Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

EDUC ASSESSMENT 30 MIN Occupational

Facility

$248.00

Service Code	HCPCS 98960 GO
Hospital Charge Code	426989600
Hospital Revenue Code	430
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$161.20
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: MDX Hawaii PPO	$240.56

EDUC ASSESSMENT 30 MIN Occupational

Facility

$248.00

Service Code	HCPCS 98960 GO
Hospital Charge Code	426989600
Hospital Revenue Code	430
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$124.00
Rate for Payer: AlohaCare Medicare	$104.16
Rate for Payer: Cash Price	$161.20
Rate for Payer: Cash Price	$161.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$228.16
Rate for Payer: Devoted Health Medicare	$104.16
Rate for Payer: Hawaii Medical Service Association Medicare	$104.16
Rate for Payer: Hawaii Western Management Group Commercial	$235.60
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$104.16
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$104.16
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$104.16
Rate for Payer: Ohana Health Plan Medicare	$104.16
Rate for Payer: UnitedHealthcare Medicaid	$22.81
Rate for Payer: UnitedHealthcare Medicare	$104.16
Rate for Payer: University Health Alliance Commercial	$180.77

EDUC ASSESSMENT 30 MIN Physical

Facility

$611.00

Service Code	HCPCS 98960 GP
Hospital Charge Code	432989600
Hospital Revenue Code	942
Min. Negotiated Rate	$519.35
Max. Negotiated Rate	$592.67
Rate for Payer: Cash Price	$397.15
Rate for Payer: Health Management Network Commercial	$519.35
Rate for Payer: Kaiser Permanente Commercial	$549.90
Rate for Payer: MDX Hawaii PPO	$592.67

EDUC ASSESSMENT 30 MIN Physical

Facility

$611.00

Service Code	HCPCS 98960 GP
Hospital Charge Code	432989600
Hospital Revenue Code	942
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$592.67
Rate for Payer: AlohaCare Medicaid	$305.50
Rate for Payer: AlohaCare Medicare	$256.62
Rate for Payer: Cash Price	$397.15
Rate for Payer: Cash Price	$397.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$562.12
Rate for Payer: Devoted Health Medicare	$256.62
Rate for Payer: Hawaii Medical Service Association Medicare	$256.62
Rate for Payer: Hawaii Western Management Group Commercial	$580.45
Rate for Payer: Health Management Network Commercial	$519.35
Rate for Payer: Humana Medicare	$256.62
Rate for Payer: Kaiser Permanente Commercial	$549.90
Rate for Payer: Kaiser Permanente Medicaid	$311.61
Rate for Payer: Kaiser Permanente Medicare	$256.62
Rate for Payer: MDX Hawaii PPO	$592.67
Rate for Payer: Ohana Health Plan Medicaid	$256.62
Rate for Payer: Ohana Health Plan Medicare	$256.62
Rate for Payer: UnitedHealthcare Medicaid	$22.81
Rate for Payer: UnitedHealthcare Medicare	$256.62
Rate for Payer: University Health Alliance Commercial	$445.36

EDUCATION&TRAINING PT SELF-MGMT NQHP INDIV PT

Professional

Both

$581.00

Service Code	HCPCS 98960
Hospital Revenue Code	521
Min. Negotiated Rate	$34.80
Max. Negotiated Rate	$493.85
Rate for Payer: AlohaCare Medicaid	$34.80
Rate for Payer: Cash Price	$377.65
Rate for Payer: Cash Price	$377.65
Rate for Payer: Cash Price	$377.65
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: Ohana Health Plan Medicaid	$34.80
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

efavirenz/emtricitabine/tenofovir 600-200-300 mg Tab [KMC]

