|
96360 IV Hydration Int 31 to 90 Min Charge
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
8220029
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$637.29 |
| Rate for Payer: AlohaCare Medicaid |
$328.50
|
| Rate for Payer: AlohaCare Medicare |
$328.50
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Devoted Health Medicare |
$361.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$328.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$624.15
|
| Rate for Payer: Health Management Network Commercial |
$558.45
|
| Rate for Payer: Humana Medicare |
$328.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$591.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$335.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$328.50
|
| Rate for Payer: MDX Hawaii PPO |
$637.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$328.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$328.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$328.50
|
| Rate for Payer: University Health Alliance Commercial |
$367.92
|
|
|
96360 IV Hydration Int 31 to 90 Min Charge
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
8220029
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.64
|
| Rate for Payer: AlohaCare Medicare |
$37.01
|
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Devoted Health Medicare |
$40.71
|
| 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 |
$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 Medicare |
$246.64
|
| 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 Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.83
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| 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 Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| 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 |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
96361- ED Hydration, each additional hour
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
1928298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$311.95 |
| Max. Negotiated Rate |
$355.99 |
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.30
|
| Rate for Payer: MDX Hawaii PPO |
$355.99
|
|
|
96361- ED Hydration, each additional hour
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
1928298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$183.50
|
| Rate for Payer: AlohaCare Medicare |
$183.50
|
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Devoted Health Medicare |
$201.85
|
| 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 |
$183.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$348.65
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Humana Medicare |
$183.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$183.50
|
| Rate for Payer: MDX Hawaii PPO |
$355.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$183.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.50
|
| Rate for Payer: University Health Alliance Commercial |
$267.51
|
|
|
96361-IV Hydration Each Addl Hour Greater Than 30 mins
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
8079978
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$180.00
|
| Rate for Payer: AlohaCare Medicare |
$180.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Devoted Health Medicare |
$198.00
|
| 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 |
$180.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network Commercial |
$306.00
|
| Rate for Payer: Humana Medicare |
$180.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.00
|
| Rate for Payer: MDX Hawaii PPO |
$349.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.00
|
| Rate for Payer: University Health Alliance Commercial |
$262.40
|
|
|
96361-IV Hydration Each Addl Hour Greater Than 30 mins
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
8079978
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$349.20 |
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Health Management Network Commercial |
$306.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.00
|
| Rate for Payer: MDX Hawaii PPO |
$349.20
|
|
|
96361 IV Hydration Each Addl Hr Charge
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
8220028
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$8.11
|
| Rate for Payer: AlohaCare Medicare |
$14.21
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Devoted Health Medicare |
$15.63
|
| 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 |
$18.68
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.05
|
| 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 |
$8.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.21
|
| 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
|
|
|
96361 IV Hydration Each Addl Hr Charge
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
8220028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$355.99 |
| Rate for Payer: AlohaCare Medicaid |
$183.50
|
| Rate for Payer: AlohaCare Medicare |
$183.50
|
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Devoted Health Medicare |
$201.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$348.65
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Humana Medicare |
$183.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$183.50
|
| Rate for Payer: MDX Hawaii PPO |
$355.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$183.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.50
|
| Rate for Payer: University Health Alliance Commercial |
$205.52
|
|
|
96361 IV Hydration Each Addl Hr Charge
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
8220028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$311.95 |
| Max. Negotiated Rate |
$355.99 |
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.30
|
| Rate for Payer: MDX Hawaii PPO |
$355.99
|
|
|
96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
8003307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$183.50
|
| Rate for Payer: AlohaCare Medicare |
$183.50
|
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Devoted Health Medicare |
$201.85
|
| 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 |
$183.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$348.65
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Humana Medicare |
$183.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$183.50
|
| Rate for Payer: MDX Hawaii PPO |
$355.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$183.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.50
|
| Rate for Payer: University Health Alliance Commercial |
$267.51
|
|
|
96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
8003307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$311.95 |
| Max. Negotiated Rate |
$355.99 |
| Rate for Payer: Cash Price |
$238.55
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.30
|
| Rate for Payer: MDX Hawaii PPO |
$355.99
|
|
|
96365-59 Infusion Initial Addl Site w/ Modification
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 96365 59
|
