Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICAL HEIGHT

Facility

$5,772.00

Service Code	HCPCS 40654
Hospital Charge Code	4504065401
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,598.84
Rate for Payer: AlohaCare Medicaid	$1,832.96
Rate for Payer: AlohaCare Medicare	$1,832.96
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Devoted Health Medicare	$2,016.26
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	$1,832.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$5,483.40
Rate for Payer: Health Management Network Commercial	$4,906.20
Rate for Payer: Humana Medicare	$1,832.96
Rate for Payer: Kaiser Permanente Commercial	$3,636.36
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,832.96
Rate for Payer: MDX Hawaii PPO	$5,598.84
Rate for Payer: Ohana Health Plan Medicaid	$2,016.26
Rate for Payer: Ohana Health Plan Medicare	$1,832.96
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,832.96
Rate for Payer: University Health Alliance Commercial	$4,207.21

HC REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICAL HEIGHT

Facility

$5,772.00

Service Code	HCPCS 40654
Hospital Charge Code	4504065401
Hospital Revenue Code	450
Min. Negotiated Rate	$4,906.20
Max. Negotiated Rate	$5,598.84
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Health Management Network Commercial	$4,906.20
Rate for Payer: MDX Hawaii PPO	$5,598.84

HC REPAIR LIP,FULL THICK,VERMILION

Facility

$2,027.00

Service Code	HCPCS 40650
Hospital Charge Code	4504065001
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 REPAIR LIP,FULL THICK,VERMILION

Facility

$2,027.00

Service Code	HCPCS 40650
Hospital Charge Code	4504065001
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 REPAIR OF PALATE, OVER 2 CM OR REQUIRING COMPLEX REPAIR

Facility

$23,052.00

Service Code	HCPCS 42182
Hospital Charge Code	4504218201
Hospital Revenue Code	450
Min. Negotiated Rate	$19,594.20
Max. Negotiated Rate	$22,360.44
Rate for Payer: Cash Price	$13,831.20
Rate for Payer: Health Management Network Commercial	$19,594.20
Rate for Payer: MDX Hawaii PPO	$22,360.44

HC REPAIR OF PALATE, OVER 2 CM OR REQUIRING COMPLEX REPAIR

Facility

$23,052.00

Service Code	HCPCS 42182
Hospital Charge Code	4504218201
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$22,360.44
Rate for Payer: AlohaCare Medicaid	$6,993.36
Rate for Payer: AlohaCare Medicare	$6,993.36
Rate for Payer: Cash Price	$13,831.20
Rate for Payer: Cash Price	$13,831.20
Rate for Payer: Cash Price	$13,831.20
Rate for Payer: Devoted Health Medicare	$7,692.70
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	$6,993.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$21,899.40
Rate for Payer: Health Management Network Commercial	$19,594.20
Rate for Payer: Humana Medicare	$6,993.36
Rate for Payer: Kaiser Permanente Commercial	$14,522.76
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$6,993.36
Rate for Payer: MDX Hawaii PPO	$22,360.44
Rate for Payer: Ohana Health Plan Medicaid	$7,692.70
Rate for Payer: Ohana Health Plan Medicare	$6,993.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$6,993.36
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE

Facility

$27,837.00

Service Code	HCPCS 24341
Hospital Charge Code	4502434101
Hospital Revenue Code	450
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$27,001.89
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Cash Price	$16,702.20
Rate for Payer: Cash Price	$16,702.20
Rate for Payer: Cash Price	$16,702.20
Rate for Payer: Devoted Health Medicare	$9,429.30
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	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$26,445.15
Rate for Payer: Health Management Network Commercial	$23,661.45
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Commercial	$17,537.31
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: MDX Hawaii PPO	$27,001.89
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE

Facility

$27,837.00

Service Code	HCPCS 24341
Hospital Charge Code	4502434101
Hospital Revenue Code	450
Min. Negotiated Rate	$23,661.45
Max. Negotiated Rate	$27,001.89
Rate for Payer: Cash Price	$16,702.20
Rate for Payer: Health Management Network Commercial	$23,661.45
Rate for Payer: MDX Hawaii PPO	$27,001.89

HC REPAIR TONGUE LACER,<2.6 CM

Facility

$1,588.00

Service Code	HCPCS 41250
Hospital Charge Code	4504125001
Hospital Revenue Code	450
Min. Negotiated Rate	$1,349.80
Max. Negotiated Rate	$1,540.36
Rate for Payer: Cash Price	$952.80
Rate for Payer: Health Management Network Commercial	$1,349.80
Rate for Payer: MDX Hawaii PPO	$1,540.36

HC REPAIR TONGUE LACER,<2.6 CM

Facility

$1,588.00

Service Code	HCPCS 41250
Hospital Charge Code	4504125001
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Devoted Health Medicare	$580.51
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	$527.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,508.60
Rate for Payer: Health Management Network Commercial	$1,349.80
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$1,000.44
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$1,540.36
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$1,157.49

HC REPAIR TONGUE LACER,2.6 CM+/COMPLX

Facility

$924.00

Service Code	HCPCS 41252
Hospital Charge Code	4504125201
Hospital Revenue Code	450
Min. Negotiated Rate	$279.80
Max. Negotiated Rate	$5,509.00
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: Devoted Health Medicare	$307.78
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	$279.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
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	$5,160.40

