|
NAIL L340MM 04.033.164S
|
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 LEFT 11X200 1818-1120S
|
Facility
|
OP
|
$6,567.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,035.77 |
| Max. Negotiated Rate |
$6,369.99 |
| Rate for Payer: AlohaCare Medicaid |
$3,283.50
|
| Rate for Payer: AlohaCare Medicare |
$2,035.77
|
| Rate for Payer: Cash Price |
$3,940.20
|
| Rate for Payer: Devoted Health Medicare |
$2,232.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,035.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,596.90
|
| Rate for Payer: Health Management Network Commercial |
$5,581.95
|
| Rate for Payer: Humana Medicare |
$2,035.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,910.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,349.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,035.77
|
| Rate for Payer: MDX Hawaii PPO |
$6,369.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,035.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,035.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,035.77
|
| Rate for Payer: University Health Alliance Commercial |
$3,677.52
|
|
|
NAIL LEFT 11X200 1818-1120S
|
Facility
|
IP
|
$6,567.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,677.52 |
| Max. Negotiated Rate |
$6,369.99 |
| Rate for Payer: Cash Price |
$3,940.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,596.90
|
| Rate for Payer: Health Management Network Commercial |
$5,581.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,910.30
|
| Rate for Payer: MDX Hawaii PPO |
$6,369.99
|
| Rate for Payer: University Health Alliance Commercial |
$3,677.52
|
|
|
NAIL LNG 125 DEG LF 8525-2320S
|
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 LNG 125 DEG LF 8525-2320S
|
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 LNG 125 DEG LF 8525-2420S
|
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 LNG 125 DEG LF 8525-2420S
|
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 LNG RT 10X340 8425-0340S
|
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 LNG RT 10X340 8425-0340S
|
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 LNG RT 8425-1400S
|
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 LNG RT 8425-1400S
|
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 LONG 12X380MM 8425-2380S
|
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 LONG 12X380MM 8425-2380S
|
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 LONG 8525-0320S
|
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 LONG 8525-0320S
|
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 LONG GAMMA4 RT 8425-1340S
|
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 LONG GAMMA4 RT 8425-1340S
|
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 LONG LEFT 8525-2360S
|
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 LONG LEFT 8525-2360S
|
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 LONG LF
|
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 LONG LF
|
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 LONG LF 12X400 8525-2400S
|
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 LONG LF 12X400 8525-2400S
|
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 LONG LF GAMMA4 8525-1360S
|
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 LONG LF GAMMA4 8525-1360S
|
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
|
|