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Charge Type Setting Price  
Service Code HCPCS 54150
Hospital Charge Code 12486399
Hospital Revenue Code 723
Min. Negotiated Rate $456.03
Max. Negotiated Rate $5,655.00
Rate for Payer: AlohaCare Medicaid $672.48
Rate for Payer: AlohaCare Medicare $1,943.13
Rate for Payer: Cash Price $2,526.07
Rate for Payer: Cash Price $2,526.07
Rate for Payer: Devoted Health Medicare $2,137.44
Rate for Payer: Hawaii Medical Service Association ABD $695.00
Rate for Payer: Hawaii Medical Service Association Commercial $5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare $1,943.13
Rate for Payer: Hawaii Medical Service Association Non-ABD $700.72
Rate for Payer: Hawaii Western Management Group Commercial $3,691.95
Rate for Payer: Health Management Network Commercial $3,303.32
Rate for Payer: Humana Medicare $1,943.13
Rate for Payer: Kaiser Permanente Commercial $3,497.63
Rate for Payer: Kaiser Permanente Medicaid $1,981.99
Rate for Payer: Kaiser Permanente Medicare $1,943.13
Rate for Payer: MDX Hawaii PPO $3,769.67
Rate for Payer: Ohana Health Plan Medicaid $1,943.13
Rate for Payer: Ohana Health Plan Medicare $1,943.13
Rate for Payer: UnitedHealthcare Medicaid $456.03
Rate for Payer: UnitedHealthcare Medicare $1,943.13
Rate for Payer: University Health Alliance Commercial $4,035.20
Service Code HCPCS 54150
Hospital Charge Code 12480401
Hospital Revenue Code 761
Min. Negotiated Rate $200.00
Max. Negotiated Rate $5,655.00
Rate for Payer: AlohaCare Medicaid $672.48
Rate for Payer: AlohaCare Medicare $200.00
Rate for Payer: Cash Price $260.00
Rate for Payer: Cash Price $260.00
Rate for Payer: Devoted Health Medicare $220.00
Rate for Payer: Hawaii Medical Service Association ABD $695.00
Rate for Payer: Hawaii Medical Service Association Commercial $5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare $200.00
Rate for Payer: Hawaii Medical Service Association Non-ABD $700.72
Rate for Payer: Hawaii Western Management Group Commercial $380.00
Rate for Payer: Health Management Network Commercial $340.00
Rate for Payer: Humana Medicare $200.00
Rate for Payer: Kaiser Permanente Commercial $360.00
Rate for Payer: Kaiser Permanente Medicaid $204.00
Rate for Payer: Kaiser Permanente Medicare $200.00
Rate for Payer: MDX Hawaii PPO $388.00
Rate for Payer: Ohana Health Plan Medicaid $200.00
Rate for Payer: Ohana Health Plan Medicare $200.00
Rate for Payer: UnitedHealthcare Medicaid $456.03
Rate for Payer: UnitedHealthcare Medicare $200.00
Rate for Payer: University Health Alliance Commercial $4,035.20
Service Code HCPCS 54150
Hospital Charge Code 12480401
Hospital Revenue Code 761
Min. Negotiated Rate $340.00
Max. Negotiated Rate $388.00
Rate for Payer: Cash Price $260.00
Rate for Payer: Health Management Network Commercial $340.00
Rate for Payer: Kaiser Permanente Commercial $360.00
Rate for Payer: MDX Hawaii PPO $388.00
Service Code MSDRG 433
Min. Negotiated Rate $44,465.02
Max. Negotiated Rate $44,465.02
Rate for Payer: Hawaii Medical Service Association Commercial $44,465.02
Service Code MSDRG 432
Min. Negotiated Rate $44,465.02
Max. Negotiated Rate $44,465.02
Rate for Payer: Hawaii Medical Service Association Commercial $44,465.02
Service Code MSDRG 434
Min. Negotiated Rate $44,465.02
Max. Negotiated Rate $44,465.02
Rate for Payer: Hawaii Medical Service Association Commercial $44,465.02
Service Code NDC 70069016110
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $696.01
Max. Negotiated Rate $794.27
Rate for Payer: Cash Price $532.25
Rate for Payer: Health Management Network Commercial $696.01
Rate for Payer: Kaiser Permanente Commercial $736.96
Rate for Payer: MDX Hawaii PPO $794.27
Service Code NDC 70069016110
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $409.42
Max. Negotiated Rate $794.27
Rate for Payer: AlohaCare Medicaid $409.42
