|
90839 Psychotherapy for crsis; first 60 min,
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
12043595
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$226.68 |
| Rate for Payer: AlohaCare Medicaid |
$112.50
|
| Rate for Payer: AlohaCare Medicare |
$112.50
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Devoted Health Medicare |
$123.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$226.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$213.75
|
| Rate for Payer: Health Management Network Commercial |
$191.25
|
| Rate for Payer: Humana Medicare |
$112.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$218.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$112.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$120.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.50
|
| Rate for Payer: University Health Alliance Commercial |
$126.00
|
|
|
90840 each additional 30 min (List separately in addition to code for primary service)
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
12031270
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$62.82 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: AlohaCare Medicaid |
$64.85
|
| Rate for Payer: AlohaCare Medicare |
$62.82
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Devoted Health Medicare |
$69.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$64.85
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.82
|
| Rate for Payer: University Health Alliance Commercial |
$74.62
|
|
|
90840 each additional 30 min (List separately in addition to code for primary service)
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
12031270
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: AlohaCare Medicaid |
$55.00
|
| Rate for Payer: AlohaCare Medicare |
$55.00
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Devoted Health Medicare |
$60.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.50
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Humana Medicare |
$55.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.00
|
| Rate for Payer: University Health Alliance Commercial |
$61.60
|
|
|
90840 each additional 30 min (List separately in addition to code for primary service)
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
12031270
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
|
|
90840 Each additional 30 minutes of psychotherapy for crisis Charge
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
8540403
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: AlohaCare Medicaid |
$69.00
|
| Rate for Payer: AlohaCare Medicare |
$69.00
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Devoted Health Medicare |
$75.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.10
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Humana Medicare |
$69.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.00
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.00
|
| Rate for Payer: University Health Alliance Commercial |
$77.28
|
|
|
90840 Each additional 30 minutes of psychotherapy for crisis Charge
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
8540403
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
|
|
90846 Family psychotherapy w/o patient presen Charge
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
8540393
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$946.05 |
| Max. Negotiated Rate |
$1,079.61 |
| Rate for Payer: Cash Price |
$723.45
|
| Rate for Payer: Health Management Network Commercial |
$946.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,001.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,079.61
|
|
|
90846 Family psychotherapy w/o patient presen Charge
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
8540393
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$71.55 |
| Max. Negotiated Rate |
$1,079.61 |
| Rate for Payer: AlohaCare Medicaid |
$556.50
|
| Rate for Payer: AlohaCare Medicare |
$556.50
|
| Rate for Payer: Cash Price |
$723.45
|
| Rate for Payer: Cash Price |
$723.45
|
| Rate for Payer: Devoted Health Medicare |
$612.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$226.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$556.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,057.35
|
| Rate for Payer: Health Management Network Commercial |
$946.05
|
| Rate for Payer: Humana Medicare |
$556.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,001.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$567.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$556.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,079.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$556.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$556.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$556.50
|
| Rate for Payer: University Health Alliance Commercial |
$623.28
|
|
|
90846 Family psychotherapy w/o patient presen Charge
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
8540393
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$97.86 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: AlohaCare Medicaid |
$97.86
|
| Rate for Payer: AlohaCare Medicare |
$99.69
|
| Rate for Payer: Cash Price |
$432.90
|
| Rate for Payer: Cash Price |
$432.90
|
| Rate for Payer: Devoted Health Medicare |
$109.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$97.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$97.86
|
| Rate for Payer: Health Management Network Commercial |
$566.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$97.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.69
|
| Rate for Payer: University Health Alliance Commercial |
$113.90
|
|
|
90847 Family psychotherapy (conjoint psychotherapy) (w/ patient present), 50 min
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
12031271
|
|
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
|
|
|
90847 Family psychotherapy (conjoint psychotherapy) (w/ patient present), 50 min
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
12031271
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$82.73 |
| 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 |
$82.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$138.32
|
|
|
90847 Family psychotherapy (conjoint psychotherapy) (w/ patient present), 50 min
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
12031271
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$102.29 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: AlohaCare Medicaid |