| Hospital Charge Code |
8079987
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$680.00 |
| Max. Negotiated Rate |
$776.00 |
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Health Management Network Commercial |
$680.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$720.00
|
| Rate for Payer: MDX Hawaii PPO |
$776.00
|
|
|
96365-59 Infusion Initial Addl Site w/ Modification
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 96365 59
|
| Hospital Charge Code |
8079987
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$400.00
|
| Rate for Payer: AlohaCare Medicare |
$400.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Devoted Health Medicare |
$440.00
|
| 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 |
$400.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$760.00
|
| Rate for Payer: Health Management Network Commercial |
$680.00
|
| Rate for Payer: Humana Medicare |
$400.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$400.00
|
| Rate for Payer: MDX Hawaii PPO |
$776.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$400.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.00
|
| Rate for Payer: University Health Alliance Commercial |
$583.12
|
|
|
96365- ED IV tx, first hour
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
1928299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$654.50 |
| Max. Negotiated Rate |
$746.90 |
| Rate for Payer: Cash Price |
$500.50
|
| Rate for Payer: Health Management Network Commercial |
$654.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$693.00
|
| Rate for Payer: MDX Hawaii PPO |
$746.90
|
|
|
96365- ED IV tx, first hour
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
1928299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$385.00
|
| Rate for Payer: AlohaCare Medicare |
$385.00
|
| Rate for Payer: Cash Price |
$500.50
|
| Rate for Payer: Cash Price |
$500.50
|
| Rate for Payer: Devoted Health Medicare |
$423.50
|
| 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 |
$385.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$731.50
|
| Rate for Payer: Health Management Network Commercial |
$654.50
|
| Rate for Payer: Humana Medicare |
$385.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$693.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.00
|
| Rate for Payer: MDX Hawaii PPO |
$746.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.00
|
| Rate for Payer: University Health Alliance Commercial |
$561.25
|
|
|
96365-Infusion Drug Initial up to 1 hr Greater Than 15 mins
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
8079980
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$637.50 |
| Max. Negotiated Rate |
$727.50 |
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Health Management Network Commercial |
$637.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$675.00
|
| Rate for Payer: MDX Hawaii PPO |
$727.50
|
|
|
96365-Infusion Drug Initial up to 1 hr Greater Than 15 mins
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
8079980
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$375.00
|
| Rate for Payer: AlohaCare Medicare |
$375.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Devoted Health Medicare |
$412.50
|
| 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 |
$375.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$712.50
|
| Rate for Payer: Health Management Network Commercial |
$637.50
|
| Rate for Payer: Humana Medicare |
$375.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$375.00
|
| Rate for Payer: MDX Hawaii PPO |
$727.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$375.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$375.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$375.00
|
| Rate for Payer: University Health Alliance Commercial |
$546.67
|
|
|
96365 IV infusion, for therapy/prophylaxis, or diagnosis; inital, up to one hour
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
8957886
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$42.05
|
| Rate for Payer: AlohaCare Medicare |
$74.63
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Devoted Health Medicare |
$82.09
|
| 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 |
$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 Medicare |
$246.64
|
| 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 Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$73.23
|
| Rate for Payer: Health Management Network Commercial |
$228.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| 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 Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| 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 |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
96365 IV infusion, for therapy/prophylaxis, or diagnosis; inital, up to one hour
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
8957886
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$259.25 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Health Management Network Commercial |
$259.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$274.50
|
| Rate for Payer: MDX Hawaii PPO |
$295.85
|
|
|
96365 IV infusion, for therapy/prophylaxis, or diagnosis; inital, up to one hour
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
8957886
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: AlohaCare Medicaid |
$152.50
|
| Rate for Payer: AlohaCare Medicare |
$152.50
|
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Devoted Health Medicare |
$167.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$289.75
|
| Rate for Payer: Health Management Network Commercial |
$259.25
|
| Rate for Payer: Humana Medicare |
$152.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$274.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.50
|
| Rate for Payer: MDX Hawaii PPO |
$295.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$152.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.50
|
| Rate for Payer: University Health Alliance Commercial |
$222.31
|
|
|
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
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
8220033
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$42.05
|
| Rate for Payer: AlohaCare Medicare |
$74.63
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Devoted Health Medicare |
$82.09
|
| 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 |
$73.23
|
| Rate for Payer: Health Management Network Commercial |
$275.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.56
|
| 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 |
$42.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.63
|
| 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
|
|
|
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 |
$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 ABD |
$469.00
|
| 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 |
$450.00
|
| 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
|
|
