Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

US Extremity Non-Vasc Real-time Complete

Facility

$944.00

Service Code	HCPCS 76881
Hospital Charge Code	424768810
Hospital Revenue Code	402
Min. Negotiated Rate	$61.93
Max. Negotiated Rate	$915.68
Rate for Payer: AlohaCare Medicaid	$472.00
Rate for Payer: AlohaCare Medicare	$396.48
Rate for Payer: Cash Price	$613.60
Rate for Payer: Cash Price	$613.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$868.48
Rate for Payer: Devoted Health Medicare	$396.48
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$61.93
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$396.48
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$802.40
Rate for Payer: Humana Medicare	$396.48
Rate for Payer: Kaiser Permanente Commercial	$849.60
Rate for Payer: Kaiser Permanente Medicaid	$481.44
Rate for Payer: Kaiser Permanente Medicare	$396.48
Rate for Payer: MDX Hawaii PPO	$915.68
Rate for Payer: Ohana Health Plan Medicaid	$396.48
Rate for Payer: Ohana Health Plan Medicare	$396.48
Rate for Payer: UnitedHealthcare Medicaid	$61.93
Rate for Payer: UnitedHealthcare Medicare	$396.48
Rate for Payer: University Health Alliance Commercial	$246.33

US Extremity Non-Vasc Real-time Complete

Facility

$944.00

Service Code	HCPCS 76881
Hospital Charge Code	424768810
Hospital Revenue Code	402
Min. Negotiated Rate	$802.40
Max. Negotiated Rate	$915.68
Rate for Payer: Cash Price	$613.60
Rate for Payer: Health Management Network Commercial	$802.40
Rate for Payer: Kaiser Permanente Commercial	$849.60
Rate for Payer: MDX Hawaii PPO	$915.68

US EXTREM NON VASC W IMAGE DOC LMTD

Facility

$462.00

Service Code	HCPCS 76882
Hospital Charge Code	424768820
Hospital Revenue Code	402
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$448.14
Rate for Payer: AlohaCare Medicaid	$231.00
Rate for Payer: AlohaCare Medicare	$194.04
Rate for Payer: Cash Price	$300.30
Rate for Payer: Cash Price	$300.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$425.04
Rate for Payer: Devoted Health Medicare	$194.04
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$194.04
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$392.70
Rate for Payer: Humana Medicare	$194.04
Rate for Payer: Kaiser Permanente Commercial	$415.80
Rate for Payer: Kaiser Permanente Medicaid	$235.62
Rate for Payer: Kaiser Permanente Medicare	$194.04
Rate for Payer: MDX Hawaii PPO	$448.14
Rate for Payer: Ohana Health Plan Medicaid	$194.04
Rate for Payer: Ohana Health Plan Medicare	$194.04
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$194.04
Rate for Payer: University Health Alliance Commercial	$60.62

US EXTREM NON VASC W IMAGE DOC LMTD

Facility

$462.00

Service Code	HCPCS 76882
Hospital Charge Code	424768820
Hospital Revenue Code	402
Min. Negotiated Rate	$392.70
Max. Negotiated Rate	$448.14
Rate for Payer: Cash Price	$300.30
Rate for Payer: Health Management Network Commercial	$392.70
Rate for Payer: Kaiser Permanente Commercial	$415.80
Rate for Payer: MDX Hawaii PPO	$448.14

US GUIDANCE NEEDLE PLACEMENT IMG S&I

Professional

Both

$90.00

Service Code	HCPCS 76942
Hospital Revenue Code	320
Min. Negotiated Rate	$37.47
Max. Negotiated Rate	$104.35
Rate for Payer: AlohaCare Medicaid	$37.47
Rate for Payer: AlohaCare Medicare	$69.20
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$69.20
Rate for Payer: Hawaii Medical Service Association Medicare	$69.20
Rate for Payer: Hawaii Western Management Group Commercial	$104.35
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$83.04
Rate for Payer: Kaiser Permanente Medicaid	$83.04
Rate for Payer: Kaiser Permanente Medicare	$83.04
Rate for Payer: Ohana Health Plan Medicaid	$37.47
Rate for Payer: Ohana Health Plan Medicare	$69.20
Rate for Payer: UnitedHealthcare Medicaid	$37.47
Rate for Payer: UnitedHealthcare Medicare	$69.20

