Kona Community Hospital

All Charges

Charge

Type

Setting

Price

REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY DWELLING URETERAL STENT VIA TRANSURETHRAL APPROACH, WITHOUT USE OF CYSTOSCOPY, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION

Facility

$6,183.00

Service Code	CPT 50386
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Devoted Health Medicare	$2,716.41
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	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46

RENAL DIALYSIS ACCESS DEVICE PROCEDURES & VESSEL REPAIR

Facility

$20,904.33

Service Code	APR-DRG 4444
Min. Negotiated Rate	$20,904.33
Max. Negotiated Rate	$20,904.33
Rate for Payer: AlohaCare Medicaid	$20,904.33
Rate for Payer: Hawaii Medical Service Association ABD	$20,904.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,904.33
Rate for Payer: Kaiser Permanente Medicaid	$20,904.33
Rate for Payer: Ohana Health Plan Medicaid	$20,904.33
Rate for Payer: UnitedHealthcare Medicaid	$20,904.33

RENAL DIALYSIS ACCESS DEVICE PROCEDURES & VESSEL REPAIR

Facility

$11,006.50

Service Code	APR-DRG 4443
Min. Negotiated Rate	$11,006.50
Max. Negotiated Rate	$11,006.50
Rate for Payer: AlohaCare Medicaid	$11,006.50
Rate for Payer: Hawaii Medical Service Association ABD	$11,006.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,006.50
Rate for Payer: Kaiser Permanente Medicaid	$11,006.50
Rate for Payer: Ohana Health Plan Medicaid	$11,006.50
Rate for Payer: UnitedHealthcare Medicaid	$11,006.50

RENAL DIALYSIS ACCESS DEVICE PROCEDURES & VESSEL REPAIR

Facility

$7,115.00

Service Code	APR-DRG 4442
Min. Negotiated Rate	$7,115.00
Max. Negotiated Rate	$7,115.00
Rate for Payer: AlohaCare Medicaid	$7,115.00
Rate for Payer: Hawaii Medical Service Association ABD	$7,115.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,115.00
Rate for Payer: Kaiser Permanente Medicaid	$7,115.00
Rate for Payer: Ohana Health Plan Medicaid	$7,115.00
Rate for Payer: UnitedHealthcare Medicaid	$7,115.00

RENAL DIALYSIS ACCESS DEVICE PROCEDURES & VESSEL REPAIR

Facility

$5,088.06

Service Code	APR-DRG 4441
Min. Negotiated Rate	$5,088.06
Max. Negotiated Rate	$5,088.06
Rate for Payer: AlohaCare Medicaid	$5,088.06
Rate for Payer: Hawaii Medical Service Association ABD	$5,088.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,088.06
Rate for Payer: Kaiser Permanente Medicaid	$5,088.06
Rate for Payer: Ohana Health Plan Medicaid	$5,088.06
Rate for Payer: UnitedHealthcare Medicaid	$5,088.06

RENAL FAILURE WITH CC

Facility

$30,519.46

Service Code	MSDRG 683
Min. Negotiated Rate	$11,519.19
Max. Negotiated Rate	$30,519.46
Rate for Payer: AlohaCare Medicare	$11,519.19
Rate for Payer: Devoted Health Medicare	$12,671.11
Rate for Payer: Hawaii Medical Service Association Commercial	$30,519.46
Rate for Payer: Hawaii Medical Service Association Medicare	$11,519.19
Rate for Payer: Humana Medicare	$11,519.19
Rate for Payer: Kaiser Permanente Commercial	$15,107.55
Rate for Payer: Kaiser Permanente Medicare	$11,519.19
Rate for Payer: Ohana Health Plan Medicare	$11,519.19
Rate for Payer: UnitedHealthcare Medicare	$11,519.19

RENAL FAILURE WITH MCC

Facility

$30,519.46

Service Code	MSDRG 682
Min. Negotiated Rate	$19,479.24
Max. Negotiated Rate	$30,519.46
Rate for Payer: AlohaCare Medicare	$19,479.24
Rate for Payer: Devoted Health Medicare	$21,427.16
Rate for Payer: Hawaii Medical Service Association Commercial	$30,519.46
Rate for Payer: Hawaii Medical Service Association Medicare	$19,479.24
Rate for Payer: Humana Medicare	$19,479.24
Rate for Payer: Kaiser Permanente Commercial	$25,547.25
Rate for Payer: Kaiser Permanente Medicare	$19,479.24
Rate for Payer: Ohana Health Plan Medicare	$19,479.24
Rate for Payer: UnitedHealthcare Medicare	$19,479.24

RENAL FAILURE WITHOUT CC/MCC

Facility

$30,519.46

Service Code	MSDRG 684
Min. Negotiated Rate	$7,895.60
Max. Negotiated Rate	$30,519.46
Rate for Payer: AlohaCare Medicare	$7,895.60
Rate for Payer: Devoted Health Medicare	$8,685.16
Rate for Payer: Hawaii Medical Service Association Commercial	$30,519.46
Rate for Payer: Hawaii Medical Service Association Medicare	$7,895.60
Rate for Payer: Humana Medicare	$7,895.60
Rate for Payer: Kaiser Permanente Commercial	$10,355.17
Rate for Payer: Kaiser Permanente Medicare	$7,895.60
Rate for Payer: Ohana Health Plan Medicare	$7,895.60
Rate for Payer: UnitedHealthcare Medicare	$7,895.60