Facility

$455.20

Service Code	NDC 65862049730
Hospital Revenue Code	250
Min. Negotiated Rate	$191.18
Max. Negotiated Rate	$441.54
Rate for Payer: AlohaCare Medicaid	$227.60
Rate for Payer: AlohaCare Medicare	$191.18
Rate for Payer: Cash Price	$295.88
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$418.78
Rate for Payer: Devoted Health Medicare	$191.18
Rate for Payer: Hawaii Medical Service Association Medicare	$191.18
Rate for Payer: Hawaii Western Management Group Commercial	$432.44
Rate for Payer: Health Management Network Commercial	$386.92
Rate for Payer: Humana Medicare	$191.18
Rate for Payer: Kaiser Permanente Commercial	$409.68
Rate for Payer: Kaiser Permanente Medicaid	$232.15
Rate for Payer: Kaiser Permanente Medicare	$191.18
Rate for Payer: MDX Hawaii PPO	$441.54
Rate for Payer: Ohana Health Plan Medicaid	$191.18
Rate for Payer: Ohana Health Plan Medicare	$191.18
Rate for Payer: UnitedHealthcare Medicaid	$273.12
Rate for Payer: UnitedHealthcare Medicare	$191.18
Rate for Payer: University Health Alliance Commercial	$331.80

efavirenz/emtricitabine/tenofovir 600-200-300 mg Tab [KMC]

Facility

$455.20

Service Code	NDC 65862049730
Hospital Revenue Code	250
Min. Negotiated Rate	$386.92
Max. Negotiated Rate	$441.54
Rate for Payer: Cash Price	$295.88
Rate for Payer: Health Management Network Commercial	$386.92
Rate for Payer: Kaiser Permanente Commercial	$409.68
Rate for Payer: MDX Hawaii PPO	$441.54

EKG

Facility

$341.00

Service Code	HCPCS 93005
Hospital Charge Code	421930050
Hospital Revenue Code	730
Min. Negotiated Rate	$15.16
Max. Negotiated Rate	$330.77
Rate for Payer: AlohaCare Medicaid	$170.50
Rate for Payer: AlohaCare Medicare	$143.22
Rate for Payer: Cash Price	$221.65
Rate for Payer: Cash Price	$221.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$313.72
Rate for Payer: Devoted Health Medicare	$143.22
Rate for Payer: Hawaii Medical Service Association Commercial	$87.11
Rate for Payer: Hawaii Medical Service Association Medicare	$143.22
Rate for Payer: Hawaii Western Management Group Commercial	$323.95
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Humana Medicare	$143.22
Rate for Payer: Kaiser Permanente Commercial	$306.90
Rate for Payer: Kaiser Permanente Medicaid	$173.91
Rate for Payer: Kaiser Permanente Medicare	$143.22
Rate for Payer: MDX Hawaii PPO	$330.77
Rate for Payer: Ohana Health Plan Medicaid	$143.22
Rate for Payer: Ohana Health Plan Medicare	$143.22
Rate for Payer: UnitedHealthcare Medicaid	$15.16
Rate for Payer: UnitedHealthcare Medicare	$143.22
Rate for Payer: University Health Alliance Commercial	$248.55

EKG

Facility

$341.00

Service Code	HCPCS 93005
Hospital Charge Code	421930050
Hospital Revenue Code	730
Min. Negotiated Rate	$289.85
Max. Negotiated Rate	$330.77
Rate for Payer: Cash Price	$221.65
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Kaiser Permanente Commercial	$306.90
Rate for Payer: MDX Hawaii PPO	$330.77

EKG TRACING FOR INITIAL PREV

Professional

Both

$29.00

Service Code	HCPCS G0404
Hospital Revenue Code	730
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$24.65
Rate for Payer: AlohaCare Medicare	$7.79
Rate for Payer: Cash Price	$18.85
Rate for Payer: Cash Price	$18.85
Rate for Payer: Devoted Health Medicare	$7.79
Rate for Payer: Hawaii Medical Service Association Medicare	$7.79
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$9.35
Rate for Payer: Kaiser Permanente Medicaid	$9.35
Rate for Payer: Kaiser Permanente Medicare	$9.35
Rate for Payer: Ohana Health Plan Medicare	$7.79
Rate for Payer: UnitedHealthcare Medicare	$7.79

ELBOW 2 VWS

Facility

$369.00

Service Code	HCPCS 73070
Hospital Charge Code	424730700
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

ELBOW 2 VWS

Facility

$369.00

Service Code	HCPCS 73070
Hospital Charge Code	424730700
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$55.57

ELBOW COMP MIN 3 VWS

Facility

$369.00

Service Code	HCPCS 73080
Hospital Charge Code	424730800
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$68.41

