Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI

Facility

$893.00

Service Code	HCPCS 23350
Hospital Charge Code	3202335001
Hospital Revenue Code	320
Min. Negotiated Rate	$759.05
Max. Negotiated Rate	$866.21
Rate for Payer: Cash Price	$535.80
Rate for Payer: Health Management Network Commercial	$759.05
Rate for Payer: MDX Hawaii PPO	$866.21

HC INJ SI JNT ANES &/TX AGT&ARTHR

Facility

$3,445.00

Service Code	HCPCS G0260
Hospital Charge Code	322G026001
Hospital Revenue Code	322
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$2,067.00
Rate for Payer: Cash Price	$2,067.00
Rate for Payer: Cash Price	$2,067.00
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	$3,272.75
Rate for Payer: Health Management Network Commercial	$2,928.25
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$2,170.35
Rate for Payer: Kaiser Permanente Medicaid	$1,756.95
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$3,341.65
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	$4,035.20

HC INJ SI JNT ANES &/TX AGT&ARTHR

Facility

$3,445.00

Service Code	HCPCS G0260
Hospital Charge Code	322G026001
Hospital Revenue Code	322
Min. Negotiated Rate	$2,928.25
Max. Negotiated Rate	$3,341.65
Rate for Payer: Cash Price	$2,067.00
Rate for Payer: Health Management Network Commercial	$2,928.25
Rate for Payer: MDX Hawaii PPO	$3,341.65

HC INJX, DX OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET JT W/ US GUIDANCE, CERV OR THOR; SINGLE LVL

Facility

$3,469.00

Service Code	HCPCS 0213T
Hospital Charge Code	4500213701
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,364.93
Rate for Payer: AlohaCare Medicaid	$1,044.87
Rate for Payer: AlohaCare Medicare	$1,044.87
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Devoted Health Medicare	$1,149.36
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	$1,044.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,295.55
Rate for Payer: Health Management Network Commercial	$2,948.65
Rate for Payer: Humana Medicare	$1,044.87
Rate for Payer: Kaiser Permanente Commercial	$2,185.47
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,044.87
Rate for Payer: MDX Hawaii PPO	$3,364.93
Rate for Payer: Ohana Health Plan Medicaid	$1,149.36
Rate for Payer: Ohana Health Plan Medicare	$1,044.87
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,044.87
Rate for Payer: University Health Alliance Commercial	$2,528.55

HC INJX, DX OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET JT W/ US GUIDANCE, CERV OR THOR; SINGLE LVL

Facility

$3,469.00

Service Code	HCPCS 0213T
Hospital Charge Code	4500213701
Hospital Revenue Code	450
Min. Negotiated Rate	$2,948.65
Max. Negotiated Rate	$3,364.93
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Health Management Network Commercial	$2,948.65
Rate for Payer: MDX Hawaii PPO	$3,364.93

HC INJX, DX OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET JT W/ US GUIDANCE, LUMB OR SACRAL; SINGLE LEVEL

Facility

$3,469.00

Service Code	HCPCS 0216T
Hospital Charge Code	4500216701
Hospital Revenue Code	450
Min. Negotiated Rate	$2,948.65
Max. Negotiated Rate	$3,364.93
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Health Management Network Commercial	$2,948.65
Rate for Payer: MDX Hawaii PPO	$3,364.93

HC INJX, DX OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET JT W/ US GUIDANCE, LUMB OR SACRAL; SINGLE LEVEL

Facility

$3,469.00

Service Code	HCPCS 0216T
Hospital Charge Code	4500216701
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,364.93
Rate for Payer: AlohaCare Medicaid	$1,044.87
Rate for Payer: AlohaCare Medicare	$1,044.87
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Devoted Health Medicare	$1,149.36
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	$1,044.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,295.55
Rate for Payer: Health Management Network Commercial	$2,948.65
Rate for Payer: Humana Medicare	$1,044.87
Rate for Payer: Kaiser Permanente Commercial	$2,185.47
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,044.87
Rate for Payer: MDX Hawaii PPO	$3,364.93
Rate for Payer: Ohana Health Plan Medicaid	$1,149.36
Rate for Payer: Ohana Health Plan Medicare	$1,044.87
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,044.87
Rate for Payer: University Health Alliance Commercial	$2,528.55

