Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]

Facility

$90.00

Service Code	HCPCS J0878
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Hawaii Medical Service Association ABD	$0.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.91
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: UnitedHealthcare Medicaid	$54.00
Rate for Payer: University Health Alliance Commercial	$65.60

DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [173322]

Facility

$19,030.00

Service Code	HCPCS J9144
Hospital Revenue Code	250
Min. Negotiated Rate	$16,175.50
Max. Negotiated Rate	$18,459.10
Rate for Payer: Cash Price	$11,418.00
Rate for Payer: Health Management Network Commercial	$16,175.50
Rate for Payer: MDX Hawaii PPO	$18,459.10

DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [173322]

Facility

$19,030.00

Service Code	HCPCS J9144
Hospital Revenue Code	636
Min. Negotiated Rate	$54.67
Max. Negotiated Rate	$18,459.10
Rate for Payer: AlohaCare Medicaid	$55.03
Rate for Payer: AlohaCare Medicare	$55.03
Rate for Payer: Cash Price	$11,418.00
Rate for Payer: Cash Price	$11,418.00
Rate for Payer: Devoted Health Medicare	$60.53
Rate for Payer: Hawaii Medical Service Association ABD	$54.67
Rate for Payer: Hawaii Medical Service Association Commercial	$68.79
Rate for Payer: Hawaii Medical Service Association Medicare	$55.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$54.67
Rate for Payer: Hawaii Western Management Group Commercial	$18,078.50
Rate for Payer: Health Management Network Commercial	$16,175.50
Rate for Payer: Humana Medicare	$55.03
Rate for Payer: Kaiser Permanente Commercial	$11,988.90
Rate for Payer: Kaiser Permanente Medicaid	$9,705.30
Rate for Payer: Kaiser Permanente Medicare	$55.03
Rate for Payer: MDX Hawaii PPO	$18,459.10
Rate for Payer: Ohana Health Plan Medicaid	$60.53
Rate for Payer: Ohana Health Plan Medicare	$55.03
Rate for Payer: UnitedHealthcare Medicaid	$11,418.00
Rate for Payer: UnitedHealthcare Medicare	$55.03
Rate for Payer: University Health Alliance Commercial	$13,870.97

DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [129766]

Facility

$558.00

Service Code	HCPCS J0882
Hospital Revenue Code	250
Min. Negotiated Rate	$474.30
Max. Negotiated Rate	$541.26
Rate for Payer: Cash Price	$334.80
Rate for Payer: Health Management Network Commercial	$474.30
Rate for Payer: MDX Hawaii PPO	$541.26

DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [129766]

Facility

$558.00

Service Code	HCPCS J0882
Hospital Revenue Code	636
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$541.26
Rate for Payer: AlohaCare Medicaid	$3.07
Rate for Payer: AlohaCare Medicare	$3.07
Rate for Payer: Cash Price	$334.80
Rate for Payer: Cash Price	$334.80
Rate for Payer: Devoted Health Medicare	$3.38
Rate for Payer: Hawaii Medical Service Association ABD	$3.00
Rate for Payer: Hawaii Medical Service Association Commercial	$3.84
Rate for Payer: Hawaii Medical Service Association Medicare	$3.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.00
Rate for Payer: Hawaii Western Management Group Commercial	$530.10
Rate for Payer: Health Management Network Commercial	$474.30
Rate for Payer: Humana Medicare	$3.07
Rate for Payer: Kaiser Permanente Commercial	$351.54
Rate for Payer: Kaiser Permanente Medicaid	$284.58
Rate for Payer: Kaiser Permanente Medicare	$3.07
Rate for Payer: MDX Hawaii PPO	$541.26
Rate for Payer: Ohana Health Plan Medicaid	$3.38
Rate for Payer: Ohana Health Plan Medicare	$3.07
Rate for Payer: UnitedHealthcare Medicaid	$334.80
Rate for Payer: UnitedHealthcare Medicare	$3.07
Rate for Payer: University Health Alliance Commercial	$406.73

