|
PR I&D SUBMUCOSAL ABSCESS RECTUM
|
Professional
|
Both
|
$697.99
|
|
|
Service Code
|
HCPCS 45005
|
| Min. Negotiated Rate |
$113.88 |
| Max. Negotiated Rate |
$593.29 |
| Rate for Payer: AlohaCare Medicaid |
$171.24
|
| Rate for Payer: AlohaCare Medicare |
$178.96
|
| Rate for Payer: Cash Price |
$418.79
|
| Rate for Payer: Cash Price |
$418.79
|
| Rate for Payer: Devoted Health Medicare |
$196.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$171.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$265.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$171.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.88
|
| Rate for Payer: Health Management Network Commercial |
$593.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$214.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$171.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.96
|
| Rate for Payer: University Health Alliance Commercial |
$230.38
|
|
|
PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$715.02
|
|
|
Service Code
|
HCPCS 23930
|
| Min. Negotiated Rate |
$198.12 |
| Max. Negotiated Rate |
$607.77 |
| Rate for Payer: AlohaCare Medicaid |
$222.59
|
| Rate for Payer: AlohaCare Medicare |
$208.45
|
| Rate for Payer: Cash Price |
$429.01
|
| Rate for Payer: Cash Price |
$429.01
|
| Rate for Payer: Devoted Health Medicare |
$229.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$222.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$344.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$208.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$222.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$198.12
|
| Rate for Payer: Health Management Network Commercial |
$607.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$250.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$250.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$250.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$222.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$208.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$222.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$208.45
|
| Rate for Payer: University Health Alliance Commercial |
$291.27
|
|
|
PR I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$270.34
|
|
|
Service Code
|
HCPCS 56405
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$229.79 |
| Rate for Payer: AlohaCare Medicaid |
$134.97
|
| Rate for Payer: AlohaCare Medicare |
$121.44
|
| Rate for Payer: Cash Price |
$162.20
|
| Rate for Payer: Cash Price |
$162.20
|
| Rate for Payer: Devoted Health Medicare |
$133.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$134.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$229.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$134.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.44
|
| Rate for Payer: University Health Alliance Commercial |
$177.04
|
|
|
PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 90656
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$23.22
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Devoted Health Medicare |
$25.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.73
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.22
|
|
|
PR IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 90655
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.08
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 90686
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.01
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
HCPCS 90685
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.30
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 90687
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.08
|
| Rate for Payer: Health Management Network Commercial |
$68.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 90688
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.16
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 90662
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$307.70 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$98.16
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Devoted Health Medicare |
$107.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.06
|
| Rate for Payer: Health Management Network Commercial |
$307.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.16
|
|
|
PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$435.54
|
|
|
Service Code
|
HCPCS 44380
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$370.21 |
| Rate for Payer: AlohaCare Medicaid |
$58.93
|
| Rate for Payer: AlohaCare Medicare |
$54.82
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Devoted Health Medicare |
$60.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$97.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$370.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.82
|
| Rate for Payer: University Health Alliance Commercial |
$75.74
|
|
|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$1,760.00
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$592.80 |
| Max. Negotiated Rate |
$1,496.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,027.68
|
| Rate for Payer: AlohaCare Medicare |
$949.96
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Devoted Health Medicare |
$1,044.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$592.80
|
| Rate for Payer: Health Management Network Commercial |
$1,496.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,139.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,139.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,139.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,027.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,027.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.96
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$32.86
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$27.93 |
| Rate for Payer: AlohaCare Medicare |
$18.78
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Devoted Health Medicare |
$20.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.00
|
| Rate for Payer: Health Management Network Commercial |
$27.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.78
