|
Screw Cortical Non-Locking Ti 2.7mm x 16mm PANL-27160-TS [3644287]
|
Facility
|
OP
|
$1,058.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.97 |
| Max. Negotiated Rate |
$1,027.01 |
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$741.14
|
| Rate for Payer: Health Management Network Commercial |
$899.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$667.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$539.97
|
| Rate for Payer: MDX Hawaii PPO |
$1,027.01
|
| Rate for Payer: University Health Alliance Commercial |
$592.91
|
|
|
Screw Cortical Non-Locking Ti 2.7mm x 16mm PANL-27160-TS [3644287]
|
Facility
|
IP
|
$1,058.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.91 |
| Max. Negotiated Rate |
$1,027.01 |
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$741.14
|
| Rate for Payer: Health Management Network Commercial |
$899.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,027.01
|
| Rate for Payer: University Health Alliance Commercial |
$592.91
|
|
|
Screw Cortical Non-Locking Ti 2.7mm x 20mm PANL-27200-TS [3644288]
|
Facility
|
IP
|
$1,058.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.91 |
| Max. Negotiated Rate |
$1,027.01 |
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$741.14
|
| Rate for Payer: Health Management Network Commercial |
$899.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,027.01
|
| Rate for Payer: University Health Alliance Commercial |
$592.91
|
|
|
Screw Cortical Non-Locking Ti 2.7mm x 20mm PANL-27200-TS [3644288]
|
Facility
|
OP
|
$1,058.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.97 |
| Max. Negotiated Rate |
$1,027.01 |
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$741.14
|
| Rate for Payer: Health Management Network Commercial |
$899.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$667.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$539.97
|
| Rate for Payer: MDX Hawaii PPO |
$1,027.01
|
| Rate for Payer: University Health Alliance Commercial |
$592.91
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 10mm PANL-35100-TS [3642650]
|
Facility
|
IP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 10mm PANL-35100-TS [3642650]
|
Facility
|
OP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.80
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 11mm PANL-35110-TS [3643094]
|
Facility
|
OP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.80
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 11mm PANL-35110-TS [3643094]
|
Facility
|
IP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 12mm PANL-35120-TS [3642910]
|
Facility
|
OP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.80
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 12mm PANL-35120-TS [3642910]
|
Facility
|
IP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 13mm PANL-35130-TS [3642911]
|
Facility
|
OP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.80
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 13mm PANL-35130-TS [3642911]
|
Facility
|
IP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 14mm PANL-35140-TS [3643417]
|
Facility
|
OP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.80
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 14mm PANL-35140-TS [3643417]
|
Facility
|
IP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 15mm PANL-35150-TS [3642991]
|
Facility
|
OP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.80
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 15mm PANL-35150-TS [3642991]
|
Facility
|
IP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non Locking Ti 3.5mm x 16mm PANL-35160-TS [3643446]
|
Facility
|
OP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.80
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non Locking Ti 3.5mm x 16mm PANL-35160-TS [3643446]
|
Facility
|
IP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non Locking Ti 3.5mm x 20mm PANL-35200-TS [3643449]
|
Facility
|
IP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non Locking Ti 3.5mm x 20mm PANL-35200-TS [3643449]
|
Facility
|
OP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.80
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 26mm PANL-35260-TS [3644000]
|
Facility
|
OP
|
$621.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.84 |
| Max. Negotiated Rate |
$602.61 |
| Rate for Payer: Cash Price |
$403.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$434.88
|
| Rate for Payer: Health Management Network Commercial |
$528.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$391.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$316.84
|
| Rate for Payer: MDX Hawaii PPO |
$602.61
|
| Rate for Payer: University Health Alliance Commercial |
$347.90
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 26mm PANL-35260-TS [3644000]
|
Facility
|
IP
|
$621.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.90 |
| Max. Negotiated Rate |
$602.61 |
| Rate for Payer: Cash Price |
$403.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$434.88
|
| Rate for Payer: Health Management Network Commercial |
$528.06
|
| Rate for Payer: MDX Hawaii PPO |
$602.61
|
| Rate for Payer: University Health Alliance Commercial |
$347.90
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 9mm PANL-35090-TS [3644529]
|
Facility
|
IP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Locking Ti 3.5mm x 9mm PANL-35090-TS [3644529]
|
Facility
|
OP
|
$683.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$663.40 |
| Rate for Payer: Cash Price |
$444.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$478.74
|
| Rate for Payer: Health Management Network Commercial |
$581.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.80
|
| Rate for Payer: MDX Hawaii PPO |
$663.40
|
| Rate for Payer: University Health Alliance Commercial |
$383.00
|
|
|
Screw Cortical Non-Lock Ti 3.5mm x 44mm PANL-35440-TS [3644082]
|
Facility
|
IP
|
$887.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$496.95 |
| Max. Negotiated Rate |
$860.79 |
| Rate for Payer: Cash Price |
$576.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$621.19
|
| Rate for Payer: Health Management Network Commercial |
$754.30
|
| Rate for Payer: MDX Hawaii PPO |
$860.79
|
| Rate for Payer: University Health Alliance Commercial |
$496.95
|
|
