|
91322 SARSCOV2 SPIKEVAX 2023-2024 formula 12+yrs
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 91322
|
| Hospital Charge Code |
11495746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$193.98 |
| Rate for Payer: AlohaCare Medicare |
$161.65
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Devoted Health Medicare |
$177.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.65
|
| Rate for Payer: Health Management Network Commercial |
$139.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$193.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$193.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$193.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.65
|
|
|
91322 SARSCOV2 SPIKEVAX 2023-2024 formula 12+yrs
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 91322
|
| Hospital Charge Code |
11495746
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$121.24 |
| Max. Negotiated Rate |
$471.42 |
| Rate for Payer: AlohaCare Medicaid |
$243.00
|
| Rate for Payer: AlohaCare Medicare |
$243.00
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Devoted Health Medicare |
$267.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$153.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$243.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$153.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$461.70
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Humana Medicare |
$243.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$437.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.00
|
| Rate for Payer: MDX Hawaii PPO |
$471.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$121.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.00
|
| Rate for Payer: University Health Alliance Commercial |
$272.16
|
|
|
91322 SARSCOV2 SPIKEVAX 2023-2024 formula 12+yrs
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 91322
|
| Hospital Charge Code |
11495746
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$413.10 |
| Max. Negotiated Rate |
$471.42 |
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$437.40
|
| Rate for Payer: MDX Hawaii PPO |
$471.42
|
|
|
92100 Eye-Glaucoma Check Serial Tonometry w/ interpretation and report, same day
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 92100
|
| Hospital Charge Code |
8040584
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$32.92
|
| Rate for Payer: AlohaCare Medicare |
$26.55
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Devoted Health Medicare |
$29.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.31
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.86
|
| 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 |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| 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 |
$32.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$39.50
|
|
|
92508 - Speech Therapy Group Charge
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 92508 GP,CQ
|
| Hospital Charge Code |
8409547
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$171.69 |
| Rate for Payer: AlohaCare Medicaid |
$88.50
|
| Rate for Payer: AlohaCare Medicare |
$88.50
|
| Rate for Payer: Cash Price |
$115.05
|
| Rate for Payer: Cash Price |
$115.05
|
| Rate for Payer: Devoted Health Medicare |
$97.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.15
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| Rate for Payer: Humana Medicare |
$88.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.50
|
| Rate for Payer: MDX Hawaii PPO |
$171.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.50
|
| Rate for Payer: University Health Alliance Commercial |
$99.12
|
|
|
92508 - Speech Therapy Group Charge
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 92508 GP,CQ
|
| Hospital Charge Code |
8409547
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$150.45 |
| Max. Negotiated Rate |
$171.69 |
| Rate for Payer: Cash Price |
$115.05
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.30
|
| Rate for Payer: MDX Hawaii PPO |
$171.69
|
|
|
92511 Nasopharyngoscopy with endoscope
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
HCPCS 92511
|
| Hospital Charge Code |
11043542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$546.50
|
| Rate for Payer: AlohaCare Medicare |
$546.50
|
| Rate for Payer: Cash Price |
$710.45
|
| Rate for Payer: Cash Price |
$710.45
|
| Rate for Payer: Devoted Health Medicare |
$601.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$546.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,038.35
|
| Rate for Payer: Health Management Network Commercial |
$929.05
|
| Rate for Payer: Humana Medicare |
$546.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$983.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$546.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,060.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$546.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$546.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$546.50
|
| Rate for Payer: University Health Alliance Commercial |
$796.69
|
|
|
92511 Nasopharyngoscopy with endoscope
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
HCPCS 92511
|
| Hospital Charge Code |
11043542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$929.05 |
| Max. Negotiated Rate |
$1,060.21 |
| Rate for Payer: Cash Price |
$710.45
|
| Rate for Payer: Health Management Network Commercial |
$929.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$983.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,060.21
|
|
|
92526 Swallowing Treatment Feeding
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
HCPCS 92526 GP,CQ
|
| Hospital Charge Code |
8222666
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$453.05 |
| Max. Negotiated Rate |
$517.01 |
| Rate for Payer: Cash Price |
$346.45
|
| Rate for Payer: Health Management Network Commercial |
$453.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$479.70
|
| Rate for Payer: MDX Hawaii PPO |
$517.01
|
|
|
92526 Swallowing Treatment Feeding
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
HCPCS 92526 GP,CQ
|
| Hospital Charge Code |
8222666
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$517.01 |
| Rate for Payer: AlohaCare Medicaid |
$266.50
