|
NAIL INTRAM 9X260 LNG FEMORAL
|
Facility
|
OP
|
$5,463.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,693.53 |
| Max. Negotiated Rate |
$5,299.11 |
| Rate for Payer: AlohaCare Medicaid |
$2,731.50
|
| Rate for Payer: AlohaCare Medicare |
$1,693.53
|
| Rate for Payer: Cash Price |
$3,277.80
|
| Rate for Payer: Devoted Health Medicare |
$1,857.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,693.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,824.10
|
| Rate for Payer: Health Management Network Commercial |
$4,643.55
|
| Rate for Payer: Humana Medicare |
$1,693.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,916.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,786.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,693.53
|
| Rate for Payer: MDX Hawaii PPO |
$5,299.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,693.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,693.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,693.53
|
| Rate for Payer: University Health Alliance Commercial |
$3,059.28
|
|
|
NAIL INTRAM 9X260 LNG FEMORAL
|
Facility
|
IP
|
$5,463.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,059.28 |
| Max. Negotiated Rate |
$5,299.11 |
| Rate for Payer: Cash Price |
$3,277.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,824.10
|
| Rate for Payer: Health Management Network Commercial |
$4,643.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,916.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,299.11
|
| Rate for Payer: University Health Alliance Commercial |
$3,059.28
|
|
|
NAIL INTRAME125DEG LF 12X440MM
|
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 INTRAME125DEG LF 12X440MM
|
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 INTRAMEDULLARY 2341-0936S
|
Facility
|
OP
|
$5,125.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,588.75 |
| Max. Negotiated Rate |
$4,971.25 |
| Rate for Payer: AlohaCare Medicaid |
$2,562.50
|
| Rate for Payer: AlohaCare Medicare |
$1,588.75
|
| Rate for Payer: Cash Price |
$3,075.00
|
| Rate for Payer: Devoted Health Medicare |
$1,742.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,588.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,587.50
|
| Rate for Payer: Health Management Network Commercial |
$4,356.25
|
| Rate for Payer: Humana Medicare |
$1,588.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,612.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,613.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,588.75
|
| Rate for Payer: MDX Hawaii PPO |
$4,971.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,588.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,588.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,588.75
|
| Rate for Payer: University Health Alliance Commercial |
$2,870.00
|
|
|
NAIL INTRAMEDULLARY 2341-0936S
|
Facility
|
IP
|
$5,125.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,870.00 |
| Max. Negotiated Rate |
$4,971.25 |
| Rate for Payer: Cash Price |
$3,075.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,587.50
|
| Rate for Payer: Health Management Network Commercial |
$4,356.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,612.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,971.25
|
| Rate for Payer: University Health Alliance Commercial |
$2,870.00
|
|
|
NAIL INTRAMEDULLARY 8525-2340S
|
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 INTRAMEDULLARY 8525-2340S
|
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 INTRAMEDULLARY 8530-9300S
|
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 INTRAMEDULLARY 8530-9300S
|
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 INTRAMEDULLARY 8530-9320S
|
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 INTRAMEDULLARY 8530-9320S
|
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 INTRAME TIB 10 2341-1133S
|
Facility
|
OP
|
$5,125.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,588.75 |
| Max. Negotiated Rate |
$4,971.25 |
| Rate for Payer: AlohaCare Medicaid |
$2,562.50
|
| Rate for Payer: AlohaCare Medicare |
$1,588.75
|
| Rate for Payer: Cash Price |
$3,075.00
|
| Rate for Payer: Devoted Health Medicare |
$1,742.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,588.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,587.50
|
| Rate for Payer: Health Management Network Commercial |
$4,356.25
|
| Rate for Payer: Humana Medicare |
$1,588.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,612.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,613.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,588.75
|
| Rate for Payer: MDX Hawaii PPO |
$4,971.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,588.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,588.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,588.75
|
| Rate for Payer: University Health Alliance Commercial |
$2,870.00
|
|
|
NAIL INTRAME TIB 10 2341-1133S
|
Facility
|
IP
|
$5,125.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,870.00 |
| Max. Negotiated Rate |
$4,971.25 |
| Rate for Payer: Cash Price |
$3,075.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,587.50
|
| Rate for Payer: Health Management Network Commercial |
$4,356.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,612.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,971.25
|
| Rate for Payer: University Health Alliance Commercial |
$2,870.00
|
|
|
NAIL KIT 11X180X125 3125-1180S
|
Facility
|
OP
|
$3,870.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.70 |
| Max. Negotiated Rate |
$3,753.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,935.00
|
| Rate for Payer: AlohaCare Medicare |
$1,199.70
|
| Rate for Payer: Cash Price |
$2,322.00
|
| Rate for Payer: Devoted Health Medicare |
$1,315.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,199.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,709.00
|
| Rate for Payer: Health Management Network Commercial |
$3,289.50
|
| Rate for Payer: Humana Medicare |
$1,199.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,483.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,973.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,199.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,753.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,199.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,199.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,199.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,167.20
|
|
|
NAIL KIT 11X180X125 3125-1180S
|
Facility
|
IP
|
$3,870.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,167.20 |
| Max. Negotiated Rate |
$3,753.90 |
| Rate for Payer: Cash Price |
