|
99417-Prolonged office or other outpatient evaluation and management service(s)
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 99417
|
| Hospital Charge Code |
9338509
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.64 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Cash Price |
$51.35
|
| 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 |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| 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 |
$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
|
|
|
99417 Prolonged Office/Outpatient E/M Svc Ea 15 Min
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 99417
|
| Hospital Charge Code |
9350613
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
|
|
99417 Prolonged Office/Outpatient E/M Svc Ea 15 Min
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 99417
|
| Hospital Charge Code |
9350613
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.64 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Cash Price |
$51.35
|
| 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 |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| 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
|
|
|
99417 Prolonged Outpatient EM Svs each 15 Min
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 99417
|
| Hospital Charge Code |
11414881
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.20
|
| Rate for Payer: MDX Hawaii PPO |
$46.56
|
|
|
99417 Prolonged Outpatient EM Svs each 15 Min
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 99417
|
| Hospital Charge Code |
11414881
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
|
|
99417 Prolonged Outpatient EM Svs each 15 Min
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 99417
|
| Hospital Charge Code |
11414881
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$21.59 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: AlohaCare Medicaid |
$24.00
|
| Rate for Payer: AlohaCare Medicare |
$24.00
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Devoted Health Medicare |
$26.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Humana Medicare |
$24.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.00
|
| Rate for Payer: MDX Hawaii PPO |
$46.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.00
|
| Rate for Payer: University Health Alliance Commercial |
$26.88
|
|
|
99418 Prolonged Inpt/Obs E/M time with or w/o Direct Pt Contact
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 99418
|
| Hospital Charge Code |
10599938
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
|
|
99418 Prolonged Inpt/Obs E/M time with or w/o Direct Pt Contact
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 99418
|
| Hospital Charge Code |
10599938
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Cash Price |
$158.60
|
| 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 |
$207.40
|
| 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
|
|
|
99418 PROLONGED INPT/OBSV E&M W/WO DIRECT PAT CONTACT, 15 MIN OF TOTAL TIME
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 99418
|
| Hospital Charge Code |
10602925
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
|
|
99421 ONLINE DIGITAL EM SERVICE FOR ESTAB 5-10 MIN
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 99421
|
| Hospital Charge Code |
8870353
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$12.90
|
| Rate for Payer: AlohaCare Medicare |
$11.02
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Devoted Health Medicare |
$12.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| 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 |
$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: Hawaii Western Management Group Commercial |
$16.14
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| 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: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.02
|
| 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
|
|
|
99422 ONLINE DIGITAL EM SERVICE FOR ESTAB 11-20 MIN
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 99422
|
| Hospital Charge Code |
8870357
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$25.42
|
| Rate for Payer: AlohaCare Medicare |
$22.41
|
| Rate for Payer: Cash Price |
$164.45
|
| Rate for Payer: Cash Price |
$164.45
|
| Rate for Payer: Cash Price |
$164.45
|
| Rate for Payer: Devoted Health Medicare |
$24.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.79
|
| 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 |
$32.10
|
| Rate for Payer: Health Management Network Commercial |
$215.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.89
|
| 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 |
$25.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.41
|
| 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
|
|
|
99423 ONLINE DIGITAL EM SERVICE FOR ESTAB 21 OR MORE MINUTES
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 99423
|
| Hospital Charge Code |
8870361
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$40.75
|
| Rate for Payer: AlohaCare Medicare |
$35.28
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Devoted Health Medicare |
$38.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$48.98
|
| 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 |
$51.96
|
| Rate for Payer: Health Management Network Commercial |
$178.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.34
|
| 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 |
$40.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.28
|
| 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
|
|
|
99455 Work Related or Medical Disability Exam
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 99455
|
| Hospital Charge Code |
8041130
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Cash Price |
$246.35
|
| 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 |
$112.49
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| 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
|
|
|
99460 Initial Hospital Care, Per Day, Normal Newborn
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
8041132
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$77.34 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: AlohaCare Medicaid |
$93.11
|
| Rate for Payer: AlohaCare Medicare |
$80.88
|
| Rate for Payer: Cash Price |
$206.70
|
| Rate for Payer: Cash Price |
$206.70
|
| Rate for Payer: Devoted Health Medicare |
$88.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.34
|
| Rate for Payer: Health Management Network Commercial |
$270.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.88
|
|
|
99461 Initial Care, Per Day, Normal Newborn, Other than Hospital
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 99461
|
| Hospital Charge Code |
8041133
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$47.09 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$61.22
