|
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
|
521
|
| 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: Cash Price |
$404.30
|
| Rate for Payer: Devoted Health Medicare |
$37.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| 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 |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
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 |
$40.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.58
|
| 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
|
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 |
$319.76
|
|
|
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 |
$23.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.59
|
| 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 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 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 |
$355.00
|
| Rate for Payer: AlohaCare Medicare |
$355.00
|
| 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 |
$469.00
|
| 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 |
$450.00
|
| 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 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 |
$390.00
|
| Rate for Payer: AlohaCare Medicare |
$390.00
|
| 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 |
$469.00
|
| 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 |
$450.00
|
| 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
|
|
|
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
|
|
|
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 |
$421.00
|
| Rate for Payer: AlohaCare Medicare |
$421.00
|
| 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 |
$469.00
|
| 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 |
$450.00
|
| 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 |
$371.00
|
| Rate for Payer: AlohaCare Medicare |
$371.00
|
| 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 |
$469.00
|
| 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 |
$450.00
|
| 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 |
$56.58
|
| 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 |
$39.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.58
|
| 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
|
|
|
43762 RPLC GTUBE NO REVJ TRC
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
9902181
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$32.98 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$35.99
|
| Rate for Payer: AlohaCare Medicare |
$32.98
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Devoted Health Medicare |
$36.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$56.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.54
|
| Rate for Payer: Health Management Network Commercial |
$321.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
43773 Laparoscopy, gastric restrictive procedure; removal & replacement of adjustable gastric restri
|
Professional
|
Both
|
$8,414.00
|
|
|
Service Code
|
HCPCS 43773
|
| Hospital Charge Code |
8039315
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$7,151.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,261.63
|
| Rate for Payer: AlohaCare Medicare |
$1,177.57
|
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Devoted Health Medicare |
$1,295.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Health Management Network Commercial |
$7,151.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,413.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,261.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,177.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
|
|
43774 Laparoscopy, gastric restrictive procedure; removal of adj gastric restrictive device and subq
|
Professional
|
Both
|
$5,366.00
|
|
|
Service Code
|
HCPCS 43774
|
| Hospital Charge Code |
8039316
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,561.10 |
| Rate for Payer: AlohaCare Medicaid |
$948.50
|
| Rate for Payer: AlohaCare Medicare |
$885.64
|
| Rate for Payer: Cash Price |
$3,487.90
|
| Rate for Payer: Cash Price |
$3,487.90
|
| Rate for Payer: Cash Price |
$3,487.90
|
| Rate for Payer: Devoted Health Medicare |
$974.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Health Management Network Commercial |
$4,561.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,062.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$948.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$885.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
|
|
43800 Pyloroplasty
|
Professional
|
Both
|
$2,508.00
|
|
|
Service Code
|
HCPCS 43800
|
| Hospital Charge Code |
8039318
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$2,131.80 |
| Rate for Payer: AlohaCare Medicaid |
$916.34
|
| Rate for Payer: AlohaCare Medicare |
$851.91
|
| Rate for Payer: Cash Price |
$1,630.20
|
| Rate for Payer: Cash Price |
$1,630.20
|
| Rate for Payer: Cash Price |
$1,630.20
|
| Rate for Payer: Devoted Health Medicare |
$937.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$511.16
|
| Rate for Payer: Health Management Network Commercial |
$2,131.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,022.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$916.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$851.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
43810 Gastroduodenostomy
|
Professional
|
Both
|
$2,729.00
|
|
|
Service Code
|
HCPCS 43810
|
| Hospital Charge Code |
8039319
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$2,319.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,000.17
|
| Rate for Payer: AlohaCare Medicare |
$929.57
|
| Rate for Payer: Cash Price |
$1,773.85
|
