|
PR ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 25101
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: AlohaCare Medicaid |
$435.54
|
| Rate for Payer: AlohaCare Medicare |
$407.15
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Devoted Health Medicare |
$447.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$407.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$316.94
|
| Rate for Payer: Health Management Network Commercial |
$637.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$488.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$488.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$488.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$435.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$407.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$435.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$407.15
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 36620
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: AlohaCare Medicaid |
$43.00
|
| Rate for Payer: AlohaCare Medicare |
$40.36
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$44.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.86
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.36
|
| Rate for Payer: University Health Alliance Commercial |
$55.00
|
|
|
PR ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 93050 26
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: AlohaCare Medicaid |
$17.12
|
| Rate for Payer: AlohaCare Medicare |
$8.53
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$9.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.53
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
PR ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 93050 TC
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: AlohaCare Medicaid |
$17.12
|
| Rate for Payer: AlohaCare Medicare |
$9.69
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Devoted Health Medicare |
$10.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.69
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.69
|
|
|
PR ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 93050
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: AlohaCare Medicaid |
$17.12
|
| Rate for Payer: AlohaCare Medicare |
$18.22
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$20.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.22
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.22
|
|
|
PR ARVEN ANAST OPN F/ARM VEIN TRPOS
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 36820
|
| Min. Negotiated Rate |
$635.92 |
| Max. Negotiated Rate |
$1,003.00 |
| Rate for Payer: AlohaCare Medicaid |
$688.15
|
| Rate for Payer: AlohaCare Medicare |
$635.92
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Devoted Health Medicare |
$699.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$635.92
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$763.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$763.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$763.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$688.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$635.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$688.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$635.92
|
| Rate for Payer: University Health Alliance Commercial |
$930.00
|
|
|
PR ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS
|
Professional
|
Both
|
$1,174.00
|
|
|
Service Code
|
HCPCS 36819
|
| Min. Negotiated Rate |
$633.60 |
| Max. Negotiated Rate |
$997.90 |
| Rate for Payer: AlohaCare Medicaid |
$689.70
|
| Rate for Payer: AlohaCare Medicare |
$633.60
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Devoted Health Medicare |
$696.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$633.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$783.64
|
| Rate for Payer: Health Management Network Commercial |
$997.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$760.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$760.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$760.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$689.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$633.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$689.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$633.60
|
|
|
PR ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS
|
Professional
|
Both
|
$1,114.00
|
|
|
Service Code
|
HCPCS 36818
|
| Min. Negotiated Rate |
$602.60 |
| Max. Negotiated Rate |
$946.90 |
| Rate for Payer: AlohaCare Medicaid |
$653.74
|
| Rate for Payer: AlohaCare Medicare |
$602.60
|
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Devoted Health Medicare |
$662.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$602.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$695.76
|
| Rate for Payer: Health Management Network Commercial |
$946.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$723.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$723.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$723.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$653.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$602.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$653.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$602.60
|
| Rate for Payer: University Health Alliance Commercial |
$910.00
|
|
|
PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Professional
|
Both
|
$448.02
|
|
|
Service Code
|
HCPCS 51102
|
| Min. Negotiated Rate |
$124.99 |
| Max. Negotiated Rate |
$380.82 |
| Rate for Payer: AlohaCare Medicaid |
$141.94
|
| Rate for Payer: AlohaCare Medicare |
$124.99
|
| Rate for Payer: Cash Price |
$268.81
|
| Rate for Payer: Cash Price |
$268.81
|
| Rate for Payer: Devoted Health Medicare |
$137.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$355.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$331.24
|
| Rate for Payer: Health Management Network Commercial |
$380.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.99
|
| Rate for Payer: University Health Alliance Commercial |
$189.74
|
|
|
PR ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Professional
|
Both
|
$126.52
|
|
|
Service Code
|
HCPCS 20612
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$107.54 |
| Rate for Payer: AlohaCare Medicaid |
$41.62
|
| Rate for Payer: AlohaCare Medicare |
$36.99
|
| Rate for Payer: Cash Price |
$75.91
|
| Rate for Payer: Cash Price |
$75.91
|
| Rate for Payer: Devoted Health Medicare |
$40.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.12
|
| Rate for Payer: Health Management Network Commercial |
$107.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.99
|
|
|
PR ASPIRATION & INJECTION TREATMENT BONE CYST
|
Professional
|
Both
|
$470.12
|
|
|
Service Code
|
HCPCS 20615
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: AlohaCare Medicaid |
$169.59
|
| Rate for Payer: AlohaCare Medicare |
$149.01
|
| Rate for Payer: Cash Price |
$282.07
|
| Rate for Payer: Cash Price |
$282.07
|
| Rate for Payer: Devoted Health Medicare |
$163.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$169.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$256.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$399.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$178.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$178.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$169.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.01
|
| Rate for Payer: University Health Alliance Commercial |
$217.44
|
|
|
PR ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 50390
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: AlohaCare Medicaid |
$91.93
|
| Rate for Payer: AlohaCare Medicare |
$79.25
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Devoted Health Medicare |
$87.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$136.50
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$91.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.25
|
|
|
PR ASSESSMENT TINNITUS
|
Professional
|
Both
|
$121.06
|
|
|
Service Code
|
HCPCS 92625
|
| Min. Negotiated Rate |
$50.57 |
| Max. Negotiated Rate |
$102.90 |
| Rate for Payer: AlohaCare Medicaid |
$62.36
|
| Rate for Payer: AlohaCare Medicare |
$50.57
|
| Rate for Payer: Cash Price |
$72.64
|
| Rate for Payer: Cash Price |
$72.64
|
| Rate for Payer: Devoted Health Medicare |
$55.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$62.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$62.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.88
|
| Rate for Payer: Health Management Network Commercial |
$102.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.57
|
|
|
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
|
OP
|
$42.00
|
|
|
Service Code
|
NDC 65862083030
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: AlohaCare Medicaid |
$21.00
|
| Rate for Payer: AlohaCare Medicare |
$31.92
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$35.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.90
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Humana Medicare |
$31.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.92
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.92
|
| Rate for Payer: University Health Alliance Commercial |
$30.61
|
|
|
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: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
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: Kaiser Permanente Commercial |
$37.80
|
| 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 |
$21.00 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: AlohaCare Medicaid |
$21.00
|
| Rate for Payer: AlohaCare Medicare |
$31.92
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$35.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.90
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Humana Medicare |
$31.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.92
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.92
|
| 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
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 60687016901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: AlohaCare Medicaid |
$6.00
|
| Rate for Payer: AlohaCare Medicare |
$9.12
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Devoted Health Medicare |
$10.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Humana Medicare |
$9.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.12
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.12
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 60505016809
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: AlohaCare Medicaid |
$6.00
|
| Rate for Payer: AlohaCare Medicare |
$9.12
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Devoted Health Medicare |
$10.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Humana Medicare |
$9.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.12
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.12
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 50268066511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicare |
$8.36
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Devoted Health Medicare |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Humana Medicare |
$8.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.36
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.36
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
PRAVASTATIN 10 MG TABLET [11110]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 50268066515
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicare |
$8.36
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Devoted Health Medicare |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Humana Medicare |
$8.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.36
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.36
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
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: Kaiser Permanente Commercial |
$10.80
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
|
|
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: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
