Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

INSULIN REGULAR 100 UNIT/ML SQ GLUCOSE CORRECTION SCALE [400932]

Facility

$116.00

Service Code	HCPCS J1817
Hospital Revenue Code	636
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$112.52
Rate for Payer: AlohaCare Medicaid	$58.00
Rate for Payer: AlohaCare Medicare	$88.16
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$69.60
Rate for Payer: Devoted Health Medicare	$97.44
Rate for Payer: Hawaii Medical Service Association ABD	$3.24
Rate for Payer: Hawaii Medical Service Association Medicare	$88.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.24
Rate for Payer: Hawaii Western Management Group Commercial	$110.20
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Humana Medicare	$88.16
Rate for Payer: Kaiser Permanente Commercial	$104.40
Rate for Payer: Kaiser Permanente Medicaid	$59.16
Rate for Payer: Kaiser Permanente Medicare	$88.16
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: Ohana Health Plan Medicaid	$88.16
Rate for Payer: Ohana Health Plan Medicare	$88.16
Rate for Payer: UnitedHealthcare Medicaid	$69.60
Rate for Payer: UnitedHealthcare Medicare	$88.16
Rate for Payer: University Health Alliance Commercial	$84.55

INSULIN REGULAR 100 UNIT/ML SQ GLUCOSE CORRECTION SCALE [400932]

Facility

$116.00

Service Code	HCPCS J1817
Hospital Revenue Code	250
Min. Negotiated Rate	$98.60
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$69.60
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Kaiser Permanente Commercial	$104.40
Rate for Payer: MDX Hawaii PPO	$112.52

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION [10289]

Facility

$12.00

Service Code	HCPCS J1817
Hospital Revenue Code	636
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicaid	$58.00
Rate for Payer: AlohaCare Medicare	$88.16
Rate for Payer: AlohaCare Medicare	$9.12
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Devoted Health Medicare	$97.44
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Hawaii Medical Service Association ABD	$3.24
Rate for Payer: Hawaii Medical Service Association ABD	$3.24
Rate for Payer: Hawaii Medical Service Association Medicare	$88.16
Rate for Payer: Hawaii Medical Service Association Medicare	$9.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.24
Rate for Payer: Hawaii Western Management Group Commercial	$110.20
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$88.16
Rate for Payer: Humana Medicare	$9.12
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Commercial	$104.40
Rate for Payer: Kaiser Permanente Medicaid	$59.16
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$88.16
Rate for Payer: Kaiser Permanente Medicare	$9.12
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$9.12
Rate for Payer: Ohana Health Plan Medicaid	$88.16
Rate for Payer: Ohana Health Plan Medicare	$88.16
Rate for Payer: Ohana Health Plan Medicare	$9.12
Rate for Payer: UnitedHealthcare Medicaid	$69.60
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: UnitedHealthcare Medicare	$9.12
Rate for Payer: UnitedHealthcare Medicare	$88.16
Rate for Payer: University Health Alliance Commercial	$84.55
Rate for Payer: University Health Alliance Commercial	$8.75

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION [10289]

Facility

$116.00

Service Code	HCPCS J1817
Hospital Revenue Code	250
Min. Negotiated Rate	$98.60
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Kaiser Permanente Commercial	$104.40
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: MDX Hawaii PPO	$11.64

INTEGRA BILAYER MATRX #BMW2021

Facility

$7,000.00

Service Code	HCPCS C9363
Hospital Revenue Code	636
Min. Negotiated Rate	$5,950.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: MDX Hawaii PPO	$6,790.00

INTEGRA BILAYER MATRX #BMW2021

Facility

$7,000.00

Service Code	HCPCS C9363
Hospital Revenue Code	636
Min. Negotiated Rate	$158.93
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$5,320.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$5,880.00
Rate for Payer: Hawaii Medical Service Association Commercial	$158.93
Rate for Payer: Hawaii Medical Service Association Medicare	$5,320.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,650.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Humana Medicare	$5,320.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$5,320.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$5,320.00
Rate for Payer: Ohana Health Plan Medicare	$5,320.00
Rate for Payer: UnitedHealthcare Medicaid	$4,200.00
Rate for Payer: UnitedHealthcare Medicare	$5,320.00
Rate for Payer: University Health Alliance Commercial	$5,102.30

