Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MAGNESIUM L-LACTATE ER 84 MG TABLET,EXTENDED RELEASE [4715]

Facility

$2.00

Service Code	NDC 42001000000
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

MAGNESIUM L-LACTATE ER 84 MG TABLET,EXTENDED RELEASE [4715]

Facility

$2.00

Service Code	NDC 42019000000
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [137043]

Facility

$27.00

Service Code	HCPCS J3475
Hospital Revenue Code	250
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: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [137043]

Facility

$27.00

Service Code	HCPCS J3475
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$26.19
Rate for Payer: AlohaCare Medicaid	$13.50
Rate for Payer: AlohaCare Medicare	$20.52
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Devoted Health Medicare	$22.68
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Medicare	$20.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Humana Medicare	$20.52
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: Kaiser Permanente Medicare	$20.52
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: Ohana Health Plan Medicaid	$20.52
Rate for Payer: Ohana Health Plan Medicare	$20.52
Rate for Payer: UnitedHealthcare Medicaid	$16.20
Rate for Payer: UnitedHealthcare Medicare	$20.52
Rate for Payer: University Health Alliance Commercial	$19.68

MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION [129653]

Facility

$27.00

Service Code	HCPCS J3475
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$26.19
Rate for Payer: AlohaCare Medicaid	$13.50
Rate for Payer: AlohaCare Medicare	$20.52
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Devoted Health Medicare	$22.68
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Medicare	$20.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Humana Medicare	$20.52
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: Kaiser Permanente Medicare	$20.52
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: Ohana Health Plan Medicaid	$20.52
Rate for Payer: Ohana Health Plan Medicare	$20.52
Rate for Payer: UnitedHealthcare Medicaid	$16.20
Rate for Payer: UnitedHealthcare Medicare	$20.52
Rate for Payer: University Health Alliance Commercial	$19.68

MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION [129653]

Facility

$27.00

Service Code	HCPCS J3475
Hospital Revenue Code	250
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: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

MAGNESIUM SULFATE 2 GM IN 1 L NS (SIMPLE) [4080270]

Facility

$30.00

Service Code	HCPCS J3475
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicare	$22.80
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Devoted Health Medicare	$25.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Medicare	$22.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$22.80
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$22.80
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$22.80
Rate for Payer: Ohana Health Plan Medicare	$22.80
Rate for Payer: UnitedHealthcare Medicaid	$18.00
Rate for Payer: UnitedHealthcare Medicare	$22.80
Rate for Payer: University Health Alliance Commercial	$21.87

MAGNESIUM SULFATE 2 GM IN 1 L NS (SIMPLE) [4080270]

Facility

$30.00

Service Code	HCPCS J3475
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

MAGNESIUM SULFATE 2 GM IN 500 ML NS (SIMPLE) [4080271]

Facility

$34.00

Service Code	HCPCS J3475
Hospital Revenue Code	250
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98

MAGNESIUM SULFATE 2 GM IN 500 ML NS (SIMPLE) [4080271]

Facility

$34.00

Service Code	HCPCS J3475
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$32.98
Rate for Payer: Ohana Health Plan Medicare	$25.84
Rate for Payer: AlohaCare Medicaid	$17.00
Rate for Payer: AlohaCare Medicare	$25.84
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cash Price	$20.40
Rate for Payer: Devoted Health Medicare	$28.56
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Medicare	$25.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Western Management Group Commercial	$32.30
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$25.84
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$25.84
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$25.84
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$25.84
Rate for Payer: University Health Alliance Commercial	$24.78

MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [129651]

Facility

$54.00

Service Code	HCPCS J3475
Hospital Revenue Code	250
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$32.40
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: Kaiser Permanente Commercial	$48.60
Rate for Payer: MDX Hawaii PPO	$52.38

MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [129651]

Facility

$54.00

Service Code	HCPCS J3475
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$52.38
Rate for Payer: AlohaCare Medicaid	$27.00
Rate for Payer: AlohaCare Medicare	$41.04
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Devoted Health Medicare	$45.36
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Medicare	$41.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Western Management Group Commercial	$51.30
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: Humana Medicare	$41.04
Rate for Payer: Kaiser Permanente Commercial	$48.60
Rate for Payer: Kaiser Permanente Medicaid	$27.54
Rate for Payer: Kaiser Permanente Medicare	$41.04
Rate for Payer: MDX Hawaii PPO	$52.38
Rate for Payer: Ohana Health Plan Medicaid	$41.04
Rate for Payer: Ohana Health Plan Medicare	$41.04
Rate for Payer: UnitedHealthcare Medicaid	$32.40
Rate for Payer: UnitedHealthcare Medicare	$41.04
Rate for Payer: University Health Alliance Commercial	$39.36

MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [129652]

Facility

$39.00

Service Code	HCPCS J3475
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [129652]

Facility

$39.00

Service Code	HCPCS J3475
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$29.64
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$32.76
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Medicare	$29.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$29.64
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$29.64
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$29.64
Rate for Payer: Ohana Health Plan Medicare	$29.64
Rate for Payer: UnitedHealthcare Medicaid	$23.40
Rate for Payer: UnitedHealthcare Medicare	$29.64
Rate for Payer: University Health Alliance Commercial	$28.43

MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]

Facility

$10.00

Service Code	HCPCS J3475
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: MDX Hawaii PPO	$2.91

MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]

Facility

$39.00

Service Code	HCPCS J3475
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$4.56
Rate for Payer: AlohaCare Medicare	$29.64
Rate for Payer: AlohaCare Medicare	$7.60
Rate for Payer: AlohaCare Medicare	$9.12
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$6.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$6.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Devoted Health Medicare	$32.76
Rate for Payer: Devoted Health Medicare	$8.40
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Medicare	$9.12
Rate for Payer: Hawaii Medical Service Association Medicare	$4.56
Rate for Payer: Hawaii Medical Service Association Medicare	$29.64
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Medical Service Association Medicare	$7.60
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$9.12
Rate for Payer: Humana Medicare	$7.60
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Humana Medicare	$29.64
Rate for Payer: Humana Medicare	$4.56
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: Kaiser Permanente Medicare	$29.64
Rate for Payer: Kaiser Permanente Medicare	$4.56
Rate for Payer: Kaiser Permanente Medicare	$7.60
Rate for Payer: Kaiser Permanente Medicare	$9.12
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicaid	$29.64
Rate for Payer: Ohana Health Plan Medicaid	$7.60
Rate for Payer: Ohana Health Plan Medicaid	$9.12
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicaid	$4.56
Rate for Payer: Ohana Health Plan Medicare	$9.12
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: Ohana Health Plan Medicare	$29.64
Rate for Payer: Ohana Health Plan Medicare	$4.56
Rate for Payer: Ohana Health Plan Medicare	$7.60
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: UnitedHealthcare Medicaid	$3.00
Rate for Payer: UnitedHealthcare Medicaid	$23.40
Rate for Payer: UnitedHealthcare Medicaid	$6.00
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicaid	$3.60
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$9.12
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$7.60
Rate for Payer: UnitedHealthcare Medicare	$4.56
Rate for Payer: UnitedHealthcare Medicare	$29.64
Rate for Payer: University Health Alliance Commercial	$3.64
Rate for Payer: University Health Alliance Commercial	$4.37
Rate for Payer: University Health Alliance Commercial	$28.43
Rate for Payer: University Health Alliance Commercial	$7.29
Rate for Payer: University Health Alliance Commercial	$8.75
Rate for Payer: University Health Alliance Commercial	$2.19

MAJOR BLADDER PROCEDURES WITH CC

Facility

$45,792.26

Service Code	MSDRG 654
Min. Negotiated Rate	$45,792.26
Max. Negotiated Rate	$45,792.26
Rate for Payer: Hawaii Medical Service Association Commercial	$45,792.26

MAJOR BLADDER PROCEDURES WITH MCC

Facility

$45,792.26

Service Code	MSDRG 653
Min. Negotiated Rate	$45,792.26
Max. Negotiated Rate	$45,792.26
Rate for Payer: Hawaii Medical Service Association Commercial	$45,792.26

MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$45,792.26

Service Code	MSDRG 655
Min. Negotiated Rate	$45,792.26
Max. Negotiated Rate	$45,792.26
Rate for Payer: Hawaii Medical Service Association Commercial	$45,792.26

MAJOR CHEST PROCEDURES WITH CC

Facility

$63,213.23

Service Code	MSDRG 164
Min. Negotiated Rate	$63,213.23
Max. Negotiated Rate	$63,213.23
Rate for Payer: Hawaii Medical Service Association Commercial	$63,213.23

MAJOR CHEST PROCEDURES WITH MCC

Facility

$63,450.25

Service Code	MSDRG 163
Min. Negotiated Rate	$63,450.25
Max. Negotiated Rate	$63,450.25
Rate for Payer: Hawaii Medical Service Association Commercial	$63,450.25

MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Facility

$45,436.73

Service Code	MSDRG 165
Min. Negotiated Rate	$45,436.73
Max. Negotiated Rate	$45,436.73
Rate for Payer: Hawaii Medical Service Association Commercial	$45,436.73

MAJOR CHEST TRAUMA WITH CC

Facility

$19,767.47

Service Code	MSDRG 184
Min. Negotiated Rate	$19,767.47
Max. Negotiated Rate	$19,767.47
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.47

MAJOR CHEST TRAUMA WITH MCC

Facility

$21,521.42

Service Code	MSDRG 183
Min. Negotiated Rate	$21,521.42
Max. Negotiated Rate	$21,521.42
Rate for Payer: Hawaii Medical Service Association Commercial	$21,521.42

MAJOR CHEST TRAUMA WITHOUT CC/MCC

Facility

$18,890.49

Service Code	MSDRG 185
Min. Negotiated Rate	$18,890.49
Max. Negotiated Rate	$18,890.49
Rate for Payer: Hawaii Medical Service Association Commercial	$18,890.49

Know your out-of-pocket cost for care.

All Charges