Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

20610 Drain Inj Major JT Bursa LT Charges

Facility

$747.00

Service Code	HCPCS 20610 LT
Hospital Charge Code	8221493
Hospital Revenue Code	761
Min. Negotiated Rate	$634.95
Max. Negotiated Rate	$724.59
Rate for Payer: Cash Price	$485.55
Rate for Payer: Health Management Network Commercial	$634.95
Rate for Payer: Kaiser Permanente Commercial	$672.30
Rate for Payer: MDX Hawaii PPO	$724.59

20610 Drain Inj Major JT Bursa RT Charges

Facility

$747.00

Service Code	HCPCS 20610 RT
Hospital Charge Code	8221494
Hospital Revenue Code	761
Min. Negotiated Rate	$634.95
Max. Negotiated Rate	$724.59
Rate for Payer: Cash Price	$485.55
Rate for Payer: Health Management Network Commercial	$634.95
Rate for Payer: Kaiser Permanente Commercial	$672.30
Rate for Payer: MDX Hawaii PPO	$724.59

20610 Drain Inj Major JT Bursa RT Charges

Facility

$747.00

Service Code	HCPCS 20610 RT
Hospital Charge Code	8221494
Hospital Revenue Code	761
Min. Negotiated Rate	$48.79
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$373.50
Rate for Payer: AlohaCare Medicare	$373.50
Rate for Payer: Cash Price	$485.55
Rate for Payer: Cash Price	$485.55
Rate for Payer: Cash Price	$485.55
Rate for Payer: Devoted Health Medicare	$410.85
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$373.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$709.65
Rate for Payer: Health Management Network Commercial	$634.95
Rate for Payer: Humana Medicare	$373.50
Rate for Payer: Kaiser Permanente Commercial	$672.30
Rate for Payer: Kaiser Permanente Medicaid	$380.97
Rate for Payer: Kaiser Permanente Medicare	$373.50
Rate for Payer: MDX Hawaii PPO	$724.59
Rate for Payer: Ohana Health Plan Medicaid	$373.50
Rate for Payer: Ohana Health Plan Medicare	$373.50
Rate for Payer: UnitedHealthcare Medicaid	$48.79
Rate for Payer: UnitedHealthcare Medicare	$373.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

20610-Major Joint Aspirate/Inject w/o US

Facility

$717.00

Service Code	HCPCS 20610
Hospital Charge Code	8080231
Hospital Revenue Code	450
Min. Negotiated Rate	$609.45
Max. Negotiated Rate	$695.49
Rate for Payer: Cash Price	$466.05
Rate for Payer: Health Management Network Commercial	$609.45
Rate for Payer: Kaiser Permanente Commercial	$645.30
Rate for Payer: MDX Hawaii PPO	$695.49

20610-Major Joint Aspirate/Inject w/o US

Facility

$717.00

Service Code	HCPCS 20610
Hospital Charge Code	8080231
Hospital Revenue Code	450
Min. Negotiated Rate	$358.50
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$358.50
Rate for Payer: Cash Price	$466.05
Rate for Payer: Cash Price	$466.05
Rate for Payer: Cash Price	$466.05
Rate for Payer: Devoted Health Medicare	$394.35
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$358.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$681.15
Rate for Payer: Health Management Network Commercial	$609.45
Rate for Payer: Humana Medicare	$358.50
Rate for Payer: Kaiser Permanente Commercial	$645.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$358.50
Rate for Payer: MDX Hawaii PPO	$695.49
Rate for Payer: Ohana Health Plan Medicaid	$358.50
Rate for Payer: Ohana Health Plan Medicare	$358.50
Rate for Payer: UnitedHealthcare Medicare	$358.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

