|
PLATE VOLAR EXT LEFT DVRAX-L
|
Facility
|
OP
|
$2,391.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.50 |
| Max. Negotiated Rate |
$2,319.27 |
| Rate for Payer: AlohaCare Medicaid |
$1,195.50
|
| Rate for Payer: AlohaCare Medicare |
$1,817.16
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Devoted Health Medicare |
$2,008.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,817.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,673.70
|
| Rate for Payer: Health Management Network Commercial |
$2,032.35
|
| Rate for Payer: Humana Medicare |
$1,817.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,151.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,219.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,817.16
|
| Rate for Payer: MDX Hawaii PPO |
$2,319.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,817.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,817.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,817.16
|
| Rate for Payer: University Health Alliance Commercial |
$1,338.96
|
|
|
PLATE VOLAR EXT RIGHT DVRAX-R
|
Facility
|
OP
|
$2,391.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.50 |
| Max. Negotiated Rate |
$2,319.27 |
| Rate for Payer: AlohaCare Medicaid |
$1,195.50
|
| Rate for Payer: AlohaCare Medicare |
$1,817.16
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Devoted Health Medicare |
$2,008.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,817.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,673.70
|
| Rate for Payer: Health Management Network Commercial |
$2,032.35
|
| Rate for Payer: Humana Medicare |
$1,817.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,151.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,219.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,817.16
|
| Rate for Payer: MDX Hawaii PPO |
$2,319.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,817.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,817.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,817.16
|
| Rate for Payer: University Health Alliance Commercial |
$1,338.96
|
|
|
PLATE VOLAR EXT RIGHT DVRAX-R
|
Facility
|
IP
|
$2,391.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.96 |
| Max. Negotiated Rate |
$2,319.27 |
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,673.70
|
| Rate for Payer: Health Management Network Commercial |
$2,032.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,151.90
|
| Rate for Payer: MDX Hawaii PPO |
$2,319.27
|
| Rate for Payer: University Health Alliance Commercial |
$1,338.96
|
|
|
PLATE VOLAR SHEAR LT VSP-L
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.00 |
| Max. Negotiated Rate |
$2,109.75 |
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,522.50
|
| Rate for Payer: Health Management Network Commercial |
$1,848.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,957.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,109.75
|
| Rate for Payer: University Health Alliance Commercial |
$1,218.00
|
|
|
PLATE VOLAR SHEAR LT VSP-L
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$2,109.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,087.50
|
| Rate for Payer: AlohaCare Medicare |
$1,653.00
|
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Devoted Health Medicare |
$1,827.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,653.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,522.50
|
| Rate for Payer: Health Management Network Commercial |
$1,848.75
|
| Rate for Payer: Humana Medicare |
$1,653.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,957.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,109.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,653.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,109.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,653.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,653.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,653.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,218.00
|
|
|
PLATE VOLAR SHEAR RT VSP-R
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.00 |
| Max. Negotiated Rate |
$2,109.75 |
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,522.50
|
| Rate for Payer: Health Management Network Commercial |
$1,848.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,957.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,109.75
|
| Rate for Payer: University Health Alliance Commercial |
$1,218.00
|
|
|
PLATE VOLAR SHEAR RT VSP-R
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$2,109.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,087.50
|
| Rate for Payer: AlohaCare Medicare |
$1,653.00
|
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Devoted Health Medicare |
$1,827.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,653.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,522.50
|
| Rate for Payer: Health Management Network Commercial |
$1,848.75
|
| Rate for Payer: Humana Medicare |
$1,653.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,957.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,109.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,653.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,109.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,653.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,653.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,653.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,218.00
|
|
|
PLATE VOL LT/3H/7PEG VLBPL-3-7
|
Facility
|
IP
|
$2,760.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.60 |
| Max. Negotiated Rate |
$2,677.20 |
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,932.00
|
| Rate for Payer: Health Management Network Commercial |
$2,346.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,484.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,677.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,545.60
|
|
|
PLATE VOL LT/3H/7PEG VLBPL-3-7
|
Facility
|
OP
|
$2,760.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.00 |
| Max. Negotiated Rate |
$2,677.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,380.00
|
| Rate for Payer: AlohaCare Medicare |
$2,097.60
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Devoted Health Medicare |
$2,318.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,097.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,932.00
|
