|
96372 INJECTION IM/SQ-THER, PROPHY, DIAGNOSTIC
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
8051103
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$16.51
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$18.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.25
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.51
|
|
|
96372 INJECTION IM/SQ-THER, PROPHY, DIAGNOSTIC
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
8051103
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$16.51
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$18.16
|
| 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 |
$17.25
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.81
|
| 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 |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.51
|
| 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
|
|
|
96372-Injection/SQ/IM
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
8079979
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Kaiser Permanente Medicare |
$102.50
|
| Rate for Payer: AlohaCare Medicaid |
$102.50
|
| Rate for Payer: AlohaCare Medicare |
$102.50
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Devoted Health Medicare |
$112.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$194.75
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Humana Medicare |
$102.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.50
|
| Rate for Payer: University Health Alliance Commercial |
$149.42
|
|
|
96372-Injection/SQ/IM
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
8079979
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
|
|
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intermuscular,
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
9880573
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$16.51
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$18.16
|
| 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 |
$17.25
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.81
|
| 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 |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.51
|
| 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
|
|
|
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intermuscular,
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
9880573
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$16.51
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$18.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.25
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.51
|
|
|
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular:
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
8041252
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$16.51
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Devoted Health Medicare |
$18.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.25
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.51
|
|
|
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular:
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
8041252
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$16.51
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$18.16
|
| 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 |
$17.25
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| 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 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 |
$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 |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.51
|
| 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
|
|
|
96373 Inj Intra Arterial Charge
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
8220026
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: AlohaCare Medicaid |
$234.50
|
| Rate for Payer: AlohaCare Medicare |
$234.50
|
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Devoted Health Medicare |
$257.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$234.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$445.55
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Humana Medicare |
$234.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.50
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$234.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.50
|
| Rate for Payer: University Health Alliance Commercial |
$262.64
|
|
|
96373 Inj Intra Arterial Charge
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
8220026
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$398.65 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
|
|
96373- Intra-Arterial Injection
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
1928304
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$398.65 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
|
|
96373- Intra-Arterial Injection
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
1928304
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: AlohaCare Medicaid |
$234.50
|
| Rate for Payer: AlohaCare Medicare |
$234.50
|
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Devoted Health Medicare |
$257.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$234.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$445.55
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Humana Medicare |
$234.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.50
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$234.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.50
|
| Rate for Payer: University Health Alliance Commercial |
$262.64
|
|
|
96374-59 IV Push Initial Drug Addl Site w/ Modification
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 96374 59
|
| Hospital Charge Code |
8079989
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$365.50 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
|
|
96374-59 IV Push Initial Drug Addl Site w/ Modification
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 96374 59
|
| Hospital Charge Code |
8079989
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$215.00
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Devoted Health Medicare |
$236.50
|
| 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 |
$215.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$408.50
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$215.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.00
|
| Rate for Payer: University Health Alliance Commercial |
$313.43
|
|
|
96374- ED Injection, single/initial
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
1928305
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$398.65 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
|
|
96374- ED Injection, single/initial
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
1928305
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$36.88 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: AlohaCare Medicaid |
$234.50
|
| Rate for Payer: AlohaCare Medicare |
$234.50
|
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Devoted Health Medicare |
$257.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$234.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$445.55
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Humana Medicare |
$234.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.50
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$234.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.50
|
| Rate for Payer: University Health Alliance Commercial |
$262.64
|
|
|
96374 Inj IV Push Initial Drug Charge
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
8220027
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$398.65 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
|
|
96374 Inj IV Push Initial Drug Charge
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
8220027
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$36.88 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: AlohaCare Medicaid |
$234.50
|
| Rate for Payer: AlohaCare Medicare |
$234.50
|
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Devoted Health Medicare |
$257.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$234.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$445.55
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Humana Medicare |
$234.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.50
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$234.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.50
|
| Rate for Payer: University Health Alliance Commercial |
$262.64
|
|
|
96374-IV Push Initial Drug
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
8079981
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$365.50 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
|
|
96374-IV Push Initial Drug
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
8079981
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$215.00
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Devoted Health Medicare |
$236.50
|
| 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 |
$215.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$408.50
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$215.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.00
|
| Rate for Payer: University Health Alliance Commercial |
$313.43
|
|
|
96374 Therapeutic, prophylactic, or diagnostic injection
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
8040859
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$24.47
|
| Rate for Payer: AlohaCare Medicare |
$41.72
|
| Rate for Payer: Cash Price |
$192.40
|
| Rate for Payer: Cash Price |
$192.40
|
| Rate for Payer: Cash Price |
$192.40
|
| Rate for Payer: Devoted Health Medicare |
$45.89
|
| 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 |
$54.61
|
| Rate for Payer: Health Management Network Commercial |
$251.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.06
|
| 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 |
$24.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.72
|
| 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
|
|
|
96375-IV Injection, add new drug
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
1928306
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$324.95 |
| Rate for Payer: Cash Price |
$217.75
|
| Rate for Payer: Health Management Network Commercial |
$284.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$301.50
|
| Rate for Payer: MDX Hawaii PPO |
$324.95
|
|
|
96375-IV Injection, add new drug
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
1928306
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$324.95 |
| Rate for Payer: AlohaCare Medicaid |
$167.50
|
| Rate for Payer: AlohaCare Medicare |
$167.50
|
| Rate for Payer: Cash Price |
$217.75
|
| Rate for Payer: Cash Price |
$217.75
|
| Rate for Payer: Devoted Health Medicare |
$184.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$318.25
|
| Rate for Payer: Health Management Network Commercial |
$284.75
|
| Rate for Payer: Humana Medicare |
$167.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$301.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$170.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$167.50
|
| Rate for Payer: MDX Hawaii PPO |
$324.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$167.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.50
|
| Rate for Payer: University Health Alliance Commercial |
$187.60
|
|
|
96375 IV Push Addl Seq New Drug Charge
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
8220035
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$324.95 |
| Rate for Payer: AlohaCare Medicaid |
$167.50
|
| Rate for Payer: AlohaCare Medicare |
$167.50
|
| Rate for Payer: Cash Price |
$217.75
|
| Rate for Payer: Cash Price |
$217.75
|
| Rate for Payer: Devoted Health Medicare |
$184.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$318.25
|
| Rate for Payer: Health Management Network Commercial |
$284.75
|
| Rate for Payer: Humana Medicare |
$167.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$301.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$170.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$167.50
|
| Rate for Payer: MDX Hawaii PPO |
$324.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$167.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.50
|
| Rate for Payer: University Health Alliance Commercial |
$187.60
|
|
|
96375 IV Push Addl Seq New Drug Charge
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
8220035
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$324.95 |
| Rate for Payer: Cash Price |
$217.75
|
| Rate for Payer: Health Management Network Commercial |
$284.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$301.50
|
| Rate for Payer: MDX Hawaii PPO |
$324.95
|
|
