|
43760 CHANGE GASTROSTOMY TUBE
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
8258856
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$421.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$421.00
|
| Rate for Payer: Cash Price |
$547.30
|
| Rate for Payer: Cash Price |
$547.30
|
| Rate for Payer: Cash Price |
$547.30
|
| Rate for Payer: Devoted Health Medicare |
$463.10
|
| 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 |
$421.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$799.90
|
| Rate for Payer: Health Management Network Commercial |
$715.70
|
| Rate for Payer: Humana Medicare |
$421.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$757.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$421.00
|
| Rate for Payer: MDX Hawaii PPO |
$816.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$421.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$421.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$421.00
|
| Rate for Payer: University Health Alliance Commercial |
$613.73
|
|
|
43760 CHANGE GASTROSTOMY TUBE
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
8258856
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$715.70 |
| Max. Negotiated Rate |
$816.74 |
| Rate for Payer: Cash Price |
$547.30
|
| Rate for Payer: Health Management Network Commercial |
$715.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$757.80
|
| Rate for Payer: MDX Hawaii PPO |
$816.74
|
|
|
43760-Gastrostomy Tube Change
|
Facility
|
OP
|
$742.00
|
|
| Hospital Charge Code |
8080213
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$371.00
|
| Rate for Payer: Cash Price |
$482.30
|
| Rate for Payer: Cash Price |
$482.30
|
| Rate for Payer: Cash Price |
$482.30
|
| Rate for Payer: Devoted Health Medicare |
$408.10
|
| 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 |
$371.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$704.90
|
| Rate for Payer: Health Management Network Commercial |
$630.70
|
| Rate for Payer: Humana Medicare |
$371.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$667.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$371.00
|
| Rate for Payer: MDX Hawaii PPO |
$719.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$371.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$371.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$371.00
|
| Rate for Payer: University Health Alliance Commercial |
$540.84
|
|
|
43760-Gastrostomy Tube Change
|
Facility
|
IP
|
$742.00
|
|
| Hospital Charge Code |
8080213
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$630.70 |
| Max. Negotiated Rate |
$719.74 |
| Rate for Payer: Cash Price |
$482.30
|
| Rate for Payer: Health Management Network Commercial |
$630.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$667.80
|
| Rate for Payer: MDX Hawaii PPO |
$719.74
|
|
|
43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC ProFee
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
8859249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.98 |
| Max. Negotiated Rate |
$295.80 |
| Rate for Payer: AlohaCare Medicaid |
$35.99
|
| Rate for Payer: AlohaCare Medicare |
$32.98
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Devoted Health Medicare |
$36.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$60.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.54
|
| Rate for Payer: Health Management Network Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.98
|
|
|
43999 UNLISTED PROCEDURE, STOMACH ProFee
|
Professional
|
Both
|
$1,702.00
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
8019924
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,446.70 |
| Max. Negotiated Rate |
$1,446.70 |
| Rate for Payer: Cash Price |
$1,106.30
|
| Rate for Payer: Health Management Network Commercial |
$1,446.70
|
|
|
44005 Enterolysis (freeing of intestinal adhesion) (separate procedure)
|
Professional
|
Both
|
$3,065.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
8039330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$852.28 |
| Max. Negotiated Rate |
$2,605.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,071.82
|
| Rate for Payer: AlohaCare Medicare |
$993.21
|
| Rate for Payer: Cash Price |
$1,992.25
|
| Rate for Payer: Cash Price |
$1,992.25
|
| Rate for Payer: Devoted Health Medicare |
$1,092.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$993.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$852.28
|
| Rate for Payer: Health Management Network Commercial |
$2,605.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,092.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,092.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,092.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,071.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$993.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,071.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$993.21
|
|
|
44021 Enterotomy, small intestine, other than duodenum; for decompression
|
Professional
|
Both
|
$2,662.00
|
|
|
Service Code
|
HCPCS 44021
|
| Hospital Charge Code |
8039334
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$562.12 |
| Max. Negotiated Rate |
$2,262.70 |
| Rate for Payer: AlohaCare Medicaid |
$955.36
|
| Rate for Payer: AlohaCare Medicare |
$886.79
|
| Rate for Payer: Cash Price |
$1,730.30
|
| Rate for Payer: Cash Price |
$1,730.30
|
| Rate for Payer: Devoted Health Medicare |