| Rate for Payer: Health Management Network Commercial |
$2,346.00
|
| Rate for Payer: Humana Medicare |
$2,097.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,484.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,407.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,097.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,677.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,097.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,097.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,097.60
|
| Rate for Payer: University Health Alliance Commercial |
$1,545.60
|
|
|
PLATE VOL LT/5H/5PEG VLBPL-5-5
|
Facility
|
IP
|
$3,020.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.20 |
| Max. Negotiated Rate |
$2,929.40 |
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,114.00
|
| Rate for Payer: Health Management Network Commercial |
$2,567.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,718.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,929.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,691.20
|
|
|
PLATE VOL LT/5H/5PEG VLBPL-5-5
|
Facility
|
OP
|
$3,020.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,510.00 |
| Max. Negotiated Rate |
$2,929.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,510.00
|
| Rate for Payer: AlohaCare Medicare |
$2,295.20
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Devoted Health Medicare |
$2,536.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,295.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,114.00
|
| Rate for Payer: Health Management Network Commercial |
$2,567.00
|
| Rate for Payer: Humana Medicare |
$2,295.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,718.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,540.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,295.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,929.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,295.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,295.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,295.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,691.20
|
|
|
PLATE VOL LT/5H/7PEG VLBPL-5-7
|
Facility
|
OP
|
$3,020.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,510.00 |
| Max. Negotiated Rate |
$2,929.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,510.00
|
| Rate for Payer: AlohaCare Medicare |
$2,295.20
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Devoted Health Medicare |
$2,536.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,295.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,114.00
|
| Rate for Payer: Health Management Network Commercial |
$2,567.00
|
| Rate for Payer: Humana Medicare |
$2,295.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,718.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,540.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,295.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,929.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,295.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,295.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,295.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,691.20
|
|
|
PLATE VOL LT/5H/7PEG VLBPL-5-7
|
Facility
|
IP
|
$3,020.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.20 |
| Max. Negotiated Rate |
$2,929.40 |
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,114.00
|
| Rate for Payer: Health Management Network Commercial |
$2,567.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,718.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,929.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,691.20
|
|
|
PLATE VOL LT/7H/7PEG VLBPL-7-7
|
Facility
|
IP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,859.20 |
| Max. Negotiated Rate |
$3,220.40 |
| Rate for Payer: Cash Price |
$1,992.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,324.00
|
| Rate for Payer: Health Management Network Commercial |
$2,822.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,988.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,220.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,859.20
|
|
|
PLATE VOL LT/7H/7PEG VLBPL-7-7
|
Facility
|
OP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.00 |
| Max. Negotiated Rate |
$3,220.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,660.00
|
| Rate for Payer: AlohaCare Medicare |
$2,523.20
|
| Rate for Payer: Cash Price |
$1,992.00
|
| Rate for Payer: Devoted Health Medicare |
$2,788.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,523.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,324.00
|
| Rate for Payer: Health Management Network Commercial |
$2,822.00
|
| Rate for Payer: Humana Medicare |
$2,523.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,988.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,693.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,523.20
|
| Rate for Payer: MDX Hawaii PPO |
$3,220.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,523.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,523.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,523.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,859.20
|
|
|
PLATE VOL RT/3H/7PEG VLBPR-3-7
|
Facility
|
IP
|
$2,760.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.60 |
| Max. Negotiated Rate |
$2,677.20 |
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,932.00
|
| Rate for Payer: Health Management Network Commercial |
$2,346.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,484.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,677.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,545.60
|
|
|
PLATE VOL RT/3H/7PEG VLBPR-3-7
|
Facility
|
OP
|
$2,760.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.00 |
| Max. Negotiated Rate |
$2,677.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,380.00
|
| Rate for Payer: AlohaCare Medicare |
$2,097.60
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Devoted Health Medicare |
$2,318.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,097.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,932.00
|
| Rate for Payer: Health Management Network Commercial |
$2,346.00
|
| Rate for Payer: Humana Medicare |
