|
Home Visit Level 4 New - 99344
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 99344
|
| Hospital Charge Code |
435993440
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$469.20 |
| Rate for Payer: AlohaCare Medicaid |
$144.42
|
| Rate for Payer: AlohaCare Medicare |
$150.60
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Devoted Health Medicare |
$150.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$136.23
|
| Rate for Payer: Health Management Network Commercial |
$469.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.60
|
|
|
Homocysteine, Total DLS
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
422830905
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.70
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
|
|
Homocysteine, Total DLS
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
422830905
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: AlohaCare Medicaid |
$51.50
|
| Rate for Payer: AlohaCare Medicare |
$43.26
|
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$94.76
|
| Rate for Payer: Devoted Health Medicare |
$43.26
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$23.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.92
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Humana Medicare |
$43.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.26
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.26
|
| Rate for Payer: University Health Alliance Commercial |
$43.60
|
|
|
Hospital Discharge > 30 min - 99239
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 99239
|
| Hospital Charge Code |
435992390
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: AlohaCare Medicaid |
$116.44
|
| Rate for Payer: AlohaCare Medicare |
$108.33
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Devoted Health Medicare |
$108.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.33
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.33
|
|
|
Hospital Discharge 30 min or less - 99238
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 99238
|
| Hospital Charge Code |
435992380
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: AlohaCare Medicaid |
$82.58
|
| Rate for Payer: AlohaCare Medicare |
$75.97
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Devoted Health Medicare |
$75.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.97
|
|
|
HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 99236
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$532.10 |
| Rate for Payer: AlohaCare Medicaid |
$208.78
|
| Rate for Payer: AlohaCare Medicare |
$189.32
|
| Rate for Payer: Cash Price |
$406.90
|
| Rate for Payer: Cash Price |
$406.90
|
| Rate for Payer: Cash Price |
$406.90
|
| Rate for Payer: Devoted Health Medicare |
$189.32
|
| 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 |
$164.50
|
| Rate for Payer: Health Management Network Commercial |
$532.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$227.18
|
| 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 |
$208.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 99235
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$117.50 |
| Max. Negotiated Rate |
$412.25 |
| Rate for Payer: AlohaCare Medicaid |
$160.14
|
| Rate for Payer: AlohaCare Medicare |
$143.06
|
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Devoted Health Medicare |
$143.06
|
| 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 |
$117.50
|
| Rate for Payer: Health Management Network Commercial |
$412.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.67
|
| 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 |
$160.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 99234
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$328.95 |
| Rate for Payer: AlohaCare Medicaid |
$97.67
|
| Rate for Payer: AlohaCare Medicare |
$87.75
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Devoted Health Medicare |
$87.75
|
| 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 |
$70.50
|
| Rate for Payer: Health Management Network Commercial |
$328.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.30
|
| 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 |
$97.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 99239
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$116.44
|
| Rate for Payer: AlohaCare Medicare |
$108.33
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Devoted Health Medicare |
$108.33
|
| 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 |
$78.33
|
| Rate for Payer: Health Management Network Commercial |
$265.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.00
|
| 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 |
$116.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 99238
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$82.58
|
| Rate for Payer: AlohaCare Medicare |
$75.97
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Devoted Health Medicare |
$75.97
|
| 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 |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$181.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.16
|
| 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 |
$82.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
Hot/Cold Pack Application Charge
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97010 GO
|
| Hospital Charge Code |
426970100
|
|
Hospital Revenue Code
|
431
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: AlohaCare Medicaid |
$68.50
|
| Rate for Payer: AlohaCare Medicare |
$57.54
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$126.04
|
| Rate for Payer: Devoted Health Medicare |
$57.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.15
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$57.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.54
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.54
|
| Rate for Payer: University Health Alliance Commercial |
$99.86
|
|
|
Hot/Cold Pack Application Charge
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97010 GO
|
| Hospital Charge Code |
426970100
|
|
Hospital Revenue Code
|
431
|
| Min. Negotiated Rate |
$116.45 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
|
|
HOT PACK
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
8147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$0.84
