|
PR LAPAROSCOPY W/LYSIS OF ADHESIONS
|
Professional
|
Both
|
$1,174.00
|
|
|
Service Code
|
HCPCS 58660
|
| Min. Negotiated Rate |
$601.12 |
| Max. Negotiated Rate |
$997.90 |
| Rate for Payer: AlohaCare Medicaid |
$688.28
|
| Rate for Payer: AlohaCare Medicare |
$617.71
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Devoted Health Medicare |
$679.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$617.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$601.12
|
| Rate for Payer: Health Management Network Commercial |
$997.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$741.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$741.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$741.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$688.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$617.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$688.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$617.71
|
|
|
PR LAPAROSCOPY W/OMENTOPEXY
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 49326
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: AlohaCare Medicaid |
$179.02
|
| Rate for Payer: AlohaCare Medicare |
$160.16
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Devoted Health Medicare |
$176.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$160.16
|
| Rate for Payer: Health Management Network Commercial |
$260.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$192.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$160.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$179.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$160.16
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 58661
|
| Min. Negotiated Rate |
$576.14 |
| Max. Negotiated Rate |
$951.15 |
| Rate for Payer: AlohaCare Medicaid |
$657.69
|
| Rate for Payer: AlohaCare Medicare |
$576.14
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Devoted Health Medicare |
$633.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$576.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$659.10
|
| Rate for Payer: Health Management Network Commercial |
$951.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$691.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$691.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$691.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$657.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$576.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$657.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$576.14
|
|
|
PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$1,398.00
|
|
|
Service Code
|
HCPCS 58570
|
| Min. Negotiated Rate |
$720.91 |
| Max. Negotiated Rate |
$1,188.30 |
| Rate for Payer: AlohaCare Medicaid |
$821.60
|
| Rate for Payer: AlohaCare Medicare |
$720.91
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Devoted Health Medicare |
$793.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$720.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$873.08
|
| Rate for Payer: Health Management Network Commercial |
$1,188.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$865.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$865.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$865.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$821.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$720.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$821.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$720.91
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 49320
|
| Min. Negotiated Rate |
$313.79 |
| Max. Negotiated Rate |
$482.80 |
| Rate for Payer: AlohaCare Medicaid |
$330.81
|
| Rate for Payer: AlohaCare Medicare |
$313.79
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Devoted Health Medicare |
$345.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$313.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$343.98
|
| Rate for Payer: Health Management Network Commercial |
$482.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$376.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$376.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$376.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$330.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$313.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$330.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$313.79
|
| Rate for Payer: University Health Alliance Commercial |
$448.00
|
|
|
PR LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$2,777.00
|
|
|
Service Code
|
HCPCS 44227
|
| Min. Negotiated Rate |
$1,484.34 |
| Max. Negotiated Rate |
$2,360.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,623.99
|
| Rate for Payer: AlohaCare Medicare |
$1,484.34
|
| Rate for Payer: Cash Price |
$1,666.20
|
| Rate for Payer: Cash Price |
$1,666.20
|
| Rate for Payer: Devoted Health Medicare |
$1,632.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,484.34
|
| Rate for Payer: Health Management Network Commercial |
$2,360.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,781.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,781.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,781.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,623.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,484.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,623.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,484.34
|
|
|
PR LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST
|
Professional
|
Both
|
$3,312.00
|
|
|
Service Code
|
HCPCS 44208
|
| Min. Negotiated Rate |
$1,772.14 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,940.57
|
| Rate for Payer: AlohaCare Medicare |
$1,772.14
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Devoted Health Medicare |
$1,949.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,772.14
|
| Rate for Payer: Health Management Network Commercial |
$2,815.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,126.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,126.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,126.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,940.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,772.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,940.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,772.14
|
|
|
PR LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST
|
Professional
|
Both
|
$3,037.00
|
|
|
Service Code
|
HCPCS 44207
|
| Min. Negotiated Rate |
$1,550.38 |
| Max. Negotiated Rate |
$2,581.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,776.24
|
| Rate for Payer: AlohaCare Medicare |
$1,614.36
|
| Rate for Payer: Cash Price |
$1,822.20
|
| Rate for Payer: Cash Price |
$1,822.20
|
| Rate for Payer: Devoted Health Medicare |
$1,775.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,614.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,550.38
|
| Rate for Payer: Health Management Network Commercial |
$2,581.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,937.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,937.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,937.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,776.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,614.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,776.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,614.36
|
|
|
PR LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM
|
Professional
|
Both
|
$2,917.00
|
|
|
Service Code
|
HCPCS 44206
|
| Min. Negotiated Rate |
$1,564.66 |
| Max. Negotiated Rate |
$2,479.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,708.31
|
