Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG SUTURE INTER-FACE+-5.1-7.5

Facility

$2,246.00

Service Code	HCPCS 12053
Hospital Charge Code	H4500748
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$2,223.54
Rate for Payer: AlohaCare Medicaid	$1,123.00
Rate for Payer: AlohaCare Medicare	$2,021.40
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$2,223.54
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$2,021.40
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$2,021.40
Rate for Payer: Ohana Health Plan Medicare	$2,021.40
Rate for Payer: UnitedHealthcare Medicare	$2,021.40
Rate for Payer: University Health Alliance Commercial	$1,637.11

HCHG SUTURE INTER-FACE+-7.6-12.5

Facility

$2,246.00

Service Code	HCPCS 12054
Hospital Charge Code	H4500750
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$2,223.54
Rate for Payer: AlohaCare Medicaid	$1,123.00
Rate for Payer: AlohaCare Medicare	$2,021.40
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$2,223.54
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$2,021.40
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$2,021.40
Rate for Payer: Ohana Health Plan Medicare	$2,021.40
Rate for Payer: UnitedHealthcare Medicare	$2,021.40
Rate for Payer: University Health Alliance Commercial	$1,637.11

HCHG SUTURE INTER-FACE+-7.6-12.5

Facility

$2,246.00

Service Code	HCPCS 12054
Hospital Charge Code	H4500750
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG SUTURE INTER-NECK+-20.1-30.0

Facility

$2,620.00

Service Code	HCPCS 12046
Hospital Charge Code	H4500760
Hospital Revenue Code	450
Min. Negotiated Rate	$2,227.00
Max. Negotiated Rate	$2,541.40
Rate for Payer: Cash Price	$1,703.00
Rate for Payer: Health Management Network Commercial	$2,227.00
Rate for Payer: Kaiser Permanente Commercial	$2,358.00
Rate for Payer: MDX Hawaii PPO	$2,541.40

HCHG SUTURE INTER-NECK+-20.1-30.0

Facility

$2,620.00

Service Code	HCPCS 12046
Hospital Charge Code	H4500760
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,593.80
Rate for Payer: AlohaCare Medicaid	$1,310.00
Rate for Payer: AlohaCare Medicare	$2,358.00
Rate for Payer: Cash Price	$1,703.00
Rate for Payer: Cash Price	$1,703.00
Rate for Payer: Devoted Health Medicare	$2,593.80
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,358.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,489.00
Rate for Payer: Health Management Network Commercial	$2,227.00
Rate for Payer: Humana Medicare	$2,358.00
Rate for Payer: Kaiser Permanente Commercial	$2,358.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,358.00
Rate for Payer: MDX Hawaii PPO	$2,541.40
Rate for Payer: Ohana Health Plan Medicaid	$2,358.00
Rate for Payer: Ohana Health Plan Medicare	$2,358.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,358.00
Rate for Payer: University Health Alliance Commercial	$1,909.72

HCHG SUTURE INTER-NECK+-2.5 OR LESS

Facility

$2,246.00

Service Code	HCPCS 12041
Hospital Charge Code	H4500756
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG SUTURE INTER-NECK+-2.5 OR LESS

Facility

$2,246.00

Service Code	HCPCS 12041
Hospital Charge Code	H4500756
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$2,223.54
Rate for Payer: AlohaCare Medicaid	$1,123.00
Rate for Payer: AlohaCare Medicare	$2,021.40
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$2,223.54
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$2,021.40
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$2,021.40
Rate for Payer: Ohana Health Plan Medicare	$2,021.40
Rate for Payer: UnitedHealthcare Medicare	$2,021.40
Rate for Payer: University Health Alliance Commercial	$1,637.11

HCHG SUTURE INTER-NECK+-2.6-7.5

Facility

$2,246.00

Service Code	HCPCS 12042
Hospital Charge Code	H4500758
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$2,223.54
Rate for Payer: AlohaCare Medicaid	$1,123.00
Rate for Payer: AlohaCare Medicare	$2,021.40
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$2,223.54
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$2,021.40
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$2,021.40
Rate for Payer: Ohana Health Plan Medicare	$2,021.40
Rate for Payer: UnitedHealthcare Medicare	$2,021.40
Rate for Payer: University Health Alliance Commercial	$1,637.11