|
| Rate for Payer: AlohaCare Medicare |
$53.31
|
| Rate for Payer: Cash Price |
$172.90
|
| Rate for Payer: Cash Price |
$172.90
|
| Rate for Payer: Cash Price |
$172.90
|
| Rate for Payer: Devoted Health Medicare |
$58.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$47.09
|
| Rate for Payer: Health Management Network Commercial |
$226.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.97
|
| 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 |
$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 |
$61.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: University Health Alliance Commercial |
$75.09
|
|
|
99462 Subsequent Hospital Care Normal Newborn
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 99462
|
| Hospital Charge Code |
8041134
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: AlohaCare Medicaid |
$40.94
|
| Rate for Payer: AlohaCare Medicare |
$35.48
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Devoted Health Medicare |
$39.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.81
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.48
|
|
|
99463 Initial Hospital Care Normal Newborn, Same Day Admit/Dc
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 99463
|
| Hospital Charge Code |
8041135
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$327.25 |
| Rate for Payer: AlohaCare Medicaid |
$109.27
|
| Rate for Payer: AlohaCare Medicare |
$95.68
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Devoted Health Medicare |
$105.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.81
|
| Rate for Payer: Health Management Network Commercial |
$327.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$109.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.68
|
|
|
99464 Attendance at Delivery & Initial Stabilization of Newborn
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 99464
|
| Hospital Charge Code |
8041136
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$63.42 |
| Max. Negotiated Rate |
$223.55 |
| Rate for Payer: AlohaCare Medicaid |
$72.83
|
| Rate for Payer: AlohaCare Medicare |
$63.42
|
| Rate for Payer: Cash Price |
$170.95
|
| Rate for Payer: Cash Price |
$170.95
|
| Rate for Payer: Devoted Health Medicare |
$69.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$157.31
|
| Rate for Payer: Health Management Network Commercial |
$223.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.42
|
|
|
99471 Initial Pediatric Critical Care; 29 Days-24 Months
|
Professional
|
Both
|
$2,158.00
|
|
|
Service Code
|
HCPCS 99471
|
| Hospital Charge Code |
8041140
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,834.30 |
| Rate for Payer: AlohaCare Medicaid |
$776.41
|
| Rate for Payer: AlohaCare Medicare |
$675.18
|
| Rate for Payer: Cash Price |
$1,402.70
|
| Rate for Payer: Cash Price |
$1,402.70
|
| Rate for Payer: Cash Price |
$1,402.70
|
| Rate for Payer: Devoted Health Medicare |
$742.70
|
| 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 |
$747.25
|
| Rate for Payer: Health Management Network Commercial |
$1,834.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$810.22
|
| 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 |
$776.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$675.18
|
| 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
|
|
|
99477 Initial ICU Care Neonate; < 28 Days
|
Professional
|
Both
|
$965.00
|
|
|
Service Code
|
HCPCS 99477
|
| Hospital Charge Code |
8041142
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$295.67 |
| Max. Negotiated Rate |
$820.25 |
| Rate for Payer: AlohaCare Medicaid |
$339.70
|
| Rate for Payer: AlohaCare Medicare |
$295.67
|
| Rate for Payer: Cash Price |
$627.25
|
| Rate for Payer: Cash Price |
$627.25
|
| Rate for Payer: Devoted Health Medicare |
$325.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$300.05
|
| Rate for Payer: Health Management Network Commercial |
$820.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$354.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$339.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$339.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.67
|
|
|
99484 Care Mgmt Services Behavioral health cond 20 mins
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 99484
|
| Hospital Charge Code |
11414882
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: AlohaCare Medicaid |
$34.00
|
| Rate for Payer: AlohaCare Medicare |
$34.00
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Devoted Health Medicare |
$37.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.60
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Humana Medicare |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.00
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.00
|
| Rate for Payer: University Health Alliance Commercial |
$38.08
|
|
|
99484 Care Mgmt Services Behavioral health cond 20 mins
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 99484
|
| Hospital Charge Code |
11414882
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
|
|
99484 Care Mgmt Services Behavioral health cond 20 mins
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 99484
|
| Hospital Charge Code |
11414882
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$38.68 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: AlohaCare Medicare |
$38.68
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Devoted Health Medicare |
$42.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.97
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.68
|
|
|
99492 1st Psychiatric Collab Care Mgmt 1st 70 Min
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 99492
|
| Hospital Charge Code |
11404762
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$205.70 |
| Max. Negotiated Rate |
$234.74 |
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Health Management Network Commercial |
$205.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.80
|
| Rate for Payer: MDX Hawaii PPO |
$234.74
|
|
|
99492 1st Psychiatric Collab Care Mgmt 1st 70 Min
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 99492
|
| Hospital Charge Code |
11404762
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$95.04 |
| Max. Negotiated Rate |
$234.74 |
| Rate for Payer: AlohaCare Medicaid |
$121.00
|
| Rate for Payer: AlohaCare Medicare |
$121.00
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Devoted Health Medicare |
$133.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$129.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$229.90
|
| Rate for Payer: Health Management Network Commercial |
$205.70
|
| Rate for Payer: Humana Medicare |
$121.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.00
|
| Rate for Payer: MDX Hawaii PPO |
$234.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.00
|
| Rate for Payer: University Health Alliance Commercial |
$135.52
|
|
