|
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
|
|
|
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
|
|