HCHG SUTURE INTER-NECK+-2.6-7.5

Facility

$2,246.00

Service Code	HCPCS 12042
Hospital Charge Code	H4500758
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG SUTURE INTER-NECK+-7.6-12.5

Facility

$3,187.00

Service Code	HCPCS 12044
Hospital Charge Code	H4500762
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$3,155.13
Rate for Payer: AlohaCare Medicaid	$1,593.50
Rate for Payer: AlohaCare Medicare	$2,868.30
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Devoted Health Medicare	$3,155.13
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,868.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.65
Rate for Payer: Health Management Network Commercial	$2,708.95
Rate for Payer: Humana Medicare	$2,868.30
Rate for Payer: Kaiser Permanente Commercial	$2,868.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,868.30
Rate for Payer: MDX Hawaii PPO	$3,091.39
Rate for Payer: Ohana Health Plan Medicaid	$2,868.30
Rate for Payer: Ohana Health Plan Medicare	$2,868.30
Rate for Payer: UnitedHealthcare Medicare	$2,868.30
Rate for Payer: University Health Alliance Commercial	$2,323.00

HCHG SUTURE INTER-NECK+-7.6-12.5

Facility

$3,187.00

Service Code	HCPCS 12044
Hospital Charge Code	H4500762
Hospital Revenue Code	450
Min. Negotiated Rate	$2,708.95
Max. Negotiated Rate	$3,091.39
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Health Management Network Commercial	$2,708.95
Rate for Payer: Kaiser Permanente Commercial	$2,868.30
Rate for Payer: MDX Hawaii PPO	$3,091.39

HCHG SUTURE INTER-SCALP+-12.6-20.0

Facility

$2,246.00

Service Code	HCPCS 12035
Hospital Charge Code	H4500766
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,123.00
Rate for Payer: AlohaCare Medicare	$2,021.40
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$2,223.54
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$2,021.40
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$2,021.40
Rate for Payer: Ohana Health Plan Medicare	$2,021.40
Rate for Payer: UnitedHealthcare Medicare	$2,021.40
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG SUTURE INTER-SCALP+-12.6-20.0

Facility

$2,246.00

Service Code	HCPCS 12035
Hospital Charge Code	H4500766
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG SUTURE INTER-SCALP+-20.1-30.0

Facility

$2,646.00

Service Code	HCPCS 12036
Hospital Charge Code	H4500772
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$2,619.54
Rate for Payer: AlohaCare Medicaid	$1,323.00
Rate for Payer: AlohaCare Medicare	$2,381.40
Rate for Payer: Cash Price	$1,719.90
Rate for Payer: Cash Price	$1,719.90
Rate for Payer: Devoted Health Medicare	$2,619.54
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,381.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,513.70
Rate for Payer: Health Management Network Commercial	$2,249.10
Rate for Payer: Humana Medicare	$2,381.40
Rate for Payer: Kaiser Permanente Commercial	$2,381.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,381.40
Rate for Payer: MDX Hawaii PPO	$2,566.62
Rate for Payer: Ohana Health Plan Medicaid	$2,381.40
Rate for Payer: Ohana Health Plan Medicare	$2,381.40
Rate for Payer: UnitedHealthcare Medicare	$2,381.40
Rate for Payer: University Health Alliance Commercial	$1,928.67

HCHG SUTURE INTER-SCALP+-20.1-30.0

Facility

$2,646.00

Service Code	HCPCS 12036
Hospital Charge Code	H4500772
Hospital Revenue Code	450
Min. Negotiated Rate	$2,249.10
Max. Negotiated Rate	$2,566.62
Rate for Payer: Cash Price	$1,719.90
Rate for Payer: Health Management Network Commercial	$2,249.10
Rate for Payer: Kaiser Permanente Commercial	$2,381.40
Rate for Payer: MDX Hawaii PPO	$2,566.62

