Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

21602 Excision Ch Wal Tum W/Rib W/O Medstnl Lymphadec

Professional

Both

$10,099.00

Service Code	HCPCS 21602
Hospital Charge Code	8881990
Hospital Revenue Code	975
Min. Negotiated Rate	$1,539.61
Max. Negotiated Rate	$8,584.15
Rate for Payer: AlohaCare Medicaid	$1,539.61
Rate for Payer: AlohaCare Medicare	$1,540.59
Rate for Payer: Cash Price	$6,564.35
Rate for Payer: Cash Price	$6,564.35
Rate for Payer: Devoted Health Medicare	$1,694.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1,540.59
Rate for Payer: Health Management Network Commercial	$8,584.15
Rate for Payer: Kaiser Permanente Commercial	$1,694.65
Rate for Payer: Kaiser Permanente Medicaid	$1,694.65
Rate for Payer: Kaiser Permanente Medicare	$1,694.65
Rate for Payer: Ohana Health Plan Medicaid	$1,539.61
Rate for Payer: Ohana Health Plan Medicare	$1,540.59
Rate for Payer: UnitedHealthcare Medicaid	$1,539.61
Rate for Payer: UnitedHealthcare Medicare	$1,540.59

21931 Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater

Professional

Both

$2,299.00

Service Code	HCPCS 21931
Hospital Charge Code	8037528
Hospital Revenue Code	975
Min. Negotiated Rate	$441.22
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$478.42
Rate for Payer: AlohaCare Medicare	$454.08
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$499.49
Rate for Payer: Hawaii Medical Service Association Medicare	$454.08
Rate for Payer: Hawaii Western Management Group Commercial	$441.22
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$499.49
Rate for Payer: Kaiser Permanente Medicaid	$499.49
Rate for Payer: Kaiser Permanente Medicare	$499.49
Rate for Payer: Ohana Health Plan Medicaid	$478.42
Rate for Payer: Ohana Health Plan Medicare	$454.08
Rate for Payer: UnitedHealthcare Medicaid	$478.42
Rate for Payer: UnitedHealthcare Medicare	$454.08

21932 Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); less than 5 cm

Professional

Both

$4,043.00

Service Code	HCPCS 21932
Hospital Charge Code	8037529
Hospital Revenue Code	975
Min. Negotiated Rate	$627.48
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$674.32
Rate for Payer: AlohaCare Medicare	$627.48
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$690.23
Rate for Payer: Hawaii Medical Service Association Medicare	$627.48
Rate for Payer: Hawaii Western Management Group Commercial	$646.88
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$690.23
Rate for Payer: Kaiser Permanente Medicaid	$690.23
Rate for Payer: Kaiser Permanente Medicare	$690.23
Rate for Payer: Ohana Health Plan Medicaid	$674.32
Rate for Payer: Ohana Health Plan Medicare	$627.48
Rate for Payer: UnitedHealthcare Medicaid	$674.32
Rate for Payer: UnitedHealthcare Medicare	$627.48

21933 Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); 5 cm or greater

Professional

Both

$4,043.00

Service Code	HCPCS 21933
Hospital Charge Code	8037530
Hospital Revenue Code	975
Min. Negotiated Rate	$546.52
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$746.05
Rate for Payer: AlohaCare Medicare	$697.14
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$766.85
Rate for Payer: Hawaii Medical Service Association Medicare	$697.14
Rate for Payer: Hawaii Western Management Group Commercial	$546.52
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$766.85
Rate for Payer: Kaiser Permanente Medicaid	$766.85
Rate for Payer: Kaiser Permanente Medicare	$766.85
Rate for Payer: Ohana Health Plan Medicaid	$746.05
Rate for Payer: Ohana Health Plan Medicare	$697.14
Rate for Payer: UnitedHealthcare Medicaid	$746.05
Rate for Payer: UnitedHealthcare Medicare	$697.14

22900 Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); less than 5 cm

Professional

Both

$4,043.00

Service Code	HCPCS 22900
Hospital Charge Code	8037609
Hospital Revenue Code	975
Min. Negotiated Rate	$351.52
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$576.51
Rate for Payer: AlohaCare Medicare	$548.43
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$603.27
Rate for Payer: Hawaii Medical Service Association Medicare	$548.43
Rate for Payer: Hawaii Western Management Group Commercial	$351.52
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$603.27
Rate for Payer: Kaiser Permanente Medicaid	$603.27
Rate for Payer: Kaiser Permanente Medicare	$603.27
Rate for Payer: Ohana Health Plan Medicaid	$576.51
Rate for Payer: Ohana Health Plan Medicare	$548.43
Rate for Payer: UnitedHealthcare Medicaid	$576.51
Rate for Payer: UnitedHealthcare Medicare	$548.43

