|
LOW PROFILE SCREW, 2.0 X 14MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 15MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 15MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 16MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 16MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 18MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 18MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 20MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 20MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 22MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 22MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 24MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 24MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12987713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 26MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 26MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 28MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 28MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 30MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 30MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 32MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 32MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 34MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 34MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 36MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.0 X 36MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
