Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

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: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: MDX Hawaii PPO	$6,254.56

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	$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: Devoted Health Medicare	$5,416.32
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	$4,900.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$4,900.48
Rate for Payer: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$4,900.48
Rate for Payer: University Health Alliance Commercial	$4,035.20

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	$450.00
Max. Negotiated Rate	$10,818.41
Rate for Payer: AlohaCare Medicaid	$5,576.50
Rate for Payer: AlohaCare Medicare	$8,476.28
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Devoted Health Medicare	$9,368.52
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	$8,476.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$8,476.28
Rate for Payer: Kaiser Permanente Commercial	$10,037.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$8,476.28
Rate for Payer: MDX Hawaii PPO	$10,818.41
Rate for Payer: Ohana Health Plan Medicaid	$8,476.28
Rate for Payer: Ohana Health Plan Medicare	$8,476.28
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$8,476.28
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: Kaiser Permanente Commercial	$10,037.70
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	$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: Devoted Health Medicare	$5,416.32
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	$4,900.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$4,900.48
Rate for Payer: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$4,900.48
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: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC REMOVAL OF NAIL PLATE

Facility

$791.00

Service Code	HCPCS 11730
Hospital Charge Code	4501173001
Hospital Revenue Code	450
Min. Negotiated Rate	$672.35
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: MDX Hawaii PPO	$767.27

HC REMOVAL OF NAIL PLATE

Facility

$791.00

Service Code	HCPCS 11730
Hospital Charge Code	4501173001
Hospital Revenue Code	450
Min. Negotiated Rate	$395.50
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$601.16
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$664.44
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	$601.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$751.45
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$601.16
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$601.16
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$601.16
Rate for Payer: Ohana Health Plan Medicare	$601.16
Rate for Payer: UnitedHealthcare Medicare	$601.16
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA

Facility

$57.00

Service Code	HCPCS 15853
Hospital Charge Code	4501585301
Hospital Revenue Code	450
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$34.20
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: MDX Hawaii PPO	$55.29

HC REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA

Facility

$57.00

Service Code	HCPCS 15853
Hospital Charge Code	4501585301
Hospital Revenue Code	450
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$28.50
Rate for Payer: AlohaCare Medicare	$43.32
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$34.20
Rate for Payer: Devoted Health Medicare	$47.88
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	$43.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$54.15
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Humana Medicare	$43.32
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$43.32
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$43.32
Rate for Payer: Ohana Health Plan Medicare	$43.32
Rate for Payer: UnitedHealthcare Medicare	$43.32
Rate for Payer: University Health Alliance Commercial	$41.55

HC REMOVAL VAGINAL FOR.BODY W ANESTH

Facility

$12,653.00

Service Code	HCPCS 57415
Hospital Charge Code	7615741501
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$12,273.41
Rate for Payer: AlohaCare Medicaid	$6,326.50
Rate for Payer: AlohaCare Medicare	$9,616.28
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Devoted Health Medicare	$10,628.52
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	$9,616.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,020.35
Rate for Payer: Health Management Network Commercial	$10,755.05
Rate for Payer: Humana Medicare	$9,616.28
Rate for Payer: Kaiser Permanente Commercial	$11,387.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$9,616.28
Rate for Payer: MDX Hawaii PPO	$12,273.41
Rate for Payer: Ohana Health Plan Medicaid	$9,616.28
Rate for Payer: Ohana Health Plan Medicare	$9,616.28
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$9,616.28
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC REMOVAL VAGINAL FOR.BODY W ANESTH

Facility

$12,653.00

Service Code	HCPCS 57415
Hospital Charge Code	7615741501
Hospital Revenue Code	450
Min. Negotiated Rate	$10,755.05
Max. Negotiated Rate	$12,273.41
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Health Management Network Commercial	$10,755.05
Rate for Payer: Kaiser Permanente Commercial	$11,387.70
Rate for Payer: MDX Hawaii PPO	$12,273.41

HC REMOVE FOREIGN BODY COMPLIC

Facility

$6,448.00

Service Code	HCPCS 10121
Hospital Charge Code	7611012101
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
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: Devoted Health Medicare	$5,416.32
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	$4,900.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$4,900.48
Rate for Payer: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
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 REMOVE FOREIGN BODY COMPLIC

Facility

$6,448.00

Service Code	HCPCS 10121
Hospital Charge Code	7611012101
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: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC REMOVE FOREIGN BODY SIMPLE

Facility

$1,590.00

Service Code	HCPCS 10120
Hospital Charge Code	7611012001
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: Kaiser Permanente Commercial	$1,431.00
Rate for Payer: MDX Hawaii PPO	$1,542.30

