Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CT Angio Upper Extremity Left

Facility

$1,977.00

Service Code	HCPCS 73206 LT
Hospital Charge Code	1167885
Hospital Revenue Code	352
Min. Negotiated Rate	$284.73
Max. Negotiated Rate	$1,917.69
Rate for Payer: AlohaCare Medicaid	$988.50
Rate for Payer: AlohaCare Medicare	$988.50
Rate for Payer: Cash Price	$1,285.05
Rate for Payer: Cash Price	$1,285.05
Rate for Payer: Devoted Health Medicare	$1,087.35
Rate for Payer: Hawaii Medical Service Association ABD	$284.73
Rate for Payer: Hawaii Medical Service Association Medicare	$988.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$388.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,878.15
Rate for Payer: Health Management Network Commercial	$1,680.45
Rate for Payer: Humana Medicare	$988.50
Rate for Payer: Kaiser Permanente Commercial	$1,779.30
Rate for Payer: Kaiser Permanente Medicaid	$1,008.27
Rate for Payer: Kaiser Permanente Medicare	$988.50
Rate for Payer: MDX Hawaii PPO	$1,917.69
Rate for Payer: Ohana Health Plan Medicaid	$988.50
Rate for Payer: Ohana Health Plan Medicare	$988.50
Rate for Payer: UnitedHealthcare Medicaid	$284.73
Rate for Payer: UnitedHealthcare Medicare	$988.50
Rate for Payer: University Health Alliance Commercial	$849.91

CT Angio Upper Extremity Left

Facility

$1,977.00

Service Code	HCPCS 73206 LT
Hospital Charge Code	1167885
Hospital Revenue Code	352
Min. Negotiated Rate	$1,680.45
Max. Negotiated Rate	$1,917.69
Rate for Payer: Cash Price	$1,285.05
Rate for Payer: Health Management Network Commercial	$1,680.45
Rate for Payer: Kaiser Permanente Commercial	$1,779.30
Rate for Payer: MDX Hawaii PPO	$1,917.69

CT Angio Upper Extremity Left - Report

Professional

Both

$355.00

Service Code	HCPCS 73206 26,LT
Hospital Charge Code	629777
Hospital Revenue Code	972
Min. Negotiated Rate	$202.84
Max. Negotiated Rate	$570.76
Rate for Payer: AlohaCare Medicaid	$202.84
Rate for Payer: Cash Price	$230.75
Rate for Payer: Cash Price	$230.75
Rate for Payer: Hawaii Western Management Group Commercial	$570.76
Rate for Payer: Health Management Network Commercial	$301.75
Rate for Payer: Ohana Health Plan Medicaid	$202.84
Rate for Payer: UnitedHealthcare Medicaid	$202.84

CT Angio Upper Extremity Right

Facility

$1,977.00

Service Code	HCPCS 73206 RT
Hospital Charge Code	1167887
Hospital Revenue Code	352
Min. Negotiated Rate	$284.73
Max. Negotiated Rate	$1,917.69
Rate for Payer: AlohaCare Medicaid	$988.50
Rate for Payer: AlohaCare Medicare	$988.50
Rate for Payer: Cash Price	$1,285.05
Rate for Payer: Cash Price	$1,285.05
Rate for Payer: Devoted Health Medicare	$1,087.35
Rate for Payer: Hawaii Medical Service Association ABD	$284.73
Rate for Payer: Hawaii Medical Service Association Medicare	$988.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$388.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,878.15
Rate for Payer: Health Management Network Commercial	$1,680.45
Rate for Payer: Humana Medicare	$988.50
Rate for Payer: Kaiser Permanente Commercial	$1,779.30
Rate for Payer: Kaiser Permanente Medicaid	$1,008.27
Rate for Payer: Kaiser Permanente Medicare	$988.50
Rate for Payer: MDX Hawaii PPO	$1,917.69
Rate for Payer: Ohana Health Plan Medicaid	$988.50
Rate for Payer: Ohana Health Plan Medicare	$988.50
Rate for Payer: UnitedHealthcare Medicaid	$284.73
Rate for Payer: UnitedHealthcare Medicare	$988.50
Rate for Payer: University Health Alliance Commercial	$849.91