22903 Excision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm or greater

Professional

Both

$4,043.00

Service Code	HCPCS 22903
Hospital Charge Code	8037611
Hospital Revenue Code	975
Min. Negotiated Rate	$423.02
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$448.37
Rate for Payer: AlohaCare Medicare	$430.04
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$473.04
Rate for Payer: Hawaii Medical Service Association Medicare	$430.04
Rate for Payer: Hawaii Western Management Group Commercial	$423.02
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$473.04
Rate for Payer: Kaiser Permanente Medicaid	$473.04
Rate for Payer: Kaiser Permanente Medicare	$473.04
Rate for Payer: Ohana Health Plan Medicaid	$448.37
Rate for Payer: Ohana Health Plan Medicare	$430.04
Rate for Payer: UnitedHealthcare Medicaid	$448.37
Rate for Payer: UnitedHealthcare Medicare	$430.04

23330 Remv Shldr Foreign Bd Bilat TechFee

Facility

$4,393.00

Service Code	HCPCS 23330
Hospital Charge Code	8343969
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,261.21
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$2,196.50
Rate for Payer: Cash Price	$2,855.45
Rate for Payer: Cash Price	$2,855.45
Rate for Payer: Devoted Health Medicare	$2,416.15
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	$2,196.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,173.35
Rate for Payer: Health Management Network Commercial	$3,734.05
Rate for Payer: Humana Medicare	$2,196.50
Rate for Payer: Kaiser Permanente Commercial	$3,953.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,196.50
Rate for Payer: MDX Hawaii PPO	$4,261.21
Rate for Payer: Ohana Health Plan Medicaid	$2,196.50
Rate for Payer: Ohana Health Plan Medicare	$2,196.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,196.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

23330 Remv Shldr Foreign Bd Bilat TechFee

Facility

$4,393.00

Service Code	HCPCS 23330
Hospital Charge Code	8343969
Hospital Revenue Code	450
Min. Negotiated Rate	$3,734.05
Max. Negotiated Rate	$4,261.21
Rate for Payer: Cash Price	$2,855.45
Rate for Payer: Health Management Network Commercial	$3,734.05
Rate for Payer: Kaiser Permanente Commercial	$3,953.70
Rate for Payer: MDX Hawaii PPO	$4,261.21

23605-Proximal Humeral w/ Manipulation

Facility

$7,150.00

Service Code	HCPCS 23605
Hospital Charge Code	8080103
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,935.50
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$3,575.00
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Devoted Health Medicare	$3,932.50
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	$3,575.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$6,792.50
Rate for Payer: Health Management Network Commercial	$6,077.50
Rate for Payer: Humana Medicare	$3,575.00
Rate for Payer: Kaiser Permanente Commercial	$6,435.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,575.00
Rate for Payer: MDX Hawaii PPO	$6,935.50
Rate for Payer: Ohana Health Plan Medicaid	$3,575.00
Rate for Payer: Ohana Health Plan Medicare	$3,575.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,575.00
Rate for Payer: University Health Alliance Commercial	$5,211.64

23605-Proximal Humeral w/ Manipulation

Facility

$7,150.00

Service Code	HCPCS 23605
Hospital Charge Code	8080103
Hospital Revenue Code	450
Min. Negotiated Rate	$6,077.50
Max. Negotiated Rate	$6,935.50
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Health Management Network Commercial	$6,077.50
Rate for Payer: Kaiser Permanente Commercial	$6,435.00
Rate for Payer: MDX Hawaii PPO	$6,935.50

23650 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES TechFee

Facility

$823.00

Service Code	HCPCS 23650
Hospital Charge Code	8022886
Hospital Revenue Code	450
Min. Negotiated Rate	$699.55
Max. Negotiated Rate	$798.31
Rate for Payer: Cash Price	$534.95
Rate for Payer: Health Management Network Commercial	$699.55
Rate for Payer: Kaiser Permanente Commercial	$740.70
Rate for Payer: MDX Hawaii PPO	$798.31

23650 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES TechFee

Facility

$823.00

Service Code	HCPCS 23650
Hospital Charge Code	8022886
Hospital Revenue Code	450
Min. Negotiated Rate	$411.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$411.50
Rate for Payer: Cash Price	$534.95
Rate for Payer: Cash Price	$534.95
Rate for Payer: Cash Price	$534.95
Rate for Payer: Devoted Health Medicare	$452.65
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	$411.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$781.85
Rate for Payer: Health Management Network Commercial	$699.55
Rate for Payer: Humana Medicare	$411.50
Rate for Payer: Kaiser Permanente Commercial	$740.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$411.50
Rate for Payer: MDX Hawaii PPO	$798.31
Rate for Payer: Ohana Health Plan Medicaid	$411.50
Rate for Payer: Ohana Health Plan Medicare	$411.50
Rate for Payer: UnitedHealthcare Medicare	$411.50
Rate for Payer: University Health Alliance Commercial	$599.88

