|
NAIL 10X360MM LEFT 04.037.057S
|
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 10X360MM LEFT 04.037.057S
|
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 10X360MM RT 04.037.056S
|
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 10X360MM RT 04.037.056S
|
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 10X380MM CANN 04.013.456S
|
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 10X380MM CANN 04.013.456S
|
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 10X380MM RT 04.033.068S
|
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 10X380MM RT 04.033.068S
|
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 10X400MM CANN 04.013.460S
|
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 10X400MM CANN 04.013.460S
|
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 10X400MM LEFT 04.037.061S
|
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 10X400MM LEFT 04.037.061S
|
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 11M HUM TI CANN PROXI
|
Facility
|
OP
|
$5,070.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.70 |
| Max. Negotiated Rate |
$4,917.90 |
| Rate for Payer: AlohaCare Medicaid |
$2,535.00
|
| Rate for Payer: AlohaCare Medicare |
$1,571.70
|
| Rate for Payer: Cash Price |
$3,042.00
|
| Rate for Payer: Devoted Health Medicare |
$1,723.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,571.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,549.00
|
| Rate for Payer: Health Management Network Commercial |
$4,309.50
|
| Rate for Payer: Humana Medicare |
$1,571.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,563.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,585.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,571.70
|
| Rate for Payer: MDX Hawaii PPO |
$4,917.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,571.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,571.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,571.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,839.20
|
|
|
NAIL 11M HUM TI CANN PROXI
|
Facility
|
IP
|
$5,070.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,839.20 |
| Max. Negotiated Rate |
$4,917.90 |
| Rate for Payer: Cash Price |
$3,042.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,549.00
|
| Rate for Payer: Health Management Network Commercial |
$4,309.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,563.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,917.90
|
| Rate for Payer: University Health Alliance Commercial |
$2,839.20
|
|
|
NAIL 11X170MM 130° 04.037.142S
|
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 11X170MM 130° 04.037.142S
|
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 11X300MM RT 04.037.150S
|
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 11X300MM RT 04.037.150S
|
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 11X320MM RT 04.037.152S
|
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 11X320MM RT 04.037.152S
|
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 11X340 3525-1340S
|
Facility
|
OP
|
$6,789.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.59 |
| Max. Negotiated Rate |
$6,585.33 |
| Rate for Payer: AlohaCare Medicaid |
$3,394.50
|
| Rate for Payer: AlohaCare Medicare |
$2,104.59
|
| Rate for Payer: Cash Price |
$4,073.40
|
| Rate for Payer: Devoted Health Medicare |
$2,308.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,104.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,752.30
|
| Rate for Payer: Health Management Network Commercial |
$5,770.65
|
| Rate for Payer: Humana Medicare |
$2,104.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,110.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,462.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,104.59
|
| Rate for Payer: MDX Hawaii PPO |
$6,585.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,104.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,104.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,104.59
|
| Rate for Payer: University Health Alliance Commercial |
$3,801.84
|
|
|
NAIL 11X340 3525-1340S
|
Facility
|
IP
|
$6,789.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,801.84 |
| Max. Negotiated Rate |
$6,585.33 |
| Rate for Payer: Cash Price |
$4,073.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,752.30
|
| Rate for Payer: Health Management Network Commercial |
$5,770.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,110.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,585.33
|
| Rate for Payer: University Health Alliance Commercial |
$3,801.84
|
|
|
NAIL 11X340MM LEFT 04.037.155S
|
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 11X340MM LEFT 04.037.155S
|
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 11X340MM RT 04.037.154S
|
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
|
|