|
| Rate for Payer: AlohaCare Medicare |
$266.50
|
| Rate for Payer: Cash Price |
$346.45
|
| Rate for Payer: Cash Price |
$346.45
|
| Rate for Payer: Devoted Health Medicare |
$293.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$506.35
|
| Rate for Payer: Health Management Network Commercial |
$453.05
|
| Rate for Payer: Humana Medicare |
$266.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$479.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$271.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.50
|
| Rate for Payer: MDX Hawaii PPO |
$517.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.50
|
| Rate for Payer: University Health Alliance Commercial |
$298.48
|
|
|
92551 Screening test, pure tone, air only
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 92551
|
| Hospital Charge Code |
8040605
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$14.34
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| 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 Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.38
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| 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 |
$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 |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
92552 Pure tone audiometry (threshold) air only
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 92552
|
| Hospital Charge Code |
8040606
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$43.41
|
| Rate for Payer: AlohaCare Medicare |
$45.77
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$50.35
|
| 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 |
$339.46
|
| 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 |
$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 |
$18.92
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.92
|
| 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 |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| 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: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
92567 Tympanometry (impedance testing)
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 92567
|
| Hospital Charge Code |
8040611
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$11.05
|
| Rate for Payer: AlohaCare Medicare |
$8.77
|
| Rate for Payer: Cash Price |
$47.45
|
| Rate for Payer: Cash Price |
$47.45
|
| Rate for Payer: Cash Price |
$47.45
|
| Rate for Payer: Devoted Health Medicare |
$9.65
|
| 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 |
$339.46
|
| 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 |
$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 |
$22.91
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.52
|
| 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 |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| 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: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
92583 Select picture audiometry
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 92583
|
| Hospital Charge Code |
8278606
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$65.21
|
| Rate for Payer: AlohaCare Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$76.66
|
| 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 |
$339.46
|
| 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 |
$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 |
$32.31
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.63
|
| 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 |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| 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: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
92585 Evoked response audiometry and/or testing of the central nervous system; comprehensive
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
8040614
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$114.68 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$119.51
|
| Rate for Payer: AlohaCare Medicare |
$114.68
|
| Rate for Payer: Cash Price |
$230.10
|
| Rate for Payer: Cash Price |
$230.10
|
| Rate for Payer: Cash Price |
$230.10
|
| Rate for Payer: Devoted Health Medicare |
$126.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| 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 Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Health Management Network Commercial |
$300.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| 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 |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
|
|
92586 NEWBORN HEARING SCREEN ABR CHARGE
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 92650
|
| Hospital Charge Code |
8140435
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$455.60 |
| Max. Negotiated Rate |
$519.92 |
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Health Management Network Commercial |
$455.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.40
|
| Rate for Payer: MDX Hawaii PPO |
$519.92
|
|
|
92586 NEWBORN HEARING SCREEN ABR CHARGE
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 92650
|
| Hospital Charge Code |
8140435
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$519.92 |
| Rate for Payer: AlohaCare Medicaid |
$268.00
|
| Rate for Payer: AlohaCare Medicare |
$268.00
|
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Devoted Health Medicare |
$294.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$268.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$509.20
|
| Rate for Payer: Health Management Network Commercial |
$455.60
|
| Rate for Payer: Humana Medicare |
$268.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$268.00
|
| Rate for Payer: MDX Hawaii PPO |
$519.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$268.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$268.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$268.00
|
| Rate for Payer: University Health Alliance Commercial |
$300.16
|
|
|
92587 Evoked otoacoustic emissions; limited evaluation, with interpretation and report
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 92587
|
| Hospital Charge Code |
8040615
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$22.35
|
| Rate for Payer: AlohaCare Medicare |
