|
99080 Special reports or insurance forms
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 99080
|
| Hospital Charge Code |
8118105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$125.00
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.48
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.00
|
| 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
|
|
|
99100 ANES PRO Age <1 or >70
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
8952659
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$294.10 |
| Rate for Payer: Cash Price |
$224.90
|
| Rate for Payer: Cash Price |
$224.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.33
|
| Rate for Payer: Health Management Network Commercial |
$294.10
|
|
|
99140 EMERGENCY CONDITIONS ProFee
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 99140
|
| Hospital Charge Code |
8022391
|
|
Hospital Revenue Code
|
963
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.10
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
|
|
99151-Same MD First 15 mins Less Than 5 yrs
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 99151
|
| Hospital Charge Code |
8080164
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: AlohaCare Medicaid |
$76.50
|
| Rate for Payer: AlohaCare Medicare |
$76.50
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Devoted Health Medicare |
$84.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$145.35
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Humana Medicare |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.50
|
| Rate for Payer: University Health Alliance Commercial |
$85.68
|
|
|
99151-Same MD First 15 mins Less Than 5 yrs
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 99151
|
| Hospital Charge Code |
8080164
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$130.05 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
|
|
99152-Same MD First 15 mins Greater Than/Equal to 5 yrs
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 99152
|
| Hospital Charge Code |
8080165
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
|
99152-Same MD First 15 mins Greater Than/Equal to 5 yrs
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 99152
|
| Hospital Charge Code |
8080165
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: AlohaCare Medicaid |
$101.00
|
| Rate for Payer: AlohaCare Medicare |
$101.00
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Devoted Health Medicare |
$111.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$191.90
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Humana Medicare |
$101.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.00
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.00
|
| Rate for Payer: University Health Alliance Commercial |
$113.12
|
|
|
99153-Same MD Each Additional 15 mins
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
8080166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$59.50
|
| Rate for Payer: AlohaCare Medicare |
$59.50
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Devoted Health Medicare |
$65.45
|
| 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 |
$59.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.05
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Humana Medicare |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$59.50
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$59.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.50
|
| Rate for Payer: University Health Alliance Commercial |
$86.74
|
|
|
99153-Same MD Each Additional 15 mins
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
8080166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
|
|
99155-Different MD First 15 mins Less Than 5 yrs
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 99155
|
| Hospital Charge Code |
8080167
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$59.68 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: AlohaCare Medicaid |
$76.50
|
| Rate for Payer: AlohaCare Medicare |
$76.50
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Devoted Health Medicare |
$84.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$145.35
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Humana Medicare |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.50
|
| Rate for Payer: University Health Alliance Commercial |
$85.68
|
|
|
99155-Different MD First 15 mins Less Than 5 yrs
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 99155
|
| Hospital Charge Code |
8080167
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$130.05 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
|
|
99156 CONS SEDATE >5Y 1ST 15MIN DIFF PROV ProFee
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
8022400
|
|
Hospital Revenue Code
|
963
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$134.30 |
| Rate for Payer: AlohaCare Medicaid |
$73.40
|
| Rate for Payer: AlohaCare Medicare |
$69.80
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Devoted Health Medicare |
$76.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.15
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.80
|
|
|
99156-Different MD First 15 mins Greater Than/Equal to 5 yrs
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
8080168
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$53.37 |
| 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 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 |
$53.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.50
|
| Rate for Payer: University Health Alliance Commercial |
$77.84
|
|
|
99156-Different MD First 15 mins Greater Than/Equal to 5 yrs
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
8080168
|
|
Hospital Revenue Code
|
370
|
| 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
|
|
|
99157 CONS SEDATE EA ADD 15MIN DIFF PROVI ProFee
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
8022401
|
|
Hospital Revenue Code
|
963
|
| Min. Negotiated Rate |
$53.19 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: AlohaCare Medicaid |
$58.96
|
| Rate for Payer: AlohaCare Medicare |
$53.19
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Devoted Health Medicare |
$58.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.56
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.19
|
|
|
99157-Different MD Each Addl 15 mins
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
8080169
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.00
|
| Rate for Payer: MDX Hawaii PPO |
$67.90
|
|
|
99157-Different MD Each Addl 15 mins
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
8080169
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: AlohaCare Medicaid |
$35.00
|
| Rate for Payer: AlohaCare Medicare |
$35.00
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Devoted Health Medicare |
$38.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.50
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Humana Medicare |
$35.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.00
|
| Rate for Payer: MDX Hawaii PPO |
$67.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.00
|
| Rate for Payer: University Health Alliance Commercial |
$39.20
|
|
|
99173 Screening test of visual acuity, quantitative, bilateral
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 99173
|
| Hospital Charge Code |
8040928
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.20
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| 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 |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| 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 |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
99175 Ipecac or similar administration for individual emesis and continued observation
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 99175
|
| Hospital Charge Code |
8040929
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$34.23
|
| Rate for Payer: AlohaCare Medicare |
$51.84
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Devoted Health Medicare |
$57.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.43
|
| Rate for Payer: Health Management Network Commercial |
$66.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.84
|
| 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
|
|
|
99195 Phlebotomy, therapeutic
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
8040930
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: AlohaCare Medicaid |
$108.60
|
| Rate for Payer: AlohaCare Medicare |
$110.72
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Devoted Health Medicare |
$121.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.61
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.72
|
|
|
99195 Phlebotomy, therapeutic
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
8040930
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$108.60
|
| Rate for Payer: AlohaCare Medicare |
$110.72
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Devoted Health Medicare |
$121.79
|
| 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 |
$18.61
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$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 |
$108.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.72
|
| 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
|
|
|
99195††PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
8258871
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$533.50 |
| Rate for Payer: AlohaCare Medicaid |
$275.00
|
| Rate for Payer: AlohaCare Medicare |
$275.00
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Devoted Health Medicare |
$302.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$522.50
|
| Rate for Payer: Health Management Network Commercial |
$467.50
|
| Rate for Payer: Humana Medicare |
$275.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$495.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$280.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$275.00
|
| Rate for Payer: MDX Hawaii PPO |
$533.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$275.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.00
|
| Rate for Payer: University Health Alliance Commercial |
$308.00
|
|
|
99195††PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
8258871
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$467.50 |
| Max. Negotiated Rate |
$533.50 |
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Health Management Network Commercial |
$467.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$495.00
|
| Rate for Payer: MDX Hawaii PPO |
$533.50
|
|
|
99199 Unlisted special service, procedure or report
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 99199
|
| Hospital Charge Code |
8040931
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Health Management Network Commercial |
$23.80
|
| 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 Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| 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
|
|
|
99202 Office/Outpatient Visit - New Patient, Level 2 (15-29 mins)
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
8041013
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$41.15 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$47.75
|
| Rate for Payer: AlohaCare Medicare |
$41.15
|
| Rate for Payer: Cash Price |
$180.05
|
| Rate for Payer: Cash Price |
$180.05
|
| Rate for Payer: Cash Price |
$180.05
|
| Rate for Payer: Devoted Health Medicare |
$45.27
|
| 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 |
$55.98
|
| Rate for Payer: Health Management Network Commercial |
$235.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.38
|
| 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 |
$47.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.15
|
| 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
|
|