$975.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$886.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$562.12
|
| Rate for Payer: Health Management Network Commercial |
$2,262.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$975.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$975.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$975.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$955.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$886.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$955.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$886.79
|
|
|
44055 Correction of malrotation by lysis of duodenal bands and/or reduction of midgut volvulus
|
Professional
|
Both
|
$3,888.00
|
|
|
Service Code
|
HCPCS 44055
|
| Hospital Charge Code |
8039337
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$611.00 |
| Max. Negotiated Rate |
$3,304.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,453.85
|
| Rate for Payer: AlohaCare Medicare |
$1,334.03
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Devoted Health Medicare |
$1,467.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,334.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$611.00
|
| Rate for Payer: Health Management Network Commercial |
$3,304.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,467.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,467.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,467.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,453.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,334.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,453.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,334.03
|
|
|
44130 Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy
|
Professional
|
Both
|
$3,497.00
|
|
|
Service Code
|
HCPCS 44130
|
| Hospital Charge Code |
8039342
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$619.32 |
| Max. Negotiated Rate |
$2,972.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,294.90
|
| Rate for Payer: AlohaCare Medicare |
$1,201.26
|
| Rate for Payer: Cash Price |
$2,273.05
|
| Rate for Payer: Cash Price |
$2,273.05
|
| Rate for Payer: Devoted Health Medicare |
$1,321.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,201.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$619.32
|
| Rate for Payer: Health Management Network Commercial |
$2,972.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,321.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,321.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,321.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,294.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,201.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,294.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,201.26
|
|
|
44139 Mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 44139
|
| Hospital Charge Code |
8039343
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$102.46 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: AlohaCare Medicaid |
$115.31
|
| Rate for Payer: AlohaCare Medicare |
$102.46
|
| Rate for Payer: Cash Price |
$211.90
|
| Rate for Payer: Cash Price |
$211.90
|
| Rate for Payer: Devoted Health Medicare |
$112.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.00
|
| Rate for Payer: Health Management Network Commercial |
$277.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$112.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.46
|
|
|
44141 Colectomy, partial; with skin level cecostomy or colostomy
|
Professional
|
Both
|
$4,702.00
|
|
|
Service Code
|
HCPCS 44141
|
| Hospital Charge Code |
8039345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$939.38 |
| Max. Negotiated Rate |
$3,996.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,784.74
|
| Rate for Payer: AlohaCare Medicare |
$1,655.89
|
| Rate for Payer: Cash Price |
$3,056.30
|
| Rate for Payer: Cash Price |
$3,056.30
|
| Rate for Payer: Devoted Health Medicare |
$1,821.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,655.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$939.38
|
| Rate for Payer: Health Management Network Commercial |
$3,996.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,821.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,821.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,821.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,784.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,655.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,784.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,655.89
|
|
|
44150 Removal of Colon TechFee
|
Facility
|
OP
|
$1,877.00
|
|
|
Service Code
|
HCPCS 44150
|
| Hospital Charge Code |
8343979
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,820.69 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$938.50
|
| Rate for Payer: Cash Price |
$1,220.05
|
| Rate for Payer: Cash Price |
$1,220.05
|
| Rate for Payer: Cash Price |
$1,220.05
|
| Rate for Payer: Devoted Health Medicare |
$1,032.35
|
| 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 |
$938.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,783.15
|
| Rate for Payer: Health Management Network Commercial |
$1,595.45
|
| Rate for Payer: Humana Medicare |