Rate for Payer: AlohaCare Medicare $409.42
Rate for Payer: Cash Price $532.25
Rate for Payer: Devoted Health Medicare $450.36
Rate for Payer: Hawaii Medical Service Association Medicare $409.42
Rate for Payer: Hawaii Western Management Group Commercial $777.90
Rate for Payer: Health Management Network Commercial $696.01
Rate for Payer: Humana Medicare $409.42
Rate for Payer: Kaiser Permanente Commercial $736.96
Rate for Payer: Kaiser Permanente Medicaid $417.61
Rate for Payer: Kaiser Permanente Medicare $409.42
Rate for Payer: MDX Hawaii PPO $794.27
Rate for Payer: Ohana Health Plan Medicaid $409.42
Rate for Payer: Ohana Health Plan Medicare $409.42
Rate for Payer: UnitedHealthcare Medicaid $491.30
Rate for Payer: UnitedHealthcare Medicare $409.42
Rate for Payer: University Health Alliance Commercial $596.85
Service Code NDC 63323041710
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $66.76
Max. Negotiated Rate $129.51
Rate for Payer: AlohaCare Medicaid $66.76
Rate for Payer: AlohaCare Medicare $66.76
Rate for Payer: Cash Price $86.79
Rate for Payer: Devoted Health Medicare $73.44
Rate for Payer: Hawaii Medical Service Association Medicare $66.76
Rate for Payer: Hawaii Western Management Group Commercial $126.84
Rate for Payer: Health Management Network Commercial $113.49
Rate for Payer: Humana Medicare $66.76
Rate for Payer: Kaiser Permanente Commercial $120.17
Rate for Payer: Kaiser Permanente Medicaid $68.10
Rate for Payer: Kaiser Permanente Medicare $66.76
Rate for Payer: MDX Hawaii PPO $129.51
Rate for Payer: Ohana Health Plan Medicaid $66.76
Rate for Payer: Ohana Health Plan Medicare $66.76
Rate for Payer: UnitedHealthcare Medicaid $80.11
Rate for Payer: UnitedHealthcare Medicare $66.76
Rate for Payer: University Health Alliance Commercial $97.32
Service Code NDC 00074438010
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $132.69
Max. Negotiated Rate $151.43
Rate for Payer: Cash Price $101.47
Rate for Payer: Health Management Network Commercial $132.69
Rate for Payer: Kaiser Permanente Commercial $140.50
Rate for Payer: MDX Hawaii PPO $151.43
Service Code NDC 00781315295
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $75.17
Max. Negotiated Rate $145.83
Rate for Payer: AlohaCare Medicaid $75.17
Rate for Payer: AlohaCare Medicare $75.17
Rate for Payer: Cash Price $97.72
Rate for Payer: Devoted Health Medicare $82.69
Rate for Payer: Hawaii Medical Service Association Medicare $75.17
Rate for Payer: Hawaii Western Management Group Commercial $142.82
Rate for Payer: Health Management Network Commercial $127.79
Rate for Payer: Humana Medicare $75.17
Rate for Payer: Kaiser Permanente Commercial $135.31
Rate for Payer: Kaiser Permanente Medicaid $76.67
Rate for Payer: Kaiser Permanente Medicare $75.17
Rate for Payer: MDX Hawaii PPO $145.83
Rate for Payer: Ohana Health Plan Medicaid $75.17
Rate for Payer: Ohana Health Plan Medicare $75.17
Rate for Payer: UnitedHealthcare Medicaid $90.20
Rate for Payer: UnitedHealthcare Medicare $75.17
Rate for Payer: University Health Alliance Commercial $109.58
Service Code NDC 00074438010
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $78.06
Max. Negotiated Rate $151.43
Rate for Payer: AlohaCare Medicaid $78.06
Rate for Payer: AlohaCare Medicare $78.06
Rate for Payer: Cash Price $101.47
Rate for Payer: Devoted Health Medicare $85.86
Rate for Payer: Hawaii Medical Service Association Medicare $78.06
Rate for Payer: Hawaii Western Management Group Commercial $148.30
Rate for Payer: Health Management Network Commercial $132.69
Rate for Payer: Humana Medicare $78.06
Rate for Payer: Kaiser Permanente Commercial $140.50
Rate for Payer: Kaiser Permanente Medicaid $79.62
Rate for Payer: Kaiser Permanente Medicare $78.06
Rate for Payer: MDX Hawaii PPO $151.43
Rate for Payer: Ohana Health Plan Medicaid $78.06
Rate for Payer: Ohana Health Plan Medicare $78.06
