|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY
|
Facility
|
OP
|
$20,300.00
|
|
|
Service Code
|
CPT 47563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$20,300.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$20,300.00
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT
|
Facility
|
OP
|
$24,500.00
|
|
|
Service Code
|
CPT 47564
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$24,500.00 |
| Rate for Payer: AlohaCare Medicaid |
$12,557.50
|
| Rate for Payer: AlohaCare Medicare |
$12,557.50
|
| Rate for Payer: Devoted Health Medicare |
$13,813.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,484.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12,557.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,902.37
|
| Rate for Payer: Humana Medicare |
$12,557.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,557.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13,813.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,557.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,557.50
|
| Rate for Payer: University Health Alliance Commercial |
$24,500.00
|
|
|
LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 44180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,715.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
|
|
LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES)
|
Facility
|
OP
|
$24,500.00
|
|
|
Service Code
|
CPT 43280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$24,500.00 |
| Rate for Payer: AlohaCare Medicaid |
$12,557.50
|
| Rate for Payer: AlohaCare Medicare |
$12,557.50
|
| Rate for Payer: Devoted Health Medicare |
$13,813.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,484.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12,557.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,902.37
|
| Rate for Payer: Humana Medicare |
$12,557.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,557.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13,813.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,557.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,557.50
|
| Rate for Payer: University Health Alliance Commercial |
$24,500.00
|
|
|
LAPAROSCOPY, SURGICAL; GASTROSTOMY, WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$24,500.00
|
|
|
Service Code
|
CPT 43653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$24,500.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,927.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$24,500.00
|
|
|
LAPAROSCOPY, SURGICAL, MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PARTIAL COLECTOMY (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE)
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 44213
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.31
|
|
|
LAPAROSCOPY, SURGICAL; PROCTOPEXY (FOR PROLAPSE)
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 45400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,715.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
|
|
LAPAROSCOPY, SURGICAL; PROCTOPEXY (FOR PROLAPSE), WITH SIGMOID RESECTION
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 45402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$975.84 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$975.84
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 49650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,715.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH IMPLANTATION OF MESH
|
Facility
|
OP
|
$18,023.00
|
|
|
Service Code
|
CPT 43282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$18,023.00 |
| Rate for Payer: AlohaCare Medicaid |
$12,557.50
|
| Rate for Payer: AlohaCare Medicare |
$12,557.50
|
| Rate for Payer: Devoted Health Medicare |
$13,813.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2,102.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,023.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12,557.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,102.18
|
| Rate for Payer: Humana Medicare |
$12,557.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,557.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13,813.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,557.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,557.50
|
|
|
LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITHOUT IMPLANTATION OF MESH
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 43281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: AlohaCare Medicaid |
$12,557.50
|
| Rate for Payer: AlohaCare Medicare |
$12,557.50
|
| Rate for Payer: Devoted Health Medicare |
$13,813.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,715.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12,557.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$12,557.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,557.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13,813.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,557.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,557.50
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA
|
Facility
|
OP
|
$16,700.00
|
|
|
Service Code
|
CPT 49651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$16,700.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,715.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$16,700.00
|
|
|
LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR MULTIPLE)
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 49322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,715.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD
|
Facility
|