| Rate for Payer: Cash Price |
$1,773.85
|
| Rate for Payer: Cash Price |
$1,773.85
|
| Rate for Payer: Devoted Health Medicare |
$1,022.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$554.06
|
| Rate for Payer: Health Management Network Commercial |
$2,319.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,115.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,000.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$929.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
43820 Gastrojejunostomy; without vagotomy
|
Professional
|
Both
|
$3,567.00
|
|
|
Service Code
|
HCPCS 43820
|
| Hospital Charge Code |
8039320
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$3,031.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,323.27
|
| Rate for Payer: AlohaCare Medicare |
$1,224.90
|
| Rate for Payer: Cash Price |
$2,318.55
|
| Rate for Payer: Cash Price |
$2,318.55
|
| Rate for Payer: Cash Price |
$2,318.55
|
| Rate for Payer: Devoted Health Medicare |
$1,347.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$773.50
|
| Rate for Payer: Health Management Network Commercial |
$3,031.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,469.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,323.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,224.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
43825 Gastrojejunostomy; with vagotomy, any type
|
Professional
|
Both
|
$3,482.00
|
|
|
Service Code
|
HCPCS 43825
|
| Hospital Charge Code |
8039321
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$2,959.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,288.83
|
| Rate for Payer: AlohaCare Medicare |
$1,196.10
|
| Rate for Payer: Cash Price |
$2,263.30
|
| Rate for Payer: Cash Price |
$2,263.30
|
| Rate for Payer: Cash Price |
$2,263.30
|
| Rate for Payer: Devoted Health Medicare |
$1,315.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$754.00
|
| Rate for Payer: Health Management Network Commercial |
$2,959.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,435.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,288.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,196.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
43830 Gastrostomy, open; without construction of gastric tube (eg, Stamm procedure)â€
|
Professional
|
Both
|
$2,671.00
|
|
|
Service Code
|
HCPCS 43830
|
| Hospital Charge Code |
8039322
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$2,270.35 |
| Rate for Payer: AlohaCare Medicaid |
$704.39
|
| Rate for Payer: AlohaCare Medicare |
$670.29
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Cash Price |
$1,736.15
|
| Rate for Payer: Devoted Health Medicare |
$737.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$521.56
|
| Rate for Payer: Health Management Network Commercial |
$2,270.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$804.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$704.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$670.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
43832 Gastrostomy, open; with construction of gastric tube (eg, Janeway procedure)
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 43832
|
| Hospital Charge Code |
8039323
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$2,422.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,031.92
|
| Rate for Payer: AlohaCare Medicare |
$962.06
|
| Rate for Payer: Cash Price |
$1,852.50
|
| Rate for Payer: Cash Price |
$1,852.50
|
| Rate for Payer: Cash Price |
$1,852.50
|
| Rate for Payer: Devoted Health Medicare |
$1,058.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$580.32
|
| Rate for Payer: Health Management Network Commercial |
$2,422.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,154.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,031.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$962.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
43840 Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury
|
Professional
|
Both
|
$5,366.00
|
|
|
Service Code
|
HCPCS 43840
|
| Hospital Charge Code |
8039324
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,561.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,336.28
|
| Rate for Payer: AlohaCare Medicare |
$1,238.26
|
| Rate for Payer: Cash Price |
$3,487.90
|
| Rate for Payer: Cash Price |
$3,487.90
|
| Rate for Payer: Cash Price |
$3,487.90
|
| Rate for Payer: Devoted Health Medicare |
$1,362.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$537.94
|
| Rate for Payer: Health Management Network Commercial |
$4,561.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,485.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,336.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,238.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
43847 Gastric restrictive procedure, with gastric bypass for morbid obesity
|
Professional
|
Both
|
$4,669.00
|
|
|
Service Code
|
HCPCS 43847
|
| Hospital Charge Code |
8039325
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$3,968.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,771.68
|
| Rate for Payer: AlohaCare Medicare |
$1,637.03
|
| Rate for Payer: Cash Price |
$3,034.85
|
| Rate for Payer: Cash Price |
$3,034.85
|
| Rate for Payer: Cash Price |
$3,034.85
|
| Rate for Payer: Devoted Health Medicare |
$1,800.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,083.16
|
| Rate for Payer: Health Management Network Commercial |
$3,968.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,964.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,771.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,637.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