20611 ARTHROCENTESIS, MAJOR JOINT WITH ULTRASOUND [HHSC]

Professional

Both

$432.00

Service Code	HCPCS 20611
Hospital Charge Code	13000936
Hospital Revenue Code	975
Min. Negotiated Rate	$49.46
Max. Negotiated Rate	$367.20
Rate for Payer: AlohaCare Medicaid	$58.92
Rate for Payer: AlohaCare Medicare	$49.46
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Devoted Health Medicare	$54.41
Rate for Payer: Hawaii Medical Service Association ABD	$58.92
Rate for Payer: Hawaii Medical Service Association Commercial	$99.17
Rate for Payer: Hawaii Medical Service Association Medicare	$49.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58.92
Rate for Payer: Hawaii Western Management Group Commercial	$99.32
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$54.41
Rate for Payer: Kaiser Permanente Medicaid	$54.41
Rate for Payer: Kaiser Permanente Medicare	$54.41
Rate for Payer: Ohana Health Plan Medicaid	$58.92
Rate for Payer: Ohana Health Plan Medicare	$49.46
Rate for Payer: UnitedHealthcare Medicaid	$58.92
Rate for Payer: UnitedHealthcare Medicare	$49.46
Rate for Payer: University Health Alliance Commercial	$138.00

20612-Aspiration/Injection Ganglion Cyst

Facility

$622.00

Service Code	HCPCS 20612
Hospital Charge Code	8080233
Hospital Revenue Code	450
Min. Negotiated Rate	$528.70
Max. Negotiated Rate	$603.34
Rate for Payer: Cash Price	$404.30
Rate for Payer: Health Management Network Commercial	$528.70
Rate for Payer: Kaiser Permanente Commercial	$559.80
Rate for Payer: MDX Hawaii PPO	$603.34

20612-Aspiration/Injection Ganglion Cyst

Facility

$622.00

Service Code	HCPCS 20612
Hospital Charge Code	8080233
Hospital Revenue Code	450
Min. Negotiated Rate	$311.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$311.00
Rate for Payer: Cash Price	$404.30
Rate for Payer: Cash Price	$404.30
Rate for Payer: Cash Price	$404.30
Rate for Payer: Devoted Health Medicare	$342.10
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$311.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$590.90
Rate for Payer: Health Management Network Commercial	$528.70
Rate for Payer: Humana Medicare	$311.00
Rate for Payer: Kaiser Permanente Commercial	$559.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$311.00
Rate for Payer: MDX Hawaii PPO	$603.34
Rate for Payer: Ohana Health Plan Medicaid	$311.00
Rate for Payer: Ohana Health Plan Medicare	$311.00
Rate for Payer: UnitedHealthcare Medicare	$311.00
Rate for Payer: University Health Alliance Commercial	$453.38

20680 Removal of implant; deep (buried wire, pin, screw, metal band, nail, rod or plate)

Professional

Both

$4,043.00

Service Code	HCPCS 20680
Hospital Charge Code	8037410
Hospital Revenue Code	975
Min. Negotiated Rate	$272.74
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$435.82
Rate for Payer: AlohaCare Medicare	$402.16
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$442.38
Rate for Payer: Hawaii Medical Service Association ABD	$435.82
Rate for Payer: Hawaii Medical Service Association Commercial	$718.87
Rate for Payer: Hawaii Medical Service Association Medicare	$402.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$435.82
Rate for Payer: Hawaii Western Management Group Commercial	$272.74
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$442.38
Rate for Payer: Kaiser Permanente Medicaid	$442.38
Rate for Payer: Kaiser Permanente Medicare	$442.38
Rate for Payer: Ohana Health Plan Medicaid	$435.82
Rate for Payer: Ohana Health Plan Medicare	$402.16
Rate for Payer: UnitedHealthcare Medicaid	$435.82
Rate for Payer: UnitedHealthcare Medicare	$402.16
Rate for Payer: University Health Alliance Commercial	$542.81

2.0MM DRILL BIT, CALIBRATED

Facility

$200.00

Hospital Charge Code	12944039
Hospital Revenue Code	272
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$100.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Devoted Health Medicare	$110.00
Rate for Payer: Hawaii Medical Service Association Medicare	$100.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$100.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$100.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$100.00
Rate for Payer: Ohana Health Plan Medicare	$100.00
Rate for Payer: UnitedHealthcare Medicare	$100.00
Rate for Payer: University Health Alliance Commercial	$145.78

2.0MM DRILL BIT, CALIBRATED

Facility

$200.00

Hospital Charge Code	12944039
Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

