|
triamcinolone 0.1% cream 15gm [HHSC]
|
Facility
|
IP
|
$30.58
|
|
|
Service Code
|
NDC 33342032915
|
| Hospital Charge Code |
2500837
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Health Management Network Commercial |
$25.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.52
|
| Rate for Payer: MDX Hawaii PPO |
$29.66
|
|
|
triamcinolone acetonide 40 mg/1ml vial [HHSC]
|
Facility
|
IP
|
$59.35
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
2500834
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.45 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cash Price |
$37.03
|
| Rate for Payer: Cash Price |
$40.08
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Health Management Network Commercial |
$48.42
|
| Rate for Payer: Health Management Network Commercial |
$50.45
|
| Rate for Payer: Health Management Network Commercial |
$52.39
|
| Rate for Payer: Health Management Network Commercial |
$52.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.41
|
| Rate for Payer: MDX Hawaii PPO |
$55.26
|
| Rate for Payer: MDX Hawaii PPO |
$59.79
|
| Rate for Payer: MDX Hawaii PPO |
$59.81
|
| Rate for Payer: MDX Hawaii PPO |
$57.57
|
|
|
triamcinolone acetonide 40 mg/1ml vial [HHSC]
|
Facility
|
OP
|
$61.64
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
2500834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$59.79 |
| Rate for Payer: AlohaCare Medicaid |
$30.82
|
| Rate for Payer: AlohaCare Medicaid |
$30.83
|
| Rate for Payer: AlohaCare Medicaid |
$29.68
|
| Rate for Payer: AlohaCare Medicaid |
$28.48
|
| Rate for Payer: AlohaCare Medicare |
$28.48
|
| Rate for Payer: AlohaCare Medicare |
$29.68
|
| Rate for Payer: AlohaCare Medicare |
$30.82
|
| Rate for Payer: AlohaCare Medicare |
$30.83
|
| Rate for Payer: Cash Price |
$37.03
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Cash Price |
$40.08
|
| Rate for Payer: Cash Price |
$37.03
|
| Rate for Payer: Cash Price |
$40.08
|
| Rate for Payer: Devoted Health Medicare |
$32.64
|
| Rate for Payer: Devoted Health Medicare |
$33.90
|
| Rate for Payer: Devoted Health Medicare |
$31.33
|
| Rate for Payer: Devoted Health Medicare |
$33.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.58
|
| Rate for Payer: Health Management Network Commercial |
$52.41
|
| Rate for Payer: Health Management Network Commercial |
$50.45
|
| Rate for Payer: Health Management Network Commercial |
$48.42
|
| Rate for Payer: Health Management Network Commercial |
$52.39
|
| Rate for Payer: Humana Medicare |
$29.68
|
| Rate for Payer: Humana Medicare |
$28.48
|
| Rate for Payer: Humana Medicare |
$30.82
|
| Rate for Payer: Humana Medicare |
$30.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.48
|
| Rate for Payer: MDX Hawaii PPO |
$59.81
|
| Rate for Payer: MDX Hawaii PPO |
$59.79
|
| Rate for Payer: MDX Hawaii PPO |
$57.57
|
| Rate for Payer: MDX Hawaii PPO |
$55.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.48
|
| Rate for Payer: University Health Alliance Commercial |
$44.94
|
| Rate for Payer: University Health Alliance Commercial |
$44.93
|
| Rate for Payer: University Health Alliance Commercial |
$41.53
|
| Rate for Payer: University Health Alliance Commercial |
$43.26
|
|
|
TRIANGLE PLATE, 2.0MM, 8 HOLE
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001594
|
|
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
|
|
|
TRIANGLE PLATE, 2.0MM, 8 HOLE
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001594
|
|
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
|
|
|
TRIANGLE PLATE, 2.4MM, 8 HOLE
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001595
|
|
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
|
|
|
TRIANGLE PLATE, 2.4MM, 8 HOLE
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001595
|
|
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
|
|
|
TRIANGULAR PLATE, 2.7MM, 10 HOLE
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,405.60 |
| Max. Negotiated Rate |
$2,434.70 |
| Rate for Payer: Cash Price |
$1,631.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,757.00
|
| Rate for Payer: Health Management Network Commercial |
$2,133.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,259.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,434.70
|
| Rate for Payer: University Health Alliance Commercial |
$1,405.60
|
|
|
TRIANGULAR PLATE, 2.7MM, 10 HOLE
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,255.00 |
| Max. Negotiated Rate |
$2,434.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,255.00
|
| Rate for Payer: AlohaCare Medicare |
$1,255.00
|
| Rate for Payer: Cash Price |
$1,631.50
|
| Rate for Payer: Devoted Health Medicare |
$1,380.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,255.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,757.00
|
| Rate for Payer: Health Management Network Commercial |
$2,133.50
|
| Rate for Payer: Humana Medicare |
$1,255.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,259.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,280.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,255.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,434.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,255.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,255.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,255.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,405.60
|
|
|
TRIANGULAR PLATE, 2.7MM, 6 HOLE
|
Facility
|
OP
|
$1,883.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.50 |
| Max. Negotiated Rate |
$1,826.51 |
| Rate for Payer: AlohaCare Medicaid |
$941.50
|
| Rate for Payer: AlohaCare Medicare |
$941.50
|
| Rate for Payer: Cash Price |
$1,223.95
|
| Rate for Payer: Devoted Health Medicare |
$1,035.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$941.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,318.10
|
| Rate for Payer: Health Management Network Commercial |
$1,600.55
|
| Rate for Payer: Humana Medicare |
$941.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,694.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$960.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$941.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,826.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$941.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$941.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$941.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,054.48
|
|
|
TRIANGULAR PLATE, 2.7MM, 6 HOLE
|
Facility
|
IP
|
$1,883.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,054.48 |
| Max. Negotiated Rate |
$1,826.51 |
| Rate for Payer: Cash Price |
$1,223.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,318.10
|
| Rate for Payer: Health Management Network Commercial |
