Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CT Drain Visceral Fluid w/Cath Perc

Facility

$1,234.00

Service Code	HCPCS 75989
Hospital Charge Code	1167986
Hospital Revenue Code	350
Min. Negotiated Rate	$1,048.90
Max. Negotiated Rate	$1,196.98
Rate for Payer: Cash Price	$802.10
Rate for Payer: Health Management Network Commercial	$1,048.90
Rate for Payer: Kaiser Permanente Commercial	$1,110.60
Rate for Payer: MDX Hawaii PPO	$1,196.98

CT Drain Visceral Fluid w/Cath Perc - Report

Professional

Both

$166.00

Service Code	HCPCS 75989 26
Hospital Charge Code	629819
Hospital Revenue Code	972
Min. Negotiated Rate	$55.10
Max. Negotiated Rate	$202.69
Rate for Payer: AlohaCare Medicaid	$72.05
Rate for Payer: AlohaCare Medicare	$55.10
Rate for Payer: Cash Price	$107.90
Rate for Payer: Cash Price	$107.90
Rate for Payer: Devoted Health Medicare	$60.61
Rate for Payer: Hawaii Medical Service Association Medicare	$55.10
Rate for Payer: Hawaii Western Management Group Commercial	$202.69
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$60.61
Rate for Payer: Kaiser Permanente Medicaid	$60.61
Rate for Payer: Kaiser Permanente Medicare	$60.61
Rate for Payer: Ohana Health Plan Medicaid	$72.05
Rate for Payer: Ohana Health Plan Medicare	$55.10
Rate for Payer: UnitedHealthcare Medicaid	$72.05
Rate for Payer: UnitedHealthcare Medicare	$55.10

CT Fine Needle Aspiration w/ Guidance

Facility

$2,665.00

Service Code	HCPCS 10009 TC
Hospital Charge Code	2424767
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,332.50
Rate for Payer: AlohaCare Medicare	$1,332.50
Rate for Payer: Cash Price	$1,732.25
Rate for Payer: Cash Price	$1,732.25
Rate for Payer: Devoted Health Medicare	$1,465.75
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	$1,332.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$2,265.25
Rate for Payer: Humana Medicare	$1,332.50
Rate for Payer: Kaiser Permanente Commercial	$2,398.50
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,332.50
Rate for Payer: MDX Hawaii PPO	$2,585.05
Rate for Payer: Ohana Health Plan Medicaid	$1,332.50
Rate for Payer: Ohana Health Plan Medicare	$1,332.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,332.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

CT Fine Needle Aspiration w/ Guidance

Facility

$2,665.00

Service Code	HCPCS 10009 TC
Hospital Charge Code	2424767
Hospital Revenue Code	361
Min. Negotiated Rate	$2,265.25
Max. Negotiated Rate	$2,585.05
Rate for Payer: Cash Price	$1,732.25
Rate for Payer: Health Management Network Commercial	$2,265.25
Rate for Payer: Kaiser Permanente Commercial	$2,398.50
Rate for Payer: MDX Hawaii PPO	$2,585.05

CT Fistula or Sinus Tract Abscess Study

Facility

$630.00

Service Code	HCPCS 76380
Hospital Charge Code	1168024
Hospital Revenue Code	350
Min. Negotiated Rate	$88.91
Max. Negotiated Rate	$611.10
Rate for Payer: AlohaCare Medicaid	$315.00
Rate for Payer: AlohaCare Medicare	$315.00
Rate for Payer: Cash Price	$409.50
Rate for Payer: Cash Price	$409.50
Rate for Payer: Devoted Health Medicare	$346.50
Rate for Payer: Hawaii Medical Service Association ABD	$115.11
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$315.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$125.04
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Humana Medicare	$315.00
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: Kaiser Permanente Medicare	$315.00
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: Ohana Health Plan Medicaid	$315.00
Rate for Payer: Ohana Health Plan Medicare	$315.00
Rate for Payer: UnitedHealthcare Medicaid	$115.11
Rate for Payer: UnitedHealthcare Medicare	$315.00
Rate for Payer: University Health Alliance Commercial	$297.96