2.0MM KIRSCHNER WIRE W/TROCAR 150MM

Facility

$1,180.00

Hospital Charge Code	13146479
Hospital Revenue Code	278
Min. Negotiated Rate	$660.80
Max. Negotiated Rate	$1,144.60
Rate for Payer: Cash Price	$767.00
Rate for Payer: Hawaii Western Management Group Commercial	$826.00
Rate for Payer: Health Management Network Commercial	$1,003.00
Rate for Payer: Kaiser Permanente Commercial	$1,062.00
Rate for Payer: MDX Hawaii PPO	$1,144.60
Rate for Payer: University Health Alliance Commercial	$660.80

2.0MM KIRSCHNER WIRE W/TROCAR 150MM

Facility

$1,180.00

Hospital Charge Code	13146479
Hospital Revenue Code	278
Min. Negotiated Rate	$590.00
Max. Negotiated Rate	$1,144.60
Rate for Payer: AlohaCare Medicaid	$590.00
Rate for Payer: AlohaCare Medicare	$590.00
Rate for Payer: Cash Price	$767.00
Rate for Payer: Devoted Health Medicare	$649.00
Rate for Payer: Hawaii Medical Service Association Medicare	$590.00
Rate for Payer: Hawaii Western Management Group Commercial	$826.00
Rate for Payer: Health Management Network Commercial	$1,003.00
Rate for Payer: Humana Medicare	$590.00
Rate for Payer: Kaiser Permanente Commercial	$1,062.00
Rate for Payer: Kaiser Permanente Medicaid	$601.80
Rate for Payer: Kaiser Permanente Medicare	$590.00
Rate for Payer: MDX Hawaii PPO	$1,144.60
Rate for Payer: Ohana Health Plan Medicaid	$590.00
Rate for Payer: Ohana Health Plan Medicare	$590.00
Rate for Payer: UnitedHealthcare Medicare	$590.00
Rate for Payer: University Health Alliance Commercial	$660.80

21013 Excision, tumor, soft tissue of face and scalp, subfascial; less than 2 cm

Professional

Both

$2,299.00

Service Code	HCPCS 21013
Hospital Charge Code	8037435
Hospital Revenue Code	975
Min. Negotiated Rate	$380.26
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$419.80
Rate for Payer: AlohaCare Medicare	$380.26
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$418.29
Rate for Payer: Hawaii Medical Service Association ABD	$419.80
Rate for Payer: Hawaii Medical Service Association Commercial	$693.07
Rate for Payer: Hawaii Medical Service Association Medicare	$380.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$419.80
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$418.29
Rate for Payer: Kaiser Permanente Medicaid	$418.29
Rate for Payer: Kaiser Permanente Medicare	$418.29
Rate for Payer: Ohana Health Plan Medicaid	$419.80
Rate for Payer: Ohana Health Plan Medicare	$380.26
Rate for Payer: UnitedHealthcare Medicaid	$419.80
Rate for Payer: UnitedHealthcare Medicare	$380.26

21320-Nasal Bone w/ Stabilization

Facility

$13,322.00

Service Code	HCPCS 21320
Hospital Charge Code	8080101
Hospital Revenue Code	450
Min. Negotiated Rate	$11,323.70
Max. Negotiated Rate	$12,922.34
Rate for Payer: Cash Price	$8,659.30
Rate for Payer: Health Management Network Commercial	$11,323.70
Rate for Payer: Kaiser Permanente Commercial	$11,989.80
Rate for Payer: MDX Hawaii PPO	$12,922.34

21320-Nasal Bone w/ Stabilization

Facility

$13,322.00

Service Code	HCPCS 21320
Hospital Charge Code	8080101
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,922.34
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: AlohaCare Medicare	$6,661.00
Rate for Payer: Cash Price	$8,659.30
Rate for Payer: Cash Price	$8,659.30
Rate for Payer: Devoted Health Medicare	$7,327.10
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,661.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$12,655.90
Rate for Payer: Health Management Network Commercial	$11,323.70
Rate for Payer: Humana Medicare	$6,661.00
Rate for Payer: Kaiser Permanente Commercial	$11,989.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$6,661.00
Rate for Payer: MDX Hawaii PPO	$12,922.34
Rate for Payer: Ohana Health Plan Medicaid	$6,661.00
Rate for Payer: Ohana Health Plan Medicare	$6,661.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$6,661.00
Rate for Payer: University Health Alliance Commercial	$5,160.40

