|
NAIL GAMMA4 LONG RT 8425-1380S
|
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: Kaiser Permanente Commercial |
$5,814.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL GAMMA4 LONG RT 8425-2360S
|
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: Kaiser Permanente Commercial |
$5,814.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL GAMMA4 LONG RT 8425-2360S
|
Facility
|
OP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: AlohaCare Medicaid |
$3,230.00
|
| Rate for Payer: AlohaCare Medicare |
$2,002.60
|
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Devoted Health Medicare |
$2,196.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,002.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: Humana Medicare |
$2,002.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,814.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,294.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,002.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,002.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,002.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,002.60
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL GAMMA4 LONG RT 8430-0400S
|
Facility
|
OP
|
$7,092.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.52 |
| Max. Negotiated Rate |
$6,879.24 |
| Rate for Payer: AlohaCare Medicaid |
$3,546.00
|
| Rate for Payer: AlohaCare Medicare |
$2,198.52
|
| Rate for Payer: Cash Price |
$4,255.20
|
| Rate for Payer: Devoted Health Medicare |
$2,411.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,198.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,964.40
|
| Rate for Payer: Health Management Network Commercial |
$6,028.20
|
| Rate for Payer: Humana Medicare |
$2,198.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,382.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,616.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,198.52
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,198.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,198.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,198.52
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL GAMMA4 LONG RT 8430-0400S
|
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: Kaiser Permanente Commercial |
$6,382.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL GAMMA4 LONG RT 8430-1400S
|
Facility
|
OP
|
$7,092.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.52 |
| Max. Negotiated Rate |
$6,879.24 |
| Rate for Payer: AlohaCare Medicaid |
$3,546.00
|
| Rate for Payer: AlohaCare Medicare |
$2,198.52
|
| Rate for Payer: Cash Price |
$4,255.20
|
| Rate for Payer: Devoted Health Medicare |
$2,411.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,198.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,964.40
|
| Rate for Payer: Health Management Network Commercial |
$6,028.20
|
| Rate for Payer: Humana Medicare |
$2,198.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,382.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,616.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,198.52
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,198.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,198.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,198.52
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL GAMMA4 LONG RT 8430-1400S
|
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: Kaiser Permanente Commercial |
$6,382.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL GAMMA4 TROCHAN 8125-9170S
|
Facility
|
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,482.11 |
| Max. Negotiated Rate |
$4,637.57 |
| Rate for Payer: AlohaCare Medicaid |
$2,390.50
|
| Rate for Payer: AlohaCare Medicare |
$1,482.11
|
| Rate for Payer: Cash Price |
$2,868.60
|
| Rate for Payer: Devoted Health Medicare |
$1,625.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,482.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,346.70
|
| Rate for Payer: Health Management Network Commercial |
$4,063.85
|
| Rate for Payer: Humana Medicare |
$1,482.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,302.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,438.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,482.11
|
| Rate for Payer: MDX Hawaii PPO |
$4,637.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,482.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,482.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,482.11
|
| Rate for Payer: University Health Alliance Commercial |
$2,677.36
|
|
|
NAIL GAMMA4 TROCHAN 8125-9170S
|
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 GAMMA LNG RT 8425-2280S
|
Facility
|
OP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: AlohaCare Medicaid |
$3,230.00
|
| Rate for Payer: AlohaCare Medicare |
$2,002.60
|
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Devoted Health Medicare |
$2,196.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,002.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: Humana Medicare |
$2,002.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,814.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,294.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,002.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,002.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,002.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,002.60
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL GAMMA LNG RT 8425-2280S
|
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: Kaiser Permanente Commercial |
$5,814.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL HUMERAL 9X270 1830-0927S
|
Facility
|
IP
|
$3,284.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,839.04 |
| Max. Negotiated Rate |
$3,185.48 |
| Rate for Payer: Cash Price |
$1,970.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,298.80
|
| Rate for Payer: Health Management Network Commercial |
$2,791.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,955.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,185.48
|
| Rate for Payer: University Health Alliance Commercial |
$1,839.04
|
|
|
NAIL HUMERAL 9X270 1830-0927S
|
Facility
|
OP
|
$3,284.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.04 |
| Max. Negotiated Rate |
$3,185.48 |
| Rate for Payer: AlohaCare Medicaid |
$1,642.00
|
| Rate for Payer: AlohaCare Medicare |
$1,018.04
|
| Rate for Payer: Cash Price |
$1,970.40
|
| Rate for Payer: Devoted Health Medicare |
$1,116.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,018.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,298.80
|
| Rate for Payer: Health Management Network Commercial |
$2,791.40
|
| Rate for Payer: Humana Medicare |
$1,018.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,955.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,674.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,018.04
|
| Rate for Payer: MDX Hawaii PPO |
$3,185.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,018.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,018.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,018.04
|
| Rate for Payer: University Health Alliance Commercial |
$1,839.04
|
|
|
NAIL HUMERAL CANN TI 9X250MM
|
Facility
|
IP
|
$4,128.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,311.68 |
| Max. Negotiated Rate |
$4,004.16 |
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,889.60
|
| Rate for Payer: Health Management Network Commercial |
$3,508.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,715.20
|
| Rate for Payer: MDX Hawaii PPO |
$4,004.16
|
| Rate for Payer: University Health Alliance Commercial |
$2,311.68