Rate for Payer: UnitedHealthcare Medicaid $93.67
Rate for Payer: UnitedHealthcare Medicare $78.06
Rate for Payer: University Health Alliance Commercial $113.79
Service Code NDC 71288071411
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $104.97
Max. Negotiated Rate $119.79
Rate for Payer: Cash Price $80.27
Rate for Payer: Health Management Network Commercial $104.97
Rate for Payer: Kaiser Permanente Commercial $111.14
Rate for Payer: MDX Hawaii PPO $119.79
Service Code NDC 00781315295
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $127.79
Max. Negotiated Rate $145.83
Rate for Payer: Cash Price $97.72
Rate for Payer: Health Management Network Commercial $127.79
Rate for Payer: Kaiser Permanente Commercial $135.31
Rate for Payer: MDX Hawaii PPO $145.83
Service Code NDC 63323041710
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $113.49
Max. Negotiated Rate $129.51
Rate for Payer: Cash Price $86.79
Rate for Payer: Health Management Network Commercial $113.49
Rate for Payer: Kaiser Permanente Commercial $120.17
Rate for Payer: MDX Hawaii PPO $129.51
Service Code NDC 25021067010
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $96.51
Max. Negotiated Rate $110.13
Rate for Payer: Cash Price $73.80
Rate for Payer: Health Management Network Commercial $96.51
Rate for Payer: Kaiser Permanente Commercial $102.19
Rate for Payer: MDX Hawaii PPO $110.13
Service Code NDC 00781903895
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $70.44
Max. Negotiated Rate $136.65
Rate for Payer: AlohaCare Medicaid $70.44
Rate for Payer: AlohaCare Medicare $70.44
Rate for Payer: Cash Price $91.57
Rate for Payer: Devoted Health Medicare $77.48
Rate for Payer: Hawaii Medical Service Association Medicare $70.44
Rate for Payer: Hawaii Western Management Group Commercial $133.84
Rate for Payer: Health Management Network Commercial $119.75
Rate for Payer: Humana Medicare $70.44
Rate for Payer: Kaiser Permanente Commercial $126.79
Rate for Payer: Kaiser Permanente Medicaid $71.85
Rate for Payer: Kaiser Permanente Medicare $70.44
Rate for Payer: MDX Hawaii PPO $136.65
Rate for Payer: Ohana Health Plan Medicaid $70.44
Rate for Payer: Ohana Health Plan Medicare $70.44
Rate for Payer: UnitedHealthcare Medicaid $84.53
Rate for Payer: UnitedHealthcare Medicare $70.44
Rate for Payer: University Health Alliance Commercial $102.69
Service Code NDC 00781903895
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $119.75
Max. Negotiated Rate $136.65
Rate for Payer: Cash Price $91.57
Rate for Payer: Health Management Network Commercial $119.75
Rate for Payer: Kaiser Permanente Commercial $126.79
Rate for Payer: MDX Hawaii PPO $136.65
Service Code NDC 25021067010
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $56.77
Max. Negotiated Rate $110.13
Rate for Payer: AlohaCare Medicaid $56.77
Rate for Payer: AlohaCare Medicare $56.77
Rate for Payer: Cash Price $73.80
Rate for Payer: Devoted Health Medicare $62.45
Rate for Payer: Hawaii Medical Service Association Medicare $56.77
Rate for Payer: Hawaii Western Management Group Commercial $107.86
Rate for Payer: Health Management Network Commercial $96.51
Rate for Payer: Humana Medicare $56.77
Rate for Payer: Kaiser Permanente Commercial $102.19
Rate for Payer: Kaiser Permanente Medicaid $57.91
Rate for Payer: Kaiser Permanente Medicare $56.77
Rate for Payer: MDX Hawaii PPO $110.13
Rate for Payer: Ohana Health Plan Medicaid $56.77
Rate for Payer: Ohana Health Plan Medicare $56.77
Rate for Payer: UnitedHealthcare Medicaid $68.12
Rate for Payer: UnitedHealthcare Medicare $56.77
Rate for Payer: University Health Alliance Commercial $82.76
Service Code NDC 71288071411
Hospital Charge Code 2500180
Hospital Revenue Code 250
Min. Negotiated Rate $61.74
Max. Negotiated Rate $119.79
Rate for Payer: AlohaCare Medicaid $61.74
Rate for Payer: AlohaCare Medicare $61.74
Rate for Payer: Cash Price $80.27
