|
99251 Inpatient Consultation, Level 1
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 99251
|
| Hospital Charge Code |
8041046
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$49.51 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.51
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
|
|
99252 Inpatient Consultation, Level 2
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 99252
|
| Hospital Charge Code |
8041047
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$77.22 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Cash Price |
$198.25
|
| 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 |
$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 |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.22
|
| Rate for Payer: Health Management Network Commercial |
$259.25
|
| 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 Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| 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
|
|
|
99252 Inpatient Consultation, Level 2
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 99252
|
| Hospital Charge Code |
8041047
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$77.22 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.22
|
| Rate for Payer: Health Management Network Commercial |
$259.25
|
|
|
99253 Inpatient Consultation, Level 3
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 99253
|
| Hospital Charge Code |
8041048
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$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 Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.55
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$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
|
|
|
99253 Inpatient Consultation, Level 3
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 99253
|
| Hospital Charge Code |
8041048
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$366.35 |
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.55
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
|
|
99254 Inpatient Consultation, Level 4
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 99254
|
| Hospital Charge Code |
8041049
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$141.07 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$141.07
|
| Rate for Payer: Health Management Network Commercial |
$497.25
|
|
|
99255 Inpatient Consultation, Level 5
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 99255
|
| Hospital Charge Code |
8041050
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$532.10 |
| Rate for Payer: Cash Price |
$406.90
|
| Rate for Payer: Cash Price |
$406.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.80
|
| Rate for Payer: Health Management Network Commercial |
$532.10
|
|
|
99255 Inpatient Consultation, Level 5
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 99255
|
| Hospital Charge Code |
8041050
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$532.10 |
| Rate for Payer: Cash Price |
$406.90
|
| Rate for Payer: Cash Price |
$406.90
|
| Rate for Payer: Cash Price |
$406.90
|
| 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 |
$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 |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.80
|
| Rate for Payer: Health Management Network Commercial |
$532.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| 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 |
$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
|
|
|
99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
2644297
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$364.00
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: Devoted Health Medicare |
$400.40
|
| 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 |
$364.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$691.60
|
| Rate for Payer: Health Management Network Commercial |
$618.80
|
| Rate for Payer: Humana Medicare |
$364.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$655.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$364.00
|
| Rate for Payer: MDX Hawaii PPO |
$706.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$364.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$364.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$364.00
|
| Rate for Payer: University Health Alliance Commercial |
$530.64
|
|
|
99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
2644297
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$618.80 |
| Max. Negotiated Rate |
$706.16 |
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: Health Management Network Commercial |
$618.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$655.20
|
| Rate for Payer: MDX Hawaii PPO |
$706.16
|
|
|
99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
2644298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$627.50
|
| Rate for Payer: Cash Price |
$815.75
|
| Rate for Payer: Cash Price |
$815.75
|
| Rate for Payer: Cash Price |
$815.75
|
| Rate for Payer: Devoted Health Medicare |
$690.25
|
| 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 |
$627.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,192.25
|
| Rate for Payer: Health Management Network Commercial |
$1,066.75
|
| Rate for Payer: Humana Medicare |
$627.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,129.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$627.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,217.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$627.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$627.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$627.50
|
| Rate for Payer: University Health Alliance Commercial |
$914.77
|
|
|
99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
2644298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,066.75 |
| Max. Negotiated Rate |
$1,217.35 |
| Rate for Payer: Cash Price |
$815.75
|
| Rate for Payer: Health Management Network Commercial |
$1,066.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,129.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,217.35
|
|
|
99283 ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW MDM, CC
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
2644299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,426.30 |
| Max. Negotiated Rate |
$1,627.66 |
| Rate for Payer: Cash Price |
$1,090.70
|
| Rate for Payer: Health Management Network Commercial |
$1,426.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,510.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,627.66
|
|
|
99283 ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW MDM, CC
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
2644299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$1,627.66 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$839.00
|
| Rate for Payer: Cash Price |
$1,090.70
|
| Rate for Payer: Cash Price |
$1,090.70
|
| Rate for Payer: Cash Price |
$1,090.70
|
| Rate for Payer: Devoted Health Medicare |
$922.90
|
| 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 |
$839.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,594.10
|
| Rate for Payer: Health Management Network Commercial |
$1,426.30
|
| Rate for Payer: Humana Medicare |
$839.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,510.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$839.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,627.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$839.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$839.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$839.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,223.09
|
|
|
99284 ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MODERATE MDM, CC
|
Facility
|
OP
|
$3,010.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
2644300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$2,919.70 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$1,505.00
|
| Rate for Payer: Cash Price |
$1,956.50
|
