|
Screw Threaded Peg Locking Ti 2.3mmX10mm TPLS-23100-TS [3643186]
|
Facility
|
IP
|
$472.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.75
|
| Rate for Payer: Health Management Network Commercial |
$401.62
|
| Rate for Payer: MDX Hawaii PPO |
$458.32
|
| Rate for Payer: University Health Alliance Commercial |
$264.60
|
|
|
Screw Threaded Peg Locking Ti 2.3mmx12mm TPLS-23120-TS [3643833]
|
Facility
|
IP
|
$494.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$479.55 |
| Rate for Payer: Cash Price |
$321.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$346.07
|
| Rate for Payer: Health Management Network Commercial |
$420.22
|
| Rate for Payer: MDX Hawaii PPO |
$479.55
|
| Rate for Payer: University Health Alliance Commercial |
$276.85
|
|
|
Screw Threaded Peg Locking Ti 2.3mmx12mm TPLS-23120-TS [3643833]
|
Facility
|
OP
|
$494.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$479.55 |
| Rate for Payer: Cash Price |
$321.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$346.07
|
| Rate for Payer: Health Management Network Commercial |
$420.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$311.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$252.13
|
| Rate for Payer: MDX Hawaii PPO |
$479.55
|
| Rate for Payer: University Health Alliance Commercial |
$276.85
|
|
|
Screw Threaded Peg Locking Ti 2.3mmX14mm TPLS23140TS [3643100]
|
Facility
|
OP
|
$472.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.97 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.75
|
| Rate for Payer: Health Management Network Commercial |
$401.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$240.97
|
| Rate for Payer: MDX Hawaii PPO |
$458.32
|
| Rate for Payer: University Health Alliance Commercial |
$264.60
|
|
|
Screw Threaded Peg Locking Ti 2.3mmX14mm TPLS23140TS [3643100]
|
Facility
|
IP
|
$472.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.75
|
| Rate for Payer: Health Management Network Commercial |
$401.62
|
| Rate for Payer: MDX Hawaii PPO |
$458.32
|
| Rate for Payer: University Health Alliance Commercial |
$264.60
|
|
|
Screw Threaded Peg Locking Ti 2.3mm x 16mm TPLS-23160-TS [3643095]
|
Facility
|
OP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.38 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$373.38
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mm x 16mm TPLS-23160-TS [3643095]
|
Facility
|
IP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.99 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mm x 18mm TPLS-23180-TS [3643101]
|
Facility
|
OP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.38 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$373.38
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mm x 18mm TPLS-23180-TS [3643101]
|
Facility
|
IP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.99 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mmX19mm TPLS23190TS [3643096]
|
Facility
|
IP
|
$472.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.75
|
| Rate for Payer: Health Management Network Commercial |
$401.62
|
| Rate for Payer: MDX Hawaii PPO |
$458.32
|
| Rate for Payer: University Health Alliance Commercial |
$264.60
|
|
|
Screw Threaded Peg Locking Ti 2.3mmX19mm TPLS23190TS [3643096]
|
Facility
|
OP
|
$472.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.97 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.75
|
| Rate for Payer: Health Management Network Commercial |
$401.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$240.97
|
| Rate for Payer: MDX Hawaii PPO |
$458.32
|
| Rate for Payer: University Health Alliance Commercial |
$264.60
|
|
|
Screw Threaded Peg Locking Ti 2.3mm x 20mm TPLS-23200-TS [3642912]
|
Facility
|
IP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.99 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mm x 20mm TPLS-23200-TS [3642912]
|
Facility
|
OP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.38 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$373.38
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mmX21mm TPLS-23210-TS [3643187]
|
Facility
|
IP
|
$705.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.99 |
| Max. Negotiated Rate |
$684.18 |
| Rate for Payer: Cash Price |
$458.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$493.74
|
| Rate for Payer: Health Management Network Commercial |
$599.54
|
| Rate for Payer: MDX Hawaii PPO |
$684.18
|
| Rate for Payer: University Health Alliance Commercial |
$394.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mmX21mm TPLS-23210-TS [3643187]
|
Facility
|
OP
|
$705.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.72 |
| Max. Negotiated Rate |
$684.18 |
| Rate for Payer: Cash Price |
$458.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$493.74
|
| Rate for Payer: Health Management Network Commercial |
$599.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$444.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$359.72
|
| Rate for Payer: MDX Hawaii PPO |
$684.18
|
| Rate for Payer: University Health Alliance Commercial |
$394.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mm x 22mm TPLS-23220-TS [3642913]
|
Facility
|
OP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.38 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$373.38
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mm x 22mm TPLS-23220-TS [3642913]
|
Facility
|
IP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3642913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.99 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mmX23mm TPLS-23230-TS [3643188]
|
Facility
|
OP
|
$472.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.97 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.75
|
| Rate for Payer: Health Management Network Commercial |
$401.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$240.97
|
| Rate for Payer: MDX Hawaii PPO |
$458.32
|
| Rate for Payer: University Health Alliance Commercial |
$264.60
|
|
|
Screw Threaded Peg Locking Ti 2.3mmX23mm TPLS-23230-TS [3643188]
|
Facility
|
IP
|
$472.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Cash Price |
$307.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.75
|
| Rate for Payer: Health Management Network Commercial |
$401.62
|
| Rate for Payer: MDX Hawaii PPO |
$458.32
|
| Rate for Payer: University Health Alliance Commercial |
$264.60
|
|
|
Screw Threaded Peg Locking Ti 2.3mmX24mm TPLS-23240-TS [3643207]
|
Facility
|
IP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.99 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3mmX24mm TPLS-23240-TS [3643207]
|
Facility
|
OP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.38 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$373.38
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3 x 26mm TPLS-23260-TS [3643904]
|
Facility
|
OP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.38 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$373.38
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Threaded Peg Locking Ti 2.3 x 26mm TPLS-23260-TS [3643904]
|
Facility
|
IP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3643904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.99 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Thread Peg Lock Ti 2.3mm x 30mm TPLS-23300-TS [3644576]
|
Facility
|
IP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.99 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
|
Screw Thread Peg Lock Ti 2.3mm x 30mm TPLS-23300-TS [3644576]
|
Facility
|
OP
|
$732.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.38 |
| Max. Negotiated Rate |
$710.16 |
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$512.48
|
| Rate for Payer: Health Management Network Commercial |
$622.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$373.38
|
| Rate for Payer: MDX Hawaii PPO |
$710.16
|
| Rate for Payer: University Health Alliance Commercial |
$409.99
|
|