$2,322.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,709.00
|
| Rate for Payer: Health Management Network Commercial |
$3,289.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,483.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,753.90
|
| Rate for Payer: University Health Alliance Commercial |
$2,167.20
|
|
|
NAIL KIT GAMMA R1.5 3425-0320S
|
Facility
|
OP
|
$6,402.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.62 |
| Max. Negotiated Rate |
$6,209.94 |
| Rate for Payer: AlohaCare Medicaid |
$3,201.00
|
| Rate for Payer: AlohaCare Medicare |
$1,984.62
|
| Rate for Payer: Cash Price |
$3,841.20
|
| Rate for Payer: Devoted Health Medicare |
$2,176.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,984.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,481.40
|
| Rate for Payer: Health Management Network Commercial |
$5,441.70
|
| Rate for Payer: Humana Medicare |
$1,984.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,761.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,265.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,984.62
|
| Rate for Payer: MDX Hawaii PPO |
$6,209.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,984.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,984.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,984.62
|
| Rate for Payer: University Health Alliance Commercial |
$3,585.12
|
|
|
NAIL KIT GAMMA R1.5 3425-0320S
|
Facility
|
IP
|
$6,402.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.12 |
| Max. Negotiated Rate |
$6,209.94 |
| Rate for Payer: Cash Price |
$3,841.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,481.40
|
| Rate for Payer: Health Management Network Commercial |
$5,441.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,761.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,209.94
|
| Rate for Payer: University Health Alliance Commercial |
$3,585.12
|
|
|
NAIL KIT LEFT LONG 3525-0360S
|
Facility
|
OP
|
$6,402.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.62 |
| Max. Negotiated Rate |
$6,209.94 |
| Rate for Payer: AlohaCare Medicaid |
$3,201.00
|
| Rate for Payer: AlohaCare Medicare |
$1,984.62
|
| Rate for Payer: Cash Price |
$3,841.20
|
| Rate for Payer: Devoted Health Medicare |
$2,176.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,984.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,481.40
|
| Rate for Payer: Health Management Network Commercial |
$5,441.70
|
| Rate for Payer: Humana Medicare |
$1,984.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,761.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,265.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,984.62
|
| Rate for Payer: MDX Hawaii PPO |
$6,209.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,984.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,984.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,984.62
|
| Rate for Payer: University Health Alliance Commercial |
$3,585.12
|
|
|
NAIL KIT LEFT LONG 3525-0360S
|
Facility
|
IP
|
$6,402.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.12 |
| Max. Negotiated Rate |
$6,209.94 |
| Rate for Payer: Cash Price |
$3,841.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,481.40
|
| Rate for Payer: Health Management Network Commercial |
$5,441.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,761.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,209.94
|
| Rate for Payer: University Health Alliance Commercial |
$3,585.12
|
|
|
NAIL KIT LONG 3525-1380S
|
Facility
|
IP
|
$6,402.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.12 |
| Max. Negotiated Rate |
$6,209.94 |
| Rate for Payer: Cash Price |
$3,841.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,481.40
|
| Rate for Payer: Health Management Network Commercial |
$5,441.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,761.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,209.94
|
| Rate for Payer: University Health Alliance Commercial |
$3,585.12
|
|
|
NAIL KIT LONG 3525-1380S
|
Facility
|
OP
|
$6,402.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.62 |
| Max. Negotiated Rate |
$6,209.94 |
| Rate for Payer: AlohaCare Medicaid |
$3,201.00
|
| Rate for Payer: AlohaCare Medicare |
$1,984.62
|
| Rate for Payer: Cash Price |
$3,841.20
|
| Rate for Payer: Devoted Health Medicare |
$2,176.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,984.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,481.40
|
| Rate for Payer: Health Management Network Commercial |
$5,441.70
|
| Rate for Payer: Humana Medicare |
$1,984.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,761.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,265.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,984.62
|
| Rate for Payer: MDX Hawaii PPO |
$6,209.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,984.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,984.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,984.62
|
| Rate for Payer: University Health Alliance Commercial |
$3,585.12
|
|
|
NAIL KIT R 360X11MM 3425-1360S
|
Facility
|
IP
|
$6,402.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.12 |
| Max. Negotiated Rate |
$6,209.94 |
| Rate for Payer: Cash Price |
$3,841.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,481.40
|
| Rate for Payer: Health Management Network Commercial |
$5,441.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,761.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,209.94
|
| Rate for Payer: University Health Alliance Commercial |
$3,585.12
|
|
|
NAIL KIT R 360X11MM 3425-1360S
|
Facility
|
OP
|
$6,402.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.62 |
| Max. Negotiated Rate |
$6,209.94 |
| Rate for Payer: AlohaCare Medicaid |
$3,201.00
|
| Rate for Payer: AlohaCare Medicare |
$1,984.62
|
| Rate for Payer: Cash Price |
$3,841.20
|
| Rate for Payer: Devoted Health Medicare |
$2,176.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,984.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,481.40
|
| Rate for Payer: Health Management Network Commercial |
$5,441.70
|
| Rate for Payer: Humana Medicare |
$1,984.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,761.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,265.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,984.62
|
| Rate for Payer: MDX Hawaii PPO |
$6,209.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,984.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,984.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,984.62
|
| Rate for Payer: University Health Alliance Commercial |
$3,585.12
|
|
|
NAIL L340MM 04.033.164S
|
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
|
|