|
Saline Laxative Enema (sodium phosphate) Pediatric 66 mL [KMC]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 00132020220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Health Management Network Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.08
|
| Rate for Payer: MDX Hawaii PPO |
$0.09
|
|
|
Saline Laxative Enema (sodium phosphate) Pediatric 66 mL [KMC]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 00132020220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: AlohaCare Medicaid |
$0.05
|
| Rate for Payer: AlohaCare Medicare |
$0.04
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$0.08
|
| Rate for Payer: Devoted Health Medicare |
$0.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network Commercial |
$0.08
|
| Rate for Payer: Humana Medicare |
$0.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.04
|
| Rate for Payer: MDX Hawaii PPO |
$0.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.04
|
| Rate for Payer: University Health Alliance Commercial |
$0.07
|
|
|
SALIVARY GLAND PROCEDURES
|
Facility
|
IP
|
$21,758.44
|
|
|
Service Code
|
MSDRG 139
|
| Min. Negotiated Rate |
$21,758.44 |
| Max. Negotiated Rate |
$21,758.44 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21,758.44
|
|
|
saliva substitutes - Spray
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
HCPCS A9155
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Health Management Network Commercial |
$0.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.49
|
| Rate for Payer: MDX Hawaii PPO |
$0.52
|
|
|
saliva substitutes - Spray
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
HCPCS A9155
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: AlohaCare Medicaid |
$0.27
|
| Rate for Payer: AlohaCare Medicare |
$0.23
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$0.50
|
| Rate for Payer: Devoted Health Medicare |
$0.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.51
|
| Rate for Payer: Health Management Network Commercial |
$0.46
|
| Rate for Payer: Humana Medicare |
$0.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.23
|
| Rate for Payer: MDX Hawaii PPO |
$0.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.23
|
| Rate for Payer: University Health Alliance Commercial |
$0.39
|
|
|
SARS-CoV-2 (COVID-19) (ID Now) POC
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
435876350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
|
|
SARS-CoV-2 (COVID-19) (ID Now) POC
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
435876350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: AlohaCare Medicaid |
$153.50
|
| Rate for Payer: AlohaCare Medicare |
$128.94
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$282.44
|
| Rate for Payer: Devoted Health Medicare |
$128.94
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Humana Medicare |
$128.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.94
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$128.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.94
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
SARS-CoV-2 (COVID-19) RNA (ID Now)
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
422876350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
|
|
SARS-CoV-2 (COVID-19) RNA (ID Now)
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
422876350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: AlohaCare Medicaid |
$153.50
|
| Rate for Payer: AlohaCare Medicare |
$128.94
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$282.44
|
| Rate for Payer: Devoted Health Medicare |
$128.94
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Humana Medicare |
$128.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.94
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$128.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.94
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
SARS-CoV-2 (COVID-19) RT-PCR DLS
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
422876355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: AlohaCare Medicaid |
$153.50
|
| Rate for Payer: AlohaCare Medicare |
$128.94
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$282.44
|
| Rate for Payer: Devoted Health Medicare |
$128.94
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Humana Medicare |
$128.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.94
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$128.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.94
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
SARS-CoV-2 (COVID-19) RT-PCR DLS
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
422876355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
|
|
SARS-CoV-2 IgG Qualitative DLS
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
422867695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.75 |
| Max. Negotiated Rate |
$150.35 |
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.50
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
|
|
SARS-CoV-2 IgG Qualitative DLS
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
422867695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$150.35 |
| Rate for Payer: AlohaCare Medicaid |
$77.50
|
| Rate for Payer: AlohaCare Medicare |
$65.10
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$142.60
|
| Rate for Payer: Devoted Health Medicare |
$65.10
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$42.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$52.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.13
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Humana Medicare |
$65.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.10
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.10
|
| Rate for Payer: University Health Alliance Commercial |
$112.98
|
|
|
SARS-CoV/CoV-2 (COVID-19) Ag (Binax) POC
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
422876350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$248.20 |
| Max. Negotiated Rate |
$283.24 |
| Rate for Payer: Cash Price |
$189.80
|
| Rate for Payer: Health Management Network Commercial |
$248.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$262.80
|
| Rate for Payer: MDX Hawaii PPO |
$283.24
|
|
|
SARS-CoV/CoV-2 (COVID-19) Ag (Binax) POC
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
422876350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$283.24 |
