|
PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
HCPCS 93351
|
| Min. Negotiated Rate |
$255.56 |
| Max. Negotiated Rate |
$592.45 |
| Rate for Payer: AlohaCare Medicaid |
$255.56
|
| Rate for Payer: AlohaCare Medicare |
$255.77
|
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Devoted Health Medicare |
$281.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.29
|
| Rate for Payer: Health Management Network Commercial |
$592.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$306.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$306.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$255.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.77
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
HCPCS 93351 TC
|
| Min. Negotiated Rate |
$172.43 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: AlohaCare Medicaid |
$255.56
|
| Rate for Payer: AlohaCare Medicare |
$172.43
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Devoted Health Medicare |
$189.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.29
|
| Rate for Payer: Health Management Network Commercial |
$468.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$255.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.43
|
|
|
PRECISION BLADE 2296-033-412
|
Facility
|
IP
|
$180.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.00
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
|
|
PRECISION BLADE 2296-033-412
|
Facility
|
OP
|
$180.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: AlohaCare Medicaid |
$90.00
|
| Rate for Payer: AlohaCare Medicare |
$136.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Devoted Health Medicare |
$151.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Humana Medicare |
$136.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.80
|
| Rate for Payer: University Health Alliance Commercial |
$131.20
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
NDC 61314063705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
NDC 61314063705
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$105.64
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Devoted Health Medicare |
$116.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.05
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$105.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$105.64
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.64
|
| Rate for Payer: University Health Alliance Commercial |
$101.32
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (5 ML) ORAL SOLUTION [205877]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 17856081501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$6.84
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$7.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Humana Medicare |
$6.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.84
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.84
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (5 ML) ORAL SOLUTION [205877]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 17856081501
|
|
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: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML (6.7 MG/5 ML) ORAL SOLN [11118]
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
NDC 13925016604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$309.60
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML (6.7 MG/5 ML) ORAL SOLN [11118]
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
NDC 13925016604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.00 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: AlohaCare Medicaid |
$172.00
|
| Rate for Payer: AlohaCare Medicare |
$261.44
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Devoted Health Medicare |
$288.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$261.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$326.80
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Humana Medicare |
$261.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$309.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$261.44
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$261.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.44
|
| Rate for Payer: University Health Alliance Commercial |
$250.74
|
|
|
PREDNISOLONE SOD PHOSPHATE SOLUTION 15 MG/5 ML UDC (ORAPRED) (TAKE HOME) [4080390]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00004080178
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
|
|
PREDNISOLONE SOD PHOSPHATE SOLUTION 15 MG/5 ML UDC (ORAPRED) (TAKE HOME) [4080390]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00004080178
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: AlohaCare Medicaid |
$7.50
|
| Rate for Payer: AlohaCare Medicare |
$11.40
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$12.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.25
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Humana Medicare |
$11.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.40
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.40
|
| Rate for Payer: University Health Alliance Commercial |
$10.93
|
|
|
PREDNISONE 10 MG TABLET [6494]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
PREDNISONE 10 MG TABLET [6494]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
PREDNISONE 1 MG TABLET [6493]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
PREDNISONE 1 MG TABLET [6493]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$2.28
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Devoted Health Medicare |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Humana Medicare |
$2.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.28
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.28
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
PREDNISONE 20 MG TABLET [6496]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
PREDNISONE 20 MG TABLET [6496]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
PREDNISONE 5 MG TABLET [6497]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
PREDNISONE 5 MG TABLET [6497]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
PREDNISONE TABLETS (DELTASONE) 20 MG (TAKE HOME) [4080391]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
|
|
PREDNISONE TABLETS (DELTASONE) 20 MG (TAKE HOME) [4080391]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: AlohaCare Medicaid |
$7.50
|
| Rate for Payer: AlohaCare Medicare |
$11.40
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$12.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.25
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Humana Medicare |
$11.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.40
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.40
|
| Rate for Payer: University Health Alliance Commercial |
$10.93
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO
|
Professional
|
Both
|
$392.96
|
|
|
Service Code
|
HCPCS 95721
|
| Min. Negotiated Rate |
$177.08 |
| Max. Negotiated Rate |
$334.02 |
| Rate for Payer: AlohaCare Medicaid |
$208.10
|
| Rate for Payer: AlohaCare Medicare |
$177.08
|
| Rate for Payer: Cash Price |
$235.78
|
| Rate for Payer: Cash Price |
$235.78
|
| Rate for Payer: Devoted Health Medicare |
$194.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$208.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$263.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$208.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$225.08
|
| Rate for Payer: Health Management Network Commercial |
$334.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$212.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$212.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$208.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$208.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.08
|
| Rate for Payer: University Health Alliance Commercial |
$249.25
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG
|
Professional
|
Both
|
$474.34
|
|
|
Service Code
|
HCPCS 95722
|
| Min. Negotiated Rate |
$214.84 |
| Max. Negotiated Rate |
$403.19 |
| Rate for Payer: AlohaCare Medicaid |
$252.09
|
| Rate for Payer: AlohaCare Medicare |
$214.84
|
| Rate for Payer: Cash Price |
$284.60
|
| Rate for Payer: Cash Price |
$284.60
|
| Rate for Payer: Devoted Health Medicare |
$236.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$252.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$320.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$252.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$272.88
|
| Rate for Payer: Health Management Network Commercial |
$403.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$252.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$252.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.84
|
| Rate for Payer: University Health Alliance Commercial |
$303.83
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO
|
Professional
|
Both
|
$476.58
|
|
|
Service Code
|
HCPCS 95723
|
| Min. Negotiated Rate |
$216.13 |
| Max. Negotiated Rate |
$405.09 |
| Rate for Payer: AlohaCare Medicaid |
$252.42
|
| Rate for Payer: AlohaCare Medicare |
$216.13
|
| Rate for Payer: Cash Price |
$285.95
|
| Rate for Payer: Cash Price |
$285.95
|
| Rate for Payer: Devoted Health Medicare |
$237.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$252.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$326.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$216.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$252.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.87
|
| Rate for Payer: Health Management Network Commercial |
$405.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$259.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$252.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$216.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$252.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$216.13
|
| Rate for Payer: University Health Alliance Commercial |
$305.85
|
|
