Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH

Facility

$28,363.00

Service Code	HCPCS 92920
Hospital Charge Code	4819292001
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$27,512.11
Rate for Payer: AlohaCare Medicaid	$6,723.70
Rate for Payer: AlohaCare Medicare	$6,723.70
Rate for Payer: Cash Price	$17,017.80
Rate for Payer: Cash Price	$17,017.80
Rate for Payer: Cash Price	$17,017.80
Rate for Payer: Devoted Health Medicare	$7,396.07
Rate for Payer: Hawaii Medical Service Association ABD	$2,102.00
Rate for Payer: Hawaii Medical Service Association Commercial	$19,192.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,723.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,561.00
Rate for Payer: Hawaii Western Management Group Commercial	$26,944.85
Rate for Payer: Health Management Network Commercial	$24,108.55
Rate for Payer: Humana Medicare	$6,723.70
Rate for Payer: Kaiser Permanente Commercial	$17,868.69
Rate for Payer: Kaiser Permanente Medicaid	$14,465.13
Rate for Payer: Kaiser Permanente Medicare	$6,723.70
Rate for Payer: MDX Hawaii PPO	$27,512.11
Rate for Payer: Ohana Health Plan Medicaid	$7,396.07
Rate for Payer: Ohana Health Plan Medicare	$6,723.70
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,723.70
Rate for Payer: University Health Alliance Commercial	$20,673.79

HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH

Facility

$28,363.00

Service Code	HCPCS 92920
Hospital Charge Code	4819292001
Hospital Revenue Code	481
Min. Negotiated Rate	$24,108.55
Max. Negotiated Rate	$27,512.11
Rate for Payer: Cash Price	$17,017.80
Rate for Payer: Health Management Network Commercial	$24,108.55
Rate for Payer: MDX Hawaii PPO	$27,512.11

HC CATH PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL

Facility

$56,414.00

Service Code	HCPCS 92943
Hospital Charge Code	4819294301
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$54,721.58
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Devoted Health Medicare	$15,001.44
Rate for Payer: Hawaii Medical Service Association ABD	$2,102.00
Rate for Payer: Hawaii Medical Service Association Commercial	$19,192.00
Rate for Payer: Hawaii Medical Service Association Medicare	$13,637.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,561.00
Rate for Payer: Hawaii Western Management Group Commercial	$53,593.30
Rate for Payer: Health Management Network Commercial	$47,951.90
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$35,540.82
Rate for Payer: Kaiser Permanente Medicaid	$28,771.14
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$54,721.58
Rate for Payer: Ohana Health Plan Medicaid	$15,001.44
Rate for Payer: Ohana Health Plan Medicare	$13,637.67
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$13,637.67
Rate for Payer: University Health Alliance Commercial	$24,500.00

HC CATH PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL

Facility

$56,414.00

Service Code	HCPCS 92943
Hospital Charge Code	4819294301
Hospital Revenue Code	481
Min. Negotiated Rate	$47,951.90
Max. Negotiated Rate	$54,721.58
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Health Management Network Commercial	$47,951.90
Rate for Payer: MDX Hawaii PPO	$54,721.58

HC CATH REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION

Facility

$4,513.00

Service Code	HCPCS 33992
Hospital Charge Code	3603399201
Hospital Revenue Code	360
Min. Negotiated Rate	$124.06
Max. Negotiated Rate	$4,377.61
Rate for Payer: Cash Price	$2,707.80
Rate for Payer: Cash Price	$2,707.80
Rate for Payer: Cash Price	$2,707.80
Rate for Payer: Health Management Network Commercial	$3,836.05
Rate for Payer: Kaiser Permanente Commercial	$2,843.19
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$4,377.61
Rate for Payer: UnitedHealthcare Medicaid	$124.06
Rate for Payer: University Health Alliance Commercial	$3,289.53

HC CATH REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION

Facility

$4,513.00

Service Code	HCPCS 33992
Hospital Charge Code	3603399201
Hospital Revenue Code	360
Min. Negotiated Rate	$3,836.05
Max. Negotiated Rate	$4,377.61
Rate for Payer: Cash Price	$2,707.80
Rate for Payer: Health Management Network Commercial	$3,836.05
Rate for Payer: MDX Hawaii PPO	$4,377.61

