Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS

Facility

$2,800.00

Service Code	HCPCS 69020
Hospital Charge Code	4506902001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$920.21
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	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$2,716.00
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
Rate for Payer: University Health Alliance Commercial	$2,040.92

HC DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED

Facility

$1,984.00

Service Code	HCPCS 40801
Hospital Charge Code	4504080101
Hospital Revenue Code	450
Min. Negotiated Rate	$637.13
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$637.13
Rate for Payer: AlohaCare Medicare	$637.13
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Devoted Health Medicare	$700.84
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	$637.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,884.80
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: Humana Medicare	$637.13
Rate for Payer: Kaiser Permanente Commercial	$1,249.92
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$637.13
Rate for Payer: MDX Hawaii PPO	$1,924.48
Rate for Payer: Ohana Health Plan Medicaid	$700.84
Rate for Payer: Ohana Health Plan Medicare	$637.13
Rate for Payer: UnitedHealthcare Medicare	$637.13
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED

Facility

$1,984.00

Service Code	HCPCS 40801
Hospital Charge Code	4504080101
Hospital Revenue Code	450
Min. Negotiated Rate	$1,686.40
Max. Negotiated Rate	$1,924.48
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: MDX Hawaii PPO	$1,924.48

HC DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; FLOOR OF MOUTH

Facility

$2,027.00

Service Code	HCPCS 41000
Hospital Charge Code	4504100001
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$637.13
Rate for Payer: AlohaCare Medicare	$637.13
Rate for Payer: Cash Price	$1,216.20
Rate for Payer: Cash Price	$1,216.20
Rate for Payer: Cash Price	$1,216.20
Rate for Payer: Devoted Health Medicare	$700.84
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	$637.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,925.65
Rate for Payer: Health Management Network Commercial	$1,722.95
Rate for Payer: Humana Medicare	$637.13
Rate for Payer: Kaiser Permanente Commercial	$1,277.01
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$637.13
Rate for Payer: MDX Hawaii PPO	$1,966.19
Rate for Payer: Ohana Health Plan Medicaid	$700.84
Rate for Payer: Ohana Health Plan Medicare	$637.13
Rate for Payer: UnitedHealthcare Medicare	$637.13
Rate for Payer: University Health Alliance Commercial	$1,477.48

HC DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; FLOOR OF MOUTH

Facility

$2,027.00

Service Code	HCPCS 41000
Hospital Charge Code	4504100001
Hospital Revenue Code	450
Min. Negotiated Rate	$1,722.95
Max. Negotiated Rate	$1,966.19
Rate for Payer: Cash Price	$1,216.20
Rate for Payer: Health Management Network Commercial	$1,722.95
Rate for Payer: MDX Hawaii PPO	$1,966.19

HC DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; SUBMANDIBULAR SPACE

Facility

$12,637.00

Service Code	HCPCS 41008
Hospital Charge Code	4504100801
Hospital Revenue Code	450
Min. Negotiated Rate	$10,741.45
Max. Negotiated Rate	$12,257.89
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Health Management Network Commercial	$10,741.45
Rate for Payer: MDX Hawaii PPO	$12,257.89

HC DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; SUBMANDIBULAR SPACE

Facility

$12,637.00

Service Code	HCPCS 41008
Hospital Charge Code	4504100801
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$12,257.89
Rate for Payer: AlohaCare Medicaid	$3,916.70
Rate for Payer: AlohaCare Medicare	$3,916.70
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Devoted Health Medicare	$4,308.37
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	$3,916.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$12,005.15
Rate for Payer: Health Management Network Commercial	$10,741.45
Rate for Payer: Humana Medicare	$3,916.70
Rate for Payer: Kaiser Permanente Commercial	$7,961.31
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,916.70
Rate for Payer: MDX Hawaii PPO	$12,257.89
Rate for Payer: Ohana Health Plan Medicaid	$4,308.37
Rate for Payer: Ohana Health Plan Medicare	$3,916.70
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,916.70
Rate for Payer: University Health Alliance Commercial	$9,211.11

HC DRAINAGE OF EYELID ABSCESS

Facility

$1,190.00

Service Code	HCPCS 67700
Hospital Charge Code	4506770001
Hospital Revenue Code	450
Min. Negotiated Rate	$1,011.50
Max. Negotiated Rate	$1,154.30
Rate for Payer: Cash Price	$714.00
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: MDX Hawaii PPO	$1,154.30

HC DRAINAGE OF EYELID ABSCESS

Facility

$1,190.00

Service Code	HCPCS 67700
Hospital Charge Code	4506770001
Hospital Revenue Code	450
Min. Negotiated Rate	$374.96
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$374.96
Rate for Payer: AlohaCare Medicare	$374.96
Rate for Payer: Cash Price	$714.00
Rate for Payer: Cash Price	$714.00
Rate for Payer: Cash Price	$714.00
Rate for Payer: Cash Price	$714.00
Rate for Payer: Devoted Health Medicare	$412.46
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	$374.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,130.50
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: Humana Medicare	$374.96
Rate for Payer: Kaiser Permanente Commercial	$749.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$374.96
Rate for Payer: MDX Hawaii PPO	$1,154.30
Rate for Payer: Ohana Health Plan Medicaid	$412.46
Rate for Payer: Ohana Health Plan Medicare	$374.96
Rate for Payer: UnitedHealthcare Medicare	$374.96
Rate for Payer: University Health Alliance Commercial	$867.39

