Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC UNLISTED PROCEDURE, RECTUM

Facility

$3,628.00

Service Code	HCPCS 45999
Hospital Charge Code	4504599901
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 UNLIST PROCEDURE MALE GENITAL

Facility

$968.00

Service Code	HCPCS 55899
Hospital Charge Code	4505589901
Hospital Revenue Code	450
Min. Negotiated Rate	$295.16
Max. Negotiated Rate	$1,600.00
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: Cash Price	$580.80
Rate for Payer: Devoted Health Medicare	$324.68
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	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
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 UNLIST PROCEDURE MALE GENITAL

Facility

$968.00

Service Code	HCPCS 55899
Hospital Charge Code	4505589901
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 UPR/LXTR ART STDY 3+ LVLS

Facility

$623.00

Service Code	HCPCS 93923
Hospital Charge Code	9219392302
Hospital Revenue Code	921
Min. Negotiated Rate	$102.27
Max. Negotiated Rate	$604.31
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$373.80
Rate for Payer: Cash Price	$373.80
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association ABD	$102.27
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$122.12
Rate for Payer: Hawaii Western Management Group Commercial	$591.85
Rate for Payer: Health Management Network Commercial	$529.55
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$392.49
Rate for Payer: Kaiser Permanente Medicaid	$317.73
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$604.31
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$102.27
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$454.10

HC UPR/LXTR ART STDY 3+ LVLS

Facility

$623.00

Service Code	HCPCS 93923
Hospital Charge Code	9219392302
Hospital Revenue Code	921
Min. Negotiated Rate	$529.55
Max. Negotiated Rate	$604.31
Rate for Payer: Cash Price	$373.80
Rate for Payer: Health Management Network Commercial	$529.55
Rate for Payer: MDX Hawaii PPO	$604.31

HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM

Facility

$1,999.00

Service Code	HCPCS 78740
Hospital Charge Code	3407874001
Hospital Revenue Code	340
Min. Negotiated Rate	$69.88
Max. Negotiated Rate	$1,939.03
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: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$69.88
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$76.04
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
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	$69.88
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$361.79

HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM

Facility

$1,999.00

Service Code	HCPCS 78740
Hospital Charge Code	3407874001
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 URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY

Facility

$19.00

Service Code	HCPCS 81003
Hospital Charge Code	3078100301
Hospital Revenue Code	307
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$18.43
Rate for Payer: AlohaCare Medicaid	$2.25
Rate for Payer: AlohaCare Medicare	$2.25
Rate for Payer: Cash Price	$11.40
Rate for Payer: Cash Price	$11.40
Rate for Payer: Devoted Health Medicare	$2.48
Rate for Payer: Hawaii Medical Service Association ABD	$3.10
Rate for Payer: Hawaii Medical Service Association Commercial	$2.81
Rate for Payer: Hawaii Medical Service Association Medicare	$2.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.25
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Humana Medicare	$2.25
Rate for Payer: Kaiser Permanente Commercial	$11.97
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: Kaiser Permanente Medicare	$2.25
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicare	$2.25
Rate for Payer: UnitedHealthcare Medicaid	$3.10
Rate for Payer: UnitedHealthcare Medicare	$2.25
Rate for Payer: University Health Alliance Commercial	$5.81

HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY

Facility

$19.00

Service Code	HCPCS 81003
Hospital Charge Code	3078100301
Hospital Revenue Code	307
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: MDX Hawaii PPO	$18.43

HC URINALYSIS, AUTO, W/SCOPE - UA REFLEX C&S

Facility

$27.00

Service Code	HCPCS 81001
Hospital Charge Code	3078100102
Hospital Revenue Code	307
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$26.19
Rate for Payer: AlohaCare Medicaid	$3.17
Rate for Payer: AlohaCare Medicare	$3.17
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Devoted Health Medicare	$3.49
Rate for Payer: Hawaii Medical Service Association ABD	$4.37
Rate for Payer: Hawaii Medical Service Association Commercial	$3.96
Rate for Payer: Hawaii Medical Service Association Medicare	$3.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.59
Rate for Payer: Hawaii Western Management Group Commercial	$3.17
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Humana Medicare	$3.17
Rate for Payer: Kaiser Permanente Commercial	$17.01
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: Kaiser Permanente Medicare	$3.17
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: Ohana Health Plan Medicaid	$3.49
Rate for Payer: Ohana Health Plan Medicare	$3.17
Rate for Payer: UnitedHealthcare Medicaid	$4.37
Rate for Payer: UnitedHealthcare Medicare	$3.17
Rate for Payer: University Health Alliance Commercial	$8.20

HC URINALYSIS, AUTO, W/SCOPE - UA REFLEX C&S

Facility

$27.00

Service Code	HCPCS 81001
Hospital Charge Code	3078100102
Hospital Revenue Code	307
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: MDX Hawaii PPO	$26.19

HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC

Facility

$27.00

Service Code	HCPCS 81001
Hospital Charge Code	3078100101
Hospital Revenue Code	307
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: MDX Hawaii PPO	$26.19

HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC

Facility

$27.00

Service Code	HCPCS 81001
Hospital Charge Code	3078100101
Hospital Revenue Code	307
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$26.19
Rate for Payer: AlohaCare Medicaid	$3.17
Rate for Payer: AlohaCare Medicare	$3.17
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Devoted Health Medicare	$3.49
Rate for Payer: Hawaii Medical Service Association ABD	$4.37
Rate for Payer: Hawaii Medical Service Association Commercial	$3.96
Rate for Payer: Hawaii Medical Service Association Medicare	$3.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.59
Rate for Payer: Hawaii Western Management Group Commercial	$3.17
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Humana Medicare	$3.17
Rate for Payer: Kaiser Permanente Commercial	$17.01
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: Kaiser Permanente Medicare	$3.17
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: Ohana Health Plan Medicaid	$3.49
Rate for Payer: Ohana Health Plan Medicare	$3.17
Rate for Payer: UnitedHealthcare Medicaid	$4.37
Rate for Payer: UnitedHealthcare Medicare	$3.17
Rate for Payer: University Health Alliance Commercial	$8.20

HC URINALYSIS NONAUTO W/O SCOPE

Facility

$29.00

Service Code	HCPCS 81002
Hospital Charge Code	3078100201
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$3.48
Rate for Payer: AlohaCare Medicare	$3.48
Rate for Payer: Cash Price	$17.40
Rate for Payer: Cash Price	$17.40
Rate for Payer: Devoted Health Medicare	$3.83
Rate for Payer: Hawaii Medical Service Association ABD	$3.54
Rate for Payer: Hawaii Medical Service Association Commercial	$4.35
Rate for Payer: Hawaii Medical Service Association Medicare	$3.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.48
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$3.48
Rate for Payer: Kaiser Permanente Commercial	$18.27
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$3.48
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$3.83
Rate for Payer: Ohana Health Plan Medicare	$3.48
Rate for Payer: UnitedHealthcare Medicaid	$3.54
Rate for Payer: UnitedHealthcare Medicare	$3.48
Rate for Payer: University Health Alliance Commercial	$6.60

HC URINALYSIS NONAUTO W/O SCOPE

Facility

$29.00

Service Code	HCPCS 81002
Hospital Charge Code	3078100201
Hospital Revenue Code	307
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: MDX Hawaii PPO	$28.13

HC URINARY BLADDER RESIDUAL STUDY

Facility

$213.00

Service Code	HCPCS 78730
Hospital Charge Code	3417873001
Hospital Revenue Code	341
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$127.80
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: MDX Hawaii PPO	$206.61

HC URINARY BLADDER RESIDUAL STUDY

Facility

$213.00

Service Code	HCPCS 78730
Hospital Charge Code	3417873001
Hospital Revenue Code	341
Min. Negotiated Rate	$48.23
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
Rate for Payer: Hawaii Medical Service Association ABD	$48.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$52.32
Rate for Payer: Hawaii Western Management Group Commercial	$202.35
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Kaiser Permanente Commercial	$134.19
Rate for Payer: Kaiser Permanente Medicaid	$108.63
Rate for Payer: MDX Hawaii PPO	$206.61
Rate for Payer: UnitedHealthcare Medicaid	$48.23
Rate for Payer: University Health Alliance Commercial	$156.88

HC URINE PREGNANCY TEST - PREGNANCY URINE

Facility

$72.00

Service Code	HCPCS 81025
Hospital Charge Code	3078102501
Hospital Revenue Code	307
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$69.84

HC URINE PREGNANCY TEST - PREGNANCY URINE

Facility

$72.00

Service Code	HCPCS 81025
Hospital Charge Code	3078102501
Hospital Revenue Code	307
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$8.61
Rate for Payer: AlohaCare Medicare	$8.61
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$9.47
Rate for Payer: Hawaii Medical Service Association ABD	$8.74
Rate for Payer: Hawaii Medical Service Association Commercial	$10.76
Rate for Payer: Hawaii Medical Service Association Medicare	$8.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.18
Rate for Payer: Hawaii Western Management Group Commercial	$8.61
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$8.61
Rate for Payer: Kaiser Permanente Commercial	$45.36
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$8.61
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$9.47
Rate for Payer: Ohana Health Plan Medicare	$8.61
Rate for Payer: UnitedHealthcare Medicaid	$8.74
Rate for Payer: UnitedHealthcare Medicare	$8.61
Rate for Payer: University Health Alliance Commercial	$16.35

HC US ABDL AORTA SCREEN AAA - US ABDOMEN AORTIC ANEURYSM SCREENING

Facility

$529.00

Service Code	HCPCS 76706
Hospital Charge Code	4027670601
Hospital Revenue Code	402
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

HC US ABDL AORTA SCREEN AAA - US ABDOMEN AORTIC ANEURYSM SCREENING

Facility

$529.00

Service Code	HCPCS 76706
Hospital Charge Code	4027670601
Hospital Revenue Code	402
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$46.35
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$63.32
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$71.33
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$196.82

HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN COMPLETE

Facility

$529.00

Service Code	HCPCS 76700
Hospital Charge Code	4027670002
Hospital Revenue Code	402
Min. Negotiated Rate	$64.94
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$64.94
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$70.56
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$64.94
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$268.45

HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN COMPLETE

Facility

$529.00

Service Code	HCPCS 76700
Hospital Charge Code	4027670002
Hospital Revenue Code	402
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED

Facility

$529.00

Service Code	HCPCS 76705
Hospital Charge Code	4027670506
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$46.98
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.90
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$200.93

HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED

Facility

$529.00

Service Code	HCPCS 76705
Hospital Charge Code	4027670506
Hospital Revenue Code	402
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

Know your out-of-pocket cost for care.

All Charges