21480 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ TechFee

Facility

$999.00

Service Code	HCPCS 21480
Hospital Charge Code	8022817
Hospital Revenue Code	450
Min. Negotiated Rate	$849.15
Max. Negotiated Rate	$969.03
Rate for Payer: Cash Price	$649.35
Rate for Payer: Health Management Network Commercial	$849.15
Rate for Payer: Kaiser Permanente Commercial	$899.10
Rate for Payer: MDX Hawaii PPO	$969.03

21480 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ TechFee

Facility

$999.00

Service Code	HCPCS 21480
Hospital Charge Code	8022817
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$499.50
Rate for Payer: Cash Price	$649.35
Rate for Payer: Cash Price	$649.35
Rate for Payer: Cash Price	$649.35
Rate for Payer: Devoted Health Medicare	$549.45
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$499.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$949.05
Rate for Payer: Health Management Network Commercial	$849.15
Rate for Payer: Humana Medicare	$499.50
Rate for Payer: Kaiser Permanente Commercial	$899.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$499.50
Rate for Payer: MDX Hawaii PPO	$969.03
Rate for Payer: Ohana Health Plan Medicaid	$499.50
Rate for Payer: Ohana Health Plan Medicare	$499.50
Rate for Payer: UnitedHealthcare Medicare	$499.50
Rate for Payer: University Health Alliance Commercial	$728.17

21480-Temporomandibular/Jaw

Facility

$929.00

Service Code	HCPCS 21480
Hospital Charge Code	8080079
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$464.50
Rate for Payer: Cash Price	$603.85
Rate for Payer: Cash Price	$603.85
Rate for Payer: Cash Price	$603.85
Rate for Payer: Devoted Health Medicare	$510.95
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$464.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$882.55
Rate for Payer: Health Management Network Commercial	$789.65
Rate for Payer: Humana Medicare	$464.50
Rate for Payer: Kaiser Permanente Commercial	$836.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$464.50
Rate for Payer: MDX Hawaii PPO	$901.13
Rate for Payer: Ohana Health Plan Medicaid	$464.50
Rate for Payer: Ohana Health Plan Medicare	$464.50
Rate for Payer: UnitedHealthcare Medicare	$464.50
Rate for Payer: University Health Alliance Commercial	$677.15

21480-Temporomandibular/Jaw

Facility

$929.00

Service Code	HCPCS 21480
Hospital Charge Code	8080079
Hospital Revenue Code	450
Min. Negotiated Rate	$789.65
Max. Negotiated Rate	$901.13
Rate for Payer: Cash Price	$603.85
Rate for Payer: Health Management Network Commercial	$789.65
Rate for Payer: Kaiser Permanente Commercial	$836.10
Rate for Payer: MDX Hawaii PPO	$901.13

21501 Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax;

Professional

Both

$4,043.00

Service Code	HCPCS 21501
Hospital Charge Code	8037504
Hospital Revenue Code	975
Min. Negotiated Rate	$158.34
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$356.25
Rate for Payer: AlohaCare Medicare	$339.33
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$373.26
Rate for Payer: Hawaii Medical Service Association ABD	$356.25
Rate for Payer: Hawaii Medical Service Association Commercial	$581.27
Rate for Payer: Hawaii Medical Service Association Medicare	$339.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$356.25
Rate for Payer: Hawaii Western Management Group Commercial	$158.34
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$373.26
Rate for Payer: Kaiser Permanente Medicaid	$373.26
Rate for Payer: Kaiser Permanente Medicare	$373.26
Rate for Payer: Ohana Health Plan Medicaid	$356.25
Rate for Payer: Ohana Health Plan Medicare	$339.33
Rate for Payer: UnitedHealthcare Medicaid	$356.25
Rate for Payer: UnitedHealthcare Medicare	$339.33
Rate for Payer: University Health Alliance Commercial	$457.81

