|
PROMETHAZINE-CODEINE 6.25-10 MG/5 ML PO SYRUP
|
Facility
|
OP
|
$1.91
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: AlohaCare Medicaid |
$0.96
|
| Rate for Payer: AlohaCare Medicare |
$1.72
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Devoted Health Medicare |
$1.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.81
|
| Rate for Payer: Health Management Network Commercial |
$1.62
|
| Rate for Payer: Humana Medicare |
$1.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.72
|
| Rate for Payer: MDX Hawaii PPO |
$1.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.72
|
| Rate for Payer: University Health Alliance Commercial |
$1.39
|
|
|
PROPOFOL 1000 MG/100 ML IV DRIP (RASS)
|
Facility
|
IP
|
$142.20
|
|
|
Service Code
|
HCPCS J2704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.87 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Cash Price |
$92.43
|
| Rate for Payer: Health Management Network Commercial |
$120.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.98
|
| Rate for Payer: MDX Hawaii PPO |
$137.93
|
|
|
PROPOFOL 1000 MG/100 ML IV DRIP (RASS)
|
Facility
|
OP
|
$142.20
|
|
|
Service Code
|
HCPCS J2704
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$140.78 |
| Rate for Payer: AlohaCare Medicaid |
$71.10
|
| Rate for Payer: AlohaCare Medicare |
$127.98
|
| Rate for Payer: Cash Price |
$92.43
|
| Rate for Payer: Cash Price |
$92.43
|
| Rate for Payer: Devoted Health Medicare |
$140.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.09
|
| Rate for Payer: Health Management Network Commercial |
$120.87
|
| Rate for Payer: Humana Medicare |
$127.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.98
|
| Rate for Payer: MDX Hawaii PPO |
$137.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.98
|
| Rate for Payer: University Health Alliance Commercial |
$103.65
|
|
|
PROPOFOL 10 MG/ML 20 ML IV FOR PROCEDURAL SEDATION COMBO
|
Facility
|
IP
|
$23.85
|
|
|
Service Code
|
HCPCS J2704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$23.13 |
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$25.10
|
| Rate for Payer: Health Management Network Commercial |
$32.83
|
| Rate for Payer: Health Management Network Commercial |
$20.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.76
|
| Rate for Payer: MDX Hawaii PPO |
$23.13
|
| Rate for Payer: MDX Hawaii PPO |
$37.46
|
|
|
PROPOFOL 10 MG/ML 20 ML IV FOR PROCEDURAL SEDATION COMBO
|
Facility
|
OP
|
$38.62
|
|
|
Service Code
|
HCPCS J2704
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$38.23 |
| Rate for Payer: AlohaCare Medicaid |
$19.31
|
| Rate for Payer: AlohaCare Medicaid |
$11.93
|
| Rate for Payer: AlohaCare Medicare |
$21.46
|
| Rate for Payer: AlohaCare Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$25.10
|
| Rate for Payer: Cash Price |
$25.10
|
| Rate for Payer: Devoted Health Medicare |
$23.61
|
| Rate for Payer: Devoted Health Medicare |
$38.23
|
| 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 |
$21.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.76
|
| 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 |
$22.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.69
|
| Rate for Payer: Health Management Network Commercial |
$20.27
|
| Rate for Payer: Health Management Network Commercial |
$32.83
|
| Rate for Payer: Humana Medicare |
$21.46
|
| Rate for Payer: Humana Medicare |
$34.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.76
|
| Rate for Payer: MDX Hawaii PPO |
$23.13
|
| Rate for Payer: MDX Hawaii PPO |
$37.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.46
|
| Rate for Payer: University Health Alliance Commercial |
$17.38
|
| Rate for Payer: University Health Alliance Commercial |
$28.15
|
|
|
PROPRANOLOL 10 MG PO TABLET
|
Facility
|
IP
|
$2.26
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Health Management Network Commercial |
$1.92
|
| Rate for Payer: Health Management Network Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.49
|
| Rate for Payer: MDX Hawaii PPO |
$1.61
|
| Rate for Payer: MDX Hawaii PPO |
$2.19
|
|
|
PROPRANOLOL 10 MG PO TABLET
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: AlohaCare Medicaid |
$0.83
|
