|
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
|
|
|
PR LAPS SURG CHOLECSTC W/EXPL COMMON DUCT
|
Professional
|
Both
|
$1,901.00
|
|
|
Service Code
|
HCPCS 47564
|
| Min. Negotiated Rate |
$753.74 |
| Max. Negotiated Rate |
$1,615.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,108.49
|
| Rate for Payer: AlohaCare Medicare |
$1,040.86
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Devoted Health Medicare |
$1,144.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,040.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$753.74
|
| Rate for Payer: Health Management Network Commercial |
$1,615.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,249.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,249.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,249.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,108.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,040.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,108.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,040.86
|
|
|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 47563
|
| Min. Negotiated Rate |
$672.19 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: AlohaCare Medicaid |
$714.60
|
| Rate for Payer: AlohaCare Medicare |
$672.19
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Devoted Health Medicare |
$739.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$672.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$738.92
|
| Rate for Payer: Health Management Network Commercial |
$1,042.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$806.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$806.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$806.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$714.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$672.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$714.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$672.19
|
|
|
PR LAPS SURG ESOPG/GSTR FUNDOPLASTY
|
Professional
|
Both
|
$1,811.00
|
|
|
Service Code
|
HCPCS 43280
|
| Min. Negotiated Rate |
$956.02 |
| Max. Negotiated Rate |
$1,539.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,057.32
|
| Rate for Payer: AlohaCare Medicare |
$984.20
|
| Rate for Payer: Cash Price |
$1,086.60
|
| Rate for Payer: Cash Price |
$1,086.60
|
| Rate for Payer: Devoted Health Medicare |
$1,082.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$984.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$956.02
|
| Rate for Payer: Health Management Network Commercial |
$1,539.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,181.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,181.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,181.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,057.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$984.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,057.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$984.20
|
|
|
PR LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX
|
Professional
|
Both
|
$1,002.00
|
|
|
Service Code
|
HCPCS 43653
|
| Min. Negotiated Rate |
$476.84 |
| Max. Negotiated Rate |
$851.70 |
| Rate for Payer: AlohaCare Medicaid |
$584.62
|
| Rate for Payer: AlohaCare Medicare |
$564.47
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Devoted Health Medicare |
$620.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$564.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network Commercial |
$851.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$677.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$677.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$677.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$584.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$564.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$584.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$564.47
|
|
|
PR LAPS SURG PRST8ECT RPBIC RAD W/NRV SPARING ROBOT
|
Professional
|
Both
|
$2,045.00
|
|
|
Service Code
|
HCPCS 55866
|
| Min. Negotiated Rate |
$1,077.11 |
| Max. Negotiated Rate |
$1,738.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,193.90
|
| Rate for Payer: AlohaCare Medicare |
$1,077.11
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Devoted Health Medicare |
$1,184.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,077.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,571.18
|
| Rate for Payer: Health Management Network Commercial |
$1,738.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,292.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,292.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,292.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,193.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,077.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,193.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,077.11
|
|
|
PR LAPS SURG PRST8ECT SMPL STOT ROBOTIC ASSISTANCE
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 55867
|
| Min. Negotiated Rate |
$942.53 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,050.25
|
| Rate for Payer: AlohaCare Medicare |
$942.53
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Devoted Health Medicare |
$1,036.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$942.53
|
| Rate for Payer: Health Management Network Commercial |
$1,530.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,131.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,131.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,131.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,050.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$942.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,050.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$942.53
|
|
|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 38570
|
| Min. Negotiated Rate |
$476.35 |
| Max. Negotiated Rate |
$759.05 |
| Rate for Payer: AlohaCare Medicaid |
$522.71
|
| Rate for Payer: AlohaCare Medicare |
$476.35
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Devoted Health Medicare |
$523.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$476.35
|
| Rate for Payer: Health Management Network Commercial |
$759.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$571.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$571.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$571.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$522.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$476.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$522.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$476.35
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 49651
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: AlohaCare Medicaid |
$571.54
|
| Rate for Payer: AlohaCare Medicare |
$548.02
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Devoted Health Medicare |
$602.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$548.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$509.60
|
| Rate for Payer: Health Management Network Commercial |
$833.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$657.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$657.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$657.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$571.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$548.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$571.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$548.02
|
|
|
PR LAPS SURG TRNSXJ VAGUS NRV TRUNCAL
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 43651
|
| Min. Negotiated Rate |
$626.57 |
| Max. Negotiated Rate |
$959.65 |
| Rate for Payer: AlohaCare Medicaid |
$658.26
|
| Rate for Payer: AlohaCare Medicare |
$626.57
|
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Devoted Health Medicare |
$689.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$626.57
|
| Rate for Payer: Health Management Network Commercial |
$959.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$751.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$751.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$751.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$658.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$626.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$658.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$626.57
|
|
