|
96523 Irrigation of implanted venous access device for drug delivery (Port Flush)
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
8040861
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$16.97
|
| Rate for Payer: AlohaCare Medicare |
$29.25
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Devoted Health Medicare |
$32.17
|
| 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 |
$26.86
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| 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 |
$16.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.25
|
| 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
|
|
|
96523 Irrig Drug Delivery Device Charges
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
8221505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
96523 Irrig Drug Delivery Device Charges
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
8221505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$80.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$88.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$152.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$80.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.00
|
| Rate for Payer: University Health Alliance Commercial |
$89.60
|
|
|
96900 Actinotherapy (ultraviolet light)
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 96900
|
| Hospital Charge Code |
8040863
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$28.49
|
| Rate for Payer: AlohaCare Medicare |
$26.78
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Devoted Health Medicare |
$29.46
|
| 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 |
$12.76
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.14
|
| 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 |
$28.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.78
|
| 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
|
|
|
96900 Actinotherapy (ultraviolet light)
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 96900
|
| Hospital Charge Code |
8040863
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$69.50
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Devoted Health Medicare |
$76.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.05
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$69.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.50
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.50
|
| Rate for Payer: University Health Alliance Commercial |
$77.84
|
|
|
96900 Actinotherapy (ultraviolet light)
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 96900
|
| Hospital Charge Code |
8040863
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: AlohaCare Medicaid |
$28.49
|
| Rate for Payer: AlohaCare Medicare |
$26.78
|
| Rate for Payer: Cash Price |
$33.80
|
| Rate for Payer: Cash Price |
$33.80
|
| Rate for Payer: Devoted Health Medicare |
$29.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.76
|
| Rate for Payer: Health Management Network Commercial |
$44.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.78
|
|
|
96900 Actinotherapy (ultraviolet light)
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 96900
|
| Hospital Charge Code |
8040863
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
96910 Photochemotherapy; tar & ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 96910
|
| Hospital Charge Code |
8040865
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$135.77
|
| Rate for Payer: AlohaCare Medicare |
$130.27
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Devoted Health Medicare |
$143.30
|
| 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 |
$24.53
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.32
|
| 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 |
$135.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.27
|
| 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
|
|
|
96912 Photochemotherapy; psoralens and ultraviolet A (PUVA)
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 96912
|
| Hospital Charge Code |
8040866
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$115.50
|
| Rate for Payer: AlohaCare Medicare |
$110.14
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Devoted Health Medicare |
$121.15
|
| 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 |
$28.08
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.17
|
| 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 |
$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 |
$115.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.14
|
| 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
|
|
|
97012 Traction Mechanical
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 97012 GP,CQ
|
| Hospital Charge Code |
8222667
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: AlohaCare Medicaid |
$63.50
|
| Rate for Payer: AlohaCare Medicare |
$63.50
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Devoted Health Medicare |
$69.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$120.65
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$63.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.50
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.50
|
| Rate for Payer: University Health Alliance Commercial |
$71.12
|
|
|
97012 Traction Mechanical
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 97012 GP,CQ
|
| Hospital Charge Code |
8222667
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.95 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
|
|
97018 Paraffin bath
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 97018
|
| Hospital Charge Code |
8040871
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$6.01
|
| Rate for Payer: AlohaCare Medicare |
$6.37
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$7.01
|
| 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 |
$10.81
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.64
|
| 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 |
$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 |
$6.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.37
|
| 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
|
|
|
97028 Application of a modality to 1 or more areas; ultraviolet
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 97028
|
| Hospital Charge Code |
8831468
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: AlohaCare Medicaid |
$8.97
|
| Rate for Payer: AlohaCare Medicare |
$8.94
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Devoted Health Medicare |
$9.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.75
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.94
|
|
|
97110 - Theurapeutic Proc Ea 15 min
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 97110 GP,CQ
|
| Hospital Charge Code |
8409226
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$193.03 |
| Rate for Payer: AlohaCare Medicaid |
$99.50
|
| Rate for Payer: AlohaCare Medicare |
$99.50
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Devoted Health Medicare |
$109.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.05
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Humana Medicare |
$99.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.50
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.50
|
| Rate for Payer: University Health Alliance Commercial |
$111.44
|
|
|
97110 - Theurapeutic Proc Ea 15 min
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 97110 GP,CQ
|
| Hospital Charge Code |
8409226
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$169.15 |
| Max. Negotiated Rate |
$193.03 |
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
|
|
97140 MANUAL THERAPY TECHNIQUES PLUS EA 15 MIN CH
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 97140 GO,59
|
| Hospital Charge Code |
8933483
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$92.50
|
| Rate for Payer: AlohaCare Medicare |
$92.50
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$101.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$92.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.50
|
| Rate for Payer: University Health Alliance Commercial |
$103.60
|
|
|
97140 MANUAL THERAPY TECHNIQUES PLUS EA 15 MIN CH
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 97140 GO,59
|
| Hospital Charge Code |
8933483
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
97140 PT Manual Therapy Assistant Units
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 97140 GP,59
|
| Hospital Charge Code |
9438781
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
97140 PT Manual Therapy Assistant Units
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 97140 GP,59
|
| Hospital Charge Code |
9438781
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$92.50
|
| Rate for Payer: AlohaCare Medicare |
$92.50
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$101.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$92.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.50
|
| Rate for Payer: University Health Alliance Commercial |
$103.60
|
|
|
97530 PT Therapeutic Activity Assistant Units
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 97530 GO,59
|
| Hospital Charge Code |
9438786
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$209.10 |
| Max. Negotiated Rate |
$238.62 |
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.40
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
|
|
97530 PT Therapeutic Activity Assistant Units
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 97530 GO,59
|
| Hospital Charge Code |
9438786
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$238.62 |
| Rate for Payer: AlohaCare Medicaid |
$123.00
|
| Rate for Payer: AlohaCare Medicare |
$123.00
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Devoted Health Medicare |
$135.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$233.70
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Humana Medicare |
$123.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.00
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.00
|
| Rate for Payer: University Health Alliance Commercial |
$137.76
|
|
|
97597 Debridement, open wound; first 20 sq cm or less
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8040894
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: AlohaCare Medicaid |
$35.17
|
| Rate for Payer: AlohaCare Medicare |
$30.95
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Devoted Health Medicare |
$34.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$58.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.88
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.95
|
| Rate for Payer: University Health Alliance Commercial |
$145.00
|
|
|
97597 Debridement, open wound; first 20 sq cm or less
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8040894
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$35.17
|
| Rate for Payer: AlohaCare Medicare |
$30.95
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Devoted Health Medicare |
$34.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$58.95
|
| 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 |
$46.88
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.14
|
| 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 |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.95
|
| 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 |
$145.00
|
|
|
97597 Debride Select 1st 20cm or less Charges
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 97597 GP
|
| Hospital Charge Code |
8221486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.07 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: AlohaCare Medicaid |
$300.00
|
| Rate for Payer: AlohaCare Medicare |
$300.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Devoted Health Medicare |
$330.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$300.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.00
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Humana Medicare |
$300.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$540.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$306.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$300.00
|
| Rate for Payer: MDX Hawaii PPO |
$582.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$300.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$300.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$300.00
|
| Rate for Payer: University Health Alliance Commercial |
$336.00
|
|
|
97597 Debride Select 1st 20cm or less Charges
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 97597 GP
|
| Hospital Charge Code |
8221486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$540.00
|
| Rate for Payer: MDX Hawaii PPO |
$582.00
|
|