CT Fistula or Sinus Tract Abscess Study

Facility

$630.00

Service Code	HCPCS 76380
Hospital Charge Code	1168024
Hospital Revenue Code	350
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$409.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: MDX Hawaii PPO	$611.10

CT Fistula or Sinus Tract Abscess Study - Report

Professional

Both

$180.00

Service Code	HCPCS 76380 26
Hospital Charge Code	629857
Hospital Revenue Code	972
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$207.33
Rate for Payer: AlohaCare Medicaid	$88.51
Rate for Payer: AlohaCare Medicare	$45.19
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Devoted Health Medicare	$49.71
Rate for Payer: Hawaii Medical Service Association Medicare	$45.19
Rate for Payer: Hawaii Western Management Group Commercial	$207.33
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Kaiser Permanente Commercial	$49.71
Rate for Payer: Kaiser Permanente Medicaid	$49.71
Rate for Payer: Kaiser Permanente Medicare	$49.71
Rate for Payer: Ohana Health Plan Medicaid	$88.51
Rate for Payer: Ohana Health Plan Medicare	$45.19
Rate for Payer: UnitedHealthcare Medicaid	$88.51
Rate for Payer: UnitedHealthcare Medicare	$45.19

CT Guided Abdominal Mass Biopsy

Facility

$3,181.00

Service Code	HCPCS 49180
Hospital Charge Code	8211698
Hospital Revenue Code	761
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 Guided Abdominal Mass Biopsy

Facility

$3,181.00

Service Code	HCPCS 49180
Hospital Charge Code	8211698
Hospital Revenue Code	761
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 GUIDED FNA 10022

Facility

$252.00

Service Code	HCPCS 10022
Hospital Charge Code	10060854
Hospital Revenue Code	975
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$126.00
Rate for Payer: AlohaCare Medicare	$126.00
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cash Price	$163.80
Rate for Payer: Devoted Health Medicare	$138.60
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	$126.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$239.40
Rate for Payer: Health Management Network Commercial	$214.20
Rate for Payer: Humana Medicare	$126.00
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: Kaiser Permanente Medicaid	$128.52
Rate for Payer: Kaiser Permanente Medicare	$126.00
Rate for Payer: MDX Hawaii PPO	$244.44
Rate for Payer: Ohana Health Plan Medicaid	$126.00
Rate for Payer: Ohana Health Plan Medicare	$126.00
Rate for Payer: UnitedHealthcare Medicare	$126.00
Rate for Payer: University Health Alliance Commercial	$183.68

CT GUIDED FNA 10022

Facility

$252.00

Service Code	HCPCS 10022
Hospital Charge Code	10060854
Hospital Revenue Code	975
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$244.44
Rate for Payer: Cash Price	$163.80
Rate for Payer: Health Management Network Commercial	$214.20
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: MDX Hawaii PPO	$244.44

CT Guided Needle Biopsy

Facility

$5,066.00

Service Code	HCPCS 77012
Hospital Charge Code	8269603
Hospital Revenue Code	350
Min. Negotiated Rate	$4,306.10
Max. Negotiated Rate	$4,914.02
Rate for Payer: Cash Price	$3,292.90
Rate for Payer: Health Management Network Commercial	$4,306.10
Rate for Payer: Kaiser Permanente Commercial	$4,559.40
Rate for Payer: MDX Hawaii PPO	$4,914.02