INTEGRA BILAYER MATRX #BMW4051

Facility

$10,898.00

Service Code	HCPCS C9363
Hospital Revenue Code	636
Min. Negotiated Rate	$9,263.30
Max. Negotiated Rate	$10,571.06
Rate for Payer: Cash Price	$6,538.80
Rate for Payer: Health Management Network Commercial	$9,263.30
Rate for Payer: Kaiser Permanente Commercial	$9,808.20
Rate for Payer: MDX Hawaii PPO	$10,571.06

INTEGRA BILAYER MATRX #BMW4051

Facility

$10,898.00

Service Code	HCPCS C9363
Hospital Revenue Code	636
Min. Negotiated Rate	$158.93
Max. Negotiated Rate	$10,571.06
Rate for Payer: AlohaCare Medicaid	$5,449.00
Rate for Payer: AlohaCare Medicare	$8,282.48
Rate for Payer: Cash Price	$6,538.80
Rate for Payer: Cash Price	$6,538.80
Rate for Payer: Devoted Health Medicare	$9,154.32
Rate for Payer: Hawaii Medical Service Association Commercial	$158.93
Rate for Payer: Hawaii Medical Service Association Medicare	$8,282.48
Rate for Payer: Hawaii Western Management Group Commercial	$10,353.10
Rate for Payer: Health Management Network Commercial	$9,263.30
Rate for Payer: Humana Medicare	$8,282.48
Rate for Payer: Kaiser Permanente Commercial	$9,808.20
Rate for Payer: Kaiser Permanente Medicaid	$5,557.98
Rate for Payer: Kaiser Permanente Medicare	$8,282.48
Rate for Payer: MDX Hawaii PPO	$10,571.06
Rate for Payer: Ohana Health Plan Medicaid	$8,282.48
Rate for Payer: Ohana Health Plan Medicare	$8,282.48
Rate for Payer: UnitedHealthcare Medicaid	$6,538.80
Rate for Payer: UnitedHealthcare Medicare	$8,282.48
Rate for Payer: University Health Alliance Commercial	$7,943.55

INTEGRATED PORT ALLOX2-FH12SE

Facility

$3,300.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

INTEGRATED PORT ALLOX2-FH12SE

Facility

$3,300.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$2,508.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$2,772.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,508.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$2,508.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$2,508.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$2,508.00
Rate for Payer: Ohana Health Plan Medicare	$2,508.00
Rate for Payer: UnitedHealthcare Medicare	$2,508.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

INTELLIS ADAPTIVESTIM 97715

Facility

$45,900.00

Service Code	HCPCS C1820
Hospital Revenue Code	278
Min. Negotiated Rate	$25,704.00
Max. Negotiated Rate	$44,523.00
Rate for Payer: Cash Price	$27,540.00
Rate for Payer: Hawaii Western Management Group Commercial	$32,130.00
Rate for Payer: Health Management Network Commercial	$39,015.00
Rate for Payer: Kaiser Permanente Commercial	$41,310.00
Rate for Payer: MDX Hawaii PPO	$44,523.00
Rate for Payer: University Health Alliance Commercial	$25,704.00

INTELLIS ADAPTIVESTIM 97715

Facility

$45,900.00

Service Code	HCPCS C1820
Hospital Revenue Code	278
Min. Negotiated Rate	$22,950.00
Max. Negotiated Rate	$44,523.00
Rate for Payer: AlohaCare Medicaid	$22,950.00
Rate for Payer: AlohaCare Medicare	$34,884.00
Rate for Payer: Cash Price	$27,540.00
Rate for Payer: Devoted Health Medicare	$38,556.00
Rate for Payer: Hawaii Medical Service Association Medicare	$34,884.00
Rate for Payer: Hawaii Western Management Group Commercial	$32,130.00
Rate for Payer: Health Management Network Commercial	$39,015.00
Rate for Payer: Humana Medicare	$34,884.00
Rate for Payer: Kaiser Permanente Commercial	$41,310.00
Rate for Payer: Kaiser Permanente Medicaid	$23,409.00
Rate for Payer: Kaiser Permanente Medicare	$34,884.00
Rate for Payer: MDX Hawaii PPO	$44,523.00
Rate for Payer: Ohana Health Plan Medicaid	$34,884.00
Rate for Payer: Ohana Health Plan Medicare	$34,884.00
Rate for Payer: UnitedHealthcare Medicare	$34,884.00
Rate for Payer: University Health Alliance Commercial	$25,704.00

INTERCEED BARRIER 3X4IN

Facility

$1,741.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,479.85
Max. Negotiated Rate	$1,688.77
Rate for Payer: Cash Price	$1,044.60
Rate for Payer: Health Management Network Commercial	$1,479.85
Rate for Payer: Kaiser Permanente Commercial	$1,566.90
Rate for Payer: MDX Hawaii PPO	$1,688.77

