|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00093406701
|
|
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
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 00093406801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$1.55
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$1.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Humana Medicare |
$1.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.55
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.55
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 00093406801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 68084099701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$2.79
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$3.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Humana Medicare |
$2.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.79
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.79
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 51079063101
|
|
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
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 68084099701
|
|
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
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 51079063101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$2.79
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$3.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Humana Medicare |
$2.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.79
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.79
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 51079063220
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: AlohaCare Medicaid |
$8.00
|
| Rate for Payer: AlohaCare Medicare |
$4.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$5.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.96
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.96
|
| Rate for Payer: University Health Alliance Commercial |
$11.66
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 51079063201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 51079063220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 51079063201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: AlohaCare Medicaid |
$8.00
|
| Rate for Payer: AlohaCare Medicare |
$4.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$5.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.96
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.96
|
| Rate for Payer: University Health Alliance Commercial |
$11.66
|
|
|
PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 90586
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Health Management Network Commercial |
$222.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT
|
Professional
|
Both
|
$914.69
|
|
|
Service Code
|
HCPCS 47542
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$777.49 |
| Rate for Payer: AlohaCare Medicaid |
$130.30
|
| Rate for Payer: AlohaCare Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$548.81
|
| Rate for Payer: Cash Price |
$548.81
|
| Rate for Payer: Devoted Health Medicare |
$125.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$130.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$206.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$130.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$585.78
|
| Rate for Payer: Health Management Network Commercial |
$777.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$130.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$130.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.43
|
|
|
PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I
|
Professional
|
Both
|
$1,535.33
|
|
|
Service Code
|
HCPCS 50706
|
| Min. Negotiated Rate |
$151.97 |
| Max. Negotiated Rate |
$1,305.03 |
| Rate for Payer: AlohaCare Medicaid |
$174.12
|
| Rate for Payer: AlohaCare Medicare |
$151.97
|
| Rate for Payer: Cash Price |
$921.20
|
| Rate for Payer: Cash Price |
$921.20
|
| Rate for Payer: Devoted Health Medicare |
$167.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$174.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.12
|
| Rate for Payer: Health Management Network Commercial |
$1,305.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$174.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.97
|
| Rate for Payer: University Health Alliance Commercial |
$233.53
|
|
|
PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Professional
|
Both
|
$9.64
|
|
|
Service Code
|
HCPCS 96127
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: AlohaCare Medicaid |
$5.16
|
| Rate for Payer: AlohaCare Medicare |
$5.51
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Devoted Health Medicare |
$6.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network Commercial |
$8.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.51
|
|
|
PR BEHAVIOR COUNSEL OBESITY 15M
|
Professional
|
Both
|
$61.69
|
|
|
Service Code
|
HCPCS G0447
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: AlohaCare Medicaid |
$22.81
|
| Rate for Payer: AlohaCare Medicare |
$26.51
|
| Rate for Payer: Cash Price |
$37.01
|
| Rate for Payer: Cash Price |
$37.01
|
| Rate for Payer: Devoted Health Medicare |
$29.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.81
|
| Rate for Payer: Health Management Network Commercial |
$52.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.51
|
|
|
PR BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT
|
Professional
|
Both
|
$154.65
|
|
|
Service Code
|
HCPCS 90912
|
| Min. Negotiated Rate |
$37.48 |
| Max. Negotiated Rate |
$131.45 |
| Rate for Payer: AlohaCare Medicaid |
$42.75
|
| Rate for Payer: AlohaCare Medicare |
$37.48
|
| Rate for Payer: Cash Price |
$92.79
|
| Rate for Payer: Cash Price |
$92.79
|
| Rate for Payer: Devoted Health Medicare |
$41.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.75
|
| Rate for Payer: Health Management Network Commercial |
$131.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.48
|
| Rate for Payer: University Health Alliance Commercial |
$52.07
|
|
|
PR BFB TRAING W/EMG&/MANOMETRY EA ADDL 15 MIN CNTCT
|
Professional
|
Both
|
$60.81
|
|
|
Service Code
|
HCPCS 90913
|
| Min. Negotiated Rate |
$21.08 |
| Max. Negotiated Rate |
$51.69 |
| Rate for Payer: AlohaCare Medicaid |
$24.09
|
| Rate for Payer: AlohaCare Medicare |
$21.08
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Devoted Health Medicare |
$23.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.09
|
| Rate for Payer: Health Management Network Commercial |
$51.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.08
|
| Rate for Payer: University Health Alliance Commercial |
$29.15
|
|
|
PR BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 47552
|
| Min. Negotiated Rate |
$210.34 |
| Max. Negotiated Rate |
$391.85 |
| Rate for Payer: AlohaCare Medicaid |
$266.94
|
| Rate for Payer: AlohaCare Medicare |
$248.32
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Devoted Health Medicare |
$273.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$248.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$210.34
|
| Rate for Payer: Health Management Network Commercial |
$391.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$297.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$297.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$248.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$266.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$248.32
|
|
|
PR BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 47554
|
| Min. Negotiated Rate |
$368.68 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: AlohaCare Medicaid |
$432.83
|
| Rate for Payer: AlohaCare Medicare |
$387.13
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Devoted Health Medicare |
$425.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$387.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$368.68
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$464.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$464.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$464.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$432.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$387.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$432.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$387.13
|
|
|
PR BILIARY NDSC INTRAOPERATIVE
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 47550
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: AlohaCare Medicaid |
$156.43
|
| Rate for Payer: AlohaCare Medicare |
$138.13
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Devoted Health Medicare |
$151.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network Commercial |
$226.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$156.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$156.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.13
|
|
|
PR BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 47556
|
| Min. Negotiated Rate |
$310.96 |
| Max. Negotiated Rate |
$522.75 |
| Rate for Payer: AlohaCare Medicaid |
$357.37
|
| Rate for Payer: AlohaCare Medicare |
$328.89
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Devoted Health Medicare |
$361.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$328.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$310.96
|
| Rate for Payer: Health Management Network Commercial |
$522.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$394.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$394.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$357.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$328.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$357.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$328.89
|
|
|
PR BILIARY NDSC PRQ T-TUBE W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 47553
|
| Min. Negotiated Rate |
$243.73 |
| Max. Negotiated Rate |
$388.45 |
| Rate for Payer: AlohaCare Medicaid |
$265.00
|
| Rate for Payer: AlohaCare Medicare |
$243.73
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Devoted Health Medicare |
$268.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$243.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$285.22
|
| Rate for Payer: Health Management Network Commercial |
$388.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$292.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$292.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$292.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$265.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$265.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.73
|
|
|
PR BILIARY NDSC PRQ T-TUBE W/DIL DUCT W/O STENT
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
HCPCS 47555
|
| Min. Negotiated Rate |
$283.14 |
| Max. Negotiated Rate |
$461.55 |
| Rate for Payer: AlohaCare Medicaid |
$315.54
|
| Rate for Payer: AlohaCare Medicare |
$290.22
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Devoted Health Medicare |
$319.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$290.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$283.14
|
| Rate for Payer: Health Management Network Commercial |
$461.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$348.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$348.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$315.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$290.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$315.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$290.22
|
|
|
PR BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE
|
Professional
|
Both
|
$55.39
|
|
|
Service Code
|
HCPCS 92504
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$47.08 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$7.72
|
| Rate for Payer: Cash Price |
$33.23
|
| Rate for Payer: Cash Price |
$33.23
|
| Rate for Payer: Devoted Health Medicare |
$8.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.85
|
| Rate for Payer: Health Management Network Commercial |
$47.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.72
|
| Rate for Payer: University Health Alliance Commercial |
$11.24
|
|
