|
NAIL 10X170 125 DEG 8125-0170S
|
Facility
|
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,677.36 |
| Max. Negotiated Rate |
$4,637.57 |
| Rate for Payer: Cash Price |
$2,868.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,346.70
|
| Rate for Payer: Health Management Network Commercial |
$4,063.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,302.90
|
| Rate for Payer: MDX Hawaii PPO |
$4,637.57
|
| Rate for Payer: University Health Alliance Commercial |
$2,677.36
|
|
|
NAIL 10X170MM 130° 04.037.042S
|
Facility
|
IP
|
$4,045.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,265.20 |
| Max. Negotiated Rate |
$3,923.65 |
| Rate for Payer: Cash Price |
$2,427.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,831.50
|
| Rate for Payer: Health Management Network Commercial |
$3,438.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,640.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,923.65
|
| Rate for Payer: University Health Alliance Commercial |
$2,265.20
|
|
|
NAIL 10X170MM 130° 04.037.042S
|
Facility
|
OP
|
$4,045.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.95 |
| Max. Negotiated Rate |
$3,923.65 |
| Rate for Payer: AlohaCare Medicaid |
$2,022.50
|
| Rate for Payer: AlohaCare Medicare |
$1,253.95
|
| Rate for Payer: Cash Price |
$2,427.00
|
| Rate for Payer: Devoted Health Medicare |
$1,375.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,253.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,831.50
|
| Rate for Payer: Health Management Network Commercial |
$3,438.25
|
| Rate for Payer: Humana Medicare |
$1,253.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,640.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,062.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,253.95
|
| Rate for Payer: MDX Hawaii PPO |
$3,923.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,253.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,253.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,253.95
|
| Rate for Payer: University Health Alliance Commercial |
$2,265.20
|
|
|
NAIL 10X300MM CANN 04.013.440S
|
Facility
|
OP
|
$3,970.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.70 |
| Max. Negotiated Rate |
$3,850.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,985.00
|
| Rate for Payer: AlohaCare Medicare |
$1,230.70
|
| Rate for Payer: Cash Price |
$2,382.00
|
| Rate for Payer: Devoted Health Medicare |
$1,349.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,230.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,779.00
|
| Rate for Payer: Health Management Network Commercial |
$3,374.50
|
| Rate for Payer: Humana Medicare |
$1,230.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,573.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,024.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,230.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,850.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,230.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,230.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,230.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,223.20
|
|
|
NAIL 10X300MM CANN 04.013.440S
|
Facility
|
IP
|
$3,970.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,223.20 |
| Max. Negotiated Rate |
$3,850.90 |
| Rate for Payer: Cash Price |
$2,382.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,779.00
|
| Rate for Payer: Health Management Network Commercial |
$3,374.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,573.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,850.90
|
| Rate for Payer: University Health Alliance Commercial |
$2,223.20
|
|
|
NAIL 10X300MM LEFT 04.037.051S
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,172.40 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X300MM LEFT 04.037.051S
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,756.15 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: AlohaCare Medicaid |
$2,832.50
|
| Rate for Payer: AlohaCare Medicare |
$1,756.15
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Devoted Health Medicare |
$1,926.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,756.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Humana Medicare |
$1,756.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,889.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,756.15
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,756.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,756.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,756.15
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X300MM RT 04.037.050S
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,172.40 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X300MM RT 04.037.050S
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,756.15 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: AlohaCare Medicaid |
$2,832.50
|
| Rate for Payer: AlohaCare Medicare |
$1,756.15
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Devoted Health Medicare |
$1,926.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,756.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Humana Medicare |
$1,756.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,889.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,756.15
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,756.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,756.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,756.15
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X320 LF ST 04.033.063S
|
Facility
|
OP
|
$5,002.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.62 |
| Max. Negotiated Rate |
$4,851.94 |
| Rate for Payer: AlohaCare Medicaid |
$2,501.00
|
| Rate for Payer: AlohaCare Medicare |
$1,550.62
|
| Rate for Payer: Cash Price |
$3,001.20
|
| Rate for Payer: Devoted Health Medicare |
$1,700.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,550.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,501.40
|
| Rate for Payer: Health Management Network Commercial |
$4,251.70
|
| Rate for Payer: Humana Medicare |
$1,550.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,501.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,551.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,550.62
|
| Rate for Payer: MDX Hawaii PPO |
$4,851.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,550.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,550.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,550.62
|
| Rate for Payer: University Health Alliance Commercial |
$2,801.12
|
|
|
NAIL 10X320 LF ST 04.033.063S
|
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: Kaiser Permanente Commercial |
$4,501.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,851.94
|
| Rate for Payer: University Health Alliance Commercial |
$2,801.12
|
|
|
NAIL 10X320MM LEFT 04.037.053S
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,756.15 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: AlohaCare Medicaid |
$2,832.50
|
| Rate for Payer: AlohaCare Medicare |
$1,756.15
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Devoted Health Medicare |
$1,926.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,756.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Humana Medicare |
$1,756.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,889.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,756.15
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,756.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,756.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,756.15
