Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

INCISION AND DRAINAGE LEG OR ANKLE DEEP ABSCESS OR

Facility

$8,013.00

Service Code	HCPCS 27603
Hospital Charge Code	440276030
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$7,772.61
Rate for Payer: AlohaCare Medicaid	$4,006.50
Rate for Payer: AlohaCare Medicare	$3,365.46
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7,371.96
Rate for Payer: Devoted Health Medicare	$3,365.46
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,365.46
Rate for Payer: Hawaii Western Management Group Commercial	$7,612.35
Rate for Payer: Health Management Network Commercial	$6,811.05
Rate for Payer: Humana Medicare	$3,365.46
Rate for Payer: Kaiser Permanente Commercial	$7,211.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,365.46
Rate for Payer: MDX Hawaii PPO	$7,772.61
Rate for Payer: Ohana Health Plan Medicaid	$3,365.46
Rate for Payer: Ohana Health Plan Medicare	$3,365.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,365.46
Rate for Payer: University Health Alliance Commercial	$5,160.40

INCISION AND DRAINAGE LEG OR ANKLE DEEP ABSCESS OR

Facility

$8,013.00

Service Code	HCPCS 27603
Hospital Charge Code	440276030
Hospital Revenue Code	450
Min. Negotiated Rate	$6,811.05
Max. Negotiated Rate	$7,772.61
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Health Management Network Commercial	$6,811.05
Rate for Payer: Kaiser Permanente Commercial	$7,211.70
Rate for Payer: MDX Hawaii PPO	$7,772.61

INCISION AND DRAINAGE PERIANAL ABSCESS SUPERFICIAL

Facility

$2,417.00

Service Code	HCPCS 46050
Hospital Charge Code	440460500
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,344.49
Rate for Payer: AlohaCare Medicaid	$1,208.50
Rate for Payer: AlohaCare Medicare	$1,015.14
Rate for Payer: Cash Price	$1,571.05
Rate for Payer: Cash Price	$1,571.05
Rate for Payer: Cash Price	$1,571.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,223.64
Rate for Payer: Devoted Health Medicare	$1,015.14
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,015.14
Rate for Payer: Hawaii Western Management Group Commercial	$2,296.15
Rate for Payer: Health Management Network Commercial	$2,054.45
Rate for Payer: Humana Medicare	$1,015.14
Rate for Payer: Kaiser Permanente Commercial	$2,175.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,015.14
Rate for Payer: MDX Hawaii PPO	$2,344.49
Rate for Payer: Ohana Health Plan Medicaid	$1,015.14
Rate for Payer: Ohana Health Plan Medicare	$1,015.14
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,015.14
Rate for Payer: University Health Alliance Commercial	$1,761.75

INCISION AND DRAINAGE PERIANAL ABSCESS SUPERFICIAL

Facility

$2,417.00

Service Code	HCPCS 46050
Hospital Charge Code	440460500
Hospital Revenue Code	450
Min. Negotiated Rate	$2,054.45
Max. Negotiated Rate	$2,344.49
Rate for Payer: Cash Price	$1,571.05
Rate for Payer: Health Management Network Commercial	$2,054.45
Rate for Payer: Kaiser Permanente Commercial	$2,175.30
Rate for Payer: MDX Hawaii PPO	$2,344.49

INCISION AND DRAINAGE SHOULDER AREA DEEP ABSCESS O

Facility

$8,013.00

Service Code	HCPCS 23030
Hospital Charge Code	440230300
Hospital Revenue Code	450
Min. Negotiated Rate	$6,811.05
Max. Negotiated Rate	$7,772.61
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Health Management Network Commercial	$6,811.05
Rate for Payer: Kaiser Permanente Commercial	$7,211.70
Rate for Payer: MDX Hawaii PPO	$7,772.61