DAVOL BARD MESH PERFEX PLUG

Facility

$1,067.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$544.17
Max. Negotiated Rate	$1,034.99
Rate for Payer: Cash Price	$640.20
Rate for Payer: Hawaii Western Management Group Commercial	$746.90
Rate for Payer: Health Management Network Commercial	$906.95
Rate for Payer: Kaiser Permanente Commercial	$672.21
Rate for Payer: Kaiser Permanente Medicaid	$544.17
Rate for Payer: MDX Hawaii PPO	$1,034.99
Rate for Payer: University Health Alliance Commercial	$597.52

DAVOL BARD MESH PERFEX PLUG

Facility

$1,067.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$597.52
Max. Negotiated Rate	$1,034.99
Rate for Payer: Cash Price	$640.20
Rate for Payer: Hawaii Western Management Group Commercial	$746.90
Rate for Payer: Health Management Network Commercial	$906.95
Rate for Payer: MDX Hawaii PPO	$1,034.99
Rate for Payer: University Health Alliance Commercial	$597.52

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$35,346.97

Service Code	MSDRG 744
Min. Negotiated Rate	$16,015.56
Max. Negotiated Rate	$35,346.97
Rate for Payer: AlohaCare Medicare	$23,306.98
Rate for Payer: Devoted Health Medicare	$25,637.68
Rate for Payer: Hawaii Medical Service Association Commercial	$16,015.56
Rate for Payer: Hawaii Medical Service Association Medicare	$23,306.98
Rate for Payer: Humana Medicare	$23,306.98
Rate for Payer: Kaiser Permanente Commercial	$35,346.97
Rate for Payer: Kaiser Permanente Medicare	$23,306.98
Rate for Payer: Ohana Health Plan Medicare	$23,306.98
Rate for Payer: UnitedHealthcare Medicare	$23,306.98

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$19,621.88

Service Code	MSDRG 745
Min. Negotiated Rate	$12,938.21
Max. Negotiated Rate	$19,621.88
Rate for Payer: AlohaCare Medicare	$12,938.21
Rate for Payer: Devoted Health Medicare	$14,232.03
Rate for Payer: Hawaii Medical Service Association Commercial	$16,015.56
Rate for Payer: Hawaii Medical Service Association Medicare	$12,938.21
Rate for Payer: Humana Medicare	$12,938.21
Rate for Payer: Kaiser Permanente Commercial	$19,621.88
Rate for Payer: Kaiser Permanente Medicare	$12,938.21
Rate for Payer: Ohana Health Plan Medicare	$12,938.21
Rate for Payer: UnitedHealthcare Medicare	$12,938.21

DCP PL 1.25 3X3H 04.503.712

Facility

$2,235.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,251.60
Max. Negotiated Rate	$2,167.95
Rate for Payer: Cash Price	$1,341.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,564.50
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: MDX Hawaii PPO	$2,167.95
Rate for Payer: University Health Alliance Commercial	$1,251.60

DCP PL 1.25 3X3H 04.503.712

Facility

$2,235.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,139.85
Max. Negotiated Rate	$2,167.95
Rate for Payer: Cash Price	$1,341.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,564.50
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: Kaiser Permanente Commercial	$1,408.05
Rate for Payer: Kaiser Permanente Medicaid	$1,139.85
Rate for Payer: MDX Hawaii PPO	$2,167.95
Rate for Payer: University Health Alliance Commercial	$1,251.60

DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$2,837.00

Service Code	CPT 11047
Hospital Revenue Code	360
Min. Negotiated Rate	$40.48
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$40.48

DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS

Facility

$8,270.00

Service Code	CPT 11044
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11

DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN AND SUBCUTANEOUS TISSUES

Facility

$5,509.00

Service Code	CPT 11010
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Devoted Health Medicare	$920.21
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55

DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, AND MUSCLE

Facility

$8,270.00

Service Code	CPT 11011
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Devoted Health Medicare	$920.21
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55

DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS

Facility

$8,270.00

Service Code	CPT 11043
Hospital Revenue Code	360
Min. Negotiated Rate	$125.89
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$873.10
Rate for Payer: AlohaCare Medicare	$873.10
Rate for Payer: Devoted Health Medicare	$960.41
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$873.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$873.10
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$873.10
Rate for Payer: Ohana Health Plan Medicaid	$960.41
Rate for Payer: Ohana Health Plan Medicare	$873.10
Rate for Payer: UnitedHealthcare Medicaid	$125.89
Rate for Payer: UnitedHealthcare Medicare	$873.10
Rate for Payer: University Health Alliance Commercial	$4,035.20

DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$2,837.00

Service Code	CPT 11045
Hospital Revenue Code	360
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$10.88

DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS

Facility

$5,160.40

Service Code	CPT 11042
Hospital Revenue Code	360
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$44.20
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$5,160.40

DECELLULARIZED DERMIS AFLEX301

Facility

$7,894.00

Service Code	HCPCS Q4125
Hospital Revenue Code	636
Min. Negotiated Rate	$6,709.90
Max. Negotiated Rate	$7,657.18
Rate for Payer: Cash Price	$4,736.40
Rate for Payer: Health Management Network Commercial	$6,709.90
Rate for Payer: MDX Hawaii PPO	$7,657.18

DECELLULARIZED DERMIS AFLEX301

Facility

$7,894.00

Service Code	HCPCS Q4125
Hospital Revenue Code	636
Min. Negotiated Rate	$147.01
Max. Negotiated Rate	$7,657.18
Rate for Payer: AlohaCare Medicaid	$147.01
Rate for Payer: AlohaCare Medicare	$147.01
Rate for Payer: Cash Price	$4,736.40
Rate for Payer: Cash Price	$4,736.40
Rate for Payer: Devoted Health Medicare	$161.71
Rate for Payer: Hawaii Medical Service Association Commercial	$183.76
Rate for Payer: Hawaii Medical Service Association Medicare	$147.01
Rate for Payer: Hawaii Western Management Group Commercial	$7,499.30
Rate for Payer: Health Management Network Commercial	$6,709.90
Rate for Payer: Humana Medicare	$147.01
Rate for Payer: Kaiser Permanente Commercial	$4,973.22
Rate for Payer: Kaiser Permanente Medicaid	$4,025.94
Rate for Payer: Kaiser Permanente Medicare	$147.01
Rate for Payer: MDX Hawaii PPO	$7,657.18
Rate for Payer: Ohana Health Plan Medicaid	$161.71
Rate for Payer: Ohana Health Plan Medicare	$147.01
Rate for Payer: UnitedHealthcare Medicaid	$4,736.40
Rate for Payer: UnitedHealthcare Medicare	$147.01
Rate for Payer: University Health Alliance Commercial	$5,753.94

DECITABINE 50 MG/10ML IV (WET SOLR VIAL) [43076364]

Facility

$2,451.00

Service Code	HCPCS J0894
Hospital Revenue Code	250
Min. Negotiated Rate	$2,083.35
Max. Negotiated Rate	$2,377.47
Rate for Payer: Cash Price	$1,470.60
Rate for Payer: Cash Price	$518.40
Rate for Payer: Health Management Network Commercial	$734.40
Rate for Payer: Health Management Network Commercial	$2,083.35
Rate for Payer: MDX Hawaii PPO	$2,377.47
Rate for Payer: MDX Hawaii PPO	$838.08

DECITABINE 50 MG/10ML IV (WET SOLR VIAL) [43076364]

