|
PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML (6.7 MG/5 ML) ORAL SOLN [11118]
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
NDC 13925016604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$309.60
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
|
|
PREDNISOLONE SOD PHOSPHATE SOLUTION 15 MG/5 ML UDC (ORAPRED) (TAKE HOME) [4080390]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00004080178
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
|
|
PREDNISOLONE SOD PHOSPHATE SOLUTION 15 MG/5 ML UDC (ORAPRED) (TAKE HOME) [4080390]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00004080178
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: AlohaCare Medicaid |
$7.50
|
| Rate for Payer: AlohaCare Medicare |
$4.65
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$5.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.25
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Humana Medicare |
$4.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.65
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.65
|
| Rate for Payer: University Health Alliance Commercial |
$10.93
|
|
|
PREDNISONE 10 MG TABLET [6494]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.31
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.31
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
PREDNISONE 10 MG TABLET [6494]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
PREDNISONE 1 MG TABLET [6493]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
PREDNISONE 1 MG TABLET [6493]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$0.93
|
| Rate for Payer: AlohaCare Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$0.34
|
| Rate for Payer: Devoted Health Medicare |
$1.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.93
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.93
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
PREDNISONE 20 MG TABLET [6496]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.31
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.31
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
PREDNISONE 20 MG TABLET [6496]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
PREDNISONE 5 MG TABLET [6497]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
PREDNISONE 5 MG TABLET [6497]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.31
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.31
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
PREDNISONE TABLETS (DELTASONE) 20 MG (TAKE HOME) [4080391]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: AlohaCare Medicaid |
$7.50
|
| Rate for Payer: AlohaCare Medicare |
$4.65
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$5.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.25
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Humana Medicare |
$4.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.65
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.65
|
| Rate for Payer: University Health Alliance Commercial |
$10.93
|
|
|
PREDNISONE TABLETS (DELTASONE) 20 MG (TAKE HOME) [4080391]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS J7512
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO
|
Professional
|
Both
|
$392.96
|
|
|
Service Code
|
HCPCS 95721
|
| Min. Negotiated Rate |
$177.08 |
| Max. Negotiated Rate |
$334.02 |
| Rate for Payer: AlohaCare Medicaid |
$208.10
|
| Rate for Payer: AlohaCare Medicare |
$177.08
|
| Rate for Payer: Cash Price |
$235.78
|
| Rate for Payer: Cash Price |
$235.78
|
| Rate for Payer: Devoted Health Medicare |
$194.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$208.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$263.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$208.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$225.08
|
| Rate for Payer: Health Management Network Commercial |
$334.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$212.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$212.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$208.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$208.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.08
|
| Rate for Payer: University Health Alliance Commercial |
$249.25
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG
|
Professional
|
Both
|
$474.34
|
|
|
Service Code
|
HCPCS 95722
|
| Min. Negotiated Rate |
$214.84 |
| Max. Negotiated Rate |
$403.19 |
| Rate for Payer: AlohaCare Medicaid |
$252.09
|
| Rate for Payer: AlohaCare Medicare |
$214.84
|
| Rate for Payer: Cash Price |
$284.60
|
| Rate for Payer: Cash Price |
$284.60
|
| Rate for Payer: Devoted Health Medicare |
$236.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$252.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$320.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$252.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$272.88
|
| Rate for Payer: Health Management Network Commercial |
$403.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$252.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$252.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.84
|
| Rate for Payer: University Health Alliance Commercial |
$303.83
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO
|
Professional
|
Both
|
$476.58
|
|
|
Service Code
|
HCPCS 95723
|
| Min. Negotiated Rate |
$216.13 |
| Max. Negotiated Rate |
$405.09 |
| Rate for Payer: AlohaCare Medicaid |
$252.42
|
| Rate for Payer: AlohaCare Medicare |
$216.13
|
| Rate for Payer: Cash Price |
$285.95
|
| Rate for Payer: Cash Price |
$285.95
|
| Rate for Payer: Devoted Health Medicare |
$237.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$252.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$326.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$216.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$252.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.87
|
| Rate for Payer: Health Management Network Commercial |
$405.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$259.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$252.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$216.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$252.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$216.13
|
| Rate for Payer: University Health Alliance Commercial |
$305.85
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG
|
Professional
|
Both
|
$601.54
|
|
|
Service Code
|
HCPCS 95724
|
| Min. Negotiated Rate |
$273.10 |
| Max. Negotiated Rate |
$511.31 |
| Rate for Payer: AlohaCare Medicaid |
$317.52
|
| Rate for Payer: AlohaCare Medicare |
$273.10
|
| Rate for Payer: Cash Price |
$360.92
|
| Rate for Payer: Cash Price |
$360.92
|
| Rate for Payer: Devoted Health Medicare |
$300.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$317.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$409.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$317.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$348.60
|
| Rate for Payer: Health Management Network Commercial |