US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG

Professional

Both

$158.00

Service Code	HCPCS 76882
Hospital Revenue Code	320
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$134.30
Rate for Payer: AlohaCare Medicaid	$40.96
Rate for Payer: AlohaCare Medicare	$68.92
Rate for Payer: Cash Price	$102.70
Rate for Payer: Cash Price	$102.70
Rate for Payer: Devoted Health Medicare	$68.92
Rate for Payer: Hawaii Medical Service Association Medicare	$68.92
Rate for Payer: Hawaii Western Management Group Commercial	$32.77
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$82.70
Rate for Payer: Kaiser Permanente Medicaid	$82.70
Rate for Payer: Kaiser Permanente Medicare	$82.70
Rate for Payer: Ohana Health Plan Medicaid	$40.96
Rate for Payer: Ohana Health Plan Medicare	$68.92
Rate for Payer: UnitedHealthcare Medicaid	$40.96
Rate for Payer: UnitedHealthcare Medicare	$68.92

US OB Complete

Facility

$689.00

Service Code	HCPCS 76805
Hospital Charge Code	424768050
Hospital Revenue Code	402
Min. Negotiated Rate	$61.23
Max. Negotiated Rate	$668.33
Rate for Payer: AlohaCare Medicaid	$344.50
Rate for Payer: AlohaCare Medicare	$289.38
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$633.88
Rate for Payer: Devoted Health Medicare	$289.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$61.23
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$289.38
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Humana Medicare	$289.38
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: Kaiser Permanente Medicare	$289.38
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: Ohana Health Plan Medicaid	$289.38
Rate for Payer: Ohana Health Plan Medicare	$289.38
Rate for Payer: UnitedHealthcare Medicaid	$61.23
Rate for Payer: UnitedHealthcare Medicare	$289.38
Rate for Payer: University Health Alliance Commercial	$287.45

US OB Complete

Facility

$689.00

Service Code	HCPCS 76805
Hospital Charge Code	424768050
Hospital Revenue Code	402
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$447.85
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: MDX Hawaii PPO	$668.33

US Pelvic

Facility

$561.00

Service Code	HCPCS 76856
Hospital Charge Code	424768560
Hospital Revenue Code	402
Min. Negotiated Rate	$50.35
Max. Negotiated Rate	$544.17
Rate for Payer: AlohaCare Medicaid	$280.50
Rate for Payer: AlohaCare Medicare	$235.62
Rate for Payer: Cash Price	$364.65
Rate for Payer: Cash Price	$364.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$516.12
Rate for Payer: Devoted Health Medicare	$235.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$50.35
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$235.62
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$476.85
Rate for Payer: Humana Medicare	$235.62
Rate for Payer: Kaiser Permanente Commercial	$504.90
Rate for Payer: Kaiser Permanente Medicaid	$286.11
Rate for Payer: Kaiser Permanente Medicare	$235.62
Rate for Payer: MDX Hawaii PPO	$544.17
Rate for Payer: Ohana Health Plan Medicaid	$235.62
Rate for Payer: Ohana Health Plan Medicare	$235.62
Rate for Payer: UnitedHealthcare Medicaid	$50.35
Rate for Payer: UnitedHealthcare Medicare	$235.62
Rate for Payer: University Health Alliance Commercial	$231.53

US Pelvic

Facility

$561.00

Service Code	HCPCS 76856
Hospital Charge Code	424768560
Hospital Revenue Code	402
Min. Negotiated Rate	$476.85
Max. Negotiated Rate	$544.17
Rate for Payer: Cash Price	$364.65
Rate for Payer: Health Management Network Commercial	$476.85
Rate for Payer: Kaiser Permanente Commercial	$504.90
Rate for Payer: MDX Hawaii PPO	$544.17

US PELVIC COMPLETE

Facility

$689.00

Service Code	HCPCS 76856
Hospital Charge Code	424768560
Hospital Revenue Code	402
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$447.85
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: MDX Hawaii PPO	$668.33

US PELVIC COMPLETE

Facility

$689.00

Service Code	HCPCS 76856
Hospital Charge Code	424768560
Hospital Revenue Code	402
Min. Negotiated Rate	$50.35
Max. Negotiated Rate	$668.33
Rate for Payer: AlohaCare Medicaid	$344.50
Rate for Payer: AlohaCare Medicare	$289.38
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$633.88
Rate for Payer: Devoted Health Medicare	$289.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$50.35
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$289.38
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Humana Medicare	$289.38
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: Kaiser Permanente Medicare	$289.38
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: Ohana Health Plan Medicaid	$289.38
Rate for Payer: Ohana Health Plan Medicare	$289.38
Rate for Payer: UnitedHealthcare Medicaid	$50.35
Rate for Payer: UnitedHealthcare Medicare	$289.38
Rate for Payer: University Health Alliance Commercial	$231.53