| Rate for Payer: AlohaCare Medicare |
$1,564.66
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Devoted Health Medicare |
$1,721.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,564.66
|
| Rate for Payer: Health Management Network Commercial |
$2,479.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,877.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,877.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,877.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,708.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,564.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,708.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,564.66
|
|
|
PR LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM
|
Professional
|
Both
|
$2,247.00
|
|
|
Service Code
|
HCPCS 44205
|
| Min. Negotiated Rate |
$1,202.63 |
| Max. Negotiated Rate |
$1,909.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,313.13
|
| Rate for Payer: AlohaCare Medicare |
$1,202.63
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Devoted Health Medicare |
$1,322.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,202.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,223.82
|
| Rate for Payer: Health Management Network Commercial |
$1,909.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,443.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,443.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,443.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,313.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,202.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,313.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,202.63
|
|
|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Professional
|
Both
|
$2,333.00
|
|
|
Service Code
|
HCPCS 44202
|
| Min. Negotiated Rate |
$968.76 |
| Max. Negotiated Rate |
$1,983.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,362.82
|
| Rate for Payer: AlohaCare Medicare |
$1,256.96
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Devoted Health Medicare |
$1,382.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,256.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$968.76
|
| Rate for Payer: Health Management Network Commercial |
$1,983.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,508.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,508.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,508.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,362.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,256.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,362.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,256.96
|
|
|
PR LAPS ESOPHAGEAL LENGTHENING ADDL
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 43283
|
| Min. Negotiated Rate |
$134.62 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: AlohaCare Medicaid |
$149.50
|
| Rate for Payer: AlohaCare Medicare |
$134.62
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Devoted Health Medicare |
$148.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.62
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$149.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.62
|
|
|
PR LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
HCPCS 43279
|
| Min. Negotiated Rate |
$869.70 |
| Max. Negotiated Rate |
$1,817.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,250.47
|
| Rate for Payer: AlohaCare Medicare |
$1,161.52
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Devoted Health Medicare |
$1,277.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,161.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$869.70
|
| Rate for Payer: Health Management Network Commercial |
$1,817.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,393.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,393.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,393.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,250.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,161.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,250.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,161.52
|
|
|
PR LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 58662
|
| Min. Negotiated Rate |
$638.14 |
| Max. Negotiated Rate |
$1,042.95 |
| Rate for Payer: AlohaCare Medicaid |
$721.53
|
| Rate for Payer: AlohaCare Medicare |
$638.14
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Devoted Health Medicare |
$701.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$638.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$655.72
|
| Rate for Payer: Health Management Network Commercial |
$1,042.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$765.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$765.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$765.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$721.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$638.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$721.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$638.14
|
|
|
PR LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 43775
|
| Min. Negotiated Rate |
$948.07 |
| Max. Negotiated Rate |
$1,541.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,060.45
|
| Rate for Payer: AlohaCare Medicare |
$948.07
|
| Rate for Payer: Cash Price |
$1,088.40
|
| Rate for Payer: Cash Price |
$1,088.40
|
| Rate for Payer: Devoted Health Medicare |
$1,042.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$948.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,252.68
|
| Rate for Payer: Health Management Network Commercial |
$1,541.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,137.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,137.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,137.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,060.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$948.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,060.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$948.07
|
|
|
PR LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
HCPCS 49324
|
| Min. Negotiated Rate |
$358.03 |
| Max. Negotiated Rate |
$555.05 |
| Rate for Payer: AlohaCare Medicaid |
$382.35
|
| Rate for Payer: AlohaCare Medicare |
$358.03
|
| Rate for Payer: Cash Price |
$391.80
|
| Rate for Payer: Cash Price |
$391.80
|
| Rate for Payer: Devoted Health Medicare |
$393.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$358.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$360.62
|
| Rate for Payer: Health Management Network Commercial |
$555.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$429.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$429.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$429.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$382.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$358.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$382.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$358.03
|
|
|
PR LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 44213
|
| Min. Negotiated Rate |
$158.96 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: AlohaCare Medicaid |
$179.49
|
| Rate for Payer: AlohaCare Medicare |
$158.96
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Devoted Health Medicare |
$174.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$162.24
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$190.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$179.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.96
|
|
|
PR LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 58545
|
| Min. Negotiated Rate |
$795.98 |
| Max. Negotiated Rate |