CT Guided Needle Biopsy

Facility

$5,066.00

Service Code	HCPCS 77012
Hospital Charge Code	8269603
Hospital Revenue Code	350
Min. Negotiated Rate	$205.11
Max. Negotiated Rate	$4,914.02
Rate for Payer: AlohaCare Medicaid	$2,533.00
Rate for Payer: AlohaCare Medicare	$2,533.00
Rate for Payer: Cash Price	$3,292.90
Rate for Payer: Cash Price	$3,292.90
Rate for Payer: Devoted Health Medicare	$2,786.30
Rate for Payer: Hawaii Medical Service Association ABD	$205.11
Rate for Payer: Hawaii Medical Service Association Medicare	$2,533.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$278.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,812.70
Rate for Payer: Health Management Network Commercial	$4,306.10
Rate for Payer: Humana Medicare	$2,533.00
Rate for Payer: Kaiser Permanente Commercial	$4,559.40
Rate for Payer: Kaiser Permanente Medicaid	$2,583.66
Rate for Payer: Kaiser Permanente Medicare	$2,533.00
Rate for Payer: MDX Hawaii PPO	$4,914.02
Rate for Payer: Ohana Health Plan Medicaid	$2,533.00
Rate for Payer: Ohana Health Plan Medicare	$2,533.00
Rate for Payer: UnitedHealthcare Medicaid	$205.11
Rate for Payer: UnitedHealthcare Medicare	$2,533.00
Rate for Payer: University Health Alliance Commercial	$535.82

CT Guided Needle Biopsy - Report

Professional

Both

$225.00

Service Code	HCPCS 77012 26
Hospital Charge Code	8269605
Hospital Revenue Code	972
Min. Negotiated Rate	$67.98
Max. Negotiated Rate	$349.73
Rate for Payer: AlohaCare Medicaid	$90.06
Rate for Payer: AlohaCare Medicare	$67.98
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Devoted Health Medicare	$74.78
Rate for Payer: Hawaii Medical Service Association Medicare	$67.98
Rate for Payer: Hawaii Western Management Group Commercial	$349.73
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$74.78
Rate for Payer: Kaiser Permanente Medicaid	$74.78
Rate for Payer: Kaiser Permanente Medicare	$74.78
Rate for Payer: Ohana Health Plan Medicaid	$90.06
Rate for Payer: Ohana Health Plan Medicare	$67.98
Rate for Payer: UnitedHealthcare Medicaid	$90.06
Rate for Payer: UnitedHealthcare Medicare	$67.98

CT Guided Needle Placement

Facility

$1,402.00

Service Code	HCPCS 77012
Hospital Charge Code	8211234
Hospital Revenue Code	350
Min. Negotiated Rate	$205.11
Max. Negotiated Rate	$1,359.94
Rate for Payer: AlohaCare Medicaid	$701.00
Rate for Payer: AlohaCare Medicare	$701.00
Rate for Payer: Cash Price	$911.30
Rate for Payer: Cash Price	$911.30
Rate for Payer: Devoted Health Medicare	$771.10
Rate for Payer: Hawaii Medical Service Association ABD	$205.11
Rate for Payer: Hawaii Medical Service Association Medicare	$701.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$278.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,331.90
Rate for Payer: Health Management Network Commercial	$1,191.70
Rate for Payer: Humana Medicare	$701.00
Rate for Payer: Kaiser Permanente Commercial	$1,261.80
Rate for Payer: Kaiser Permanente Medicaid	$715.02
Rate for Payer: Kaiser Permanente Medicare	$701.00
Rate for Payer: MDX Hawaii PPO	$1,359.94
Rate for Payer: Ohana Health Plan Medicaid	$701.00
Rate for Payer: Ohana Health Plan Medicare	$701.00
Rate for Payer: UnitedHealthcare Medicaid	$205.11
Rate for Payer: UnitedHealthcare Medicare	$701.00
Rate for Payer: University Health Alliance Commercial	$535.82

CT Guided Needle Placement

Facility

$1,402.00

Service Code	HCPCS 77012
Hospital Charge Code	8211234
Hospital Revenue Code	350
Min. Negotiated Rate	$1,191.70
Max. Negotiated Rate	$1,359.94
Rate for Payer: Cash Price	$911.30
Rate for Payer: Health Management Network Commercial	$1,191.70
Rate for Payer: Kaiser Permanente Commercial	$1,261.80
Rate for Payer: MDX Hawaii PPO	$1,359.94