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X320MM LEFT 04.037.053S
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,172.40 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X320MM RT 04.037.052S
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,172.40 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X320MM RT 04.037.052S
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,756.15 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: AlohaCare Medicaid |
$2,832.50
|
| Rate for Payer: AlohaCare Medicare |
$1,756.15
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Devoted Health Medicare |
$1,926.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,756.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Humana Medicare |
$1,756.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,889.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,756.15
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,756.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,756.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,756.15
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X340 LF 04.033.065S
|
Facility
|
OP
|
$5,002.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.62 |
| Max. Negotiated Rate |
$4,851.94 |
| Rate for Payer: AlohaCare Medicaid |
$2,501.00
|
| Rate for Payer: AlohaCare Medicare |
$1,550.62
|
| Rate for Payer: Cash Price |
$3,001.20
|
| Rate for Payer: Devoted Health Medicare |
$1,700.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,550.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,501.40
|
| Rate for Payer: Health Management Network Commercial |
$4,251.70
|
| Rate for Payer: Humana Medicare |
$1,550.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,501.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,551.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,550.62
|
| Rate for Payer: MDX Hawaii PPO |
$4,851.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,550.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,550.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,550.62
|
| Rate for Payer: University Health Alliance Commercial |
$2,801.12
|
|
|
NAIL 10X340 LF 04.033.065S
|
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: Kaiser Permanente Commercial |
$4,501.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,851.94
|
| Rate for Payer: University Health Alliance Commercial |
$2,801.12
|
|
|
NAIL 10X340MM LEFT 04.037.055S
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,756.15 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: AlohaCare Medicaid |
$2,832.50
|
| Rate for Payer: AlohaCare Medicare |
$1,756.15
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Devoted Health Medicare |
$1,926.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,756.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Humana Medicare |
$1,756.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,889.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,756.15
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,756.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,756.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,756.15
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X340MM LEFT 04.037.055S
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,172.40 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X340MM RT 04.037.054S
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,756.15 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: AlohaCare Medicaid |
$2,832.50
|
| Rate for Payer: AlohaCare Medicare |
$1,756.15
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Devoted Health Medicare |
$1,926.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,756.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Humana Medicare |
$1,756.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,889.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,756.15
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,756.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,756.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,756.15
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X340MM RT 04.037.054S
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,172.40 |
| Max. Negotiated Rate |
$5,495.05 |
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,965.50
|
| Rate for Payer: Health Management Network Commercial |
$4,815.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,098.50
|
| Rate for Payer: MDX Hawaii PPO |
$5,495.05
|
| Rate for Payer: University Health Alliance Commercial |
$3,172.40
|
|
|
NAIL 10X340 RT 04.033.064S
|
Facility
|
OP
|
$5,002.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.62 |
| Max. Negotiated Rate |
$4,851.94 |
| Rate for Payer: AlohaCare Medicaid |
$2,501.00
|
| Rate for Payer: AlohaCare Medicare |
$1,550.62
|
| Rate for Payer: Cash Price |
$3,001.20
|
| Rate for Payer: Devoted Health Medicare |
$1,700.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,550.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,501.40
|
| Rate for Payer: Health Management Network Commercial |
$4,251.70
|
| Rate for Payer: Humana Medicare |
$1,550.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,501.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,551.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,550.62
|
| Rate for Payer: MDX Hawaii PPO |
$4,851.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,550.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,550.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,550.62
|
| Rate for Payer: University Health Alliance Commercial |
$2,801.12
|
|
|
NAIL 10X340 RT 04.033.064S
|
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: Kaiser Permanente Commercial |
$4,501.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,851.94
|
| Rate for Payer: University Health Alliance Commercial |
$2,801.12
|
|
|
NAIL 10X360MM CANN 04.013.452S
|
Facility
|
OP
|
$3,970.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.70 |
| Max. Negotiated Rate |
$3,850.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,985.00
|
| Rate for Payer: AlohaCare Medicare |
$1,230.70
|
| Rate for Payer: Cash Price |
$2,382.00
|
| Rate for Payer: Devoted Health Medicare |
$1,349.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,230.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,779.00
|
| Rate for Payer: Health Management Network Commercial |
$3,374.50
|
| Rate for Payer: Humana Medicare |
$1,230.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,573.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,024.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,230.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,850.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,230.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,230.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,230.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,223.20
|
|
|
NAIL 10X360MM CANN 04.013.452S
|
Facility
|
IP
|
$3,970.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,223.20 |
| Max. Negotiated Rate |
$3,850.90 |
| Rate for Payer: Cash Price |
$2,382.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,779.00
|
| Rate for Payer: Health Management Network Commercial |
$3,374.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,573.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,850.90
|
| Rate for Payer: University Health Alliance Commercial |
$2,223.20
|
|