|
90792 Psychiatric diagnostic Evaluation - with medical services Charge
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
8540239
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$935.85 |
| Max. Negotiated Rate |
$1,067.97 |
| Rate for Payer: Cash Price |
$715.65
|
| Rate for Payer: Health Management Network Commercial |
$935.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$990.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,067.97
|
|
|
90792 Psychiatric diagnostic Evaluation - with medical services Charge
|
Professional
|
Both
|
$1,001.00
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
8540239
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$850.85 |
| Rate for Payer: AlohaCare Medicaid |
$170.34
|
| Rate for Payer: AlohaCare Medicare |
$158.95
|
| Rate for Payer: Cash Price |
$650.65
|
| Rate for Payer: Cash Price |
$650.65
|
| Rate for Payer: Devoted Health Medicare |
$174.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$170.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$170.34
|
| Rate for Payer: Health Management Network Commercial |
$850.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$190.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$170.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.95
|
| Rate for Payer: University Health Alliance Commercial |
$205.90
|
|
|
90832 Psychotherapy, 30 minutes w/ patient
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
12043594
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$239.59 |
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Health Management Network Commercial |
$209.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$222.30
|
| Rate for Payer: MDX Hawaii PPO |
$239.59
|
|
|
90832 Psychotherapy, 30 minutes w/ patient
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
12043594
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$46.62 |
| Max. Negotiated Rate |
$239.59 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$226.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.65
|
| Rate for Payer: Health Management Network Commercial |
$209.95
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$222.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$239.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$138.32
|
|
|
90832 Psychotherapy, 30 minutes w/ patient
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
12043594
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: AlohaCare Medicaid |
$68.60
|
| Rate for Payer: AlohaCare Medicare |
$69.93
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$76.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.60
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.93
|
| Rate for Payer: University Health Alliance Commercial |
$80.22
|
|
|
90833 Psychotherapy w/Pt w/EM Srvs 30 Min
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
11404757
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: AlohaCare Medicaid |
$53.50
|
| Rate for Payer: AlohaCare Medicare |
$53.50
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Devoted Health Medicare |
$58.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.65
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Humana Medicare |
$53.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.50
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.50
|
| Rate for Payer: University Health Alliance Commercial |
$59.92
|
|
|
90833 Psychotherapy w/Pt w/EM Srvs 30 Min
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
11404757
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: AlohaCare Medicaid |
$64.28
|
| Rate for Payer: AlohaCare Medicare |
$65.68
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Devoted Health Medicare |
$72.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$64.28
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.68
|
|
|
90833 Psychotherapy w/Pt w/EM Srvs 30 Min
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
11404757
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.30
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
|
|
90834 Psychotherapy w/Pt 45 Min
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
11404758
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$90.82 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: AlohaCare Medicaid |
$90.82
|
| Rate for Payer: AlohaCare Medicare |
$92.35
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Devoted Health Medicare |
$101.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$90.82
|
| Rate for Payer: Health Management Network Commercial |
$209.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.35
|
| Rate for Payer: University Health Alliance Commercial |
$105.43
|
|
|
90834 Psychotherapy w/Pt 45 Min
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
11404758
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$239.59 |
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Health Management Network Commercial |
$209.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$222.30
|
| Rate for Payer: MDX Hawaii PPO |
$239.59
|
|
|
90834 Psychotherapy w/Pt 45 Min
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
11404758
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$239.59 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$226.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.65
|
| Rate for Payer: Health Management Network Commercial |
$209.95
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$222.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$239.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$138.32
|
|
|
90836 Psychotherapy w/Pt w/EM Srvs 45 Min
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
11414879
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
|
|
90836 Psychotherapy w/Pt w/EM Srvs 45 Min
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
11414879
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: AlohaCare Medicaid |
$67.50
|
| Rate for Payer: AlohaCare Medicare |
$67.50
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Devoted Health Medicare |
$74.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$128.25
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Humana Medicare |
$67.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.50
|
| Rate for Payer: University Health Alliance Commercial |
$75.60
|
|
|
90836 Psychotherapy w/Pt w/EM Srvs 45 Min
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
11414879
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: AlohaCare Medicaid |
