|
58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less
|
Professional
|
Both
|
$3,561.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
8039950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$765.70 |
| Max. Negotiated Rate |
$3,026.85 |
| Rate for Payer: AlohaCare Medicaid |
$990.56
|
| Rate for Payer: AlohaCare Medicare |
$865.91
|
| Rate for Payer: Cash Price |
$2,314.65
|
| Rate for Payer: Cash Price |
$2,314.65
|
| Rate for Payer: Devoted Health Medicare |
$952.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$865.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$765.70
|
| Rate for Payer: Health Management Network Commercial |
$3,026.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$952.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$952.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$952.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$990.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$865.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$990.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$865.91
|
|
|
58558 Hysteroscopy, surgical; w/ biopsy of endometrium and/or polypectomy, with or w/o D & C
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
8039953
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$200.38 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$230.09
|
| Rate for Payer: AlohaCare Medicare |
$200.38
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$220.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$230.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$385.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$230.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$220.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$220.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.38
|
|
|
58559 Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)
|
Professional
|
Both
|
$6,962.00
|
|
|
Service Code
|
HCPCS 58559
|
| Hospital Charge Code |
8039954
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.52 |
| Max. Negotiated Rate |
$5,917.70 |
| Rate for Payer: AlohaCare Medicaid |
$281.70
|
| Rate for Payer: AlohaCare Medicare |
$243.52
|
| Rate for Payer: Cash Price |
$4,525.30
|
| Rate for Payer: Cash Price |
$4,525.30
|
| Rate for Payer: Devoted Health Medicare |
$267.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$243.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$321.88
|
| Rate for Payer: Health Management Network Commercial |
$5,917.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$267.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$281.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$281.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.52
|
|
|
58561 Hysteroscopy, surgical; with removal of leiomyomata
|
Professional
|
Both
|
$6,962.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
8039956
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.08 |
| Max. Negotiated Rate |
$5,917.70 |
| Rate for Payer: AlohaCare Medicaid |
$354.39
|
| Rate for Payer: AlohaCare Medicare |
$306.08
|
| Rate for Payer: Cash Price |
$4,525.30
|
| Rate for Payer: Cash Price |
$4,525.30
|
| Rate for Payer: Devoted Health Medicare |
$336.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$306.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$550.16
|
| Rate for Payer: Health Management Network Commercial |
$5,917.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$336.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$336.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$336.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$306.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$354.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$306.08
|
|
|
58562 Hysteroscopy, surgical; with removal of impacted foreign body
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 58562
|
| Hospital Charge Code |
8039957
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$191.26 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$220.43
|
| Rate for Payer: AlohaCare Medicare |
$191.26
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$210.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$220.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$406.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$220.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$271.44
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$210.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$210.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$220.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$220.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.26
|
|
|
58563 Hysteroscopy, surgical; with endometrial ablation
|
Professional
|
Both
|
$6,962.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
8039958
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.36 |
| Max. Negotiated Rate |
$5,917.70 |
| Rate for Payer: AlohaCare Medicaid |
$244.27
|
| Rate for Payer: AlohaCare Medicare |
$212.36
|
| Rate for Payer: Cash Price |
$4,525.30
|
| Rate for Payer: Cash Price |
$4,525.30
|
| Rate for Payer: Devoted Health Medicare |
$233.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$244.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$478.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$212.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$244.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$355.68
|
| Rate for Payer: Health Management Network Commercial |
$5,917.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$233.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$233.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$233.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$244.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$212.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$212.36
|
|
|
58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;
|
Professional
|
Both
|
$14,794.00
|
|
|
Service Code
|
HCPCS 58570
|
| Hospital Charge Code |
8039960
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$720.91 |
| Max. Negotiated Rate |
$12,574.90 |
| Rate for Payer: AlohaCare Medicaid |
$821.60
|
| Rate for Payer: AlohaCare Medicare |
$720.91
|
| Rate for Payer: Cash Price |
$9,616.10
|
| Rate for Payer: Cash Price |
$9,616.10
|
| 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 |
$12,574.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$793.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$793.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$793.00
|
| 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
|
|
|
58571 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL ProFee
|
Professional
|
Both
|
$14,794.00
|
|
|
Service Code
|
HCPCS 58571
|
| Hospital Charge Code |
8021105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$819.91 |
| Max. Negotiated Rate |
$12,574.90 |
| Rate for Payer: AlohaCare Medicaid |
$925.01
|
| Rate for Payer: AlohaCare Medicare |
$819.91
|
| Rate for Payer: Cash Price |
$9,616.10
|
| Rate for Payer: Cash Price |
$9,616.10
|
| Rate for Payer: Devoted Health Medicare |
$901.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$819.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$990.86
|
| Rate for Payer: Health Management Network Commercial |
$12,574.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$901.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$901.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$901.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$925.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$819.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$925.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$819.91
