|
G0463 Other Outpatient Visit 5 Charges
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
|
|
G0463 Other Outpatient Visit 5 Charges
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: AlohaCare Medicaid |
$214.00
|
| Rate for Payer: AlohaCare Medicare |
$214.00
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Devoted Health Medicare |
$235.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.60
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Humana Medicare |
$214.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.00
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.00
|
| Rate for Payer: University Health Alliance Commercial |
$239.68
|
|
|
G0463 Other Outpatient Visit New 1 Charges
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: AlohaCare Medicaid |
$127.50
|
| Rate for Payer: AlohaCare Medicare |
$127.50
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Devoted Health Medicare |
$140.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$242.25
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Humana Medicare |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.50
|
| Rate for Payer: University Health Alliance Commercial |
$142.80
|
|
|
G0463 Other Outpatient Visit New 1 Charges
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.75 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.50
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
|
|
G0463 Other Outpatient Visit New 2 Charges
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.75 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.50
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
|
|
G0463 Other Outpatient Visit New 2 Charges
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: AlohaCare Medicaid |
$127.50
|
| Rate for Payer: AlohaCare Medicare |
$127.50
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Devoted Health Medicare |
$140.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$242.25
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Humana Medicare |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.50
|
| Rate for Payer: University Health Alliance Commercial |
$142.80
|
|
|
G0463 Other Outpatient Visit New 3 Charges
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.05 |
| Max. Negotiated Rate |
$284.21 |
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Health Management Network Commercial |
$249.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$263.70
|
| Rate for Payer: MDX Hawaii PPO |
$284.21
|
|
|
G0463 Other Outpatient Visit New 3 Charges
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$284.21 |
| Rate for Payer: AlohaCare Medicaid |
$146.50
|
| Rate for Payer: AlohaCare Medicare |
$146.50
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Devoted Health Medicare |
$161.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.35
|
| Rate for Payer: Health Management Network Commercial |
$249.05
|
| Rate for Payer: Humana Medicare |
$146.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$263.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.50
|
| Rate for Payer: MDX Hawaii PPO |
$284.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$146.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.50
|
| Rate for Payer: University Health Alliance Commercial |
$164.08
|
|
|
G0463 Other Outpatient Visit New 4 Charges
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
|
|
G0463 Other Outpatient Visit New 4 Charges
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: AlohaCare Medicaid |
$214.00
|
| Rate for Payer: AlohaCare Medicare |
$214.00
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Devoted Health Medicare |
$235.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.60
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Humana Medicare |
$214.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.00
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.00
|
| Rate for Payer: University Health Alliance Commercial |
$239.68
|
|
|
G0463 Other Outpatient Visit New 5 Charges
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: AlohaCare Medicaid |
$214.00
|
| Rate for Payer: AlohaCare Medicare |
$214.00
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Devoted Health Medicare |
$235.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.60
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Humana Medicare |
$214.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.00
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.00
|
| Rate for Payer: University Health Alliance Commercial |
$239.68
|
|
|
G0463 Other Outpatient Visit New 5 Charges
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8221526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
|
|
G0463 OUTPATIENT VISIT CHARGE
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8302170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$464.63 |
| Rate for Payer: AlohaCare Medicaid |
$239.50
|
| Rate for Payer: AlohaCare Medicare |
$239.50
|
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Devoted Health Medicare |
$263.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$239.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$455.05
|
| Rate for Payer: Health Management Network Commercial |
$407.15
|
| Rate for Payer: Humana Medicare |
$239.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.50
|
| Rate for Payer: MDX Hawaii PPO |
$464.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$239.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$239.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$239.50
|
| Rate for Payer: University Health Alliance Commercial |
$268.24
|
|
|
G0463 OUTPATIENT VISIT CHARGE
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
8302170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$407.15 |
| Max. Negotiated Rate |
$464.63 |
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Health Management Network Commercial |
$407.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.10
|
| Rate for Payer: MDX Hawaii PPO |
$464.63
|
|
|
G0511 CCM/BHI BY RHC/FQHC 20MIN MO