23650-Shoulder w/o Anesthesia

Facility

$848.00

Service Code	HCPCS 23650
Hospital Charge Code	8080081
Hospital Revenue Code	450
Min. Negotiated Rate	$720.80
Max. Negotiated Rate	$822.56
Rate for Payer: Cash Price	$551.20
Rate for Payer: Health Management Network Commercial	$720.80
Rate for Payer: Kaiser Permanente Commercial	$763.20
Rate for Payer: MDX Hawaii PPO	$822.56

23650-Shoulder w/o Anesthesia

Facility

$848.00

Service Code	HCPCS 23650
Hospital Charge Code	8080081
Hospital Revenue Code	450
Min. Negotiated Rate	$424.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$424.00
Rate for Payer: Cash Price	$551.20
Rate for Payer: Cash Price	$551.20
Rate for Payer: Cash Price	$551.20
Rate for Payer: Devoted Health Medicare	$466.40
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	$424.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$805.60
Rate for Payer: Health Management Network Commercial	$720.80
Rate for Payer: Humana Medicare	$424.00
Rate for Payer: Kaiser Permanente Commercial	$763.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$424.00
Rate for Payer: MDX Hawaii PPO	$822.56
Rate for Payer: Ohana Health Plan Medicaid	$424.00
Rate for Payer: Ohana Health Plan Medicare	$424.00
Rate for Payer: UnitedHealthcare Medicare	$424.00
Rate for Payer: University Health Alliance Commercial	$618.11

23655-Shoulder w/ Anesthesia

Facility

$7,364.00

Service Code	HCPCS 23655
Hospital Charge Code	8080083
Hospital Revenue Code	450
Min. Negotiated Rate	$6,259.40
Max. Negotiated Rate	$7,143.08
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Health Management Network Commercial	$6,259.40
Rate for Payer: Kaiser Permanente Commercial	$6,627.60
Rate for Payer: MDX Hawaii PPO	$7,143.08

23655-Shoulder w/ Anesthesia

Facility

$7,364.00

Service Code	HCPCS 23655
Hospital Charge Code	8080083
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$7,143.08
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$3,682.00
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Devoted Health Medicare	$4,050.20
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	$3,682.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,995.80
Rate for Payer: Health Management Network Commercial	$6,259.40
Rate for Payer: Humana Medicare	$3,682.00
Rate for Payer: Kaiser Permanente Commercial	$6,627.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,682.00
Rate for Payer: MDX Hawaii PPO	$7,143.08
Rate for Payer: Ohana Health Plan Medicaid	$3,682.00
Rate for Payer: Ohana Health Plan Medicare	$3,682.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,682.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

23665-Shoulder Dislocation w/ Humeral Fx

Facility

$7,364.00

Service Code	HCPCS 23665
Hospital Charge Code	8080085
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$7,143.08
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$3,682.00
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Devoted Health Medicare	$4,050.20
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	$3,682.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,995.80
Rate for Payer: Health Management Network Commercial	$6,259.40
Rate for Payer: Humana Medicare	$3,682.00
Rate for Payer: Kaiser Permanente Commercial	$6,627.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,682.00
Rate for Payer: MDX Hawaii PPO	$7,143.08
Rate for Payer: Ohana Health Plan Medicaid	$3,682.00
Rate for Payer: Ohana Health Plan Medicare	$3,682.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,682.00
Rate for Payer: University Health Alliance Commercial	$5,367.62

23665-Shoulder Dislocation w/ Humeral Fx

Facility

$7,364.00

Service Code	HCPCS 23665
Hospital Charge Code	8080085
Hospital Revenue Code	450
Min. Negotiated Rate	$6,259.40
Max. Negotiated Rate	$7,143.08
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Health Management Network Commercial	$6,259.40
Rate for Payer: Kaiser Permanente Commercial	$6,627.60
Rate for Payer: MDX Hawaii PPO	$7,143.08

23675 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ TechFee

Facility

$3,830.00

Service Code	HCPCS 23675
Hospital Charge Code	8022890
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$3,715.10
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$1,915.00
Rate for Payer: Cash Price	$2,489.50
Rate for Payer: Cash Price	$2,489.50
Rate for Payer: Cash Price	$2,489.50
Rate for Payer: Devoted Health Medicare	$2,106.50
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	$1,915.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,638.50
Rate for Payer: Health Management Network Commercial	$3,255.50
Rate for Payer: Humana Medicare	$1,915.00
Rate for Payer: Kaiser Permanente Commercial	$3,447.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,915.00
Rate for Payer: MDX Hawaii PPO	$3,715.10
Rate for Payer: Ohana Health Plan Medicaid	$1,915.00
Rate for Payer: Ohana Health Plan Medicare	$1,915.00
Rate for Payer: UnitedHealthcare Medicare	$1,915.00
Rate for Payer: University Health Alliance Commercial	$2,791.69

