Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC IAAD IA ROTAVIRUS - ROTAVIRUS ANTIGEN STOOL

Facility

$101.00

Service Code	HCPCS 87425
Hospital Charge Code	3068742501
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HC IAAD IA ROTAVIRUS - ROTAVIRUS ANTIGEN STOOL

Facility

$101.00

Service Code	HCPCS 87425
Hospital Charge Code	3068742501
Hospital Revenue Code	306
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: MDX Hawaii PPO	$97.97

HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HEP C QUANT SO

Facility

$359.00

Service Code	HCPCS 87522
Hospital Charge Code	3068752201
Hospital Revenue Code	306
Min. Negotiated Rate	$305.15
Max. Negotiated Rate	$348.23
Rate for Payer: Cash Price	$215.40
Rate for Payer: Health Management Network Commercial	$305.15
Rate for Payer: MDX Hawaii PPO	$348.23

HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HEP C QUANT SO

Facility

$359.00

Service Code	HCPCS 87522
Hospital Charge Code	3068752201
Hospital Revenue Code	306
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$348.23
Rate for Payer: AlohaCare Medicaid	$42.84
Rate for Payer: AlohaCare Medicare	$42.84
Rate for Payer: Cash Price	$215.40
Rate for Payer: Cash Price	$215.40
Rate for Payer: Devoted Health Medicare	$47.12
Rate for Payer: Hawaii Medical Service Association ABD	$59.20
Rate for Payer: Hawaii Medical Service Association Commercial	$53.55
Rate for Payer: Hawaii Medical Service Association Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$62.16
Rate for Payer: Hawaii Western Management Group Commercial	$42.84
Rate for Payer: Health Management Network Commercial	$305.15
Rate for Payer: Humana Medicare	$42.84
Rate for Payer: Kaiser Permanente Commercial	$226.17
Rate for Payer: Kaiser Permanente Medicaid	$183.09
Rate for Payer: Kaiser Permanente Medicare	$42.84
Rate for Payer: MDX Hawaii PPO	$348.23
Rate for Payer: Ohana Health Plan Medicaid	$47.12
Rate for Payer: Ohana Health Plan Medicare	$42.84
Rate for Payer: UnitedHealthcare Medicaid	$59.20
Rate for Payer: UnitedHealthcare Medicare	$42.84
Rate for Payer: University Health Alliance Commercial	$110.72

HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV HIGH RISK TYPES

Facility

$294.00

Service Code	HCPCS 87624
Hospital Charge Code	3068762402
Hospital Revenue Code	306
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.29
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.70
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$28.68
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$88.36

HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV HIGH RISK TYPES

Facility

$294.00

Service Code	HCPCS 87624
Hospital Charge Code	3068762402
Hospital Revenue Code	306
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - COVID ID POCT

Facility

$430.00

Service Code	HCPCS 87635
Hospital Charge Code	3068763504
Hospital Revenue Code	306
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$417.10
Rate for Payer: AlohaCare Medicaid	$51.31
Rate for Payer: AlohaCare Medicare	$51.31
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Devoted Health Medicare	$56.44
Rate for Payer: Hawaii Medical Service Association ABD	$51.31
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Medicare	$51.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.31
Rate for Payer: Hawaii Western Management Group Commercial	$51.31
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: Humana Medicare	$51.31
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$219.30
Rate for Payer: Kaiser Permanente Medicare	$51.31
Rate for Payer: MDX Hawaii PPO	$417.10
Rate for Payer: Ohana Health Plan Medicaid	$56.44
Rate for Payer: Ohana Health Plan Medicare	$51.31
Rate for Payer: UnitedHealthcare Medicaid	$51.31
Rate for Payer: UnitedHealthcare Medicare	$51.31
Rate for Payer: University Health Alliance Commercial	$94.96

HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - COVID ID POCT

Facility

$430.00

Service Code	HCPCS 87635
Hospital Charge Code	3068763504
Hospital Revenue Code	306
Min. Negotiated Rate	$365.50
Max. Negotiated Rate	$417.10
Rate for Payer: Cash Price	$258.00
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: MDX Hawaii PPO	$417.10

HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 AMP PR ABBOTT

Facility

$430.00

Service Code	HCPCS 87635
Hospital Charge Code	3068763503
Hospital Revenue Code	306
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$417.10
Rate for Payer: AlohaCare Medicaid	$51.31
Rate for Payer: AlohaCare Medicare	$51.31
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Devoted Health Medicare	$56.44
Rate for Payer: Hawaii Medical Service Association ABD	$51.31
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Medicare	$51.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.31
Rate for Payer: Hawaii Western Management Group Commercial	$51.31
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: Humana Medicare	$51.31
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$219.30
Rate for Payer: Kaiser Permanente Medicare	$51.31
Rate for Payer: MDX Hawaii PPO	$417.10
Rate for Payer: Ohana Health Plan Medicaid	$56.44
Rate for Payer: Ohana Health Plan Medicare	$51.31
Rate for Payer: UnitedHealthcare Medicaid	$51.31
Rate for Payer: UnitedHealthcare Medicare	$51.31
Rate for Payer: University Health Alliance Commercial	$94.96

HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 AMP PR ABBOTT

Facility

$430.00

Service Code	HCPCS 87635
Hospital Charge Code	3068763503
Hospital Revenue Code	306
Min. Negotiated Rate	$365.50
Max. Negotiated Rate	$417.10
Rate for Payer: Cash Price	$258.00
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: MDX Hawaii PPO	$417.10

HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 COVID19 AP PAN

Facility

$430.00

Service Code	HCPCS 87635
Hospital Charge Code	3068763502
Hospital Revenue Code	306
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$417.10
Rate for Payer: AlohaCare Medicaid	$51.31
Rate for Payer: AlohaCare Medicare	$51.31
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Devoted Health Medicare	$56.44
Rate for Payer: Hawaii Medical Service Association ABD	$51.31
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Medicare	$51.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.31
Rate for Payer: Hawaii Western Management Group Commercial	$51.31
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: Humana Medicare	$51.31
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$219.30
Rate for Payer: Kaiser Permanente Medicare	$51.31
Rate for Payer: MDX Hawaii PPO	$417.10
Rate for Payer: Ohana Health Plan Medicaid	$56.44
Rate for Payer: Ohana Health Plan Medicare	$51.31
Rate for Payer: UnitedHealthcare Medicaid	$51.31
Rate for Payer: UnitedHealthcare Medicare	$51.31
Rate for Payer: University Health Alliance Commercial	$94.96

HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 COVID19 AP PAN

Facility

$430.00

Service Code	HCPCS 87635
Hospital Charge Code	3068763502
Hospital Revenue Code	306
Min. Negotiated Rate	$365.50
Max. Negotiated Rate	$417.10
Rate for Payer: Cash Price	$258.00
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: MDX Hawaii PPO	$417.10

HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 RT PCR SO DLS

Facility

$430.00

Service Code	HCPCS 87635
Hospital Charge Code	3068763501
Hospital Revenue Code	306
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$417.10
Rate for Payer: AlohaCare Medicaid	$51.31
Rate for Payer: AlohaCare Medicare	$51.31
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Devoted Health Medicare	$56.44
Rate for Payer: Hawaii Medical Service Association ABD	$51.31
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Medicare	$51.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.31
Rate for Payer: Hawaii Western Management Group Commercial	$51.31
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: Humana Medicare	$51.31
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$219.30
Rate for Payer: Kaiser Permanente Medicare	$51.31
Rate for Payer: MDX Hawaii PPO	$417.10
Rate for Payer: Ohana Health Plan Medicaid	$56.44
Rate for Payer: Ohana Health Plan Medicare	$51.31
Rate for Payer: UnitedHealthcare Medicaid	$51.31
Rate for Payer: UnitedHealthcare Medicare	$51.31
Rate for Payer: University Health Alliance Commercial	$94.96

HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 RT PCR SO DLS

Facility

$430.00

Service Code	HCPCS 87635
Hospital Charge Code	3068763501
Hospital Revenue Code	306
Min. Negotiated Rate	$365.50
Max. Negotiated Rate	$417.10
Rate for Payer: Cash Price	$258.00
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: MDX Hawaii PPO	$417.10

HC ICU/CCU ROOM DAILY

Facility

$6,250.00

Hospital Charge Code	2000000001
Hospital Revenue Code	200
Min. Negotiated Rate	$5,312.50
Max. Negotiated Rate	$12,050.00
Rate for Payer: Cash Price	$3,750.00
Rate for Payer: Cash Price	$3,750.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,050.00
Rate for Payer: Health Management Network Commercial	$5,312.50
Rate for Payer: MDX Hawaii PPO	$6,062.50
Rate for Payer: University Health Alliance Commercial	$6,369.00

HC I&D BARTHOLIN GLAND ABSCESS

Facility

$801.00

Service Code	HCPCS 56420
Hospital Charge Code	7615642001
Hospital Revenue Code	761
Min. Negotiated Rate	$680.85
Max. Negotiated Rate	$776.97
Rate for Payer: Cash Price	$480.60
Rate for Payer: Health Management Network Commercial	$680.85
Rate for Payer: MDX Hawaii PPO	$776.97