HC INSER HART PACER XVENOUS ATR/VENTR

Facility

$41,648.00

Service Code	HCPCS 33208
Hospital Charge Code	3613320801
Hospital Revenue Code	361
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$40,398.56
Rate for Payer: AlohaCare Medicaid	$12,347.41
Rate for Payer: AlohaCare Medicare	$12,347.41
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Devoted Health Medicare	$13,582.15
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	$12,347.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$35,400.80
Rate for Payer: Humana Medicare	$12,347.41
Rate for Payer: Kaiser Permanente Commercial	$26,238.24
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$12,347.41
Rate for Payer: MDX Hawaii PPO	$40,398.56
Rate for Payer: Ohana Health Plan Medicaid	$13,582.15
Rate for Payer: Ohana Health Plan Medicare	$12,347.41
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$12,347.41
Rate for Payer: University Health Alliance Commercial	$11,157.19

HC INSER HART PACER XVENOUS ATR/VENTR

Facility

$41,648.00

Service Code	HCPCS 33208
Hospital Charge Code	3613320801
Hospital Revenue Code	361
Min. Negotiated Rate	$35,400.80
Max. Negotiated Rate	$40,398.56
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Health Management Network Commercial	$35,400.80
Rate for Payer: MDX Hawaii PPO	$40,398.56

HC INSERT CATH,ART,PERCUT,SHORTTERM

Facility

$254.00

Service Code	HCPCS 36620
Hospital Charge Code	7613662001
Hospital Revenue Code	761
Min. Negotiated Rate	$47.24
Max. Negotiated Rate	$2,536.00
Rate for Payer: Cash Price	$152.40
Rate for Payer: Cash Price	$152.40
Rate for Payer: Cash Price	$152.40
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 Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$241.30
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: Kaiser Permanente Commercial	$160.02
Rate for Payer: Kaiser Permanente Medicaid	$129.54
Rate for Payer: MDX Hawaii PPO	$246.38
Rate for Payer: UnitedHealthcare Medicaid	$47.24
Rate for Payer: University Health Alliance Commercial	$185.14

HC INSERT CATH,ART,PERCUT,SHORTTERM

Facility

$254.00

Service Code	HCPCS 36620
Hospital Charge Code	7613662001
Hospital Revenue Code	761
Min. Negotiated Rate	$215.90
Max. Negotiated Rate	$246.38
Rate for Payer: Cash Price	$152.40
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: MDX Hawaii PPO	$246.38

HC INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS

Facility

$4,595.00

Service Code	HCPCS 49442
Hospital Charge Code	3614944201
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Cash Price	$2,757.00
Rate for Payer: Cash Price	$2,757.00
Rate for Payer: Cash Price	$2,757.00
Rate for Payer: Devoted Health Medicare	$1,555.02
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	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$3,905.75
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Commercial	$2,894.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: MDX Hawaii PPO	$4,457.15
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65
Rate for Payer: University Health Alliance Commercial	$3,349.30

HC INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS

Facility

$4,595.00

Service Code	HCPCS 49442
Hospital Charge Code	3614944201
Hospital Revenue Code	361
Min. Negotiated Rate	$3,905.75
Max. Negotiated Rate	$4,457.15
Rate for Payer: Cash Price	$2,757.00
Rate for Payer: Health Management Network Commercial	$3,905.75
Rate for Payer: MDX Hawaii PPO	$4,457.15

HC INSERT CERVICAL DILATOR

Facility

$1,514.00

Service Code	HCPCS 59200
Hospital Charge Code	7205920001
Hospital Revenue Code	720
Min. Negotiated Rate	$1,286.90
Max. Negotiated Rate	$1,468.58
Rate for Payer: Cash Price	$908.40
Rate for Payer: Health Management Network Commercial	$1,286.90
Rate for Payer: MDX Hawaii PPO	$1,468.58

HC INSERT CERVICAL DILATOR

Facility

$1,514.00

Service Code	HCPCS 59200
Hospital Charge Code	7205920001
Hospital Revenue Code	720
Min. Negotiated Rate	$29.09
Max. Negotiated Rate	$1,468.58
Rate for Payer: AlohaCare Medicaid	$359.99
Rate for Payer: AlohaCare Medicare	$359.99
Rate for Payer: Cash Price	$908.40
Rate for Payer: Cash Price	$908.40
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	$1,438.30
Rate for Payer: Health Management Network Commercial	$1,286.90
Rate for Payer: Humana Medicare	$359.99
Rate for Payer: Kaiser Permanente Commercial	$953.82
Rate for Payer: Kaiser Permanente Medicaid	$772.14
Rate for Payer: Kaiser Permanente Medicare	$359.99
Rate for Payer: MDX Hawaii PPO	$1,468.58
Rate for Payer: Ohana Health Plan Medicaid	$395.99
Rate for Payer: Ohana Health Plan Medicare	$359.99
Rate for Payer: UnitedHealthcare Medicaid	$29.09
Rate for Payer: UnitedHealthcare Medicare	$359.99
Rate for Payer: University Health Alliance Commercial	$1,103.55

HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS

Facility

$7,549.00

Service Code	HCPCS 49441
Hospital Charge Code	3614944101
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,322.53
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Devoted Health Medicare	$2,493.58
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	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$6,416.65
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Commercial	$4,755.87
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: MDX Hawaii PPO	$7,322.53
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$5,502.47

HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS

Facility

$7,549.00

Service Code	HCPCS 49441
Hospital Charge Code	3614944101
Hospital Revenue Code	361
Min. Negotiated Rate	$6,416.65
Max. Negotiated Rate	$7,322.53
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Health Management Network Commercial	$6,416.65
Rate for Payer: MDX Hawaii PPO	$7,322.53

HC INSERT EMERGENCY ENDOTRACH AIRWAY

Facility

$924.00

Service Code	HCPCS 31500
Hospital Charge Code	7613150001
Hospital Revenue Code	761
Min. Negotiated Rate	$93.64
Max. Negotiated Rate	$4,035.20
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: Devoted Health Medicare	$307.78
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	$279.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
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	$471.24
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 Medicaid	$93.64
Rate for Payer: UnitedHealthcare Medicare	$279.80
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INSERT EMERGENCY ENDOTRACH AIRWAY

Facility

$924.00

Service Code	HCPCS 31500
Hospital Charge Code	7613150001
Hospital Revenue Code	761
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 INSERT GASTROSTOMY TUBE PERCUTANEOUS

Facility

$7,549.00

Service Code	HCPCS 49440
Hospital Charge Code	3614944001
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,322.53
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Devoted Health Medicare	$2,493.58
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	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$6,416.65
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Commercial	$4,755.87
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: MDX Hawaii PPO	$7,322.53
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$5,502.47

HC INSERT GASTROSTOMY TUBE PERCUTANEOUS

Facility

$7,549.00

Service Code	HCPCS 49440
Hospital Charge Code	3614944001
Hospital Revenue Code	361
Min. Negotiated Rate	$6,416.65
Max. Negotiated Rate	$7,322.53
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Health Management Network Commercial	$6,416.65
Rate for Payer: MDX Hawaii PPO	$7,322.53

HC INSERTION INDWELLING TUNNELED PLEURAL CATHETER

Facility

$14,044.00

Service Code	HCPCS 32550
Hospital Charge Code	3613255001
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$13,622.68
Rate for Payer: AlohaCare Medicaid	$4,229.69
Rate for Payer: AlohaCare Medicare	$4,229.69
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Devoted Health Medicare	$4,652.66
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	$4,229.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$11,937.40
Rate for Payer: Humana Medicare	$4,229.69
Rate for Payer: Kaiser Permanente Commercial	$8,847.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,229.69
Rate for Payer: MDX Hawaii PPO	$13,622.68
Rate for Payer: Ohana Health Plan Medicaid	$4,652.66
Rate for Payer: Ohana Health Plan Medicare	$4,229.69
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,229.69
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INSERTION INDWELLING TUNNELED PLEURAL CATHETER

Facility

$14,044.00

Service Code	HCPCS 32550
Hospital Charge Code	3613255001
Hospital Revenue Code	361
Min. Negotiated Rate	$11,937.40
Max. Negotiated Rate	$13,622.68
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Health Management Network Commercial	$11,937.40
Rate for Payer: MDX Hawaii PPO	$13,622.68

HC INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION, INCLUDING REMOVAL

Facility

$12,643.00

Service Code	HCPCS 20650
Hospital Charge Code	4502065001
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,263.71
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Devoted Health Medicare	$4,251.90
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	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$12,010.85
Rate for Payer: Health Management Network Commercial	$10,746.55
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Commercial	$7,965.09
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: MDX Hawaii PPO	$12,263.71
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION, INCLUDING REMOVAL

Facility

$12,643.00

Service Code	HCPCS 20650
Hospital Charge Code	4502065001
Hospital Revenue Code	450
Min. Negotiated Rate	$10,746.55
Max. Negotiated Rate	$12,263.71
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Health Management Network Commercial	$10,746.55
Rate for Payer: MDX Hawaii PPO	$12,263.71

Know your out-of-pocket cost for care.

All Charges