Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

DAPTOmycin 350 mg REC vial [KMC]

Facility

$192.00

Service Code	HCPCS J0878
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicare	$80.64
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$176.64
Rate for Payer: Devoted Health Medicare	$80.64
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.91
Rate for Payer: Hawaii Medical Service Association Medicare	$80.64
Rate for Payer: Hawaii Western Management Group Commercial	$182.40
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$80.64
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$80.64
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$80.64
Rate for Payer: Ohana Health Plan Medicare	$80.64
Rate for Payer: UnitedHealthcare Medicaid	$115.20
Rate for Payer: UnitedHealthcare Medicare	$80.64
Rate for Payer: University Health Alliance Commercial	$139.95

DAPTOmycin 350 mg REC vial [KMC]

Facility

$192.00

Service Code	HCPCS J0878
Hospital Revenue Code	636
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

DAPTOmycin 500 mg IV Inj [KMC]

Facility

$1,982.44

Service Code	HCPCS J0878
Hospital Revenue Code	636
Min. Negotiated Rate	$1,685.07
Max. Negotiated Rate	$1,922.97
Rate for Payer: Cash Price	$1,288.59
Rate for Payer: Health Management Network Commercial	$1,685.07
Rate for Payer: Kaiser Permanente Commercial	$1,784.20
Rate for Payer: MDX Hawaii PPO	$1,922.97

DAPTOmycin 500 mg IV Inj [KMC]

Facility

$1,982.44

Service Code	HCPCS J0878
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1,922.97
Rate for Payer: AlohaCare Medicaid	$991.22
Rate for Payer: AlohaCare Medicare	$832.62
Rate for Payer: Cash Price	$1,288.59
Rate for Payer: Cash Price	$1,288.59
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,823.84
Rate for Payer: Devoted Health Medicare	$832.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.91
Rate for Payer: Hawaii Medical Service Association Medicare	$832.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,883.32
Rate for Payer: Health Management Network Commercial	$1,685.07
Rate for Payer: Humana Medicare	$832.62
Rate for Payer: Kaiser Permanente Commercial	$1,784.20
Rate for Payer: Kaiser Permanente Medicaid	$1,011.04
Rate for Payer: Kaiser Permanente Medicare	$832.62
Rate for Payer: MDX Hawaii PPO	$1,922.97
Rate for Payer: Ohana Health Plan Medicaid	$832.62
Rate for Payer: Ohana Health Plan Medicare	$832.62
Rate for Payer: UnitedHealthcare Medicaid	$1,189.46
Rate for Payer: UnitedHealthcare Medicare	$832.62
Rate for Payer: University Health Alliance Commercial	$1,445.00

darunavir 600 mg Tab [KMC]

Facility

$150.86

Service Code	NDC 59651008560
Hospital Revenue Code	250
Min. Negotiated Rate	$63.36
Max. Negotiated Rate	$146.33
Rate for Payer: AlohaCare Medicaid	$75.43
Rate for Payer: AlohaCare Medicare	$63.36
Rate for Payer: Cash Price	$98.06
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$138.79
Rate for Payer: Devoted Health Medicare	$63.36
Rate for Payer: Hawaii Medical Service Association Medicare	$63.36
Rate for Payer: Hawaii Western Management Group Commercial	$143.32
Rate for Payer: Health Management Network Commercial	$128.23
Rate for Payer: Humana Medicare	$63.36
Rate for Payer: Kaiser Permanente Commercial	$135.77
Rate for Payer: Kaiser Permanente Medicaid	$76.94
Rate for Payer: Kaiser Permanente Medicare	$63.36
Rate for Payer: MDX Hawaii PPO	$146.33
Rate for Payer: Ohana Health Plan Medicaid	$63.36
Rate for Payer: Ohana Health Plan Medicare	$63.36
Rate for Payer: UnitedHealthcare Medicaid	$90.52
Rate for Payer: UnitedHealthcare Medicare	$63.36
Rate for Payer: University Health Alliance Commercial	$109.96

darunavir 600 mg Tab [KMC]

Facility

$150.86

Service Code	NDC 59651008560
Hospital Revenue Code	250
Min. Negotiated Rate	$128.23
Max. Negotiated Rate	$146.33
Rate for Payer: Cash Price	$98.06
Rate for Payer: Health Management Network Commercial	$128.23
Rate for Payer: Kaiser Permanente Commercial	$135.77
Rate for Payer: MDX Hawaii PPO	$146.33

darunavir 800 mg Tab [KMC]