INCISION AND DRAINAGE SHOULDER AREA DEEP ABSCESS O

Facility

$8,013.00

Service Code	HCPCS 23030
Hospital Charge Code	440230300
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$7,772.61
Rate for Payer: AlohaCare Medicaid	$4,006.50
Rate for Payer: AlohaCare Medicare	$3,365.46
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7,371.96
Rate for Payer: Devoted Health Medicare	$3,365.46
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,365.46
Rate for Payer: Hawaii Western Management Group Commercial	$7,612.35
Rate for Payer: Health Management Network Commercial	$6,811.05
Rate for Payer: Humana Medicare	$3,365.46
Rate for Payer: Kaiser Permanente Commercial	$7,211.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,365.46
Rate for Payer: MDX Hawaii PPO	$7,772.61
Rate for Payer: Ohana Health Plan Medicaid	$3,365.46
Rate for Payer: Ohana Health Plan Medicare	$3,365.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,365.46
Rate for Payer: University Health Alliance Commercial	$4,035.20

INCISION BONE CORTEX FOOT

Professional

Both

$1,234.00

Service Code	HCPCS 28005
Hospital Revenue Code	361
Min. Negotiated Rate	$526.50
Max. Negotiated Rate	$1,048.90
Rate for Payer: AlohaCare Medicaid	$594.37
Rate for Payer: AlohaCare Medicare	$548.02
Rate for Payer: Cash Price	$802.10
Rate for Payer: Cash Price	$802.10
Rate for Payer: Devoted Health Medicare	$548.02
Rate for Payer: Hawaii Medical Service Association Medicare	$548.02
Rate for Payer: Hawaii Western Management Group Commercial	$526.50
Rate for Payer: Health Management Network Commercial	$1,048.90
Rate for Payer: Kaiser Permanente Commercial	$657.62
Rate for Payer: Kaiser Permanente Medicaid	$657.62
Rate for Payer: Kaiser Permanente Medicare	$657.62
Rate for Payer: Ohana Health Plan Medicaid	$594.37
Rate for Payer: Ohana Health Plan Medicare	$548.02
Rate for Payer: UnitedHealthcare Medicaid	$594.37
Rate for Payer: UnitedHealthcare Medicare	$548.02

INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE

Professional

Both

$584.00

Service Code	HCPCS 10061
Hospital Revenue Code	361
Min. Negotiated Rate	$95.42
Max. Negotiated Rate	$496.40
Rate for Payer: AlohaCare Medicaid	$194.24
Rate for Payer: AlohaCare Medicare	$180.01
Rate for Payer: Cash Price	$379.60
Rate for Payer: Cash Price	$379.60
Rate for Payer: Devoted Health Medicare	$180.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$194.24
Rate for Payer: Hawaii Medical Service Association Medicare	$180.01
Rate for Payer: Hawaii Western Management Group Commercial	$95.42
Rate for Payer: Health Management Network Commercial	$496.40
Rate for Payer: Kaiser Permanente Commercial	$216.01
Rate for Payer: Kaiser Permanente Medicaid	$216.01
Rate for Payer: Kaiser Permanente Medicare	$216.01
Rate for Payer: Ohana Health Plan Medicaid	$194.24
Rate for Payer: Ohana Health Plan Medicare	$180.01
Rate for Payer: UnitedHealthcare Medicaid	$194.24
Rate for Payer: UnitedHealthcare Medicare	$180.01
Rate for Payer: University Health Alliance Commercial	$209.93

INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE

Professional

Both

$584.00

Service Code	HCPCS 10060
Hospital Revenue Code	361
Min. Negotiated Rate	$66.56
Max. Negotiated Rate	$496.40
Rate for Payer: AlohaCare Medicaid	$114.56
Rate for Payer: AlohaCare Medicare	$106.44
Rate for Payer: Cash Price	$379.60
Rate for Payer: Cash Price	$379.60
Rate for Payer: Devoted Health Medicare	$106.44
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$114.56
Rate for Payer: Hawaii Medical Service Association Commercial	$168.35
Rate for Payer: Hawaii Medical Service Association Medicare	$106.44
Rate for Payer: Hawaii Western Management Group Commercial	$66.56
Rate for Payer: Health Management Network Commercial	$496.40
Rate for Payer: Kaiser Permanente Commercial	$127.73
Rate for Payer: Kaiser Permanente Medicaid	$127.73
Rate for Payer: Kaiser Permanente Medicare	$127.73
Rate for Payer: Ohana Health Plan Medicaid	$114.56
Rate for Payer: Ohana Health Plan Medicare	$106.44
Rate for Payer: UnitedHealthcare Medicaid	$114.56
Rate for Payer: UnitedHealthcare Medicare	$106.44

INCISION & DRAINAGE COMPLEX PO WOUND INFECTION

Professional

Both

$5,725.00

Service Code	HCPCS 10180
Hospital Revenue Code	361
Min. Negotiated Rate	$126.62
Max. Negotiated Rate	$4,866.25
Rate for Payer: AlohaCare Medicaid	$184.76
Rate for Payer: AlohaCare Medicare	$180.19
Rate for Payer: Cash Price	$3,721.25
Rate for Payer: Cash Price	$3,721.25
Rate for Payer: Devoted Health Medicare	$180.19
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$184.76
Rate for Payer: Hawaii Medical Service Association Commercial	$284.06
Rate for Payer: Hawaii Medical Service Association Medicare	$180.19
Rate for Payer: Hawaii Western Management Group Commercial	$126.62
Rate for Payer: Health Management Network Commercial	$4,866.25
Rate for Payer: Kaiser Permanente Commercial	$216.23
Rate for Payer: Kaiser Permanente Medicaid	$216.23
Rate for Payer: Kaiser Permanente Medicare	$216.23
Rate for Payer: Ohana Health Plan Medicaid	$184.76
Rate for Payer: Ohana Health Plan Medicare	$180.19
Rate for Payer: UnitedHealthcare Medicaid	$184.76
Rate for Payer: UnitedHealthcare Medicare	$180.19
Rate for Payer: University Health Alliance Commercial	$210.20

INCISION & DRAINAGE PILONIDAL CYST COMPLICATED

Professional

Both

$3,087.00

Service Code	HCPCS 10081
Hospital Revenue Code	361
Min. Negotiated Rate	$111.54
Max. Negotiated Rate	$2,623.95
Rate for Payer: AlohaCare Medicaid	$175.37
Rate for Payer: AlohaCare Medicare	$171.67
Rate for Payer: Cash Price	$2,006.55
Rate for Payer: Cash Price	$2,006.55
Rate for Payer: Devoted Health Medicare	$171.67
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$175.37
Rate for Payer: Hawaii Medical Service Association Commercial	$272.42
Rate for Payer: Hawaii Medical Service Association Medicare	$171.67
Rate for Payer: Hawaii Western Management Group Commercial	$111.54
Rate for Payer: Health Management Network Commercial	$2,623.95
Rate for Payer: Kaiser Permanente Commercial	$206.00
Rate for Payer: Kaiser Permanente Medicaid	$206.00
Rate for Payer: Kaiser Permanente Medicare	$206.00
Rate for Payer: Ohana Health Plan Medicaid	$175.37
Rate for Payer: Ohana Health Plan Medicare	$171.67
Rate for Payer: UnitedHealthcare Medicaid	$175.37
Rate for Payer: UnitedHealthcare Medicare	$171.67
Rate for Payer: University Health Alliance Commercial	$201.59

