|
PR OPEN TX RADIAL HEAD/NECK FRACTURE
|
Professional
|
Both
|
$1,195.00
|
|
|
Service Code
|
HCPCS 24665
|
| Min. Negotiated Rate |
$468.26 |
| Max. Negotiated Rate |
$1,015.75 |
| Rate for Payer: AlohaCare Medicaid |
$694.44
|
| Rate for Payer: AlohaCare Medicare |
$639.65
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Devoted Health Medicare |
$703.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$639.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$468.26
|
| Rate for Payer: Health Management Network Commercial |
$1,015.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$767.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$767.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$767.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$694.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$639.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$694.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$639.65
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC
|
Professional
|
Both
|
$1,315.00
|
|
|
Service Code
|
HCPCS 24666
|
| Min. Negotiated Rate |
$596.44 |
| Max. Negotiated Rate |
$1,117.75 |
| Rate for Payer: AlohaCare Medicaid |
$765.27
|
| Rate for Payer: AlohaCare Medicare |
$698.59
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Devoted Health Medicare |
$768.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$698.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$596.44
|
| Rate for Payer: Health Management Network Commercial |
$1,117.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$838.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$838.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$838.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$765.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$698.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$765.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$698.59
|
|
|
PR OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES
|
Professional
|
Both
|
$1,095.00
|
|
|
Service Code
|
HCPCS 25670
|
| Min. Negotiated Rate |
$459.42 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: AlohaCare Medicaid |
$638.62
|
| Rate for Payer: AlohaCare Medicare |
$592.24
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Devoted Health Medicare |
$651.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$592.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$459.42
|
| Rate for Payer: Health Management Network Commercial |
$930.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$710.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$710.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$710.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$638.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$592.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$638.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$592.24
|
|
|
PR OPEN TX SCAPULAR FX W/INT FIXATION WHEN PFRMD
|
Professional
|
Both
|
$1,721.00
|
|
|
Service Code
|
HCPCS 23585
|
| Min. Negotiated Rate |
$666.12 |
| Max. Negotiated Rate |
$1,462.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,002.91
|
| Rate for Payer: AlohaCare Medicare |
$902.13
|
| Rate for Payer: Cash Price |
$1,032.60
|
| Rate for Payer: Cash Price |
$1,032.60
|
| Rate for Payer: Devoted Health Medicare |
$992.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$902.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$666.12
|
| Rate for Payer: Health Management Network Commercial |
$1,462.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,082.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,082.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,082.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,002.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$902.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,002.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$902.13
|
|
|
PR OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA
|
Professional
|
Both
|
$1,163.00
|
|
|
Service Code
|
HCPCS 28465
|
| Min. Negotiated Rate |
$483.34 |
| Max. Negotiated Rate |
$988.55 |
| Rate for Payer: AlohaCare Medicaid |
$675.97
|
| Rate for Payer: AlohaCare Medicare |
$639.86
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Devoted Health Medicare |
$703.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$639.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$483.34
|
| Rate for Payer: Health Management Network Commercial |
$988.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$767.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$767.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$767.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$675.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$639.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$675.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$639.86
|
|
|
PR OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
Both
|
$1,568.00
|
|
|
Service Code
|
HCPCS 27535
|
| Min. Negotiated Rate |
$815.95 |
| Max. Negotiated Rate |
$1,332.80 |
| Rate for Payer: AlohaCare Medicaid |
$914.07
|
| Rate for Payer: AlohaCare Medicare |
$815.95
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Devoted Health Medicare |
$897.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$815.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$929.50
|
| Rate for Payer: Health Management Network Commercial |
$1,332.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$979.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$979.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$979.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$914.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$815.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$914.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$815.95
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 27823
|
| Min. Negotiated Rate |
$921.18 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,025.17
|
| Rate for Payer: AlohaCare Medicare |
$943.82
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Devoted Health Medicare |
$1,038.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$943.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$921.18
|
| Rate for Payer: Health Management Network Commercial |
$1,487.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,132.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,132.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,132.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,025.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$943.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,025.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$943.82
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 27822
|
| Min. Negotiated Rate |
$849.65 |
| Max. Negotiated Rate |
$1,326.85 |
| Rate for Payer: AlohaCare Medicaid |
$915.30
|
| Rate for Payer: AlohaCare Medicare |
$849.65
|
| Rate for Payer: Cash Price |
$936.60
|
| Rate for Payer: Cash Price |
$936.60
|
| Rate for Payer: Devoted Health Medicare |
$934.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$849.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,021.54
|
| Rate for Payer: Health Management Network Commercial |
$1,326.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,019.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$915.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$849.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$915.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$849.65
|
|
|
PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 34812
|