HC REPAIR TONGUE LACER,2.6 CM+/COMPLX

Facility

$924.00

Service Code	HCPCS 41252
Hospital Charge Code	4504125201
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 REPAIR TONGUE LACER,POST 1/3

Facility

$924.00

Service Code	HCPCS 41251
Hospital Charge Code	7614125101
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 REPAIR TONGUE LACER,POST 1/3

Facility

$924.00

Service Code	HCPCS 41251
Hospital Charge Code	7614125101
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 REPLACE CV CATH, COMPLETE, NON-TUNNELED, W SUBQ PORT OR PUMP

Facility

$12,265.00

Service Code	HCPCS 36582
Hospital Charge Code	3613658201
Hospital Revenue Code	361
Min. Negotiated Rate	$10,425.25
Max. Negotiated Rate	$11,897.05
Rate for Payer: Cash Price	$7,359.00
Rate for Payer: Health Management Network Commercial	$10,425.25
Rate for Payer: MDX Hawaii PPO	$11,897.05

HC REPLACE CV CATH, COMPLETE, NON-TUNNELED, W SUBQ PORT OR PUMP

Facility

$12,265.00

Service Code	HCPCS 36582
Hospital Charge Code	3613658201
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,897.05
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,359.00
Rate for Payer: Cash Price	$7,359.00
Rate for Payer: Cash Price	$7,359.00
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$10,425.25
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,726.95
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$11,897.05
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC REPLACE CV CATH, COMPLETE, TUNNELED, W/O SUBQ PORT OR PUMP

Facility

$12,526.00

Service Code	HCPCS 36581
Hospital Charge Code	3613658101
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,150.22
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,891.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$12,150.22
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC REPLACE CV CATH, COMPLETE, TUNNELED, W/O SUBQ PORT OR PUMP

Facility

$12,526.00

Service Code	HCPCS 36581
Hospital Charge Code	3613658101
Hospital Revenue Code	361
Min. Negotiated Rate	$10,647.10
Max. Negotiated Rate	$12,150.22
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: MDX Hawaii PPO	$12,150.22

HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS

Facility

$4,664.00

Service Code	HCPCS 49450
Hospital Charge Code	3614945001
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,524.08
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$2,798.40
Rate for Payer: Cash Price	$2,798.40
Rate for Payer: Cash Price	$2,798.40
Rate for Payer: Devoted Health Medicare	$1,178.61
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	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$3,964.40
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$2,938.32
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$4,524.08
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$3,399.59

HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS

Facility

$4,664.00

Service Code	HCPCS 49450
Hospital Charge Code	3614945001
Hospital Revenue Code	361
Min. Negotiated Rate	$3,964.40
Max. Negotiated Rate	$4,524.08
Rate for Payer: Cash Price	$2,798.40
Rate for Payer: Health Management Network Commercial	$3,964.40
Rate for Payer: MDX Hawaii PPO	$4,524.08

HC REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS

Facility

$4,664.00

Service Code	HCPCS 49452
Hospital Charge Code	3204945201
Hospital Revenue Code	320
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,524.08
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$2,798.40
Rate for Payer: Cash Price	$2,798.40
Rate for Payer: Cash Price	$2,798.40
Rate for Payer: Devoted Health Medicare	$1,178.61
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	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$4,430.80
Rate for Payer: Health Management Network Commercial	$3,964.40
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$2,938.32
Rate for Payer: Kaiser Permanente Medicaid	$2,378.64
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$4,524.08
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$3,399.59

HC REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS

Facility

$4,664.00

Service Code	HCPCS 49452
Hospital Charge Code	3204945201
Hospital Revenue Code	320
Min. Negotiated Rate	$3,964.40
Max. Negotiated Rate	$4,524.08
Rate for Payer: Cash Price	$2,798.40
Rate for Payer: Health Management Network Commercial	$3,964.40
Rate for Payer: MDX Hawaii PPO	$4,524.08

HC REPOSITION GASTROSTOMY TUBE - GASTROSTOMY TUBE, CHANGE / REPOSITION

Facility

$968.00

Service Code	HCPCS 43761
Hospital Charge Code	7504376101
Hospital Revenue Code	450
Min. Negotiated Rate	$295.16
Max. Negotiated Rate	$2,536.00
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: Hawaii Western Management Group Commercial	$919.60
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	$937.50
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 Medicare	$295.16
Rate for Payer: University Health Alliance Commercial	$705.58

HC REPOSITION GASTROSTOMY TUBE - GASTROSTOMY TUBE, CHANGE / REPOSITION

Facility

$968.00

Service Code	HCPCS 43761
Hospital Charge Code	7504376101
Hospital Revenue Code	450
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 REPOSITION VENOUS CATHETER

Facility

$6,182.00

Service Code	HCPCS 36597
Hospital Charge Code	3613659701
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,996.54
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Devoted Health Medicare	$2,045.58
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	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$5,254.70
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$3,894.66
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$5,996.54
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$4,506.06

Know your out-of-pocket cost for care.

All Charges