Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HC PBB CLOSED RX NOSE FRACTURE, W/O STABILIZATION

Facility

$5,895.00

Service Code	HCPCS 21315
Hospital Charge Code	76121315PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,718.15
Rate for Payer: AlohaCare Medicaid	$2,947.50
Rate for Payer: AlohaCare Medicare	$4,480.20
Rate for Payer: Cash Price	$3,537.00
Rate for Payer: Cash Price	$3,537.00
Rate for Payer: Cash Price	$3,537.00
Rate for Payer: Devoted Health Medicare	$4,951.80
Rate for Payer: Hawaii Medical Service Association Commercial	$1,981.49
Rate for Payer: Hawaii Medical Service Association Medicare	$4,480.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.25
Rate for Payer: Health Management Network Commercial	$5,010.75
Rate for Payer: Humana Medicare	$4,480.20
Rate for Payer: Kaiser Permanente Commercial	$5,305.50
Rate for Payer: Kaiser Permanente Medicaid	$3,006.45
Rate for Payer: Kaiser Permanente Medicare	$4,480.20
Rate for Payer: MDX Hawaii PPO	$5,718.15
Rate for Payer: Ohana Health Plan Medicaid	$4,480.20
Rate for Payer: Ohana Health Plan Medicare	$4,480.20
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,480.20
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC PBB CLOSED RX NOSE FRACTURE, W/O STABILIZATION

Facility

$5,895.00

Service Code	HCPCS 21315
Hospital Charge Code	76121315PB
Hospital Revenue Code	761
Min. Negotiated Rate	$5,010.75
Max. Negotiated Rate	$5,718.15
Rate for Payer: Cash Price	$3,537.00
Rate for Payer: Health Management Network Commercial	$5,010.75
Rate for Payer: Kaiser Permanente Commercial	$5,305.50
Rate for Payer: MDX Hawaii PPO	$5,718.15

HC PBB CLOSED RX PROX HUMERUS FRACTURE

Facility

$955.00

Service Code	HCPCS 23600
Hospital Charge Code	76123600PB
Hospital Revenue Code	761
Min. Negotiated Rate	$183.80
Max. Negotiated Rate	$926.35
Rate for Payer: AlohaCare Medicaid	$477.50
Rate for Payer: AlohaCare Medicare	$725.80
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$802.20
Rate for Payer: Hawaii Medical Service Association Commercial	$315.01
Rate for Payer: Hawaii Medical Service Association Medicare	$725.80
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$725.80
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: Kaiser Permanente Medicaid	$487.05
Rate for Payer: Kaiser Permanente Medicare	$725.80
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$725.80
Rate for Payer: Ohana Health Plan Medicare	$725.80
Rate for Payer: UnitedHealthcare Medicaid	$183.80
Rate for Payer: UnitedHealthcare Medicare	$725.80
Rate for Payer: University Health Alliance Commercial	$696.10

HC PBB CLOSED RX PROX HUMERUS FRACTURE

Facility

$955.00

Service Code	HCPCS 23600
Hospital Charge Code	76123600PB
Hospital Revenue Code	761
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: MDX Hawaii PPO	$926.35

HC PBB CLOSED RX TARSAL FX,EACH

Facility

$955.00

Service Code	HCPCS 28450
Hospital Charge Code	76128450PB
Hospital Revenue Code	761
Min. Negotiated Rate	$126.55
Max. Negotiated Rate	$926.35
Rate for Payer: AlohaCare Medicaid	$477.50
Rate for Payer: AlohaCare Medicare	$725.80
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$802.20
Rate for Payer: Hawaii Medical Service Association Commercial	$315.01
Rate for Payer: Hawaii Medical Service Association Medicare	$725.80
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$725.80
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: Kaiser Permanente Medicaid	$487.05
Rate for Payer: Kaiser Permanente Medicare	$725.80
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$725.80
Rate for Payer: Ohana Health Plan Medicare	$725.80
Rate for Payer: UnitedHealthcare Medicaid	$126.55
Rate for Payer: UnitedHealthcare Medicare	$725.80
Rate for Payer: University Health Alliance Commercial	$696.10

HC PBB CLOSED RX TARSAL FX,EACH

Facility

$955.00

Service Code	HCPCS 28450
Hospital Charge Code	76128450PB
Hospital Revenue Code	761
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: MDX Hawaii PPO	$926.35