HC CATH RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT

Facility

$16,000.00

Service Code	HCPCS 93451
Hospital Charge Code	4819345101
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$15,520.00
Rate for Payer: AlohaCare Medicaid	$3,829.84
Rate for Payer: AlohaCare Medicare	$3,829.84
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Devoted Health Medicare	$4,212.82
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	$3,829.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$15,200.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: Humana Medicare	$3,829.84
Rate for Payer: Kaiser Permanente Commercial	$10,080.00
Rate for Payer: Kaiser Permanente Medicaid	$8,160.00
Rate for Payer: Kaiser Permanente Medicare	$3,829.84
Rate for Payer: MDX Hawaii PPO	$15,520.00
Rate for Payer: Ohana Health Plan Medicaid	$4,212.82
Rate for Payer: Ohana Health Plan Medicare	$3,829.84
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$3,829.84
Rate for Payer: University Health Alliance Commercial	$11,662.40

HC CATH RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT

Facility

$16,000.00

Service Code	HCPCS 93451
Hospital Charge Code	4819345101
Hospital Revenue Code	481
Min. Negotiated Rate	$13,600.00
Max. Negotiated Rate	$15,520.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: MDX Hawaii PPO	$15,520.00

HC CATH RIGHT & LEFT HEART CATH INJECT VETRICULOGRAPHY, IMAGE SUPERVISE/INTERP

Facility

$16,000.00

Service Code	HCPCS 93453
Hospital Charge Code	4819345301
Hospital Revenue Code	481
Min. Negotiated Rate	$13,600.00
Max. Negotiated Rate	$15,520.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: MDX Hawaii PPO	$15,520.00

HC CATH RIGHT & LEFT HEART CATH INJECT VETRICULOGRAPHY, IMAGE SUPERVISE/INTERP

Facility

$16,000.00

Service Code	HCPCS 93453
Hospital Charge Code	4819345301
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$15,520.00
Rate for Payer: AlohaCare Medicaid	$3,829.84
Rate for Payer: AlohaCare Medicare	$3,829.84
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Devoted Health Medicare	$4,212.82
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,395.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,829.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Hawaii Western Management Group Commercial	$15,200.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: Humana Medicare	$3,829.84
Rate for Payer: Kaiser Permanente Commercial	$10,080.00
Rate for Payer: Kaiser Permanente Medicaid	$8,160.00
Rate for Payer: Kaiser Permanente Medicare	$3,829.84
Rate for Payer: MDX Hawaii PPO	$15,520.00
Rate for Payer: Ohana Health Plan Medicaid	$4,212.82
Rate for Payer: Ohana Health Plan Medicare	$3,829.84
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$3,829.84
Rate for Payer: University Health Alliance Commercial	$11,662.40

HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST

Facility

$885.00

Service Code	HCPCS 71270
Hospital Charge Code	3527127001
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$858.45
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$291.10
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$316.52
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$752.25
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$557.55
Rate for Payer: Kaiser Permanente Medicaid	$451.35
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$858.45
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$291.10
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$799.87

HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST

Facility

$885.00

Service Code	HCPCS 71270
Hospital Charge Code	3527127001
Hospital Revenue Code	352
Min. Negotiated Rate	$752.25
Max. Negotiated Rate	$858.45
Rate for Payer: Cash Price	$531.00
Rate for Payer: Health Management Network Commercial	$752.25
Rate for Payer: MDX Hawaii PPO	$858.45

HC CAT SCAN OF CHEST CONTRAST - CT CHEST W CONTRAST

Facility

$885.00

Service Code	HCPCS 71260
Hospital Charge Code	3527126002
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$858.45
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$232.90
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$253.12
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$752.25
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$557.55
Rate for Payer: Kaiser Permanente Medicaid	$451.35
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$858.45
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$686.18

HC CAT SCAN OF CHEST CONTRAST - CT CHEST W CONTRAST

Facility

$885.00

Service Code	HCPCS 71260
Hospital Charge Code	3527126002
Hospital Revenue Code	352
Min. Negotiated Rate	$752.25
Max. Negotiated Rate	$858.45
Rate for Payer: Cash Price	$531.00
Rate for Payer: Health Management Network Commercial	$752.25
Rate for Payer: MDX Hawaii PPO	$858.45

