|
CANNULATED CANC SCREW,36MM THD,7.0X115MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X125MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X125MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X130MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X130MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X50MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X50MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X55MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X55MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X60MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X60MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X65MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X65MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X70MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X70MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X75MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X75MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X80MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X80MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X85MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW,36MM THD,7.0X85MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12983057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW, FT, 7.0X100MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW, FT, 7.0X100MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW, FT, 7.0X105MM
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.64 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
|
CANNULATED CANC SCREW, FT, 7.0X105MM
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12974120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$259.50
|
| Rate for Payer: AlohaCare Medicare |
$259.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$259.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.50
|
| Rate for Payer: University Health Alliance Commercial |
$290.64
|
|
