Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

26755-Distal Phalangeal w/ Manipulation

Facility

$1,441.00

Service Code	HCPCS 26755
Hospital Charge Code	8080102
Hospital Revenue Code	450
Min. Negotiated Rate	$1,224.85
Max. Negotiated Rate	$1,397.77
Rate for Payer: Cash Price	$936.65
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77

26765-Distal Phalangeal Open

Facility

$13,790.00

Service Code	HCPCS 26765
Hospital Charge Code	8080104
Hospital Revenue Code	450
Min. Negotiated Rate	$11,721.50
Max. Negotiated Rate	$13,376.30
Rate for Payer: Cash Price	$8,963.50
Rate for Payer: Health Management Network Commercial	$11,721.50
Rate for Payer: Kaiser Permanente Commercial	$12,411.00
Rate for Payer: MDX Hawaii PPO	$13,376.30

26765-Distal Phalangeal Open

Facility

$13,790.00

Service Code	HCPCS 26765
Hospital Charge Code	8080104
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,376.30
Rate for Payer: AlohaCare Medicaid	$1,379.34
Rate for Payer: AlohaCare Medicare	$6,895.00
Rate for Payer: Cash Price	$8,963.50
Rate for Payer: Cash Price	$8,963.50
Rate for Payer: Devoted Health Medicare	$7,584.50
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	$6,895.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$13,100.50
Rate for Payer: Health Management Network Commercial	$11,721.50
Rate for Payer: Humana Medicare	$6,895.00
Rate for Payer: Kaiser Permanente Commercial	$12,411.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$6,895.00
Rate for Payer: MDX Hawaii PPO	$13,376.30
Rate for Payer: Ohana Health Plan Medicaid	$6,895.00
Rate for Payer: Ohana Health Plan Medicare	$6,895.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$6,895.00
Rate for Payer: University Health Alliance Commercial	$10,679.55

26770 CLTX IPHAL JT DISLC W/MANJ

Facility

$823.00

Service Code	HCPCS 26770
Hospital Charge Code	8023078
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

26770 CLTX IPHAL JT DISLC W/MANJ

Facility

$823.00

Service Code	HCPCS 26770
Hospital Charge Code	8023078
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

26770-Interphalangeal Hand w/o Anesthesia

Facility

$848.00

Service Code	HCPCS 26770
Hospital Charge Code	8080082
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

26770-Interphalangeal Hand w/o Anesthesia

Facility

$848.00

Service Code	HCPCS 26770
Hospital Charge Code	8080082
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

26775-Interphalangeal Hand w/ Anesthesia

Facility

$1,611.00

Service Code	HCPCS 26775
Hospital Charge Code	8080084
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	$805.50
Rate for Payer: Cash Price	$1,047.15
Rate for Payer: Cash Price	$1,047.15
Rate for Payer: Cash Price	$1,047.15
Rate for Payer: Devoted Health Medicare	$886.05
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	$805.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,530.45
Rate for Payer: Health Management Network Commercial	$1,369.35
Rate for Payer: Humana Medicare	$805.50
Rate for Payer: Kaiser Permanente Commercial	$1,449.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$805.50
Rate for Payer: MDX Hawaii PPO	$1,562.67
Rate for Payer: Ohana Health Plan Medicaid	$805.50
Rate for Payer: Ohana Health Plan Medicare	$805.50
Rate for Payer: UnitedHealthcare Medicare	$805.50
Rate for Payer: University Health Alliance Commercial	$1,174.26

26775-Interphalangeal Hand w/ Anesthesia

Facility

$1,611.00

Service Code	HCPCS 26775
Hospital Charge Code	8080084
Hospital Revenue Code	450
Min. Negotiated Rate	$1,369.35
Max. Negotiated Rate	$1,562.67
Rate for Payer: Cash Price	$1,047.15
Rate for Payer: Health Management Network Commercial	$1,369.35
Rate for Payer: Kaiser Permanente Commercial	$1,449.90
Rate for Payer: MDX Hawaii PPO	$1,562.67

26785 Open treatment of interphalangeal joint dislocation, includes internal fixation,single

Facility

$13,734.00

Service Code	HCPCS 26785
Hospital Charge Code	8038013
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,321.98
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: AlohaCare Medicare	$6,867.00
Rate for Payer: Cash Price	$8,927.10
Rate for Payer: Cash Price	$8,927.10
Rate for Payer: Devoted Health Medicare	$7,553.70
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	$6,867.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$13,047.30
Rate for Payer: Health Management Network Commercial	$11,673.90
Rate for Payer: Humana Medicare	$6,867.00
Rate for Payer: Kaiser Permanente Commercial	$12,360.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$6,867.00
Rate for Payer: MDX Hawaii PPO	$13,321.98
Rate for Payer: Ohana Health Plan Medicaid	$6,867.00
Rate for Payer: Ohana Health Plan Medicare	$6,867.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$6,867.00
Rate for Payer: University Health Alliance Commercial	$5,160.40