$1,314.10 |
| Rate for Payer: AlohaCare Medicaid |
$909.97
|
| Rate for Payer: AlohaCare Medicare |
$795.98
|
| Rate for Payer: Cash Price |
$927.60
|
| Rate for Payer: Cash Price |
$927.60
|
| Rate for Payer: Devoted Health Medicare |
$875.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$795.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$845.52
|
| Rate for Payer: Health Management Network Commercial |
$1,314.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$955.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$955.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$955.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$909.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$795.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$909.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$795.98
|
|
|
PR LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS
|
Professional
|
Both
|
$1,897.00
|
|
|
Service Code
|
HCPCS 58546
|
| Min. Negotiated Rate |
$961.54 |
| Max. Negotiated Rate |
$1,612.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,116.23
|
| Rate for Payer: AlohaCare Medicare |
$961.54
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Devoted Health Medicare |
$1,057.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$961.54
|
| Rate for Payer: Health Management Network Commercial |
$1,612.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,153.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,153.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,153.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,116.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$961.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,116.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$961.54
|
|
|
PR LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR
|
Professional
|
Both
|
$3,601.00
|
|
|
Service Code
|
HCPCS 45397
|
| Min. Negotiated Rate |
$1,930.31 |
| Max. Negotiated Rate |
$3,060.85 |
| Rate for Payer: AlohaCare Medicaid |
$2,109.38
|
| Rate for Payer: AlohaCare Medicare |
$1,930.31
|
| Rate for Payer: Cash Price |
$2,160.60
|
| Rate for Payer: Cash Price |
$2,160.60
|
| Rate for Payer: Devoted Health Medicare |
$2,123.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,930.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,232.88
|
| Rate for Payer: Health Management Network Commercial |
$3,060.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,316.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,316.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,316.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,109.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,930.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,109.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,930.31
|
|
|
PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH
|
Professional
|
Both
|
$2,875.00
|
|
|
Service Code
|
HCPCS 43282
|
| Min. Negotiated Rate |
$1,543.55 |
| Max. Negotiated Rate |
$2,443.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,680.48
|
| Rate for Payer: AlohaCare Medicare |
$1,543.55
|
| Rate for Payer: Cash Price |
$1,725.00
|
| Rate for Payer: Cash Price |
$1,725.00
|
| Rate for Payer: Devoted Health Medicare |
$1,697.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,543.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,668.16
|
| Rate for Payer: Health Management Network Commercial |
$2,443.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,852.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,852.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,852.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,680.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,543.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,680.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,543.55
|
|
|
PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH
|
Professional
|
Both
|
$2,553.00
|
|
|
Service Code
|
HCPCS 43281
|
| Min. Negotiated Rate |
$1,375.59 |
| Max. Negotiated Rate |
$2,170.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,493.62
|
| Rate for Payer: AlohaCare Medicare |
$1,375.59
|
| Rate for Payer: Cash Price |
$1,531.80
|
| Rate for Payer: Cash Price |
$1,531.80
|
| Rate for Payer: Devoted Health Medicare |
$1,513.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,375.59
|
| Rate for Payer: Health Management Network Commercial |
$2,170.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,650.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,650.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,650.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,493.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,375.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,493.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,375.59
|
|
|
PR LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 58544
|
| Min. Negotiated Rate |
$793.21 |
| Max. Negotiated Rate |
$1,322.60 |
| Rate for Payer: AlohaCare Medicaid |
$915.11
|
| Rate for Payer: AlohaCare Medicare |
$793.21
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Devoted Health Medicare |
$872.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$793.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$913.12
|
| Rate for Payer: Health Management Network Commercial |
$1,322.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$951.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$951.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$915.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$793.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$915.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$793.21
|
|
|
PR LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR
|
Professional
|
Both
|
$1,429.00
|
|
|
Service Code
|
HCPCS 58542
|
| Min. Negotiated Rate |
$726.79 |
| Max. Negotiated Rate |
$1,214.65 |
| Rate for Payer: AlohaCare Medicaid |
$841.50
|
| Rate for Payer: AlohaCare Medicare |
$726.79
|
| Rate for Payer: Cash Price |
$857.40
|
| Rate for Payer: Cash Price |
$857.40
|
| Rate for Payer: Devoted Health Medicare |
$799.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$726.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$857.48
|
| Rate for Payer: Health Management Network Commercial |
$1,214.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$872.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$872.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$872.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$841.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$726.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$841.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$726.79
|
|
|
PR LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 38571
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$969.85 |
| Rate for Payer: AlohaCare Medicaid |
$666.10
|
| Rate for Payer: AlohaCare Medicare |
$593.60
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Devoted Health Medicare |
$652.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$593.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$753.74
|
| Rate for Payer: Health Management Network Commercial |
$969.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$712.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$712.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$712.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$666.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$593.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$666.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$593.60
|
|