INTERCEED BARRIER 3X4IN

Facility

$1,741.00

Hospital Revenue Code	272
Min. Negotiated Rate	$870.50
Max. Negotiated Rate	$1,688.77
Rate for Payer: AlohaCare Medicaid	$870.50
Rate for Payer: AlohaCare Medicare	$1,323.16
Rate for Payer: Cash Price	$1,044.60
Rate for Payer: Devoted Health Medicare	$1,462.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,323.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,653.95
Rate for Payer: Health Management Network Commercial	$1,479.85
Rate for Payer: Humana Medicare	$1,323.16
Rate for Payer: Kaiser Permanente Commercial	$1,566.90
Rate for Payer: Kaiser Permanente Medicaid	$887.91
Rate for Payer: Kaiser Permanente Medicare	$1,323.16
Rate for Payer: MDX Hawaii PPO	$1,688.77
Rate for Payer: Ohana Health Plan Medicaid	$1,323.16
Rate for Payer: Ohana Health Plan Medicare	$1,323.16
Rate for Payer: UnitedHealthcare Medicare	$1,323.16
Rate for Payer: University Health Alliance Commercial	$1,269.01

INTERGARD KNITTED IGK0022-40

Facility

$1,953.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.68
Max. Negotiated Rate	$1,894.41
Rate for Payer: Cash Price	$1,171.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,367.10
Rate for Payer: Health Management Network Commercial	$1,660.05
Rate for Payer: Kaiser Permanente Commercial	$1,757.70
Rate for Payer: MDX Hawaii PPO	$1,894.41
Rate for Payer: University Health Alliance Commercial	$1,093.68

INTERGARD KNITTED IGK0022-40

Facility

$1,953.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$976.50
Max. Negotiated Rate	$1,894.41
Rate for Payer: AlohaCare Medicaid	$976.50
Rate for Payer: AlohaCare Medicare	$1,484.28
Rate for Payer: Cash Price	$1,171.80
Rate for Payer: Devoted Health Medicare	$1,640.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,484.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,367.10
Rate for Payer: Health Management Network Commercial	$1,660.05
Rate for Payer: Humana Medicare	$1,484.28
Rate for Payer: Kaiser Permanente Commercial	$1,757.70
Rate for Payer: Kaiser Permanente Medicaid	$996.03
Rate for Payer: Kaiser Permanente Medicare	$1,484.28
Rate for Payer: MDX Hawaii PPO	$1,894.41
Rate for Payer: Ohana Health Plan Medicaid	$1,484.28
Rate for Payer: Ohana Health Plan Medicare	$1,484.28
Rate for Payer: UnitedHealthcare Medicare	$1,484.28
Rate for Payer: University Health Alliance Commercial	$1,093.68

INTERGARD KNITTED IGK2211

Facility

$1,570.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$879.20
Max. Negotiated Rate	$1,522.90
Rate for Payer: Cash Price	$942.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,099.00
Rate for Payer: Health Management Network Commercial	$1,334.50
Rate for Payer: Kaiser Permanente Commercial	$1,413.00
Rate for Payer: MDX Hawaii PPO	$1,522.90
Rate for Payer: University Health Alliance Commercial	$879.20

INTERGARD KNITTED IGK2211

Facility

$1,570.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$785.00
Max. Negotiated Rate	$1,522.90
Rate for Payer: AlohaCare Medicaid	$785.00
Rate for Payer: AlohaCare Medicare	$1,193.20
Rate for Payer: Cash Price	$942.00
Rate for Payer: Devoted Health Medicare	$1,318.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,193.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,099.00
Rate for Payer: Health Management Network Commercial	$1,334.50
Rate for Payer: Humana Medicare	$1,193.20
Rate for Payer: Kaiser Permanente Commercial	$1,413.00
Rate for Payer: Kaiser Permanente Medicaid	$800.70
Rate for Payer: Kaiser Permanente Medicare	$1,193.20
Rate for Payer: MDX Hawaii PPO	$1,522.90
Rate for Payer: Ohana Health Plan Medicaid	$1,193.20
Rate for Payer: Ohana Health Plan Medicare	$1,193.20
Rate for Payer: UnitedHealthcare Medicare	$1,193.20
Rate for Payer: University Health Alliance Commercial	$879.20

