|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 93312 26
|
| Min. Negotiated Rate |
$108.07 |
| Max. Negotiated Rate |
$288.56 |
| Rate for Payer: AlohaCare Medicaid |
$256.47
|
| Rate for Payer: AlohaCare Medicare |
$108.07
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Devoted Health Medicare |
$118.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.56
|
| Rate for Payer: Health Management Network Commercial |
$160.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.07
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$256.47 |
| Max. Negotiated Rate |
$561.85 |
| Rate for Payer: AlohaCare Medicaid |
$256.47
|
| Rate for Payer: AlohaCare Medicare |
$260.18
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Devoted Health Medicare |
$286.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$260.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.56
|
| Rate for Payer: Health Management Network Commercial |
$561.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$312.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$312.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$312.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$260.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$260.18
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Min. Negotiated Rate |
$152.11 |
| Max. Negotiated Rate |
$401.20 |
| Rate for Payer: AlohaCare Medicaid |
$256.47
|
| Rate for Payer: AlohaCare Medicare |
$152.11
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Devoted Health Medicare |
$167.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.56
|
| Rate for Payer: Health Management Network Commercial |
$401.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.11
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 93307
|
| Min. Negotiated Rate |
$150.89 |
| Max. Negotiated Rate |
$357.85 |
| Rate for Payer: AlohaCare Medicaid |
$150.89
|
| Rate for Payer: AlohaCare Medicare |
$151.79
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Devoted Health Medicare |
$166.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.77
|
| Rate for Payer: Health Management Network Commercial |
$357.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$150.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.79
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 93307 26
|
| Min. Negotiated Rate |
$44.31 |
| Max. Negotiated Rate |
$212.77 |
| Rate for Payer: AlohaCare Medicaid |
$150.89
|
| Rate for Payer: AlohaCare Medicare |
$44.31
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Devoted Health Medicare |
$48.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.77
|
| Rate for Payer: Health Management Network Commercial |
$66.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$150.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.31
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Min. Negotiated Rate |
$107.48 |
| Max. Negotiated Rate |
$291.55 |
| Rate for Payer: AlohaCare Medicaid |
$150.89
|
| Rate for Payer: AlohaCare Medicare |
$107.48
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Devoted Health Medicare |
$118.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.77
|
| Rate for Payer: Health Management Network Commercial |
$291.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$150.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.48
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 93308 26
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: AlohaCare Medicaid |
$109.80
|
| Rate for Payer: AlohaCare Medicare |
$25.35
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$27.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.16
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$109.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.35
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$80.16 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: AlohaCare Medicaid |
$109.80
|
| Rate for Payer: AlohaCare Medicare |
$111.94
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Devoted Health Medicare |
$123.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.16
|
| Rate for Payer: Health Management Network Commercial |
$267.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$109.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.94
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Min. Negotiated Rate |
$80.16 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: AlohaCare Medicaid |
$109.80
|
| Rate for Payer: AlohaCare Medicare |
$86.59
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Devoted Health Medicare |
$95.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.16
|
| Rate for Payer: Health Management Network Commercial |
$230.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$109.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.59
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$133.95 |
| Max. Negotiated Rate |
$466.65 |
| Rate for Payer: AlohaCare Medicaid |
$204.04
|
| Rate for Payer: AlohaCare Medicare |
$202.97
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Devoted Health Medicare |
$223.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$202.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.95
|
| Rate for Payer: Health Management Network Commercial |
$466.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$243.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$243.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.97
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 93350 26
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$204.04 |
| Rate for Payer: AlohaCare Medicaid |
$204.04
|
| Rate for Payer: AlohaCare Medicare |
$69.28
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$76.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.95
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.28
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 93350 TC
|
| Min. Negotiated Rate |
$133.69 |
| Max. Negotiated Rate |
$363.80 |
| Rate for Payer: AlohaCare Medicaid |
$204.04
|
| Rate for Payer: AlohaCare Medicare |
$133.69
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Devoted Health Medicare |
$147.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.95
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.69
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 93306 26
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$270.09 |
| Rate for Payer: AlohaCare Medicaid |
$216.47
|
| Rate for Payer: AlohaCare Medicare |
$69.28
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$76.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$270.09
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.28
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Min. Negotiated Rate |
$146.41 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: AlohaCare Medicaid |
$216.47
|
| Rate for Payer: AlohaCare Medicare |
$146.41
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Devoted Health Medicare |
$161.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$270.09
|
| Rate for Payer: Health Management Network Commercial |
$399.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.41
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$215.69 |
| Max. Negotiated Rate |
$502.35 |
| Rate for Payer: AlohaCare Medicaid |
$216.47
|
| Rate for Payer: AlohaCare Medicare |
$215.69
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Devoted Health Medicare |
$237.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$270.09
|
| Rate for Payer: Health Management Network Commercial |
$502.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$258.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.69
|
|
|
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
|
|
|
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
|
$146.00
|
|
|
Service Code
|
HCPCS 93351 26
|
| Min. Negotiated Rate |
$83.34 |
| Max. Negotiated Rate |
$278.29 |
| Rate for Payer: AlohaCare Medicaid |
$255.56
|
| Rate for Payer: AlohaCare Medicare |
$83.34
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Devoted Health Medicare |
$91.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.29
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$255.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.34
|
|
|
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 |
$55.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: AlohaCare Medicaid |
$90.00
|
| Rate for Payer: AlohaCare Medicare |
$55.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Devoted Health Medicare |
$61.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Humana Medicare |
$55.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.80
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.80
|
| Rate for Payer: University Health Alliance Commercial |
$131.20
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
NDC 61314063705
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$43.09
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Devoted Health Medicare |
$47.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.05
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$43.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.09
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.09
|
| Rate for Payer: University Health Alliance Commercial |
$101.32
|
|
|
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 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 15 MG/5 ML (5 ML) ORAL SOLUTION [205877]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 17856081501
|
|
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
|
|
|
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 |
$106.64 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: AlohaCare Medicaid |
$172.00
|
| Rate for Payer: AlohaCare Medicare |
$106.64
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Devoted Health Medicare |
$116.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$326.80
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Humana Medicare |
$106.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$309.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.64
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.64
|
| Rate for Payer: University Health Alliance Commercial |
$250.74
|
|
