Kau Hospital

All Charges

Charge

Type

Setting

Price

PR REVSC EVASC IVT ST PLMT UNI SF LES EA ADDL VSL

Professional

Both

$2,337.00

Service Code	HCPCS 37259
Min. Negotiated Rate	$169.65
Max. Negotiated Rate	$1,986.45
Rate for Payer: AlohaCare Medicare	$169.65
Rate for Payer: Cash Price	$1,402.20
Rate for Payer: Cash Price	$1,402.20
Rate for Payer: Devoted Health Medicare	$186.62
Rate for Payer: Hawaii Medical Service Association Medicare	$169.65
Rate for Payer: Health Management Network Commercial	$1,986.45
Rate for Payer: Kaiser Permanente Commercial	$203.58
Rate for Payer: Kaiser Permanente Medicaid	$203.58
Rate for Payer: Kaiser Permanente Medicare	$203.58
Rate for Payer: Ohana Health Plan Medicare	$169.65
Rate for Payer: UnitedHealthcare Medicare	$169.65

PR REVSC EVASC TPVT ANGIOP UNI CPLX LES 1ST VSL

Professional

Both

$11,950.00

Service Code	HCPCS 37282
Min. Negotiated Rate	$528.01
Max. Negotiated Rate	$10,157.50
Rate for Payer: AlohaCare Medicare	$528.01
Rate for Payer: Cash Price	$7,170.00
Rate for Payer: Cash Price	$7,170.00
Rate for Payer: Devoted Health Medicare	$580.81
Rate for Payer: Hawaii Medical Service Association Medicare	$528.01
Rate for Payer: Health Management Network Commercial	$10,157.50
Rate for Payer: Kaiser Permanente Commercial	$633.61
Rate for Payer: Kaiser Permanente Medicaid	$633.61
Rate for Payer: Kaiser Permanente Medicare	$633.61
Rate for Payer: Ohana Health Plan Medicare	$528.01
Rate for Payer: UnitedHealthcare Medicare	$528.01

PR REVSC EVASC TPVT ANGIOP UNI CPLX LES EA ADDL VSL

Professional

Both

$1,653.00

Service Code	HCPCS 37283
Min. Negotiated Rate	$180.79
Max. Negotiated Rate	$1,405.05
Rate for Payer: AlohaCare Medicare	$180.79
Rate for Payer: Cash Price	$991.80
Rate for Payer: Cash Price	$991.80
Rate for Payer: Devoted Health Medicare	$198.87
Rate for Payer: Hawaii Medical Service Association Medicare	$180.79
Rate for Payer: Health Management Network Commercial	$1,405.05
Rate for Payer: Kaiser Permanente Commercial	$216.95
Rate for Payer: Kaiser Permanente Medicaid	$216.95
Rate for Payer: Kaiser Permanente Medicare	$216.95
Rate for Payer: Ohana Health Plan Medicare	$180.79
Rate for Payer: UnitedHealthcare Medicare	$180.79

PR REVSC EVASC TPVT ANGIOP UNI SF LES 1ST VSL

Professional

Both

$5,217.00

Service Code	HCPCS 37280
Min. Negotiated Rate	$420.99
Max. Negotiated Rate	$4,434.45
Rate for Payer: AlohaCare Medicare	$420.99
Rate for Payer: Cash Price	$3,130.20
Rate for Payer: Cash Price	$3,130.20
Rate for Payer: Devoted Health Medicare	$463.09
Rate for Payer: Hawaii Medical Service Association Medicare	$420.99
Rate for Payer: Health Management Network Commercial	$4,434.45
Rate for Payer: Kaiser Permanente Commercial	$505.19
Rate for Payer: Kaiser Permanente Medicaid	$505.19
Rate for Payer: Kaiser Permanente Medicare	$505.19
Rate for Payer: Ohana Health Plan Medicare	$420.99
Rate for Payer: UnitedHealthcare Medicare	$420.99