INTERGARD KNITTED, IGK2412

Facility

$2,886.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.16
Max. Negotiated Rate	$2,799.42
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.20
Rate for Payer: Health Management Network Commercial	$2,453.10
Rate for Payer: Kaiser Permanente Commercial	$2,597.40
Rate for Payer: MDX Hawaii PPO	$2,799.42
Rate for Payer: University Health Alliance Commercial	$1,616.16

INTERGARD KNITTED, IGK2412

Facility

$2,886.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,443.00
Max. Negotiated Rate	$2,799.42
Rate for Payer: AlohaCare Medicaid	$1,443.00
Rate for Payer: AlohaCare Medicare	$2,193.36
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Devoted Health Medicare	$2,424.24
Rate for Payer: Hawaii Medical Service Association Medicare	$2,193.36
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.20
Rate for Payer: Health Management Network Commercial	$2,453.10
Rate for Payer: Humana Medicare	$2,193.36
Rate for Payer: Kaiser Permanente Commercial	$2,597.40
Rate for Payer: Kaiser Permanente Medicaid	$1,471.86
Rate for Payer: Kaiser Permanente Medicare	$2,193.36
Rate for Payer: MDX Hawaii PPO	$2,799.42
Rate for Payer: Ohana Health Plan Medicaid	$2,193.36
Rate for Payer: Ohana Health Plan Medicare	$2,193.36
Rate for Payer: UnitedHealthcare Medicare	$2,193.36
Rate for Payer: University Health Alliance Commercial	$1,616.16

INTERGUARD KNITTED IGK0020-40

Facility

$1,497.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$838.32
Max. Negotiated Rate	$1,452.09
Rate for Payer: Cash Price	$898.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.90
Rate for Payer: Health Management Network Commercial	$1,272.45
Rate for Payer: Kaiser Permanente Commercial	$1,347.30
Rate for Payer: MDX Hawaii PPO	$1,452.09
Rate for Payer: University Health Alliance Commercial	$838.32

INTERGUARD KNITTED IGK0020-40

Facility

$1,497.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$748.50
Max. Negotiated Rate	$1,452.09
Rate for Payer: AlohaCare Medicaid	$748.50
Rate for Payer: AlohaCare Medicare	$1,137.72
Rate for Payer: Cash Price	$898.20
Rate for Payer: Devoted Health Medicare	$1,257.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,137.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.90
Rate for Payer: Health Management Network Commercial	$1,272.45
Rate for Payer: Humana Medicare	$1,137.72
Rate for Payer: Kaiser Permanente Commercial	$1,347.30
Rate for Payer: Kaiser Permanente Medicaid	$763.47
Rate for Payer: Kaiser Permanente Medicare	$1,137.72
Rate for Payer: MDX Hawaii PPO	$1,452.09
Rate for Payer: Ohana Health Plan Medicaid	$1,137.72
Rate for Payer: Ohana Health Plan Medicare	$1,137.72
Rate for Payer: UnitedHealthcare Medicare	$1,137.72
Rate for Payer: University Health Alliance Commercial	$838.32

INTERNALBRACE KIT AR-1688-CP

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,085.50
Rate for Payer: Cash Price	$1,290.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,505.00
Rate for Payer: Health Management Network Commercial	$1,827.50
Rate for Payer: Kaiser Permanente Commercial	$1,935.00
Rate for Payer: MDX Hawaii PPO	$2,085.50
Rate for Payer: University Health Alliance Commercial	$1,204.00

INTERNALBRACE KIT AR-1688-CP

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.00
Max. Negotiated Rate	$2,085.50
Rate for Payer: AlohaCare Medicaid	$1,075.00
Rate for Payer: AlohaCare Medicare	$1,634.00
Rate for Payer: Cash Price	$1,290.00
Rate for Payer: Devoted Health Medicare	$1,806.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,634.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,505.00
Rate for Payer: Health Management Network Commercial	$1,827.50
Rate for Payer: Humana Medicare	$1,634.00
Rate for Payer: Kaiser Permanente Commercial	$1,935.00
Rate for Payer: Kaiser Permanente Medicaid	$1,096.50
Rate for Payer: Kaiser Permanente Medicare	$1,634.00
Rate for Payer: MDX Hawaii PPO	$2,085.50
Rate for Payer: Ohana Health Plan Medicaid	$1,634.00
Rate for Payer: Ohana Health Plan Medicare	$1,634.00
Rate for Payer: UnitedHealthcare Medicare	$1,634.00
Rate for Payer: University Health Alliance Commercial	$1,204.00

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$34,391.60

Service Code	MSDRG 197
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

Know your out-of-pocket cost for care.

All Charges