Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US

Facility

$1,175.00

Service Code	HCPCS 20605
Hospital Charge Code	3612060501
Hospital Revenue Code	361
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US

Facility

$2,756.00

Service Code	HCPCS 20606
Hospital Charge Code	7612060601
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,673.32
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$917.28
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,618.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$1,736.28
Rate for Payer: Kaiser Permanente Medicaid	$1,405.56
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$2,008.85

HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US

Facility

$2,756.00

Service Code	HCPCS 20606
Hospital Charge Code	7612060601
Hospital Revenue Code	761
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: MDX Hawaii PPO	$2,673.32

HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US

Facility

$2,756.00

Service Code	HCPCS 20606
Hospital Charge Code	3612060601
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$917.28
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$1,736.28
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$2,008.85

HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US

Facility

$2,756.00

Service Code	HCPCS 20606
Hospital Charge Code	3612060601
Hospital Revenue Code	361
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: MDX Hawaii PPO	$2,673.32

HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US

Facility

$1,175.00

Service Code	HCPCS 20610
Hospital Charge Code	3612061001
Hospital Revenue Code	361
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US

Facility

$1,175.00

Service Code	HCPCS 20610
Hospital Charge Code	3612061001
Hospital Revenue Code	361
Min. Negotiated Rate	$48.79
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$48.79
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US

Facility

$1,175.00

Service Code	HCPCS 20611
Hospital Charge Code	7612061101
Hospital Revenue Code	761
Min. Negotiated Rate	$58.92
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,116.25
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$599.25
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$58.92
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US

Facility

$1,175.00

Service Code	HCPCS 20611
Hospital Charge Code	7612061101
Hospital Revenue Code	761
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US

Facility

$1,175.00

Service Code	HCPCS 20611
Hospital Charge Code	3612061101
Hospital Revenue Code	361
Min. Negotiated Rate	$58.92
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$58.92
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US

Facility

$1,175.00

Service Code	HCPCS 20611
Hospital Charge Code	3612061101
Hospital Revenue Code	361
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US

Facility

$1,175.00

Service Code	HCPCS 20600
Hospital Charge Code	7612060001
Hospital Revenue Code	761
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$1,139.75
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association Commercial	$453.27
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,116.25
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$599.25
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$40.93
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$856.46

HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US

Facility

$1,175.00

Service Code	HCPCS 20600
Hospital Charge Code	7612060001
Hospital Revenue Code	761
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US

Facility

$1,175.00

Service Code	HCPCS 20600
Hospital Charge Code	3612060001
Hospital Revenue Code	361
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association Commercial	$453.27
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$40.93
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$856.46

HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US

Facility

$1,175.00

Service Code	HCPCS 20600
Hospital Charge Code	3612060001
Hospital Revenue Code	361
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT

Facility

$1,175.00

Service Code	HCPCS 20604
Hospital Charge Code	3612060401
Hospital Revenue Code	450
Min. Negotiated Rate	$362.62
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,116.25
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$856.46

HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT

Facility

$1,175.00

Service Code	HCPCS 20604
Hospital Charge Code	3612060401
Hospital Revenue Code	450
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT

Facility

$1,175.00

Service Code	HCPCS 20604
Hospital Charge Code	3612060401
Hospital Revenue Code	361
Min. Negotiated Rate	$45.64
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association Commercial	$453.27
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$45.64
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$856.46

HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT

Facility

$1,175.00

Service Code	HCPCS 20604
Hospital Charge Code	3612060401
Hospital Revenue Code	361
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC ARTHROGRAM OF ANKLE - XR ANKLE ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73615
Hospital Charge Code	3227361501
Hospital Revenue Code	322
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC ARTHROGRAM OF ANKLE - XR ANKLE ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73615
Hospital Charge Code	3227361501
Hospital Revenue Code	322
Min. Negotiated Rate	$69.25
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$69.25
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.32
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$69.25
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$212.97

HC ARTHROGRAM OF ELBOW - XR ELBOW ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73085
Hospital Charge Code	3227308501
Hospital Revenue Code	322
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC ARTHROGRAM OF ELBOW - XR ELBOW ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73085
Hospital Charge Code	3227308501
Hospital Revenue Code	322
Min. Negotiated Rate	$69.25
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$69.25
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.32
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$69.25
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$206.85

HC ARTHROGRAM OF HIP - XR HIP ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73525
Hospital Charge Code	3227352501
Hospital Revenue Code	322
Min. Negotiated Rate	$69.25
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$69.25
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.32
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$69.25
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$206.57

HC ARTHROGRAM OF HIP - XR HIP ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73525
Hospital Charge Code	3227352501
Hospital Revenue Code	322
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

Know your out-of-pocket cost for care.

All Charges