21550 Biopsy, soft tissue of neck or thorax

Professional

Both

$2,299.00

Service Code	HCPCS 21550
Hospital Charge Code	8037505
Hospital Revenue Code	975
Min. Negotiated Rate	$90.74
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$163.23
Rate for Payer: AlohaCare Medicare	$148.28
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$163.11
Rate for Payer: Hawaii Medical Service Association ABD	$163.23
Rate for Payer: Hawaii Medical Service Association Commercial	$270.16
Rate for Payer: Hawaii Medical Service Association Medicare	$148.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$163.23
Rate for Payer: Hawaii Western Management Group Commercial	$90.74
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$163.11
Rate for Payer: Kaiser Permanente Medicaid	$163.11
Rate for Payer: Kaiser Permanente Medicare	$163.11
Rate for Payer: Ohana Health Plan Medicaid	$163.23
Rate for Payer: Ohana Health Plan Medicare	$148.28
Rate for Payer: UnitedHealthcare Medicaid	$163.23
Rate for Payer: UnitedHealthcare Medicare	$148.28
Rate for Payer: University Health Alliance Commercial	$212.78

21552 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater

Professional

Both

$4,043.00

Service Code	HCPCS 21552
Hospital Charge Code	8037506
Hospital Revenue Code	975
Min. Negotiated Rate	$431.08
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$456.89
Rate for Payer: AlohaCare Medicare	$431.08
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$474.19
Rate for Payer: Hawaii Medical Service Association Medicare	$431.08
Rate for Payer: Hawaii Western Management Group Commercial	$432.12
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$474.19
Rate for Payer: Kaiser Permanente Medicaid	$474.19
Rate for Payer: Kaiser Permanente Medicare	$474.19
Rate for Payer: Ohana Health Plan Medicaid	$456.89
Rate for Payer: Ohana Health Plan Medicare	$431.08
Rate for Payer: UnitedHealthcare Medicaid	$456.89
Rate for Payer: UnitedHealthcare Medicare	$431.08

21555 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm

Professional

Both

$2,299.00

Service Code	HCPCS 21555
Hospital Charge Code	8037508
Hospital Revenue Code	975
Min. Negotiated Rate	$238.42
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$321.74
Rate for Payer: AlohaCare Medicare	$305.43
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$335.97
Rate for Payer: Hawaii Medical Service Association ABD	$321.74
Rate for Payer: Hawaii Medical Service Association Commercial	$531.67
Rate for Payer: Hawaii Medical Service Association Medicare	$305.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$321.74
Rate for Payer: Hawaii Western Management Group Commercial	$238.42
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$335.97
Rate for Payer: Kaiser Permanente Medicaid	$335.97
Rate for Payer: Kaiser Permanente Medicare	$335.97
Rate for Payer: Ohana Health Plan Medicaid	$321.74
Rate for Payer: Ohana Health Plan Medicare	$305.43
Rate for Payer: UnitedHealthcare Medicaid	$321.74
Rate for Payer: UnitedHealthcare Medicare	$305.43
Rate for Payer: University Health Alliance Commercial	$418.74

21601 Excision of chest wall tumor including rib(s)

Professional

Both

$4,043.00

Service Code	HCPCS 21601
Hospital Charge Code	8881989
Hospital Revenue Code	975
Min. Negotiated Rate	$1,101.77
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$1,142.33
Rate for Payer: AlohaCare Medicare	$1,101.77
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$1,211.95
Rate for Payer: Hawaii Medical Service Association Medicare	$1,101.77
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$1,211.95
Rate for Payer: Kaiser Permanente Medicaid	$1,211.95
Rate for Payer: Kaiser Permanente Medicare	$1,211.95
Rate for Payer: Ohana Health Plan Medicaid	$1,142.33
Rate for Payer: Ohana Health Plan Medicare	$1,101.77
Rate for Payer: UnitedHealthcare Medicaid	$1,142.33
Rate for Payer: UnitedHealthcare Medicare	$1,101.77

Know your out-of-pocket cost for care.

All Charges