|
PT Community/Work Reintegration Charge
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97537 GP
|
| Hospital Charge Code |
432975370
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: AlohaCare Medicaid |
$89.50
|
| Rate for Payer: AlohaCare Medicare |
$75.18
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$164.68
|
| Rate for Payer: Devoted Health Medicare |
$75.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$170.05
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Humana Medicare |
$75.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.18
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.18
|
| Rate for Payer: University Health Alliance Commercial |
$130.47
|
|
|
PT EVALUATION Physical
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
HCPCS 97001 GP
|
| Hospital Charge Code |
426970010
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$384.12 |
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Health Management Network Commercial |
$336.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.40
|
| Rate for Payer: MDX Hawaii PPO |
$384.12
|
|
|
PT EVALUATION Physical
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
HCPCS 97001 GP
|
| Hospital Charge Code |
426970010
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$384.12 |
| Rate for Payer: AlohaCare Medicaid |
$198.00
|
| Rate for Payer: AlohaCare Medicare |
$166.32
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$364.32
|
| Rate for Payer: Devoted Health Medicare |
$166.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$376.20
|
| Rate for Payer: Health Management Network Commercial |
$336.60
|
| Rate for Payer: Humana Medicare |
$166.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.32
|
| Rate for Payer: MDX Hawaii PPO |
$384.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.32
|
| Rate for Payer: University Health Alliance Commercial |
$288.64
|
|
|
PT FALLS ASSESS DOCD 2/> FALLS/FALL W/INJURY/YR
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS 1100F
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| 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: Health Management Network Commercial |
$0.01
|
| 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
|
|
|
PT FALLS ASSESS DOCD W/O FALL/INJURY PAST YEAR
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS 1101F
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| 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: Health Management Network Commercial |
$0.01
|
| 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 |
$273.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
|
|
PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 96160
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$3.44
|
| Rate for Payer: AlohaCare Medicare |
$3.42
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Devoted Health Medicare |
$3.42
|
| 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 |
$5.38
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.10
|
| 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: Ohana Health Plan Medicaid |
$3.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
|
|
PT Functional Measure Testing Charge
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS 97750 GP
|
| Hospital Charge Code |
432977500
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$189.55 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
|
|
PT Functional Measure Testing Charge
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS 97750 GP
|
| Hospital Charge Code |
432977500
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.83 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: AlohaCare Medicaid |
$111.50
|
| Rate for Payer: AlohaCare Medicare |
$93.66
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$205.16
|
| Rate for Payer: Devoted Health Medicare |
$93.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$211.85
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Humana Medicare |
$93.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.66
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.66
|
| Rate for Payer: University Health Alliance Commercial |
$162.54
|
|
|
PT High Complex Units
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS 97163 GP
|
| Hospital Charge Code |
432971630
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
|
|
PT High Complex Units
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS 97163 GP
|
| Hospital Charge Code |
432971630
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: AlohaCare Medicaid |
$180.50
|
| Rate for Payer: AlohaCare Medicare |
$151.62
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$332.12
|
| Rate for Payer: Devoted Health Medicare |
$151.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.95
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Humana Medicare |
$151.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.62
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.62
|
| Rate for Payer: University Health Alliance Commercial |
$263.13
|
|
|
PTH, Intact DLS
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
422839705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$345.10 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.40
|
| Rate for Payer: MDX Hawaii PPO |
$393.82
|
|
|
PTH, Intact DLS
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
422839705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: AlohaCare Medicaid |
$203.00
|
| Rate for Payer: AlohaCare Medicare |
$170.52
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$373.52
|
| Rate for Payer: Devoted Health Medicare |
$170.52
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$57.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.28
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Humana Medicare |
$170.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.52
|
| Rate for Payer: MDX Hawaii PPO |
$393.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.52
|
| Rate for Payer: University Health Alliance Commercial |
$106.69
|
|
|
PT/INR
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
422856100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$80.51 |
| Rate for Payer: AlohaCare Medicaid |
$41.50
|
| Rate for Payer: AlohaCare Medicare |
$34.86
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$76.36
|
| Rate for Payer: Devoted Health Medicare |
$34.86
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$5.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.29
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Humana Medicare |
$34.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.86
|
| Rate for Payer: MDX Hawaii PPO |
$80.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.86
|
| Rate for Payer: University Health Alliance Commercial |
$10.16
|
|
|
PT/INR
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
422856100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$70.55 |
| Max. Negotiated Rate |
$80.51 |
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.70
|
| Rate for Payer: MDX Hawaii PPO |
$80.51
|
|
|
PT Low Complex Units
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
432971610
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: AlohaCare Medicaid |
$180.50
|
| Rate for Payer: AlohaCare Medicare |
$151.62
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$332.12
|
| Rate for Payer: Devoted Health Medicare |
$151.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.95
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Humana Medicare |
$151.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.62
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.62
|
| Rate for Payer: University Health Alliance Commercial |
$263.13
|
|
|
PT Low Complex Units
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
432971610
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
|
|
PT Low Complex Units BCE
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
432971610
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
|
|
PT Low Complex Units BCE
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
432971610
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: AlohaCare Medicaid |
$180.50
|
| Rate for Payer: AlohaCare Medicare |
$151.62
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$332.12
|
| Rate for Payer: Devoted Health Medicare |
$151.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.95
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Humana Medicare |
$151.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.62
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.62
|
| Rate for Payer: University Health Alliance Commercial |
$263.13
|
|
|
PT Moderate Complex Units
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS 97162 GP
|
| Hospital Charge Code |
432971620
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: AlohaCare Medicaid |
$180.50
|
| Rate for Payer: AlohaCare Medicare |
$151.62
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$332.12
|
| Rate for Payer: Devoted Health Medicare |
$151.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.95
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Humana Medicare |
$151.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.62
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.62
|
| Rate for Payer: University Health Alliance Commercial |
$263.13
|
|
|
PT Moderate Complex Units
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS 97162 GP
|
| Hospital Charge Code |
432971620
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
|
|
PT Muscle Testing Exl. Hands Charge
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 95831 GP
|
| Hospital Charge Code |
432958310
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.66 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: AlohaCare Medicaid |
$86.50
|
| Rate for Payer: AlohaCare Medicare |
$72.66
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$159.16
|
| Rate for Payer: Devoted Health Medicare |
$72.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$164.35
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Humana Medicare |
$72.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.66
|
| Rate for Payer: MDX Hawaii PPO |
$167.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.66
|
| Rate for Payer: University Health Alliance Commercial |
$126.10
|
|
|
PT Muscle Testing Exl. Hands Charge
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 95831 GP
|
| Hospital Charge Code |
432958310
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.70
|
| Rate for Payer: MDX Hawaii PPO |
$167.81
|
|
|
PT Physical Performance Test Charges
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS 97750 GP
|
| Hospital Charge Code |
432977500
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.83 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: AlohaCare Medicaid |
$111.50
|
| Rate for Payer: AlohaCare Medicare |
$93.66
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$205.16
|
| Rate for Payer: Devoted Health Medicare |
$93.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$211.85
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Humana Medicare |
$93.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.66
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.66
|
| Rate for Payer: University Health Alliance Commercial |
$162.54
|
|
|
PT Physical Performance Test Charges
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS 97750 GP
|
| Hospital Charge Code |
432977500
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$189.55 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
|
|
PT RE-EVALUATION Physical
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
HCPCS 97002 GP
|
| Hospital Charge Code |
426970020
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$384.12 |
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Health Management Network Commercial |
$336.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.40
|
| Rate for Payer: MDX Hawaii PPO |
$384.12
|
|