CT Angio Upper Extremity Right

Facility

$1,977.00

Service Code	HCPCS 73206 RT
Hospital Charge Code	1167887
Hospital Revenue Code	352
Min. Negotiated Rate	$1,680.45
Max. Negotiated Rate	$1,917.69
Rate for Payer: Cash Price	$1,285.05
Rate for Payer: Health Management Network Commercial	$1,680.45
Rate for Payer: Kaiser Permanente Commercial	$1,779.30
Rate for Payer: MDX Hawaii PPO	$1,917.69

CT Angio Upper Extremity Right - Report

Professional

Both

$355.00

Service Code	HCPCS 73206 26,RT
Hospital Charge Code	629779
Hospital Revenue Code	972
Min. Negotiated Rate	$202.84
Max. Negotiated Rate	$570.76
Rate for Payer: AlohaCare Medicaid	$202.84
Rate for Payer: Cash Price	$230.75
Rate for Payer: Cash Price	$230.75
Rate for Payer: Hawaii Western Management Group Commercial	$570.76
Rate for Payer: Health Management Network Commercial	$301.75
Rate for Payer: Ohana Health Plan Medicaid	$202.84
Rate for Payer: UnitedHealthcare Medicaid	$202.84

CT Arthrogram Elbow Injection Left

Facility

$214.00

Service Code	HCPCS 24220
Hospital Charge Code	2424698
Hospital Revenue Code	361
Min. Negotiated Rate	$50.57
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$107.00
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Devoted Health Medicare	$117.70
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$107.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$107.00
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$107.00
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$107.00
Rate for Payer: Ohana Health Plan Medicare	$107.00
Rate for Payer: UnitedHealthcare Medicaid	$50.57
Rate for Payer: UnitedHealthcare Medicare	$107.00
Rate for Payer: University Health Alliance Commercial	$155.98

CT Arthrogram Elbow Injection Left

Facility

$214.00

Service Code	HCPCS 24220
Hospital Charge Code	2424698
Hospital Revenue Code	361
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$139.10
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

CT Arthrogram Elbow Injection Right

Facility

$214.00

Service Code	HCPCS 24220
Hospital Charge Code	2424701
Hospital Revenue Code	361
Min. Negotiated Rate	$50.57
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$107.00
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Devoted Health Medicare	$117.70
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$107.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$107.00
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$107.00
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$107.00
Rate for Payer: Ohana Health Plan Medicare	$107.00
Rate for Payer: UnitedHealthcare Medicaid	$50.57
Rate for Payer: UnitedHealthcare Medicare	$107.00
Rate for Payer: University Health Alliance Commercial	$155.98

CT Arthrogram Elbow Injection Right

Facility

$214.00

Service Code	HCPCS 24220
Hospital Charge Code	2424701
Hospital Revenue Code	361
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$139.10
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

CT Biopsy Abdominal Mass

Facility

$3,181.00

Service Code	HCPCS 49180
Hospital Charge Code	8207912
Hospital Revenue Code	350
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$1,590.50
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Devoted Health Medicare	$1,749.55
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	$1,590.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$3,021.95
Rate for Payer: Health Management Network Commercial	$2,703.85
Rate for Payer: Humana Medicare	$1,590.50
Rate for Payer: Kaiser Permanente Commercial	$2,862.90
Rate for Payer: Kaiser Permanente Medicaid	$1,622.31
Rate for Payer: Kaiser Permanente Medicare	$1,590.50
Rate for Payer: MDX Hawaii PPO	$3,085.57
Rate for Payer: Ohana Health Plan Medicaid	$1,590.50
Rate for Payer: Ohana Health Plan Medicare	$1,590.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,590.50
Rate for Payer: University Health Alliance Commercial	$2,318.63

CT Biopsy Abdominal Mass

Facility

$3,181.00

Service Code	HCPCS 49180
Hospital Charge Code	8207912
Hospital Revenue Code	350
Min. Negotiated Rate	$2,703.85
Max. Negotiated Rate	$3,085.57
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Health Management Network Commercial	$2,703.85
Rate for Payer: Kaiser Permanente Commercial	$2,862.90
Rate for Payer: MDX Hawaii PPO	$3,085.57