ELBOW COMP MIN 3 VWS

Facility

$369.00

Service Code	HCPCS 73080
Hospital Charge Code	424730800
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

ELEC STIM NON WOUND Physical

Facility

$71.00

Service Code	HCPCS G0283 GP
Hospital Charge Code	432G02830
Hospital Revenue Code	420
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

ELEC STIM NON WOUND Physical

Facility

$71.00

Service Code	HCPCS G0283 GP
Hospital Charge Code	432G02830
Hospital Revenue Code	420
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$29.82
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$65.32
Rate for Payer: Devoted Health Medicare	$29.82
Rate for Payer: Hawaii Medical Service Association Medicare	$29.82
Rate for Payer: Hawaii Western Management Group Commercial	$67.45
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$29.82
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$29.82
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$29.82
Rate for Payer: Ohana Health Plan Medicare	$29.82
Rate for Payer: UnitedHealthcare Medicaid	$9.73
Rate for Payer: UnitedHealthcare Medicare	$29.82
Rate for Payer: University Health Alliance Commercial	$51.75

ELEC STIM OTHER THAN WOUND

Professional

Both

$68.00

Service Code	HCPCS G0283
Hospital Revenue Code	420
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$57.80
Rate for Payer: AlohaCare Medicaid	$12.30
Rate for Payer: AlohaCare Medicare	$13.42
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Devoted Health Medicare	$13.42
Rate for Payer: Hawaii Medical Service Association Medicare	$13.42
Rate for Payer: Hawaii Western Management Group Commercial	$13.52
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$16.10
Rate for Payer: Kaiser Permanente Medicaid	$16.10
Rate for Payer: Kaiser Permanente Medicare	$16.10
Rate for Payer: Ohana Health Plan Medicaid	$12.30
Rate for Payer: Ohana Health Plan Medicare	$13.42
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: UnitedHealthcare Medicare	$13.42

ELEC STIM UNATTEND FOR PRESS

Professional

Both

$67.00

Service Code	HCPCS G0281
Hospital Revenue Code	420
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$56.95
Rate for Payer: AlohaCare Medicaid	$12.30
Rate for Payer: AlohaCare Medicare	$12.28
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Devoted Health Medicare	$12.28
Rate for Payer: Hawaii Medical Service Association Medicare	$12.28
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Kaiser Permanente Commercial	$14.74
Rate for Payer: Kaiser Permanente Medicaid	$14.74
Rate for Payer: Kaiser Permanente Medicare	$14.74
Rate for Payer: Ohana Health Plan Medicaid	$12.30
Rate for Payer: Ohana Health Plan Medicare	$12.28
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: UnitedHealthcare Medicare	$12.28

ELECTRICAL STIMULATION BONE HEALING INVASIVE

Professional

Both

$350.00

Service Code	HCPCS 20975
Hospital Revenue Code	361
Min. Negotiated Rate	$159.12
Max. Negotiated Rate	$297.50
Rate for Payer: AlohaCare Medicaid	$176.12
Rate for Payer: AlohaCare Medicare	$166.18
Rate for Payer: Cash Price	$227.50
Rate for Payer: Cash Price	$227.50
Rate for Payer: Devoted Health Medicare	$166.18
Rate for Payer: Hawaii Medical Service Association Medicare	$166.18
Rate for Payer: Hawaii Western Management Group Commercial	$159.12
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$199.42
Rate for Payer: Kaiser Permanente Medicaid	$199.42
Rate for Payer: Kaiser Permanente Medicare	$199.42
Rate for Payer: Ohana Health Plan Medicaid	$176.12
Rate for Payer: Ohana Health Plan Medicare	$166.18
Rate for Payer: UnitedHealthcare Medicaid	$176.12
Rate for Payer: UnitedHealthcare Medicare	$166.18