|
|
|
58571 Laparoscopy, surgical, w/ total hysterectomy, for uterus 250 g or less; w/ remvl tubes/ovaries
|
Professional
|
Both
|
$14,794.00
|
|
|
Service Code
|
HCPCS 58571
|
| Hospital Charge Code |
8039961
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$819.91 |
| Max. Negotiated Rate |
$12,574.90 |
| Rate for Payer: AlohaCare Medicaid |
$925.01
|
| Rate for Payer: AlohaCare Medicare |
$819.91
|
| Rate for Payer: Cash Price |
$9,616.10
|
| Rate for Payer: Cash Price |
$9,616.10
|
| Rate for Payer: Devoted Health Medicare |
$901.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$819.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$990.86
|
| Rate for Payer: Health Management Network Commercial |
$12,574.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$901.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$901.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$901.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$925.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$819.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$925.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$819.91
|
|
|
58600 Ligation/transection of fallopian tube(s), abdominal or vaginal approach, uni/bilateral
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 58600
|
| Hospital Charge Code |
8039965
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$380.44
|
| Rate for Payer: AlohaCare Medicare |
$332.50
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$365.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$327.60
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$365.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$365.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$380.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$380.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.50
|
|
|
58605 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum
|
Professional
|
Both
|
$1,086.00
|
|
|
Service Code
|
HCPCS 58605
|
| Hospital Charge Code |
8039966
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.84 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: AlohaCare Medicaid |
$346.70
|
| Rate for Payer: AlohaCare Medicare |
$303.16
|
| Rate for Payer: Cash Price |
$705.90
|
| Rate for Payer: Cash Price |
$705.90
|
| Rate for Payer: Devoted Health Medicare |
$333.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.84
|
| Rate for Payer: Health Management Network Commercial |
$923.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$333.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$333.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$346.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$303.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$346.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.16
|
|
|
58611 Ligation/transection of fallopian tube(s); cesarean delivery or intra-abdominal surgery
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 58611
|
| Hospital Charge Code |
8039967
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: AlohaCare Medicare |
$63.13
|
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Devoted Health Medicare |
$69.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.42
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.13
|
|
|
58661 Laparoscopy, surgical; with removal of adnexal structures
|
Professional
|
Both
|
$2,329.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
8039970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$576.14 |
| Max. Negotiated Rate |
$1,979.65 |
| Rate for Payer: AlohaCare Medicaid |
$657.69
|
| Rate for Payer: AlohaCare Medicare |
$576.14
|
| Rate for Payer: Cash Price |
$1,513.85
|
| Rate for Payer: Cash Price |
$1,513.85
|
| 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 |
$1,979.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$633.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$633.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$633.75
|
| 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
|
|
|
58662 Laparoscopy, surgical; w/ fulguration or excision of lesions of the ovary, by any method
|
Professional
|
Both
|
$2,561.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
8039971
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$638.14 |
| Max. Negotiated Rate |
$2,176.85 |
| Rate for Payer: AlohaCare Medicaid |
$721.53
|
| Rate for Payer: AlohaCare Medicare |
$638.14
|
| Rate for Payer: Cash Price |
$1,664.65
|
| Rate for Payer: Cash Price |
$1,664.65
|
| 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 |
$2,176.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$701.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$701.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$701.95
|
| 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
|
|
|
58670 Laparoscopy, surgical; with fulguration of oviducts (with or w/o transection)
|
Professional
|
Both
|
$8,414.00
|
|
|
Service Code
|
HCPCS 58670
|
| Hospital Charge Code |
8039972
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.26 |
| Max. Negotiated Rate |
$7,151.90 |
| Rate for Payer: AlohaCare Medicaid |
$381.20
|
| Rate for Payer: AlohaCare Medicare |
$333.26
|
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Cash Price |
$5,469.10
|
| 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 |
$7,151.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$366.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$366.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$366.59
|
| 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
|
|
|
58700 Salpingectomy, complete or partial, unilateral or bilateral
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 58700
|
| Hospital Charge Code |
8039977
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.74 |
| Max. Negotiated Rate |
$1,966.05 |
| Rate for Payer: AlohaCare Medicaid |
$813.42
|
| Rate for Payer: AlohaCare Medicare |
$726.35
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Devoted Health Medicare |
$798.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$726.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$493.74
|
| Rate for Payer: Health Management Network Commercial |
$1,966.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$798.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$798.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$813.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$726.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$813.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$726.35
|
|
|
58720 Salpingo-oophorectomy, complete or partial, unilateral or bilateral
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 58720
|
| Hospital Charge Code |
8039978
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$694.54 |
| Max. Negotiated Rate |
$1,712.75 |
| Rate for Payer: AlohaCare Medicaid |
$775.77
|
| Rate for Payer: AlohaCare Medicare |
$694.54
|
| Rate for Payer: Cash Price |
$1,309.75
|
| Rate for Payer: Cash Price |
$1,309.75
|
| Rate for Payer: Devoted Health Medicare |
$763.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$694.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$725.40
|
| Rate for Payer: Health Management Network Commercial |