HC I&D BARTHOLIN GLAND ABSCESS

Facility

$801.00

Service Code	HCPCS 56420
Hospital Charge Code	7615642001
Hospital Revenue Code	761
Min. Negotiated Rate	$63.97
Max. Negotiated Rate	$776.97
Rate for Payer: AlohaCare Medicaid	$238.83
Rate for Payer: AlohaCare Medicare	$238.83
Rate for Payer: Cash Price	$480.60
Rate for Payer: Cash Price	$480.60
Rate for Payer: Devoted Health Medicare	$262.71
Rate for Payer: Hawaii Medical Service Association Commercial	$298.54
Rate for Payer: Hawaii Medical Service Association Medicare	$238.83
Rate for Payer: Hawaii Western Management Group Commercial	$760.95
Rate for Payer: Health Management Network Commercial	$680.85
Rate for Payer: Humana Medicare	$238.83
Rate for Payer: Kaiser Permanente Commercial	$504.63
Rate for Payer: Kaiser Permanente Medicaid	$408.51
Rate for Payer: Kaiser Permanente Medicare	$238.83
Rate for Payer: MDX Hawaii PPO	$776.97
Rate for Payer: Ohana Health Plan Medicaid	$262.71
Rate for Payer: Ohana Health Plan Medicare	$238.83
Rate for Payer: UnitedHealthcare Medicaid	$63.97
Rate for Payer: UnitedHealthcare Medicare	$238.83
Rate for Payer: University Health Alliance Commercial	$583.85

HC I&D DP ABSC BURSA/HMTMA THI/KN

Facility

$11,390.00

Service Code	HCPCS 27301
Hospital Charge Code	4502730101
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,048.30
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Cash Price	$6,834.00
Rate for Payer: Cash Price	$6,834.00
Rate for Payer: Cash Price	$6,834.00
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$10,820.50
Rate for Payer: Health Management Network Commercial	$9,681.50
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Commercial	$7,175.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: MDX Hawaii PPO	$11,048.30
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC I&D DP ABSC BURSA/HMTMA THI/KN

Facility

$11,390.00

Service Code	HCPCS 27301
Hospital Charge Code	4502730101
Hospital Revenue Code	450
Min. Negotiated Rate	$9,681.50
Max. Negotiated Rate	$11,048.30
Rate for Payer: Cash Price	$6,834.00
Rate for Payer: Health Management Network Commercial	$9,681.50
Rate for Payer: MDX Hawaii PPO	$11,048.30

HC IDENTIFY SENTINEL NODE

Facility

$1,999.00

Service Code	HCPCS 38792
Hospital Charge Code	3403879201
Hospital Revenue Code	340
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC IDENTIFY SENTINEL NODE

Facility

$1,999.00

Service Code	HCPCS 38792
Hospital Charge Code	3403879201
Hospital Revenue Code	340
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
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	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,899.05
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$27.71
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$1,457.07

HC I&D OF VULVA/PERINEUM ABSCESS

Facility

$1,211.00

Service Code	HCPCS 56405
Hospital Charge Code	7615640501
Hospital Revenue Code	761
Min. Negotiated Rate	$1,029.35
Max. Negotiated Rate	$1,174.67
Rate for Payer: Cash Price	$726.60
Rate for Payer: Health Management Network Commercial	$1,029.35
Rate for Payer: MDX Hawaii PPO	$1,174.67

HC I&D OF VULVA/PERINEUM ABSCESS

Facility

$1,211.00

Service Code	HCPCS 56405
Hospital Charge Code	7615640501
Hospital Revenue Code	761
Min. Negotiated Rate	$66.23
Max. Negotiated Rate	$1,174.67
Rate for Payer: AlohaCare Medicaid	$359.99
Rate for Payer: AlohaCare Medicare	$359.99
Rate for Payer: Cash Price	$726.60
Rate for Payer: Cash Price	$726.60
Rate for Payer: Devoted Health Medicare	$395.99
Rate for Payer: Hawaii Medical Service Association Commercial	$449.99
Rate for Payer: Hawaii Medical Service Association Medicare	$359.99
Rate for Payer: Hawaii Western Management Group Commercial	$1,150.45
Rate for Payer: Health Management Network Commercial	$1,029.35
Rate for Payer: Humana Medicare	$359.99
Rate for Payer: Kaiser Permanente Commercial	$762.93
Rate for Payer: Kaiser Permanente Medicaid	$617.61
Rate for Payer: Kaiser Permanente Medicare	$359.99
Rate for Payer: MDX Hawaii PPO	$1,174.67
Rate for Payer: Ohana Health Plan Medicaid	$395.99
Rate for Payer: Ohana Health Plan Medicare	$359.99
Rate for Payer: UnitedHealthcare Medicaid	$66.23
Rate for Payer: UnitedHealthcare Medicare	$359.99
Rate for Payer: University Health Alliance Commercial	$882.70

HC I&D PERIANAL ABSCESS,SUPERFICIAL

Facility

$3,628.00

Service Code	HCPCS 46050
Hospital Charge Code	4504605001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,519.16
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Devoted Health Medicare	$1,208.46
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	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,446.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Commercial	$2,285.64
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,098.60
Rate for Payer: University Health Alliance Commercial	$2,644.45

HC I&D PERIANAL ABSCESS,SUPERFICIAL

Facility

$3,628.00

Service Code	HCPCS 46050
Hospital Charge Code	4504605001
Hospital Revenue Code	450
Min. Negotiated Rate	$3,083.80
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: MDX Hawaii PPO	$3,519.16

Know your out-of-pocket cost for care.

All Charges