26785 Open treatment of interphalangeal joint dislocation, includes internal fixation,single

Facility

$13,734.00

Service Code	HCPCS 26785
Hospital Charge Code	8038013
Hospital Revenue Code	450
Min. Negotiated Rate	$11,673.90
Max. Negotiated Rate	$13,321.98
Rate for Payer: Cash Price	$8,927.10
Rate for Payer: Health Management Network Commercial	$11,673.90
Rate for Payer: Kaiser Permanente Commercial	$12,360.60
Rate for Payer: MDX Hawaii PPO	$13,321.98

27043 Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or greater

Professional

Both

$4,043.00

Service Code	HCPCS 27043
Hospital Charge Code	8038035
Hospital Revenue Code	975
Min. Negotiated Rate	$440.44
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$477.84
Rate for Payer: AlohaCare Medicare	$454.65
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$500.12
Rate for Payer: Hawaii Medical Service Association Medicare	$454.65
Rate for Payer: Hawaii Western Management Group Commercial	$440.44
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$500.12
Rate for Payer: Kaiser Permanente Medicaid	$500.12
Rate for Payer: Kaiser Permanente Medicare	$500.12
Rate for Payer: Ohana Health Plan Medicaid	$477.84
Rate for Payer: Ohana Health Plan Medicare	$454.65
Rate for Payer: UnitedHealthcare Medicaid	$477.84
Rate for Payer: UnitedHealthcare Medicare	$454.65

27250-Hip Traumatic w/o Anesthesia

Facility

$1,434.00

Service Code	HCPCS 27250
Hospital Charge Code	8080086
Hospital Revenue Code	450
Min. Negotiated Rate	$1,218.90
Max. Negotiated Rate	$1,390.98
Rate for Payer: Cash Price	$932.10
Rate for Payer: Health Management Network Commercial	$1,218.90
Rate for Payer: Kaiser Permanente Commercial	$1,290.60
Rate for Payer: MDX Hawaii PPO	$1,390.98

27250-Hip Traumatic w/o Anesthesia

Facility

$1,434.00

Service Code	HCPCS 27250
Hospital Charge Code	8080086
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	$717.00
Rate for Payer: Cash Price	$932.10
Rate for Payer: Cash Price	$932.10
Rate for Payer: Cash Price	$932.10
Rate for Payer: Devoted Health Medicare	$788.70
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	$717.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,362.30
Rate for Payer: Health Management Network Commercial	$1,218.90
Rate for Payer: Humana Medicare	$717.00
Rate for Payer: Kaiser Permanente Commercial	$1,290.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$717.00
Rate for Payer: MDX Hawaii PPO	$1,390.98
Rate for Payer: Ohana Health Plan Medicaid	$717.00
Rate for Payer: Ohana Health Plan Medicare	$717.00
Rate for Payer: UnitedHealthcare Medicare	$717.00
Rate for Payer: University Health Alliance Commercial	$1,045.24

27265-Hip Post Arthroplasty

Facility

$1,434.00

Service Code	HCPCS 27265
Hospital Charge Code	8080088
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	$717.00
Rate for Payer: Cash Price	$932.10
Rate for Payer: Cash Price	$932.10
Rate for Payer: Cash Price	$932.10
Rate for Payer: Devoted Health Medicare	$788.70
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	$717.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,362.30
Rate for Payer: Health Management Network Commercial	$1,218.90
Rate for Payer: Humana Medicare	$717.00
Rate for Payer: Kaiser Permanente Commercial	$1,290.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$717.00
Rate for Payer: MDX Hawaii PPO	$1,390.98
Rate for Payer: Ohana Health Plan Medicaid	$717.00
Rate for Payer: Ohana Health Plan Medicare	$717.00
Rate for Payer: UnitedHealthcare Medicare	$717.00
Rate for Payer: University Health Alliance Commercial	$1,045.24

27265-Hip Post Arthroplasty

Facility

$1,434.00

Service Code	HCPCS 27265
Hospital Charge Code	8080088
Hospital Revenue Code	450
Min. Negotiated Rate	$1,218.90
Max. Negotiated Rate	$1,390.98
Rate for Payer: Cash Price	$932.10
Rate for Payer: Health Management Network Commercial	$1,218.90
Rate for Payer: Kaiser Permanente Commercial	$1,290.60
Rate for Payer: MDX Hawaii PPO	$1,390.98

