|
42999 Throat, adenoids, or tonsils procedure
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
HCPCS 42999
|
| Hospital Charge Code |
8729079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$786.00
|
| Rate for Payer: Cash Price |
$1,021.80
|
| Rate for Payer: Cash Price |
$1,021.80
|
| Rate for Payer: Cash Price |
$1,021.80
|
| Rate for Payer: Devoted Health Medicare |
$864.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$786.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,493.40
|
| Rate for Payer: Health Management Network Commercial |
$1,336.20
|
| Rate for Payer: Humana Medicare |
$786.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,414.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$786.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,524.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$786.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$786.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$786.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,145.83
|
|
|
43215 Esophagoscopy, flexible, transoral; with removal of foreign body
|
Professional
|
Both
|
$2,671.00
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
8039246
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.47 |
| Max. Negotiated Rate |
$2,270.35 |
| Rate for Payer: AlohaCare Medicaid |
$140.72
|
| Rate for Payer: AlohaCare Medicare |
$127.47
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Devoted Health Medicare |
$140.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$140.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$266.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$140.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$155.48
|
| Rate for Payer: Health Management Network Commercial |
$2,270.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$140.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.47
|
| Rate for Payer: University Health Alliance Commercial |
$190.47
|
|
|
43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, collection of specimen brsh/floss
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
8039254
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.90 |
| Max. Negotiated Rate |
$1,072.70 |
| Rate for Payer: AlohaCare Medicaid |
$123.38
|
| Rate for Payer: AlohaCare Medicare |
$111.90
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Devoted Health Medicare |
$123.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$123.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$238.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$123.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$232.96
|
| Rate for Payer: Health Management Network Commercial |
$1,072.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.90
|
|
|
43237 Endoscopic US Exam Esoph TechFee
|
Facility
|
IP
|
$5,660.00
|
|
|
Service Code
|
HCPCS 43237
|
| Hospital Charge Code |
8343978
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,811.00 |
| Max. Negotiated Rate |
$5,490.20 |
| Rate for Payer: Cash Price |
$3,679.00
|
| Rate for Payer: Health Management Network Commercial |
$4,811.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,094.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,490.20
|
|
|
43237 Endoscopic US Exam Esoph TechFee
|
Facility
|
OP
|
$5,660.00
|
|
|
Service Code
|
HCPCS 43237
|
| Hospital Charge Code |
8343978
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$901.48
|
| Rate for Payer: AlohaCare Medicare |
$2,830.00
|
| Rate for Payer: Cash Price |
$3,679.00
|
| Rate for Payer: Cash Price |
$3,679.00
|
| Rate for Payer: Devoted Health Medicare |
$3,113.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,830.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,377.00
|
| Rate for Payer: Health Management Network Commercial |
$4,811.00
|
| Rate for Payer: Humana Medicare |
$2,830.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,094.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,830.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,490.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,830.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,830.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,830.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
8039256
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$124.82 |
| Max. Negotiated Rate |
$1,072.70 |
| Rate for Payer: AlohaCare Medicaid |
$139.09
|
| Rate for Payer: AlohaCare Medicare |
$124.82
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Devoted Health Medicare |
$137.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$139.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$282.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$139.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$256.36
|
| Rate for Payer: Health Management Network Commercial |
$1,072.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.82
|
|
|
43241 Esophagogastroduodenoscopy, flexible, transoral; w/ insertion of intraluminal tube or catheter
|
Professional
|
Both
|
$2,671.00
|
|
|
Service Code
|
HCPCS 43241
|
| Hospital Charge Code |
8039257
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$2,270.35 |
| Rate for Payer: AlohaCare Medicaid |
$142.21
|
| Rate for Payer: AlohaCare Medicare |
$127.60
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Devoted Health Medicare |
$140.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.46
|
| Rate for Payer: Health Management Network Commercial |
$2,270.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.60
|
|
|
43245 Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s
|
Professional
|
Both
|
$2,671.00
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
8039260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.94 |
| Max. Negotiated Rate |
$2,270.35 |
| Rate for Payer: AlohaCare Medicaid |
$174.62
|
| Rate for Payer: AlohaCare Medicare |
$156.94
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Devoted Health Medicare |
$172.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$174.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$312.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$156.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.48