CT Biopsy Abdominal Mass - Report

Professional

Both

$376.00

Service Code	HCPCS 49180
Hospital Charge Code	8207914
Hospital Revenue Code	972
Min. Negotiated Rate	$69.80
Max. Negotiated Rate	$319.60
Rate for Payer: AlohaCare Medicaid	$80.65
Rate for Payer: AlohaCare Medicare	$69.80
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cash Price	$244.40
Rate for Payer: Devoted Health Medicare	$76.78
Rate for Payer: Hawaii Medical Service Association ABD	$80.65
Rate for Payer: Hawaii Medical Service Association Commercial	$137.22
Rate for Payer: Hawaii Medical Service Association Medicare	$69.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$80.65
Rate for Payer: Hawaii Western Management Group Commercial	$158.86
Rate for Payer: Health Management Network Commercial	$319.60
Rate for Payer: Kaiser Permanente Commercial	$76.78
Rate for Payer: Kaiser Permanente Medicaid	$76.78
Rate for Payer: Kaiser Permanente Medicare	$76.78
Rate for Payer: Ohana Health Plan Medicaid	$80.65
Rate for Payer: Ohana Health Plan Medicare	$69.80
Rate for Payer: UnitedHealthcare Medicaid	$80.65
Rate for Payer: UnitedHealthcare Medicare	$69.80
Rate for Payer: University Health Alliance Commercial	$108.08

CT Biopsy Bone Superficial

Facility

$3,171.00

Service Code	HCPCS 20220
Hospital Charge Code	1167917
Hospital Revenue Code	350
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,585.50
Rate for Payer: AlohaCare Medicare	$1,585.50
Rate for Payer: Cash Price	$2,061.15
Rate for Payer: Cash Price	$2,061.15
Rate for Payer: Devoted Health Medicare	$1,744.05
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,585.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,012.45
Rate for Payer: Health Management Network Commercial	$2,695.35
Rate for Payer: Humana Medicare	$1,585.50
Rate for Payer: Kaiser Permanente Commercial	$2,853.90
Rate for Payer: Kaiser Permanente Medicaid	$1,617.21
Rate for Payer: Kaiser Permanente Medicare	$1,585.50
Rate for Payer: MDX Hawaii PPO	$3,075.87
Rate for Payer: Ohana Health Plan Medicaid	$1,585.50
Rate for Payer: Ohana Health Plan Medicare	$1,585.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,585.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

CT Biopsy Bone Superficial

Facility

$3,171.00

Service Code	HCPCS 20220
Hospital Charge Code	1167917
Hospital Revenue Code	350
Min. Negotiated Rate	$2,695.35
Max. Negotiated Rate	$3,075.87
Rate for Payer: Cash Price	$2,061.15
Rate for Payer: Health Management Network Commercial	$2,695.35
Rate for Payer: Kaiser Permanente Commercial	$2,853.90
Rate for Payer: MDX Hawaii PPO	$3,075.87

CT Biopsy Bone Superficial - Report

Professional

Both

$965.00

Service Code	HCPCS 20220
Hospital Charge Code	627631
Hospital Revenue Code	972
Min. Negotiated Rate	$76.43
Max. Negotiated Rate	$820.25
Rate for Payer: AlohaCare Medicaid	$86.98
Rate for Payer: AlohaCare Medicare	$76.43
Rate for Payer: Cash Price	$627.25
Rate for Payer: Cash Price	$627.25
Rate for Payer: Devoted Health Medicare	$84.07
Rate for Payer: Hawaii Medical Service Association ABD	$86.98
Rate for Payer: Hawaii Medical Service Association Commercial	$143.37
Rate for Payer: Hawaii Medical Service Association Medicare	$76.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$86.98
Rate for Payer: Hawaii Western Management Group Commercial	$89.18
Rate for Payer: Health Management Network Commercial	$820.25
Rate for Payer: Kaiser Permanente Commercial	$84.07
Rate for Payer: Kaiser Permanente Medicaid	$84.07
Rate for Payer: Kaiser Permanente Medicare	$84.07
Rate for Payer: Ohana Health Plan Medicaid	$86.98
Rate for Payer: Ohana Health Plan Medicare	$76.43
Rate for Payer: UnitedHealthcare Medicaid	$86.98
Rate for Payer: UnitedHealthcare Medicare	$76.43
Rate for Payer: University Health Alliance Commercial	$115.07