$938.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,689.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$938.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,820.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$938.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$938.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$938.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,368.15
|
|
|
44150 Removal of Colon TechFee
|
Facility
|
IP
|
$1,877.00
|
|
|
Service Code
|
HCPCS 44150
|
| Hospital Charge Code |
8343979
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,595.45 |
| Max. Negotiated Rate |
$1,820.69 |
| Rate for Payer: Cash Price |
$1,220.05
|
| Rate for Payer: Health Management Network Commercial |
$1,595.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,689.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,820.69
|
|
|
44160 Colectomy, partial, with removal of terminal ileum with ileocolostomy
|
Professional
|
Both
|
$3,320.00
|
|
|
Service Code
|
HCPCS 44160
|
| Hospital Charge Code |
8039353
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$831.22 |
| Max. Negotiated Rate |
$2,822.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,223.11
|
| Rate for Payer: AlohaCare Medicare |
$1,131.36
|
| Rate for Payer: Cash Price |
$2,158.00
|
| Rate for Payer: Cash Price |
$2,158.00
|
| Rate for Payer: Devoted Health Medicare |
$1,244.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,131.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$831.22
|
| Rate for Payer: Health Management Network Commercial |
$2,822.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,244.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,244.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,244.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,223.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,131.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,223.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,131.36
|
|
|
44180 Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
|
Professional
|
Both
|
$8,414.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
8039354
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$806.26 |
| Max. Negotiated Rate |
$7,151.90 |
| Rate for Payer: AlohaCare Medicaid |
$907.45
|
| Rate for Payer: AlohaCare Medicare |
$844.07
|
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Devoted Health Medicare |
$928.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$844.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$806.26
|
| Rate for Payer: Health Management Network Commercial |
$7,151.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$928.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$928.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$928.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$907.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$844.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$907.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$844.07
|
|
|
44204 Laparoscopy, surgical; colectomy, partial, with anastomosis
|
Professional
|
Both
|
$4,022.00
|
|
|
Service Code
|
HCPCS 44204
|
| Hospital Charge Code |
8039358
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,359.80 |
| Max. Negotiated Rate |
$3,418.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,508.54
|
| Rate for Payer: AlohaCare Medicare |
$1,381.76
|
| Rate for Payer: Cash Price |
$2,614.30
|
| Rate for Payer: Cash Price |
$2,614.30
|
| Rate for Payer: Devoted Health Medicare |
$1,519.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,381.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,359.80
|
| Rate for Payer: Health Management Network Commercial |
$3,418.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,519.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,519.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,519.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,508.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,381.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,508.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,381.76
|
|
|
44372 Small intestinal endoscopy, enteroscopy beyond second portio
|
Professional
|
Both
|
$1,176.00
|
|
|
Service Code
|
HCPCS 44372
|
| Hospital Charge Code |
12571383
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$211.73 |
| Max. Negotiated Rate |
$999.60 |
| Rate for Payer: AlohaCare Medicaid |
$237.74
|
| Rate for Payer: AlohaCare Medicare |
$211.73
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Devoted Health Medicare |
$232.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$211.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.46
|
| Rate for Payer: Health Management Network Commercial |
$999.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$232.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$232.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$232.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$237.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$211.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$237.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$211.73
|
|
|
44701 INTRAOPERATIVE COLONIC LAVAGE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDU ProFee
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 44701
|
| Hospital Charge Code |
8020042
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.26 |
| Max. Negotiated Rate |
$202.30 |
| Rate for Payer: AlohaCare Medicaid |
