Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE

Facility

$3,731.00

Service Code	HCPCS 40804
Hospital Charge Code	4504080401
Hospital Revenue Code	450
Min. Negotiated Rate	$3,171.35
Max. Negotiated Rate	$3,619.07
Rate for Payer: Cash Price	$2,238.60
Rate for Payer: Health Management Network Commercial	$3,171.35
Rate for Payer: MDX Hawaii PPO	$3,619.07

HC REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA

Facility

$4,692.00

Service Code	HCPCS 45915
Hospital Charge Code	4504591501
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,551.24
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Devoted Health Medicare	$1,555.02
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	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$4,457.40
Rate for Payer: Health Management Network Commercial	$3,988.20
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Commercial	$2,955.96
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: MDX Hawaii PPO	$4,551.24
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	$3,420.00

HC REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA

Facility

$4,692.00

Service Code	HCPCS 45915
Hospital Charge Code	4504591501
Hospital Revenue Code	450
Min. Negotiated Rate	$3,988.20
Max. Negotiated Rate	$4,551.24
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Health Management Network Commercial	$3,988.20
Rate for Payer: MDX Hawaii PPO	$4,551.24

HC REMOVAL OF FOREIGN BODY

Facility

$6,448.00

Service Code	HCPCS 20520
Hospital Charge Code	7612052001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
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: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,699.95

HC REMOVAL OF FOREIGN BODY

Facility

$6,448.00

Service Code	HCPCS 20520
Hospital Charge Code	7612052001
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 REMOVAL OF FOREIGN BODY FROM SCROTUM

Facility

$7,982.00

Service Code	HCPCS 55120
Hospital Charge Code	4505512001
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Cash Price	$4,789.20
Rate for Payer: Cash Price	$4,789.20
Rate for Payer: Cash Price	$4,789.20
Rate for Payer: Devoted Health Medicare	$2,716.41
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	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$7,582.90
Rate for Payer: Health Management Network Commercial	$6,784.70
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Commercial	$5,028.66
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: MDX Hawaii PPO	$7,742.54
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC REMOVAL OF FOREIGN BODY FROM SCROTUM

Facility

$7,982.00

Service Code	HCPCS 55120
Hospital Charge Code	4505512001
Hospital Revenue Code	450
Min. Negotiated Rate	$6,784.70
Max. Negotiated Rate	$7,742.54
Rate for Payer: Cash Price	$4,789.20
Rate for Payer: Health Management Network Commercial	$6,784.70
Rate for Payer: MDX Hawaii PPO	$7,742.54

HC REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED

Facility

$11,390.00

Service Code	HCPCS 20525
Hospital Charge Code	4502052501
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 REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED

Facility

$11,390.00

Service Code	HCPCS 20525
Hospital Charge Code	4502052501
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 REMOVAL OF FOREIGN BODY, PELVIS OR HIP JOINT AREA; DEEP

Facility

$12,643.00

Service Code	HCPCS 27087
Hospital Charge Code	4502708701
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 REMOVAL OF FOREIGN BODY, PELVIS OR HIP JOINT AREA; DEEP

Facility

$12,643.00

Service Code	HCPCS 27087
Hospital Charge Code	4502708701
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

HC REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBQ TISSUE

Facility

$11,153.00

Service Code	HCPCS 27086
Hospital Charge Code	4502708601
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,818.41
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,595.35
Rate for Payer: Health Management Network Commercial	$9,480.05
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Commercial	$7,026.39
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: MDX Hawaii PPO	$10,818.41
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	$4,035.20

HC REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBQ TISSUE

Facility

$11,153.00

Service Code	HCPCS 27086
Hospital Charge Code	4502708601
Hospital Revenue Code	450
Min. Negotiated Rate	$9,480.05
Max. Negotiated Rate	$10,818.41
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Health Management Network Commercial	$9,480.05
Rate for Payer: MDX Hawaii PPO	$10,818.41

HC REMOVAL OF FOREIGN BODY, SHOULDER; DEEP

Facility

$11,153.00

Service Code	HCPCS 23333
Hospital Charge Code	4502333301
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$10,818.41
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,595.35
Rate for Payer: Health Management Network Commercial	$9,480.05
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Commercial	$7,026.39
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: MDX Hawaii PPO	$10,818.41
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$8,129.42

HC REMOVAL OF FOREIGN BODY, SHOULDER; DEEP

Facility

$11,153.00

Service Code	HCPCS 23333
Hospital Charge Code	4502333301
Hospital Revenue Code	450
Min. Negotiated Rate	$9,480.05
Max. Negotiated Rate	$10,818.41
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Health Management Network Commercial	$9,480.05
Rate for Payer: MDX Hawaii PPO	$10,818.41

HC REMOVAL OF FOREIGN BODY, SHOULDER; SUBQ

Facility

$6,448.00

Service Code	HCPCS 23330
Hospital Charge Code	4502333001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC REMOVAL OF FOREIGN BODY, SHOULDER; SUBQ

Facility

$6,448.00

Service Code	HCPCS 23330
Hospital Charge Code	4502333001
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 REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP

Facility

$11,153.00

Service Code	HCPCS 24201
Hospital Charge Code	4502420101
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,818.41
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
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	$10,595.35
Rate for Payer: Health Management Network Commercial	$9,480.05
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Commercial	$7,026.39
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: MDX Hawaii PPO	$10,818.41
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	$5,160.40

HC REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP

Facility

$11,153.00

Service Code	HCPCS 24201
Hospital Charge Code	4502420101
Hospital Revenue Code	450
Min. Negotiated Rate	$9,480.05
Max. Negotiated Rate	$10,818.41
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Health Management Network Commercial	$9,480.05
Rate for Payer: MDX Hawaii PPO	$10,818.41

HC REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBQ

Facility

$6,448.00

Service Code	HCPCS 24200
Hospital Charge Code	4502420001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBQ

Facility

$6,448.00

Service Code	HCPCS 24200
Hospital Charge Code	4502420001
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 REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF

Facility

$2,460.00

Service Code	HCPCS 32552
Hospital Charge Code	3613255201
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$741.06
Rate for Payer: AlohaCare Medicare	$741.06
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Devoted Health Medicare	$815.17
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	$741.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: Humana Medicare	$741.06
Rate for Payer: Kaiser Permanente Commercial	$1,549.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$741.06
Rate for Payer: MDX Hawaii PPO	$2,386.20
Rate for Payer: Ohana Health Plan Medicaid	$815.17
Rate for Payer: Ohana Health Plan Medicare	$741.06
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$741.06
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF

Facility

$2,460.00

Service Code	HCPCS 32552
Hospital Charge Code	3613255201
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

HC REMOVAL OF NAIL BED

Facility

$1,590.00

Service Code	HCPCS 11750
Hospital Charge Code	4501175001
Hospital Revenue Code	450
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$1,542.30
Rate for Payer: Cash Price	$954.00
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: MDX Hawaii PPO	$1,542.30

HC REMOVAL OF NAIL BED

Facility

$1,590.00

Service Code	HCPCS 11750
Hospital Charge Code	4501175001
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,510.50
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,001.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$1,542.30
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$1,158.95

Know your out-of-pocket cost for care.

All Charges