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1.84
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$0.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.84
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.84
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
HOT PACK
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
8147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
HOT PACK/COLD PACK Occupational
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97010 GO
|
| Hospital Charge Code |
426970100
|
|
Hospital Revenue Code
|
431
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: AlohaCare Medicaid |
$68.50
|
| Rate for Payer: AlohaCare Medicare |
$57.54
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$126.04
|
| Rate for Payer: Devoted Health Medicare |
$57.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.15
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$57.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.54
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.54
|
| Rate for Payer: University Health Alliance Commercial |
$99.86
|
|
|
HOT PACK/COLD PACK Occupational
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97010 GO
|
| Hospital Charge Code |
426970100
|
|
Hospital Revenue Code
|
431
|
| Min. Negotiated Rate |
$116.45 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
|
|
HOT PACK/COLD PACK Physical
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
432970100
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$44.62 |
| Rate for Payer: AlohaCare Medicaid |
$23.00
|
| Rate for Payer: AlohaCare Medicare |
$19.32
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$42.32
|
| Rate for Payer: Devoted Health Medicare |
$19.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.70
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Humana Medicare |
$19.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.32
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.32
|
| Rate for Payer: University Health Alliance Commercial |
$33.53
|
|
|
HOT PACK/COLD PACK Physical
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
432970100
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$44.62 |
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
|
|
HPV DLS
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 87624
|
| Hospital Charge Code |
422876245
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Health Management Network Commercial |
$110.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.00
|
| Rate for Payer: MDX Hawaii PPO |
$126.10
|
|
|
HPV DLS
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 87624
|
| Hospital Charge Code |
422876245
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: AlohaCare Medicaid |
$65.00
|
| Rate for Payer: AlohaCare Medicare |
$54.60
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$119.60
|
| Rate for Payer: Devoted Health Medicare |
$54.60
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$48.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$110.50
|
| Rate for Payer: Humana Medicare |
$54.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.60
|
| Rate for Payer: MDX Hawaii PPO |
$126.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.60
|
| Rate for Payer: University Health Alliance Commercial |
$88.36
|
|
|
H. Pylori Ag, Stool DLS
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
422873385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$211.46 |
| Rate for Payer: AlohaCare Medicaid |
$109.00
|
| Rate for Payer: AlohaCare Medicare |
$91.56
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$200.56
|
| Rate for Payer: Devoted Health Medicare |
$91.56
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.38
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| Rate for Payer: Humana Medicare |
$91.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$196.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.56
|
| Rate for Payer: MDX Hawaii PPO |
$211.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.56
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
H. Pylori Ag, Stool DLS
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
422873385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.30 |
| Max. Negotiated Rate |
$211.46 |
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$196.20
|
| Rate for Payer: MDX Hawaii PPO |
$211.46
|
|
|
H. pylori Antibody, IgG DLS
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
422866775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$158.10 |
| Max. Negotiated Rate |
$180.42 |
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Health Management Network Commercial |
$158.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$167.40
|
| Rate for Payer: MDX Hawaii PPO |
$180.42
|
|
|
H. pylori Antibody, IgG DLS
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
422866775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$180.42 |
| Rate for Payer: AlohaCare Medicaid |
$93.00
|
| Rate for Payer: AlohaCare Medicare |
$78.12
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$171.12
|
| Rate for Payer: Devoted Health Medicare |
$78.12
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$20.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.85
|
| Rate for Payer: Health Management Network Commercial |
$158.10
|
| Rate for Payer: Humana Medicare |
$78.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$167.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.12
|
| Rate for Payer: MDX Hawaii PPO |
$180.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.12
|
| Rate for Payer: University Health Alliance Commercial |
$37.52
|
|
|
H.Pylori-Stool DLS
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
422873385
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$217.28 |
| Rate for Payer: AlohaCare Medicaid |
$112.00
|
| Rate for Payer: AlohaCare Medicare |
$94.08
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$206.08
|
| Rate for Payer: Devoted Health Medicare |
$94.08
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.38
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Humana Medicare |
$94.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.08
|
| Rate for Payer: MDX Hawaii PPO |
$217.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.08
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
