|
59151 Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy
|
Professional
|
Both
|
$8,414.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
8040008
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$602.68 |
| Max. Negotiated Rate |
$7,151.90 |
| Rate for Payer: AlohaCare Medicaid |
$766.13
|
| Rate for Payer: AlohaCare Medicare |
$665.05
|
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Devoted Health Medicare |
$731.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$665.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$602.68
|
| Rate for Payer: Health Management Network Commercial |
$7,151.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$731.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$731.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$731.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$766.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$665.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$766.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$665.05
|
|
|
59160 Curettage, postpartum
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
8040009
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$188.45
|
| Rate for Payer: AlohaCare Medicare |
$162.12
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$178.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$188.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$162.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$188.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$231.40
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$178.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$178.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$162.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$162.12
|
| Rate for Payer: University Health Alliance Commercial |
$250.65
|
|
|
59200 INSERTION OF CERVICAL DILATOR CHARGE
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
8021176
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$767.55 |
| Max. Negotiated Rate |
$875.91 |
| Rate for Payer: Cash Price |
$586.95
|
| Rate for Payer: Health Management Network Commercial |
$767.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$812.70
|
| Rate for Payer: MDX Hawaii PPO |
$875.91
|
|
|
59200 INSERTION OF CERVICAL DILATOR CHARGE
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
8021176
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$29.09 |
| Max. Negotiated Rate |
$875.91 |
| Rate for Payer: AlohaCare Medicaid |
$451.50
|
| Rate for Payer: AlohaCare Medicare |
$451.50
|
| Rate for Payer: Cash Price |
$586.95
|
| Rate for Payer: Cash Price |
$586.95
|
| Rate for Payer: Devoted Health Medicare |
$496.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$389.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$451.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$857.85
|
| Rate for Payer: Health Management Network Commercial |
$767.55
|
| Rate for Payer: Humana Medicare |
$451.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$812.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$460.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$451.50
|
| Rate for Payer: MDX Hawaii PPO |
$875.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$451.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$451.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$451.50
|
| Rate for Payer: University Health Alliance Commercial |
$658.20
|
|
|
59200 Insertion of cervical dilator (eg, laminaria, prostaglandin)
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
8040010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$360.40 |
| Rate for Payer: AlohaCare Medicaid |
$42.45
|
| Rate for Payer: AlohaCare Medicare |
$55.92
|
| Rate for Payer: Cash Price |
$275.60
|
| Rate for Payer: Cash Price |
$275.60
|
| Rate for Payer: Devoted Health Medicare |
$61.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.02
|
| Rate for Payer: Health Management Network Commercial |
$360.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.92
|
| Rate for Payer: University Health Alliance Commercial |
$79.55
|
|
|
59300 Episiotomy or vaginal repair, by other than attending
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
8040011
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.99 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$143.76
|
| Rate for Payer: AlohaCare Medicare |
$126.99
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$139.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$143.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$238.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$143.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.86
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$143.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$143.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.99
|
| Rate for Payer: University Health Alliance Commercial |
$189.45
|
|
|
59400 Routine obstetric care including antepartum care, vaginal delivery, postpartum care
|
Professional
|
Both
|
$6,236.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
8040014
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,053.78 |
| Max. Negotiated Rate |
$5,300.60 |
| Rate for Payer: AlohaCare Medicaid |
$2,408.90
|
| Rate for Payer: AlohaCare Medicare |
$2,152.11
|
| Rate for Payer: Cash Price |
$4,053.40
|
| Rate for Payer: Cash Price |
$4,053.40
|
| Rate for Payer: Devoted Health Medicare |
$2,367.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,152.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,053.78
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,367.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,367.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,367.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,408.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,152.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,408.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,152.11
|
|
|
59409 Vaginal delivery only, with or without episiotomy and/or forceps
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
8040015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$553.28 |
| Max. Negotiated Rate |
$1,875.95 |
| Rate for Payer: AlohaCare Medicaid |
$770.52
|
| Rate for Payer: AlohaCare Medicare |
$680.00
|
| Rate for Payer: Cash Price |
$1,434.55
|
| Rate for Payer: Cash Price |
$1,434.55
|
| Rate for Payer: Devoted Health Medicare |
$748.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$680.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$553.28
|
| Rate for Payer: Health Management Network Commercial |
$1,875.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$748.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$748.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$748.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$770.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$680.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$770.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$680.00
|
|
|
59410 Vaginal delivery only; including postpartum care
|
Professional
|
Both
|
$2,894.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
8040016
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$514.02 |
| Max. Negotiated Rate |
$2,459.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,049.57
|
| Rate for Payer: AlohaCare Medicare |
$924.69
|
| Rate for Payer: Cash Price |
$1,881.10
|
| Rate for Payer: Cash Price |
$1,881.10
|
| Rate for Payer: Devoted Health Medicare |
$1,017.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$924.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.02
|
| Rate for Payer: Health Management Network Commercial |
