Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES TechFee

Facility

$613.00

Service Code	HCPCS 29505
Hospital Charge Code	8023349
Hospital Revenue Code	450
Min. Negotiated Rate	$521.05
Max. Negotiated Rate	$594.61
Rate for Payer: Cash Price	$398.45
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: MDX Hawaii PPO	$594.61

29505-Long Leg

Facility

$533.00

Service Code	HCPCS 29505
Hospital Charge Code	8080074
Hospital Revenue Code	450
Min. Negotiated Rate	$266.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$266.50
Rate for Payer: Cash Price	$346.45
Rate for Payer: Cash Price	$346.45
Rate for Payer: Cash Price	$346.45
Rate for Payer: Devoted Health Medicare	$293.15
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	$266.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$506.35
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: Humana Medicare	$266.50
Rate for Payer: Kaiser Permanente Commercial	$479.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$266.50
Rate for Payer: MDX Hawaii PPO	$517.01
Rate for Payer: Ohana Health Plan Medicaid	$266.50
Rate for Payer: Ohana Health Plan Medicare	$266.50
Rate for Payer: UnitedHealthcare Medicare	$266.50
Rate for Payer: University Health Alliance Commercial	$388.50

29505-Long Leg

Facility

$533.00

Service Code	HCPCS 29505
Hospital Charge Code	8080074
Hospital Revenue Code	450
Min. Negotiated Rate	$453.05
Max. Negotiated Rate	$517.01
Rate for Payer: Cash Price	$346.45
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: Kaiser Permanente Commercial	$479.70
Rate for Payer: MDX Hawaii PPO	$517.01

29515 Application of short leg splint (calf to foot)

Professional

Both

$268.00

Service Code	HCPCS 29515
Hospital Charge Code	8038459
Hospital Revenue Code	975
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$227.80
Rate for Payer: AlohaCare Medicaid	$51.60
Rate for Payer: AlohaCare Medicare	$51.10
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Devoted Health Medicare	$56.21
Rate for Payer: Hawaii Medical Service Association ABD	$51.60
Rate for Payer: Hawaii Medical Service Association Commercial	$83.56
Rate for Payer: Hawaii Medical Service Association Medicare	$51.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.60
Rate for Payer: Hawaii Western Management Group Commercial	$66.04
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Kaiser Permanente Commercial	$56.21
Rate for Payer: Kaiser Permanente Medicaid	$56.21
Rate for Payer: Kaiser Permanente Medicare	$56.21
Rate for Payer: Ohana Health Plan Medicaid	$51.60
Rate for Payer: Ohana Health Plan Medicare	$51.10
Rate for Payer: UnitedHealthcare Medicaid	$51.60
Rate for Payer: UnitedHealthcare Medicare	$51.10
Rate for Payer: University Health Alliance Commercial	$65.81

29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee

Facility

$613.00

Service Code	HCPCS 29515
Hospital Charge Code	8023350
Hospital Revenue Code	450
Min. Negotiated Rate	$521.05
Max. Negotiated Rate	$594.61
Rate for Payer: Cash Price	$398.45
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: MDX Hawaii PPO	$594.61

29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee

Facility

$613.00

Service Code	HCPCS 29515
Hospital Charge Code	8023350
Hospital Revenue Code	450
Min. Negotiated Rate	$306.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$306.50
Rate for Payer: Cash Price	$398.45
Rate for Payer: Cash Price	$398.45
Rate for Payer: Cash Price	$398.45
Rate for Payer: Devoted Health Medicare	$337.15
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	$306.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$582.35
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Humana Medicare	$306.50
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$306.50
Rate for Payer: MDX Hawaii PPO	$594.61
Rate for Payer: Ohana Health Plan Medicaid	$306.50
Rate for Payer: Ohana Health Plan Medicare	$306.50
Rate for Payer: UnitedHealthcare Medicare	$306.50
Rate for Payer: University Health Alliance Commercial	$446.82

29515-Short Leg

Facility

$533.00

Service Code	HCPCS 29515
Hospital Charge Code	8080075
Hospital Revenue Code	450
Min. Negotiated Rate	$453.05
Max. Negotiated Rate	$517.01
Rate for Payer: Cash Price	$346.45
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: Kaiser Permanente Commercial	$479.70
Rate for Payer: MDX Hawaii PPO	$517.01