$81.51
|
| Rate for Payer: AlohaCare Medicare |
$83.14
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Devoted Health Medicare |
$91.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$81.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.51
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.14
|
| Rate for Payer: University Health Alliance Commercial |
$94.85
|
|
|
90837 Psychotherapy, 60 minutes w/ patient
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
12039585
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$110.09 |
| Max. Negotiated Rate |
$226.68 |
| Rate for Payer: AlohaCare Medicaid |
$115.00
|
| Rate for Payer: AlohaCare Medicare |
$115.00
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$126.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$226.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$218.50
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Humana Medicare |
$115.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.00
|
| Rate for Payer: University Health Alliance Commercial |
$128.80
|
|
|
90837 Psychotherapy, 60 minutes w/ patient
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
12039585
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
|
|
90837 Psychotherapy, 60 minutes w/ patient
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
12039585
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: AlohaCare Medicaid |
$134.02
|
| Rate for Payer: AlohaCare Medicare |
$136.14
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$149.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$134.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.02
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$134.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.14
|
| Rate for Payer: University Health Alliance Commercial |
$155.93
|
|
|
90838 Psychotherapy w/Pt w/EM Srvs 60 Min
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 90838
|
| Hospital Charge Code |
11414880
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$165.87 |
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.90
|
| Rate for Payer: MDX Hawaii PPO |
$165.87
|
|
|
90838 Psychotherapy w/Pt w/EM Srvs 60 Min
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 90838
|
| Hospital Charge Code |
11414880
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$165.87 |
| Rate for Payer: AlohaCare Medicaid |
$85.50
|
| Rate for Payer: AlohaCare Medicare |
$85.50
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Devoted Health Medicare |
$94.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$162.45
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Humana Medicare |
$85.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.50
|
| Rate for Payer: MDX Hawaii PPO |
$165.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.50
|
| Rate for Payer: University Health Alliance Commercial |
$95.76
|
|
|
90838 Psychotherapy w/Pt w/EM Srvs 60 Min
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 90838
|
| Hospital Charge Code |
11414880
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$108.01 |
| Max. Negotiated Rate |
$181.90 |
| Rate for Payer: AlohaCare Medicaid |
$108.01
|
| Rate for Payer: AlohaCare Medicare |
$110.00
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Devoted Health Medicare |
$121.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$108.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$108.01
|
| Rate for Payer: Health Management Network Commercial |
$181.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.00
|
| Rate for Payer: University Health Alliance Commercial |
$129.10
|
|
|
90839 Psychotherapy for Crisis Initial 60 Min
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
11404759
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$239.59 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$226.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.65
|
| Rate for Payer: Health Management Network Commercial |
$209.95
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$222.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$239.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$120.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$138.32
|
|
|
90839 Psychotherapy for Crisis Initial 60 Min
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
11404759
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$239.59 |
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Health Management Network Commercial |
$209.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$222.30
|
| Rate for Payer: MDX Hawaii PPO |
$239.59
|
|
|
90839 Psychotherapy for Crisis Initial 60 Min
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
11404759
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$129.79 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: AlohaCare Medicaid |
$129.79
|
| Rate for Payer: AlohaCare Medicare |
$130.41
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Devoted Health Medicare |
$143.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$129.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$130.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.79
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$156.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.41
|
| Rate for Payer: University Health Alliance Commercial |
$149.05
|
|
|
90839 Psychotherapy for crsis; first 60 min,
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
12043595
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Health Management Network Commercial |
$191.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.50
|
| Rate for Payer: MDX Hawaii PPO |
$218.25
|
|
|
90839 Psychotherapy for crsis; first 60 min,
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
12043595
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$129.79 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: AlohaCare Medicaid |
$129.79
|
| Rate for Payer: AlohaCare Medicare |
$130.41
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Devoted Health Medicare |
$143.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$129.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$130.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.79
|
| Rate for Payer: Health Management Network Commercial |
$191.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$156.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.41
|
| Rate for Payer: University Health Alliance Commercial |
$149.05
|
|
