|
G0008 ADMIN OF INFLUENZA VACCINE CHARGE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
8107366
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$96.05 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
|
|
G0008: Medicare Influenza - Admin Immunization charge
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
12139184
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: AlohaCare Medicaid |
$100.00
|
| Rate for Payer: AlohaCare Medicare |
$100.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Devoted Health Medicare |
$110.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.00
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Humana Medicare |
$100.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.00
|
| Rate for Payer: MDX Hawaii PPO |
$194.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.00
|
| Rate for Payer: University Health Alliance Commercial |
$145.78
|
|
|
G0008: Medicare Influenza - Admin Immunization charge
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
12139184
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.00
|
| Rate for Payer: MDX Hawaii PPO |
$194.00
|
|
|
G0008: Medicare Influenza - Admin Immunization Charge
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
9539766
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.00
|
| Rate for Payer: MDX Hawaii PPO |
$194.00
|
|
|
G0008: Medicare Influenza - Admin Immunization Charge
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
9539766
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: AlohaCare Medicaid |
$100.00
|
| Rate for Payer: AlohaCare Medicare |
$100.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Devoted Health Medicare |
$110.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.00
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Humana Medicare |
$100.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.00
|
| Rate for Payer: MDX Hawaii PPO |
$194.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.00
|
| Rate for Payer: University Health Alliance Commercial |
$145.78
|
|
|
G0009 ADMIN OF PNEUMOCOCCAL VACCINE CHARGE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
8107367
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$96.05 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
|
|
G0009 ADMIN OF PNEUMOCOCCAL VACCINE CHARGE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
8107367
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: AlohaCare Medicaid |
$56.50
|
| Rate for Payer: AlohaCare Medicare |
$56.50
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Devoted Health Medicare |
$62.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.35
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Humana Medicare |
$56.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.50
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.50
|
| Rate for Payer: University Health Alliance Commercial |
$82.37
|
|
|
G0009 Admin pneumococcal vaccine ProFee
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
8804763
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$100.30 |
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
|
|
G0009: Medicare Pneum - Admin Immunization charge
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
12139183
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: AlohaCare Medicaid |
$56.50
|
| Rate for Payer: AlohaCare Medicare |
$56.50
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Devoted Health Medicare |
$62.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.35
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Humana Medicare |
$56.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.50
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.50
|
| Rate for Payer: University Health Alliance Commercial |
$82.37
|
|
|
G0009: Medicare Pneum - Admin Immunization charge
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
12139183
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$96.05 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
|
|
G0009: Medicare Pneum - Admin Immunization Charge
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
9539765
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: AlohaCare Medicaid |
$56.50
|
| Rate for Payer: AlohaCare Medicare |
$56.50
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Devoted Health Medicare |
$62.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.35
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Humana Medicare |
$56.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.50
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.50
|
| Rate for Payer: University Health Alliance Commercial |
$82.37
|
|
|
G0009: Medicare Pneum - Admin Immunization Charge
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
9539765
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$96.05 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
|
|
G0010 HEPATITIS B VACCINE ADMINISTRATION CHARGE
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
8107368
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.60
|
| Rate for Payer: MDX Hawaii PPO |
$23.28
|
|
|
G0010 HEPATITIS B VACCINE ADMINISTRATION CHARGE
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
8107368
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.00
|
| Rate for Payer: MDX Hawaii PPO |
$23.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.00
|
| Rate for Payer: University Health Alliance Commercial |
$17.49
|
|
|
G0010: Medicare Hep B - Admin Immunization charge
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
12139182
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.00
|
| Rate for Payer: MDX Hawaii PPO |
$23.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.00
|
| Rate for Payer: University Health Alliance Commercial |
$17.49
|
|
|
G0010: Medicare Hep B - Admin Immunization charge
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
12139182
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.60
|
| Rate for Payer: MDX Hawaii PPO |
$23.28
|
|
|
G0010: Medicare Hep B - Admin Immunization Charge
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
9539764
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.60
|
| Rate for Payer: MDX Hawaii PPO |
$23.28
|
|
|
G0010: Medicare Hep B - Admin Immunization Charge
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
9539764
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.00
|
| Rate for Payer: MDX Hawaii PPO |
$23.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.00
|
| Rate for Payer: University Health Alliance Commercial |
$17.49
|
|
|
G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
8041152
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: AlohaCare Medicaid |
$27.76
|
| Rate for Payer: AlohaCare Medicare |
$24.78
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Devoted Health Medicare |
$27.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.20
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.78
|
|
|
G0104 Colorectal cancer screening; flexible sigmoidoscopy
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
8040934
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: AlohaCare Medicaid |
$58.12
|
| Rate for Payer: AlohaCare Medicare |
$54.96
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Devoted Health Medicare |
$60.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$95.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.21
|
| Rate for Payer: Health Management Network Commercial |
$355.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.96
|
|
|
G0105 Colorectal cancer screening; colonoscopy on individual at high risk
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
8040935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.26 |
| Max. Negotiated Rate |
$1,002.15 |
| Rate for Payer: AlohaCare Medicaid |
$184.06
|
| Rate for Payer: AlohaCare Medicare |
$165.03
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Devoted Health Medicare |
$181.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$184.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$374.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$184.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$713.46
|
| Rate for Payer: Health Management Network Commercial |
$1,002.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$181.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.03
|
| Rate for Payer: University Health Alliance Commercial |
$125.26
|
|
|
G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS G0121
|
| Hospital Charge Code |
8040938
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.26 |
| Max. Negotiated Rate |
$1,002.15 |
| Rate for Payer: AlohaCare Medicaid |
$184.24
|
| Rate for Payer: AlohaCare Medicare |
$165.23
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Devoted Health Medicare |
$181.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$184.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$374.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$184.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$319.54
|
| Rate for Payer: Health Management Network Commercial |
$1,002.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$181.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.23
|
| Rate for Payer: University Health Alliance Commercial |
$125.26
|
|
|
G0127 Trimming of dystrophic nails, any number
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
8040940
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: AlohaCare Medicaid |
$7.38
|
| Rate for Payer: AlohaCare Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Devoted Health Medicare |
$7.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.63
|
|
|
G0283 Electrical stimulation, one or more areas, other than wound care, part of therapy plan of care
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
8040949
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: AlohaCare Medicaid |
$12.30
|
| Rate for Payer: AlohaCare Medicare |
$13.42
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Devoted Health Medicare |
$14.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.52
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.42
|
|
|
G0283 ESTIM UNATTENDED PT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS G0283 GP,59
|
| Hospital Charge Code |
8323308
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: AlohaCare Medicaid |
$34.50
|
| Rate for Payer: AlohaCare Medicare |
$34.50
|
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Devoted Health Medicare |
$37.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.55
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Humana Medicare |
$34.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.50
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.50
|
| Rate for Payer: University Health Alliance Commercial |
$50.29
|
|