$102.29
|
| Rate for Payer: AlohaCare Medicare |
$103.51
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Devoted Health Medicare |
$113.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$102.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$102.29
|
| Rate for Payer: Health Management Network Commercial |
$209.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.51
|
| Rate for Payer: University Health Alliance Commercial |
$124.35
|
|
|
90849 Multiple-family group psychotherapy BH charges
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
12039593
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: AlohaCare Medicaid |
$30.19
|
| Rate for Payer: AlohaCare Medicare |
$30.74
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Devoted Health Medicare |
$33.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.19
|
| Rate for Payer: Health Management Network Commercial |
$209.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.74
|
| Rate for Payer: University Health Alliance Commercial |
$33.81
|
|
|
90849 Multiple-family group psychotherapy BH charges
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
12039593
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$25.38 |
| 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 |
$25.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$138.32
|
|
|
90849 Multiple-family group psychotherapy BH charges
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
12039593
|
|
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
|
|
|
90853 Group psychotherapy (other than of a multiple-family group) BH charges
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
12043628
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
|
|
90853 Group psychotherapy (other than of a multiple-family group) BH charges
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
12043628
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: AlohaCare Medicaid |
$24.07
|
| Rate for Payer: AlohaCare Medicare |
$24.47
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Devoted Health Medicare |
$26.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.07
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.47
|
| Rate for Payer: University Health Alliance Commercial |
$29.44
|
|
|
90853 Group psychotherapy (other than of a multiple-family group) BH charges
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
12043628
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: AlohaCare Medicaid |
$70.50
|
| Rate for Payer: AlohaCare Medicare |
$70.50
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Devoted Health Medicare |
$77.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$129.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.95
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Humana Medicare |
$70.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.50
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.50
|
| Rate for Payer: University Health Alliance Commercial |
$78.96
|
|
|
90863 Pharmacologic management, including prescription and review of medication, when performed w/ p
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 90863
|
| Hospital Charge Code |
12043629
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$20.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Devoted Health Medicare |
$22.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$20.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.00
|
| Rate for Payer: University Health Alliance Commercial |
$22.40
|
|
|
90863 Pharmacologic management, including prescription and review of medication, when performed w/ p
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 90863
|
| Hospital Charge Code |
12043629
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
90863 Pharmacologic management, including prescription and review of medication, when performed w/ p
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 90863
|
| Hospital Charge Code |
12043629
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.81
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
|
|
90887 Interpretation or explanation of results
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 90887
|
| Hospital Charge Code |
12031292
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$199.75 |
| Max. Negotiated Rate |
$227.95 |
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.50
|
| Rate for Payer: MDX Hawaii PPO |
$227.95
|
|
|
90887 Interpretation or explanation of results
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 90887
|
| Hospital Charge Code |
12031292
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$51.92 |
| Max. Negotiated Rate |
$227.95 |
| Rate for Payer: AlohaCare Medicaid |
$117.50
|
| Rate for Payer: AlohaCare Medicare |
$117.50
|
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Devoted Health Medicare |
$129.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$223.25
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
| Rate for Payer: Humana Medicare |
$117.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.50
|
| Rate for Payer: MDX Hawaii PPO |
$227.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.50
|
| Rate for Payer: University Health Alliance Commercial |
$131.60
|
|
|
90887 Interpretation or explanation of results
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 90887
|
| Hospital Charge Code |
12031292
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$72.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$72.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.69
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
|
|
91035 Esophagus, gastroesophageal reflux test; with mucosal telemetry placement/rec/anal/interp
|
Professional
|
Both
|
$1,569.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
8040576
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: AlohaCare Medicaid |
$511.07
|
| Rate for Payer: AlohaCare Medicare |
$561.28
|
| Rate for Payer: Cash Price |
$1,019.85
|
| Rate for Payer: Cash Price |
$1,019.85
|
| Rate for Payer: Cash Price |
$1,019.85
|
| Rate for Payer: Devoted Health Medicare |
$617.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.05
|
| Rate for Payer: Health Management Network Commercial |
$1,333.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$673.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$561.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
