|
96365 IV Infusion Init 16 to 90 Min Charge
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
8220033
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$362.78 |
| Rate for Payer: AlohaCare Medicaid |
$187.00
|
| Rate for Payer: AlohaCare Medicare |
$187.00
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Devoted Health Medicare |
$205.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$187.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$355.30
|
| Rate for Payer: Health Management Network Commercial |
$317.90
|
| Rate for Payer: Humana Medicare |
$187.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$336.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$190.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.00
|
| Rate for Payer: MDX Hawaii PPO |
$362.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$187.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$187.00
|
| Rate for Payer: University Health Alliance Commercial |
$272.61
|
|
|
96365 IV Infusion Init 16 to 90 Min Charge
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
8220033
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$317.90 |
| Max. Negotiated Rate |
$362.78 |
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Health Management Network Commercial |
$317.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$336.60
|
| Rate for Payer: MDX Hawaii PPO |
$362.78
|
|
|
96366- ED IV tx, each additional hour
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
1928300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$181.50
|
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Devoted Health Medicare |
$199.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$344.85
|
| Rate for Payer: Health Management Network Commercial |
$308.55
|
| Rate for Payer: Humana Medicare |
$181.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.50
|
| Rate for Payer: MDX Hawaii PPO |
$352.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$181.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.50
|
| Rate for Payer: University Health Alliance Commercial |
$264.59
|
|
|
96366- ED IV tx, each additional hour
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
1928300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.55 |
| Max. Negotiated Rate |
$352.11 |
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Health Management Network Commercial |
$308.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.70
|
| Rate for Payer: MDX Hawaii PPO |
$352.11
|
|
|
96366-Infuse Drug Each Addl Hour Greater Than 30 mins
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
8079982
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$339.50 |
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Health Management Network Commercial |
$297.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.00
|
| Rate for Payer: MDX Hawaii PPO |
$339.50
|
|
|
96366-Infuse Drug Each Addl Hour Greater Than 30 mins
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
8079982
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$175.00
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Devoted Health Medicare |
$192.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$332.50
|
| Rate for Payer: Health Management Network Commercial |
$297.50
|
| Rate for Payer: Humana Medicare |
$175.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.00
|
| Rate for Payer: MDX Hawaii PPO |
$339.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.00
|
| Rate for Payer: University Health Alliance Commercial |
$255.12
|
|
|
96366 IV Infusion Ea Addl Hr Charge
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
8220032
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$352.11 |
| Rate for Payer: AlohaCare Medicaid |
$181.50
|
| Rate for Payer: AlohaCare Medicare |
$181.50
|
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Devoted Health Medicare |
$199.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$344.85
|
| Rate for Payer: Health Management Network Commercial |
$308.55
|
| Rate for Payer: Humana Medicare |
$181.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$185.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.50
|
| Rate for Payer: MDX Hawaii PPO |
$352.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$181.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.50
|
| Rate for Payer: University Health Alliance Commercial |
$264.59
|
|
|
96366 IV Infusion Ea Addl Hr Charge
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
8220032
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$308.55 |
| Max. Negotiated Rate |
$352.11 |
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Health Management Network Commercial |
$308.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.70
|
| Rate for Payer: MDX Hawaii PPO |
$352.11
|
|
|
96367- ED IV tx, sequential infusion
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
1928301
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$322.15 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$341.10
|
| Rate for Payer: MDX Hawaii PPO |
$367.63
|
|
|
96367- ED IV tx, sequential infusion
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
1928301
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: AlohaCare Medicaid |
$189.50
|
| Rate for Payer: AlohaCare Medicare |
$189.50
|
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Devoted Health Medicare |
$208.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$189.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$360.05
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Humana Medicare |
$189.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$341.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$193.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$189.50
|
| Rate for Payer: MDX Hawaii PPO |
$367.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$189.50
|
| Rate for Payer: University Health Alliance Commercial |
$276.25
|
|
|
96367-Infusion Sequential 1 hr Greater Than 15 mins
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
8079984
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$363.75 |
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Health Management Network Commercial |
$318.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.50
|
| Rate for Payer: MDX Hawaii PPO |
$363.75
|
|
|
96367-Infusion Sequential 1 hr Greater Than 15 mins
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
8079984
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$187.50
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Devoted Health Medicare |
$206.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$187.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.25
