|
HC PROSTATE BIOPSY 10-20
|
Facility
|
OP
|
$3,564.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
314G041601
|
|
Hospital Revenue Code
|
314
|
| Min. Negotiated Rate |
$309.32 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: AlohaCare Medicaid |
$1,782.00
|
| Rate for Payer: AlohaCare Medicare |
$1,104.84
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Devoted Health Medicare |
$1,211.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,104.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,385.80
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: Humana Medicare |
$1,104.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,207.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,817.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,104.84
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,104.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,104.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$309.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,104.84
|
| Rate for Payer: University Health Alliance Commercial |
$2,597.80
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY SERUM - PROTEIN TOTAL
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3018415501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: AlohaCare Medicaid |
$15.50
|
| Rate for Payer: AlohaCare Medicare |
$9.61
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$10.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.67
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Humana Medicare |
$9.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.61
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.61
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY SERUM - PROTEIN TOTAL
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3018415501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
3058561001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$18.00
|
| Rate for Payer: AlohaCare Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$12.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.29
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$11.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.16
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.16
|
| Rate for Payer: University Health Alliance Commercial |
$10.16
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
3058561001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
HC PT CANALITH REPOSITIONING PROCEDURE, PER DAY
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 95992 GP
|
| Hospital Charge Code |
4209599201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.72 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: AlohaCare Medicaid |
$82.50
|
| Rate for Payer: AlohaCare Medicare |
$51.15
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Devoted Health Medicare |
$56.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$156.75
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Humana Medicare |
$51.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.15
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.15
|
| Rate for Payer: University Health Alliance Commercial |
$120.27
|
|
|
HC PT CANALITH REPOSITIONING PROCEDURE, PER DAY
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 95992 GP
|
| Hospital Charge Code |
4209599201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
|
|
HC PT DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
4209759801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$279.36 |
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Management Network Commercial |
$244.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.20
|
| Rate for Payer: MDX Hawaii PPO |
$279.36
|
|
|
HC PT DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
4209759801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.28 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$144.00
|
| Rate for Payer: AlohaCare Medicare |
$89.28
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Devoted Health Medicare |
$97.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$273.60
|
| Rate for Payer: Health Management Network Commercial |
$244.80
|
| Rate for Payer: Humana Medicare |
$89.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.28
|
| Rate for Payer: MDX Hawaii PPO |
$279.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.28
|
| Rate for Payer: University Health Alliance Commercial |
$209.92
|
|
|
HC PT-FOCUSED HLTH RISK ASSMT
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
9189616001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
|
|
HC PT-FOCUSED HLTH RISK ASSMT
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
9189616001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: AlohaCare Medicaid |
$59.50
|
| Rate for Payer: AlohaCare Medicare |
$36.89
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Devoted Health Medicare |
$40.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.05
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Humana Medicare |
$36.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.89
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.89
|
| Rate for Payer: University Health Alliance Commercial |
$86.74
|
|
|
HC PT GAIT TRAINING THERAPY
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 97116 GP
|
| Hospital Charge Code |
4209711601
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
|
|
HC PT GAIT TRAINING THERAPY
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 97116 GP
|
| Hospital Charge Code |
4209711601
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: AlohaCare Medicaid |
$71.00
|
| Rate for Payer: AlohaCare Medicare |
$44.02
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Devoted Health Medicare |
$48.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$134.90
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Humana Medicare |
$44.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.02
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.02
|
| Rate for Payer: University Health Alliance Commercial |
$103.50
|
|
|
HC PT MANUAL THER TECH,1+REGIONS,EA 15 MIN
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 97140 GP
|
| Hospital Charge Code |
4209714001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$127.07 |
| Rate for Payer: AlohaCare Medicaid |
$65.50
|
| Rate for Payer: AlohaCare Medicare |
$40.61
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Devoted Health Medicare |
$44.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$124.45
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Humana Medicare |
$40.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.61
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.61
|
| Rate for Payer: University Health Alliance Commercial |
$95.49
|
|
|
HC PT MANUAL THER TECH,1+REGIONS,EA 15 MIN
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 97140 GP
|
| Hospital Charge Code |
4209714001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$127.07 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.90
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
|
|
HC PT MASSAGE THERAPY
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 97124 GP
|
| Hospital Charge Code |
4209712401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$75.00
|
| Rate for Payer: AlohaCare Medicare |
$46.50
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Devoted Health Medicare |
$51.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.50
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Humana Medicare |
$46.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.50
|
| Rate for Payer: University Health Alliance Commercial |
$109.33
|
|
|
HC PT MASSAGE THERAPY
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 97124 GP
|
| Hospital Charge Code |
4209712401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.00
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HC PT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 97112 GP
|
| Hospital Charge Code |
4209711201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$138.55 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.70
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
|
|
HC PT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 97112 GP
|
| Hospital Charge Code |
4209711201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: AlohaCare Medicaid |
$81.50
|
| Rate for Payer: AlohaCare Medicare |
$50.53
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Devoted Health Medicare |
$55.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.85
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Humana Medicare |
$50.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.53
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.53
|
| Rate for Payer: University Health Alliance Commercial |
$118.81
|
|
|
HC PT PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 97163 GP
|
| Hospital Charge Code |
4249716301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$471.42 |
| Rate for Payer: AlohaCare Medicaid |
$243.00
|
| Rate for Payer: AlohaCare Medicare |
$150.66
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Devoted Health Medicare |
$165.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$461.70
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Humana Medicare |
$150.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$437.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.66
|
| Rate for Payer: MDX Hawaii PPO |
$471.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.66
|
| Rate for Payer: University Health Alliance Commercial |
$354.25
|
|
|
HC PT PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 97163 GP
|
| Hospital Charge Code |
4249716301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$413.10 |
| Max. Negotiated Rate |
$471.42 |
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$437.40
|
| Rate for Payer: MDX Hawaii PPO |
$471.42
|
|
|
HC PT PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
4249716101
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$413.10 |
| Max. Negotiated Rate |
$471.42 |
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$437.40
|
| Rate for Payer: MDX Hawaii PPO |
$471.42
|
|
|
HC PT PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
4249716101
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$471.42 |
| Rate for Payer: AlohaCare Medicaid |
$243.00
|
| Rate for Payer: AlohaCare Medicare |
$150.66
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Devoted Health Medicare |
$165.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$461.70
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Humana Medicare |
$150.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$437.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.66
|
| Rate for Payer: MDX Hawaii PPO |
$471.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.66
|
| Rate for Payer: University Health Alliance Commercial |
$354.25
|
|
|
HC PT PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 97162 GP
|
| Hospital Charge Code |
4249716201
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$413.10 |
| Max. Negotiated Rate |
$471.42 |
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$437.40
|
| Rate for Payer: MDX Hawaii PPO |
$471.42
|
|
|
HC PT PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 97162 GP
|
| Hospital Charge Code |
4249716201
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$471.42 |
| Rate for Payer: AlohaCare Medicaid |
$243.00
|
| Rate for Payer: AlohaCare Medicare |
$150.66
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Devoted Health Medicare |
$165.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$461.70
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Humana Medicare |
$150.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$437.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.66
|
| Rate for Payer: MDX Hawaii PPO |
$471.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.66
|
| Rate for Payer: University Health Alliance Commercial |
$354.25
|
|