PR REVSC EVASC TPVT ANGIOP UNI SF LES EA ADDL VSL

Professional

Both

$1,421.00

Service Code	HCPCS 37281
Min. Negotiated Rate	$127.02
Max. Negotiated Rate	$1,207.85
Rate for Payer: AlohaCare Medicare	$127.02
Rate for Payer: Cash Price	$852.60
Rate for Payer: Cash Price	$852.60
Rate for Payer: Devoted Health Medicare	$139.72
Rate for Payer: Hawaii Medical Service Association Medicare	$127.02
Rate for Payer: Health Management Network Commercial	$1,207.85
Rate for Payer: Kaiser Permanente Commercial	$152.42
Rate for Payer: Kaiser Permanente Medicaid	$152.42
Rate for Payer: Kaiser Permanente Medicare	$152.42
Rate for Payer: Ohana Health Plan Medicare	$127.02
Rate for Payer: UnitedHealthcare Medicare	$127.02

PR REVSC EVASC TPVT ATHRC UNI CPLX LES 1ST VSL

Professional

Both

$20,948.00

Service Code	HCPCS 37290
Min. Negotiated Rate	$727.43
Max. Negotiated Rate	$17,805.80
Rate for Payer: AlohaCare Medicare	$727.43
Rate for Payer: Cash Price	$12,568.80
Rate for Payer: Cash Price	$12,568.80
Rate for Payer: Devoted Health Medicare	$800.17
Rate for Payer: Hawaii Medical Service Association Medicare	$727.43
Rate for Payer: Health Management Network Commercial	$17,805.80
Rate for Payer: Kaiser Permanente Commercial	$872.92
Rate for Payer: Kaiser Permanente Medicaid	$872.92
Rate for Payer: Kaiser Permanente Medicare	$872.92
Rate for Payer: Ohana Health Plan Medicare	$727.43
Rate for Payer: UnitedHealthcare Medicare	$727.43

PR REVSC EVASC TPVT ATHRC UNI CPLX LES EA ADDL VSL

Professional

Both

$2,045.00

Service Code	HCPCS 37291
Min. Negotiated Rate	$278.15
Max. Negotiated Rate	$1,738.25
Rate for Payer: AlohaCare Medicare	$278.15
Rate for Payer: Cash Price	$1,227.00
Rate for Payer: Cash Price	$1,227.00
Rate for Payer: Devoted Health Medicare	$305.96
Rate for Payer: Hawaii Medical Service Association Medicare	$278.15
Rate for Payer: Health Management Network Commercial	$1,738.25
Rate for Payer: Kaiser Permanente Commercial	$333.78
Rate for Payer: Kaiser Permanente Medicaid	$333.78
Rate for Payer: Kaiser Permanente Medicare	$333.78
Rate for Payer: Ohana Health Plan Medicare	$278.15
Rate for Payer: UnitedHealthcare Medicare	$278.15

PR REVSC EVASC TPVT ATHRC UNI SF LES 1ST VSL

Professional

Both

$15,323.00

Service Code	HCPCS 37288
Min. Negotiated Rate	$578.37
Max. Negotiated Rate	$13,024.55
Rate for Payer: AlohaCare Medicare	$578.37
Rate for Payer: Cash Price	$9,193.80
Rate for Payer: Cash Price	$9,193.80
Rate for Payer: Devoted Health Medicare	$636.21
Rate for Payer: Hawaii Medical Service Association Medicare	$578.37
Rate for Payer: Health Management Network Commercial	$13,024.55
Rate for Payer: Kaiser Permanente Commercial	$694.04
Rate for Payer: Kaiser Permanente Medicaid	$694.04
Rate for Payer: Kaiser Permanente Medicare	$694.04
Rate for Payer: Ohana Health Plan Medicare	$578.37
Rate for Payer: UnitedHealthcare Medicare	$578.37

PR REVSC EVASC TPVT ATHRC UNI SF LES EA ADDL VSL

Professional

Both

$1,764.00

Service Code	HCPCS 37289
Min. Negotiated Rate	$203.63
Max. Negotiated Rate	$1,499.40
Rate for Payer: AlohaCare Medicare	$203.63
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Devoted Health Medicare	$223.99
Rate for Payer: Hawaii Medical Service Association Medicare	$203.63
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Commercial	$244.36
Rate for Payer: Kaiser Permanente Medicaid	$244.36
Rate for Payer: Kaiser Permanente Medicare	$244.36
Rate for Payer: Ohana Health Plan Medicare	$203.63
Rate for Payer: UnitedHealthcare Medicare	$203.63

