Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

Hemoglobin A1c DLS

Facility

$155.00

Service Code	HCPCS 83036
Hospital Charge Code	422830365
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$65.10
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$142.60
Rate for Payer: Devoted Health Medicare	$65.10
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$13.42
Rate for Payer: Hawaii Medical Service Association Commercial	$12.14
Rate for Payer: Hawaii Medical Service Association Medicare	$65.10
Rate for Payer: Hawaii Western Management Group Commercial	$9.71
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$65.10
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$65.10
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$65.10
Rate for Payer: Ohana Health Plan Medicare	$65.10
Rate for Payer: UnitedHealthcare Medicaid	$13.42
Rate for Payer: UnitedHealthcare Medicare	$65.10
Rate for Payer: University Health Alliance Commercial	$25.09

Hemoglobin A1c DLS

Facility

$155.00

Service Code	HCPCS 83036
Hospital Charge Code	422830365
Hospital Revenue Code	301
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

Hemoglobin and Hematocrit

Facility

$38.00

Service Code	HCPCS 85018
Hospital Charge Code	422850141
Hospital Revenue Code	305
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$36.86
Rate for Payer: AlohaCare Medicaid	$19.00
Rate for Payer: AlohaCare Medicare	$15.96
Rate for Payer: Cash Price	$24.70
Rate for Payer: Cash Price	$24.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$34.96
Rate for Payer: Devoted Health Medicare	$15.96
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$3.27
Rate for Payer: Hawaii Medical Service Association Commercial	$2.96
Rate for Payer: Hawaii Medical Service Association Medicare	$15.96
Rate for Payer: Hawaii Western Management Group Commercial	$2.37
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Humana Medicare	$15.96
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: Kaiser Permanente Medicare	$15.96
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: Ohana Health Plan Medicaid	$15.96
Rate for Payer: Ohana Health Plan Medicare	$15.96
Rate for Payer: UnitedHealthcare Medicaid	$3.27
Rate for Payer: UnitedHealthcare Medicare	$15.96
Rate for Payer: University Health Alliance Commercial	$6.12

Hemoglobin and Hematocrit

Facility

$38.00

Service Code	HCPCS 85018
Hospital Charge Code	422850141
Hospital Revenue Code	305
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$24.70
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: MDX Hawaii PPO	$36.86

Hemoglobin DLS

Facility

$45.00

Service Code	HCPCS 85018
Hospital Charge Code	422850185
Hospital Revenue Code	305
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Kaiser Permanente Commercial	$40.50
Rate for Payer: MDX Hawaii PPO	$43.65

Hemoglobin DLS

Facility

$45.00

Service Code	HCPCS 85018
Hospital Charge Code	422850185
Hospital Revenue Code	305
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$43.65
Rate for Payer: AlohaCare Medicaid	$22.50
Rate for Payer: AlohaCare Medicare	$18.90
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$41.40
Rate for Payer: Devoted Health Medicare	$18.90
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$3.27
Rate for Payer: Hawaii Medical Service Association Commercial	$2.96
Rate for Payer: Hawaii Medical Service Association Medicare	$18.90
Rate for Payer: Hawaii Western Management Group Commercial	$2.37
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Humana Medicare	$18.90
Rate for Payer: Kaiser Permanente Commercial	$40.50
Rate for Payer: Kaiser Permanente Medicaid	$22.95
Rate for Payer: Kaiser Permanente Medicare	$18.90
Rate for Payer: MDX Hawaii PPO	$43.65
Rate for Payer: Ohana Health Plan Medicaid	$18.90
Rate for Payer: Ohana Health Plan Medicare	$18.90
Rate for Payer: UnitedHealthcare Medicaid	$3.27
Rate for Payer: UnitedHealthcare Medicare	$18.90
Rate for Payer: University Health Alliance Commercial	$6.12

HEMOGLOBIN GLYCOSYLATED A1C

Professional

Both

$38.00

Service Code	HCPCS 83036
Hospital Revenue Code	300
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$32.30
Rate for Payer: AlohaCare Medicaid	$13.42
Rate for Payer: AlohaCare Medicare	$9.71
Rate for Payer: Cash Price	$24.70
Rate for Payer: Cash Price	$24.70
Rate for Payer: Devoted Health Medicare	$9.71
Rate for Payer: Hawaii Medical Service Association Medicare	$9.71
Rate for Payer: Hawaii Western Management Group Commercial	$13.43
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$11.65
Rate for Payer: Kaiser Permanente Medicaid	$11.65
Rate for Payer: Kaiser Permanente Medicare	$11.65
Rate for Payer: Ohana Health Plan Medicaid	$13.42
Rate for Payer: Ohana Health Plan Medicare	$9.71
Rate for Payer: UnitedHealthcare Medicaid	$13.42
Rate for Payer: UnitedHealthcare Medicare	$9.71