INCISION & DRAINAGE PILONIDAL CYST SIMPLE

Professional

Both

$584.00

Service Code	HCPCS 10080
Hospital Revenue Code	361
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$496.40
Rate for Payer: AlohaCare Medicaid	$111.66
Rate for Payer: AlohaCare Medicare	$110.45
Rate for Payer: Cash Price	$379.60
Rate for Payer: Cash Price	$379.60
Rate for Payer: Devoted Health Medicare	$110.45
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$111.66
Rate for Payer: Hawaii Medical Service Association Commercial	$168.65
Rate for Payer: Hawaii Medical Service Association Medicare	$110.45
Rate for Payer: Hawaii Western Management Group Commercial	$59.80
Rate for Payer: Health Management Network Commercial	$496.40
Rate for Payer: Kaiser Permanente Commercial	$132.54
Rate for Payer: Kaiser Permanente Medicaid	$132.54
Rate for Payer: Kaiser Permanente Medicare	$132.54
Rate for Payer: Ohana Health Plan Medicaid	$111.66
Rate for Payer: Ohana Health Plan Medicare	$110.45
Rate for Payer: UnitedHealthcare Medicaid	$111.66
Rate for Payer: UnitedHealthcare Medicare	$110.45
Rate for Payer: University Health Alliance Commercial	$120.86

INCISION&DRAINAGE UPPER ARM/ELBOW BURSA

Professional

Both

$867.00

Service Code	HCPCS 23931
Hospital Revenue Code	361
Min. Negotiated Rate	$95.16
Max. Negotiated Rate	$736.95
Rate for Payer: AlohaCare Medicaid	$172.20
Rate for Payer: AlohaCare Medicare	$165.68
Rate for Payer: Cash Price	$563.55
Rate for Payer: Cash Price	$563.55
Rate for Payer: Devoted Health Medicare	$165.68
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$172.20
Rate for Payer: Hawaii Medical Service Association Commercial	$261.47
Rate for Payer: Hawaii Medical Service Association Medicare	$165.68
Rate for Payer: Hawaii Western Management Group Commercial	$95.16
Rate for Payer: Health Management Network Commercial	$736.95
Rate for Payer: Kaiser Permanente Commercial	$198.82
Rate for Payer: Kaiser Permanente Medicaid	$198.82
Rate for Payer: Kaiser Permanente Medicare	$198.82
Rate for Payer: Ohana Health Plan Medicaid	$172.20
Rate for Payer: Ohana Health Plan Medicare	$165.68
Rate for Payer: UnitedHealthcare Medicaid	$172.20
Rate for Payer: UnitedHealthcare Medicare	$165.68
Rate for Payer: University Health Alliance Commercial	$221.37

INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP

Professional

Both

$4,182.00

Service Code	HCPCS 10121
Hospital Revenue Code	361
Min. Negotiated Rate	$151.06
Max. Negotiated Rate	$3,554.70
Rate for Payer: AlohaCare Medicaid	$189.71
Rate for Payer: AlohaCare Medicare	$175.90
Rate for Payer: Cash Price	$2,718.30
Rate for Payer: Cash Price	$2,718.30
Rate for Payer: Devoted Health Medicare	$175.90
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$189.71
Rate for Payer: Hawaii Medical Service Association Commercial	$292.59
Rate for Payer: Hawaii Medical Service Association Medicare	$175.90
Rate for Payer: Hawaii Western Management Group Commercial	$151.06
Rate for Payer: Health Management Network Commercial	$3,554.70
Rate for Payer: Kaiser Permanente Commercial	$211.08
Rate for Payer: Kaiser Permanente Medicaid	$211.08
Rate for Payer: Kaiser Permanente Medicare	$211.08
Rate for Payer: Ohana Health Plan Medicaid	$189.71
Rate for Payer: Ohana Health Plan Medicare	$175.90
Rate for Payer: UnitedHealthcare Medicaid	$189.71
Rate for Payer: UnitedHealthcare Medicare	$175.90
Rate for Payer: University Health Alliance Commercial	$216.52

INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE

Professional

Both

$1,004.00

Service Code	HCPCS 10120
Hospital Revenue Code	361
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$853.40
Rate for Payer: AlohaCare Medicaid	$113.02
Rate for Payer: AlohaCare Medicare	$108.15
Rate for Payer: Cash Price	$652.60
Rate for Payer: Cash Price	$652.60
Rate for Payer: Devoted Health Medicare	$108.15
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$113.02
Rate for Payer: Hawaii Medical Service Association Commercial	$160.25
Rate for Payer: Hawaii Medical Service Association Medicare	$108.15
Rate for Payer: Hawaii Western Management Group Commercial	$59.80
Rate for Payer: Health Management Network Commercial	$853.40
Rate for Payer: Kaiser Permanente Commercial	$129.78
Rate for Payer: Kaiser Permanente Medicaid	$129.78
Rate for Payer: Kaiser Permanente Medicare	$129.78
Rate for Payer: Ohana Health Plan Medicaid	$113.02
Rate for Payer: Ohana Health Plan Medicare	$108.15
Rate for Payer: UnitedHealthcare Medicaid	$113.02
Rate for Payer: UnitedHealthcare Medicare	$108.15
Rate for Payer: University Health Alliance Commercial	$125.09

INCISION, THROMBOSED HEM, EXT CHARGE

Facility

$1,080.00

Service Code	HCPCS 46083
Hospital Charge Code	440460830
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$540.00
Rate for Payer: AlohaCare Medicare	$453.60
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$993.60
Rate for Payer: Devoted Health Medicare	$453.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$453.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,026.00
Rate for Payer: Health Management Network Commercial	$918.00
Rate for Payer: Humana Medicare	$453.60
Rate for Payer: Kaiser Permanente Commercial	$972.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$453.60
Rate for Payer: MDX Hawaii PPO	$1,047.60
Rate for Payer: Ohana Health Plan Medicaid	$453.60
Rate for Payer: Ohana Health Plan Medicare	$453.60
Rate for Payer: UnitedHealthcare Medicare	$453.60
Rate for Payer: University Health Alliance Commercial	$787.21

INCISION, THROMBOSED HEM, EXT CHARGE

Facility

$1,080.00

Service Code	HCPCS 46083
Hospital Charge Code	440460830
Hospital Revenue Code	450
Min. Negotiated Rate	$918.00
Max. Negotiated Rate	$1,047.60
Rate for Payer: Cash Price	$702.00
Rate for Payer: Health Management Network Commercial	$918.00
Rate for Payer: Kaiser Permanente Commercial	$972.00
Rate for Payer: MDX Hawaii PPO	$1,047.60

indomethacin 25 mg Cap [KMC]

Facility

$3.00

Service Code	NDC 68462040601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

indomethacin 25 mg Cap [KMC]

Facility

$3.00

Service Code	NDC 68462040601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$13,652.35

Service Code	MSDRG 758
Min. Negotiated Rate	$13,652.35
Max. Negotiated Rate	$13,652.35
Rate for Payer: Hawaii Medical Service Association Commercial	$13,652.35

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$13,652.35

Service Code	MSDRG 757
Min. Negotiated Rate	$13,652.35
Max. Negotiated Rate	$13,652.35
Rate for Payer: Hawaii Medical Service Association Commercial	$13,652.35

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$13,652.35

Service Code	MSDRG 759
Min. Negotiated Rate	$13,652.35
Max. Negotiated Rate	$13,652.35
Rate for Payer: Hawaii Medical Service Association Commercial	$13,652.35

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC

Facility

$154,039.30

Service Code	MSDRG 854
Min. Negotiated Rate	$154,039.30
Max. Negotiated Rate	$154,039.30
Rate for Payer: Hawaii Medical Service Association Commercial	$154,039.30

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility

$154,039.30

Service Code	MSDRG 853
Min. Negotiated Rate	$154,039.30
Max. Negotiated Rate	$154,039.30
Rate for Payer: Hawaii Medical Service Association Commercial	$154,039.30

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$154,039.30

Service Code	MSDRG 855
Min. Negotiated Rate	$154,039.30
Max. Negotiated Rate	$154,039.30
Rate for Payer: Hawaii Medical Service Association Commercial	$154,039.30

Know your out-of-pocket cost for care.

All Charges