$1,712.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$763.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$763.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$763.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$775.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$694.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$775.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$694.54
|
|
|
58805 Drainage of ovarian cyst(s), unilateral or bilateral; abdominal approach
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 58805
|
| Hospital Charge Code |
8039984
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$360.88 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$443.08
|
| Rate for Payer: AlohaCare Medicare |
$384.17
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$422.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$384.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$360.88
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$422.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$422.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$443.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$384.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$443.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$384.17
|
|
|
58940 Oophorectomy, partial or total, unilateral or bilateral;
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
8039990
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$403.78 |
| Max. Negotiated Rate |
$1,224.85 |
| Rate for Payer: AlohaCare Medicaid |
$571.25
|
| Rate for Payer: AlohaCare Medicare |
$518.20
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$570.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$518.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$403.78
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$570.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$570.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$570.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$571.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$518.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$571.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$518.20
|
|
|
58999 UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NONOBSTETRICAL) ProFee
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
8021152
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.03 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: AlohaCare Medicaid |
$375.03
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Health Management Network Commercial |
$2,125.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$375.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$375.03
|
|
|
59070 Amnio Infusion
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 59070
|
| Hospital Charge Code |
8864493
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$301.72 |
| Max. Negotiated Rate |
$1,091.25 |
| Rate for Payer: AlohaCare Medicaid |
$562.50
|
| Rate for Payer: AlohaCare Medicare |
$562.50
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Devoted Health Medicare |
$618.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$389.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$562.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,068.75
|
| Rate for Payer: Health Management Network Commercial |
$956.25
|
| Rate for Payer: Humana Medicare |
$562.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,012.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$573.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$562.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,091.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$562.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$562.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$301.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$562.50
|
| Rate for Payer: University Health Alliance Commercial |
$820.01
|
|
|
59070 Amnio Infusion
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 59070
|
| Hospital Charge Code |
8864493
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$956.25 |
| Max. Negotiated Rate |
$1,091.25 |
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Health Management Network Commercial |
$956.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,012.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,091.25
|
|
|
59120 Surgical treatment of ectopic pregnancy; requiring salpingectomy and/or oophorectomy
|
Professional
|
Both
|
$2,199.00
|
|
|
Service Code
|
HCPCS 59120
|
| Hospital Charge Code |
8040005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$705.36 |
| Max. Negotiated Rate |
$1,869.15 |
| Rate for Payer: AlohaCare Medicaid |
$808.22
|
| Rate for Payer: AlohaCare Medicare |
$705.36
|
| Rate for Payer: Cash Price |
$1,429.35
|
| Rate for Payer: Cash Price |
$1,429.35
|
| Rate for Payer: Devoted Health Medicare |
$775.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$705.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$739.44
|
| Rate for Payer: Health Management Network Commercial |
$1,869.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$775.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$775.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$775.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$808.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$705.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$808.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$705.36
|
|
|
59121 Surgical treatment of ectopic pregnancy; tubal or ovarian, w/o salpingectomy/oophorectomy
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 59121
|
| Hospital Charge Code |
8040006
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$568.36 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: AlohaCare Medicaid |
$807.86
|
| Rate for Payer: AlohaCare Medicare |
$704.86
|
| Rate for Payer: Cash Price |
$1,430.00
|
| Rate for Payer: Cash Price |
$1,430.00
|
| Rate for Payer: Devoted Health Medicare |
$775.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$704.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$568.36
|
| Rate for Payer: Health Management Network Commercial |
$1,870.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$775.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$775.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$775.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$807.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$704.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$807.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$704.86
|
|
|
59150 Laparoscopic treatment of ectopic pregnancy; w/o salpingectomy and/or oophorectomy
|
Professional
|
Both
|
$8,414.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
8040007
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$452.14 |
| Max. Negotiated Rate |
$7,151.90 |
| Rate for Payer: AlohaCare Medicaid |
$784.15
|
| Rate for Payer: AlohaCare Medicare |
$684.42
|
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Devoted Health Medicare |
$752.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$684.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$452.14
|
| Rate for Payer: Health Management Network Commercial |
$7,151.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$752.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$752.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$784.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$684.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$784.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$684.42
|
|
