|
PROBENECID 500 MG TABLET [6561]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00591534701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
|
|
PROBE PRASS MONOPOLAR
|
Facility
|
OP
|
$593.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.83 |
| Max. Negotiated Rate |
$575.21 |
| Rate for Payer: AlohaCare Medicaid |
$296.50
|
| Rate for Payer: AlohaCare Medicare |
$183.83
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Devoted Health Medicare |
$201.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$563.35
|
| Rate for Payer: Health Management Network Commercial |
$504.05
|
| Rate for Payer: Humana Medicare |
$183.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$533.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$302.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$183.83
|
| Rate for Payer: MDX Hawaii PPO |
$575.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$183.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.83
|
| Rate for Payer: University Health Alliance Commercial |
$432.24
|
|
|
PROBE PRASS MONOPOLAR
|
Facility
|
IP
|
$593.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$504.05 |
| Max. Negotiated Rate |
$575.21 |
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Health Management Network Commercial |
$504.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$533.70
|
| Rate for Payer: MDX Hawaii PPO |
$575.21
|
|
|
PROBE PRASS NERVE LOCATE
|
Facility
|
IP
|
$953.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$810.05 |
| Max. Negotiated Rate |
$924.41 |
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Health Management Network Commercial |
$810.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$857.70
|
| Rate for Payer: MDX Hawaii PPO |
$924.41
|
|
|
PROBE PRASS NERVE LOCATE
|
Facility
|
OP
|
$953.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$295.43 |
| Max. Negotiated Rate |
$924.41 |
| Rate for Payer: AlohaCare Medicaid |
$476.50
|
| Rate for Payer: AlohaCare Medicare |
$295.43
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Devoted Health Medicare |
$324.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$905.35
|
| Rate for Payer: Health Management Network Commercial |
$810.05
|
| Rate for Payer: Humana Medicare |
$295.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$857.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$295.43
|
| Rate for Payer: MDX Hawaii PPO |
$924.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$295.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.43
|
| Rate for Payer: University Health Alliance Commercial |
$694.64
|
|
|
PR OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE
|
Professional
|
Both
|
$1,410.13
|
|
|
Service Code
|
HCPCS 49460
|
| Min. Negotiated Rate |
$42.07 |
| Max. Negotiated Rate |
$1,198.61 |
| Rate for Payer: AlohaCare Medicaid |
$49.68
|
| Rate for Payer: AlohaCare Medicare |
$42.07
|
| Rate for Payer: Cash Price |
$846.08
|
| Rate for Payer: Cash Price |
$846.08
|
| Rate for Payer: Devoted Health Medicare |
$46.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$74.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.68
|
| Rate for Payer: Health Management Network Commercial |
$1,198.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.07
|
| Rate for Payer: University Health Alliance Commercial |
$63.46
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$87.85
|
|
|
Service Code
|
HCPCS Q0091
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$74.67 |
| Rate for Payer: AlohaCare Medicare |
$15.64
|
| Rate for Payer: Cash Price |
$52.71
|
| Rate for Payer: Cash Price |
$52.71
|
| Rate for Payer: Devoted Health Medicare |
$17.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.00
|
| Rate for Payer: Health Management Network Commercial |
$74.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.64
|
| Rate for Payer: University Health Alliance Commercial |
$17.91
|
|
|
PR OCCLUSIVE DEVICE IN VEIN ART
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS G0269
|
| Min. Negotiated Rate |
$290.70 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Health Management Network Commercial |
$290.70
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
NDC 00574722612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: AlohaCare Medicaid |
$16.00
|
| Rate for Payer: AlohaCare Medicare |
$9.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$10.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.40
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Humana Medicare |
$9.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.92
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.92
|
| Rate for Payer: University Health Alliance Commercial |
$23.32
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
NDC 00713013512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: AlohaCare Medicaid |
$15.50
|
| Rate for Payer: AlohaCare Medicare |
$9.61
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$10.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.45
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Humana Medicare |
$9.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.61
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.61
|
| Rate for Payer: University Health Alliance Commercial |
$22.60
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
NDC 00713013506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: AlohaCare Medicaid |
$15.50
|
| Rate for Payer: AlohaCare Medicare |
$9.61
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$10.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.45
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Humana Medicare |
$9.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.61
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.61
|
| Rate for Payer: University Health Alliance Commercial |
$22.60
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 00574722612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
NDC 00713013506
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
NDC 00713013512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [166223]
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS J0780
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Health Management Network Commercial |
$21.25
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: MDX Hawaii PPO |
$23.28
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: MDX Hawaii PPO |
$24.25
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [166223]
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J0780
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: AlohaCare Medicaid |
$11.50
|
| Rate for Payer: AlohaCare Medicaid |
$12.50
|
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$7.44
|
| Rate for Payer: AlohaCare Medicare |
$7.13
|
| Rate for Payer: AlohaCare Medicare |
$7.75
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Devoted Health Medicare |
$7.82
|
| Rate for Payer: Devoted Health Medicare |
$8.50
|
| Rate for Payer: Devoted Health Medicare |
$8.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.75
|
| Rate for Payer: Health Management Network Commercial |
$21.25
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Humana Medicare |
$7.13
|
| Rate for Payer: Humana Medicare |
$7.44
|
| Rate for Payer: Humana Medicare |
$7.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.75
|
| Rate for Payer: MDX Hawaii PPO |
$24.25
|
| Rate for Payer: MDX Hawaii PPO |
$23.28
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.75
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
| Rate for Payer: University Health Alliance Commercial |
$17.49
|
| Rate for Payer: University Health Alliance Commercial |
$18.22
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS Q0164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.00