$2,459.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,017.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,017.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,017.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,049.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$924.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,049.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$924.69
|
|
|
59410 VAGINAL DELIVERY ONLY WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS INCLUDING POSTPARTU ProFee
|
Professional
|
Both
|
$2,309.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
8021183
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$514.02 |
| Max. Negotiated Rate |
$1,962.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,049.57
|
| Rate for Payer: AlohaCare Medicare |
$924.69
|
| Rate for Payer: Cash Price |
$1,500.85
|
| Rate for Payer: Cash Price |
$1,500.85
|
| Rate for Payer: Devoted Health Medicare |
$1,017.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$924.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.02
|
| Rate for Payer: Health Management Network Commercial |
$1,962.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,017.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,017.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,017.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,049.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$924.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,049.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$924.69
|
|
|
59412 EXTERNAL CEPHALIC VERSION CHARGE
|
Facility
|
IP
|
$6,802.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
8021184
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$5,781.70 |
| Max. Negotiated Rate |
$6,597.94 |
| Rate for Payer: Cash Price |
$4,421.30
|
| Rate for Payer: Health Management Network Commercial |
$5,781.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,121.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,597.94
|
|
|
59412 EXTERNAL CEPHALIC VERSION CHARGE
|
Facility
|
OP
|
$6,802.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
8021184
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$6,597.94 |
| Rate for Payer: AlohaCare Medicaid |
$3,401.00
|
| Rate for Payer: AlohaCare Medicare |
$3,401.00
|
| Rate for Payer: Cash Price |
$4,421.30
|
| Rate for Payer: Cash Price |
$4,421.30
|
| Rate for Payer: Devoted Health Medicare |
$3,741.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,401.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,461.90
|
| Rate for Payer: Health Management Network Commercial |
$5,781.70
|
| Rate for Payer: Humana Medicare |
$3,401.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,121.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,469.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,401.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,597.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,401.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,401.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,401.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
59412 External cephalic version, with or without tocolysis
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
8040017
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.21 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$99.52
|
| Rate for Payer: AlohaCare Medicare |
$89.21
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$98.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$118.04
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.21
|
|
|
59414 Delivery of placenta (separate procedure)
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
8040018
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.74 |
| Max. Negotiated Rate |
$276.25 |
| Rate for Payer: AlohaCare Medicaid |
$86.46
|
| Rate for Payer: AlohaCare Medicare |
$76.74
|
| Rate for Payer: Cash Price |
$211.25
|
| Rate for Payer: Cash Price |
$211.25
|
| Rate for Payer: Devoted Health Medicare |
$84.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.72
|
| Rate for Payer: Health Management Network Commercial |
$276.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.74
|
|
|
59426 Antepartum care only; 7 or more visits
|
Professional
|
Both
|
$2,848.00
|
|
|
Service Code
|
HCPCS 59426
|
| Hospital Charge Code |
8040020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.20 |
| Max. Negotiated Rate |
$2,420.80 |
| Rate for Payer: AlohaCare Medicaid |
$765.67
|
| Rate for Payer: AlohaCare Medicare |
$675.03
|
| Rate for Payer: Cash Price |
$1,851.20
|
| Rate for Payer: Cash Price |
$1,851.20
|
| Rate for Payer: Devoted Health Medicare |
$742.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$765.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$675.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$765.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$395.20
|
| Rate for Payer: Health Management Network Commercial |
$2,420.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$742.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$742.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$742.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$765.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$675.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$765.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$675.03
|
|
|
59430 Postpartum care only (separate procedure)
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
HCPCS 59430
|
| Hospital Charge Code |
8040021
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$79.04 |
| Max. Negotiated Rate |
$485.35 |
| Rate for Payer: AlohaCare Medicaid |
$172.57
|
| Rate for Payer: AlohaCare Medicare |
$151.93
|
| Rate for Payer: Cash Price |
$371.15
|
| Rate for Payer: Cash Price |
$371.15
|
| Rate for Payer: Devoted Health Medicare |
$167.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.04
|
| Rate for Payer: Health Management Network Commercial |
$485.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$167.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$167.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$172.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.93
|
|
|
59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care
|
Professional
|
Both
|
$6,845.00
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
8040022
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,448.98 |
| Max. Negotiated Rate |
$5,818.25 |
| Rate for Payer: AlohaCare Medicaid |
$2,656.47
|
| Rate for Payer: AlohaCare Medicare |
$2,382.05
|
| Rate for Payer: Cash Price |
$4,449.25
|
| Rate for Payer: Cash Price |
$4,449.25
|
| Rate for Payer: Devoted Health Medicare |
$2,620.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,382.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,448.98
|
| Rate for Payer: Health Management Network Commercial |
$5,818.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,620.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,620.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,620.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,656.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,382.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,656.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,382.05
|
|
|
59514 Cesarean delivery only
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
8040023
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$422.76 |
| Max. Negotiated Rate |
$2,088.45 |
| Rate for Payer: AlohaCare Medicaid |
$867.91
|
| Rate for Payer: AlohaCare Medicare |
$769.32
|
| Rate for Payer: Cash Price |
$1,597.05
|
| Rate for Payer: Cash Price |
$1,597.05
|
| Rate for Payer: Devoted Health Medicare |
