|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687062211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 71399824503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904725261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 71399824503
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
SENNOSIDES 8.6 MG TABLET [11349]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904725261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 57237031005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 57237031054
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 57237031005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicare |
$8.36
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Devoted Health Medicare |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Humana Medicare |
$8.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.36
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.36
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 48433021940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 57237031054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicare |
$8.36
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Devoted Health Medicare |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Humana Medicare |
$8.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.36
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.36
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 50268073111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 50268073111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicare |
$8.36
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Devoted Health Medicare |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Humana Medicare |
$8.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.36
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.36
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 48433021940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$6.84
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$7.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Humana Medicare |
$6.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.84
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.84
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
SENSIA DUAL CHMBR GNRTR SEDR01
|
Facility
|
IP
|
$11,520.00
|
|
|
Service Code
|
HCPCS C1785
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,451.20 |
| Max. Negotiated Rate |
$11,174.40 |
| Rate for Payer: Cash Price |
$6,912.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,064.00
|
| Rate for Payer: Health Management Network Commercial |
$9,792.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,368.00
|
| Rate for Payer: MDX Hawaii PPO |
$11,174.40
|
| Rate for Payer: University Health Alliance Commercial |
$6,451.20
|
|
|
SENSIA DUAL CHMBR GNRTR SEDR01
|
Facility
|
OP
|
$11,520.00
|
|
|
Service Code
|
HCPCS C1785
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,760.00 |
| Max. Negotiated Rate |
$11,174.40 |
| Rate for Payer: AlohaCare Medicaid |
$5,760.00
|
| Rate for Payer: AlohaCare Medicare |
$8,755.20
|
| Rate for Payer: Cash Price |
$6,912.00
|
| Rate for Payer: Devoted Health Medicare |
$9,676.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,755.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,064.00
|
| Rate for Payer: Health Management Network Commercial |
$9,792.00
|
| Rate for Payer: Humana Medicare |
$8,755.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,368.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5,875.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,755.20
|
| Rate for Payer: MDX Hawaii PPO |
$11,174.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,755.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,755.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,755.20
|
| Rate for Payer: University Health Alliance Commercial |
$6,451.20
|
|
|
SENSIA DUAL CHMBR GNRTR SESR01
|
Facility
|
OP
|
$9,720.00
|
|
|
Service Code
|
HCPCS C1786
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,860.00 |
| Max. Negotiated Rate |
$9,428.40 |
| Rate for Payer: AlohaCare Medicaid |
$4,860.00
|
| Rate for Payer: AlohaCare Medicare |
$7,387.20
|
| Rate for Payer: Cash Price |
$5,832.00
|
| Rate for Payer: Devoted Health Medicare |
$8,164.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,387.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,804.00
|
| Rate for Payer: Health Management Network Commercial |
$8,262.00
|
| Rate for Payer: Humana Medicare |
$7,387.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,748.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,957.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,387.20
|
| Rate for Payer: MDX Hawaii PPO |
$9,428.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,387.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,387.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,387.20
|
| Rate for Payer: University Health Alliance Commercial |
$5,443.20
|
|
|
SENSIA DUAL CHMBR GNRTR SESR01
|
Facility
|
IP
|
$9,720.00
|
|
|
Service Code
|
HCPCS C1786
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,443.20 |
| Max. Negotiated Rate |
$9,428.40 |
| Rate for Payer: Cash Price |
$5,832.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,804.00
|
| Rate for Payer: Health Management Network Commercial |
$8,262.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,748.00
|
| Rate for Payer: MDX Hawaii PPO |
$9,428.40
|
| Rate for Payer: University Health Alliance Commercial |
$5,443.20
|
|
|
SENSOR ANGLE TIP
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
HCPCS C1769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$196.91 |
| Rate for Payer: AlohaCare Medicaid |
$101.50
|
| Rate for Payer: AlohaCare Medicare |
$154.28
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Devoted Health Medicare |
$170.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$192.85
|
| Rate for Payer: Health Management Network Commercial |
$172.55
|
| Rate for Payer: Humana Medicare |
$154.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$154.28
|
| Rate for Payer: MDX Hawaii PPO |
$196.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$154.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.28
|
| Rate for Payer: University Health Alliance Commercial |
$147.97
|
|
|
SENSOR ANGLE TIP
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
HCPCS C1769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.55 |
| Max. Negotiated Rate |
$196.91 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Health Management Network Commercial |
$172.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.70
|
| Rate for Payer: MDX Hawaii PPO |
$196.91
|
|
|
SENSOR PAD BED 10X30
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS A9280
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.90
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
|
|
SENSOR PAD BED 10X30
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS A9280
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: AlohaCare Medicaid |
$60.50
|
| Rate for Payer: AlohaCare Medicare |
$91.96
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$101.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.95
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Humana Medicare |
$91.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.96
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.96
|
| Rate for Payer: University Health Alliance Commercial |
$88.20
|
|
|
SEPRA FILM ADH BARRIER 4301-02
|
Facility
|
IP
|
$1,018.00
|
|
|
Service Code
|
HCPCS C1765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.08 |
| Max. Negotiated Rate |
$987.46 |
| Rate for Payer: Cash Price |
$610.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$712.60
|
| Rate for Payer: Health Management Network Commercial |
$865.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$916.20
|
| Rate for Payer: MDX Hawaii PPO |
$987.46
|
| Rate for Payer: University Health Alliance Commercial |
$570.08
|
|
|
SEPRA FILM ADH BARRIER 4301-02
|
Facility
|
OP
|
$1,018.00
|
|
|
Service Code
|
HCPCS C1765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.00 |
| Max. Negotiated Rate |
$987.46 |
| Rate for Payer: AlohaCare Medicaid |
$509.00
|
| Rate for Payer: AlohaCare Medicare |
$773.68
|
| Rate for Payer: Cash Price |
$610.80
|
| Rate for Payer: Devoted Health Medicare |
$855.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$773.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$712.60
|
| Rate for Payer: Health Management Network Commercial |
$865.30
|
| Rate for Payer: Humana Medicare |
$773.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$916.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$519.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$773.68
|
| Rate for Payer: MDX Hawaii PPO |
$987.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$773.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$773.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$773.68
|
| Rate for Payer: University Health Alliance Commercial |
$570.08
|
|
|
SEPTIC ARTHRITIS WITH CC
|
Facility
|
IP
|
$24,460.46
|
|
|
Service Code
|
MSDRG 549
|
| Min. Negotiated Rate |
$24,460.46 |
| Max. Negotiated Rate |
$24,460.46 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24,460.46
|
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
|
IP
|
$24,460.46
|
|
|
Service Code
|
MSDRG 548
|
| Min. Negotiated Rate |
$24,460.46 |
| Max. Negotiated Rate |
$24,460.46 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24,460.46
|
|