23675 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ TechFee

Facility

$3,830.00

Service Code	HCPCS 23675
Hospital Charge Code	8022890
Hospital Revenue Code	450
Min. Negotiated Rate	$3,255.50
Max. Negotiated Rate	$3,715.10
Rate for Payer: Cash Price	$2,489.50
Rate for Payer: Health Management Network Commercial	$3,255.50
Rate for Payer: Kaiser Permanente Commercial	$3,447.00
Rate for Payer: MDX Hawaii PPO	$3,715.10

23675 - Shoulder dis w/manip

Facility

$3,544.00

Service Code	HCPCS 23675
Hospital Charge Code	10498899
Hospital Revenue Code	450
Min. Negotiated Rate	$3,012.40
Max. Negotiated Rate	$3,437.68
Rate for Payer: Cash Price	$2,303.60
Rate for Payer: Health Management Network Commercial	$3,012.40
Rate for Payer: Kaiser Permanente Commercial	$3,189.60
Rate for Payer: MDX Hawaii PPO	$3,437.68

23675 - Shoulder dis w/manip

Facility

$3,544.00

Service Code	HCPCS 23675
Hospital Charge Code	10498899
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$3,437.68
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$1,772.00
Rate for Payer: Cash Price	$2,303.60
Rate for Payer: Cash Price	$2,303.60
Rate for Payer: Cash Price	$2,303.60
Rate for Payer: Devoted Health Medicare	$1,949.20
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	$1,772.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,366.80
Rate for Payer: Health Management Network Commercial	$3,012.40
Rate for Payer: Humana Medicare	$1,772.00
Rate for Payer: Kaiser Permanente Commercial	$3,189.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,772.00
Rate for Payer: MDX Hawaii PPO	$3,437.68
Rate for Payer: Ohana Health Plan Medicaid	$1,772.00
Rate for Payer: Ohana Health Plan Medicare	$1,772.00
Rate for Payer: UnitedHealthcare Medicare	$1,772.00
Rate for Payer: University Health Alliance Commercial	$2,583.22

23931-I&D Elbow Abscess/Bursa/Hematoma

Facility

$7,249.00

Service Code	HCPCS 23931
Hospital Charge Code	8080065
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$7,031.53
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: AlohaCare Medicare	$3,624.50
Rate for Payer: Cash Price	$4,711.85
Rate for Payer: Cash Price	$4,711.85
Rate for Payer: Devoted Health Medicare	$3,986.95
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	$3,624.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,886.55
Rate for Payer: Health Management Network Commercial	$6,161.65
Rate for Payer: Humana Medicare	$3,624.50
Rate for Payer: Kaiser Permanente Commercial	$6,524.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,624.50
Rate for Payer: MDX Hawaii PPO	$7,031.53
Rate for Payer: Ohana Health Plan Medicaid	$3,624.50
Rate for Payer: Ohana Health Plan Medicare	$3,624.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,624.50
Rate for Payer: University Health Alliance Commercial	$5,160.40

23931-I&D Elbow Abscess/Bursa/Hematoma

Facility

$7,249.00

Service Code	HCPCS 23931
Hospital Charge Code	8080065
Hospital Revenue Code	450
Min. Negotiated Rate	$6,161.65
Max. Negotiated Rate	$7,031.53
Rate for Payer: Cash Price	$4,711.85
Rate for Payer: Health Management Network Commercial	$6,161.65
Rate for Payer: Kaiser Permanente Commercial	$6,524.10
Rate for Payer: MDX Hawaii PPO	$7,031.53

24075 Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm

Professional

Both

$2,299.00

Service Code	HCPCS 24075
Hospital Charge Code	8037697
Hospital Revenue Code	975
Min. Negotiated Rate	$216.58
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$345.74
Rate for Payer: AlohaCare Medicare	$328.91
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$361.80
Rate for Payer: Hawaii Medical Service Association ABD	$345.74
Rate for Payer: Hawaii Medical Service Association Commercial	$572.01
Rate for Payer: Hawaii Medical Service Association Medicare	$328.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$345.74
Rate for Payer: Hawaii Western Management Group Commercial	$216.58
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$361.80
Rate for Payer: Kaiser Permanente Medicaid	$361.80
Rate for Payer: Kaiser Permanente Medicare	$361.80
Rate for Payer: Ohana Health Plan Medicaid	$345.74
Rate for Payer: Ohana Health Plan Medicare	$328.91
Rate for Payer: UnitedHealthcare Medicaid	$345.74
Rate for Payer: UnitedHealthcare Medicare	$328.91
Rate for Payer: University Health Alliance Commercial	$449.80

Know your out-of-pocket cost for care.

All Charges