Rate for Payer: Devoted Health Medicare $67.92
Rate for Payer: Hawaii Medical Service Association Medicare $61.74
Rate for Payer: Hawaii Western Management Group Commercial $117.32
Rate for Payer: Health Management Network Commercial $104.97
Rate for Payer: Humana Medicare $61.74
Rate for Payer: Kaiser Permanente Commercial $111.14
Rate for Payer: Kaiser Permanente Medicaid $62.98
Rate for Payer: Kaiser Permanente Medicare $61.74
Rate for Payer: MDX Hawaii PPO $119.79
Rate for Payer: Ohana Health Plan Medicaid $61.74
Rate for Payer: Ohana Health Plan Medicare $61.74
Rate for Payer: UnitedHealthcare Medicaid $74.09
Rate for Payer: UnitedHealthcare Medicare $61.74
Rate for Payer: University Health Alliance Commercial $90.01
Service Code HCPCS 82507
Hospital Charge Code 8228854
Hospital Revenue Code 301
Min. Negotiated Rate $27.80
Max. Negotiated Rate $306.52
Rate for Payer: AlohaCare Medicaid $158.00
Rate for Payer: AlohaCare Medicare $158.00
Rate for Payer: Cash Price $205.40
Rate for Payer: Cash Price $205.40
Rate for Payer: Devoted Health Medicare $173.80
Rate for Payer: Hawaii Medical Service Association ABD $38.43
Rate for Payer: Hawaii Medical Service Association Commercial $34.75
Rate for Payer: Hawaii Medical Service Association Medicare $158.00
Rate for Payer: Hawaii Medical Service Association Non-ABD $40.35
Rate for Payer: Hawaii Western Management Group Commercial $27.80
Rate for Payer: Health Management Network Commercial $268.60
Rate for Payer: Humana Medicare $158.00
Rate for Payer: Kaiser Permanente Commercial $284.40
Rate for Payer: Kaiser Permanente Medicaid $161.16
Rate for Payer: Kaiser Permanente Medicare $158.00
Rate for Payer: MDX Hawaii PPO $306.52
Rate for Payer: Ohana Health Plan Medicaid $158.00
Rate for Payer: Ohana Health Plan Medicare $158.00
Rate for Payer: UnitedHealthcare Medicaid $38.43
Rate for Payer: UnitedHealthcare Medicare $158.00
Rate for Payer: University Health Alliance Commercial $71.87
Service Code HCPCS 82507
Hospital Charge Code 8228854
Hospital Revenue Code 301
Min. Negotiated Rate $268.60
Max. Negotiated Rate $306.52
Rate for Payer: Cash Price $205.40
Rate for Payer: Health Management Network Commercial $268.60
Rate for Payer: Kaiser Permanente Commercial $284.40
Rate for Payer: MDX Hawaii PPO $306.52
Service Code HCPCS A9270
Hospital Charge Code 2501019
Hospital Revenue Code 255
Min. Negotiated Rate $14.38
Max. Negotiated Rate $16.41
Rate for Payer: Cash Price $11.00
Rate for Payer: Health Management Network Commercial $14.38
Rate for Payer: Kaiser Permanente Commercial $15.23
Rate for Payer: MDX Hawaii PPO $16.41
Service Code HCPCS A9270
Hospital Charge Code 2501019
Hospital Revenue Code 255
Min. Negotiated Rate $8.46
Max. Negotiated Rate $16.41
Rate for Payer: AlohaCare Medicaid $8.46
Rate for Payer: AlohaCare Medicare $8.46
Rate for Payer: Cash Price $11.00
Rate for Payer: Devoted Health Medicare $9.31
Rate for Payer: Hawaii Medical Service Association Medicare $8.46
Rate for Payer: Hawaii Western Management Group Commercial $16.07
Rate for Payer: Health Management Network Commercial $14.38
Rate for Payer: Humana Medicare $8.46
Rate for Payer: Kaiser Permanente Commercial $15.23
Rate for Payer: Kaiser Permanente Medicaid $8.63
Rate for Payer: Kaiser Permanente Medicare $8.46
Rate for Payer: MDX Hawaii PPO $16.41
Rate for Payer: Ohana Health Plan Medicaid $8.46
Rate for Payer: Ohana Health Plan Medicare $8.46
Rate for Payer: UnitedHealthcare Medicare $8.46
Rate for Payer: University Health Alliance Commercial $12.33
Service Code NDC 00121119000
Hospital Charge Code 2500182
Hospital Revenue Code 250
Min. Negotiated Rate $14.07
Max. Negotiated Rate $16.05
Rate for Payer: Cash Price $10.76
Rate for Payer: Health Management Network Commercial $14.07
Rate for Payer: Kaiser Permanente Commercial $14.89
Rate for Payer: MDX Hawaii PPO $16.05