|
HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
|
IP
|
$57,643.26
|
|
|
Service Code
|
MSDRG 975
|
| Min. Negotiated Rate |
$57,643.26 |
| Max. Negotiated Rate |
$57,643.26 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57,643.26
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
|
IP
|
$57,643.26
|
|
|
Service Code
|
MSDRG 974
|
| Min. Negotiated Rate |
$57,643.26 |
| Max. Negotiated Rate |
$57,643.26 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57,643.26
|
|
|
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
|
IP
|
$57,643.26
|
|
|
Service Code
|
MSDRG 976
|
| Min. Negotiated Rate |
$57,643.26 |
| Max. Negotiated Rate |
$57,643.26 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57,643.26
|
|
|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$41,431.10
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$41,431.10 |
| Max. Negotiated Rate |
$41,431.10 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$41,431.10
|
|
|
HL DRAINABLE POUCH BAG
|
Facility
|
OP
|
$579.00
|
|
| Hospital Charge Code |
8518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$243.18 |
| Max. Negotiated Rate |
$561.63 |
| Rate for Payer: AlohaCare Medicaid |
$289.50
|
| Rate for Payer: AlohaCare Medicare |
$243.18
|
| Rate for Payer: Cash Price |
$376.35
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$532.68
|
| Rate for Payer: Devoted Health Medicare |
$243.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$243.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$550.05
|
| Rate for Payer: Health Management Network Commercial |
$492.15
|
| Rate for Payer: Humana Medicare |
$243.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$521.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$295.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.18
|
| Rate for Payer: MDX Hawaii PPO |
$561.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.18
|
| Rate for Payer: University Health Alliance Commercial |
$422.03
|
|
|
HL DRAINABLE POUCH BAG
|
Facility
|
IP
|
$579.00
|
|
| Hospital Charge Code |
8518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$492.15 |
| Max. Negotiated Rate |
$561.63 |
| Rate for Payer: Cash Price |
$376.35
|
| Rate for Payer: Health Management Network Commercial |
$492.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$521.10
|
| Rate for Payer: MDX Hawaii PPO |
$561.63
|
|
|
HL DRAINABLE POUCH FLANGE
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
8519
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$121.25 |
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$121.25
|
|
|
HL DRAINABLE POUCH FLANGE
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
8519
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$121.25 |
| Rate for Payer: AlohaCare Medicaid |
$62.50
|
| Rate for Payer: AlohaCare Medicare |
$52.50
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$115.00
|
| Rate for Payer: Devoted Health Medicare |
$52.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$118.75
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Humana Medicare |
$52.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.50
|
| Rate for Payer: MDX Hawaii PPO |
$121.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.50
|
| Rate for Payer: University Health Alliance Commercial |
$91.11
|
|
|
Hme Vis For E&M Of New Pat,Req:Comp Hx,Exam;Med De
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 99345
|
| Hospital Charge Code |
435993450
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$205.73 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: AlohaCare Medicaid |
$205.73
|
| Rate for Payer: AlohaCare Medicare |
$216.46
|
| Rate for Payer: Cash Price |
$432.25
|
| Rate for Payer: Cash Price |
$432.25
|
| Rate for Payer: Devoted Health Medicare |
$216.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$216.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$220.97
|
| Rate for Payer: Health Management Network Commercial |
$565.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$259.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$216.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$216.46
|
|
|
Hm Vis For E&M Of Estab Pat,Req At Least 2:Comp In
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 99350
|
| Hospital Charge Code |
435993500
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$178.08 |
| Max. Negotiated Rate |
$456.45 |
| Rate for Payer: AlohaCare Medicaid |
$188.57
|
| Rate for Payer: AlohaCare Medicare |
$198.56
|
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Devoted Health Medicare |
$198.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.08
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.56
|
|
|
HO CF MP/DIP EX MP EXT Occupational
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
432L39190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.48 |
| Max. Negotiated Rate |
$444.26 |
| Rate for Payer: Cash Price |
$297.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$320.60
|
| Rate for Payer: Health Management Network Commercial |
$389.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$412.20
|
| Rate for Payer: MDX Hawaii PPO |
$444.26
|
| Rate for Payer: University Health Alliance Commercial |
$256.48
|
|
|
HO CF MP/DIP EX MP EXT Occupational
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
432L39190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.21 |
| Max. Negotiated Rate |
$444.26 |
| Rate for Payer: AlohaCare Medicaid |
$229.00
|
| Rate for Payer: AlohaCare Medicare |
$192.36
|
| Rate for Payer: Cash Price |
$297.70
|
| Rate for Payer: Cash Price |
$297.70
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$421.36
|
| Rate for Payer: Devoted Health Medicare |
$192.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$192.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$320.60
|
| Rate for Payer: Health Management Network Commercial |
$389.30
|
| Rate for Payer: Humana Medicare |
$192.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$412.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$233.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.36
|
| Rate for Payer: MDX Hawaii PPO |