| Min. Negotiated Rate |
$172.57 |
| Max. Negotiated Rate |
$471.83 |
| Rate for Payer: AlohaCare Medicaid |
$189.22
|
| Rate for Payer: AlohaCare Medicare |
$172.57
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Devoted Health Medicare |
$189.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$357.50
|
| Rate for Payer: Health Management Network Commercial |
$273.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.57
|
| Rate for Payer: University Health Alliance Commercial |
$471.83
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [131626]
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS J2704
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicaid |
$13.00
|
| Rate for Payer: AlohaCare Medicare |
$8.06
|
| Rate for Payer: AlohaCare Medicare |
$39.06
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$42.84
|
| Rate for Payer: Devoted Health Medicare |
$8.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Humana Medicare |
$39.06
|
| Rate for Payer: Humana Medicare |
$8.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.06
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.06
|
| Rate for Payer: University Health Alliance Commercial |
$91.84
|
| Rate for Payer: University Health Alliance Commercial |
$18.95
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [131626]
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS J2704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
PROPOFOL INFUSION 10 MG/ML (WRAPPED) [40840026]
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS J2704
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicaid |
$13.00
|
| Rate for Payer: AlohaCare Medicare |
$8.06
|
| Rate for Payer: AlohaCare Medicare |
$39.06
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$42.84
|
| Rate for Payer: Devoted Health Medicare |
$8.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Humana Medicare |
$39.06
|
| Rate for Payer: Humana Medicare |
$8.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.06
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.06
|
| Rate for Payer: University Health Alliance Commercial |
$91.84
|
| Rate for Payer: University Health Alliance Commercial |
$18.95
|
|
|
PROPOFOL INFUSION 10 MG/ML (WRAPPED) [40840026]
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS J2704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
PROPRANOLOL 10 MG TABLET [6656]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687058711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
PROPRANOLOL 10 MG TABLET [6656]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687058701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
PROPRANOLOL 10 MG TABLET [6656]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687058711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$0.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$0.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.62
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.62
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
PROPRANOLOL 10 MG TABLET [6656]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687058701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$0.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$0.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.62
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.62
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION [29335]
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J1800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$33.95 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: MDX Hawaii PPO |
$28.13
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: MDX Hawaii PPO |
$33.95
|
|
|
PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION [29335]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS J1800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: AlohaCare Medicaid |
$7.50
|
| Rate for Payer: AlohaCare Medicaid |
$17.50
|
| Rate for Payer: AlohaCare Medicaid |
$14.50
|
| Rate for Payer: AlohaCare Medicare |
$8.99
|
| Rate for Payer: AlohaCare Medicare |
$4.65
|
| Rate for Payer: AlohaCare Medicare |
$10.85
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Devoted Health Medicare |
$5.10
|
| Rate for Payer: Devoted Health Medicare |
$11.90
|
| Rate for Payer: Devoted Health Medicare |
$9.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.25
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Humana Medicare |
$4.65
|
| Rate for Payer: Humana Medicare |
$8.99
|
| Rate for Payer: Humana Medicare |
$10.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.85
|
| Rate for Payer: MDX Hawaii PPO |
$33.95
|
| Rate for Payer: MDX Hawaii PPO |
$28.13
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.85
|
| Rate for Payer: University Health Alliance Commercial |
$10.93
|
| Rate for Payer: University Health Alliance Commercial |
$21.14
|
| Rate for Payer: University Health Alliance Commercial |
$25.51
|
|
|
PROPRANOLOL 20 MG TABLET [6657]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687059801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
PROPRANOLOL 20 MG TABLET [6657]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687059801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$0.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$0.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.62
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.62
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
PROPRANOLOL 20 MG TABLET [6657]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687059811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
PROPRANOLOL 20 MG TABLET [6657]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687059811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$0.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$0.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.62
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.62
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$1,161.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$478.14 |
| Max. Negotiated Rate |
$986.85 |
| Rate for Payer: AlohaCare Medicaid |
$679.70
|
| Rate for Payer: AlohaCare Medicare |
$625.26
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Devoted Health Medicare |
$687.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$625.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.14
|
| Rate for Payer: Health Management Network Commercial |
$986.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$750.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$750.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$750.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$679.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$625.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$679.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$625.26
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$729.56 |
| Max. Negotiated Rate |
$1,198.50 |
| Rate for Payer: AlohaCare Medicaid |
$815.47
|
| Rate for Payer: AlohaCare Medicare |
$746.72
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Devoted Health Medicare |
$821.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$746.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$729.56
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$896.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$896.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$896.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$815.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$746.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$815.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$746.72
|
|