| Rate for Payer: Cash Price |
$1,956.50
|
| Rate for Payer: Cash Price |
$1,956.50
|
| Rate for Payer: Devoted Health Medicare |
$1,655.50
|
| 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 |
$1,505.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,859.50
|
| Rate for Payer: Health Management Network Commercial |
$2,558.50
|
| Rate for Payer: Humana Medicare |
$1,505.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,709.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,505.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,919.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,505.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,505.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,505.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,193.99
|
|
|
99284 ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MODERATE MDM, CC
|
Facility
|
IP
|
$3,010.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
2644300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,558.50 |
| Max. Negotiated Rate |
$2,919.70 |
| Rate for Payer: Cash Price |
$1,956.50
|
| Rate for Payer: Health Management Network Commercial |
$2,558.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,709.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,919.70
|
|
|
99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC
|
Facility
|
OP
|
$4,646.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
2644301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$4,506.62 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$2,323.00
|
| Rate for Payer: Cash Price |
$3,019.90
|
| Rate for Payer: Cash Price |
$3,019.90
|
| Rate for Payer: Cash Price |
$3,019.90
|
| Rate for Payer: Devoted Health Medicare |
$2,555.30
|
| 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 |
$2,323.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,413.70
|
| Rate for Payer: Health Management Network Commercial |
$3,949.10
|
| Rate for Payer: Humana Medicare |
$2,323.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,181.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,323.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,506.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,323.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,323.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,323.00
|
| Rate for Payer: University Health Alliance Commercial |
$3,386.47
|
|
|
99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC
|
Facility
|
IP
|
$4,646.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
2644301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,949.10 |
| Max. Negotiated Rate |
$4,506.62 |
| Rate for Payer: Cash Price |
$3,019.90
|
| Rate for Payer: Health Management Network Commercial |
$3,949.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,181.40
|
| Rate for Payer: MDX Hawaii PPO |
$4,506.62
|
|
|
99291 Critical Care, First 30-74 Min
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
8041056
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$197.18 |
| Max. Negotiated Rate |
$977.50 |
| Rate for Payer: AlohaCare Medicaid |
$210.80
|
| Rate for Payer: AlohaCare Medicare |
$197.18
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Devoted Health Medicare |
$216.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$210.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$210.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$251.64
|
| Rate for Payer: Health Management Network Commercial |
$977.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$236.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$236.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$236.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.18
|
|
|
99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN ProFee
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
8218186
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$197.18 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: AlohaCare Medicaid |
$210.80
|
| Rate for Payer: AlohaCare Medicare |
$197.18
|
| Rate for Payer: Cash Price |
$359.45
|
| Rate for Payer: Cash Price |
$359.45
|
| Rate for Payer: Devoted Health Medicare |
$216.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$210.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$210.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$251.64
|
| Rate for Payer: Health Management Network Commercial |
$470.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$236.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$236.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$236.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.18
|
|
|
99291 Facility Level Critical Care Ill/Injured Patient Init 30-74 Min
|
Facility
|
OP
|
$7,640.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
2389455
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,410.80 |
| Rate for Payer: AlohaCare Medicaid |
$3,820.00
|
| Rate for Payer: AlohaCare Medicare |
$3,820.00
|
| Rate for Payer: Cash Price |
$4,966.00
|
| Rate for Payer: Cash Price |
$4,966.00
|
| Rate for Payer: Devoted Health Medicare |
$4,202.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,820.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,258.00
|
| Rate for Payer: Health Management Network Commercial |
$6,494.00
|
| Rate for Payer: Humana Medicare |
$3,820.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,876.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,820.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,410.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,820.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,820.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,820.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,568.80
|
|
|
99291 Facility Level Critical Care Ill/Injured Patient Init 30-74 Min
|
Facility
|
IP
|
$7,640.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
2389455
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,494.00 |
| Max. Negotiated Rate |
$7,410.80 |
| Rate for Payer: Cash Price |
$4,966.00
|
| Rate for Payer: Health Management Network Commercial |
$6,494.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,876.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,410.80
|
|
|
99292 Critical Care, Each Additional 30 Min
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
8041057
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$99.35 |
| Max. Negotiated Rate |
$318.75 |
| Rate for Payer: AlohaCare Medicaid |
$105.97
|
| Rate for Payer: AlohaCare Medicare |
$99.35
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Devoted Health Medicare |
$109.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$105.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.90
|
| Rate for Payer: Health Management Network Commercial |
$318.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.35
|
|
|
99292 ED Critical Care, E/M each additional 30 min over 74 minutes
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
8749414
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$99.35 |
| Max. Negotiated Rate |
$202.30 |
| Rate for Payer: AlohaCare Medicaid |
$105.97
|
| Rate for Payer: AlohaCare Medicare |
$99.35
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$109.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$105.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.90
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.35
|
|
|
99304 Initial Nursing Facility Care, Low
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
HCPCS 99304
|
| Hospital Charge Code |
8041058
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$72.35 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: AlohaCare Medicaid |
$81.82
|
| Rate for Payer: AlohaCare Medicare |
$72.35
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: Devoted Health Medicare |
$79.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.35
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.35
|
|