HC C DIFF AMP PROBE/CDT

Facility

$313.00

Service Code	HCPCS 87493
Hospital Charge Code	3068749302
Hospital Revenue Code	306
Min. Negotiated Rate	$37.27
Max. Negotiated Rate	$303.61
Rate for Payer: AlohaCare Medicaid	$37.27
Rate for Payer: AlohaCare Medicare	$37.27
Rate for Payer: Cash Price	$187.80
Rate for Payer: Cash Price	$187.80
Rate for Payer: Devoted Health Medicare	$41.00
Rate for Payer: Hawaii Medical Service Association ABD	$50.27
Rate for Payer: Hawaii Medical Service Association Commercial	$46.59
Rate for Payer: Hawaii Medical Service Association Medicare	$37.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$37.27
Rate for Payer: Health Management Network Commercial	$266.05
Rate for Payer: Humana Medicare	$37.27
Rate for Payer: Kaiser Permanente Commercial	$197.19
Rate for Payer: Kaiser Permanente Medicaid	$159.63
Rate for Payer: Kaiser Permanente Medicare	$37.27
Rate for Payer: MDX Hawaii PPO	$303.61
Rate for Payer: Ohana Health Plan Medicaid	$41.00
Rate for Payer: Ohana Health Plan Medicare	$37.27
Rate for Payer: UnitedHealthcare Medicaid	$50.27
Rate for Payer: UnitedHealthcare Medicare	$37.27
Rate for Payer: University Health Alliance Commercial	$93.00

HC C DIFF AMP PROBE/CDT

Facility

$313.00

Service Code	HCPCS 87493
Hospital Charge Code	3068749302
Hospital Revenue Code	306
Min. Negotiated Rate	$266.05
Max. Negotiated Rate	$303.61
Rate for Payer: Cash Price	$187.80
Rate for Payer: Health Management Network Commercial	$266.05
Rate for Payer: MDX Hawaii PPO	$303.61

HC C DIFF AMP PROBE/TCDB

Facility

$313.00

Service Code	HCPCS 87493
Hospital Charge Code	3068749301
Hospital Revenue Code	306
Min. Negotiated Rate	$37.27
Max. Negotiated Rate	$303.61
Rate for Payer: AlohaCare Medicaid	$37.27
Rate for Payer: AlohaCare Medicare	$37.27
Rate for Payer: Cash Price	$187.80
Rate for Payer: Cash Price	$187.80
Rate for Payer: Devoted Health Medicare	$41.00
Rate for Payer: Hawaii Medical Service Association ABD	$50.27
Rate for Payer: Hawaii Medical Service Association Commercial	$46.59
Rate for Payer: Hawaii Medical Service Association Medicare	$37.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$37.27
Rate for Payer: Health Management Network Commercial	$266.05
Rate for Payer: Humana Medicare	$37.27
Rate for Payer: Kaiser Permanente Commercial	$197.19
Rate for Payer: Kaiser Permanente Medicaid	$159.63
Rate for Payer: Kaiser Permanente Medicare	$37.27
Rate for Payer: MDX Hawaii PPO	$303.61
Rate for Payer: Ohana Health Plan Medicaid	$41.00
Rate for Payer: Ohana Health Plan Medicare	$37.27
Rate for Payer: UnitedHealthcare Medicaid	$50.27
Rate for Payer: UnitedHealthcare Medicare	$37.27
Rate for Payer: University Health Alliance Commercial	$93.00

HC C DIFF AMP PROBE/TCDB

Facility

$313.00

Service Code	HCPCS 87493
Hospital Charge Code	3068749301
Hospital Revenue Code	306
Min. Negotiated Rate	$266.05
Max. Negotiated Rate	$303.61
Rate for Payer: Cash Price	$187.80
Rate for Payer: Health Management Network Commercial	$266.05
Rate for Payer: MDX Hawaii PPO	$303.61