CT Guided Needle Placement - Report

Professional

Both

$210.00

Service Code	HCPCS 77012 26
Hospital Charge Code	8211236
Hospital Revenue Code	972
Min. Negotiated Rate	$67.98
Max. Negotiated Rate	$349.73
Rate for Payer: AlohaCare Medicaid	$90.06
Rate for Payer: AlohaCare Medicare	$67.98
Rate for Payer: Cash Price	$136.50
Rate for Payer: Cash Price	$136.50
Rate for Payer: Devoted Health Medicare	$74.78
Rate for Payer: Hawaii Medical Service Association Medicare	$67.98
Rate for Payer: Hawaii Western Management Group Commercial	$349.73
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Kaiser Permanente Commercial	$74.78
Rate for Payer: Kaiser Permanente Medicaid	$74.78
Rate for Payer: Kaiser Permanente Medicare	$74.78
Rate for Payer: Ohana Health Plan Medicaid	$90.06
Rate for Payer: Ohana Health Plan Medicare	$67.98
Rate for Payer: UnitedHealthcare Medicaid	$90.06
Rate for Payer: UnitedHealthcare Medicare	$67.98

CT Heart Calcium Scoring

Facility

$443.00

Service Code	HCPCS 75571
Hospital Charge Code	2424345
Hospital Revenue Code	352
Min. Negotiated Rate	$376.55
Max. Negotiated Rate	$429.71
Rate for Payer: Cash Price	$287.95
Rate for Payer: Health Management Network Commercial	$376.55
Rate for Payer: Kaiser Permanente Commercial	$398.70
Rate for Payer: MDX Hawaii PPO	$429.71

CT Heart Calcium Scoring

Facility

$443.00

Service Code	HCPCS 75571
Hospital Charge Code	2424345
Hospital Revenue Code	352
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$429.71
Rate for Payer: AlohaCare Medicaid	$221.50
Rate for Payer: AlohaCare Medicare	$221.50
Rate for Payer: Cash Price	$287.95
Rate for Payer: Cash Price	$287.95
Rate for Payer: Devoted Health Medicare	$243.65
Rate for Payer: Hawaii Medical Service Association ABD	$31.36
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$221.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.09
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$376.55
Rate for Payer: Humana Medicare	$221.50
Rate for Payer: Kaiser Permanente Commercial	$398.70
Rate for Payer: Kaiser Permanente Medicaid	$225.93
Rate for Payer: Kaiser Permanente Medicare	$221.50
Rate for Payer: MDX Hawaii PPO	$429.71
Rate for Payer: Ohana Health Plan Medicaid	$221.50
Rate for Payer: Ohana Health Plan Medicare	$221.50
Rate for Payer: UnitedHealthcare Medicaid	$31.36
Rate for Payer: UnitedHealthcare Medicare	$221.50
Rate for Payer: University Health Alliance Commercial	$150.03

CT Heart Calcium Scoring

Professional

Both

$145.00

Service Code	HCPCS 75571
Hospital Charge Code	2424345
Hospital Revenue Code	972
Min. Negotiated Rate	$68.14
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$68.14
Rate for Payer: AlohaCare Medicare	$109.63
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$120.59
Rate for Payer: Hawaii Medical Service Association Medicare	$109.63
Rate for Payer: Hawaii Western Management Group Commercial	$84.48
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$120.59
Rate for Payer: Kaiser Permanente Medicaid	$120.59
Rate for Payer: Kaiser Permanente Medicare	$120.59
Rate for Payer: Ohana Health Plan Medicaid	$68.14
Rate for Payer: Ohana Health Plan Medicare	$109.63
Rate for Payer: UnitedHealthcare Medicaid	$68.14
Rate for Payer: UnitedHealthcare Medicare	$109.63

CT Introduction Catheter Renal Pelvis

Facility

$11,693.00

Service Code	HCPCS 50432
Hospital Charge Code	2424797
Hospital Revenue Code	350
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,342.21
Rate for Payer: AlohaCare Medicaid	$5,846.50
Rate for Payer: AlohaCare Medicare	$5,846.50
Rate for Payer: Cash Price	$7,600.45
Rate for Payer: Cash Price	$7,600.45
Rate for Payer: Devoted Health Medicare	$6,431.15
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,846.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Hawaii Western Management Group Commercial	$11,108.35
Rate for Payer: Health Management Network Commercial	$9,939.05
Rate for Payer: Humana Medicare	$5,846.50
Rate for Payer: Kaiser Permanente Commercial	$10,523.70
Rate for Payer: Kaiser Permanente Medicaid	$5,963.43
Rate for Payer: Kaiser Permanente Medicare	$5,846.50
Rate for Payer: MDX Hawaii PPO	$11,342.21
Rate for Payer: Ohana Health Plan Medicaid	$5,846.50
Rate for Payer: Ohana Health Plan Medicare	$5,846.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$5,846.50
Rate for Payer: University Health Alliance Commercial	$6,743.44