US PELVIC LIMITED OR F U

Facility

$462.00

Service Code	HCPCS 76857
Hospital Charge Code	424768570
Hospital Revenue Code	402
Min. Negotiated Rate	$392.70
Max. Negotiated Rate	$448.14
Rate for Payer: Cash Price	$300.30
Rate for Payer: Health Management Network Commercial	$392.70
Rate for Payer: Kaiser Permanente Commercial	$415.80
Rate for Payer: MDX Hawaii PPO	$448.14

US PELVIC LIMITED OR F U

Facility

$462.00

Service Code	HCPCS 76857
Hospital Charge Code	424768570
Hospital Revenue Code	402
Min. Negotiated Rate	$44.29
Max. Negotiated Rate	$448.14
Rate for Payer: AlohaCare Medicaid	$231.00
Rate for Payer: AlohaCare Medicare	$194.04
Rate for Payer: Cash Price	$300.30
Rate for Payer: Cash Price	$300.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$425.04
Rate for Payer: Devoted Health Medicare	$194.04
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$44.29
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$194.04
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$392.70
Rate for Payer: Humana Medicare	$194.04
Rate for Payer: Kaiser Permanente Commercial	$415.80
Rate for Payer: Kaiser Permanente Medicaid	$235.62
Rate for Payer: Kaiser Permanente Medicare	$194.04
Rate for Payer: MDX Hawaii PPO	$448.14
Rate for Payer: Ohana Health Plan Medicaid	$194.04
Rate for Payer: Ohana Health Plan Medicare	$194.04
Rate for Payer: UnitedHealthcare Medicaid	$44.29
Rate for Payer: UnitedHealthcare Medicare	$194.04
Rate for Payer: University Health Alliance Commercial	$161.45

US Renal

Facility

$689.00

Service Code	HCPCS 76770
Hospital Charge Code	424767700
Hospital Revenue Code	402
Min. Negotiated Rate	$64.94
Max. Negotiated Rate	$668.33
Rate for Payer: AlohaCare Medicaid	$344.50
Rate for Payer: AlohaCare Medicare	$289.38
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$633.88
Rate for Payer: Devoted Health Medicare	$289.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$64.94
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$289.38
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Humana Medicare	$289.38
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: Kaiser Permanente Medicare	$289.38
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: Ohana Health Plan Medicaid	$289.38
Rate for Payer: Ohana Health Plan Medicare	$289.38
Rate for Payer: UnitedHealthcare Medicaid	$64.94
Rate for Payer: UnitedHealthcare Medicare	$289.38
Rate for Payer: University Health Alliance Commercial	$258.91

US Renal

Facility

$689.00

Service Code	HCPCS 76770
Hospital Charge Code	424767700
Hospital Revenue Code	402
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$447.85
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: MDX Hawaii PPO	$668.33

US RENAL AORTA NODES COMP

Facility

$689.00

Service Code	HCPCS 76770
Hospital Charge Code	424767700
Hospital Revenue Code	402
Min. Negotiated Rate	$64.94
Max. Negotiated Rate	$668.33
Rate for Payer: AlohaCare Medicaid	$344.50
Rate for Payer: AlohaCare Medicare	$289.38
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$633.88
Rate for Payer: Devoted Health Medicare	$289.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$64.94
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$289.38
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Humana Medicare	$289.38
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: Kaiser Permanente Medicare	$289.38
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: Ohana Health Plan Medicaid	$289.38
Rate for Payer: Ohana Health Plan Medicare	$289.38
Rate for Payer: UnitedHealthcare Medicaid	$64.94
Rate for Payer: UnitedHealthcare Medicare	$289.38
Rate for Payer: University Health Alliance Commercial	$258.91

US RENAL AORTA NODES COMP

Facility

$689.00

Service Code	HCPCS 76770
Hospital Charge Code	424767700
Hospital Revenue Code	402
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$447.85
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: MDX Hawaii PPO	$668.33

