|
Toxoplasma IgG FSI
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
8404553
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: AlohaCare Medicaid |
$82.50
|
| Rate for Payer: AlohaCare Medicare |
$82.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$90.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Humana Medicare |
$82.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.50
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
Toxoplasma IgG FSI
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
8404553
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
|
|
Toxoplasma IgM FSI
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
8404554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: AlohaCare Medicaid |
$82.50
|
| Rate for Payer: AlohaCare Medicare |
$82.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$90.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.41
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Humana Medicare |
$82.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.50
|
| Rate for Payer: University Health Alliance Commercial |
$37.22
|
|
|
Toxoplasma IgM FSI
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
8404554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
|
|
Toxoplasma Panel Adult FSI
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 86406
|
| Hospital Charge Code |
8118064
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
Toxoplasma Panel Adult FSI
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 86406
|
| Hospital Charge Code |
8118064
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicare |
$63.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Devoted Health Medicare |
$69.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.64
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Humana Medicare |
$63.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.00
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.00
|
| Rate for Payer: University Health Alliance Commercial |
$27.51
|
|
|
Toxoplasmosis IgG and IgM FSI
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
9904297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: AlohaCare Medicaid |
$57.00
|
| Rate for Payer: AlohaCare Medicare |
$57.00
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$62.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.00
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.00
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
Toxoplasmosis IgG and IgM FSI
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
9904297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
Toxoplasmosis IgG and IgM (Palo Alto) FSI
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
10004696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: AlohaCare Medicaid |
$57.00
|
| Rate for Payer: AlohaCare Medicare |
$57.00
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$62.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.00
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.00
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
Toxoplasmosis IgG and IgM (Palo Alto) FSI
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
10004696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
T-PLATE, 2.0MM, 6 HOLE
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$1,418.14 |
| Rate for Payer: AlohaCare Medicaid |
$731.00
|
| Rate for Payer: AlohaCare Medicare |
$731.00
|
| Rate for Payer: Cash Price |
$950.30
|
| Rate for Payer: Devoted Health Medicare |
$804.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$731.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,023.40
|
| Rate for Payer: Health Management Network Commercial |
$1,242.70
|
| Rate for Payer: Humana Medicare |
$731.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,315.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$745.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$731.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,418.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$731.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$731.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$731.00
|
| Rate for Payer: University Health Alliance Commercial |
$818.72
|
|
|
T-PLATE, 2.0MM, 6 HOLE
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.72 |
| Max. Negotiated Rate |
$1,418.14 |
| Rate for Payer: Cash Price |
$950.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,023.40
|
| Rate for Payer: Health Management Network Commercial |
$1,242.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,315.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,418.14
|
| Rate for Payer: University Health Alliance Commercial |
$818.72
|
|
|
T-PLATE, 2.0MM, 6 HOLE, REINFORCED
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.72 |
| Max. Negotiated Rate |
$1,418.14 |
| Rate for Payer: Cash Price |
$950.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,023.40
|
| Rate for Payer: Health Management Network Commercial |
$1,242.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,315.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,418.14
|
| Rate for Payer: University Health Alliance Commercial |
$818.72
|
|
|
T-PLATE, 2.0MM, 6 HOLE, REINFORCED
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$1,418.14 |
| Rate for Payer: AlohaCare Medicaid |
$731.00
|
| Rate for Payer: AlohaCare Medicare |
$731.00
|
| Rate for Payer: Cash Price |
$950.30
|
| Rate for Payer: Devoted Health Medicare |
$804.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$731.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,023.40
|
| Rate for Payer: Health Management Network Commercial |
$1,242.70
|
| Rate for Payer: Humana Medicare |
$731.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,315.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$745.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$731.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,418.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$731.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$731.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$731.00
|
| Rate for Payer: University Health Alliance Commercial |
$818.72
|
|
|
T-PLATE, 2.0MM, 8 HOLE
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.72 |
| Max. Negotiated Rate |
$1,418.14 |
| Rate for Payer: Cash Price |
$950.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,023.40
|
| Rate for Payer: Health Management Network Commercial |
$1,242.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,315.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,418.14
|
| Rate for Payer: University Health Alliance Commercial |
$818.72
|
|
|
T-PLATE, 2.0MM, 8 HOLE
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$1,418.14 |
| Rate for Payer: AlohaCare Medicaid |
$731.00
|
| Rate for Payer: AlohaCare Medicare |
$731.00
|
| Rate for Payer: Cash Price |
$950.30
|
| Rate for Payer: Devoted Health Medicare |
$804.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$731.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,023.40
|
| Rate for Payer: Health Management Network Commercial |
$1,242.70