Hemoglobinopathy Screen DLS

Facility

$115.00

Service Code	HCPCS 83021
Hospital Charge Code	422830215
Hospital Revenue Code	301
Min. Negotiated Rate	$97.75
Max. Negotiated Rate	$111.55
Rate for Payer: Cash Price	$74.75
Rate for Payer: Health Management Network Commercial	$97.75
Rate for Payer: Kaiser Permanente Commercial	$103.50
Rate for Payer: MDX Hawaii PPO	$111.55

Hemoglobinopathy Screen DLS

Facility

$115.00

Service Code	HCPCS 83021
Hospital Charge Code	422830215
Hospital Revenue Code	301
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$111.55
Rate for Payer: AlohaCare Medicaid	$57.50
Rate for Payer: AlohaCare Medicare	$48.30
Rate for Payer: Cash Price	$74.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$105.80
Rate for Payer: Devoted Health Medicare	$48.30
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$24.96
Rate for Payer: Hawaii Medical Service Association Commercial	$22.57
Rate for Payer: Hawaii Medical Service Association Medicare	$48.30
Rate for Payer: Hawaii Western Management Group Commercial	$18.06
Rate for Payer: Health Management Network Commercial	$97.75
Rate for Payer: Humana Medicare	$48.30
Rate for Payer: Kaiser Permanente Commercial	$103.50
Rate for Payer: Kaiser Permanente Medicaid	$58.65
Rate for Payer: Kaiser Permanente Medicare	$48.30
Rate for Payer: MDX Hawaii PPO	$111.55
Rate for Payer: Ohana Health Plan Medicaid	$48.30
Rate for Payer: Ohana Health Plan Medicare	$48.30
Rate for Payer: UnitedHealthcare Medicaid	$24.96
Rate for Payer: UnitedHealthcare Medicare	$48.30
Rate for Payer: University Health Alliance Commercial	$46.68

Hemoglobinopathy screen w/ Interp DLS

Facility

$40.00

Service Code	HCPCS 83021
Hospital Charge Code	422830215
Hospital Revenue Code	300
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$26.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

Hemoglobinopathy screen w/ Interp DLS

Facility

$40.00

Service Code	HCPCS 83021
Hospital Charge Code	422830215
Hospital Revenue Code	300
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$46.68
Rate for Payer: AlohaCare Medicaid	$20.00
Rate for Payer: AlohaCare Medicare	$16.80
Rate for Payer: Cash Price	$26.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$36.80
Rate for Payer: Devoted Health Medicare	$16.80
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$24.96
Rate for Payer: Hawaii Medical Service Association Commercial	$22.57
Rate for Payer: Hawaii Medical Service Association Medicare	$16.80
Rate for Payer: Hawaii Western Management Group Commercial	$18.06
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$16.80
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$16.80
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$16.80
Rate for Payer: Ohana Health Plan Medicare	$16.80
Rate for Payer: UnitedHealthcare Medicaid	$24.96
Rate for Payer: UnitedHealthcare Medicare	$16.80
Rate for Payer: University Health Alliance Commercial	$46.68

Hemogram1

Facility

$184.00

Service Code	HCPCS 85027
Hospital Charge Code	422850270
Hospital Revenue Code	305
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$119.60
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48

Hemogram1

Facility

$184.00

Service Code	HCPCS 85027
Hospital Charge Code	422850270
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$77.28
Rate for Payer: Cash Price	$119.60
Rate for Payer: Cash Price	$119.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$169.28
Rate for Payer: Devoted Health Medicare	$77.28
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$8.95
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Medicare	$77.28
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$77.28
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$77.28
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$77.28
Rate for Payer: Ohana Health Plan Medicare	$77.28
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$77.28
Rate for Payer: University Health Alliance Commercial	$16.72

