|
PROBE GOLD INJ 10FR
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS C1889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.80 |
| Max. Negotiated Rate |
$764.36 |
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Health Management Network Commercial |
$669.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$709.20
|
| Rate for Payer: MDX Hawaii PPO |
$764.36
|
|
|
PROBE GOLD INJ 10FR
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS C1889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$394.00 |
| Max. Negotiated Rate |
$764.36 |
| Rate for Payer: AlohaCare Medicaid |
$394.00
|
| Rate for Payer: AlohaCare Medicare |
$598.88
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Devoted Health Medicare |
$661.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$598.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$748.60
|
| Rate for Payer: Health Management Network Commercial |
$669.80
|
| Rate for Payer: Humana Medicare |
$598.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$709.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$401.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$598.88
|
| Rate for Payer: MDX Hawaii PPO |
$764.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$598.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$598.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$598.88
|
| Rate for Payer: University Health Alliance Commercial |
$574.37
|
|
|
PROBE GOLD INJ 7FR
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
HCPCS C1889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.35 |
| Max. Negotiated Rate |
$786.67 |
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Health Management Network Commercial |
$689.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.90
|
| Rate for Payer: MDX Hawaii PPO |
$786.67
|
|
|
PROBE GOLD INJ 7FR
|
Facility
|
OP
|
$811.00
|
|
|
Service Code
|
HCPCS C1889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.50 |
| Max. Negotiated Rate |
$786.67 |
| Rate for Payer: AlohaCare Medicaid |
$405.50
|
| Rate for Payer: AlohaCare Medicare |
$616.36
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Devoted Health Medicare |
$681.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$616.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$770.45
|
| Rate for Payer: Health Management Network Commercial |
$689.35
|
| Rate for Payer: Humana Medicare |
$616.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$413.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$616.36
|
| Rate for Payer: MDX Hawaii PPO |
$786.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$616.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$616.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$616.36
|
| Rate for Payer: University Health Alliance Commercial |
$591.14
|
|
|
PROBE LITHOTRISPY 11.3FR
|
Facility
|
IP
|
$1,935.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,644.75 |
| Max. Negotiated Rate |
$1,876.95 |
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Health Management Network Commercial |
$1,644.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,741.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,876.95
|
|
|
PROBE LITHOTRISPY 11.3FR
|
Facility
|
OP
|
$1,935.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$967.50 |
| Max. Negotiated Rate |
$1,876.95 |
| Rate for Payer: AlohaCare Medicaid |
$967.50
|
| Rate for Payer: AlohaCare Medicare |
$1,470.60
|
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Devoted Health Medicare |
$1,625.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,470.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,838.25
|
| Rate for Payer: Health Management Network Commercial |
$1,644.75
|
| Rate for Payer: Humana Medicare |
$1,470.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,741.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$986.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,470.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,876.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,470.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,470.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,470.60
|
| Rate for Payer: University Health Alliance Commercial |
$1,410.42
|
|
|
PROBE LITHROTRIPSY 1.9FR
|
Facility
|
IP
|
$1,502.00
|
|
|
Service Code
|
HCPCS C1889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,276.70 |
| Max. Negotiated Rate |
$1,456.94 |
| Rate for Payer: Cash Price |
$901.20
|
| Rate for Payer: Health Management Network Commercial |
$1,276.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,351.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,456.94
|
|
|
PROBE LITHROTRIPSY 1.9FR
|
Facility
|
OP
|
$1,502.00
|
|
|
Service Code
|
HCPCS C1889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.00 |
| Max. Negotiated Rate |
$1,456.94 |
| Rate for Payer: AlohaCare Medicaid |
$751.00
|
| Rate for Payer: AlohaCare Medicare |
$1,141.52
|
| Rate for Payer: Cash Price |
$901.20
|
| Rate for Payer: Devoted Health Medicare |
$1,261.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,141.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,426.90
|
| Rate for Payer: Health Management Network Commercial |
$1,276.70
|
| Rate for Payer: Humana Medicare |
$1,141.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,351.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$766.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,141.52
|
| Rate for Payer: MDX Hawaii PPO |
$1,456.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,141.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,141.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,141.52
|
| Rate for Payer: University Health Alliance Commercial |
$1,094.81
|
|
|
PROBENECID 500 MG TABLET [6561]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00591534701
|
|
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
|
|
|
PROBENECID 500 MG TABLET [6561]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00591534701
|
|
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
|
|
|
PROBE PRASS MONOPOLAR
|
Facility
|
IP
|
$593.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$504.05 |
| Max. Negotiated Rate |
$575.21 |
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Health Management Network Commercial |
$504.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$533.70
|
| Rate for Payer: MDX Hawaii PPO |
$575.21
|
|
|
PROBE PRASS MONOPOLAR
|
Facility
|
OP
|
$593.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$296.50 |
| Max. Negotiated Rate |
$575.21 |
| Rate for Payer: AlohaCare Medicaid |
$296.50
|
| Rate for Payer: AlohaCare Medicare |
$450.68
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Devoted Health Medicare |
$498.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$450.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$563.35
|
| Rate for Payer: Health Management Network Commercial |
$504.05
|
