Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HC INJECT NERV BLCK,OTHR PERIPH NERV

Facility

$2,756.00

Service Code	HCPCS 64450
Hospital Charge Code	7616445001
Hospital Revenue Code	761
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: MDX Hawaii PPO	$2,673.32

HC INJECT NERV BLCK,OTHR PERIPH NERV

Facility

$2,756.00

Service Code	HCPCS 64450
Hospital Charge Code	7616445001
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,378.00
Rate for Payer: AlohaCare Medicare	$2,094.56
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$2,315.04
Rate for Payer: Hawaii Medical Service Association Commercial	$901.46
Rate for Payer: Hawaii Medical Service Association Medicare	$2,094.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,618.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$2,094.56
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: Kaiser Permanente Medicaid	$1,405.56
Rate for Payer: Kaiser Permanente Medicare	$2,094.56
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$2,094.56
Rate for Payer: Ohana Health Plan Medicare	$2,094.56
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,094.56
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INJECT NERV BLCK,PUDENDAL

Facility

$3,469.00

Service Code	HCPCS 64430
Hospital Charge Code	3616443001
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: Kaiser Permanente Commercial	$3,122.10
Rate for Payer: MDX Hawaii PPO	$3,364.93

HC INJECT NERV BLCK,PUDENDAL

Facility

$3,469.00

Service Code	HCPCS 64430
Hospital Charge Code	3616443001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,734.50
Rate for Payer: AlohaCare Medicare	$2,636.44
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Devoted Health Medicare	$2,913.96
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,636.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$2,636.44
Rate for Payer: Kaiser Permanente Commercial	$3,122.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,636.44
Rate for Payer: MDX Hawaii PPO	$3,364.93
Rate for Payer: Ohana Health Plan Medicaid	$2,636.44
Rate for Payer: Ohana Health Plan Medicare	$2,636.44
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,636.44
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INJECT NERV BLCK,SUPRASCAP N.

Facility

$2,756.00

Service Code	HCPCS 64418
Hospital Charge Code	3616441801
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,378.00
Rate for Payer: AlohaCare Medicare	$2,094.56
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$2,315.04
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,094.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,618.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$2,094.56
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,094.56
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$2,094.56
Rate for Payer: Ohana Health Plan Medicare	$2,094.56
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,094.56
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INJECT NERV BLCK,SUPRASCAP N.

Facility

$2,756.00

Service Code	HCPCS 64418
Hospital Charge Code	3616441801
Hospital Revenue Code	450
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: MDX Hawaii PPO	$2,673.32

HC INJECT NERV BLCK,TRIGEMINAL

Facility

$1,175.00

Service Code	HCPCS 64400
Hospital Charge Code	4506440001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$587.50
Rate for Payer: AlohaCare Medicare	$893.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$987.00
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$893.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,116.25
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$893.00
Rate for Payer: Kaiser Permanente Commercial	$1,057.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$893.00
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$893.00
Rate for Payer: Ohana Health Plan Medicare	$893.00
Rate for Payer: UnitedHealthcare Medicare	$893.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INJECT NERV BLCK,TRIGEMINAL

Facility

$1,175.00

Service Code	HCPCS 64400
Hospital Charge Code	4506440001
Hospital Revenue Code	450
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Kaiser Permanente Commercial	$1,057.50
Rate for Payer: MDX Hawaii PPO	$1,139.75

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	$1,734.50
Rate for Payer: AlohaCare Medicare	$2,636.44
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Devoted Health Medicare	$2,913.96
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,636.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$2,636.44
Rate for Payer: Kaiser Permanente Commercial	$3,122.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,636.44
Rate for Payer: MDX Hawaii PPO	$3,364.93
Rate for Payer: Ohana Health Plan Medicaid	$2,636.44
Rate for Payer: Ohana Health Plan Medicare	$2,636.44
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,636.44
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: Kaiser Permanente Commercial	$3,122.10
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: Kaiser Permanente Commercial	$3,122.10
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	$1,734.50
Rate for Payer: AlohaCare Medicare	$2,636.44
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Devoted Health Medicare	$2,913.96
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,636.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$2,636.44
Rate for Payer: Kaiser Permanente Commercial	$3,122.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,636.44
Rate for Payer: MDX Hawaii PPO	$3,364.93
Rate for Payer: Ohana Health Plan Medicaid	$2,636.44
Rate for Payer: Ohana Health Plan Medicare	$2,636.44
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,636.44
Rate for Payer: University Health Alliance Commercial	$2,528.55

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	$450.00
Max. Negotiated Rate	$12,263.71
Rate for Payer: AlohaCare Medicaid	$6,321.50
Rate for Payer: AlohaCare Medicare	$9,608.68
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Devoted Health Medicare	$10,620.12
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$9,608.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$9,608.68
Rate for Payer: Kaiser Permanente Commercial	$11,378.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$9,608.68
Rate for Payer: MDX Hawaii PPO	$12,263.71
Rate for Payer: Ohana Health Plan Medicaid	$9,608.68
Rate for Payer: Ohana Health Plan Medicare	$9,608.68
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$9,608.68
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: Kaiser Permanente Commercial	$11,378.70
Rate for Payer: MDX Hawaii PPO	$12,263.71

HC INSERT NON-TUNNEL CV CATH < 5 Y/O

Facility

$12,526.00

Service Code	HCPCS 36555
Hospital Charge Code	7613655501
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$12,150.22
Rate for Payer: AlohaCare Medicaid	$6,263.00
Rate for Payer: AlohaCare Medicare	$9,519.76
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$10,521.84
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$9,519.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$11,899.70
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$9,519.76
Rate for Payer: Kaiser Permanente Commercial	$11,273.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$9,519.76
Rate for Payer: MDX Hawaii PPO	$12,150.22
Rate for Payer: Ohana Health Plan Medicaid	$9,519.76
Rate for Payer: Ohana Health Plan Medicare	$9,519.76
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$9,519.76
Rate for Payer: University Health Alliance Commercial	$9,130.20