|
|
|
PR IM ADM INTRANSL/ORAL EA VACCINE
|
Professional
|
Both
|
$23.06
|
|
|
Service Code
|
HCPCS 90474
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: AlohaCare Medicare |
$13.18
|
| Rate for Payer: Cash Price |
$13.84
|
| Rate for Payer: Cash Price |
$13.84
|
| Rate for Payer: Devoted Health Medicare |
$14.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.00
|
| Rate for Payer: Health Management Network Commercial |
$19.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.18
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Professional
|
Both
|
$42.18
|
|
|
Service Code
|
HCPCS 90471
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: AlohaCare Medicare |
$24.10
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Devoted Health Medicare |
$26.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$35.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.10
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Professional
|
Both
|
$30.38
|
|
|
Service Code
|
HCPCS 90472
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$25.82 |
| Rate for Payer: AlohaCare Medicare |
$17.36
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Devoted Health Medicare |
$19.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$25.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.36
|
|
|
PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
|
Professional
|
Both
|
$44.03
|
|
|
Service Code
|
HCPCS 90460
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$37.43 |
| Rate for Payer: AlohaCare Medicare |
$25.16
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Devoted Health Medicare |
$27.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$37.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.16
|
|
|
PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT
|
Professional
|
Both
|
$15.50
|
|
|
Service Code
|
HCPCS 90461
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: AlohaCare Medicare |
$8.86
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Devoted Health Medicare |
$9.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$13.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.86
|
|
|
PR IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ
|
Professional
|
Both
|
$1,622.53
|
|
|
Service Code
|
HCPCS 49405
|
| Min. Negotiated Rate |
$163.83 |
| Max. Negotiated Rate |
$1,379.15 |
| Rate for Payer: AlohaCare Medicaid |
$189.19
|
| Rate for Payer: AlohaCare Medicare |
$163.83
|
| Rate for Payer: Cash Price |
$973.52
|
| Rate for Payer: Cash Price |
$973.52
|
| Rate for Payer: Devoted Health Medicare |
$180.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$189.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$312.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$189.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$996.06
|
| Rate for Payer: Health Management Network Commercial |
$1,379.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$196.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$196.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$196.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.83
|
| Rate for Payer: University Health Alliance Commercial |
$253.75
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET [179299]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 00024159601
|
|
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
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET [179299]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 00024159601
|
|
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
|
|
|
PR IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ
|
Professional
|
Both
|
$1,203.93
|
|
|
Service Code
|
HCPCS 10030
|
| Min. Negotiated Rate |
$115.65 |
| Max. Negotiated Rate |
$1,023.34 |
| Rate for Payer: AlohaCare Medicaid |
$132.13
|
| Rate for Payer: AlohaCare Medicare |
$115.65
|
| Rate for Payer: Cash Price |
$722.36
|
| Rate for Payer: Cash Price |
$722.36
|
| Rate for Payer: Devoted Health Medicare |
$127.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$226.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$132.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$893.88
|
| Rate for Payer: Health Management Network Commercial |
$1,023.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.65
|
| Rate for Payer: University Health Alliance Commercial |
$160.00
|
|
|
PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Professional
|
Both
|
$1,621.86
|
|
|
Service Code
|
HCPCS 49406
|
| Min. Negotiated Rate |
$163.83 |
| Max. Negotiated Rate |
$1,378.58 |
| Rate for Payer: AlohaCare Medicaid |
$189.19
|
| Rate for Payer: AlohaCare Medicare |
$163.83
|
| Rate for Payer: Cash Price |
$973.12
|
| Rate for Payer: Cash Price |
$973.12
|
| Rate for Payer: Devoted Health Medicare |
$180.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$189.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$313.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$189.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$995.54
|
| Rate for Payer: Health Management Network Commercial |
$1,378.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$196.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$196.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$196.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.83
|
| Rate for Payer: University Health Alliance Commercial |
$253.25
|
|
|
PRIMIDONE 250 MG TABLET [6544]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00527123101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.00
|
| Rate for Payer: AlohaCare Medicare |
$3.04
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$3.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Humana Medicare |
$3.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.04
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.04
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
PRIMIDONE 250 MG TABLET [6544]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00527123101
|
|
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: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
|