| Rate for Payer: AlohaCare Medicaid |
$1.13
|
| Rate for Payer: AlohaCare Medicare |
$1.49
|
| Rate for Payer: AlohaCare Medicare |
$2.03
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Devoted Health Medicare |
$1.64
|
| Rate for Payer: Devoted Health Medicare |
$2.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.58
|
| Rate for Payer: Health Management Network Commercial |
$1.41
|
| Rate for Payer: Health Management Network Commercial |
$1.92
|
| Rate for Payer: Humana Medicare |
$2.03
|
| Rate for Payer: Humana Medicare |
$1.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.49
|
| Rate for Payer: MDX Hawaii PPO |
$2.19
|
| Rate for Payer: MDX Hawaii PPO |
$1.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.03
|
| Rate for Payer: University Health Alliance Commercial |
$1.65
|
| Rate for Payer: University Health Alliance Commercial |
$1.21
|
|
|
PROPRANOLOL 1 MG/ML IV SOLN
|
Facility
|
IP
|
$65.53
|
|
|
Service Code
|
HCPCS J1800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.70 |
| Max. Negotiated Rate |
$63.56 |
| Rate for Payer: Cash Price |
$42.59
|
| Rate for Payer: Health Management Network Commercial |
$55.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.98
|
| Rate for Payer: MDX Hawaii PPO |
$63.56
|
|
|
PROPRANOLOL 1 MG/ML IV SOLN
|
Facility
|
OP
|
$65.53
|
|
|
Service Code
|
HCPCS J1800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$64.87 |
| Rate for Payer: AlohaCare Medicaid |
$32.77
|
| Rate for Payer: AlohaCare Medicare |
$58.98
|
| Rate for Payer: Cash Price |
$42.59
|
| Rate for Payer: Cash Price |
$42.59
|
| Rate for Payer: Devoted Health Medicare |
$64.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.25
|
| Rate for Payer: Health Management Network Commercial |
$55.70
|
| Rate for Payer: Humana Medicare |
$58.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.98
|
| Rate for Payer: MDX Hawaii PPO |
$63.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.98
|
| Rate for Payer: University Health Alliance Commercial |
$47.76
|
|
|
PROPRANOLOL 20 MG PO TABLET
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: AlohaCare Medicaid |
$1.41
|
| Rate for Payer: AlohaCare Medicare |
$2.54
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Devoted Health Medicare |
$2.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.68
|
| Rate for Payer: Health Management Network Commercial |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.54
|
| Rate for Payer: MDX Hawaii PPO |
$2.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.54
|
| Rate for Payer: University Health Alliance Commercial |
$2.06
|
|
|
PROPRANOLOL 20 MG PO TABLET
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Health Management Network Commercial |
$2.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.54
|
| Rate for Payer: MDX Hawaii PPO |
$2.74
|
|
|
PROPRANOLOL 60 MG PO CAP SA 24H
|
Facility
|
IP
|
$11.37
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$11.03 |
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Health Management Network Commercial |
$9.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.23
|
| Rate for Payer: MDX Hawaii PPO |
$11.03
|
|
|
PROPRANOLOL 60 MG PO CAP SA 24H
|
Facility
|
OP
|
$11.37
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$11.26 |
| Rate for Payer: AlohaCare Medicaid |
$5.68
|
| Rate for Payer: AlohaCare Medicare |
$10.23
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Devoted Health Medicare |
$11.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network Commercial |
$9.66
|
| Rate for Payer: Humana Medicare |
$10.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.23
|
| Rate for Payer: MDX Hawaii PPO |
$11.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.23
|
| Rate for Payer: University Health Alliance Commercial |
$8.29
|
|
|
PROPRANOLOL 80 MG PO CAP SA 24H
|
Facility
|
IP
|
$13.30
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$11.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.97
|
| Rate for Payer: MDX Hawaii PPO |
$12.90
|
|
|
PROPRANOLOL 80 MG PO CAP SA 24H
|
Facility
|
OP
|
$13.30
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$13.17 |
| Rate for Payer: AlohaCare Medicaid |
$6.65
|
| Rate for Payer: AlohaCare Medicare |
