Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15

Facility

$1,233.00

Service Code	HCPCS 11200
Hospital Charge Code	H4501090
Hospital Revenue Code	450
Min. Negotiated Rate	$1,048.05
Max. Negotiated Rate	$1,196.01
Rate for Payer: Cash Price	$801.45
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: MDX Hawaii PPO	$1,196.01

HCHG REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15

Facility

$1,233.00

Service Code	HCPCS 11200
Hospital Charge Code	H4501090
Hospital Revenue Code	450
Min. Negotiated Rate	$237.02
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Devoted Health Medicare	$260.72
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$237.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.35
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Commercial	$776.79
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$898.73

HCHG REMOVE EMBEDDED FB MOUTH VESTIB

Facility

$4,548.00

Service Code	HCPCS 40804
Hospital Charge Code	H4500662
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$4,411.56
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$2,956.20
Rate for Payer: Cash Price	$2,956.20
Rate for Payer: Cash Price	$2,956.20
Rate for Payer: Cash Price	$2,956.20
Rate for Payer: Devoted Health Medicare	$1,178.61
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,320.60
Rate for Payer: Health Management Network Commercial	$3,865.80
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$2,865.24
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$4,411.56
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$3,315.04

HCHG REMOVE EMBEDDED FB MOUTH VESTIB

Facility

$4,548.00

Service Code	HCPCS 40804
Hospital Charge Code	H4500662
Hospital Revenue Code	450
Min. Negotiated Rate	$3,865.80
Max. Negotiated Rate	$4,411.56
Rate for Payer: Cash Price	$2,956.20
Rate for Payer: Health Management Network Commercial	$3,865.80
Rate for Payer: MDX Hawaii PPO	$4,411.56

HCHG REMOVE EYELID FOREIGN BODY

Facility

$1,736.00

Service Code	HCPCS 67938
Hospital Charge Code	H4500987
Hospital Revenue Code	450
Min. Negotiated Rate	$1,475.60
Max. Negotiated Rate	$1,683.92
Rate for Payer: Cash Price	$1,128.40
Rate for Payer: Health Management Network Commercial	$1,475.60
Rate for Payer: MDX Hawaii PPO	$1,683.92

HCHG REMOVE EYELID FOREIGN BODY

Facility

$1,736.00

Service Code	HCPCS 67938
Hospital Charge Code	H4500987
Hospital Revenue Code	450
Min. Negotiated Rate	$374.96
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$374.96
Rate for Payer: AlohaCare Medicare	$374.96
Rate for Payer: Cash Price	$1,128.40
Rate for Payer: Cash Price	$1,128.40
Rate for Payer: Cash Price	$1,128.40
Rate for Payer: Devoted Health Medicare	$412.46
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$374.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,649.20
Rate for Payer: Health Management Network Commercial	$1,475.60
Rate for Payer: Humana Medicare	$374.96
Rate for Payer: Kaiser Permanente Commercial	$1,093.68
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$374.96
Rate for Payer: MDX Hawaii PPO	$1,683.92
Rate for Payer: Ohana Health Plan Medicaid	$412.46
Rate for Payer: Ohana Health Plan Medicare	$374.96
Rate for Payer: UnitedHealthcare Medicare	$374.96
Rate for Payer: University Health Alliance Commercial	$1,265.37

HCHG REMOVE FB CONJUCTIVA EMBEDDED

Facility

$2,251.00

Service Code	HCPCS 65210
Hospital Charge Code	H4500602
Hospital Revenue Code	450
Min. Negotiated Rate	$1,913.35
Max. Negotiated Rate	$2,183.47
Rate for Payer: Cash Price	$1,463.15
Rate for Payer: Health Management Network Commercial	$1,913.35
Rate for Payer: MDX Hawaii PPO	$2,183.47

HCHG REMOVE FB CONJUCTIVA EMBEDDED

Facility

$2,251.00

Service Code	HCPCS 65210
Hospital Charge Code	H4500602
Hospital Revenue Code	450
Min. Negotiated Rate	$527.74
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$1,463.15
Rate for Payer: Cash Price	$1,463.15
Rate for Payer: Cash Price	$1,463.15
Rate for Payer: Devoted Health Medicare	$580.51
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$527.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,138.45
Rate for Payer: Health Management Network Commercial	$1,913.35
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$1,418.13
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$2,183.47
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$1,640.75

HCHG REMOVE FB CONJUCTIVA SUPERFIC

Facility

$816.00

Service Code	HCPCS 65205
Hospital Charge Code	H4500604
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: MDX Hawaii PPO	$791.52

HCHG REMOVE FB CONJUCTIVA SUPERFIC

Facility

$816.00

Service Code	HCPCS 65205
Hospital Charge Code	H4500604
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$514.08
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$594.78