HC INSERT NON-TUNNEL CV CATH < 5 Y/O

Facility

$12,526.00

Service Code	HCPCS 36555
Hospital Charge Code	7613655501
Hospital Revenue Code	450
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: Kaiser Permanente Commercial	$11,273.40
Rate for Payer: MDX Hawaii PPO	$12,150.22

HC INSERT,TEMP INDWELLING BLAD CATH,COMP

Facility

$623.00

Service Code	HCPCS 51703
Hospital Charge Code	7615170301
Hospital Revenue Code	450
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: Kaiser Permanente Commercial	$560.70
Rate for Payer: MDX Hawaii PPO	$604.31

HC INSERT,TEMP INDWELLING BLAD CATH,COMP

Facility

$623.00

Service Code	HCPCS 51703
Hospital Charge Code	7615170301
Hospital Revenue Code	450
Min. Negotiated Rate	$311.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$311.50
Rate for Payer: AlohaCare Medicare	$473.48
Rate for Payer: Cash Price	$373.80
Rate for Payer: Cash Price	$373.80
Rate for Payer: Devoted Health Medicare	$523.32
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$473.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$591.85
Rate for Payer: Health Management Network Commercial	$529.55
Rate for Payer: Humana Medicare	$473.48
Rate for Payer: Kaiser Permanente Commercial	$560.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$473.48
Rate for Payer: MDX Hawaii PPO	$604.31
Rate for Payer: Ohana Health Plan Medicaid	$473.48
Rate for Payer: Ohana Health Plan Medicare	$473.48
Rate for Payer: UnitedHealthcare Medicare	$473.48
Rate for Payer: University Health Alliance Commercial	$454.10

HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE

Facility

$513.00

Service Code	HCPCS 51702
Hospital Charge Code	76151702PB
Hospital Revenue Code	761
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: MDX Hawaii PPO	$497.61

HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE

Facility

$513.00

Service Code	HCPCS 51702
Hospital Charge Code	76151702PB
Hospital Revenue Code	761
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$497.61
Rate for Payer: AlohaCare Medicaid	$256.50
Rate for Payer: AlohaCare Medicare	$389.88
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$430.92
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$389.88
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$389.88
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: Kaiser Permanente Medicaid	$261.63
Rate for Payer: Kaiser Permanente Medicare	$389.88
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$389.88
Rate for Payer: Ohana Health Plan Medicare	$389.88
Rate for Payer: UnitedHealthcare Medicaid	$21.90
Rate for Payer: UnitedHealthcare Medicare	$389.88
Rate for Payer: University Health Alliance Commercial	$373.93

HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE

Facility

$513.00

Service Code	HCPCS 51702
Hospital Charge Code	3615170201
Hospital Revenue Code	361
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$256.50
Rate for Payer: AlohaCare Medicare	$389.88
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$430.92
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$389.88
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$389.88
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$389.88
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$389.88
Rate for Payer: Ohana Health Plan Medicare	$389.88
Rate for Payer: UnitedHealthcare Medicaid	$21.90
Rate for Payer: UnitedHealthcare Medicare	$389.88
Rate for Payer: University Health Alliance Commercial	$373.93

HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE

Facility

$513.00

Service Code	HCPCS 51702
Hospital Charge Code	3615170201
Hospital Revenue Code	361
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: MDX Hawaii PPO	$497.61

HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 12.6 TO 20.0 CM

Facility

$2,436.00

Service Code	HCPCS 12045
Hospital Charge Code	4501204501
Hospital Revenue Code	450
Min. Negotiated Rate	$2,070.60
Max. Negotiated Rate	$2,362.92
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: Kaiser Permanente Commercial	$2,192.40
Rate for Payer: MDX Hawaii PPO	$2,362.92

HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 12.6 TO 20.0 CM

Facility

$2,436.00

Service Code	HCPCS 12045
Hospital Charge Code	4501204501
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$2,362.92
Rate for Payer: AlohaCare Medicaid	$1,218.00
Rate for Payer: AlohaCare Medicare	$1,851.36
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Devoted Health Medicare	$2,046.24
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,851.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,314.20
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: Humana Medicare	$1,851.36
Rate for Payer: Kaiser Permanente Commercial	$2,192.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,851.36
Rate for Payer: MDX Hawaii PPO	$2,362.92
Rate for Payer: Ohana Health Plan Medicaid	$1,851.36
Rate for Payer: Ohana Health Plan Medicare	$1,851.36
Rate for Payer: UnitedHealthcare Medicare	$1,851.36
Rate for Payer: University Health Alliance Commercial	$1,775.60

HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM

Facility

$2,436.00

Service Code	HCPCS 12046
Hospital Charge Code	4501204601
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,362.92
Rate for Payer: AlohaCare Medicaid	$1,218.00
Rate for Payer: AlohaCare Medicare	$1,851.36
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Devoted Health Medicare	$2,046.24
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,851.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,314.20
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: Humana Medicare	$1,851.36
Rate for Payer: Kaiser Permanente Commercial	$2,192.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,851.36
Rate for Payer: MDX Hawaii PPO	$2,362.92
Rate for Payer: Ohana Health Plan Medicaid	$1,851.36
Rate for Payer: Ohana Health Plan Medicare	$1,851.36
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,851.36
Rate for Payer: University Health Alliance Commercial	$1,775.60

Know your out-of-pocket cost for care.

All Charges