PR REVSC EVASC TPVT ST ATHRC UNI SF LES EA ADDL VSL

Professional

Both

$6,892.00

Service Code	HCPCS 37293
Min. Negotiated Rate	$284.79
Max. Negotiated Rate	$5,858.20
Rate for Payer: AlohaCare Medicare	$284.79
Rate for Payer: Cash Price	$4,135.20
Rate for Payer: Cash Price	$4,135.20
Rate for Payer: Devoted Health Medicare	$313.27
Rate for Payer: Hawaii Medical Service Association Medicare	$284.79
Rate for Payer: Health Management Network Commercial	$5,858.20
Rate for Payer: Kaiser Permanente Commercial	$341.75
Rate for Payer: Kaiser Permanente Medicaid	$341.75
Rate for Payer: Kaiser Permanente Medicare	$341.75
Rate for Payer: Ohana Health Plan Medicare	$284.79
Rate for Payer: UnitedHealthcare Medicare	$284.79

PR REVSC EVASC TPVT ST PLMT UNI CPLX LES 1ST VSL

Professional

Both

$20,436.00

Service Code	HCPCS 37286
Min. Negotiated Rate	$584.90
Max. Negotiated Rate	$17,370.60
Rate for Payer: AlohaCare Medicare	$584.90
Rate for Payer: Cash Price	$12,261.60
Rate for Payer: Cash Price	$12,261.60
Rate for Payer: Devoted Health Medicare	$643.39
Rate for Payer: Hawaii Medical Service Association Medicare	$584.90
Rate for Payer: Health Management Network Commercial	$17,370.60
Rate for Payer: Kaiser Permanente Commercial	$701.88
Rate for Payer: Kaiser Permanente Medicaid	$701.88
Rate for Payer: Kaiser Permanente Medicare	$701.88
Rate for Payer: Ohana Health Plan Medicare	$584.90
Rate for Payer: UnitedHealthcare Medicare	$584.90

PR REVSC EVASC TPVT ST PLMT UNI CPLX LES EA ADD VSL

Professional

Both

$9,761.00

Service Code	HCPCS 37287
Min. Negotiated Rate	$216.77
Max. Negotiated Rate	$8,296.85
Rate for Payer: AlohaCare Medicare	$216.77
Rate for Payer: Cash Price	$5,856.60
Rate for Payer: Cash Price	$5,856.60
Rate for Payer: Devoted Health Medicare	$238.45
Rate for Payer: Hawaii Medical Service Association Medicare	$216.77
Rate for Payer: Health Management Network Commercial	$8,296.85
Rate for Payer: Kaiser Permanente Commercial	$260.12
Rate for Payer: Kaiser Permanente Medicaid	$260.12
Rate for Payer: Kaiser Permanente Medicare	$260.12
Rate for Payer: Ohana Health Plan Medicare	$216.77
Rate for Payer: UnitedHealthcare Medicare	$216.77

PR REVSC EVASC TPVT ST PLMT UNI SF LES 1ST VSL

Professional

Both

$11,049.00

Service Code	HCPCS 37284
Min. Negotiated Rate	$436.21
Max. Negotiated Rate	$9,391.65
Rate for Payer: AlohaCare Medicare	$436.21
Rate for Payer: Cash Price	$6,629.40
Rate for Payer: Cash Price	$6,629.40
Rate for Payer: Devoted Health Medicare	$479.83
Rate for Payer: Hawaii Medical Service Association Medicare	$436.21
Rate for Payer: Health Management Network Commercial	$9,391.65
Rate for Payer: Kaiser Permanente Commercial	$523.45
Rate for Payer: Kaiser Permanente Medicaid	$523.45
Rate for Payer: Kaiser Permanente Medicare	$523.45
Rate for Payer: Ohana Health Plan Medicare	$436.21
Rate for Payer: UnitedHealthcare Medicare	$436.21

PR REVSC EVASC TPVT ST PLMT UNI SF LES EA ADDL VSL

Professional

Both

$5,502.00

Service Code	HCPCS 37285
Min. Negotiated Rate	$144.29
Max. Negotiated Rate	$4,676.70
Rate for Payer: AlohaCare Medicare	$144.29
Rate for Payer: Cash Price	$3,301.20
Rate for Payer: Cash Price	$3,301.20
Rate for Payer: Devoted Health Medicare	$158.72
Rate for Payer: Hawaii Medical Service Association Medicare	$144.29
Rate for Payer: Health Management Network Commercial	$4,676.70
Rate for Payer: Kaiser Permanente Commercial	$173.15
Rate for Payer: Kaiser Permanente Medicaid	$173.15
Rate for Payer: Kaiser Permanente Medicare	$173.15
Rate for Payer: Ohana Health Plan Medicare	$144.29
Rate for Payer: UnitedHealthcare Medicare	$144.29