HCHG SUTURE INTER-SCALP+-2.5 OR LESS

Facility

$2,246.00

Service Code	HCPCS 12031
Hospital Charge Code	H4500768
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$2,223.54
Rate for Payer: AlohaCare Medicaid	$1,123.00
Rate for Payer: AlohaCare Medicare	$2,021.40
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$2,223.54
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$2,021.40
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$2,021.40
Rate for Payer: Ohana Health Plan Medicare	$2,021.40
Rate for Payer: UnitedHealthcare Medicare	$2,021.40
Rate for Payer: University Health Alliance Commercial	$1,637.11

HCHG SUTURE INTER-SCALP+-2.5 OR LESS

Facility

$2,246.00

Service Code	HCPCS 12031
Hospital Charge Code	H4500768
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG SUTURE INTER-SCALP+-2.6-7.5

Facility

$2,246.00

Service Code	HCPCS 12032
Hospital Charge Code	H4500770
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG SUTURE INTER-SCALP+-2.6-7.5

Facility

$2,246.00

Service Code	HCPCS 12032
Hospital Charge Code	H4500770
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,123.00
Rate for Payer: AlohaCare Medicare	$2,021.40
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$2,223.54
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$2,021.40
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$2,021.40
Rate for Payer: Ohana Health Plan Medicare	$2,021.40
Rate for Payer: UnitedHealthcare Medicare	$2,021.40
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG SUTURE INTER-SCALP+-7.6-12.5

Facility

$2,246.00

Service Code	HCPCS 12034
Hospital Charge Code	H4500774
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,123.00
Rate for Payer: AlohaCare Medicare	$2,021.40
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$2,223.54
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$2,021.40
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$2,021.40
Rate for Payer: Ohana Health Plan Medicare	$2,021.40
Rate for Payer: UnitedHealthcare Medicare	$2,021.40
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG SUTURE INTER-SCALP+-7.6-12.5

Facility

$2,246.00

Service Code	HCPCS 12034
Hospital Charge Code	H4500774
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG SUTURE INTER-SCALP+-OVER 30.0

Facility

$7,738.00

Service Code	HCPCS 12037
Hospital Charge Code	H4500776
Hospital Revenue Code	450
Min. Negotiated Rate	$6,577.30
Max. Negotiated Rate	$7,505.86
Rate for Payer: Cash Price	$5,029.70
Rate for Payer: Health Management Network Commercial	$6,577.30
Rate for Payer: Kaiser Permanente Commercial	$6,964.20
Rate for Payer: MDX Hawaii PPO	$7,505.86

HCHG SUTURE INTER-SCALP+-OVER 30.0

Facility

$7,738.00

Service Code	HCPCS 12037
Hospital Charge Code	H4500776
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$7,660.62
Rate for Payer: AlohaCare Medicaid	$3,869.00
Rate for Payer: AlohaCare Medicare	$6,964.20
Rate for Payer: Cash Price	$5,029.70
Rate for Payer: Cash Price	$5,029.70
Rate for Payer: Devoted Health Medicare	$7,660.62
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,964.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,351.10
Rate for Payer: Health Management Network Commercial	$6,577.30
Rate for Payer: Humana Medicare	$6,964.20
Rate for Payer: Kaiser Permanente Commercial	$6,964.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$6,964.20
Rate for Payer: MDX Hawaii PPO	$7,505.86
Rate for Payer: Ohana Health Plan Medicaid	$6,964.20
Rate for Payer: Ohana Health Plan Medicare	$6,964.20
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$6,964.20
Rate for Payer: University Health Alliance Commercial	$5,640.23

HCHG SUTURE SIMP-FACE+-12.6-20.0

Facility

$2,246.00

Service Code	HCPCS 12016
Hospital Charge Code	H4500778
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG SUTURE SIMP-FACE+-12.6-20.0

Facility

$2,246.00

Service Code	HCPCS 12016
Hospital Charge Code	H4500778
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$2,223.54
Rate for Payer: AlohaCare Medicaid	$1,123.00
Rate for Payer: AlohaCare Medicare	$2,021.40
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$2,223.54
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$2,021.40
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$2,021.40
Rate for Payer: Ohana Health Plan Medicare	$2,021.40
Rate for Payer: UnitedHealthcare Medicare	$2,021.40
Rate for Payer: University Health Alliance Commercial	$1,637.11

Know your out-of-pocket cost for care.

All Charges