27279 ARTHRODESIS, SACROILIAC JOINT, PERCUTANEOUS OR MINIMALLY INVASIVE (INDIRECT VISUALIZAT ProFee

Professional

Both

$24,403.00

Service Code	HCPCS 27279
Hospital Charge Code	8017851
Hospital Revenue Code	975
Min. Negotiated Rate	$759.49
Max. Negotiated Rate	$20,742.55
Rate for Payer: AlohaCare Medicaid	$816.33
Rate for Payer: AlohaCare Medicare	$759.49
Rate for Payer: Cash Price	$15,861.95
Rate for Payer: Cash Price	$15,861.95
Rate for Payer: Devoted Health Medicare	$835.44
Rate for Payer: Hawaii Medical Service Association Medicare	$759.49
Rate for Payer: Health Management Network Commercial	$20,742.55
Rate for Payer: Kaiser Permanente Commercial	$835.44
Rate for Payer: Kaiser Permanente Medicaid	$835.44
Rate for Payer: Kaiser Permanente Medicare	$835.44
Rate for Payer: Ohana Health Plan Medicaid	$816.33
Rate for Payer: Ohana Health Plan Medicare	$759.49
Rate for Payer: UnitedHealthcare Medicaid	$816.33
Rate for Payer: UnitedHealthcare Medicare	$759.49

27280 Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation

Professional

Both

$24,403.00

Service Code	HCPCS 27280
Hospital Charge Code	8038098
Hospital Revenue Code	975
Min. Negotiated Rate	$726.96
Max. Negotiated Rate	$20,742.55
Rate for Payer: AlohaCare Medicaid	$1,357.25
Rate for Payer: AlohaCare Medicare	$1,257.65
Rate for Payer: Cash Price	$15,861.95
Rate for Payer: Cash Price	$15,861.95
Rate for Payer: Devoted Health Medicare	$1,383.41
Rate for Payer: Hawaii Medical Service Association Medicare	$1,257.65
Rate for Payer: Hawaii Western Management Group Commercial	$726.96
Rate for Payer: Health Management Network Commercial	$20,742.55
Rate for Payer: Kaiser Permanente Commercial	$1,383.41
Rate for Payer: Kaiser Permanente Medicaid	$1,383.41
Rate for Payer: Kaiser Permanente Medicare	$1,383.41
Rate for Payer: Ohana Health Plan Medicaid	$1,357.25
Rate for Payer: Ohana Health Plan Medicare	$1,257.65
Rate for Payer: UnitedHealthcare Medicaid	$1,357.25
Rate for Payer: UnitedHealthcare Medicare	$1,257.65

27280 ARTHRODESIS, OPEN, SACROILIAC JOINT, INCLUDING OBTAINING BONE GRAFT, INCLUDING INSTRUM ProFee

Professional

Both

$24,403.00

Service Code	HCPCS 27280
Hospital Charge Code	8017852
Hospital Revenue Code	975
Min. Negotiated Rate	$726.96
Max. Negotiated Rate	$20,742.55
Rate for Payer: AlohaCare Medicaid	$1,357.25
Rate for Payer: AlohaCare Medicare	$1,257.65
Rate for Payer: Cash Price	$15,861.95
Rate for Payer: Cash Price	$15,861.95
Rate for Payer: Devoted Health Medicare	$1,383.41
Rate for Payer: Hawaii Medical Service Association Medicare	$1,257.65
Rate for Payer: Hawaii Western Management Group Commercial	$726.96
Rate for Payer: Health Management Network Commercial	$20,742.55
Rate for Payer: Kaiser Permanente Commercial	$1,383.41
Rate for Payer: Kaiser Permanente Medicaid	$1,383.41
Rate for Payer: Kaiser Permanente Medicare	$1,383.41
Rate for Payer: Ohana Health Plan Medicaid	$1,357.25
Rate for Payer: Ohana Health Plan Medicare	$1,257.65
Rate for Payer: UnitedHealthcare Medicaid	$1,357.25
Rate for Payer: UnitedHealthcare Medicare	$1,257.65

27301-I&D Thigh/Knee Abscess/Bursa/Hematoma

Facility

$12,231.00

Service Code	HCPCS 27301
Hospital Charge Code	8080067
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,864.07
Rate for Payer: AlohaCare Medicaid	$1,030.55
Rate for Payer: AlohaCare Medicare	$6,115.50
Rate for Payer: Cash Price	$7,950.15
Rate for Payer: Cash Price	$7,950.15
Rate for Payer: Devoted Health Medicare	$6,727.05
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	$6,115.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$11,619.45
Rate for Payer: Health Management Network Commercial	$10,396.35
Rate for Payer: Humana Medicare	$6,115.50
Rate for Payer: Kaiser Permanente Commercial	$11,007.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$6,115.50
Rate for Payer: MDX Hawaii PPO	$11,864.07
Rate for Payer: Ohana Health Plan Medicaid	$6,115.50
Rate for Payer: Ohana Health Plan Medicare	$6,115.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$6,115.50
Rate for Payer: University Health Alliance Commercial	$6,743.44