Facility

$864.00

Service Code	HCPCS J0894
Hospital Revenue Code	636
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$838.08
Rate for Payer: Cash Price	$518.40
Rate for Payer: Cash Price	$1,470.60
Rate for Payer: Cash Price	$518.40
Rate for Payer: Cash Price	$1,470.60
Rate for Payer: Hawaii Medical Service Association ABD	$1.59
Rate for Payer: Hawaii Medical Service Association ABD	$1.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.59
Rate for Payer: Hawaii Western Management Group Commercial	$2,328.45
Rate for Payer: Hawaii Western Management Group Commercial	$820.80
Rate for Payer: Health Management Network Commercial	$734.40
Rate for Payer: Health Management Network Commercial	$2,083.35
Rate for Payer: Kaiser Permanente Commercial	$544.32
Rate for Payer: Kaiser Permanente Commercial	$1,544.13
Rate for Payer: Kaiser Permanente Medicaid	$440.64
Rate for Payer: Kaiser Permanente Medicaid	$1,250.01
Rate for Payer: MDX Hawaii PPO	$2,377.47
Rate for Payer: MDX Hawaii PPO	$838.08
Rate for Payer: UnitedHealthcare Medicaid	$1,470.60
Rate for Payer: UnitedHealthcare Medicaid	$518.40
Rate for Payer: University Health Alliance Commercial	$629.77
Rate for Payer: University Health Alliance Commercial	$1,786.53

DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]

Facility

$864.00

Service Code	HCPCS J0894
Hospital Revenue Code	250
Min. Negotiated Rate	$734.40
Max. Negotiated Rate	$838.08
Rate for Payer: Cash Price	$518.40
Rate for Payer: Cash Price	$230.40
Rate for Payer: Cash Price	$1,470.60
Rate for Payer: Health Management Network Commercial	$734.40
Rate for Payer: Health Management Network Commercial	$2,083.35
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: MDX Hawaii PPO	$838.08
Rate for Payer: MDX Hawaii PPO	$372.48
Rate for Payer: MDX Hawaii PPO	$2,377.47

DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]

Facility

$384.00

Service Code	HCPCS J0894
Hospital Revenue Code	636
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$372.48
Rate for Payer: Cash Price	$230.40
Rate for Payer: Cash Price	$518.40
Rate for Payer: Cash Price	$1,470.60
Rate for Payer: Cash Price	$1,470.60
Rate for Payer: Cash Price	$518.40
Rate for Payer: Cash Price	$230.40
Rate for Payer: Hawaii Medical Service Association ABD	$1.59
Rate for Payer: Hawaii Medical Service Association ABD	$1.59
Rate for Payer: Hawaii Medical Service Association ABD	$1.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.59
Rate for Payer: Hawaii Western Management Group Commercial	$2,328.45
Rate for Payer: Hawaii Western Management Group Commercial	$364.80
Rate for Payer: Hawaii Western Management Group Commercial	$820.80
Rate for Payer: Health Management Network Commercial	$734.40
Rate for Payer: Health Management Network Commercial	$2,083.35
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Kaiser Permanente Commercial	$544.32
Rate for Payer: Kaiser Permanente Commercial	$241.92
Rate for Payer: Kaiser Permanente Commercial	$1,544.13
Rate for Payer: Kaiser Permanente Medicaid	$1,250.01
Rate for Payer: Kaiser Permanente Medicaid	$195.84
Rate for Payer: Kaiser Permanente Medicaid	$440.64
Rate for Payer: MDX Hawaii PPO	$2,377.47
Rate for Payer: MDX Hawaii PPO	$372.48
Rate for Payer: MDX Hawaii PPO	$838.08
Rate for Payer: UnitedHealthcare Medicaid	$230.40
Rate for Payer: UnitedHealthcare Medicaid	$518.40
Rate for Payer: UnitedHealthcare Medicaid	$1,470.60
Rate for Payer: University Health Alliance Commercial	$1,786.53
Rate for Payer: University Health Alliance Commercial	$279.90
Rate for Payer: University Health Alliance Commercial	$629.77

DECOMPRESSION HIP 800-0541

Facility

$4,464.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,276.64
Max. Negotiated Rate	$4,330.08
Rate for Payer: Cash Price	$2,678.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,240.80
Rate for Payer: Health Management Network Commercial	$3,794.40
Rate for Payer: Kaiser Permanente Commercial	$2,812.32
Rate for Payer: Kaiser Permanente Medicaid	$2,276.64
Rate for Payer: MDX Hawaii PPO	$4,330.08
Rate for Payer: University Health Alliance Commercial	$3,253.81

Know your out-of-pocket cost for care.

All Charges