$1,600.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,694.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,826.51
|
| Rate for Payer: University Health Alliance Commercial |
$1,054.48
|
|
|
Trichomonas vaginalis, Male FSI
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
12384347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$362.78 |
| Rate for Payer: AlohaCare Medicaid |
$187.00
|
| Rate for Payer: AlohaCare Medicare |
$187.00
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Devoted Health Medicare |
$205.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$187.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$317.90
|
| Rate for Payer: Humana Medicare |
$187.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$336.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$190.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.00
|
| Rate for Payer: MDX Hawaii PPO |
$362.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$187.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$187.00
|
| Rate for Payer: University Health Alliance Commercial |
$88.56
|
|
|
Trichomonas vaginalis, Male FSI
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
12384347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$317.90 |
| Max. Negotiated Rate |
$362.78 |
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Health Management Network Commercial |
$317.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$336.60
|
| Rate for Payer: MDX Hawaii PPO |
$362.78
|
|
|
Triglyceride FSI
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
8118066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: AlohaCare Medicaid |
$43.00
|
| Rate for Payer: AlohaCare Medicare |
$43.00
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Devoted Health Medicare |
$47.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.74
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Humana Medicare |
$43.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.00
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.00
|
| Rate for Payer: University Health Alliance Commercial |
$14.87
|
|
|
Triglyceride FSI
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
8118066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
|
|
Triglycerides, Body Fluid FSI
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
8228931
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: AlohaCare Medicaid |
$43.00
|
| Rate for Payer: AlohaCare Medicare |
$43.00
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Devoted Health Medicare |
$47.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.74
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Humana Medicare |
$43.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.00
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.00
|
| Rate for Payer: University Health Alliance Commercial |
$14.87
|
|
|
Triglycerides, Body Fluid FSI
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
8228931
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
|
|
TROCHANTERIC NAIL, 10MM X 20CM X 125
|
Facility
|
IP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.60 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
|
TROCHANTERIC NAIL, 10MM X 20CM X 125
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.00 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: AlohaCare Medicaid |
$2,305.00
|
| Rate for Payer: AlohaCare Medicare |
$2,305.00
|
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Devoted Health Medicare |
$2,535.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,305.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Humana Medicare |
$2,305.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,351.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,305.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,305.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,305.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
|
TROCHANTERIC NAIL, 10MM X 20CM X 130
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.00 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: AlohaCare Medicaid |
$2,305.00
|
| Rate for Payer: AlohaCare Medicare |
$2,305.00
|
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Devoted Health Medicare |
$2,535.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,305.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Humana Medicare |
$2,305.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,351.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,305.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,305.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,305.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
|
TROCHANTERIC NAIL, 10MM X 20CM X 130
|
Facility
|
IP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.60 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
|
TROCHANTERIC NAIL, 11MM X 20CM X 125
|
Facility
|
IP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.60 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
|
TROCHANTERIC NAIL, 11MM X 20CM X 125
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13000999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.00 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: AlohaCare Medicaid |
$2,305.00
|
| Rate for Payer: AlohaCare Medicare |
$2,305.00
|
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Devoted Health Medicare |
$2,535.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,305.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Humana Medicare |
$2,305.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,351.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,305.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,305.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,305.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
|
TROCHANTERIC NAIL, 11MM X 20CM X 130
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.00 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: AlohaCare Medicaid |
$2,305.00
|
| Rate for Payer: AlohaCare Medicare |
$2,305.00
|
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Devoted Health Medicare |
$2,535.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,305.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Humana Medicare |
$2,305.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,351.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,305.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,305.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,305.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
|
TROCHANTERIC NAIL, 11MM X 20CM X 130
|
Facility
|
IP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13001000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.60 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
