|
POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET [70284]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00601000000
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$0.93
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$1.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.93
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.93
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
POVIDONE-IODINE 10 % TOPICAL OINTMENT [6455]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00536127180
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
|
|
POVIDONE-IODINE 10 % TOPICAL OINTMENT [6455]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00536127180
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$2.48
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Devoted Health Medicare |
$2.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.48
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.48
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION [19791]
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
NDC 00065041130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION [19791]
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
NDC 00065041130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: AlohaCare Medicaid |
$37.50
|
| Rate for Payer: AlohaCare Medicare |
$23.25
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Devoted Health Medicare |
$25.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.25
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Humana Medicare |
$23.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.25
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.25
|
| Rate for Payer: University Health Alliance Commercial |
$54.67
|
|
|
POWER DRIVER ON-CONTROL
|
Facility
|
IP
|
$2,400.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,040.00 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Health Management Network Commercial |
$2,040.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,160.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,328.00
|
|
|
POWER DRIVER ON-CONTROL
|
Facility
|
OP
|
$2,400.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.00 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,200.00
|
| Rate for Payer: AlohaCare Medicare |
$744.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Devoted Health Medicare |
$816.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$744.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,280.00
|
| Rate for Payer: Health Management Network Commercial |
$2,040.00
|
| Rate for Payer: Humana Medicare |
$744.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,160.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,224.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$744.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,328.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$744.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$744.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$744.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,749.36
|
|
|
POWERPORT SLIM 6FR 1716000
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
HCPCS C1788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.59 |
| Max. Negotiated Rate |
$862.33 |
| Rate for Payer: AlohaCare Medicaid |
$444.50
|
| Rate for Payer: AlohaCare Medicare |
$275.59
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Devoted Health Medicare |
$302.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$622.30
|
| Rate for Payer: Health Management Network Commercial |
$755.65
|
| Rate for Payer: Humana Medicare |
$275.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$800.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$453.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$275.59
|
| Rate for Payer: MDX Hawaii PPO |
$862.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$275.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.59
|
| Rate for Payer: University Health Alliance Commercial |
$497.84
|
|
|
POWERPORT SLIM 6FR 1716000
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
HCPCS C1788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.84 |
| Max. Negotiated Rate |
$862.33 |
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$622.30
|
| Rate for Payer: Health Management Network Commercial |
$755.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$800.10
|
| Rate for Payer: MDX Hawaii PPO |
$862.33
|
| Rate for Payer: University Health Alliance Commercial |
$497.84
|
|
|
POWER RASP 4.0 AR-8400PR
|
Facility
|
IP
|
$544.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$527.68 |
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Health Management Network Commercial |
$462.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.60
|
| Rate for Payer: MDX Hawaii PPO |
$527.68
|
|
|
POWER RASP 4.0 AR-8400PR
|
Facility
|
OP
|
$544.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.64 |
| Max. Negotiated Rate |
$527.68 |
| Rate for Payer: AlohaCare Medicaid |
$272.00
|
| Rate for Payer: AlohaCare Medicare |
$168.64
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Devoted Health Medicare |
$184.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$516.80
|
| Rate for Payer: Health Management Network Commercial |
$462.40
|
| Rate for Payer: Humana Medicare |
$168.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$277.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$168.64
|
| Rate for Payer: MDX Hawaii PPO |
$527.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.64
|
| Rate for Payer: University Health Alliance Commercial |
$396.52
|
|
|
PR 1ST CARE PR DAY NML NB XCPT HOSP/BIRTHING CENTER
|
Professional
|
Both
|
$174.37
|
|
|
Service Code
|
HCPCS 99461
|
| Min. Negotiated Rate |
$47.09 |
| Max. Negotiated Rate |
$148.21 |
| Rate for Payer: AlohaCare Medicaid |
$61.22
|
| Rate for Payer: AlohaCare Medicare |
$53.31
|
| Rate for Payer: Cash Price |
$104.62
|
| Rate for Payer: Cash Price |
$104.62
|
| Rate for Payer: Devoted Health Medicare |
$58.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.09
|
| Rate for Payer: Health Management Network Commercial |
$148.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.31
|
| Rate for Payer: University Health Alliance Commercial |
$75.09
|
|
|
PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99460
|
| Min. Negotiated Rate |
$77.34 |
| Max. Negotiated Rate |
$134.30 |
| Rate for Payer: AlohaCare Medicaid |
$93.11
|
| Rate for Payer: AlohaCare Medicare |
$80.88
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Devoted Health Medicare |
$88.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.34
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.88
|
|
|
PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 99463