PR REVSC EVSC TPVT ST ATHRC UNI CPLX LES EA ADD VSL

Professional

Both

$11,829.00

Service Code	HCPCS 37295
Min. Negotiated Rate	$358.60
Max. Negotiated Rate	$10,054.65
Rate for Payer: AlohaCare Medicare	$358.60
Rate for Payer: Cash Price	$7,097.40
Rate for Payer: Cash Price	$7,097.40
Rate for Payer: Devoted Health Medicare	$394.46
Rate for Payer: Hawaii Medical Service Association Medicare	$358.60
Rate for Payer: Health Management Network Commercial	$10,054.65
Rate for Payer: Kaiser Permanente Commercial	$430.32
Rate for Payer: Kaiser Permanente Medicaid	$430.32
Rate for Payer: Kaiser Permanente Medicare	$430.32
Rate for Payer: Ohana Health Plan Medicare	$358.60
Rate for Payer: UnitedHealthcare Medicare	$358.60

PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR

Professional

Both

$2,589.00

Service Code	HCPCS 30420
Min. Negotiated Rate	$976.30
Max. Negotiated Rate	$2,200.65
Rate for Payer: AlohaCare Medicaid	$1,542.48
Rate for Payer: AlohaCare Medicare	$1,370.10
Rate for Payer: Cash Price	$1,553.40
Rate for Payer: Cash Price	$1,553.40
Rate for Payer: Devoted Health Medicare	$1,507.11
Rate for Payer: Hawaii Medical Service Association Medicare	$1,370.10
Rate for Payer: Hawaii Western Management Group Commercial	$976.30
Rate for Payer: Health Management Network Commercial	$2,200.65
Rate for Payer: Kaiser Permanente Commercial	$1,644.12
Rate for Payer: Kaiser Permanente Medicaid	$1,644.12
Rate for Payer: Kaiser Permanente Medicare	$1,644.12
Rate for Payer: Ohana Health Plan Medicaid	$1,542.48
Rate for Payer: Ohana Health Plan Medicare	$1,370.10
Rate for Payer: UnitedHealthcare Medicaid	$1,542.48
Rate for Payer: UnitedHealthcare Medicare	$1,370.10

PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION

Professional

Both

$2,427.00

Service Code	HCPCS 30435
Min. Negotiated Rate	$647.92
Max. Negotiated Rate	$2,062.95
Rate for Payer: AlohaCare Medicaid	$1,433.96
Rate for Payer: AlohaCare Medicare	$1,367.58
Rate for Payer: Cash Price	$1,456.20
Rate for Payer: Cash Price	$1,456.20
Rate for Payer: Devoted Health Medicare	$1,504.34
Rate for Payer: Hawaii Medical Service Association Medicare	$1,367.58
Rate for Payer: Hawaii Western Management Group Commercial	$647.92
Rate for Payer: Health Management Network Commercial	$2,062.95
Rate for Payer: Kaiser Permanente Commercial	$1,641.10
Rate for Payer: Kaiser Permanente Medicaid	$1,641.10
Rate for Payer: Kaiser Permanente Medicare	$1,641.10
Rate for Payer: Ohana Health Plan Medicaid	$1,433.96
Rate for Payer: Ohana Health Plan Medicare	$1,367.58
Rate for Payer: UnitedHealthcare Medicaid	$1,433.96
Rate for Payer: UnitedHealthcare Medicare	$1,367.58