HC PBB CLOSED TX ULNAR FRACTURE PROX END W/O MANIPULATE

Facility

$935.00

Service Code	HCPCS 24670
Hospital Charge Code	76124670PB
Hospital Revenue Code	761
Min. Negotiated Rate	$149.15
Max. Negotiated Rate	$906.95
Rate for Payer: AlohaCare Medicaid	$467.50
Rate for Payer: AlohaCare Medicare	$710.60
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$785.40
Rate for Payer: Hawaii Medical Service Association Commercial	$315.01
Rate for Payer: Hawaii Medical Service Association Medicare	$710.60
Rate for Payer: Hawaii Western Management Group Commercial	$888.25
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Humana Medicare	$710.60
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: Kaiser Permanente Medicaid	$476.85
Rate for Payer: Kaiser Permanente Medicare	$710.60
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$710.60
Rate for Payer: Ohana Health Plan Medicare	$710.60
Rate for Payer: UnitedHealthcare Medicaid	$149.15
Rate for Payer: UnitedHealthcare Medicare	$710.60
Rate for Payer: University Health Alliance Commercial	$681.52

HC PBB CLOSED TX ULNAR FRACTURE PROX END W/O MANIPULATE

Facility

$935.00

Service Code	HCPCS 24670
Hospital Charge Code	76124670PB
Hospital Revenue Code	761
Min. Negotiated Rate	$794.75
Max. Negotiated Rate	$906.95
Rate for Payer: Cash Price	$561.00
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: MDX Hawaii PPO	$906.95

HC PBB I&D DEEP ABSC/HEMATOMA NECK/CHEST

Facility

$11,390.00

Service Code	HCPCS 21501
Hospital Charge Code	76121501PB
Hospital Revenue Code	761
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: Kaiser Permanente Commercial	$10,251.00
Rate for Payer: MDX Hawaii PPO	$11,048.30

HC PBB I&D DEEP ABSC/HEMATOMA NECK/CHEST

Facility

$11,390.00

Service Code	HCPCS 21501
Hospital Charge Code	76121501PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,048.30
Rate for Payer: AlohaCare Medicaid	$5,695.00
Rate for Payer: AlohaCare Medicare	$8,656.40
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	$9,567.60
Rate for Payer: Hawaii Medical Service Association Commercial	$3,709.54
Rate for Payer: Hawaii Medical Service Association Medicare	$8,656.40
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	$8,656.40
Rate for Payer: Kaiser Permanente Commercial	$10,251.00
Rate for Payer: Kaiser Permanente Medicaid	$5,808.90
Rate for Payer: Kaiser Permanente Medicare	$8,656.40
Rate for Payer: MDX Hawaii PPO	$11,048.30
Rate for Payer: Ohana Health Plan Medicaid	$8,656.40
Rate for Payer: Ohana Health Plan Medicare	$8,656.40
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$8,656.40
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC PBB I&D MOUTH/TONG INTRA,MASTICATOR

Facility

$1,984.00

Service Code	HCPCS 41009
Hospital Charge Code	76141009PB
Hospital Revenue Code	761
Min. Negotiated Rate	$1,686.40
Max. Negotiated Rate	$1,924.48
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: Kaiser Permanente Commercial	$1,785.60
Rate for Payer: MDX Hawaii PPO	$1,924.48

HC PBB I&D MOUTH/TONG INTRA,MASTICATOR

Facility

$1,984.00

Service Code	HCPCS 41009
Hospital Charge Code	76141009PB
Hospital Revenue Code	761
Min. Negotiated Rate	$200.41
Max. Negotiated Rate	$1,924.48
Rate for Payer: AlohaCare Medicaid	$992.00
Rate for Payer: AlohaCare Medicare	$1,507.84
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Devoted Health Medicare	$1,666.56
Rate for Payer: Hawaii Medical Service Association Commercial	$688.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,507.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,884.80
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: Humana Medicare	$1,507.84
Rate for Payer: Kaiser Permanente Commercial	$1,785.60
Rate for Payer: Kaiser Permanente Medicaid	$1,011.84
Rate for Payer: Kaiser Permanente Medicare	$1,507.84
Rate for Payer: MDX Hawaii PPO	$1,924.48
Rate for Payer: Ohana Health Plan Medicaid	$1,507.84
Rate for Payer: Ohana Health Plan Medicare	$1,507.84
Rate for Payer: UnitedHealthcare Medicaid	$200.41
Rate for Payer: UnitedHealthcare Medicare	$1,507.84
Rate for Payer: University Health Alliance Commercial	$1,446.14