|
| Rate for Payer: AlohaCare Medicare |
$1.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$1.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Humana Medicare |
$1.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.24
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.24
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS Q0164
|
|
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
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS Q0164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS Q0164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$0.93
|
| Rate for Payer: AlohaCare Medicare |
$1.86
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$2.04
|
| Rate for Payer: Devoted Health Medicare |
$1.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Humana Medicare |
$1.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.93
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.86
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 99245
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$615.19 |
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$449.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$450.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$361.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$615.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$319.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$449.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.80
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$361.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$450.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$615.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$449.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$361.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$450.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$615.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$449.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$319.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$361.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$450.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$615.19
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 99243
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$105.54 |
| Max. Negotiated Rate |
$615.19 |
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$449.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$615.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$319.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$450.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$361.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$449.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.54
|
| Rate for Payer: Health Management Network Commercial |
$175.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$615.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$361.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$450.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$449.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$361.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$450.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$615.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$449.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$319.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$361.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$615.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$450.50
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 99244
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$139.47 |
| Max. Negotiated Rate |
$615.19 |
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$449.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$450.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$361.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$615.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$319.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$449.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$139.47
|
| Rate for Payer: Health Management Network Commercial |
$249.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$361.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$450.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$615.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$449.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$361.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$450.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$615.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$449.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$319.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$361.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$450.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$615.19
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 99242
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$82.11 |
| Max. Negotiated Rate |
$615.19 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$449.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$615.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$319.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$450.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$361.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$449.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.11
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$615.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$361.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$450.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$449.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$361.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$450.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$615.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$449.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$319.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$361.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$615.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$450.50
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$353.54
|
|
|
Service Code
|
HCPCS 99215
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$83.80 |
| Max. Negotiated Rate |
$615.19 |
| Rate for Payer: AlohaCare Medicaid |
$145.89
|
| Rate for Payer: AlohaCare Medicare |
$126.07
|
| Rate for Payer: Cash Price |
$212.12
|
| Rate for Payer: Cash Price |
$212.12
|
| Rate for Payer: Cash Price |
$212.12
|
| Rate for Payer: Devoted Health Medicare |
$138.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$449.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$450.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$615.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$361.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$319.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$449.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.80
|
| Rate for Payer: Health Management Network Commercial |
$300.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$450.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$615.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$361.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$449.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$361.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$450.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$615.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$145.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$449.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$319.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$450.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$361.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$615.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
|