|
| Rate for Payer: Health Management Network Commercial |
$2,270.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$172.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$172.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$172.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$156.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$174.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$156.94
|
|
|
43246 Esophagogastroduodenoscopy, flxble, transoral; w/ directed placemt of percutaneous gastro tube
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
8039261
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$177.04 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: AlohaCare Medicaid |
$198.00
|
| Rate for Payer: AlohaCare Medicare |
$177.04
|
| Rate for Payer: Cash Price |
$464.75
|
| Rate for Payer: Cash Price |
$464.75
|
| Rate for Payer: Devoted Health Medicare |
$194.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.72
|
| Rate for Payer: Health Management Network Commercial |
$607.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$194.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$198.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.04
|
|
|
43247-EGD w/ Removal Foreign Body
|
Facility
|
OP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
8080207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$901.48
|
| Rate for Payer: AlohaCare Medicare |
$2,267.50
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Devoted Health Medicare |
$2,494.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,267.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,308.25
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Humana Medicare |
$2,267.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,081.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,267.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,267.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,267.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,267.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
43247-EGD w/ Removal Foreign Body
|
Facility
|
IP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
8080207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,854.75 |
| Max. Negotiated Rate |
$4,398.95 |
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,081.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
|
|
43247 Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
8039262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$157.92 |
| Max. Negotiated Rate |
$1,072.70 |
| Rate for Payer: AlohaCare Medicaid |
$176.40
|
| Rate for Payer: AlohaCare Medicare |
$157.92
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Devoted Health Medicare |
$173.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$176.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$331.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$176.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$258.96
|
| Rate for Payer: Health Management Network Commercial |
$1,072.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.92
|
|
|
43249 Esophagogastroduodenoscop >30 mm diameter, balloon dilation of esophagus
|
Professional
|
Both
|
$2,671.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
8039264
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.46 |
| Max. Negotiated Rate |
$2,270.35 |
| Rate for Payer: AlohaCare Medicaid |
$153.75
|
| Rate for Payer: AlohaCare Medicare |
$137.46
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Devoted Health Medicare |
$151.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$153.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$286.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$153.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$221.00
|
| Rate for Payer: Health Management Network Commercial |
$2,270.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$153.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.46
|
|
|
43264 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF CALCULI/DEBRIS ProFee
|
Professional
|
Both
|
$5,366.00
|
|
|
Service Code
|
HCPCS 43264
|
| Hospital Charge Code |
8019803
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,561.10 |
| Rate for Payer: AlohaCare Medicaid |
$361.48
|
| Rate for Payer: AlohaCare Medicare |
$317.80
|
| Rate for Payer: Cash Price |
$3,487.90
|
| Rate for Payer: Cash Price |
$3,487.90
|
| Rate for Payer: Devoted Health Medicare |
$349.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$317.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$638.82
|
| Rate for Payer: Health Management Network Commercial |
$4,561.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$349.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$349.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$349.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$361.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$317.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$361.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$317.80
|
|
|
43273 ENDOSCOPIC CANNULATION OF PAPILLA WITH DIRECT VISUALIZATION OF PANCREATIC/COMMON BILE ProFee
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 43273
|
| Hospital Charge Code |
8019807
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: AlohaCare Medicaid |
$117.67
|
| Rate for Payer: AlohaCare Medicare |
$101.57
|
| Rate for Payer: Cash Price |
$111.80
|
| Rate for Payer: Cash Price |
$111.80
|
| Rate for Payer: Devoted Health Medicare |
$111.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$124.80
|
| Rate for Payer: Health Management Network Commercial |
$146.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$117.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.57
|
|
|
43752-Insertion NG tube
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
8080209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$269.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$269.00
|
| Rate for Payer: Cash Price |
$349.70
|