HC PBB I&D MOUTH/TONG INTRA,SUBLING,SUPERF

Facility

$905.00

Service Code	HCPCS 41005
Hospital Charge Code	76141005PB
Hospital Revenue Code	761
Min. Negotiated Rate	$74.43
Max. Negotiated Rate	$877.85
Rate for Payer: AlohaCare Medicaid	$452.50
Rate for Payer: AlohaCare Medicare	$687.80
Rate for Payer: Cash Price	$543.00
Rate for Payer: Cash Price	$543.00
Rate for Payer: Devoted Health Medicare	$760.20
Rate for Payer: Hawaii Medical Service Association Commercial	$302.48
Rate for Payer: Hawaii Medical Service Association Medicare	$687.80
Rate for Payer: Hawaii Western Management Group Commercial	$859.75
Rate for Payer: Health Management Network Commercial	$769.25
Rate for Payer: Humana Medicare	$687.80
Rate for Payer: Kaiser Permanente Commercial	$814.50
Rate for Payer: Kaiser Permanente Medicaid	$461.55
Rate for Payer: Kaiser Permanente Medicare	$687.80
Rate for Payer: MDX Hawaii PPO	$877.85
Rate for Payer: Ohana Health Plan Medicaid	$687.80
Rate for Payer: Ohana Health Plan Medicare	$687.80
Rate for Payer: UnitedHealthcare Medicaid	$74.43
Rate for Payer: UnitedHealthcare Medicare	$687.80
Rate for Payer: University Health Alliance Commercial	$659.65

HC PBB I&D MOUTH/TONG INTRA,SUBLING,SUPERF

Facility

$905.00

Service Code	HCPCS 41005
Hospital Charge Code	76141005PB
Hospital Revenue Code	761
Min. Negotiated Rate	$769.25
Max. Negotiated Rate	$877.85
Rate for Payer: Cash Price	$543.00
Rate for Payer: Health Management Network Commercial	$769.25
Rate for Payer: Kaiser Permanente Commercial	$814.50
Rate for Payer: MDX Hawaii PPO	$877.85

HC PBB I&D MOUTH/TONG INTRA,SUBMENTAL

Facility

$5,772.00

Service Code	HCPCS 41007
Hospital Charge Code	76141007PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,598.84
Rate for Payer: AlohaCare Medicaid	$2,886.00
Rate for Payer: AlohaCare Medicare	$4,386.72
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	$4,848.48
Rate for Payer: Hawaii Medical Service Association Commercial	$1,981.49
Rate for Payer: Hawaii Medical Service Association Medicare	$4,386.72
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	$4,386.72
Rate for Payer: Kaiser Permanente Commercial	$5,194.80
Rate for Payer: Kaiser Permanente Medicaid	$2,943.72
Rate for Payer: Kaiser Permanente Medicare	$4,386.72
Rate for Payer: MDX Hawaii PPO	$5,598.84
Rate for Payer: Ohana Health Plan Medicaid	$4,386.72
Rate for Payer: Ohana Health Plan Medicare	$4,386.72
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,386.72
Rate for Payer: University Health Alliance Commercial	$4,207.21

HC PBB I&D MOUTH/TONG INTRA,SUBMENTAL

Facility

$5,772.00

Service Code	HCPCS 41007
Hospital Charge Code	76141007PB
Hospital Revenue Code	761
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: Kaiser Permanente Commercial	$5,194.80
Rate for Payer: MDX Hawaii PPO	$5,598.84

HC PBB INCIS/DRAIN ARM/ELBOW INFECT BURSA

Facility

$6,448.00

Service Code	HCPCS 23931
Hospital Charge Code	76123931PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$3,224.00
Rate for Payer: AlohaCare Medicare	$4,900.48
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	$5,416.32
Rate for Payer: Hawaii Medical Service Association Commercial	$2,109.21
Rate for Payer: Hawaii Medical Service Association Medicare	$4,900.48
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	$4,900.48
Rate for Payer: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: Kaiser Permanente Medicaid	$3,288.48
Rate for Payer: Kaiser Permanente Medicare	$4,900.48
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$4,900.48
Rate for Payer: Ohana Health Plan Medicare	$4,900.48
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,900.48
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC PBB INCIS/DRAIN ARM/ELBOW INFECT BURSA

Facility

$6,448.00

Service Code	HCPCS 23931
Hospital Charge Code	76123931PB
Hospital Revenue Code	761
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: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC PBB INJECT NERV BLCK,PARACERVICAL