$23.09
|
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Devoted Health Medicare |
$25.40
|
| 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 |
$339.46
|
| 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 |
$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 |
$43.71
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.71
|
| 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 |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| 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: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
92587 NEWBORN HEARING SCREEN OAE CHARGE
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
HCPCS 92587
|
| Hospital Charge Code |
8083985
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$538.90 |
| Max. Negotiated Rate |
$614.98 |
| Rate for Payer: Cash Price |
$412.10
|
| Rate for Payer: Health Management Network Commercial |
$538.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$570.60
|
| Rate for Payer: MDX Hawaii PPO |
$614.98
|
|
|
92587 NEWBORN HEARING SCREEN OAE CHARGE
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
HCPCS 92587
|
| Hospital Charge Code |
8083985
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$614.98 |
| Rate for Payer: AlohaCare Medicaid |
$317.00
|
| Rate for Payer: AlohaCare Medicare |
$317.00
|
| Rate for Payer: Cash Price |
$412.10
|
| Rate for Payer: Cash Price |
$412.10
|
| Rate for Payer: Devoted Health Medicare |
$348.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$43.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$317.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$47.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$602.30
|
| Rate for Payer: Health Management Network Commercial |
$538.90
|
| Rate for Payer: Humana Medicare |
$317.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$570.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$317.00
|
| Rate for Payer: MDX Hawaii PPO |
$614.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$317.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$317.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$317.00
|
| Rate for Payer: University Health Alliance Commercial |
$355.04
|
|
|
92588 Evoked otoacoustic emissions; comprehensive diagnostic eval, with interpretation and report
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
HCPCS 92588
|
| Hospital Charge Code |
8040616
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$441.15 |
| Rate for Payer: AlohaCare Medicaid |
$34.75
|
| Rate for Payer: AlohaCare Medicare |
$35.47
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$39.02
|
| 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 |
$339.46
|
| 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 |
$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 |
$68.95
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.56
|
| 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 |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| 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: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
92612 Flexible endoscopic evaluation of swallowing by cine or video recording
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 92612
|
| Hospital Charge Code |
8040619
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$67.87
|
| Rate for Payer: AlohaCare Medicare |
$54.92
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Devoted Health Medicare |
$60.41
|
| 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 |
$339.46
|
| 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 |
$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 |
$199.07
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.90
|
| 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 |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| 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: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
92950 Cardiopulmonary resuscitation
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
8040634
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$167.64 |
| Max. Negotiated Rate |
$908.65 |
| Rate for Payer: AlohaCare Medicaid |
$179.25
|
| Rate for Payer: AlohaCare Medicare |
$167.64
|
| Rate for Payer: Cash Price |
$694.85
|
| Rate for Payer: Cash Price |
$694.85
|
| Rate for Payer: Cash Price |
$694.85
|
| Rate for Payer: Devoted Health Medicare |
$184.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$213.90
|
| Rate for Payer: Health Management Network Commercial |
$908.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.17
|
| 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 |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| 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 |
$179.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$218.44
|
|
|
92950-Cardiopulmonary Resuscitation
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
8080174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,061.65 |
| Max. Negotiated Rate |
$1,211.53 |
| Rate for Payer: Cash Price |
$811.85
|
| Rate for Payer: Health Management Network Commercial |
$1,061.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,124.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,211.53
|
|
|
92950-Cardiopulmonary Resuscitation
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
8080174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$624.50
|
| Rate for Payer: AlohaCare Medicare |
$624.50
|
| Rate for Payer: Cash Price |
$811.85
|
| Rate for Payer: Cash Price |
$811.85
|
| Rate for Payer: Devoted Health Medicare |
$686.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$624.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,186.55
|
| Rate for Payer: Health Management Network Commercial |
$1,061.65
|
| Rate for Payer: Humana Medicare |
$624.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,124.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$624.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,211.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$624.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$624.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$624.50
|
| Rate for Payer: University Health Alliance Commercial |
$910.40
|
|
