|
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
|
|
|
NAIL 11X360MM LEFT 04.037.157S
|
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 11X360MM LEFT 04.037.157S
|
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 11X360MM RT 04.037.156S
|
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 11X360MM RT 04.037.156S
|
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 11X380MM LEFT 04.037.159S
|
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 11X380MM LEFT 04.037.159S
|
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 11X380MM RT 04.037.158S
|
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 11X380MM RT 04.037.158S
|
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 11X400MM RT 04.037.160S
|
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 11X400MM RT 04.037.160S
|
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 11X420MM LEFT 04.037.163S
|
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 11X420MM LEFT 04.037.163S
|
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 125 DEG 12MM DIA 40CM
|
Facility
|
IP
|
$4,867.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.52 |
| Max. Negotiated Rate |
$4,720.99 |
| Rate for Payer: Cash Price |
$2,920.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,406.90
|
| Rate for Payer: Health Management Network Commercial |
$4,136.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,380.30
|
| Rate for Payer: MDX Hawaii PPO |
$4,720.99
|
| Rate for Payer: University Health Alliance Commercial |
$2,725.52
|
|
|
NAIL 125 DEG 12MM DIA 40CM
|
Facility
|
OP
|
$4,867.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,508.77 |
| Max. Negotiated Rate |
$4,720.99 |
| Rate for Payer: AlohaCare Medicaid |
$2,433.50
|
| Rate for Payer: AlohaCare Medicare |
$1,508.77
|
| Rate for Payer: Cash Price |
$2,920.20
|
| Rate for Payer: Devoted Health Medicare |
$1,654.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,508.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,406.90
|
| Rate for Payer: Health Management Network Commercial |
$4,136.95
|
| Rate for Payer: Humana Medicare |
$1,508.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,380.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,482.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,508.77
|
| Rate for Payer: MDX Hawaii PPO |
$4,720.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,508.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,508.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,508.77
|
| Rate for Payer: University Health Alliance Commercial |
$2,725.52
|
|
|
NAIL 12MM/340MM LF 04.033.265S
|
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 12MM/340MM LF 04.033.265S
|
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 12X170MM/130° 04.037.242S
|
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 12X170MM/130° 04.037.242S
|
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 12X320MM RT 04.037.252S
|
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 12X320MM RT 04.037.252S
|
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 12X340MM LEFT 04.037.255S
|
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 12X340MM LEFT 04.037.255S
|
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 12X360MM LEFT 04.037.257S
|
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 12X360MM LEFT 04.037.257S
|
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
|
|