|
NAIL LONG RIGHT 8425-2320S
|
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 RIGHT 8425-2320S
|
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 RT 10X 60MMX12
|
Facility
|
OP
|
$6,160.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,909.60 |
| Max. Negotiated Rate |
$5,975.20 |
| Rate for Payer: AlohaCare Medicaid |
$3,080.00
|
| Rate for Payer: AlohaCare Medicare |
$1,909.60
|
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: Devoted Health Medicare |
$2,094.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,909.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,312.00
|
| Rate for Payer: Health Management Network Commercial |
$5,236.00
|
| Rate for Payer: Humana Medicare |
$1,909.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,544.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,141.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,909.60
|
| Rate for Payer: MDX Hawaii PPO |
$5,975.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,909.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,909.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,909.60
|
| Rate for Payer: University Health Alliance Commercial |
$3,449.60
|
|
|
NAIL LONG RT 10X 60MMX12
|
Facility
|
IP
|
$6,160.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,449.60 |
| Max. Negotiated Rate |
$5,975.20 |
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,312.00
|
| Rate for Payer: Health Management Network Commercial |
$5,236.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,544.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,975.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,449.60
|
|
|
NAIL LONG RT 12X340 8425-2340S
|
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 LONG RT 12X340 8425-2340S
|
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 LONG RT 12X420 8425-2420S
|
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 LONG RT 12X420 8425-2420S
|
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 LONG RT 9X34MM 8430-9340S
|
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 RT 9X34MM 8430-9340S
|
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 RT 9X360 130 DEGREE
|
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 RT 9X360 130 DEGREE
|
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 L R 11X360X125 8425-1360S
|
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 L R 11X360X125 8425-1360S
|
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 PROX HEM 8X240 1832-2824S
|
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 PROX HEM 8X240 1832-2824S
|
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 PROXI HUME RT 1832-1045S
|
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 PROXI HUME RT 1832-1045S
|
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 RECON SYS ST 04.033.967S
|
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 RECON SYS ST 04.033.967S
|
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 T2 FE RETRO 2339-1020S
|
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 T2 FE RETRO 2339-1020S
|
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 TFNA 9X320 L 04.037.953S
|
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 TFNA 9X320 L 04.037.953S
|
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 TFNA 9X320 R 04.037.952S
|
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
|
|