|
|
|
NAIL HUMERAL CANN TI 9X250MM
|
Facility
|
OP
|
$4,128.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,279.68 |
| Max. Negotiated Rate |
$4,004.16 |
| Rate for Payer: AlohaCare Medicaid |
$2,064.00
|
| Rate for Payer: AlohaCare Medicare |
$1,279.68
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Devoted Health Medicare |
$1,403.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,279.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,889.60
|
| Rate for Payer: Health Management Network Commercial |
$3,508.80
|
| Rate for Payer: Humana Medicare |
$1,279.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,715.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,105.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,279.68
|
| Rate for Payer: MDX Hawaii PPO |
$4,004.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,279.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,279.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,279.68
|
| Rate for Payer: University Health Alliance Commercial |
$2,311.68
|
|
|
NAIL HUMERAL LF 1832-1035S
|
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: Kaiser Permanente Commercial |
$5,375.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,793.81
|
| Rate for Payer: University Health Alliance Commercial |
$3,344.88
|
|
|
NAIL HUMERAL LF 1832-1035S
|
Facility
|
OP
|
$5,973.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,851.63 |
| Max. Negotiated Rate |
$5,793.81 |
| Rate for Payer: AlohaCare Medicaid |
$2,986.50
|
| Rate for Payer: AlohaCare Medicare |
$1,851.63
|
| Rate for Payer: Cash Price |
$3,583.80
|
| Rate for Payer: Devoted Health Medicare |
$2,030.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,851.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,181.10
|
| Rate for Payer: Health Management Network Commercial |
$5,077.05
|
| Rate for Payer: Humana Medicare |
$1,851.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,375.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,046.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,851.63
|
| Rate for Payer: MDX Hawaii PPO |
$5,793.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,851.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,851.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,851.63
|
| Rate for Payer: University Health Alliance Commercial |
$3,344.88
|
|
|
NAIL HUMERAL LONG RIGHT 8X220
|
Facility
|
OP
|
$4,070.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.70 |
| Max. Negotiated Rate |
$3,947.90 |
| Rate for Payer: AlohaCare Medicaid |
$2,035.00
|
| Rate for Payer: AlohaCare Medicare |
$1,261.70
|
| Rate for Payer: Cash Price |
$2,442.00
|
| Rate for Payer: Devoted Health Medicare |
$1,383.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,261.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,849.00
|
| Rate for Payer: Health Management Network Commercial |
$3,459.50
|
| Rate for Payer: Humana Medicare |
$1,261.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,663.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,075.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,261.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,947.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,261.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,261.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,261.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,279.20
|
|
|
NAIL HUMERAL LONG RIGHT 8X220
|
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: Kaiser Permanente Commercial |
$3,663.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,947.90
|
| Rate for Payer: University Health Alliance Commercial |
$2,279.20
|
|
|
NAIL IM LNG 125D LF 8525-0340S
|
Facility
|
OP
|
$7,092.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.52 |
| Max. Negotiated Rate |
$6,879.24 |
| Rate for Payer: AlohaCare Medicaid |
$3,546.00
|
| Rate for Payer: AlohaCare Medicare |
$2,198.52
|
| Rate for Payer: Cash Price |
$4,255.20
|
| Rate for Payer: Devoted Health Medicare |
$2,411.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,198.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,964.40
|
| Rate for Payer: Health Management Network Commercial |
$6,028.20
|
| Rate for Payer: Humana Medicare |
$2,198.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,382.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,616.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,198.52
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,198.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,198.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,198.52
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL IM LNG 125D LF 8525-0340S
|
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: Kaiser Permanente Commercial |
$6,382.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL IM LNG LT 12M 8525-2380S
|
Facility
|
OP
|
$6,460.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.60 |
| Max. Negotiated Rate |
$6,266.20 |
| Rate for Payer: AlohaCare Medicaid |
$3,230.00
|
| Rate for Payer: AlohaCare Medicare |
$2,002.60
|
| Rate for Payer: Cash Price |
$3,876.00
|
| Rate for Payer: Devoted Health Medicare |
$2,196.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,002.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,522.00
|
| Rate for Payer: Health Management Network Commercial |
$5,491.00
|
| Rate for Payer: Humana Medicare |
$2,002.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,814.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,294.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,002.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,002.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,002.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,002.60
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL IM LNG LT 12M 8525-2380S
|
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: Kaiser Permanente Commercial |
$5,814.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,266.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,617.60
|
|
|
NAIL INTERMEDIATE RT
|
Facility
|
IP
|
$6,770.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.20 |
| Max. Negotiated Rate |
$6,566.90 |
| Rate for Payer: Cash Price |
$4,062.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,739.00
|
| Rate for Payer: Health Management Network Commercial |
$5,754.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,093.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,566.90
|
| Rate for Payer: University Health Alliance Commercial |
$3,791.20
|
|
|
NAIL INTERMEDIATE RT
|
Facility
|
OP
|
$6,770.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,098.70 |
| Max. Negotiated Rate |
$6,566.90 |
| Rate for Payer: AlohaCare Medicaid |
$3,385.00
|
| Rate for Payer: AlohaCare Medicare |
$2,098.70
|
| Rate for Payer: Cash Price |
$4,062.00
|
| Rate for Payer: Devoted Health Medicare |
$2,301.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,098.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,739.00
|
| Rate for Payer: Health Management Network Commercial |
$5,754.50
|
| Rate for Payer: Humana Medicare |
$2,098.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,093.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,452.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,098.70
|
| Rate for Payer: MDX Hawaii PPO |
$6,566.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,098.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,098.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,098.70
|
| Rate for Payer: University Health Alliance Commercial |
$3,791.20
|
|