| Rate for Payer: AlohaCare Medicaid |
$146.00
|
| Rate for Payer: AlohaCare Medicare |
$122.64
|
| Rate for Payer: Cash Price |
$189.80
|
| Rate for Payer: Cash Price |
$189.80
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$268.64
|
| Rate for Payer: Devoted Health Medicare |
$122.64
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$248.20
|
| Rate for Payer: Humana Medicare |
$122.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$262.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.64
|
| Rate for Payer: MDX Hawaii PPO |
$283.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.64
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
SARS-CoV or CoV-2 (COVID-19) Ag (Binax)
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
422876350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$248.20 |
| Max. Negotiated Rate |
$283.24 |
| Rate for Payer: Cash Price |
$189.80
|
| Rate for Payer: Health Management Network Commercial |
$248.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$262.80
|
| Rate for Payer: MDX Hawaii PPO |
$283.24
|
|
|
SARS-CoV or CoV-2 (COVID-19) Ag (Binax)
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
422876350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$283.24 |
| Rate for Payer: AlohaCare Medicaid |
$146.00
|
| Rate for Payer: AlohaCare Medicare |
$122.64
|
| Rate for Payer: Cash Price |
$189.80
|
| Rate for Payer: Cash Price |
$189.80
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$268.64
|
| Rate for Payer: Devoted Health Medicare |
$122.64
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$248.20
|
| Rate for Payer: Humana Medicare |
$122.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$262.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.64
|
| Rate for Payer: MDX Hawaii PPO |
$283.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.64
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
sAXagliptin 5 mg Tab [KMC]
|
Facility
|
IP
|
$75.35
|
|
|
Service Code
|
NDC 00310610530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.05 |
| Max. Negotiated Rate |
$73.09 |
| Rate for Payer: Cash Price |
$48.98
|
| Rate for Payer: Health Management Network Commercial |
$64.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.81
|
| Rate for Payer: MDX Hawaii PPO |
$73.09
|
|
|
sAXagliptin 5 mg Tab [KMC]
|
Facility
|
OP
|
$75.35
|
|
|
Service Code
|
NDC 00310610530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.65 |
| Max. Negotiated Rate |
$73.09 |
| Rate for Payer: AlohaCare Medicaid |
$37.67
|
| Rate for Payer: AlohaCare Medicare |
$31.65
|
| Rate for Payer: Cash Price |
$48.98
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$69.32
|
| Rate for Payer: Devoted Health Medicare |
$31.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.58
|
| Rate for Payer: Health Management Network Commercial |
$64.05
|
| Rate for Payer: Humana Medicare |
$31.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.65
|
| Rate for Payer: MDX Hawaii PPO |
$73.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.65
|
| Rate for Payer: University Health Alliance Commercial |
$54.92
|
|
|
SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 99233
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.28 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$119.20
|
| Rate for Payer: AlohaCare Medicare |
$107.19
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Devoted Health Medicare |
$107.19
|
| 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 |
$76.28
|
| Rate for Payer: Health Management Network Commercial |
$255.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.63
|
| 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 |
$119.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 99232
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$79.26
|
| Rate for Payer: AlohaCare Medicare |
$70.62
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Devoted Health Medicare |
$70.62
|
| 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 |
$54.57
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.74
|
| 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 |
$79.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 99231
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$36.28 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$44.06
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$44.06
|
| 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 |
$36.28
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.87
|
| 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 |
$49.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 99310
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$334.05 |
| Rate for Payer: AlohaCare Medicaid |
$157.37
|
| Rate for Payer: AlohaCare Medicare |
$142.78
|
| Rate for Payer: Cash Price |
$255.45
|
| Rate for Payer: Cash Price |
$255.45
|
| Rate for Payer: Cash Price |
$255.45
|
| Rate for Payer: Devoted Health Medicare |
$142.78
|
| 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 |
$111.74
|
| Rate for Payer: Health Management Network Commercial |
$334.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.34
|
| 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 |
$157.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 99308
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$50.97 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$76.70
|
| Rate for Payer: AlohaCare Medicare |
$69.65
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Devoted Health Medicare |
$69.65
|
| 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 |
$50.97
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.58
|
| 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 |
$76.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 99309
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$110.71
|
| Rate for Payer: AlohaCare Medicare |
$100.64
|
| Rate for Payer: Cash Price |
$172.25
|
| Rate for Payer: Cash Price |
$172.25
|
| Rate for Payer: Cash Price |
$172.25
|
| Rate for Payer: Devoted Health Medicare |
$100.64
|
| 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 |
$69.47
|
| Rate for Payer: Health Management Network Commercial |
$225.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.77
|
| 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 |
$110.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