HC DRAINAGE OF GUM LESION

Facility

$513.00

Service Code	HCPCS 41800
Hospital Charge Code	4504180001
Hospital Revenue Code	450
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC DRAINAGE OF GUM LESION

Facility

$513.00

Service Code	HCPCS 41800
Hospital Charge Code	4504180001
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
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	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC DRAINAGE OF HEMATOMA/FLUID

Facility

$6,448.00

Service Code	HCPCS 10140
Hospital Charge Code	4501014001
Hospital Revenue Code	450
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC DRAINAGE OF HEMATOMA/FLUID

Facility

$6,448.00

Service Code	HCPCS 10140
Hospital Charge Code	4501014001
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.60
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC DRAINAGE OF NASAL ABSCESS

Facility

$924.00

Service Code	HCPCS 30000
Hospital Charge Code	4503000001
Hospital Revenue Code	450
Min. Negotiated Rate	$785.40
Max. Negotiated Rate	$896.28
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Management Network Commercial	$785.40
Rate for Payer: MDX Hawaii PPO	$896.28

HC DRAINAGE OF NASAL ABSCESS

Facility

$924.00

Service Code	HCPCS 30000
Hospital Charge Code	4503000001
Hospital Revenue Code	450
Min. Negotiated Rate	$279.80
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$279.80
Rate for Payer: AlohaCare Medicare	$279.80
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Devoted Health Medicare	$307.78
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	$279.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$877.80
Rate for Payer: Health Management Network Commercial	$785.40
Rate for Payer: Humana Medicare	$279.80
Rate for Payer: Kaiser Permanente Commercial	$582.12
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$279.80
Rate for Payer: MDX Hawaii PPO	$896.28
Rate for Payer: Ohana Health Plan Medicaid	$307.78
Rate for Payer: Ohana Health Plan Medicare	$279.80
Rate for Payer: UnitedHealthcare Medicare	$279.80
Rate for Payer: University Health Alliance Commercial	$673.50

HC DRAINAGE OF NASAL SEPTAL ABSCESS

Facility

$2,027.00

Service Code	HCPCS 30020
Hospital Charge Code	4503002001
Hospital Revenue Code	450
Min. Negotiated Rate	$1,722.95
Max. Negotiated Rate	$1,966.19
Rate for Payer: Cash Price	$1,216.20
Rate for Payer: Health Management Network Commercial	$1,722.95
Rate for Payer: MDX Hawaii PPO	$1,966.19

HC DRAINAGE OF NASAL SEPTAL ABSCESS

Facility

$2,027.00

Service Code	HCPCS 30020
Hospital Charge Code	4503002001
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,966.19
Rate for Payer: AlohaCare Medicaid	$637.13
Rate for Payer: AlohaCare Medicare	$637.13
Rate for Payer: Cash Price	$1,216.20
Rate for Payer: Cash Price	$1,216.20
Rate for Payer: Cash Price	$1,216.20
Rate for Payer: Cash Price	$1,216.20
Rate for Payer: Devoted Health Medicare	$700.84
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	$637.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,925.65
Rate for Payer: Health Management Network Commercial	$1,722.95
Rate for Payer: Humana Medicare	$637.13
Rate for Payer: Kaiser Permanente Commercial	$1,277.01
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$637.13
Rate for Payer: MDX Hawaii PPO	$1,966.19
Rate for Payer: Ohana Health Plan Medicaid	$700.84
Rate for Payer: Ohana Health Plan Medicare	$637.13
Rate for Payer: UnitedHealthcare Medicare	$637.13
Rate for Payer: University Health Alliance Commercial	$1,477.48

HC DRAINAGE SCROTAL WALL ABSCESS

Facility

$6,448.00

Service Code	HCPCS 55100
Hospital Charge Code	4505510001
Hospital Revenue Code	450
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC DRAINAGE SCROTAL WALL ABSCESS

Facility

$6,448.00

Service Code	HCPCS 55100
Hospital Charge Code	4505510001
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.60
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC DRAIN BLOOD FROM UNDER NAIL

Facility

$513.00

Service Code	HCPCS 11740
Hospital Charge Code	4501174001
Hospital Revenue Code	450
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC DRAIN BLOOD FROM UNDER NAIL

Facility

$513.00

Service Code	HCPCS 11740
Hospital Charge Code	4501174001
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
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	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC DRAIN EXT EAR ABSC/BLOOD,COMPLIC

Facility

$6,448.00

Service Code	HCPCS 69005
Hospital Charge Code	7616900501
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.60
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC DRAIN EXT EAR ABSC/BLOOD,COMPLIC

Facility

$6,448.00

Service Code	HCPCS 69005
Hospital Charge Code	7616900501
Hospital Revenue Code	450
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC DRAIN EXT EAR ABSC/BLOOD,SIMPLE

Facility

$2,800.00

Service Code	HCPCS 69000
Hospital Charge Code	4506900001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$920.21
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	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$2,716.00
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
Rate for Payer: University Health Alliance Commercial	$2,040.92

HC DRAIN EXT EAR ABSC/BLOOD,SIMPLE

Facility

$2,800.00

Service Code	HCPCS 69000
Hospital Charge Code	4506900001
Hospital Revenue Code	450
Min. Negotiated Rate	$2,380.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00

Know your out-of-pocket cost for care.

All Charges