|
| Rate for Payer: Health Management Network Commercial |
$318.75
|
| Rate for Payer: Humana Medicare |
$187.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.50
|
| Rate for Payer: MDX Hawaii PPO |
$363.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$187.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$187.50
|
| Rate for Payer: University Health Alliance Commercial |
$273.34
|
|
|
96367 IV Inf Addl Seq 16 to 90 Min Charge
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
8220030
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$322.15 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$341.10
|
| Rate for Payer: MDX Hawaii PPO |
$367.63
|
|
|
96367 IV Inf Addl Seq 16 to 90 Min Charge
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
8220030
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: AlohaCare Medicaid |
$189.50
|
| Rate for Payer: AlohaCare Medicare |
$189.50
|
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Devoted Health Medicare |
$208.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$189.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$360.05
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Humana Medicare |
$189.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$341.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$193.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$189.50
|
| Rate for Payer: MDX Hawaii PPO |
$367.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$189.50
|
| Rate for Payer: University Health Alliance Commercial |
$276.25
|
|
|
96368- ED IV tx, concurrent infusion
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
1928302
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$99.50
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Devoted Health Medicare |
$109.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.05
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Humana Medicare |
$99.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.50
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.50
|
| Rate for Payer: University Health Alliance Commercial |
$145.05
|
|
|
96368- ED IV tx, concurrent infusion
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
1928302
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.15 |
| Max. Negotiated Rate |
$193.03 |
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
|
|
96368-Infusion Concurrent Greater Than 15 mins
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
8079977
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$99.50
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Devoted Health Medicare |
$109.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.05
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Humana Medicare |
$99.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.50
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.50
|
| Rate for Payer: University Health Alliance Commercial |
$145.05
|
|
|
96368-Infusion Concurrent Greater Than 15 mins
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
8079977
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.15 |
| Max. Negotiated Rate |
$193.03 |
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
|
|
96368 IV Infusion Concurrent Charge
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
8220031
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$193.03 |
| Rate for Payer: AlohaCare Medicaid |
$99.50
|
| Rate for Payer: AlohaCare Medicare |
$99.50
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Devoted Health Medicare |
$109.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.05
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Humana Medicare |
$99.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.50
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.50
|
| Rate for Payer: University Health Alliance Commercial |
$145.05
|
|
|
96368 IV Infusion Concurrent Charge
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
8220031
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$169.15 |
| Max. Negotiated Rate |
$193.03 |
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
|
|
96372-59 SQ/IM Injection w/ Modification
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 96372 59
|
| Hospital Charge Code |
8079988
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$102.50
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Devoted Health Medicare |
$112.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$194.75
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Humana Medicare |
$102.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.50
|
| Rate for Payer: University Health Alliance Commercial |
$149.42
|
|
|
96372-59 SQ/IM Injection w/ Modification
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 96372 59
|
| Hospital Charge Code |
8079988
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
|
|
96372 ED Subq/IM Injection
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
1928303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$125.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Devoted Health Medicare |
$137.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$125.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$237.50
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: Humana Medicare |
$125.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$225.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.00
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$125.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$125.00
|
| Rate for Payer: University Health Alliance Commercial |
$182.22
|
|
|
96372 ED Subq/IM Injection
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
1928303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$225.00
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
|
|
96372 IM SC Injection Each Charge
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
8220025
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: AlohaCare Medicaid |
$125.00
|
| Rate for Payer: AlohaCare Medicare |
$125.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Devoted Health Medicare |
$137.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$125.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$237.50
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: Humana Medicare |
$125.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$225.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.00
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$125.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$125.00
|
| Rate for Payer: University Health Alliance Commercial |
$182.22
|
|