$11.97
|
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Devoted Health Medicare |
$13.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.63
|
| Rate for Payer: Health Management Network Commercial |
$11.30
|
| Rate for Payer: Humana Medicare |
$11.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.97
|
| Rate for Payer: MDX Hawaii PPO |
$12.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.97
|
| Rate for Payer: University Health Alliance Commercial |
$9.69
|
|
|
PROPYLTHIOURACIL 50 MG PO TABLET
|
Facility
|
OP
|
$4.97
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: AlohaCare Medicaid |
$2.48
|
| Rate for Payer: AlohaCare Medicare |
$4.47
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Devoted Health Medicare |
$4.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.72
|
| Rate for Payer: Health Management Network Commercial |
$4.22
|
| Rate for Payer: Humana Medicare |
$4.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.47
|
| Rate for Payer: MDX Hawaii PPO |
$4.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.47
|
| Rate for Payer: University Health Alliance Commercial |
$3.62
|
|
|
PROPYLTHIOURACIL 50 MG PO TABLET
|
Facility
|
IP
|
$4.97
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Health Management Network Commercial |
$4.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.47
|
| Rate for Payer: MDX Hawaii PPO |
$4.82
|
|
|
PROSTATECTOMY WITH CC
|
Facility
|
IP
|
$22,564.30
|
|
|
Service Code
|
MSDRG 666
|
| Min. Negotiated Rate |
$22,564.30 |
| Max. Negotiated Rate |
$22,564.30 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22,564.30
|
|
|
PROSTATECTOMY WITH MCC
|
Facility
|
IP
|
$22,564.30
|
|
|
Service Code
|
MSDRG 665
|
| Min. Negotiated Rate |
$22,564.30 |
| Max. Negotiated Rate |
$22,564.30 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22,564.30
|
|
|
PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$15,927.74
|
|
|
Service Code
|
MSDRG 667
|
| Min. Negotiated Rate |
$15,927.74 |
| Max. Negotiated Rate |
$15,927.74 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,927.74
|
|
|
PROTAMINE 10 MG/ML IV SOLN
|
Facility
|
OP
|
$85.45
|
|
|
Service Code
|
HCPCS J2720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: AlohaCare Medicaid |
$42.73
|
| Rate for Payer: AlohaCare Medicaid |
$41.05
|
| Rate for Payer: AlohaCare Medicare |
$76.91
|
| Rate for Payer: AlohaCare Medicare |
$73.88
|
| Rate for Payer: Cash Price |
$55.54
|
| Rate for Payer: Cash Price |
$53.36
|
| Rate for Payer: Cash Price |
$53.36
|
| Rate for Payer: Cash Price |
$55.54
|
| Rate for Payer: Devoted Health Medicare |
$81.27
|
| Rate for Payer: Devoted Health Medicare |
$84.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.18
|
| Rate for Payer: Health Management Network Commercial |
$72.63
|
| Rate for Payer: Health Management Network Commercial |
$69.78
|
| Rate for Payer: Humana Medicare |
$76.91
|
| Rate for Payer: Humana Medicare |
$73.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.91
|
| Rate for Payer: MDX Hawaii PPO |
$82.89
|
| Rate for Payer: MDX Hawaii PPO |
$79.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.91
|
| Rate for Payer: University Health Alliance Commercial |
$62.28
|
| Rate for Payer: University Health Alliance Commercial |
$59.84
|
|
|
PROTAMINE 10 MG/ML IV SOLN
|
Facility
|
IP
|
$85.45
|
|
|
Service Code
|
HCPCS J2720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.63 |
| Max. Negotiated Rate |
$82.89 |
| Rate for Payer: Cash Price |
$55.54
|
| Rate for Payer: Cash Price |
$53.36
|
| Rate for Payer: Health Management Network Commercial |
$72.63
|
| Rate for Payer: Health Management Network Commercial |
$69.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.91
|
| Rate for Payer: MDX Hawaii PPO |
$82.89
|
| Rate for Payer: MDX Hawaii PPO |
$79.63
|
|
|
PSEUDOEPHEDRINE HCL 30 MG PO TABLET
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
PSEUDOEPHEDRINE HCL 30 MG PO TABLET
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$15,761.83
|
|
|
Service Code
|
MSDRG 885
|
| Min. Negotiated Rate |
$15,761.83 |
| Max. Negotiated Rate |
$15,761.83 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,761.83
|
|