29515-Short Leg

Facility

$533.00

Service Code	HCPCS 29515
Hospital Charge Code	8080075
Hospital Revenue Code	450
Min. Negotiated Rate	$266.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$266.50
Rate for Payer: Cash Price	$346.45
Rate for Payer: Cash Price	$346.45
Rate for Payer: Cash Price	$346.45
Rate for Payer: Devoted Health Medicare	$293.15
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	$266.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$506.35
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: Humana Medicare	$266.50
Rate for Payer: Kaiser Permanente Commercial	$479.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$266.50
Rate for Payer: MDX Hawaii PPO	$517.01
Rate for Payer: Ohana Health Plan Medicaid	$266.50
Rate for Payer: Ohana Health Plan Medicare	$266.50
Rate for Payer: UnitedHealthcare Medicare	$266.50
Rate for Payer: University Health Alliance Commercial	$388.50

29530 STRAPPING KNEE TechFee

Facility

$566.00

Service Code	HCPCS 29530
Hospital Charge Code	8023351
Hospital Revenue Code	450
Min. Negotiated Rate	$283.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$283.00
Rate for Payer: Cash Price	$367.90
Rate for Payer: Cash Price	$367.90
Rate for Payer: Cash Price	$367.90
Rate for Payer: Devoted Health Medicare	$311.30
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	$283.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$537.70
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Humana Medicare	$283.00
Rate for Payer: Kaiser Permanente Commercial	$509.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$283.00
Rate for Payer: MDX Hawaii PPO	$549.02
Rate for Payer: Ohana Health Plan Medicaid	$283.00
Rate for Payer: Ohana Health Plan Medicare	$283.00
Rate for Payer: UnitedHealthcare Medicare	$283.00
Rate for Payer: University Health Alliance Commercial	$412.56

29530 STRAPPING KNEE TechFee

Facility

$566.00

Service Code	HCPCS 29530
Hospital Charge Code	8023351
Hospital Revenue Code	450
Min. Negotiated Rate	$481.10
Max. Negotiated Rate	$549.02
Rate for Payer: Cash Price	$367.90
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Kaiser Permanente Commercial	$509.40
Rate for Payer: MDX Hawaii PPO	$549.02

29540 STRAPPING ANKLE &/FOOT TechFee

Facility

$566.00

Service Code	HCPCS 29540
Hospital Charge Code	8023352
Hospital Revenue Code	450
Min. Negotiated Rate	$283.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$283.00
Rate for Payer: Cash Price	$367.90
Rate for Payer: Cash Price	$367.90
Rate for Payer: Cash Price	$367.90
Rate for Payer: Devoted Health Medicare	$311.30
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	$283.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$537.70
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Humana Medicare	$283.00
Rate for Payer: Kaiser Permanente Commercial	$509.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$283.00
Rate for Payer: MDX Hawaii PPO	$549.02
Rate for Payer: Ohana Health Plan Medicaid	$283.00
Rate for Payer: Ohana Health Plan Medicare	$283.00
Rate for Payer: UnitedHealthcare Medicare	$283.00
Rate for Payer: University Health Alliance Commercial	$412.56

29540 STRAPPING ANKLE &/FOOT TechFee

Facility

$566.00

Service Code	HCPCS 29540
Hospital Charge Code	8023352
Hospital Revenue Code	450
Min. Negotiated Rate	$481.10
Max. Negotiated Rate	$549.02
Rate for Payer: Cash Price	$367.90
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Kaiser Permanente Commercial	$509.40
Rate for Payer: MDX Hawaii PPO	$549.02

29550 Strapping of Toes

Professional

Both

$82.00

Service Code	HCPCS 29550
Hospital Charge Code	11094847
Hospital Revenue Code	975
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$69.70
Rate for Payer: AlohaCare Medicaid	$10.99
Rate for Payer: AlohaCare Medicare	$9.54
Rate for Payer: Cash Price	$53.30
Rate for Payer: Cash Price	$53.30
Rate for Payer: Devoted Health Medicare	$10.49
Rate for Payer: Hawaii Medical Service Association ABD	$10.99
Rate for Payer: Hawaii Medical Service Association Commercial	$46.11
Rate for Payer: Hawaii Medical Service Association Medicare	$9.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.99
Rate for Payer: Hawaii Western Management Group Commercial	$29.64
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$10.49
Rate for Payer: Kaiser Permanente Medicaid	$10.49
Rate for Payer: Kaiser Permanente Medicare	$10.49
Rate for Payer: Ohana Health Plan Medicaid	$10.99
Rate for Payer: Ohana Health Plan Medicare	$9.54
Rate for Payer: UnitedHealthcare Medicaid	$10.99
Rate for Payer: UnitedHealthcare Medicare	$9.54
Rate for Payer: University Health Alliance Commercial	$14.71

