 |
| Rate for Payer: AlohaCare Medicaid |
$918.85
|
| Rate for Payer: AlohaCare Medicare |
$818.17
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Devoted Health Medicare |
$899.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$818.17
|
| Rate for Payer: Health Management Network Commercial |
$1,338.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$981.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$981.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$981.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$918.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$818.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$918.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$818.17
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTECTOMY
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 47562
|
| Min. Negotiated Rate |
$622.04 |
| Max. Negotiated Rate |
$959.65 |
| Rate for Payer: AlohaCare Medicaid |
$658.28
|
| Rate for Payer: AlohaCare Medicare |
$622.04
|
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Devoted Health Medicare |
$684.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$622.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$686.66
|
| Rate for Payer: Health Management Network Commercial |
$959.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$746.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$746.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$746.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$658.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$622.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$658.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$622.04
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTOENETEROSTOMY
|
Professional
|
Both
|
$1,317.00
|
|
|
Service Code
|
HCPCS 47570
|
| Min. Negotiated Rate |
$720.01 |
| Max. Negotiated Rate |
$1,119.45 |
| Rate for Payer: AlohaCare Medicaid |
$768.32
|
| Rate for Payer: AlohaCare Medicare |
$720.01
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Devoted Health Medicare |
$792.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$720.01
|
| Rate for Payer: Health Management Network Commercial |
$1,119.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$864.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$864.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$864.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$768.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$720.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$768.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$720.01
|
|
|
PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Professional
|
Both
|
$2,065.00
|
|
|
Service Code
|
HCPCS 44188
|
| Min. Negotiated Rate |
$1,032.46 |
| Max. Negotiated Rate |
$1,755.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,209.63
|
| Rate for Payer: AlohaCare Medicare |
$1,130.96
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Devoted Health Medicare |
$1,244.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,130.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,032.46
|
| Rate for Payer: Health Management Network Commercial |
$1,755.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,357.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,357.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,357.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,209.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,130.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,209.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,130.96
|
|
|
PR LAPAROSCOPY SURGICAL JEJUNOSTOMY
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 44186
|
| Min. Negotiated Rate |
$457.60 |
| Max. Negotiated Rate |
$942.65 |
| Rate for Payer: AlohaCare Medicaid |
$648.04
|
| Rate for Payer: AlohaCare Medicare |
$615.97
|
| Rate for Payer: Cash Price |
$665.40
|
| Rate for Payer: Cash Price |
$665.40
|
| Rate for Payer: Devoted Health Medicare |
$677.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$615.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$457.60
|
| Rate for Payer: Health Management Network Commercial |
$942.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$739.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$739.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$739.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$648.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$615.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$648.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$615.97
|
|
|
PR LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$1,868.00
|
|
|
Service Code
|
HCPCS 44187
|
| Min. Negotiated Rate |
$1,024.11 |
| Max. Negotiated Rate |
$1,587.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,093.84
|
| Rate for Payer: AlohaCare Medicare |
$1,024.11
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Devoted Health Medicare |
$1,126.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,024.11
|
| Rate for Payer: Health Management Network Commercial |
$1,587.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,228.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,228.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,228.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,093.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,024.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,093.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,024.11
|
|
|
PR LAPAROSCOPY SURG PARTIAL NEPHRECTOMY
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 50543
|
| Min. Negotiated Rate |
$1,325.10 |
| Max. Negotiated Rate |
$2,170.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,491.10
|
| Rate for Payer: AlohaCare Medicare |
$1,325.10
|
| Rate for Payer: Cash Price |
$1,532.40
|
| Rate for Payer: Cash Price |
$1,532.40
|
| Rate for Payer: Devoted Health Medicare |
$1,457.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,325.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,349.40
|
| Rate for Payer: Health Management Network Commercial |
$2,170.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,590.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,590.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,590.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,491.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,325.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,491.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,325.10
|
|
|
PR LAPAROSCOPY SURG PYELOPLASTY
|
Professional
|
Both
|
$2,117.00
|
|
|
Service Code
|
HCPCS 50544
|
| Min. Negotiated Rate |
$1,095.11 |
| Max. Negotiated Rate |
$1,799.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,236.19
|
| Rate for Payer: AlohaCare Medicare |
$1,095.11
|
| Rate for Payer: Cash Price |
$1,270.20
|
| Rate for Payer: Cash Price |
$1,270.20
|
| Rate for Payer: Devoted Health Medicare |
$1,204.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,095.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,250.86
|
| Rate for Payer: Health Management Network Commercial |
$1,799.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,314.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,314.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,314.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,236.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,095.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,236.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,095.11
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 49650
|
| Min. Negotiated Rate |
$398.58 |
| Max. Negotiated Rate |
$640.05 |
| Rate for Payer: AlohaCare Medicaid |
$438.75
|
| Rate for Payer: AlohaCare Medicare |
$423.56
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Devoted Health Medicare |
$465.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$423.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$398.58
|
| Rate for Payer: Health Management Network Commercial |
$640.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$508.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$508.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$508.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$438.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$423.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$438.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$423.56
|
|
|
PR LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 49321
|
| Min. Negotiated Rate |
$326.72 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: AlohaCare Medicaid |
$346.53
|
| Rate for Payer: AlohaCare Medicare |
$326.72
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Devoted Health Medicare |
$359.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$326.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.86
|
| Rate for Payer: Health Management Network Commercial |
$504.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$392.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$392.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$392.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$346.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$326.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$346.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$326.72
|
|
|
PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM
|
Professional
|
Both
|
$1,792.00
|
|
|
Service Code
|
HCPCS 58572
|
| Min. Negotiated Rate |
$931.42 |
| Max. Negotiated Rate |
$1,523.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,022.67
|
| Rate for Payer: AlohaCare Medicare |
$931.42
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Devoted Health Medicare |
$1,024.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$931.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,028.56
|
| Rate for Payer: Health Management Network Commercial |
$1,523.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,117.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,117.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,117.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,022.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$931.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,022.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$931.42
|
|
|
PR LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR
|
Professional
|
Both
|
$2,095.00
|
|
|
Service Code
|
HCPCS 58573
|
| Min. Negotiated Rate |
$948.48 |
| Max. Negotiated Rate |
$1,780.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,232.23
|
| Rate for Payer: AlohaCare Medicare |
$1,088.05
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Devoted Health Medicare |
$1,196.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,088.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$948.48
|
| Rate for Payer: Health Management Network Commercial |
$1,780.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,305.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,305.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,305.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,232.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,088.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,232.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,088.05
|
|