$2,097.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,484.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,407.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,097.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,677.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,097.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,097.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,097.60
|
| Rate for Payer: University Health Alliance Commercial |
$1,545.60
|
|
|
PLATE VOL RT/5H/7PEG VLBPR-5-7
|
Facility
|
IP
|
$3,020.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.20 |
| Max. Negotiated Rate |
$2,929.40 |
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,114.00
|
| Rate for Payer: Health Management Network Commercial |
$2,567.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,718.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,929.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,691.20
|
|
|
PLATE VOL RT/5H/7PEG VLBPR-5-7
|
Facility
|
OP
|
$3,020.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,510.00 |
| Max. Negotiated Rate |
$2,929.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,510.00
|
| Rate for Payer: AlohaCare Medicare |
$2,295.20
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Devoted Health Medicare |
$2,536.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,295.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,114.00
|
| Rate for Payer: Health Management Network Commercial |
$2,567.00
|
| Rate for Payer: Humana Medicare |
$2,295.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,718.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,540.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,295.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,929.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,295.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,295.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,295.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,691.20
|
|
|
PLATE VOL RT/7H/7PEG VLBPR-7-7
|
Facility
|
IP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,859.20 |
| Max. Negotiated Rate |
$3,220.40 |
| Rate for Payer: Cash Price |
$1,992.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,324.00
|
| Rate for Payer: Health Management Network Commercial |
$2,822.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,988.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,220.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,859.20
|
|
|
PLATE VOL RT/7H/7PEG VLBPR-7-7
|
Facility
|
OP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.00 |
| Max. Negotiated Rate |
$3,220.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,660.00
|
| Rate for Payer: AlohaCare Medicare |
$2,523.20
|
| Rate for Payer: Cash Price |
$1,992.00
|
| Rate for Payer: Devoted Health Medicare |
$2,788.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,523.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,324.00
|
| Rate for Payer: Health Management Network Commercial |
$2,822.00
|
| Rate for Payer: Humana Medicare |
$2,523.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,988.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,693.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,523.20
|
| Rate for Payer: MDX Hawaii PPO |
$3,220.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,523.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,523.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,523.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,859.20
|
|
|
PLATE VOL RT/9H/7PEG VLBPR-9-7
|
Facility
|
IP
|
$4,330.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,424.80 |
| Max. Negotiated Rate |
$4,200.10 |
| Rate for Payer: Cash Price |
$2,598.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,031.00
|
| Rate for Payer: Health Management Network Commercial |
$3,680.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,897.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,200.10
|
| Rate for Payer: University Health Alliance Commercial |
$2,424.80
|
|
|
PLATE VOL RT/9H/7PEG VLBPR-9-7
|
Facility
|
OP
|
$4,330.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,165.00 |
| Max. Negotiated Rate |
$4,200.10 |
| Rate for Payer: AlohaCare Medicaid |
$2,165.00
|
| Rate for Payer: AlohaCare Medicare |
$3,290.80
|
| Rate for Payer: Cash Price |
$2,598.00
|
| Rate for Payer: Devoted Health Medicare |
$3,637.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,290.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,031.00
|
| Rate for Payer: Health Management Network Commercial |
$3,680.50
|
| Rate for Payer: Humana Medicare |
$3,290.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,897.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,208.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,290.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,200.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,290.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,290.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,290.80
|
| Rate for Payer: University Health Alliance Commercial |
$2,424.80
|
|
|
PLATE WIRE FORM 3H WFP3
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$924.00 |
| Max. Negotiated Rate |
$1,600.50 |
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,155.00
|
| Rate for Payer: Health Management Network Commercial |
$1,402.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,485.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,600.50
|
| Rate for Payer: University Health Alliance Commercial |
$924.00
|
|
|
PLATE WIRE FORM 3H WFP3
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,600.50 |
| Rate for Payer: AlohaCare Medicaid |
$825.00
|
| Rate for Payer: AlohaCare Medicare |
$1,254.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Devoted Health Medicare |
$1,386.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,254.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,155.00
|
| Rate for Payer: Health Management Network Commercial |
$1,402.50
|
| Rate for Payer: Humana Medicare |
$1,254.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,485.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$841.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,254.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,600.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,254.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,254.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,254.00
|
| Rate for Payer: University Health Alliance Commercial |
$924.00
|
|