29550-Strapping Toes

Facility

$428.00

Service Code	HCPCS 29550
Hospital Charge Code	8080076
Hospital Revenue Code	450
Min. Negotiated Rate	$363.80
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$278.20
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Kaiser Permanente Commercial	$385.20
Rate for Payer: MDX Hawaii PPO	$415.16

29550-Strapping Toes

Facility

$428.00

Service Code	HCPCS 29550
Hospital Charge Code	8080076
Hospital Revenue Code	450
Min. Negotiated Rate	$214.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$214.00
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Devoted Health Medicare	$235.40
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	$214.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$406.60
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Humana Medicare	$214.00
Rate for Payer: Kaiser Permanente Commercial	$385.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$214.00
Rate for Payer: MDX Hawaii PPO	$415.16
Rate for Payer: Ohana Health Plan Medicaid	$214.00
Rate for Payer: Ohana Health Plan Medicare	$214.00
Rate for Payer: UnitedHealthcare Medicare	$214.00
Rate for Payer: University Health Alliance Commercial	$311.97

29550 STRAPPING TOES TechFee

Facility

$528.00

Service Code	HCPCS 29550
Hospital Charge Code	8023353
Hospital Revenue Code	450
Min. Negotiated Rate	$448.80
Max. Negotiated Rate	$512.16
Rate for Payer: Cash Price	$343.20
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Kaiser Permanente Commercial	$475.20
Rate for Payer: MDX Hawaii PPO	$512.16

29550 STRAPPING TOES TechFee

Facility

$528.00

Service Code	HCPCS 29550
Hospital Charge Code	8023353
Hospital Revenue Code	450
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$264.00
Rate for Payer: Cash Price	$343.20
Rate for Payer: Cash Price	$343.20
Rate for Payer: Cash Price	$343.20
Rate for Payer: Devoted Health Medicare	$290.40
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	$264.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$501.60
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Humana Medicare	$264.00
Rate for Payer: Kaiser Permanente Commercial	$475.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$264.00
Rate for Payer: MDX Hawaii PPO	$512.16
Rate for Payer: Ohana Health Plan Medicaid	$264.00
Rate for Payer: Ohana Health Plan Medicare	$264.00
Rate for Payer: UnitedHealthcare Medicare	$264.00
Rate for Payer: University Health Alliance Commercial	$384.86

29580-Strapping Unna Boot

Facility

$865.00

Service Code	HCPCS 29580
Hospital Charge Code	8080077
Hospital Revenue Code	450
Min. Negotiated Rate	$735.25
Max. Negotiated Rate	$839.05
Rate for Payer: Cash Price	$562.25
Rate for Payer: Health Management Network Commercial	$735.25
Rate for Payer: Kaiser Permanente Commercial	$778.50
Rate for Payer: MDX Hawaii PPO	$839.05

29580-Strapping Unna Boot

Facility

$865.00

Service Code	HCPCS 29580
Hospital Charge Code	8080077
Hospital Revenue Code	450
Min. Negotiated Rate	$432.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$432.50
Rate for Payer: Cash Price	$562.25
Rate for Payer: Cash Price	$562.25
Rate for Payer: Cash Price	$562.25
Rate for Payer: Devoted Health Medicare	$475.75
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	$432.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$821.75
Rate for Payer: Health Management Network Commercial	$735.25
Rate for Payer: Humana Medicare	$432.50
Rate for Payer: Kaiser Permanente Commercial	$778.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$432.50
Rate for Payer: MDX Hawaii PPO	$839.05
Rate for Payer: Ohana Health Plan Medicaid	$432.50
Rate for Payer: Ohana Health Plan Medicare	$432.50
Rate for Payer: UnitedHealthcare Medicare	$432.50
Rate for Payer: University Health Alliance Commercial	$630.50

29705-Remove/Bivalving Cast Full Arm/Leg

Facility

$1,611.00

Service Code	HCPCS 29705
Hospital Charge Code	8080078
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,600.00
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	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$805.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
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