$511.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$327.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$327.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$327.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$317.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$273.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$317.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.10
|
| Rate for Payer: University Health Alliance Commercial |
$386.23
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/O VID
|
Professional
|
Both
|
$549.50
|
|
|
Service Code
|
HCPCS 95725
|
| Min. Negotiated Rate |
$247.92 |
| Max. Negotiated Rate |
$467.07 |
| Rate for Payer: AlohaCare Medicaid |
$291.43
|
| Rate for Payer: AlohaCare Medicare |
$247.92
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Devoted Health Medicare |
$272.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$291.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$371.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$247.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$291.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$318.50
|
| Rate for Payer: Health Management Network Commercial |
$467.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$297.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$297.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$291.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$247.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$291.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$247.92
|
| Rate for Payer: University Health Alliance Commercial |
$350.99
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG
|
Professional
|
Both
|
$767.76
|
|
|
Service Code
|
HCPCS 95726
|
| Min. Negotiated Rate |
$347.19 |
| Max. Negotiated Rate |
$652.60 |
| Rate for Payer: AlohaCare Medicaid |
$406.95
|
| Rate for Payer: AlohaCare Medicare |
$347.19
|
| Rate for Payer: Cash Price |
$460.66
|
| Rate for Payer: Cash Price |
$460.66
|
| Rate for Payer: Devoted Health Medicare |
$381.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$406.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$516.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$347.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$406.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$440.53
|
| Rate for Payer: Health Management Network Commercial |
$652.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$416.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$416.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$416.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$406.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$347.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$406.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$347.19
|
| Rate for Payer: University Health Alliance Commercial |
$490.15
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS 95813 TC
|
| Min. Negotiated Rate |
$107.72 |
| Max. Negotiated Rate |
$1,135.60 |
| Rate for Payer: AlohaCare Medicaid |
$498.26
|
| Rate for Payer: AlohaCare Medicare |
$444.16
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Devoted Health Medicare |
$488.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$444.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.72
|
| Rate for Payer: Health Management Network Commercial |
$1,135.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$532.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$532.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$444.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$498.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$444.16
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 95813 26
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$498.26 |
| Rate for Payer: AlohaCare Medicaid |
$498.26
|
| Rate for Payer: AlohaCare Medicare |
$91.50
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Devoted Health Medicare |
$100.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.72
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$498.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.50
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
HCPCS 95813
|
| Min. Negotiated Rate |
$107.72 |
| Max. Negotiated Rate |
$1,271.60 |
| Rate for Payer: AlohaCare Medicaid |
$498.26
|
| Rate for Payer: AlohaCare Medicare |
$535.65
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Devoted Health Medicare |
$589.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$535.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.72
|
| Rate for Payer: Health Management Network Commercial |
$1,271.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$642.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$642.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$642.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$535.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$498.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$535.65
|
|
|
PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO
|
Professional
|
Both
|
$197.82
|
|
|
Service Code
|
HCPCS 95717
|
| Min. Negotiated Rate |
$89.49 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: AlohaCare Medicaid |
$106.66
|
| Rate for Payer: AlohaCare Medicare |
$89.49
|
| Rate for Payer: Cash Price |
$118.69
|
| Rate for Payer: Cash Price |
$118.69
|
| Rate for Payer: Devoted Health Medicare |
$98.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$129.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.25
|
| Rate for Payer: Health Management Network Commercial |
$168.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.49
|
| Rate for Payer: University Health Alliance Commercial |
$121.96
|
|
|
PR EEG PHYS/QHP 2-12 HR WITH VEEG
|
Professional
|
Both
|
$248.41
|
|
|
Service Code
|
HCPCS 95718
|
| Min. Negotiated Rate |
$111.95 |
| Max. Negotiated Rate |
$211.15 |
| Rate for Payer: AlohaCare Medicaid |
$135.33
|
| Rate for Payer: AlohaCare Medicare |
$111.95
|
| Rate for Payer: Cash Price |
$149.05
|
| Rate for Payer: Cash Price |
$149.05
|
| Rate for Payer: Devoted Health Medicare |
$123.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$135.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$135.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.08
|
| Rate for Payer: Health Management Network Commercial |
$211.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$135.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.95
|
| Rate for Payer: University Health Alliance Commercial |
$162.76
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$297.34
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$134.59 |
| Max. Negotiated Rate |
$252.74 |
| Rate for Payer: AlohaCare Medicaid |
$161.72
|
| Rate for Payer: AlohaCare Medicare |
$134.59
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Devoted Health Medicare |
$148.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$161.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$200.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$161.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$169.11
|
| Rate for Payer: Health Management Network Commercial |
$252.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.59
|
| Rate for Payer: University Health Alliance Commercial |
$189.53
|
|