CT Biopsy Liver

Facility

$2,664.00

Service Code	HCPCS 47000
Hospital Charge Code	1167919
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$1,332.00
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Devoted Health Medicare	$1,465.20
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,332.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$2,264.40
Rate for Payer: Humana Medicare	$1,332.00
Rate for Payer: Kaiser Permanente Commercial	$2,397.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,332.00
Rate for Payer: MDX Hawaii PPO	$2,584.08
Rate for Payer: Ohana Health Plan Medicaid	$1,332.00
Rate for Payer: Ohana Health Plan Medicare	$1,332.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,332.00
Rate for Payer: University Health Alliance Commercial	$1,941.79

CT Biopsy Liver

Facility

$2,664.00

Service Code	HCPCS 47000
Hospital Charge Code	1167919
Hospital Revenue Code	361
Min. Negotiated Rate	$2,264.40
Max. Negotiated Rate	$2,584.08
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Health Management Network Commercial	$2,264.40
Rate for Payer: Kaiser Permanente Commercial	$2,397.60
Rate for Payer: MDX Hawaii PPO	$2,584.08

CT Biopsy Liver - Report

Professional

Both

$999.00

Service Code	HCPCS 47000
Hospital Charge Code	629783
Hospital Revenue Code	972
Min. Negotiated Rate	$76.43
Max. Negotiated Rate	$849.15
Rate for Payer: AlohaCare Medicaid	$87.17
Rate for Payer: AlohaCare Medicare	$76.43
Rate for Payer: Cash Price	$649.35
Rate for Payer: Cash Price	$649.35
Rate for Payer: Devoted Health Medicare	$84.07
Rate for Payer: Hawaii Medical Service Association ABD	$87.17
Rate for Payer: Hawaii Medical Service Association Commercial	$146.74
Rate for Payer: Hawaii Medical Service Association Medicare	$76.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$87.17
Rate for Payer: Hawaii Western Management Group Commercial	$184.86
Rate for Payer: Health Management Network Commercial	$849.15
Rate for Payer: Kaiser Permanente Commercial	$84.07
Rate for Payer: Kaiser Permanente Medicaid	$84.07
Rate for Payer: Kaiser Permanente Medicare	$84.07
Rate for Payer: Ohana Health Plan Medicaid	$87.17
Rate for Payer: Ohana Health Plan Medicare	$76.43
Rate for Payer: UnitedHealthcare Medicaid	$87.17
Rate for Payer: UnitedHealthcare Medicare	$76.43
Rate for Payer: University Health Alliance Commercial	$115.57

CT Biopsy Lung/Mediastinum

Facility

$7,135.00

Service Code	HCPCS 32408
Hospital Charge Code	1167921
Hospital Revenue Code	761
Min. Negotiated Rate	$6,064.75
Max. Negotiated Rate	$6,920.95
Rate for Payer: Cash Price	$4,637.75
Rate for Payer: Health Management Network Commercial	$6,064.75
Rate for Payer: Kaiser Permanente Commercial	$6,421.50
Rate for Payer: MDX Hawaii PPO	$6,920.95

CT Biopsy Lung/Mediastinum

Facility

$7,135.00

Service Code	HCPCS 32408
Hospital Charge Code	1167921
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,920.95
Rate for Payer: AlohaCare Medicaid	$3,567.50
Rate for Payer: AlohaCare Medicare	$3,567.50
Rate for Payer: Cash Price	$4,637.75
Rate for Payer: Cash Price	$4,637.75
Rate for Payer: Devoted Health Medicare	$3,924.25
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	$3,567.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$6,778.25
Rate for Payer: Health Management Network Commercial	$6,064.75
Rate for Payer: Humana Medicare	$3,567.50
Rate for Payer: Kaiser Permanente Commercial	$6,421.50
Rate for Payer: Kaiser Permanente Medicaid	$3,638.85
Rate for Payer: Kaiser Permanente Medicare	$3,567.50
Rate for Payer: MDX Hawaii PPO	$6,920.95
Rate for Payer: Ohana Health Plan Medicaid	$3,567.50
Rate for Payer: Ohana Health Plan Medicare	$3,567.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,567.50
Rate for Payer: University Health Alliance Commercial	$5,160.40