29705-Remove/Bivalving Cast Full Arm/Leg

Facility

$1,611.00

Service Code	HCPCS 29705
Hospital Charge Code	8080078
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

29892 Arthrs Aid Rpr Les/Talar Dome Fx/Tibl Plafond Fx

Professional

Both

$10,099.00

Service Code	HCPCS 29892
Hospital Charge Code	11104904
Hospital Revenue Code	975
Min. Negotiated Rate	$610.12
Max. Negotiated Rate	$8,584.15
Rate for Payer: AlohaCare Medicaid	$666.98
Rate for Payer: AlohaCare Medicare	$610.12
Rate for Payer: Cash Price	$6,564.35
Rate for Payer: Cash Price	$6,564.35
Rate for Payer: Devoted Health Medicare	$671.13
Rate for Payer: Hawaii Medical Service Association Medicare	$610.12
Rate for Payer: Health Management Network Commercial	$8,584.15
Rate for Payer: Kaiser Permanente Commercial	$671.13
Rate for Payer: Kaiser Permanente Medicaid	$671.13
Rate for Payer: Kaiser Permanente Medicare	$671.13
Rate for Payer: Ohana Health Plan Medicaid	$666.98
Rate for Payer: Ohana Health Plan Medicare	$610.12
Rate for Payer: UnitedHealthcare Medicaid	$666.98
Rate for Payer: UnitedHealthcare Medicare	$610.12

29893 Endoscopic Plantar Fascitomy

Professional

Both

$4,554.00

Service Code	HCPCS 29893
Hospital Charge Code	10144874
Hospital Revenue Code	975
Min. Negotiated Rate	$436.47
Max. Negotiated Rate	$3,870.90
Rate for Payer: AlohaCare Medicaid	$466.39
Rate for Payer: AlohaCare Medicare	$436.47
Rate for Payer: Cash Price	$2,960.10
Rate for Payer: Cash Price	$2,960.10
Rate for Payer: Devoted Health Medicare	$480.12
Rate for Payer: Hawaii Medical Service Association ABD	$466.39
Rate for Payer: Hawaii Medical Service Association Commercial	$751.96
Rate for Payer: Hawaii Medical Service Association Medicare	$436.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$466.39
Rate for Payer: Hawaii Western Management Group Commercial	$445.12
Rate for Payer: Health Management Network Commercial	$3,870.90
Rate for Payer: Kaiser Permanente Commercial	$480.12
Rate for Payer: Kaiser Permanente Medicaid	$480.12
Rate for Payer: Kaiser Permanente Medicare	$480.12
Rate for Payer: Ohana Health Plan Medicaid	$466.39
Rate for Payer: Ohana Health Plan Medicare	$436.47
Rate for Payer: UnitedHealthcare Medicaid	$466.39
Rate for Payer: UnitedHealthcare Medicare	$436.47
Rate for Payer: University Health Alliance Commercial	$582.88

30000-Drainage Nasal Abscess/Hematoma

Facility

$1,316.00

Service Code	HCPCS 30000
Hospital Charge Code	8080063
Hospital Revenue Code	450
Min. Negotiated Rate	$1,118.60
Max. Negotiated Rate	$1,276.52
Rate for Payer: Cash Price	$855.40
Rate for Payer: Health Management Network Commercial	$1,118.60
Rate for Payer: Kaiser Permanente Commercial	$1,184.40
Rate for Payer: MDX Hawaii PPO	$1,276.52

30000-Drainage Nasal Abscess/Hematoma

Facility

$1,316.00

Service Code	HCPCS 30000
Hospital Charge Code	8080063
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$658.00
Rate for Payer: Cash Price	$855.40
Rate for Payer: Cash Price	$855.40
Rate for Payer: Cash Price	$855.40
Rate for Payer: Devoted Health Medicare	$723.80
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	$658.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,250.20
Rate for Payer: Health Management Network Commercial	$1,118.60
Rate for Payer: Humana Medicare	$658.00
Rate for Payer: Kaiser Permanente Commercial	$1,184.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$658.00
Rate for Payer: MDX Hawaii PPO	$1,276.52
Rate for Payer: Ohana Health Plan Medicaid	$658.00
Rate for Payer: Ohana Health Plan Medicare	$658.00
Rate for Payer: UnitedHealthcare Medicare	$658.00
Rate for Payer: University Health Alliance Commercial	$959.23

Know your out-of-pocket cost for care.

All Charges