RENAL FUNCTION PANEL

Professional

Both

$17.00

Service Code	HCPCS 80069
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$18.00
Rate for Payer: AlohaCare Medicaid	$12.00
Rate for Payer: AlohaCare Medicare	$8.68
Rate for Payer: Cash Price	$11.05
Rate for Payer: Cash Price	$11.05
Rate for Payer: Devoted Health Medicare	$9.55
Rate for Payer: Hawaii Medical Service Association Medicare	$8.68
Rate for Payer: Hawaii Western Management Group Commercial	$18.00
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.42
Rate for Payer: Kaiser Permanente Medicaid	$10.42
Rate for Payer: Kaiser Permanente Medicare	$10.42
Rate for Payer: Ohana Health Plan Medicaid	$12.00
Rate for Payer: Ohana Health Plan Medicare	$8.68
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: UnitedHealthcare Medicare	$8.68

REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM

Facility

$6,743.44

Service Code	CPT 13152
Hospital Revenue Code	360
Min. Negotiated Rate	$279.51
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$873.10
Rate for Payer: AlohaCare Medicare	$873.10
Rate for Payer: Devoted Health Medicare	$960.41
Rate for Payer: Hawaii Medical Service Association Commercial	$1,091.38
Rate for Payer: Hawaii Medical Service Association Medicare	$873.10
Rate for Payer: Humana Medicare	$873.10
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$873.10
Rate for Payer: Ohana Health Plan Medicaid	$960.41
Rate for Payer: Ohana Health Plan Medicare	$873.10
Rate for Payer: UnitedHealthcare Medicaid	$279.51
Rate for Payer: UnitedHealthcare Medicare	$873.10
Rate for Payer: University Health Alliance Commercial	$6,743.44

REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 1.1 CM TO 2.5 CM

Facility

$2,837.00

Service Code	CPT 13131
Hospital Revenue Code	360
Min. Negotiated Rate	$159.07
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$159.07
Rate for Payer: UnitedHealthcare Medicare	$480.23

REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM

Facility

$5,160.40

Service Code	CPT 13121
Hospital Revenue Code	360
Min. Negotiated Rate	$179.03
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$179.03
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$5,160.40

REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$2,837.00

Service Code	CPT 13122
Hospital Revenue Code	360
Min. Negotiated Rate	$60.73
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$60.73

REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON

Facility

$10,679.55

Service Code	CPT 26418
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Devoted Health Medicare	$2,089.55
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	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$10,679.55

REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON

Facility

$9,429.30

Service Code	CPT 27659
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,429.30
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
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	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$5,160.40

REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE

Facility

$10,679.55

Service Code	CPT 49505
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$4,229.69
Rate for Payer: AlohaCare Medicare	$4,229.69
Rate for Payer: Devoted Health Medicare	$4,652.66
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	$4,229.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$4,229.69
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,229.69
Rate for Payer: Ohana Health Plan Medicaid	$4,652.66
Rate for Payer: Ohana Health Plan Medicare	$4,229.69
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,229.69
Rate for Payer: University Health Alliance Commercial	$10,679.55

REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 5.1 CM TO 7.5 CM

Facility

$2,837.00

Service Code	CPT 12053
Hospital Revenue Code	360
Min. Negotiated Rate	$140.57
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$140.57
Rate for Payer: UnitedHealthcare Medicare	$480.23

REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR LESS

Facility

$2,837.00

Service Code	CPT 12041
Hospital Revenue Code	360
Min. Negotiated Rate	$92.51
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$92.51
Rate for Payer: UnitedHealthcare Medicare	$480.23

REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM

Facility

$2,837.00

Service Code	CPT 12042
Hospital Revenue Code	360
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$107.80
Rate for Payer: UnitedHealthcare Medicare	$480.23

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM

Facility

$5,160.40

Service Code	CPT 12035
Hospital Revenue Code	360
Min. Negotiated Rate	$155.98
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$155.98
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$5,160.40

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM

Facility

$4,035.20

Service Code	CPT 12032
Hospital Revenue Code	360
Min. Negotiated Rate	$104.83
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$104.83
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$4,035.20

REPAIR, NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUT BONE GRAFT (INCLUDES OBTAINING GRAFT)

Facility

$10,679.55

Service Code	CPT 28322
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
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	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$10,679.55

REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, INCARCERATED OR STRANGULATED

Facility

$14,715.00

Service Code	CPT 49594
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$14,715.00
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85
Rate for Payer: University Health Alliance Commercial	$11,157.19

Facility

$10,679.55

Service Code	CPT 49593
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$7,647.81
Rate for Payer: AlohaCare Medicare	$7,647.81
Rate for Payer: Devoted Health Medicare	$8,412.59
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	$7,647.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$7,647.81
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,647.81
Rate for Payer: Ohana Health Plan Medicaid	$8,412.59
Rate for Payer: Ohana Health Plan Medicare	$7,647.81
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$7,647.81
Rate for Payer: University Health Alliance Commercial	$10,679.55

Facility

$14,715.00

Service Code	CPT 49595
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$14,715.00
Rate for Payer: AlohaCare Medicaid	$7,647.81
Rate for Payer: AlohaCare Medicare	$7,647.81
Rate for Payer: Devoted Health Medicare	$8,412.59
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,647.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$7,647.81
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,647.81
Rate for Payer: Ohana Health Plan Medicaid	$8,412.59
Rate for Payer: Ohana Health Plan Medicare	$7,647.81
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$7,647.81
Rate for Payer: University Health Alliance Commercial	$11,157.19

Know your out-of-pocket cost for care.

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