Facility

$245.77

Service Code	NDC 59676056630
Hospital Revenue Code	250
Min. Negotiated Rate	$208.90
Max. Negotiated Rate	$238.40
Rate for Payer: Cash Price	$159.75
Rate for Payer: Health Management Network Commercial	$208.90
Rate for Payer: Kaiser Permanente Commercial	$221.19
Rate for Payer: MDX Hawaii PPO	$238.40

darunavir 800 mg Tab [KMC]

Facility

$245.77

Service Code	NDC 59676056630
Hospital Revenue Code	250
Min. Negotiated Rate	$103.22
Max. Negotiated Rate	$238.40
Rate for Payer: AlohaCare Medicaid	$122.89
Rate for Payer: AlohaCare Medicare	$103.22
Rate for Payer: Cash Price	$159.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$226.11
Rate for Payer: Devoted Health Medicare	$103.22
Rate for Payer: Hawaii Medical Service Association Medicare	$103.22
Rate for Payer: Hawaii Western Management Group Commercial	$233.48
Rate for Payer: Health Management Network Commercial	$208.90
Rate for Payer: Humana Medicare	$103.22
Rate for Payer: Kaiser Permanente Commercial	$221.19
Rate for Payer: Kaiser Permanente Medicaid	$125.34
Rate for Payer: Kaiser Permanente Medicare	$103.22
Rate for Payer: MDX Hawaii PPO	$238.40
Rate for Payer: Ohana Health Plan Medicaid	$103.22
Rate for Payer: Ohana Health Plan Medicare	$103.22
Rate for Payer: UnitedHealthcare Medicaid	$147.46
Rate for Payer: UnitedHealthcare Medicare	$103.22
Rate for Payer: University Health Alliance Commercial	$179.14

DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF

Professional

Both

$1,004.00

Service Code	HCPCS 11000
Hospital Revenue Code	361
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$853.40
Rate for Payer: AlohaCare Medicaid	$27.41
Rate for Payer: AlohaCare Medicare	$24.09
Rate for Payer: Cash Price	$652.60
Rate for Payer: Cash Price	$652.60
Rate for Payer: Devoted Health Medicare	$24.09
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$27.41
Rate for Payer: Hawaii Medical Service Association Commercial	$42.71
Rate for Payer: Hawaii Medical Service Association Medicare	$24.09
Rate for Payer: Hawaii Western Management Group Commercial	$39.00
Rate for Payer: Health Management Network Commercial	$853.40
Rate for Payer: Kaiser Permanente Commercial	$28.91
Rate for Payer: Kaiser Permanente Medicaid	$28.91
Rate for Payer: Kaiser Permanente Medicare	$28.91
Rate for Payer: Ohana Health Plan Medicaid	$27.41
Rate for Payer: Ohana Health Plan Medicare	$24.09
Rate for Payer: UnitedHealthcare Medicaid	$27.41
Rate for Payer: UnitedHealthcare Medicare	$24.09

DBRDMT FX&/DISLC SUBQ T/M/F BONE

Professional

Both

$2,338.00

Service Code	HCPCS 11012
Hospital Revenue Code	361
Min. Negotiated Rate	$356.79
Max. Negotiated Rate	$1,987.30
Rate for Payer: AlohaCare Medicaid	$413.97
Rate for Payer: AlohaCare Medicare	$356.79
Rate for Payer: Cash Price	$1,519.70
Rate for Payer: Cash Price	$1,519.70
Rate for Payer: Devoted Health Medicare	$356.79
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$413.97
Rate for Payer: Hawaii Medical Service Association Commercial	$646.49
Rate for Payer: Hawaii Medical Service Association Medicare	$356.79
Rate for Payer: Hawaii Western Management Group Commercial	$520.26
Rate for Payer: Health Management Network Commercial	$1,987.30
Rate for Payer: Kaiser Permanente Commercial	$428.15
Rate for Payer: Kaiser Permanente Medicaid	$428.15
Rate for Payer: Kaiser Permanente Medicare	$428.15
Rate for Payer: Ohana Health Plan Medicaid	$413.97
Rate for Payer: Ohana Health Plan Medicare	$356.79
Rate for Payer: UnitedHealthcare Medicaid	$413.97
Rate for Payer: UnitedHealthcare Medicare	$356.79
Rate for Payer: University Health Alliance Commercial	$800.00

DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS

Professional

Both

$2,338.00

Service Code	HCPCS 11010
Hospital Revenue Code	361
Min. Negotiated Rate	$250.99
Max. Negotiated Rate	$1,987.30
Rate for Payer: AlohaCare Medicaid	$280.66
Rate for Payer: AlohaCare Medicare	$250.99
Rate for Payer: Cash Price	$1,519.70
Rate for Payer: Cash Price	$1,519.70
Rate for Payer: Devoted Health Medicare	$250.99
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$280.66
Rate for Payer: Hawaii Medical Service Association Commercial	$434.99
Rate for Payer: Hawaii Medical Service Association Medicare	$250.99
Rate for Payer: Hawaii Western Management Group Commercial	$308.36
Rate for Payer: Health Management Network Commercial	$1,987.30
Rate for Payer: Kaiser Permanente Commercial	$301.19
Rate for Payer: Kaiser Permanente Medicaid	$301.19
Rate for Payer: Kaiser Permanente Medicare	$301.19
Rate for Payer: Ohana Health Plan Medicaid	$280.66
Rate for Payer: Ohana Health Plan Medicare	$250.99
Rate for Payer: UnitedHealthcare Medicaid	$280.66
Rate for Payer: UnitedHealthcare Medicare	$250.99
Rate for Payer: University Health Alliance Commercial	$321.89

DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC

Professional

Both

$1,165.00

Service Code	HCPCS 11011
Hospital Revenue Code	361
Min. Negotiated Rate	$261.39
Max. Negotiated Rate	$990.25
Rate for Payer: AlohaCare Medicaid	$296.15
Rate for Payer: AlohaCare Medicare	$261.39
Rate for Payer: Cash Price	$757.25
Rate for Payer: Cash Price	$757.25
Rate for Payer: Devoted Health Medicare	$261.39
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$296.15
Rate for Payer: Hawaii Medical Service Association Commercial	$460.79
Rate for Payer: Hawaii Medical Service Association Medicare	$261.39
Rate for Payer: Hawaii Western Management Group Commercial	$373.10
Rate for Payer: Health Management Network Commercial	$990.25
Rate for Payer: Kaiser Permanente Commercial	$313.67
Rate for Payer: Kaiser Permanente Medicaid	$313.67
Rate for Payer: Kaiser Permanente Medicare	$313.67
Rate for Payer: Ohana Health Plan Medicaid	$296.15
Rate for Payer: Ohana Health Plan Medicare	$261.39
Rate for Payer: UnitedHealthcare Medicaid	$296.15
Rate for Payer: UnitedHealthcare Medicare	$261.39
Rate for Payer: University Health Alliance Commercial	$500.00

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$15,643.32

Service Code	MSDRG 744
Min. Negotiated Rate	$15,643.32
Max. Negotiated Rate	$15,643.32
Rate for Payer: Hawaii Medical Service Association Commercial	$15,643.32

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$15,643.32

Service Code	MSDRG 745
Min. Negotiated Rate	$15,643.32
Max. Negotiated Rate	$15,643.32
Rate for Payer: Hawaii Medical Service Association Commercial	$15,643.32

D-Dimer

Facility

$193.00

Service Code	HCPCS 85379
Hospital Charge Code	422853790
Hospital Revenue Code	305
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$81.06
Rate for Payer: Cash Price	$125.45
Rate for Payer: Cash Price	$125.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$177.56
Rate for Payer: Devoted Health Medicare	$81.06
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$14.06
Rate for Payer: Hawaii Medical Service Association Commercial	$12.72
Rate for Payer: Hawaii Medical Service Association Medicare	$81.06
Rate for Payer: Hawaii Western Management Group Commercial	$10.18
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$81.06
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$81.06
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$81.06
Rate for Payer: Ohana Health Plan Medicare	$81.06
Rate for Payer: UnitedHealthcare Medicaid	$14.06
Rate for Payer: UnitedHealthcare Medicare	$81.06
Rate for Payer: University Health Alliance Commercial	$26.31

D-Dimer

Facility

$193.00

Service Code	HCPCS 85379
Hospital Charge Code	422853790
Hospital Revenue Code	305
Min. Negotiated Rate	$164.05
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21