ELECTRICAL STIMULATION BONE HEALING NONINVASIVE

Professional

Both

$121.00

Service Code	HCPCS 20974
Hospital Revenue Code	361
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$113.62
Rate for Payer: AlohaCare Medicaid	$52.69
Rate for Payer: AlohaCare Medicare	$52.00
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Devoted Health Medicare	$52.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$52.69
Rate for Payer: Hawaii Medical Service Association Commercial	$78.84
Rate for Payer: Hawaii Medical Service Association Medicare	$52.00
Rate for Payer: Hawaii Western Management Group Commercial	$113.62
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$62.40
Rate for Payer: Kaiser Permanente Medicaid	$62.40
Rate for Payer: Kaiser Permanente Medicare	$62.40
Rate for Payer: Ohana Health Plan Medicaid	$52.69
Rate for Payer: Ohana Health Plan Medicare	$52.00
Rate for Payer: UnitedHealthcare Medicaid	$52.69
Rate for Payer: UnitedHealthcare Medicare	$52.00
Rate for Payer: University Health Alliance Commercial	$66.75

Electrolyte Panel1

Facility

$134.00

Service Code	HCPCS 80051
Hospital Charge Code	422800510
Hospital Revenue Code	301
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$67.00
Rate for Payer: AlohaCare Medicare	$56.28
Rate for Payer: Cash Price	$87.10
Rate for Payer: Cash Price	$87.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$123.28
Rate for Payer: Devoted Health Medicare	$56.28
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.69
Rate for Payer: Hawaii Medical Service Association Commercial	$8.76
Rate for Payer: Hawaii Medical Service Association Medicare	$56.28
Rate for Payer: Hawaii Western Management Group Commercial	$7.01
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$56.28
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$56.28
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$56.28
Rate for Payer: Ohana Health Plan Medicare	$56.28
Rate for Payer: UnitedHealthcare Medicaid	$9.69
Rate for Payer: UnitedHealthcare Medicare	$56.28
Rate for Payer: University Health Alliance Commercial	$18.13

Electrolyte Panel1

Facility

$134.00

Service Code	HCPCS 80051
Hospital Charge Code	422800510
Hospital Revenue Code	301
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: MDX Hawaii PPO	$129.98

electrolyte pediatric oral sol 1000 mL [KMC]

Facility

$0.02

Service Code	HCPCS J7120
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: MDX Hawaii PPO	$0.02

electrolyte pediatric oral sol 1000 mL [KMC]

Facility

$0.02

Service Code	HCPCS J7120
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.46
Rate for Payer: AlohaCare Medicaid	$0.01
Rate for Payer: AlohaCare Medicare	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.02
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.46
Rate for Payer: Hawaii Medical Service Association Medicare	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$0.02
Rate for Payer: Health Management Network Commercial	$0.02
Rate for Payer: Humana Medicare	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: Kaiser Permanente Medicaid	$0.01
Rate for Payer: Kaiser Permanente Medicare	$0.01
Rate for Payer: MDX Hawaii PPO	$0.02
Rate for Payer: Ohana Health Plan Medicaid	$0.01
Rate for Payer: Ohana Health Plan Medicare	$0.01
Rate for Payer: UnitedHealthcare Medicaid	$0.01
Rate for Payer: UnitedHealthcare Medicare	$0.01
Rate for Payer: University Health Alliance Commercial	$0.01

ELONGATED MASK PEDS

Facility

$338.00

Hospital Charge Code	8094
Hospital Revenue Code	270
Min. Negotiated Rate	$141.96
Max. Negotiated Rate	$327.86
Rate for Payer: AlohaCare Medicaid	$169.00
Rate for Payer: AlohaCare Medicare	$141.96
Rate for Payer: Cash Price	$219.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$310.96
Rate for Payer: Devoted Health Medicare	$141.96
Rate for Payer: Hawaii Medical Service Association Medicare	$141.96
Rate for Payer: Hawaii Western Management Group Commercial	$321.10
Rate for Payer: Health Management Network Commercial	$287.30
Rate for Payer: Humana Medicare	$141.96
Rate for Payer: Kaiser Permanente Commercial	$304.20
Rate for Payer: Kaiser Permanente Medicaid	$172.38
Rate for Payer: Kaiser Permanente Medicare	$141.96
Rate for Payer: MDX Hawaii PPO	$327.86
Rate for Payer: Ohana Health Plan Medicaid	$141.96
Rate for Payer: Ohana Health Plan Medicare	$141.96
Rate for Payer: UnitedHealthcare Medicare	$141.96
Rate for Payer: University Health Alliance Commercial	$246.37

Know your out-of-pocket cost for care.

All Charges