HC REMOVE FOREIGN BODY SIMPLE

Facility

$1,590.00

Service Code	HCPCS 10120
Hospital Charge Code	7611012001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$795.00
Rate for Payer: AlohaCare Medicare	$1,208.40
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Devoted Health Medicare	$1,335.60
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	$1,208.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$1,208.40
Rate for Payer: Kaiser Permanente Commercial	$1,431.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,208.40
Rate for Payer: MDX Hawaii PPO	$1,542.30
Rate for Payer: Ohana Health Plan Medicaid	$1,208.40
Rate for Payer: Ohana Health Plan Medicare	$1,208.40
Rate for Payer: UnitedHealthcare Medicare	$1,208.40
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC REMOVE FOREIGN BODY SIMPLE

Facility

$1,590.00

Service Code	HCPCS 10120
Hospital Charge Code	3611012001
Hospital Revenue Code	361
Min. Negotiated Rate	$54.57
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$795.00
Rate for Payer: AlohaCare Medicare	$1,208.40
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	$1,335.60
Rate for Payer: Hawaii Medical Service Association Commercial	$519.15
Rate for Payer: Hawaii Medical Service Association Medicare	$1,208.40
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: Humana Medicare	$1,208.40
Rate for Payer: Kaiser Permanente Commercial	$1,431.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,208.40
Rate for Payer: MDX Hawaii PPO	$1,542.30
Rate for Payer: Ohana Health Plan Medicaid	$1,208.40
Rate for Payer: Ohana Health Plan Medicare	$1,208.40
Rate for Payer: UnitedHealthcare Medicaid	$54.57
Rate for Payer: UnitedHealthcare Medicare	$1,208.40
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC REMOVE FOREIGN BODY SIMPLE

Facility

$1,590.00

Service Code	HCPCS 10120
Hospital Charge Code	3611012001
Hospital Revenue Code	361
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: Kaiser Permanente Commercial	$1,431.00
Rate for Payer: MDX Hawaii PPO	$1,542.30

HC REMV EXT CANAL FOREIGN BODY

Facility

$513.00

Service Code	HCPCS 69200
Hospital Charge Code	7616920001
Hospital Revenue Code	761
Min. Negotiated Rate	$35.80
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	$35.80
Rate for Payer: UnitedHealthcare Medicare	$389.88
Rate for Payer: University Health Alliance Commercial	$373.93

HC REMV EXT CANAL FOREIGN BODY

Facility

$513.00

Service Code	HCPCS 69200
Hospital Charge Code	7616920001
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 REMV F.B.,EYE,CORNEA,NO SLIT

Facility

$1,588.00

Service Code	HCPCS 65220
Hospital Charge Code	4506522001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$794.00
Rate for Payer: AlohaCare Medicare	$1,206.88
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Devoted Health Medicare	$1,333.92
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	$1,206.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$1,206.88
Rate for Payer: Kaiser Permanente Commercial	$1,429.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,206.88
Rate for Payer: MDX Hawaii PPO	$1,540.36
Rate for Payer: Ohana Health Plan Medicaid	$1,206.88
Rate for Payer: Ohana Health Plan Medicare	$1,206.88
Rate for Payer: UnitedHealthcare Medicare	$1,206.88
Rate for Payer: University Health Alliance Commercial	$1,157.49

HC REMV F.B.,EYE,CORNEA,NO SLIT

Facility

$1,588.00

Service Code	HCPCS 65220
Hospital Charge Code	4506522001
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: Kaiser Permanente Commercial	$1,429.20
Rate for Payer: MDX Hawaii PPO	$1,540.36

HC REMV F.B.,EYE,CORNEA,SLIT LAMP

Facility

$513.00

Service Code	HCPCS 65222
Hospital Charge Code	4506522201
Hospital Revenue Code	450
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 REMV F.B.,EYE,CORNEA,SLIT LAMP

Facility

$513.00

Service Code	HCPCS 65222
Hospital Charge Code	4506522201
Hospital Revenue Code	450
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$1,600.00
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: Devoted Health Medicare	$430.92
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	$389.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$937.50
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 Medicare	$389.88
Rate for Payer: University Health Alliance Commercial	$373.93

HC REMV F.B.,EYE,EMBED CONJUNC

Facility

$1,588.00

Service Code	HCPCS 65210
Hospital Charge Code	3616521001
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: Kaiser Permanente Commercial	$1,429.20
Rate for Payer: MDX Hawaii PPO	$1,540.36

Know your out-of-pocket cost for care.

All Charges