27301-I&D Thigh/Knee Abscess/Bursa/Hematoma

Facility

$12,231.00

Service Code	HCPCS 27301
Hospital Charge Code	8080067
Hospital Revenue Code	450
Min. Negotiated Rate	$10,396.35
Max. Negotiated Rate	$11,864.07
Rate for Payer: Cash Price	$7,950.15
Rate for Payer: Health Management Network Commercial	$10,396.35
Rate for Payer: Kaiser Permanente Commercial	$11,007.90
Rate for Payer: MDX Hawaii PPO	$11,864.07

27310 Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg, infection)

Facility

$10,932.00

Service Code	HCPCS 27310
Hospital Charge Code	8038104
Hospital Revenue Code	360
Min. Negotiated Rate	$9,292.20
Max. Negotiated Rate	$10,604.04
Rate for Payer: Cash Price	$7,105.80
Rate for Payer: Health Management Network Commercial	$9,292.20
Rate for Payer: Kaiser Permanente Commercial	$9,838.80
Rate for Payer: MDX Hawaii PPO	$10,604.04

27310 Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg, infection)

Facility

$10,932.00

Service Code	HCPCS 27310
Hospital Charge Code	8038104
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$1,379.34
Rate for Payer: AlohaCare Medicare	$5,466.00
Rate for Payer: Cash Price	$7,105.80
Rate for Payer: Cash Price	$7,105.80
Rate for Payer: Devoted Health Medicare	$6,012.60
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,466.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Health Management Network Commercial	$9,292.20
Rate for Payer: Humana Medicare	$5,466.00
Rate for Payer: Kaiser Permanente Commercial	$9,838.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$5,466.00
Rate for Payer: MDX Hawaii PPO	$10,604.04
Rate for Payer: Ohana Health Plan Medicaid	$5,466.00
Rate for Payer: Ohana Health Plan Medicare	$5,466.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$5,466.00
Rate for Payer: University Health Alliance Commercial	$10,679.55

27337 Excision, tumor, soft tissue of thigh or knee area, subcutaneous; 3 cm or greater

Professional

Both

$4,043.00

Service Code	HCPCS 27337
Hospital Charge Code	8038116
Hospital Revenue Code	975
Min. Negotiated Rate	$411.81
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$430.95
Rate for Payer: AlohaCare Medicare	$411.81
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$452.99
Rate for Payer: Hawaii Medical Service Association Medicare	$411.81
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$452.99
Rate for Payer: Kaiser Permanente Medicaid	$452.99
Rate for Payer: Kaiser Permanente Medicare	$452.99
Rate for Payer: Ohana Health Plan Medicaid	$430.95
Rate for Payer: Ohana Health Plan Medicare	$411.81
Rate for Payer: UnitedHealthcare Medicaid	$430.95
Rate for Payer: UnitedHealthcare Medicare	$411.81

27372 REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA ProFee

Professional

Both

$4,043.00

Service Code	HCPCS 27372
Hospital Charge Code	8017892
Hospital Revenue Code	987
Min. Negotiated Rate	$205.14
Max. Negotiated Rate	$3,436.55
Rate for Payer: AlohaCare Medicaid	$418.67
Rate for Payer: AlohaCare Medicare	$401.90
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Cash Price	$2,627.95
Rate for Payer: Devoted Health Medicare	$442.09
Rate for Payer: Hawaii Medical Service Association ABD	$418.67
Rate for Payer: Hawaii Medical Service Association Commercial	$697.50
Rate for Payer: Hawaii Medical Service Association Medicare	$401.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$418.67
Rate for Payer: Hawaii Western Management Group Commercial	$205.14
Rate for Payer: Health Management Network Commercial	$3,436.55
Rate for Payer: Kaiser Permanente Commercial	$442.09
Rate for Payer: Kaiser Permanente Medicaid	$442.09
Rate for Payer: Kaiser Permanente Medicare	$442.09
Rate for Payer: Ohana Health Plan Medicaid	$418.67
Rate for Payer: Ohana Health Plan Medicare	$401.90
Rate for Payer: UnitedHealthcare Medicaid	$418.67
Rate for Payer: UnitedHealthcare Medicare	$401.90
Rate for Payer: University Health Alliance Commercial	$549.35

Know your out-of-pocket cost for care.

All Charges