| Rate for Payer: Humana Medicare |
$450.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$533.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$302.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$450.68
|
| Rate for Payer: MDX Hawaii PPO |
$575.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$450.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$450.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$450.68
|
| Rate for Payer: University Health Alliance Commercial |
$432.24
|
|
|
PROBE PRASS NERVE LOCATE
|
Facility
|
OP
|
$953.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$476.50 |
| Max. Negotiated Rate |
$924.41 |
| Rate for Payer: AlohaCare Medicaid |
$476.50
|
| Rate for Payer: AlohaCare Medicare |
$724.28
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Devoted Health Medicare |
$800.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$724.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$905.35
|
| Rate for Payer: Health Management Network Commercial |
$810.05
|
| Rate for Payer: Humana Medicare |
$724.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$857.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$724.28
|
| Rate for Payer: MDX Hawaii PPO |
$924.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$724.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$724.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$724.28
|
| Rate for Payer: University Health Alliance Commercial |
$694.64
|
|
|
PROBE PRASS NERVE LOCATE
|
Facility
|
IP
|
$953.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$810.05 |
| Max. Negotiated Rate |
$924.41 |
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Health Management Network Commercial |
$810.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$857.70
|
| Rate for Payer: MDX Hawaii PPO |
$924.41
|
|
|
PR OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE
|
Professional
|
Both
|
$1,410.13
|
|
|
Service Code
|
HCPCS 49460
|
| Min. Negotiated Rate |
$42.07 |
| Max. Negotiated Rate |
$1,198.61 |
| Rate for Payer: AlohaCare Medicaid |
$49.68
|
| Rate for Payer: AlohaCare Medicare |
$42.07
|
| Rate for Payer: Cash Price |
$846.08
|
| Rate for Payer: Cash Price |
$846.08
|
| Rate for Payer: Devoted Health Medicare |
$46.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$74.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.68
|
| Rate for Payer: Health Management Network Commercial |
$1,198.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.07
|
| Rate for Payer: University Health Alliance Commercial |
$63.46
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$87.85
|
|
|
Service Code
|
HCPCS Q0091
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$74.67 |
| Rate for Payer: AlohaCare Medicare |
$15.64
|
| Rate for Payer: Cash Price |
$52.71
|
| Rate for Payer: Cash Price |
$52.71
|
| Rate for Payer: Devoted Health Medicare |
$17.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.00
|
| Rate for Payer: Health Management Network Commercial |
$74.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.64
|
| Rate for Payer: University Health Alliance Commercial |
$17.91
|
|
|
PR OCCLUSIVE DEVICE IN VEIN ART
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS G0269
|
| Min. Negotiated Rate |
$290.70 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Health Management Network Commercial |
$290.70
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 00574722612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
NDC 00713013512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: AlohaCare Medicaid |
$15.50
|
| Rate for Payer: AlohaCare Medicare |
$23.56
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$26.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.45
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Humana Medicare |
$23.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.56
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.56
|
| Rate for Payer: University Health Alliance Commercial |
$22.60
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
NDC 00713013506
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
NDC 00713013512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
NDC 00574722612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: AlohaCare Medicaid |
$16.00
|
| Rate for Payer: AlohaCare Medicare |
$24.32
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$26.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.40
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Humana Medicare |
$24.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.32
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.32
|
| Rate for Payer: University Health Alliance Commercial |
$23.32
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
NDC 00713013506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: AlohaCare Medicaid |
$15.50
|
| Rate for Payer: AlohaCare Medicare |
$23.56
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$26.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.45
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Humana Medicare |
$23.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.56
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.56
|
| Rate for Payer: University Health Alliance Commercial |
$22.60
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [166223]
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J0780
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: AlohaCare Medicaid |
$11.50
|
| Rate for Payer: AlohaCare Medicaid |
$12.50
|
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$18.24
|
| Rate for Payer: AlohaCare Medicare |
$17.48
|
| Rate for Payer: AlohaCare Medicare |
$19.00
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Devoted Health Medicare |
$19.32
|
| Rate for Payer: Devoted Health Medicare |
$21.00
|
| Rate for Payer: Devoted Health Medicare |
$20.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.75
|
| Rate for Payer: Health Management Network Commercial |
$21.25
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Humana Medicare |
$17.48
|
| Rate for Payer: Humana Medicare |
$18.24
|
| Rate for Payer: Humana Medicare |
$19.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.00
|
| Rate for Payer: MDX Hawaii PPO |
$24.25
|
| Rate for Payer: MDX Hawaii PPO |
$23.28
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.00
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
| Rate for Payer: University Health Alliance Commercial |
$17.49
|
| Rate for Payer: University Health Alliance Commercial |
$18.22
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [166223]
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS J0780
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Health Management Network Commercial |
$21.25
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: MDX Hawaii PPO |
$23.28
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: MDX Hawaii PPO |
$24.25
|
|