$846.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$769.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$422.76
|
| Rate for Payer: Health Management Network Commercial |
$2,088.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$846.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$846.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$846.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$867.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$769.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$867.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$769.32
|
|
|
59515 Cesarean delivery only; including postpartum care
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 59515
|
| Hospital Charge Code |
8040024
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$841.62 |
| Max. Negotiated Rate |
$2,975.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,296.15
|
| Rate for Payer: AlohaCare Medicare |
$1,153.02
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Devoted Health Medicare |
$1,268.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,153.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$841.62
|
| Rate for Payer: Health Management Network Commercial |
$2,975.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,268.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,268.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,268.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,153.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,296.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,153.02
|
|
|
59515 CESAREAN DELIVERY ONLY INCLUDING POSTPARTUM CARE ProFee
|
Professional
|
Both
|
$1,716.00
|
|
|
Service Code
|
HCPCS 59515
|
| Hospital Charge Code |
8021191
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$841.62 |
| Max. Negotiated Rate |
$1,458.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,296.15
|
| Rate for Payer: AlohaCare Medicare |
$1,153.02
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Devoted Health Medicare |
$1,268.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,153.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$841.62
|
| Rate for Payer: Health Management Network Commercial |
$1,458.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,268.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,268.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,268.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,153.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,296.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,153.02
|
|
|
59812 Treatment of incomplete abortion, any trimester, completed surgically
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
8040032
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.52 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$309.17
|
| Rate for Payer: AlohaCare Medicare |
$272.52
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$299.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$309.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$322.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$272.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$309.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.34
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$299.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$299.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$272.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$309.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$272.52
|
| Rate for Payer: University Health Alliance Commercial |
$409.08
|
|
|
59820 Treatment of missed abortion, completed surgically; first trimester
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
8040033
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.36 |
| Max. Negotiated Rate |
$1,198.50 |
| Rate for Payer: AlohaCare Medicaid |
$397.39
|
| Rate for Payer: AlohaCare Medicare |
$349.96
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Devoted Health Medicare |
$384.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$397.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$410.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$349.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$397.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$321.36
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$384.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$384.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$384.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$397.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$349.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$397.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$349.96
|
| Rate for Payer: University Health Alliance Commercial |
$521.02
|
|
|
59821 Treatment of missed abortion, completed surgically; second trimester
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 59821
|
| Hospital Charge Code |
8040034
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$301.60 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$384.06
|
| Rate for Payer: AlohaCare Medicare |
$338.83
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$372.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$384.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$397.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$338.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$384.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$301.60
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$384.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$338.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$384.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$338.83
|
| Rate for Payer: University Health Alliance Commercial |
$505.16
|
|
|
59830 Treatment of septic abortion, completed surgically
|
Professional
|
Both
|
$1,219.00
|
|
|
Service Code
|
HCPCS 59830
|
| Hospital Charge Code |
8040035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$308.10 |
| Max. Negotiated Rate |
$1,036.15 |
| Rate for Payer: AlohaCare Medicaid |
$467.45
|
| Rate for Payer: AlohaCare Medicare |
$408.79
|
| Rate for Payer: Cash Price |
$792.35
|
| Rate for Payer: Cash Price |
$792.35
|
| Rate for Payer: Devoted Health Medicare |
$449.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$408.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$308.10
|
| Rate for Payer: Health Management Network Commercial |
$1,036.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$449.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$449.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$449.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$467.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$408.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$467.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$408.79
|
|
|
59840 Induced abortion, by dilation and curettage
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 59840
|
| Hospital Charge Code |
8040036
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$198.26 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$225.42
|
| Rate for Payer: AlohaCare Medicare |
$198.26
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$218.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$225.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$333.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$225.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$269.10
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$225.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$225.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.26
|
| Rate for Payer: University Health Alliance Commercial |
$298.16
|
|