HC CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY

Facility

$2,678.00

Service Code	HCPCS 78635
Hospital Charge Code	3407863501
Hospital Revenue Code	340
Min. Negotiated Rate	$84.10
Max. Negotiated Rate	$2,597.66
Rate for Payer: AlohaCare Medicaid	$641.43
Rate for Payer: AlohaCare Medicare	$641.43
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Devoted Health Medicare	$705.57
Rate for Payer: Hawaii Medical Service Association ABD	$84.10
Rate for Payer: Hawaii Medical Service Association Commercial	$801.79
Rate for Payer: Hawaii Medical Service Association Medicare	$641.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$91.20
Rate for Payer: Hawaii Western Management Group Commercial	$641.43
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Humana Medicare	$641.43
Rate for Payer: Kaiser Permanente Commercial	$1,687.14
Rate for Payer: Kaiser Permanente Medicaid	$1,365.78
Rate for Payer: Kaiser Permanente Medicare	$641.43
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: Ohana Health Plan Medicaid	$705.57
Rate for Payer: Ohana Health Plan Medicare	$641.43
Rate for Payer: UnitedHealthcare Medicaid	$84.10
Rate for Payer: UnitedHealthcare Medicare	$641.43
Rate for Payer: University Health Alliance Commercial	$510.14

HC CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY

Facility

$2,678.00

Service Code	HCPCS 78635
Hospital Charge Code	3407863501
Hospital Revenue Code	340
Min. Negotiated Rate	$2,276.30
Max. Negotiated Rate	$2,597.66
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: MDX Hawaii PPO	$2,597.66

HC CHANGE OF BLADDER TUBE,SIMPLE

Facility

$968.00

Service Code	HCPCS 51705
Hospital Charge Code	3615170501
Hospital Revenue Code	361
Min. Negotiated Rate	$49.55
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$295.16
Rate for Payer: AlohaCare Medicare	$295.16
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$580.80
Rate for Payer: Devoted Health Medicare	$324.68
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	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$822.80
Rate for Payer: Humana Medicare	$295.16
Rate for Payer: Kaiser Permanente Commercial	$609.84
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$295.16
Rate for Payer: MDX Hawaii PPO	$938.96
Rate for Payer: Ohana Health Plan Medicaid	$324.68
Rate for Payer: Ohana Health Plan Medicare	$295.16
Rate for Payer: UnitedHealthcare Medicaid	$49.55
Rate for Payer: UnitedHealthcare Medicare	$295.16
Rate for Payer: University Health Alliance Commercial	$705.58

HC CHANGE OF BLADDER TUBE,SIMPLE

Facility

$968.00

Service Code	HCPCS 51705
Hospital Charge Code	3615170501
Hospital Revenue Code	361
Min. Negotiated Rate	$822.80
Max. Negotiated Rate	$938.96
Rate for Payer: Cash Price	$580.80
Rate for Payer: Health Management Network Commercial	$822.80
Rate for Payer: MDX Hawaii PPO	$938.96

HC CHANGE OF CYSTOSTOMY TUBE; COMPLICATED

Facility

$2,656.00

Service Code	HCPCS 51710
Hospital Charge Code	4505171001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$823.75
Rate for Payer: AlohaCare Medicare	$823.75
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Devoted Health Medicare	$906.12
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	$823.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.20
Rate for Payer: Health Management Network Commercial	$2,257.60
Rate for Payer: Humana Medicare	$823.75
Rate for Payer: Kaiser Permanente Commercial	$1,673.28
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$823.75
Rate for Payer: MDX Hawaii PPO	$2,576.32
Rate for Payer: Ohana Health Plan Medicaid	$906.12
Rate for Payer: Ohana Health Plan Medicare	$823.75
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$823.75
Rate for Payer: University Health Alliance Commercial	$1,935.96

HC CHANGE OF CYSTOSTOMY TUBE; COMPLICATED

Facility

$2,656.00

Service Code	HCPCS 51710
Hospital Charge Code	4505171001
Hospital Revenue Code	450
Min. Negotiated Rate	$2,257.60
Max. Negotiated Rate	$2,576.32
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Health Management Network Commercial	$2,257.60
Rate for Payer: MDX Hawaii PPO	$2,576.32

HC CHEMICAL PLEURODESIS FOR PERSISTENT PNEUMOTHORAX

Facility

$2,460.00

Service Code	HCPCS 32560
Hospital Charge Code	3613256001
Hospital Revenue Code	361
Min. Negotiated Rate	$2,091.00
Max. Negotiated Rate	$2,386.20
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: MDX Hawaii PPO	$2,386.20

Know your out-of-pocket cost for care.

All Charges