|
| Rate for Payer: Humana Medicare |
$731.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,315.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$745.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$731.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,418.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$731.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$731.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$731.00
|
| Rate for Payer: University Health Alliance Commercial |
$818.72
|
|
|
T-PLATE, 2.0MM, 8 HOLE, REINFORCED
|
Facility
|
IP
|
$2,505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.80 |
| Max. Negotiated Rate |
$2,429.85 |
| Rate for Payer: Cash Price |
$1,628.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,753.50
|
| Rate for Payer: Health Management Network Commercial |
$2,129.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,254.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,429.85
|
| Rate for Payer: University Health Alliance Commercial |
$1,402.80
|
|
|
T-PLATE, 2.0MM, 8 HOLE, REINFORCED
|
Facility
|
OP
|
$2,505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.50 |
| Max. Negotiated Rate |
$2,429.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,252.50
|
| Rate for Payer: AlohaCare Medicare |
$1,252.50
|
| Rate for Payer: Cash Price |
$1,628.25
|
| Rate for Payer: Devoted Health Medicare |
$1,377.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,252.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,753.50
|
| Rate for Payer: Health Management Network Commercial |
$2,129.25
|
| Rate for Payer: Humana Medicare |
$1,252.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,254.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,277.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,252.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,429.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,252.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,252.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,252.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,402.80
|
|
|
T-PLATE, 2.4MM, 6 HOLE
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.72 |
| Max. Negotiated Rate |
$1,418.14 |
| Rate for Payer: Cash Price |
$950.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,023.40
|
| Rate for Payer: Health Management Network Commercial |
$1,242.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,315.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,418.14
|
| Rate for Payer: University Health Alliance Commercial |
$818.72
|
|
|
T-PLATE, 2.4MM, 6 HOLE
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$1,418.14 |
| Rate for Payer: AlohaCare Medicaid |
$731.00
|
| Rate for Payer: AlohaCare Medicare |
$731.00
|
| Rate for Payer: Cash Price |
$950.30
|
| Rate for Payer: Devoted Health Medicare |
$804.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$731.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,023.40
|
| Rate for Payer: Health Management Network Commercial |
$1,242.70
|
| Rate for Payer: Humana Medicare |
$731.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,315.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$745.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$731.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,418.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$731.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$731.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$731.00
|
| Rate for Payer: University Health Alliance Commercial |
$818.72
|
|
|
T-PLATE, 2.4MM, 6 HOLE,REINFORCED
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$1,418.14 |
| Rate for Payer: AlohaCare Medicaid |
$731.00
|
| Rate for Payer: AlohaCare Medicare |
$731.00
|
| Rate for Payer: Cash Price |
$950.30
|
| Rate for Payer: Devoted Health Medicare |
$804.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$731.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,023.40
|
| Rate for Payer: Health Management Network Commercial |
$1,242.70
|
| Rate for Payer: Humana Medicare |
$731.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,315.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$745.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$731.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,418.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$731.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$731.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$731.00
|
| Rate for Payer: University Health Alliance Commercial |
$818.72
|
|
|
T-PLATE, 2.4MM, 6 HOLE,REINFORCED
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.72 |
| Max. Negotiated Rate |
$1,418.14 |
| Rate for Payer: Cash Price |
$950.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,023.40
|
| Rate for Payer: Health Management Network Commercial |
$1,242.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,315.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,418.14
|
| Rate for Payer: University Health Alliance Commercial |
$818.72
|
|
|
T-PLATE, 2.4MM, 8 HOLE
|
Facility
|
IP
|
$2,505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.80 |
| Max. Negotiated Rate |
$2,429.85 |
| Rate for Payer: Cash Price |
$1,628.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,753.50
|
| Rate for Payer: Health Management Network Commercial |
$2,129.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,254.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,429.85
|
| Rate for Payer: University Health Alliance Commercial |
$1,402.80
|
|
|
T-PLATE, 2.4MM, 8 HOLE
|
Facility
|
OP
|
$2,505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.50 |
| Max. Negotiated Rate |
$2,429.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,252.50
|
| Rate for Payer: AlohaCare Medicare |
$1,252.50
|
| Rate for Payer: Cash Price |
$1,628.25
|
| Rate for Payer: Devoted Health Medicare |
$1,377.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,252.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,753.50
|
| Rate for Payer: Health Management Network Commercial |
$2,129.25
|
| Rate for Payer: Humana Medicare |
$1,252.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,254.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,277.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,252.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,429.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,252.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,252.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,252.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,402.80
|
|
|
T-PLATE, 2.4MM, 8 HOLE,REINFORCED
|
Facility
|
IP
|
$2,505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.80 |
| Max. Negotiated Rate |
$2,429.85 |
| Rate for Payer: Cash Price |
$1,628.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,753.50
|
| Rate for Payer: Health Management Network Commercial |
$2,129.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,254.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,429.85
|
| Rate for Payer: University Health Alliance Commercial |
$1,402.80
|
|