US RENAL AORTA NODES LIM

Facility

$561.00

Service Code	HCPCS 76775
Hospital Charge Code	424767750
Hospital Revenue Code	402
Min. Negotiated Rate	$476.85
Max. Negotiated Rate	$544.17
Rate for Payer: Cash Price	$364.65
Rate for Payer: Health Management Network Commercial	$476.85
Rate for Payer: Kaiser Permanente Commercial	$504.90
Rate for Payer: MDX Hawaii PPO	$544.17

US RENAL AORTA NODES LIM

Facility

$561.00

Service Code	HCPCS 76775
Hospital Charge Code	424767750
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$544.17
Rate for Payer: AlohaCare Medicaid	$280.50
Rate for Payer: AlohaCare Medicare	$235.62
Rate for Payer: Cash Price	$364.65
Rate for Payer: Cash Price	$364.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$516.12
Rate for Payer: Devoted Health Medicare	$235.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$46.98
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$235.62
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$476.85
Rate for Payer: Humana Medicare	$235.62
Rate for Payer: Kaiser Permanente Commercial	$504.90
Rate for Payer: Kaiser Permanente Medicaid	$286.11
Rate for Payer: Kaiser Permanente Medicare	$235.62
Rate for Payer: MDX Hawaii PPO	$544.17
Rate for Payer: Ohana Health Plan Medicaid	$235.62
Rate for Payer: Ohana Health Plan Medicare	$235.62
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$235.62
Rate for Payer: University Health Alliance Commercial	$202.63

US SOFT TISSUE HEAD NECK

Facility

$689.00

Service Code	HCPCS 76536
Hospital Charge Code	424765360
Hospital Revenue Code	402
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$447.85
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: MDX Hawaii PPO	$668.33

US SOFT TISSUE HEAD NECK

Facility

$689.00

Service Code	HCPCS 76536
Hospital Charge Code	424765360
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$668.33
Rate for Payer: AlohaCare Medicaid	$344.50
Rate for Payer: AlohaCare Medicare	$289.38
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$633.88
Rate for Payer: Devoted Health Medicare	$289.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$46.98
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$289.38
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Humana Medicare	$289.38
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: Kaiser Permanente Medicare	$289.38
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: Ohana Health Plan Medicaid	$289.38
Rate for Payer: Ohana Health Plan Medicare	$289.38
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$289.38
Rate for Payer: University Health Alliance Commercial	$211.12

US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM

Professional

Both

$689.00

Service Code	HCPCS 76536
Hospital Revenue Code	320
Min. Negotiated Rate	$73.82
Max. Negotiated Rate	$585.65
Rate for Payer: AlohaCare Medicaid	$73.82
Rate for Payer: AlohaCare Medicare	$120.16
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Devoted Health Medicare	$120.16
Rate for Payer: Hawaii Medical Service Association Medicare	$120.16
Rate for Payer: Hawaii Western Management Group Commercial	$93.29
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$144.19
Rate for Payer: Kaiser Permanente Medicaid	$144.19
Rate for Payer: Kaiser Permanente Medicare	$144.19
Rate for Payer: Ohana Health Plan Medicaid	$73.82
Rate for Payer: Ohana Health Plan Medicare	$120.16
Rate for Payer: UnitedHealthcare Medicaid	$73.82
Rate for Payer: UnitedHealthcare Medicare	$120.16

US TRANSPLANTED KIDNEY

Facility

$689.00

Service Code	HCPCS 76776
Hospital Charge Code	424767760
Hospital Revenue Code	402
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$447.85
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: MDX Hawaii PPO	$668.33

US TRANSPLANTED KIDNEY

Facility

$689.00

Service Code	HCPCS 76776
Hospital Charge Code	424767760
Hospital Revenue Code	402
Min. Negotiated Rate	$67.84
Max. Negotiated Rate	$668.33
Rate for Payer: AlohaCare Medicaid	$344.50
Rate for Payer: AlohaCare Medicare	$289.38
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$633.88
Rate for Payer: Devoted Health Medicare	$289.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$67.84
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$289.38
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Humana Medicare	$289.38
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: Kaiser Permanente Medicare	$289.38
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: Ohana Health Plan Medicaid	$289.38
Rate for Payer: Ohana Health Plan Medicare	$289.38
Rate for Payer: UnitedHealthcare Medicaid	$67.84
Rate for Payer: UnitedHealthcare Medicare	$289.38
Rate for Payer: University Health Alliance Commercial	$281.14

Know your out-of-pocket cost for care.

All Charges