Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

IP

$5,401.51

Service Code	APR-DRG 5303
Min. Negotiated Rate	$5,401.51
Max. Negotiated Rate	$5,401.51
Rate for Payer: AlohaCare Medicaid	$5,401.51
Rate for Payer: Hawaii Medical Service Association ABD	$5,401.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,401.51
Rate for Payer: Kaiser Permanente Medicaid	$5,401.51
Rate for Payer: Ohana Health Plan Medicaid	$5,401.51
Rate for Payer: UnitedHealthcare Medicaid	$5,401.51

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

IP

$23,930.92

Service Code	MSDRG 748
Min. Negotiated Rate	$15,779.51
Max. Negotiated Rate	$23,930.92
Rate for Payer: AlohaCare Medicare	$15,779.51
Rate for Payer: Devoted Health Medicare	$17,357.46
Rate for Payer: Hawaii Medical Service Association Commercial	$18,636.29
Rate for Payer: Hawaii Medical Service Association Medicare	$15,779.51
Rate for Payer: Humana Medicare	$15,779.51
Rate for Payer: Kaiser Permanente Commercial	$23,930.92
Rate for Payer: Kaiser Permanente Medicare	$15,779.51
Rate for Payer: Ohana Health Plan Medicare	$15,779.51
Rate for Payer: UnitedHealthcare Medicare	$15,779.51

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

IP

$19,208.91

Service Code	APR-DRG 5144
Min. Negotiated Rate	$19,208.91
Max. Negotiated Rate	$19,208.91
Rate for Payer: AlohaCare Medicaid	$19,208.91
Rate for Payer: Hawaii Medical Service Association ABD	$19,208.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,208.91
Rate for Payer: Kaiser Permanente Medicaid	$19,208.91
Rate for Payer: Ohana Health Plan Medicaid	$19,208.91
Rate for Payer: UnitedHealthcare Medicaid	$19,208.91

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

IP

$4,086.52

Service Code	APR-DRG 5141
Min. Negotiated Rate	$4,086.52
Max. Negotiated Rate	$4,086.52
Rate for Payer: AlohaCare Medicaid	$4,086.52
Rate for Payer: Hawaii Medical Service Association ABD	$4,086.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,086.52
Rate for Payer: Kaiser Permanente Medicaid	$4,086.52
Rate for Payer: Ohana Health Plan Medicaid	$4,086.52
Rate for Payer: UnitedHealthcare Medicaid	$4,086.52

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

IP

$5,995.73

Service Code	APR-DRG 5142
Min. Negotiated Rate	$5,995.73
Max. Negotiated Rate	$5,995.73
Rate for Payer: AlohaCare Medicaid	$5,995.73
Rate for Payer: Hawaii Medical Service Association ABD	$5,995.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,995.73
Rate for Payer: Kaiser Permanente Medicaid	$5,995.73
Rate for Payer: Ohana Health Plan Medicaid	$5,995.73
Rate for Payer: UnitedHealthcare Medicaid	$5,995.73

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

IP

$10,958.25

Service Code	APR-DRG 5143
Min. Negotiated Rate	$10,958.25
Max. Negotiated Rate	$10,958.25
Rate for Payer: AlohaCare Medicaid	$10,958.25
Rate for Payer: Hawaii Medical Service Association ABD	$10,958.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,958.25
Rate for Payer: Kaiser Permanente Medicaid	$10,958.25
Rate for Payer: Ohana Health Plan Medicaid	$10,958.25
Rate for Payer: UnitedHealthcare Medicaid	$10,958.25

FEM CNL PRESS MED 206-566-000

Facility

IP

$138.00

Hospital Revenue Code	272
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: MDX Hawaii PPO	$133.86

FEM CNL PRESS MED 206-566-000

Facility

OP

$138.00

Hospital Revenue Code	272
Min. Negotiated Rate	$70.38
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Hawaii Western Management Group Commercial	$131.10
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$86.94
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: University Health Alliance Commercial	$100.59