DEBRD,REMVL-MATRL-FX-SKIN/TISS Charge

Facility

$3,272.00

Service Code	HCPCS 11010
Hospital Charge Code	440110100
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,173.84
Rate for Payer: AlohaCare Medicaid	$1,636.00
Rate for Payer: AlohaCare Medicare	$1,374.24
Rate for Payer: Cash Price	$2,126.80
Rate for Payer: Cash Price	$2,126.80
Rate for Payer: Cash Price	$2,126.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3,010.24
Rate for Payer: Devoted Health Medicare	$1,374.24
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	$1,374.24
Rate for Payer: Hawaii Western Management Group Commercial	$3,108.40
Rate for Payer: Health Management Network Commercial	$2,781.20
Rate for Payer: Humana Medicare	$1,374.24
Rate for Payer: Kaiser Permanente Commercial	$2,944.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,374.24
Rate for Payer: MDX Hawaii PPO	$3,173.84
Rate for Payer: Ohana Health Plan Medicaid	$1,374.24
Rate for Payer: Ohana Health Plan Medicare	$1,374.24
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,374.24
Rate for Payer: University Health Alliance Commercial	$2,384.96

DEBRD,REMVL-MATRL-FX-SKIN/TISS Charge

Facility

$3,272.00

Service Code	HCPCS 11010
Hospital Charge Code	440110100
Hospital Revenue Code	450
Min. Negotiated Rate	$2,781.20
Max. Negotiated Rate	$3,173.84
Rate for Payer: Cash Price	$2,126.80
Rate for Payer: Health Management Network Commercial	$2,781.20
Rate for Payer: Kaiser Permanente Commercial	$2,944.80
Rate for Payer: MDX Hawaii PPO	$3,173.84

DEBRIDE EXT ECZ INF SKIN ED Charge

Facility

$301.00

Service Code	HCPCS 11000
Hospital Charge Code	4501000
Hospital Revenue Code	450
Min. Negotiated Rate	$255.85
Max. Negotiated Rate	$291.97
Rate for Payer: Cash Price	$195.65
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: MDX Hawaii PPO	$291.97

DEBRIDE EXT ECZ INF SKIN ED Charge

Facility

$301.00

Service Code	HCPCS 11000
Hospital Charge Code	4501000
Hospital Revenue Code	450
Min. Negotiated Rate	$126.42
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$150.50
Rate for Payer: AlohaCare Medicare	$126.42
Rate for Payer: Cash Price	$195.65
Rate for Payer: Cash Price	$195.65
Rate for Payer: Cash Price	$195.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$276.92
Rate for Payer: Devoted Health Medicare	$126.42
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	$126.42
Rate for Payer: Hawaii Western Management Group Commercial	$285.95
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Humana Medicare	$126.42
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$126.42
Rate for Payer: MDX Hawaii PPO	$291.97
Rate for Payer: Ohana Health Plan Medicaid	$126.42
Rate for Payer: Ohana Health Plan Medicare	$126.42
Rate for Payer: UnitedHealthcare Medicare	$126.42
Rate for Payer: University Health Alliance Commercial	$219.40

DEBRIDEMENT BONE 1ST 20 SQ CM/<

Professional

Both

$678.00

Service Code	HCPCS 11044
Hospital Revenue Code	361
Min. Negotiated Rate	$198.39
Max. Negotiated Rate	$576.30
Rate for Payer: AlohaCare Medicaid	$223.77
Rate for Payer: AlohaCare Medicare	$198.39
Rate for Payer: Cash Price	$440.70
Rate for Payer: Cash Price	$440.70
Rate for Payer: Devoted Health Medicare	$198.39
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$223.77
Rate for Payer: Hawaii Medical Service Association Commercial	$429.51
Rate for Payer: Hawaii Medical Service Association Medicare	$198.39
Rate for Payer: Hawaii Western Management Group Commercial	$234.52
Rate for Payer: Health Management Network Commercial	$576.30
Rate for Payer: Kaiser Permanente Commercial	$238.07
Rate for Payer: Kaiser Permanente Medicaid	$238.07
Rate for Payer: Kaiser Permanente Medicare	$238.07
Rate for Payer: Ohana Health Plan Medicaid	$223.77
Rate for Payer: Ohana Health Plan Medicare	$198.39
Rate for Payer: UnitedHealthcare Medicaid	$223.77
Rate for Payer: UnitedHealthcare Medicare	$198.39
Rate for Payer: University Health Alliance Commercial	$450.00

DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM

Professional

Both

$321.00

Service Code	HCPCS 11047
Hospital Revenue Code	361
Min. Negotiated Rate	$82.26
Max. Negotiated Rate	$272.85
Rate for Payer: AlohaCare Medicaid	$94.37
Rate for Payer: AlohaCare Medicare	$82.26
Rate for Payer: Cash Price	$208.65
Rate for Payer: Cash Price	$208.65
Rate for Payer: Devoted Health Medicare	$82.26
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$94.37
Rate for Payer: Hawaii Medical Service Association Commercial	$137.26
Rate for Payer: Hawaii Medical Service Association Medicare	$82.26
Rate for Payer: Health Management Network Commercial	$272.85
Rate for Payer: Kaiser Permanente Commercial	$98.71
Rate for Payer: Kaiser Permanente Medicaid	$98.71
Rate for Payer: Kaiser Permanente Medicare	$98.71
Rate for Payer: Ohana Health Plan Medicaid	$94.37
Rate for Payer: Ohana Health Plan Medicare	$82.26
Rate for Payer: UnitedHealthcare Medicaid	$94.37
Rate for Payer: UnitedHealthcare Medicare	$82.26
Rate for Payer: University Health Alliance Commercial	$109.82

DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<

Professional

Both

$1,004.00

Service Code	HCPCS 11043
Hospital Revenue Code	361
Min. Negotiated Rate	$137.36
Max. Negotiated Rate	$853.40
Rate for Payer: AlohaCare Medicaid	$153.95
Rate for Payer: AlohaCare Medicare	$137.36
Rate for Payer: Cash Price	$652.60
Rate for Payer: Cash Price	$652.60
Rate for Payer: Devoted Health Medicare	$137.36
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$153.95
Rate for Payer: Hawaii Medical Service Association Commercial	$316.72
Rate for Payer: Hawaii Medical Service Association Medicare	$137.36
Rate for Payer: Hawaii Western Management Group Commercial	$168.22
Rate for Payer: Health Management Network Commercial	$853.40
Rate for Payer: Kaiser Permanente Commercial	$164.83
Rate for Payer: Kaiser Permanente Medicaid	$164.83
Rate for Payer: Kaiser Permanente Medicare	$164.83
Rate for Payer: Ohana Health Plan Medicaid	$153.95
Rate for Payer: Ohana Health Plan Medicare	$137.36
Rate for Payer: UnitedHealthcare Medicaid	$153.95
Rate for Payer: UnitedHealthcare Medicare	$137.36

DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM

Professional

Both

$195.00

Service Code	HCPCS 11046
Hospital Revenue Code	361
Min. Negotiated Rate	$46.19
Max. Negotiated Rate	$165.75
Rate for Payer: AlohaCare Medicaid	$53.52
Rate for Payer: AlohaCare Medicare	$46.19
Rate for Payer: Cash Price	$126.75
Rate for Payer: Cash Price	$126.75
Rate for Payer: Devoted Health Medicare	$46.19
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$53.52
Rate for Payer: Hawaii Medical Service Association Commercial	$79.28
Rate for Payer: Hawaii Medical Service Association Medicare	$46.19
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$55.43
Rate for Payer: Kaiser Permanente Medicaid	$55.43
Rate for Payer: Kaiser Permanente Medicare	$55.43
Rate for Payer: Ohana Health Plan Medicaid	$53.52
Rate for Payer: Ohana Health Plan Medicare	$46.19
Rate for Payer: UnitedHealthcare Medicaid	$53.52
Rate for Payer: UnitedHealthcare Medicare	$46.19
Rate for Payer: University Health Alliance Commercial	$62.70

DEBRIDEMENT MUSCLES AND/OR FASCIA <= 20 SQ CM CHAR

Facility

$1,405.00

Service Code	HCPCS 11043
Hospital Charge Code	440110430
Hospital Revenue Code	450
Min. Negotiated Rate	$1,194.25
Max. Negotiated Rate	$1,362.85
Rate for Payer: Cash Price	$913.25
Rate for Payer: Health Management Network Commercial	$1,194.25
Rate for Payer: Kaiser Permanente Commercial	$1,264.50
Rate for Payer: MDX Hawaii PPO	$1,362.85

Know your out-of-pocket cost for care.

All Charges