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: AlohaCare Medicaid |
$109.27
|
| Rate for Payer: AlohaCare Medicare |
$95.68
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Devoted Health Medicare |
$105.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.81
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$109.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.68
|
|
|
PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 99223
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: AlohaCare Medicaid |
$174.14
|
| Rate for Payer: AlohaCare Medicare |
$156.50
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Devoted Health Medicare |
$172.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$156.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$149.55
|
| Rate for Payer: Health Management Network Commercial |
$252.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$156.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$174.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$156.50
|
|
|
PR 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 99222
|
| Min. Negotiated Rate |
$113.39 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: AlohaCare Medicaid |
$131.00
|
| Rate for Payer: AlohaCare Medicare |
$116.73
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Devoted Health Medicare |
$128.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.39
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.73
|
|
|
PR 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 99221
|
| Min. Negotiated Rate |
$68.50 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: AlohaCare Medicaid |
$82.48
|
| Rate for Payer: AlohaCare Medicare |
$73.69
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Devoted Health Medicare |
$81.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.50
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.69
|
|
|
PR 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 99468
|
| Min. Negotiated Rate |
$161.59 |
| Max. Negotiated Rate |
$1,289.45 |
| Rate for Payer: AlohaCare Medicaid |
$896.57
|
| Rate for Payer: AlohaCare Medicare |
$779.52
|
| Rate for Payer: Cash Price |
$910.20
|
| Rate for Payer: Cash Price |
$910.20
|
| Rate for Payer: Devoted Health Medicare |
$857.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$779.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.59
|
| Rate for Payer: Health Management Network Commercial |
$1,289.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$935.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$935.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$935.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$896.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$779.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$896.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$779.52
|
|
|
PR 2D TTE W OR W/O FOL W/CON,FU
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS C8924
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Management Network Commercial |
$166.60
|
|
|
PR 3D ECHO IMG&PST-PXESSING TEE/TTE CGEN CAR ANOMAL
|
Professional
|
Both
|
$105.75
|
|
|
Service Code
|
HCPCS 93319
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$89.89 |
| Rate for Payer: AlohaCare Medicaid |
$23.13
|
| Rate for Payer: AlohaCare Medicare |
$20.56
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Devoted Health Medicare |
$22.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$38.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.13
|
| Rate for Payer: Health Management Network Commercial |
$89.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.56
|
|
|
PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 90649
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$257.55 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.49
|
| Rate for Payer: Health Management Network Commercial |
$257.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR 9VHPV VACC 2/3 DOSE SCHED IM USE
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 90651
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.35
|
| Rate for Payer: Health Management Network Commercial |
$391.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Professional
|
Both
|
$543.78
|
|
|
Service Code
|
HCPCS 49083
|
| Min. Negotiated Rate |
$92.74 |
| Max. Negotiated Rate |
$462.21 |
| Rate for Payer: AlohaCare Medicaid |
$105.50
|
| Rate for Payer: AlohaCare Medicare |
$92.74
|
| Rate for Payer: Cash Price |
$326.27
|
| Rate for Payer: Cash Price |
$326.27
|
| Rate for Payer: Devoted Health Medicare |
$102.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$165.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$105.50
|
| Rate for Payer: Health Management Network Commercial |
$462.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.74
|
| Rate for Payer: University Health Alliance Commercial |
$140.13
|
|
|
PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Professional
|
Both
|
$472.27
|
|
|
Service Code
|
HCPCS 49082
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$401.43 |
| Rate for Payer: AlohaCare Medicaid |
$73.51
|
| Rate for Payer: AlohaCare Medicare |
$71.63
|
| Rate for Payer: Cash Price |
$283.36
|
| Rate for Payer: Cash Price |
$283.36
|
| Rate for Payer: Devoted Health Medicare |
$78.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$73.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$214.76
|
| Rate for Payer: Health Management Network Commercial |
$401.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.63
|
|
|
PR ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION
|
Professional
|
Both
|
$11,489.96
|
|
|
Service Code
|
HCPCS 47383
|
| Min. Negotiated Rate |
$397.88 |
| Max. Negotiated Rate |
$9,766.47 |
| Rate for Payer: AlohaCare Medicaid |
$439.18
|
| Rate for Payer: AlohaCare Medicare |
$397.88
|
| Rate for Payer: Cash Price |
$6,893.98
|
| Rate for Payer: Cash Price |
$6,893.98
|
| Rate for Payer: Devoted Health Medicare |
$437.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$439.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$723.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$397.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$439.18
|
| Rate for Payer: Health Management Network Commercial |
$9,766.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$477.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$477.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$477.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$439.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$397.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$439.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$397.88
|
| Rate for Payer: University Health Alliance Commercial |
$582.36
|
|