$444.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$192.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$192.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$192.36
|
| Rate for Payer: University Health Alliance Commercial |
$256.48
|
|
|
HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 99350
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$436.90 |
| Rate for Payer: AlohaCare Medicaid |
$188.57
|
| Rate for Payer: AlohaCare Medicare |
$198.56
|
| Rate for Payer: Cash Price |
$334.10
|
| Rate for Payer: Cash Price |
$334.10
|
| Rate for Payer: Cash Price |
$334.10
|
| Rate for Payer: Devoted Health Medicare |
$198.56
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.08
|
| Rate for Payer: Health Management Network Commercial |
$436.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 99348
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$78.20
|
| Rate for Payer: AlohaCare Medicare |
$81.46
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Devoted Health Medicare |
$81.46
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.38
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 99349
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$96.63 |
| Max. Negotiated Rate |
$313.65 |
| Rate for Payer: AlohaCare Medicaid |
$129.72
|
| Rate for Payer: AlohaCare Medicare |
$136.24
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Devoted Health Medicare |
$136.24
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.63
|
| Rate for Payer: Health Management Network Commercial |
$313.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 99347
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$46.19
|
| Rate for Payer: AlohaCare Medicare |
$47.54
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Devoted Health Medicare |
$47.54
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.79
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 99345
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$538.90 |
| Rate for Payer: AlohaCare Medicaid |
$205.73
|
| Rate for Payer: AlohaCare Medicare |
$216.46
|
| Rate for Payer: Cash Price |
$412.10
|
| Rate for Payer: Cash Price |
$412.10
|
| Rate for Payer: Cash Price |
$412.10
|
| Rate for Payer: Devoted Health Medicare |
$216.46
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$220.97
|
| Rate for Payer: Health Management Network Commercial |
$538.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$216.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 99342
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$78.09 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$79.37
|
| Rate for Payer: AlohaCare Medicare |
$80.77
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$80.77
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.09
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 99344
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: AlohaCare Medicaid |
$144.42
|
| Rate for Payer: AlohaCare Medicare |
$150.60
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Devoted Health Medicare |
$150.60
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$136.23
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
Home Visit Level 1 Est - 99347
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 99347
|
| Hospital Charge Code |
435993470
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: AlohaCare Medicaid |
$46.19
|
| Rate for Payer: AlohaCare Medicare |
$47.54
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Devoted Health Medicare |
$47.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.79
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.54
|
|
|
Home Visit Level 1 New - 99341
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 99341
|
| Hospital Charge Code |
435993410
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$50.29 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: AlohaCare Medicaid |
$50.29
|
| Rate for Payer: AlohaCare Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Devoted Health Medicare |
$50.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.66
|
| Rate for Payer: Health Management Network Commercial |
$142.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.50
|
|
|
Home Visit Level 2 Est - 99348
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 99348
|
| Hospital Charge Code |
435993480
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$217.60 |
| Rate for Payer: AlohaCare Medicaid |
$78.20
|
| Rate for Payer: AlohaCare Medicare |
$81.46
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Devoted Health Medicare |
$81.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.38
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.46
|
|
|
Home Visit Level 2 New - 99342
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 99342
|
| Hospital Charge Code |
435993420
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$78.09 |
| Max. Negotiated Rate |
$204.85 |
| Rate for Payer: AlohaCare Medicaid |
$79.37
|
| Rate for Payer: AlohaCare Medicare |
$80.77
|
| Rate for Payer: Cash Price |
$156.65
|
| Rate for Payer: Cash Price |
$156.65
|
| Rate for Payer: Devoted Health Medicare |
$80.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.09
|
| Rate for Payer: Health Management Network Commercial |
$204.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.77
|
|
|
Home Visit Level 3 Est - 99349
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 99349
|
| Hospital Charge Code |
435993490
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$96.63 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: AlohaCare Medicaid |
$129.72
|
| Rate for Payer: AlohaCare Medicare |
$136.24
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Devoted Health Medicare |
$136.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.63
|
| Rate for Payer: Health Management Network Commercial |
$329.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.24
|
|
|
Home Visit Level 3 New - 99343
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 99343
|
| Hospital Charge Code |
435993430
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$112.31 |
| Max. Negotiated Rate |
$334.90 |
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$112.31
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
|