$161.55
|
| Rate for Payer: AlohaCare Medicare |
$144.26
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$158.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.26
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.26
|
|
|
44899 UNLISTED PROCEDURE, MECKEL'S DIVERTICULUM AND THE MESENTERY ProFee
|
Professional
|
Both
|
$3,583.00
|
|
|
Service Code
|
HCPCS 44899
|
| Hospital Charge Code |
8020051
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$3,045.55 |
| Max. Negotiated Rate |
$3,045.55 |
| Rate for Payer: Cash Price |
$2,328.95
|
| Rate for Payer: Health Management Network Commercial |
$3,045.55
|
|
|
44950 Appendectomy;
|
Professional
|
Both
|
$9,010.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
8039405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$525.20 |
| Max. Negotiated Rate |
$7,658.50 |
| Rate for Payer: AlohaCare Medicaid |
$635.28
|
| Rate for Payer: AlohaCare Medicare |
$592.56
|
| Rate for Payer: Cash Price |
$5,856.50
|
| Rate for Payer: Cash Price |
$5,856.50
|
| Rate for Payer: Devoted Health Medicare |
$651.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$592.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$525.20
|
| Rate for Payer: Health Management Network Commercial |
$7,658.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$651.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$651.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$651.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$635.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$592.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$635.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$592.56
|
|
|
44970 Laparoscopy, surgical, appendectomy
|
Professional
|
Both
|
$2,106.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
8039408
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$485.68 |
| Max. Negotiated Rate |
$1,790.10 |
| Rate for Payer: AlohaCare Medicaid |
$602.67
|
| Rate for Payer: AlohaCare Medicare |
$570.88
|
| Rate for Payer: Cash Price |
$1,368.90
|
| Rate for Payer: Cash Price |
$1,368.90
|
| Rate for Payer: Devoted Health Medicare |
$627.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$570.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$485.68
|
| Rate for Payer: Health Management Network Commercial |
$1,790.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$627.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$627.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$627.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$602.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$570.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$602.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$570.88
|
|
|
45100 Biopsy of anorectal wall, anal approach (eg, congenital megacolon)
|
Professional
|
Both
|
$3,863.00
|
|
|
Service Code
|
HCPCS 45100
|
| Hospital Charge Code |
8039411
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$3,283.55 |
| Rate for Payer: AlohaCare Medicaid |
$316.39
|
| Rate for Payer: AlohaCare Medicare |
$311.12
|
| Rate for Payer: Cash Price |
$2,510.95
|
| Rate for Payer: Cash Price |
$2,510.95
|
| Rate for Payer: Devoted Health Medicare |
$342.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$311.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.00
|
| Rate for Payer: Health Management Network Commercial |
$3,283.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$342.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$342.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$342.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$311.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$311.12
|
|
|
45330 Sigmoidoscopy, flexible; dx, with or without collection of specimen(s) by brushing or washing
|
Professional
|
Both
|
$1,294.00
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
8039426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.15 |
| Max. Negotiated Rate |
$1,099.90 |
| Rate for Payer: AlohaCare Medicaid |
$58.12
|
| Rate for Payer: AlohaCare Medicare |
$55.15
|
| Rate for Payer: Cash Price |
$841.10
|
| Rate for Payer: Cash Price |
$841.10
|
| Rate for Payer: Devoted Health Medicare |
$60.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$95.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$118.04
|
| Rate for Payer: Health Management Network Commercial |
$1,099.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.15
|
| Rate for Payer: University Health Alliance Commercial |
$72.43
|
|
|
45331 Sigmoidoscopy, flexible; with biopsy, single or multiple
|
Professional
|
Both
|
$1,294.00
|
|
|
Service Code
|
HCPCS 45331
|
| Hospital Charge Code |
8039427
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$68.27 |
| Max. Negotiated Rate |
$1,099.90 |
| Rate for Payer: AlohaCare Medicaid |
$73.64
|
| Rate for Payer: AlohaCare Medicare |
$68.27
|
| Rate for Payer: Cash Price |
$841.10
|
| Rate for Payer: Cash Price |
$841.10
|
| Rate for Payer: Devoted Health Medicare |
$75.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$121.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$73.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$141.96
|
| Rate for Payer: Health Management Network Commercial |
$1,099.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.27
|
| Rate for Payer: University Health Alliance Commercial |
$91.58
|
|
