|
NAIL LONG LF
|
Facility
|
OP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,294.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,069.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,294.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG LF 12X400 8525-2400S
|
Facility
|
IP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG LF 12X400 8525-2400S
|
Facility
|
OP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,294.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,069.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,294.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG LF GAMMA4 8525-1360S
|
Facility
|
IP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG LF GAMMA4 8525-1360S
|
Facility
|
OP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,294.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,069.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,294.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG RIGHT 8425-2320S
|
Facility
|
IP
|
$7,092.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,971.52 |
| Max. Negotiated Rate |
$6,879.24 |
| Rate for Payer: Cash Price |
$4,255.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,964.40
|
| Rate for Payer: Health Management Network Commercial |
$6,028.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL LONG RIGHT 8425-2320S
|
Facility
|
OP
|
$7,092.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,616.92 |
| Max. Negotiated Rate |
$6,879.24 |
| Rate for Payer: Cash Price |
$4,255.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,964.40
|
| Rate for Payer: Health Management Network Commercial |
$6,028.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,467.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,616.92
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL LONG RT 10X 60MMX12
|
Facility
|
OP
|
$6,160.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,141.60 |
| Max. Negotiated Rate |
$5,975.20 |
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,312.00
|
| Rate for Payer: Health Management Network Commercial |
$5,236.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,880.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,141.60
|
| Rate for Payer: MDX Hawaii PPO |
$5,975.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,449.60
|
|
|
NAIL LONG RT 10X 60MMX12
|
Facility
|
IP
|
$6,160.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,449.60 |
| Max. Negotiated Rate |
$5,975.20 |
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,312.00
|
| Rate for Payer: Health Management Network Commercial |
$5,236.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,975.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,449.60
|
|
|
NAIL LONG RT 12X340 8425-2340S
|
Facility
|
IP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG RT 12X340 8425-2340S
|
Facility
|
OP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,294.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,069.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,294.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG RT 12X420 8425-2420S
|
Facility
|
IP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG RT 12X420 8425-2420S
|
Facility
|
OP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,294.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,069.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,294.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG RT 9X34MM 8430-9340S
|
Facility
|
IP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG RT 9X34MM 8430-9340S
|
Facility
|
OP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,294.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,069.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,294.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG RT 9X360 130 DEGREE
|
Facility
|
IP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL LONG RT 9X360 130 DEGREE
|
Facility
|
OP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,294.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,069.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,294.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL L R 11X360X125 8425-1360S
|
Facility
|
IP
|
$7,092.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,971.52 |
| Max. Negotiated Rate |
$6,879.24 |
| Rate for Payer: Cash Price |
$4,255.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,964.40
|
| Rate for Payer: Health Management Network Commercial |
$6,028.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL L R 11X360X125 8425-1360S
|
Facility
|
OP
|
$7,092.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,616.92 |
| Max. Negotiated Rate |
$6,879.24 |
| Rate for Payer: Cash Price |
$4,255.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,964.40
|
| Rate for Payer: Health Management Network Commercial |
$6,028.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,467.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,616.92
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL PROX HEM 8X240 1832-2824S
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.20 |
| Max. Negotiated Rate |
$3,947.90 |
| Rate for Payer: Cash Price |
$2,442.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,849.00
|
| Rate for Payer: Health Management Network Commercial |
$3,459.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,947.90
|
| Rate for Payer: University Health Alliance Commercial |
$2,279.20
|
|
|
NAIL PROX HEM 8X240 1832-2824S
|
Facility
|
OP
|
$4,070.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,075.70 |
| Max. Negotiated Rate |
$3,947.90 |
| Rate for Payer: Cash Price |
$2,442.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,849.00
|
| Rate for Payer: Health Management Network Commercial |
$3,459.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,564.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,075.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,947.90
|
| Rate for Payer: University Health Alliance Commercial |
$2,279.20
|
|
|
NAIL PROXI HUME RT 1832-1045S
|
Facility
|
OP
|
$5,973.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.23 |
| Max. Negotiated Rate |
$5,793.81 |
| Rate for Payer: Cash Price |
$3,583.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,181.10
|
| Rate for Payer: Health Management Network Commercial |
$5,077.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,762.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,046.23
|
| Rate for Payer: MDX Hawaii PPO |
$5,793.81
|
| Rate for Payer: University Health Alliance Commercial |
$3,344.88
|
|
|
NAIL PROXI HUME RT 1832-1045S
|
Facility
|
IP
|
$5,973.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,344.88 |
| Max. Negotiated Rate |
$5,793.81 |
| Rate for Payer: Cash Price |
$3,583.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,181.10
|
| Rate for Payer: Health Management Network Commercial |
$5,077.05
|
| Rate for Payer: MDX Hawaii PPO |
$5,793.81
|
| Rate for Payer: University Health Alliance Commercial |
$3,344.88
|
|
|
NAIL RECON SYS ST 04.033.967S
|
Facility
|
IP
|
$5,002.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,801.12 |
| Max. Negotiated Rate |
$4,851.94 |
| Rate for Payer: Cash Price |
$3,001.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,501.40
|
| Rate for Payer: Health Management Network Commercial |
$4,251.70
|
| Rate for Payer: MDX Hawaii PPO |
$4,851.94
|
| Rate for Payer: University Health Alliance Commercial |
$2,801.12
|
|
|
NAIL RECON SYS ST 04.033.967S
|
Facility
|
OP
|
$5,002.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,551.02 |
| Max. Negotiated Rate |
$4,851.94 |
| Rate for Payer: Cash Price |
$3,001.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,501.40
|
| Rate for Payer: Health Management Network Commercial |
$4,251.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,151.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,551.02
|
| Rate for Payer: MDX Hawaii PPO |
$4,851.94
|
| Rate for Payer: University Health Alliance Commercial |
$2,801.12
|
|