|
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
|
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 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 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
|
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
|
|
|
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 38MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991227
|
|
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 38MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991227
|
|
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 40MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991225
|
|
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 40MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12991225
|
|
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 7MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989507
|
|
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 7MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989507
|
|
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 8MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989508
|
|
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 8MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989508
|
|
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 9MM, CORTICAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989509
|
|
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 9MM, CORTICAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989509
|
|
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, 2.4MM X 13MM CORTEX
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989535
|
|
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, 2.4MM X 13MM CORTEX
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989535
|
|
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, 2.4MM X 36MM CORTEX
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989536
|
|
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, 2.4MM X 36MM CORTEX
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989536
|
|
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
|
|