PR RHINOPLASTY SECONDARY MAJOR REVISION

Professional

Both

$3,132.00

Service Code	HCPCS 30450
Min. Negotiated Rate	$878.02
Max. Negotiated Rate	$2,662.20
Rate for Payer: AlohaCare Medicaid	$1,844.01
Rate for Payer: AlohaCare Medicare	$1,711.35
Rate for Payer: Cash Price	$1,879.20
Rate for Payer: Cash Price	$1,879.20
Rate for Payer: Devoted Health Medicare	$1,882.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,711.35
Rate for Payer: Hawaii Western Management Group Commercial	$878.02
Rate for Payer: Health Management Network Commercial	$2,662.20
Rate for Payer: Kaiser Permanente Commercial	$2,053.62
Rate for Payer: Kaiser Permanente Medicaid	$2,053.62
Rate for Payer: Kaiser Permanente Medicare	$2,053.62
Rate for Payer: Ohana Health Plan Medicaid	$1,844.01
Rate for Payer: Ohana Health Plan Medicare	$1,711.35
Rate for Payer: UnitedHealthcare Medicaid	$1,844.01
Rate for Payer: UnitedHealthcare Medicare	$1,711.35

PR RHINOPLASTY SECONDARY MINOR REVISION

Professional

Both

$2,003.49

Service Code	HCPCS 30430
Min. Negotiated Rate	$402.74
Max. Negotiated Rate	$1,702.97
Rate for Payer: AlohaCare Medicaid	$1,168.59
Rate for Payer: AlohaCare Medicare	$1,144.47
Rate for Payer: Cash Price	$1,202.09
Rate for Payer: Cash Price	$1,202.09
Rate for Payer: Devoted Health Medicare	$1,258.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,144.47
Rate for Payer: Hawaii Western Management Group Commercial	$402.74
Rate for Payer: Health Management Network Commercial	$1,702.97
Rate for Payer: Kaiser Permanente Commercial	$1,373.36
Rate for Payer: Kaiser Permanente Medicaid	$1,373.36
Rate for Payer: Kaiser Permanente Medicare	$1,373.36
Rate for Payer: Ohana Health Plan Medicaid	$1,168.59
Rate for Payer: Ohana Health Plan Medicare	$1,144.47
Rate for Payer: UnitedHealthcare Medicaid	$1,168.59
Rate for Payer: UnitedHealthcare Medicare	$1,144.47

PR RHINP DFRM COLUM LNGTH TIP SEPTUM OSTEOT

Professional

Both

$2,825.00

Service Code	HCPCS 30462
Min. Negotiated Rate	$1,068.34
Max. Negotiated Rate	$2,401.25
Rate for Payer: AlohaCare Medicaid	$1,658.45
Rate for Payer: AlohaCare Medicare	$1,503.00
Rate for Payer: Cash Price	$1,695.00
Rate for Payer: Cash Price	$1,695.00
Rate for Payer: Devoted Health Medicare	$1,653.30
Rate for Payer: Hawaii Medical Service Association Medicare	$1,503.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,068.34
Rate for Payer: Health Management Network Commercial	$2,401.25
Rate for Payer: Kaiser Permanente Commercial	$1,803.60
Rate for Payer: Kaiser Permanente Medicaid	$1,803.60
Rate for Payer: Kaiser Permanente Medicare	$1,803.60
Rate for Payer: Ohana Health Plan Medicaid	$1,658.45
Rate for Payer: Ohana Health Plan Medicare	$1,503.00
Rate for Payer: UnitedHealthcare Medicaid	$1,658.45
Rate for Payer: UnitedHealthcare Medicare	$1,503.00

PR RHINP DFRM W/COLUM LNGTH TIP ONLY

Professional

Both

$1,476.00

Service Code	HCPCS 30460
Min. Negotiated Rate	$724.88
Max. Negotiated Rate	$1,254.60
Rate for Payer: AlohaCare Medicaid	$865.90
Rate for Payer: AlohaCare Medicare	$791.82
Rate for Payer: Cash Price	$885.60
Rate for Payer: Cash Price	$885.60
Rate for Payer: Devoted Health Medicare	$871.00
Rate for Payer: Hawaii Medical Service Association Medicare	$791.82
Rate for Payer: Hawaii Western Management Group Commercial	$724.88
Rate for Payer: Health Management Network Commercial	$1,254.60
Rate for Payer: Kaiser Permanente Commercial	$950.18
Rate for Payer: Kaiser Permanente Medicaid	$950.18
Rate for Payer: Kaiser Permanente Medicare	$950.18
Rate for Payer: Ohana Health Plan Medicaid	$865.90
Rate for Payer: Ohana Health Plan Medicare	$791.82
Rate for Payer: UnitedHealthcare Medicaid	$865.90
Rate for Payer: UnitedHealthcare Medicare	$791.82