HEMORRHOID EXCISION Charge

Facility

$7,251.00

Service Code	HCPCS 46320
Hospital Charge Code	440463200
Hospital Revenue Code	450
Min. Negotiated Rate	$6,163.35
Max. Negotiated Rate	$7,033.47
Rate for Payer: Cash Price	$4,713.15
Rate for Payer: Health Management Network Commercial	$6,163.35
Rate for Payer: Kaiser Permanente Commercial	$6,525.90
Rate for Payer: MDX Hawaii PPO	$7,033.47

HEMORRHOID EXCISION Charge

Facility

$7,251.00

Service Code	HCPCS 46320
Hospital Charge Code	440463200
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$7,033.47
Rate for Payer: AlohaCare Medicaid	$3,625.50
Rate for Payer: AlohaCare Medicare	$3,045.42
Rate for Payer: Cash Price	$4,713.15
Rate for Payer: Cash Price	$4,713.15
Rate for Payer: Cash Price	$4,713.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6,670.92
Rate for Payer: Devoted Health Medicare	$3,045.42
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,045.42
Rate for Payer: Hawaii Western Management Group Commercial	$6,888.45
Rate for Payer: Health Management Network Commercial	$6,163.35
Rate for Payer: Humana Medicare	$3,045.42
Rate for Payer: Kaiser Permanente Commercial	$6,525.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,045.42
Rate for Payer: MDX Hawaii PPO	$7,033.47
Rate for Payer: Ohana Health Plan Medicaid	$3,045.42
Rate for Payer: Ohana Health Plan Medicare	$3,045.42
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,045.42
Rate for Payer: University Health Alliance Commercial	$5,285.25

heparin 25,000 units / 250 mL D5W IV bag [KMC]

Facility

$0.16

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.22
Rate for Payer: AlohaCare Medicaid	$0.08
Rate for Payer: AlohaCare Medicare	$0.07
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cash Price	$0.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.15
Rate for Payer: Devoted Health Medicare	$0.07
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$0.15
Rate for Payer: Health Management Network Commercial	$0.14
Rate for Payer: Humana Medicare	$0.07
Rate for Payer: Kaiser Permanente Commercial	$0.14
Rate for Payer: Kaiser Permanente Medicaid	$0.08
Rate for Payer: Kaiser Permanente Medicare	$0.07
Rate for Payer: MDX Hawaii PPO	$0.16
Rate for Payer: Ohana Health Plan Medicaid	$0.07
Rate for Payer: Ohana Health Plan Medicare	$0.07
Rate for Payer: UnitedHealthcare Medicaid	$0.10
Rate for Payer: UnitedHealthcare Medicare	$0.07
Rate for Payer: University Health Alliance Commercial	$0.12

heparin 25,000 units / 250 mL D5W IV bag [KMC]

Facility

$0.16

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Management Network Commercial	$0.14
Rate for Payer: Kaiser Permanente Commercial	$0.14
Rate for Payer: MDX Hawaii PPO	$0.16

heparin 5000 units/mL Inj Soln [KMC]

Facility

$19.97

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$16.97
Max. Negotiated Rate	$19.37
Rate for Payer: Cash Price	$12.98
Rate for Payer: Health Management Network Commercial	$16.97
Rate for Payer: Kaiser Permanente Commercial	$17.97
Rate for Payer: MDX Hawaii PPO	$19.37

heparin 5000 units/mL Inj Soln [KMC]

Facility

$19.97

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$19.37
Rate for Payer: AlohaCare Medicaid	$9.98
Rate for Payer: AlohaCare Medicare	$8.39
Rate for Payer: Cash Price	$12.98
Rate for Payer: Cash Price	$12.98
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$18.37
Rate for Payer: Devoted Health Medicare	$8.39
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$8.39
Rate for Payer: Hawaii Western Management Group Commercial	$18.97
Rate for Payer: Health Management Network Commercial	$16.97
Rate for Payer: Humana Medicare	$8.39
Rate for Payer: Kaiser Permanente Commercial	$17.97
Rate for Payer: Kaiser Permanente Medicaid	$10.18
Rate for Payer: Kaiser Permanente Medicare	$8.39
Rate for Payer: MDX Hawaii PPO	$19.37
Rate for Payer: Ohana Health Plan Medicaid	$8.39
Rate for Payer: Ohana Health Plan Medicare	$8.39
Rate for Payer: UnitedHealthcare Medicaid	$11.98
Rate for Payer: UnitedHealthcare Medicare	$8.39
Rate for Payer: University Health Alliance Commercial	$14.56

heparin flush 300 units / 3 mL Syringe [KMC]