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS G0511
|
| Hospital Charge Code |
11641935
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$119.31 |
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.70
|
| Rate for Payer: MDX Hawaii PPO |
$119.31
|
|
|
G0511 CCM/BHI BY RHC/FQHC 20MIN MO
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS G0511
|
| Hospital Charge Code |
11641935
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$23.54 |
| Max. Negotiated Rate |
$119.31 |
| Rate for Payer: AlohaCare Medicaid |
$61.50
|
| Rate for Payer: AlohaCare Medicare |
$61.50
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Devoted Health Medicare |
$67.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.85
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Humana Medicare |
$61.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.50
|
| Rate for Payer: MDX Hawaii PPO |
$119.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.50
|
| Rate for Payer: University Health Alliance Commercial |
$68.88
|
|
|
G0512 COCM BY RHC/FQHC 60 MIN MO
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS G0512
|
| Hospital Charge Code |
11641937
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$199.75 |
| Max. Negotiated Rate |
$227.95 |
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.50
|
| Rate for Payer: MDX Hawaii PPO |
$227.95
|
|
|
G0512 COCM BY RHC/FQHC 60 MIN MO
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS G0512
|
| Hospital Charge Code |
11641937
|
|
Hospital Revenue Code
|
961
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$227.95 |
| Rate for Payer: AlohaCare Medicaid |
$117.50
|
| Rate for Payer: AlohaCare Medicare |
$117.50
|
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Devoted Health Medicare |
$129.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$223.25
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
| Rate for Payer: Humana Medicare |
$117.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.50
|
| Rate for Payer: MDX Hawaii PPO |
$227.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.50
|
| Rate for Payer: University Health Alliance Commercial |
$131.60
|
|
|
G2010 Remote Evaluation of recorded video/images with interpretation ñ 5 to 10 minutes
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS G2010
|
| Hospital Charge Code |
8861542
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Devoted Health Medicare |
$8.91
|
| 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 |
$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 |
$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 |
$12.96
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| 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 |
$9.72
|
| 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 |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
G2025 - 98008 SYNCHRONOUS AUDIO-ONLY VISIT NEW SF MDM 15 MIN
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 98008
|
| Hospital Charge Code |
12548212
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$180.05
|
| Rate for Payer: Cash Price |
$180.05
|
| 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 |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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: Health Management Network Commercial |
$235.45
|
| 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
|
|
|
G2025 - 98009 SYNCHRONOUS AUDIO-ONLY VISIT NEW LOW MDM 30 MIN
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 98009
|
| Hospital Charge Code |
12548213
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| 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 |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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: Health Management Network Commercial |
$353.60
|
| 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
|
|
|
G2025 - 98010 SYNCHRONOUS AUDIO-ONLY VISIT NEW MOD MDM 45 MIN
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
HCPCS 98010
|
| Hospital Charge Code |
12539741
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$490.45 |
| Rate for Payer: Cash Price |
$375.05
|
| Rate for Payer: Cash Price |
$375.05
|
| 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 |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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: Health Management Network Commercial |
$490.45
|
| 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
|
|
|
G2025 - 98011 SYNCHRONOUS AUDIO-ONLY VISIT NEW HIGH MDM 60 MIN
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
HCPCS 98011
|
| Hospital Charge Code |
12545373
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$628.15 |
| Rate for Payer: Cash Price |
$480.35
|
| Rate for Payer: Cash Price |
$480.35
|
| 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 |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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: Health Management Network Commercial |
$628.15
|
| 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
|
|
|
G2025 - 98012 SYNCHRONOUS AUDIO-ONLY VISIT EST SF MDM 10 MIN
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 98012
|
| Hospital Charge Code |
12545374
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Cash Price |
$113.75
|
| 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 |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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: Health Management Network Commercial |
$148.75
|
| 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
|
|
|
G2025 - 98013 SYNCHRONOUS AUDIO-ONLY VISIT EST LOW MDM 20 MIN
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 98013
|
| Hospital Charge Code |
12545375
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| 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 |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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: Health Management Network Commercial |
$297.50
|
| 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
|
|