CT Introduction Catheter Renal Pelvis

Facility

$11,693.00

Service Code	HCPCS 50432
Hospital Charge Code	2424797
Hospital Revenue Code	350
Min. Negotiated Rate	$9,939.05
Max. Negotiated Rate	$11,342.21
Rate for Payer: Cash Price	$7,600.45
Rate for Payer: Health Management Network Commercial	$9,939.05
Rate for Payer: Kaiser Permanente Commercial	$10,523.70
Rate for Payer: MDX Hawaii PPO	$11,342.21

CT Introduction Catheter Renal Pelvis - Report

Professional

Both

$2,909.00

Service Code	HCPCS 50432 26
Hospital Charge Code	2424799
Hospital Revenue Code	972
Min. Negotiated Rate	$200.29
Max. Negotiated Rate	$2,472.65
Rate for Payer: AlohaCare Medicaid	$200.29
Rate for Payer: Cash Price	$1,890.85
Rate for Payer: Cash Price	$1,890.85
Rate for Payer: Hawaii Medical Service Association ABD	$200.29
Rate for Payer: Hawaii Medical Service Association Commercial	$349.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$200.29
Rate for Payer: Hawaii Western Management Group Commercial	$968.50
Rate for Payer: Health Management Network Commercial	$2,472.65
Rate for Payer: Ohana Health Plan Medicaid	$200.29
Rate for Payer: UnitedHealthcare Medicaid	$200.29

CT Lower Extremity w/ Contrast Left

Facility

$1,869.00

Service Code	HCPCS 73701 LT
Hospital Charge Code	1168166
Hospital Revenue Code	352
Min. Negotiated Rate	$1,588.65
Max. Negotiated Rate	$1,812.93
Rate for Payer: Cash Price	$1,214.85
Rate for Payer: Health Management Network Commercial	$1,588.65
Rate for Payer: Kaiser Permanente Commercial	$1,682.10
Rate for Payer: MDX Hawaii PPO	$1,812.93

CT Lower Extremity w/ Contrast Left

Facility

$1,869.00

Service Code	HCPCS 73701 LT
Hospital Charge Code	1168166
Hospital Revenue Code	352
Min. Negotiated Rate	$194.84
Max. Negotiated Rate	$1,812.93
Rate for Payer: AlohaCare Medicaid	$934.50
Rate for Payer: AlohaCare Medicare	$934.50
Rate for Payer: Cash Price	$1,214.85
Rate for Payer: Cash Price	$1,214.85
Rate for Payer: Devoted Health Medicare	$1,027.95
Rate for Payer: Hawaii Medical Service Association ABD	$194.84
Rate for Payer: Hawaii Medical Service Association Medicare	$934.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$211.43
Rate for Payer: Hawaii Western Management Group Commercial	$1,775.55
Rate for Payer: Health Management Network Commercial	$1,588.65
Rate for Payer: Humana Medicare	$934.50
Rate for Payer: Kaiser Permanente Commercial	$1,682.10
Rate for Payer: Kaiser Permanente Medicaid	$953.19
Rate for Payer: Kaiser Permanente Medicare	$934.50
Rate for Payer: MDX Hawaii PPO	$1,812.93
Rate for Payer: Ohana Health Plan Medicaid	$934.50
Rate for Payer: Ohana Health Plan Medicare	$934.50
Rate for Payer: UnitedHealthcare Medicaid	$194.84
Rate for Payer: UnitedHealthcare Medicare	$934.50
Rate for Payer: University Health Alliance Commercial	$662.37

Know your out-of-pocket cost for care.

All Charges