Facility

$4.52

Service Code	HCPCS J1642
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$4.38
Rate for Payer: AlohaCare Medicaid	$2.26
Rate for Payer: AlohaCare Medicare	$1.90
Rate for Payer: Cash Price	$2.94
Rate for Payer: Cash Price	$2.94
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.16
Rate for Payer: Devoted Health Medicare	$1.90
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.02
Rate for Payer: Hawaii Medical Service Association Medicare	$1.90
Rate for Payer: Hawaii Western Management Group Commercial	$4.29
Rate for Payer: Health Management Network Commercial	$3.84
Rate for Payer: Humana Medicare	$1.90
Rate for Payer: Kaiser Permanente Commercial	$4.07
Rate for Payer: Kaiser Permanente Medicaid	$2.31
Rate for Payer: Kaiser Permanente Medicare	$1.90
Rate for Payer: MDX Hawaii PPO	$4.38
Rate for Payer: Ohana Health Plan Medicaid	$1.90
Rate for Payer: Ohana Health Plan Medicare	$1.90
Rate for Payer: UnitedHealthcare Medicaid	$2.71
Rate for Payer: UnitedHealthcare Medicare	$1.90
Rate for Payer: University Health Alliance Commercial	$3.29

heparin flush 300 units / 3 mL Syringe [KMC]

Facility

$4.52

Service Code	HCPCS J1642
Hospital Revenue Code	636
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$4.38
Rate for Payer: Cash Price	$2.94
Rate for Payer: Health Management Network Commercial	$3.84
Rate for Payer: Kaiser Permanente Commercial	$4.07
Rate for Payer: MDX Hawaii PPO	$4.38

Hepatic Function Profile DLS

Facility

$361.00

Service Code	HCPCS 80076
Hospital Charge Code	422800765
Hospital Revenue Code	301
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$350.17
Rate for Payer: AlohaCare Medicaid	$180.50
Rate for Payer: AlohaCare Medicare	$151.62
Rate for Payer: Cash Price	$234.65
Rate for Payer: Cash Price	$234.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$332.12
Rate for Payer: Devoted Health Medicare	$151.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.29
Rate for Payer: Hawaii Medical Service Association Commercial	$10.21
Rate for Payer: Hawaii Medical Service Association Medicare	$151.62
Rate for Payer: Hawaii Western Management Group Commercial	$8.17
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Humana Medicare	$151.62
Rate for Payer: Kaiser Permanente Commercial	$324.90
Rate for Payer: Kaiser Permanente Medicaid	$184.11
Rate for Payer: Kaiser Permanente Medicare	$151.62
Rate for Payer: MDX Hawaii PPO	$350.17
Rate for Payer: Ohana Health Plan Medicaid	$151.62
Rate for Payer: Ohana Health Plan Medicare	$151.62
Rate for Payer: UnitedHealthcare Medicaid	$11.29
Rate for Payer: UnitedHealthcare Medicare	$151.62
Rate for Payer: University Health Alliance Commercial	$21.13

Hepatic Function Profile DLS

Facility

$361.00

Service Code	HCPCS 80076
Hospital Charge Code	422800765
Hospital Revenue Code	301
Min. Negotiated Rate	$306.85
Max. Negotiated Rate	$350.17
Rate for Payer: Cash Price	$234.65
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Kaiser Permanente Commercial	$324.90
Rate for Payer: MDX Hawaii PPO	$350.17

Hepatic Panel

Facility

$152.00

Service Code	HCPCS 80076
Hospital Charge Code	422800760
Hospital Revenue Code	301
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: AlohaCare Medicare	$63.84
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$139.84
Rate for Payer: Devoted Health Medicare	$63.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.29
Rate for Payer: Hawaii Medical Service Association Commercial	$10.21
Rate for Payer: Hawaii Medical Service Association Medicare	$63.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.17
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Humana Medicare	$63.84
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: Kaiser Permanente Medicare	$63.84
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: Ohana Health Plan Medicaid	$63.84
Rate for Payer: Ohana Health Plan Medicare	$63.84
Rate for Payer: UnitedHealthcare Medicaid	$11.29
Rate for Payer: UnitedHealthcare Medicare	$63.84
Rate for Payer: University Health Alliance Commercial	$21.13

Hepatic Panel

Facility

$152.00

Service Code	HCPCS 80076
Hospital Charge Code	422800760
Hospital Revenue Code	301
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

Know your out-of-pocket cost for care.

All Charges