CT Biopsy Lung/Mediastinum - Report

Professional

Both

$1,930.00

Service Code	HCPCS 32408
Hospital Charge Code	629785
Hospital Revenue Code	972
Min. Negotiated Rate	$127.97
Max. Negotiated Rate	$1,640.50
Rate for Payer: AlohaCare Medicaid	$148.55
Rate for Payer: AlohaCare Medicare	$127.97
Rate for Payer: Cash Price	$1,254.50
Rate for Payer: Cash Price	$1,254.50
Rate for Payer: Devoted Health Medicare	$140.77
Rate for Payer: Hawaii Medical Service Association ABD	$148.55
Rate for Payer: Hawaii Medical Service Association Commercial	$253.18
Rate for Payer: Hawaii Medical Service Association Medicare	$127.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$148.55
Rate for Payer: Hawaii Western Management Group Commercial	$1,086.28
Rate for Payer: Health Management Network Commercial	$1,640.50
Rate for Payer: Kaiser Permanente Commercial	$140.77
Rate for Payer: Kaiser Permanente Medicaid	$140.77
Rate for Payer: Kaiser Permanente Medicare	$140.77
Rate for Payer: Ohana Health Plan Medicaid	$148.55
Rate for Payer: Ohana Health Plan Medicare	$127.97
Rate for Payer: UnitedHealthcare Medicaid	$148.55
Rate for Payer: UnitedHealthcare Medicare	$127.97
Rate for Payer: University Health Alliance Commercial	$184.28

CT Biopsy Lymph Node

Facility

$3,181.00

Service Code	HCPCS 38505
Hospital Charge Code	2424728
Hospital Revenue Code	320
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$3,085.57
Rate for Payer: AlohaCare Medicaid	$1,590.50
Rate for Payer: AlohaCare Medicare	$1,590.50
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Devoted Health Medicare	$1,749.55
Rate for Payer: Hawaii Medical Service Association Commercial	$2,109.21
Rate for Payer: Hawaii Medical Service Association Medicare	$1,590.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,021.95
Rate for Payer: Health Management Network Commercial	$2,703.85
Rate for Payer: Humana Medicare	$1,590.50
Rate for Payer: Kaiser Permanente Commercial	$2,862.90
Rate for Payer: Kaiser Permanente Medicaid	$1,622.31
Rate for Payer: Kaiser Permanente Medicare	$1,590.50
Rate for Payer: MDX Hawaii PPO	$3,085.57
Rate for Payer: Ohana Health Plan Medicaid	$1,590.50
Rate for Payer: Ohana Health Plan Medicare	$1,590.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,590.50
Rate for Payer: University Health Alliance Commercial	$2,318.63

CT Biopsy Lymph Node

Facility

$3,181.00

Service Code	HCPCS 38505
Hospital Charge Code	2424728
Hospital Revenue Code	320
Min. Negotiated Rate	$2,703.85
Max. Negotiated Rate	$3,085.57
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Health Management Network Commercial	$2,703.85
Rate for Payer: Kaiser Permanente Commercial	$2,862.90
Rate for Payer: MDX Hawaii PPO	$3,085.57

CT Biopsy Renal

Facility

$3,171.00

Service Code	HCPCS 50200
Hospital Charge Code	1167931
Hospital Revenue Code	350
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$1,585.50
Rate for Payer: Cash Price	$2,061.15
Rate for Payer: Cash Price	$2,061.15
Rate for Payer: Devoted Health Medicare	$1,744.05
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	$1,585.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$3,012.45
Rate for Payer: Health Management Network Commercial	$2,695.35
Rate for Payer: Humana Medicare	$1,585.50
Rate for Payer: Kaiser Permanente Commercial	$2,853.90
Rate for Payer: Kaiser Permanente Medicaid	$1,617.21
Rate for Payer: Kaiser Permanente Medicare	$1,585.50
Rate for Payer: MDX Hawaii PPO	$3,075.87
Rate for Payer: Ohana Health Plan Medicaid	$1,585.50
Rate for Payer: Ohana Health Plan Medicare	$1,585.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,585.50
Rate for Payer: University Health Alliance Commercial	$2,311.34

Know your out-of-pocket cost for care.

All Charges