|
PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT
|
Professional
|
Both
|
$543.29
|
|
|
Service Code
|
HCPCS 99483
|
| Min. Negotiated Rate |
$170.32 |
| Max. Negotiated Rate |
$461.80 |
| Rate for Payer: AlohaCare Medicaid |
$195.40
|
| Rate for Payer: AlohaCare Medicare |
$170.32
|
| Rate for Payer: Cash Price |
$325.97
|
| Rate for Payer: Cash Price |
$325.97
|
| Rate for Payer: Devoted Health Medicare |
$187.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$195.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$195.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.98
|
| Rate for Payer: Health Management Network Commercial |
$461.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$204.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$204.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$195.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$195.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.32
|
| Rate for Payer: University Health Alliance Commercial |
$236.55
|
|
|
PRASUGREL HCL 10 MG TABLET [98373]
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
NDC 60505464303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
PRASUGREL HCL 10 MG TABLET [98373]
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
NDC 65862083030
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.90
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: University Health Alliance Commercial |
$30.61
|
|
|
PRASUGREL HCL 10 MG TABLET [98373]
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
NDC 65862083030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
PRASUGREL HCL 10 MG TABLET [98373]
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
NDC 60505464303
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.90
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: University Health Alliance Commercial |
$30.61
|
|
|
PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 99464
|
| Min. Negotiated Rate |
$63.42 |
| Max. Negotiated Rate |
$157.31 |
| Rate for Payer: AlohaCare Medicaid |
$72.83
|
| Rate for Payer: AlohaCare Medicare |
$63.42
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| 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 |
$104.55
|
| 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
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 60687016901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 60505016809
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 50268066511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 60505016809
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 50268066515
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 50268066515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 60687016901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 50268066511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$211.19
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$49.29 |
| Max. Negotiated Rate |
$179.51 |
| Rate for Payer: AlohaCare Medicaid |
$54.23
|
| Rate for Payer: AlohaCare Medicare |
$49.29
|
| Rate for Payer: Cash Price |
$126.71
|
| Rate for Payer: Cash Price |
$126.71
|
| Rate for Payer: Devoted Health Medicare |
$54.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$90.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$49.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.18
|
| Rate for Payer: Health Management Network Commercial |
$179.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$59.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.29
|
| Rate for Payer: University Health Alliance Commercial |
$59.12
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$60.53
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$51.45 |
| Rate for Payer: AlohaCare Medicaid |
$16.65
|
| Rate for Payer: AlohaCare Medicare |
$14.84
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Devoted Health Medicare |
$16.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$41.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.62
|
| Rate for Payer: Health Management Network Commercial |
$51.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.84
|
| Rate for Payer: University Health Alliance Commercial |
$17.96
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,511.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$670.80 |
| Max. Negotiated Rate |
$1,284.35 |
| Rate for Payer: AlohaCare Medicaid |
$881.24
|
| Rate for Payer: AlohaCare Medicare |
$829.70
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Devoted Health Medicare |
$912.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$829.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network Commercial |
$1,284.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$995.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$995.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$995.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$881.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$829.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$881.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$829.70
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$1,209.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$341.38 |
| Max. Negotiated Rate |
$1,027.65 |
| Rate for Payer: AlohaCare Medicaid |
$705.32
|
| Rate for Payer: AlohaCare Medicare |
$668.32
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Devoted Health Medicare |
$735.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$668.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$341.38
|
| Rate for Payer: Health Management Network Commercial |
$1,027.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$801.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$801.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$801.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$668.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$705.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$668.32
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 68084099611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.65
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.57
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
| Rate for Payer: University Health Alliance Commercial |
$5.10
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00093406701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 68084099611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00093406701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 00093406801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 51079063101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 51079063101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