OP
|
$11,157.19
|
|
|
Service Code
|
CPT 58662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$11,157.19 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$11,157.19
|
|
|
LAPAROSCOPY, SURGICAL; WITH INSERTION OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$16,700.00
|
|
|
Service Code
|
CPT 49324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$16,700.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$16,700.00
|
|
|
LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)
|
Facility
|
OP
|
$11,157.19
|
|
|
Service Code
|
CPT 58661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$11,157.19 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$11,157.19
|
|
|
LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$24,500.00
|
|
|
Service Code
|
CPT 58571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$24,500.00 |
| Rate for Payer: AlohaCare Medicaid |
$12,557.50
|
| Rate for Payer: AlohaCare Medicare |
$12,557.50
|
| Rate for Payer: Devoted Health Medicare |
$13,813.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,484.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12,557.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,902.37
|
| Rate for Payer: Humana Medicare |
$12,557.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,557.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13,813.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,557.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,557.50
|
| Rate for Payer: University Health Alliance Commercial |
$24,500.00
|
|
|
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
|
Facility
|
OP
|
$24,500.00
|
|
|
Service Code
|
CPT 58550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$24,500.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,484.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,902.37
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$24,500.00
|
|
|
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$24,500.00
|
|
|
Service Code
|
CPT 58552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$24,500.00 |
| Rate for Payer: AlohaCare Medicaid |
$12,557.50
|
| Rate for Payer: AlohaCare Medicare |
$12,557.50
|
| Rate for Payer: Devoted Health Medicare |
$13,813.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,484.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12,557.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,902.37
|
| Rate for Payer: Humana Medicare |
$12,557.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,557.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13,813.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,557.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,557.50
|
| Rate for Payer: University Health Alliance Commercial |
$24,500.00
|
|
|
Lap Bluntport Plus (Hassan) BPT12STS [3602933]
|
Facility
|
IP
|
$425.03
|
|
| Hospital Charge Code |
3602933
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.28 |
| Max. Negotiated Rate |
$412.28 |
| Rate for Payer: Cash Price |
$276.27
|
| Rate for Payer: Health Management Network Commercial |
$361.28
|
| Rate for Payer: MDX Hawaii PPO |
$412.28
|
|
|
Lap Bluntport Plus (Hassan) BPT12STS [3602933]
|
Facility
|
OP
|
$425.03
|
|
| Hospital Charge Code |
3602933
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.77 |
| Max. Negotiated Rate |
$412.28 |
| Rate for Payer: Cash Price |
$276.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$403.78
|
| Rate for Payer: Health Management Network Commercial |
$361.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$216.77
|
| Rate for Payer: MDX Hawaii PPO |
$412.28
|
| Rate for Payer: University Health Alliance Commercial |
$309.80
|
|
|
Lap Cath Cholangiogram Aerostat Rigid C1002 [3600509]
|
Facility
|
IP
|
$577.75
|
|
| Hospital Charge Code |
3600509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.09 |
| Max. Negotiated Rate |
$560.42 |
| Rate for Payer: Cash Price |
$375.54
|
| Rate for Payer: Health Management Network Commercial |
$491.09
|
| Rate for Payer: MDX Hawaii PPO |
$560.42
|
|
|
Lap Cath Cholangiogram Aerostat Rigid C1002 [3600509]
|
Facility
|
OP
|
$577.75
|
|
| Hospital Charge Code |
3600509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.65 |
| Max. Negotiated Rate |
$560.42 |
| Rate for Payer: Cash Price |
$375.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$548.86
|
| Rate for Payer: Health Management Network Commercial |
$491.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$363.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$294.65
|
| Rate for Payer: MDX Hawaii PPO |
$560.42
|
| Rate for Payer: University Health Alliance Commercial |
$421.12
|
|
|
Lap Cath Cholangiogram Taut 20018010 [3602941]
|
Facility
|
OP
|
$424.23
|
|
| Hospital Charge Code |
3602941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.36 |
| Max. Negotiated Rate |
$411.50 |
| Rate for Payer: Cash Price |
$275.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$403.02
|
| Rate for Payer: Health Management Network Commercial |
$360.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$216.36
|
| Rate for Payer: MDX Hawaii PPO |
$411.50
|
| Rate for Payer: University Health Alliance Commercial |
$309.22
|
|
|
Lap Cath Cholangiogram Taut 20018010 [3602941]
|
Facility
|
IP
|
$424.23
|
|
| Hospital Charge Code |
3602941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.60 |
| Max. Negotiated Rate |
$411.50 |
| Rate for Payer: Cash Price |
$275.75
|
| Rate for Payer: Health Management Network Commercial |
$360.60
|
| Rate for Payer: MDX Hawaii PPO |
$411.50
|
|