HCHG REMOVE FB CORNEA WO SLIT LAMP

Facility

$2,244.00

Service Code	HCPCS 65220
Hospital Charge Code	H4500608
Hospital Revenue Code	450
Min. Negotiated Rate	$1,907.40
Max. Negotiated Rate	$2,176.68
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Health Management Network Commercial	$1,907.40
Rate for Payer: MDX Hawaii PPO	$2,176.68

HCHG REMOVE FB CORNEA WO SLIT LAMP

Facility

$2,244.00

Service Code	HCPCS 65220
Hospital Charge Code	H4500608
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,176.68
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Devoted Health Medicare	$580.51
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$527.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,131.80
Rate for Payer: Health Management Network Commercial	$1,907.40
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$1,413.72
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$2,176.68
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$1,635.65

HCHG REMOVE FB CORNEA W SLIT LAMP

Facility

$816.00

Service Code	HCPCS 65222
Hospital Charge Code	H4500606
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: MDX Hawaii PPO	$791.52

HCHG REMOVE FB CORNEA W SLIT LAMP

Facility

$816.00

Service Code	HCPCS 65222
Hospital Charge Code	H4500606
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$514.08
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$594.78

HCHG REMOVE FB EAR WO ANESTH

Facility

$816.00

Service Code	HCPCS 69200
Hospital Charge Code	H4500594
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$514.08
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$594.78

HCHG REMOVE FB EAR WO ANESTH

Facility

$816.00

Service Code	HCPCS 69200
Hospital Charge Code	H4500594
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: MDX Hawaii PPO	$791.52

HCHG REMOVE FB FOOT SUBQ

Facility

$3,592.00

Service Code	HCPCS 28190
Hospital Charge Code	H4500598
Hospital Revenue Code	450
Min. Negotiated Rate	$3,053.20
Max. Negotiated Rate	$3,484.24
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Health Management Network Commercial	$3,053.20
Rate for Payer: MDX Hawaii PPO	$3,484.24

HCHG REMOVE FB FOOT SUBQ

Facility

$3,592.00

Service Code	HCPCS 28190
Hospital Charge Code	H4500598
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Devoted Health Medicare	$920.21
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,412.40
Rate for Payer: Health Management Network Commercial	$3,053.20
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$2,262.96
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$3,484.24
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG REMOVE FB INTRANASAL

Facility

$816.00

Service Code	HCPCS 30300
Hospital Charge Code	H4500610
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: MDX Hawaii PPO	$791.52

HCHG REMOVE FB INTRANASAL

Facility

$816.00

Service Code	HCPCS 30300
Hospital Charge Code	H4500610
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$514.08
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$594.78

HCHG REMOVE FB PHARYNX

Facility

$2,244.00

Service Code	HCPCS 42809
Hospital Charge Code	H4500612
Hospital Revenue Code	450
Min. Negotiated Rate	$527.74
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Devoted Health Medicare	$580.51
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$527.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,131.80
Rate for Payer: Health Management Network Commercial	$1,907.40
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$1,413.72
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$2,176.68
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$1,635.65

HCHG REMOVE FB PHARYNX

Facility

$2,244.00

Service Code	HCPCS 42809
Hospital Charge Code	H4500612
Hospital Revenue Code	450
Min. Negotiated Rate	$1,907.40
Max. Negotiated Rate	$2,176.68
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Health Management Network Commercial	$1,907.40
Rate for Payer: MDX Hawaii PPO	$2,176.68

HCHG REMOVE IMPACTED CERUMEN UNILAT

Facility

$428.00

Service Code	HCPCS 69210
Hospital Charge Code	H4500614
Hospital Revenue Code	450
Min. Negotiated Rate	$69.69
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$278.20
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	$76.66
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$69.69
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	$69.69
Rate for Payer: Kaiser Permanente Commercial	$269.64
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$415.16
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG REMOVE IMPACTED CERUMEN UNILAT

Facility

$428.00

Service Code	HCPCS 69210
Hospital Charge Code	H4500614
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: MDX Hawaii PPO	$415.16

HCHG REMOVE IMPL VA DEVICE/SUBQ RESV

Facility

$3,214.00

Service Code	HCPCS 36589
Hospital Charge Code	H4500616
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,117.58
Rate for Payer: AlohaCare Medicaid	$741.06
Rate for Payer: AlohaCare Medicare	$741.06
Rate for Payer: Cash Price	$2,089.10
Rate for Payer: Cash Price	$2,089.10
Rate for Payer: Cash Price	$2,089.10
Rate for Payer: Devoted Health Medicare	$815.17
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$741.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,053.30
Rate for Payer: Health Management Network Commercial	$2,731.90
Rate for Payer: Humana Medicare	$741.06
Rate for Payer: Kaiser Permanente Commercial	$2,024.82
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$741.06
Rate for Payer: MDX Hawaii PPO	$3,117.58
Rate for Payer: Ohana Health Plan Medicaid	$815.17
Rate for Payer: Ohana Health Plan Medicare	$741.06
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$741.06
Rate for Payer: University Health Alliance Commercial	$2,342.68

Know your out-of-pocket cost for care.

All Charges