Facility

$2,699.00

Service Code	HCPCS 64435
Hospital Charge Code	76164435PB
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,618.03
Rate for Payer: AlohaCare Medicaid	$1,349.50
Rate for Payer: AlohaCare Medicare	$2,051.24
Rate for Payer: Cash Price	$1,619.40
Rate for Payer: Cash Price	$1,619.40
Rate for Payer: Cash Price	$1,619.40
Rate for Payer: Devoted Health Medicare	$2,267.16
Rate for Payer: Hawaii Medical Service Association Commercial	$901.46
Rate for Payer: Hawaii Medical Service Association Medicare	$2,051.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.05
Rate for Payer: Health Management Network Commercial	$2,294.15
Rate for Payer: Humana Medicare	$2,051.24
Rate for Payer: Kaiser Permanente Commercial	$2,429.10
Rate for Payer: Kaiser Permanente Medicaid	$1,376.49
Rate for Payer: Kaiser Permanente Medicare	$2,051.24
Rate for Payer: MDX Hawaii PPO	$2,618.03
Rate for Payer: Ohana Health Plan Medicaid	$2,051.24
Rate for Payer: Ohana Health Plan Medicare	$2,051.24
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,051.24
Rate for Payer: University Health Alliance Commercial	$1,967.30

HC PBB INJECT NERV BLCK,PARACERVICAL

Facility

$2,699.00

Service Code	HCPCS 64435
Hospital Charge Code	76164435PB
Hospital Revenue Code	761
Min. Negotiated Rate	$2,294.15
Max. Negotiated Rate	$2,618.03
Rate for Payer: Cash Price	$1,619.40
Rate for Payer: Health Management Network Commercial	$2,294.15
Rate for Payer: Kaiser Permanente Commercial	$2,429.10
Rate for Payer: MDX Hawaii PPO	$2,618.03

HC PBB MARSUP BARTHOLIN GLAND CYST

Facility

$12,390.00

Service Code	HCPCS 56440
Hospital Charge Code	76156440PB
Hospital Revenue Code	761
Min. Negotiated Rate	$10,531.50
Max. Negotiated Rate	$12,018.30
Rate for Payer: Cash Price	$7,434.00
Rate for Payer: Health Management Network Commercial	$10,531.50
Rate for Payer: Kaiser Permanente Commercial	$11,151.00
Rate for Payer: MDX Hawaii PPO	$12,018.30

HC PBB MARSUP BARTHOLIN GLAND CYST

Facility

$12,390.00

Service Code	HCPCS 56440
Hospital Charge Code	76156440PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,018.30
Rate for Payer: MDX Hawaii PPO	$12,018.30
Rate for Payer: AlohaCare Medicaid	$6,195.00
Rate for Payer: AlohaCare Medicare	$9,416.40
Rate for Payer: Cash Price	$7,434.00
Rate for Payer: Cash Price	$7,434.00
Rate for Payer: Cash Price	$7,434.00
Rate for Payer: Devoted Health Medicare	$10,407.60
Rate for Payer: Hawaii Medical Service Association Commercial	$4,134.05
Rate for Payer: Hawaii Medical Service Association Medicare	$9,416.40
Rate for Payer: Hawaii Western Management Group Commercial	$11,770.50
Rate for Payer: Health Management Network Commercial	$10,531.50
Rate for Payer: Humana Medicare	$9,416.40
Rate for Payer: Kaiser Permanente Commercial	$11,151.00
Rate for Payer: Kaiser Permanente Medicaid	$6,318.90
Rate for Payer: Kaiser Permanente Medicare	$9,416.40
Rate for Payer: Ohana Health Plan Medicaid	$9,416.40
Rate for Payer: Ohana Health Plan Medicare	$9,416.40
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$9,416.40
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC PBB NERVOUS SYSTEM SURGERY UNLISTED

Facility

$1,175.00

Service Code	HCPCS 64999
Hospital Charge Code	76164999PB
Hospital Revenue Code	761
Min. Negotiated Rate	$392.00
Max. Negotiated Rate	$1,139.75
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 Commercial	$392.00
Rate for Payer: Hawaii Medical Service Association Medicare	$893.00
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	$599.25
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 Medicaid	$932.99
Rate for Payer: UnitedHealthcare Medicare	$893.00
Rate for Payer: University Health Alliance Commercial	$856.46

HC PBB NERVOUS SYSTEM SURGERY UNLISTED

Facility

$1,175.00

Service Code	HCPCS 64999
Hospital Charge Code	76164999PB
Hospital Revenue Code	761
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 PBB POSTOP FOLLOW-UP VISIT TC

Facility

$513.00

Service Code	HCPCS 99024
Hospital Charge Code	51099024PB
Hospital Revenue Code	510
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

Know your out-of-pocket cost for care.

All Charges