PR RHINP PRIM COMPLETE XTRNL PARTS

Professional

Both

$2,556.00

Service Code	HCPCS 30410
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$2,172.60
Rate for Payer: AlohaCare Medicaid	$1,509.20
Rate for Payer: AlohaCare Medicare	$1,430.35
Rate for Payer: Cash Price	$1,533.60
Rate for Payer: Cash Price	$1,533.60
Rate for Payer: Devoted Health Medicare	$1,573.38
Rate for Payer: Hawaii Medical Service Association Medicare	$1,430.35
Rate for Payer: Hawaii Western Management Group Commercial	$260.00
Rate for Payer: Health Management Network Commercial	$2,172.60
Rate for Payer: Kaiser Permanente Commercial	$1,716.42
Rate for Payer: Kaiser Permanente Medicaid	$1,716.42
Rate for Payer: Kaiser Permanente Medicare	$1,716.42
Rate for Payer: Ohana Health Plan Medicaid	$1,509.20
Rate for Payer: Ohana Health Plan Medicare	$1,430.35
Rate for Payer: UnitedHealthcare Medicaid	$1,509.20
Rate for Payer: UnitedHealthcare Medicare	$1,430.35

PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI

Professional

Both

$2,237.00

Service Code	HCPCS 30400
Min. Negotiated Rate	$590.98
Max. Negotiated Rate	$1,901.45
Rate for Payer: AlohaCare Medicaid	$1,323.48
Rate for Payer: AlohaCare Medicare	$1,274.96
Rate for Payer: Cash Price	$1,342.20
Rate for Payer: Cash Price	$1,342.20
Rate for Payer: Devoted Health Medicare	$1,402.46
Rate for Payer: Hawaii Medical Service Association Medicare	$1,274.96
Rate for Payer: Hawaii Western Management Group Commercial	$590.98
Rate for Payer: Health Management Network Commercial	$1,901.45
Rate for Payer: Kaiser Permanente Commercial	$1,529.95
Rate for Payer: Kaiser Permanente Medicaid	$1,529.95
Rate for Payer: Kaiser Permanente Medicare	$1,529.95
Rate for Payer: Ohana Health Plan Medicaid	$1,323.48
Rate for Payer: Ohana Health Plan Medicare	$1,274.96
Rate for Payer: UnitedHealthcare Medicaid	$1,323.48
Rate for Payer: UnitedHealthcare Medicare	$1,274.96

PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON

Professional

Both

$12.42

Service Code	HCPCS 93042
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$10.56
Rate for Payer: AlohaCare Medicaid	$6.71
Rate for Payer: AlohaCare Medicare	$7.10
Rate for Payer: Cash Price	$7.45
Rate for Payer: Cash Price	$7.45
Rate for Payer: Devoted Health Medicare	$7.81
Rate for Payer: Hawaii Medical Service Association Medicare	$7.10
Rate for Payer: Hawaii Western Management Group Commercial	$9.94
Rate for Payer: Health Management Network Commercial	$10.56
Rate for Payer: Kaiser Permanente Commercial	$8.52
Rate for Payer: Kaiser Permanente Medicaid	$8.52
Rate for Payer: Kaiser Permanente Medicare	$8.52
Rate for Payer: Ohana Health Plan Medicaid	$6.71
Rate for Payer: Ohana Health Plan Medicare	$7.10
Rate for Payer: UnitedHealthcare Medicaid	$6.71
Rate for Payer: UnitedHealthcare Medicare	$7.10

PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R

Professional

Both

$16.00

Service Code	HCPCS 93041
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$13.60
Rate for Payer: AlohaCare Medicaid	$7.07
Rate for Payer: AlohaCare Medicare	$8.93
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$9.82
Rate for Payer: Hawaii Medical Service Association Medicare	$8.93
Rate for Payer: Hawaii Western Management Group Commercial	$6.11
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$10.72
Rate for Payer: Kaiser Permanente Medicaid	$10.72
Rate for Payer: Kaiser Permanente Medicare	$10.72
Rate for Payer: Ohana Health Plan Medicaid	$7.07
Rate for Payer: Ohana Health Plan Medicare	$8.93
Rate for Payer: UnitedHealthcare Medicaid	$7.07
Rate for Payer: UnitedHealthcare Medicare	$8.93

Know your out-of-pocket cost for care.

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