|
Obs/ Same Day Inpatient Care Level 1 - 99234
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 99234
|
| Hospital Charge Code |
435992340
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: AlohaCare Medicaid |
$97.67
|
| Rate for Payer: AlohaCare Medicare |
$87.75
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Devoted Health Medicare |
$87.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.50
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$105.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$97.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.75
|
|
|
Occult Blood Stool
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
422822710
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.50
|
| Rate for Payer: AlohaCare Medicare |
$25.62
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$56.12
|
| Rate for Payer: Devoted Health Medicare |
$25.62
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$4.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.32
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Humana Medicare |
$25.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.62
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.62
|
| Rate for Payer: University Health Alliance Commercial |
$8.40
|
|
|
Occult Blood Stool
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
422822710
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
|
|
Occult Blood Stool Screen DLS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
422822745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: AlohaCare Medicaid |
$47.00
|
| Rate for Payer: AlohaCare Medicare |
$39.48
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$86.48
|
| Rate for Payer: Devoted Health Medicare |
$39.48
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$13.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.92
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Humana Medicare |
$39.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.48
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.48
|
| Rate for Payer: University Health Alliance Commercial |
$41.11
|
|
|
Occult Blood Stool Screen DLS
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
422822745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
|
|
OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 97167
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$299.20 |
| Rate for Payer: AlohaCare Medicaid |
$107.85
|
| Rate for Payer: AlohaCare Medicare |
$107.08
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Devoted Health Medicare |
$107.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.42
|
| Rate for Payer: Health Management Network Commercial |
$299.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$107.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.08
|
|
|
OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 97165
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$299.20 |
| Rate for Payer: AlohaCare Medicaid |
$107.85
|
| Rate for Payer: AlohaCare Medicare |
$107.08
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Devoted Health Medicare |
$107.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.42
|
| Rate for Payer: Health Management Network Commercial |
$299.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$107.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.08
|
|
|
OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 97166
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$299.20 |
| Rate for Payer: AlohaCare Medicaid |
$107.85
|
| Rate for Payer: AlohaCare Medicare |
$107.08
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Devoted Health Medicare |
$107.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.42
|
| Rate for Payer: Health Management Network Commercial |
$299.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$107.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.08
|
|
|
OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 97168
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: AlohaCare Medicaid |
$74.97
|
| Rate for Payer: AlohaCare Medicare |
$73.27
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Devoted Health Medicare |
$73.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.98
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$74.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.27
|
|
|
octreotide 100 mcg/mL Inj Sol [KMC]
|
Facility
|
OP
|
$47.71
|
|
|
Service Code
|
HCPCS J2354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$46.28 |
| Rate for Payer: AlohaCare Medicaid |
$23.86
|
| Rate for Payer: AlohaCare Medicare |
$20.04
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$43.89
|
| Rate for Payer: Devoted Health Medicare |
$20.04
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$0.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.32
|
| Rate for Payer: Health Management Network Commercial |
$40.55
|
| Rate for Payer: Humana Medicare |
$20.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.04
|
| Rate for Payer: MDX Hawaii PPO |
$46.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.04
|
| Rate for Payer: University Health Alliance Commercial |
$34.78
|
|
|
octreotide 100 mcg/mL Inj Sol [KMC]
|
Facility
|
IP
|
$47.71
|
|
|
Service Code
|
HCPCS J2354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$46.28 |
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Health Management Network Commercial |
$40.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.94
|
| Rate for Payer: MDX Hawaii PPO |
$46.28
|
|
|
ocular lubricant Ointment (Artificial tears) [KMC]
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 17478006235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$8.38 |
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Health Management Network Commercial |
$7.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.78
|
| Rate for Payer: MDX Hawaii PPO |
$8.38
|
|
|
ocular lubricant Ointment (Artificial tears) [KMC]
|
Facility
|
OP
|
$8.64
|
|
|
Service Code
|
NDC 17478006235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$8.38 |
| Rate for Payer: AlohaCare Medicaid |
$4.32
|
| Rate for Payer: AlohaCare Medicare |
$3.63
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$7.95
|
| Rate for Payer: Devoted Health Medicare |
$3.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.21
|
| Rate for Payer: Health Management Network Commercial |
$7.34
|
| Rate for Payer: Humana Medicare |
$3.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.63
|
| Rate for Payer: MDX Hawaii PPO |
$8.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.63
|
| Rate for Payer: University Health Alliance Commercial |
$6.30
|
|
|
ocular lubricant - Sol UD [KMC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00023455430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.26
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$2.76
|
| Rate for Payer: Devoted Health Medicare |
$1.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.26
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.26
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
ocular lubricant - Sol UD [KMC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00023455430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
ocular lubricant Solution (Artificial Tears) [KMC]
|
Facility
|
OP
|
$2.11
|
|
|
Service Code
|
NDC 50268004315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: AlohaCare Medicaid |
$1.05
|
| Rate for Payer: AlohaCare Medicare |
$0.89
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1.94
|
| Rate for Payer: Devoted Health Medicare |
$0.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.00
|
| Rate for Payer: Health Management Network Commercial |
$1.79
|
| Rate for Payer: Humana Medicare |
$0.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.89
|
| Rate for Payer: MDX Hawaii PPO |
$2.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.89
|
| Rate for Payer: University Health Alliance Commercial |
$1.54
|
|
|
ocular lubricant Solution (Artificial Tears) [KMC]
|
Facility
|
IP
|
$2.11
|
|
|
Service Code
|
NDC 50268004315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Management Network Commercial |
$1.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.90
|
| Rate for Payer: MDX Hawaii PPO |
$2.05
|
|
|
Ocuvite Lutein Multivitamin (I-Vite) Tab [KMC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00536509008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
Ocuvite Lutein Multivitamin (I-Vite) Tab [KMC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00536509008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.26
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$2.76
|
| Rate for Payer: Devoted Health Medicare |
$1.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.26
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.26
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 99245
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: Cash Price |
$180.70
|
| Rate for Payer: Cash Price |
$180.70
|
| Rate for Payer: Cash Price |
$180.70
|
| 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 |
$150.80
|
| Rate for Payer: Health Management Network Commercial |
$236.30
|
| 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 |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99243
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$105.54 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$102.70
|
| 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 |
$105.54
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| 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: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
|
|
OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 99244
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$139.47 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Cash Price |
$174.20
|
| 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 |
$139.47
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| 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 |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 99242
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| 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 |
$82.11
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| 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: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
|
|
OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$471.00
|
|
|
Service Code
|
HCPCS 99215
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$83.80 |
| Max. Negotiated Rate |
$400.35 |
| Rate for Payer: AlohaCare Medicaid |
$145.89
|
| Rate for Payer: AlohaCare Medicare |
$126.07
|
| Rate for Payer: Cash Price |
$306.15
|
| Rate for Payer: Cash Price |
$306.15
|
| Rate for Payer: Cash Price |
$306.15
|
| Rate for Payer: Devoted Health Medicare |
$126.07
|
| 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 |
$83.80
|
| Rate for Payer: Health Management Network Commercial |
$400.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.28
|
| 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 |
$145.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 99213
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$42.37 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$66.56
|
| Rate for Payer: AlohaCare Medicare |
$57.69
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$57.69
|
| 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 |
$42.37
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.23
|
| 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 |
$66.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