| Rate for Payer: Cash Price |
$349.70
|
| Rate for Payer: Cash Price |
$349.70
|
| Rate for Payer: Devoted Health Medicare |
$295.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$511.10
|
| Rate for Payer: Health Management Network Commercial |
$457.30
|
| Rate for Payer: Humana Medicare |
$269.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$484.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$269.00
|
| Rate for Payer: MDX Hawaii PPO |
$521.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$269.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.00
|
| Rate for Payer: University Health Alliance Commercial |
$392.15
|
|
|
43752-Insertion NG tube
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
8080209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$457.30 |
| Max. Negotiated Rate |
$521.86 |
| Rate for Payer: Cash Price |
$349.70
|
| Rate for Payer: Health Management Network Commercial |
$457.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$484.20
|
| Rate for Payer: MDX Hawaii PPO |
$521.86
|
|
|
43752 Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
8039312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: AlohaCare Medicaid |
$39.16
|
| Rate for Payer: AlohaCare Medicare |
$33.82
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Devoted Health Medicare |
$37.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.04
|
| Rate for Payer: Health Management Network Commercial |
$528.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.82
|
|
|
43753 Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
HCPCS 43753
|
| Hospital Charge Code |
8039313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$485.35 |
| Max. Negotiated Rate |
$553.87 |
| Rate for Payer: Cash Price |
$371.15
|
| Rate for Payer: Health Management Network Commercial |
$485.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$513.90
|
| Rate for Payer: MDX Hawaii PPO |
$553.87
|
|
|
43753 Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 43753
|
| Hospital Charge Code |
8039313
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$255.85 |
| Rate for Payer: AlohaCare Medicaid |
$20.68
|
| Rate for Payer: AlohaCare Medicare |
$19.66
|
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Devoted Health Medicare |
$21.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.66
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.66
|
|
|
43753 Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
HCPCS 43753
|
| Hospital Charge Code |
8039313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$285.50
|
| Rate for Payer: AlohaCare Medicare |
$285.50
|
| Rate for Payer: Cash Price |
$371.15
|
| Rate for Payer: Cash Price |
$371.15
|
| Rate for Payer: Cash Price |
$371.15
|
| Rate for Payer: Devoted Health Medicare |
$314.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$285.50
|
| Rate for Payer: Health Management Network Commercial |
$485.35
|
| Rate for Payer: Humana Medicare |
$285.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$513.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$285.50
|
| Rate for Payer: MDX Hawaii PPO |
$553.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$285.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$285.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$285.50
|
| Rate for Payer: University Health Alliance Commercial |
$416.20
|
|
|
43753-Gastric Intubation w/ Lavage
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS 43753
|
| Hospital Charge Code |
8080211
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$355.00
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Devoted Health Medicare |
$390.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$355.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$674.50
|
| Rate for Payer: Health Management Network Commercial |
$603.50
|
| Rate for Payer: Humana Medicare |
$355.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$639.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.00
|
| Rate for Payer: MDX Hawaii PPO |
$688.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$355.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$355.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$355.00
|
| Rate for Payer: University Health Alliance Commercial |
$517.52
|
|
|
43753-Gastric Intubation w/ Lavage
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS 43753
|
| Hospital Charge Code |
8080211
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$603.50 |
| Max. Negotiated Rate |
$688.70 |
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Health Management Network Commercial |
$603.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$639.00
|
| Rate for Payer: MDX Hawaii PPO |
$688.70
|
|
|
43753 GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE TechFee
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 43753
|
| Hospital Charge Code |
8211324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$756.60 |
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Health Management Network Commercial |
$663.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$702.00
|
| Rate for Payer: MDX Hawaii PPO |
$756.60
|
|
|
43753 GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE TechFee
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 43753
|
| Hospital Charge Code |
8211324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$390.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Devoted Health Medicare |
$429.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$390.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$741.00
|
| Rate for Payer: Health Management Network Commercial |
$663.00
|
| Rate for Payer: Humana Medicare |
$390.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$702.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$390.00
|
| Rate for Payer: MDX Hawaii PPO |
$756.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$390.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$390.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$390.00
|
| Rate for Payer: University Health Alliance Commercial |
$568.54
|
|