FEM HEAD 36/+0 00-8775-036-02

Facility

IP

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM HEAD 36/+0 00-8775-036-02

Facility

OP

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$1,638.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM HEAD 40/+0 00-8775-040-02

Facility

IP

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM HEAD 40/+0 00-8775-040-02

Facility

OP

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$1,638.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM HED 36/-3.5 00-8775-036-01

Facility

OP

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$1,638.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM HED 36/-3.5 00-8775-036-01

Facility

IP

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM KNE SZ:D/RT 00-5956-014-02

Facility

IP

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEM KNE SZ:D/RT 00-5956-014-02

Facility

OP

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEMORAL #6 RETAIN 5517-F-602

Facility

IP

$5,947.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,330.32
Max. Negotiated Rate	$5,768.59
Rate for Payer: Cash Price	$3,568.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,162.90
Rate for Payer: Health Management Network Commercial	$5,054.95
Rate for Payer: MDX Hawaii PPO	$5,768.59
Rate for Payer: University Health Alliance Commercial	$3,330.32

FEMORAL #6 RETAIN 5517-F-602

Facility

OP

$5,947.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,032.97
Max. Negotiated Rate	$5,768.59
Rate for Payer: Cash Price	$3,568.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,162.90
Rate for Payer: Health Management Network Commercial	$5,054.95
Rate for Payer: Kaiser Permanente Commercial	$3,746.61
Rate for Payer: Kaiser Permanente Medicaid	$3,032.97
Rate for Payer: MDX Hawaii PPO	$5,768.59
Rate for Payer: University Health Alliance Commercial	$3,330.32

FEMORAL 8MM LEFT PS 5516-F-801

Facility

OP

$16,152.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,237.52
Max. Negotiated Rate	$15,667.44
Rate for Payer: Cash Price	$9,691.20
Rate for Payer: Hawaii Western Management Group Commercial	$11,306.40
Rate for Payer: Health Management Network Commercial	$13,729.20
Rate for Payer: Kaiser Permanente Commercial	$10,175.76
Rate for Payer: Kaiser Permanente Medicaid	$8,237.52
Rate for Payer: MDX Hawaii PPO	$15,667.44
Rate for Payer: University Health Alliance Commercial	$9,045.12

FEMORAL 8MM LEFT PS 5516-F-801

Facility

IP

$16,152.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,045.12
Max. Negotiated Rate	$15,667.44
Rate for Payer: Cash Price	$9,691.20
Rate for Payer: Hawaii Western Management Group Commercial	$11,306.40
Rate for Payer: Health Management Network Commercial	$13,729.20
Rate for Payer: MDX Hawaii PPO	$15,667.44
Rate for Payer: University Health Alliance Commercial	$9,045.12

FEMORAL AUGMENT LF 5541-A-201

Facility

OP

$2,438.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,243.38
Max. Negotiated Rate	$2,364.86
Rate for Payer: Cash Price	$1,462.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,706.60
Rate for Payer: Health Management Network Commercial	$2,072.30
Rate for Payer: Kaiser Permanente Commercial	$1,535.94
Rate for Payer: Kaiser Permanente Medicaid	$1,243.38
Rate for Payer: MDX Hawaii PPO	$2,364.86
Rate for Payer: University Health Alliance Commercial	$1,365.28

FEMORAL AUGMENT LF 5541-A-201

Facility

IP

$2,438.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.28
Max. Negotiated Rate	$2,364.86
Rate for Payer: Cash Price	$1,462.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,706.60
Rate for Payer: Health Management Network Commercial	$2,072.30
Rate for Payer: MDX Hawaii PPO	$2,364.86
Rate for Payer: University Health Alliance Commercial	$1,365.28

FEMORAL CEMENT SZ6 1504-00-206

Facility

IP

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEMORAL CEMENT SZ6 1504-00-206

Facility

OP

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEMORAL CEMENT SZ6 1504-10-206

Facility

IP

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

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