Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Culture, AFB with Smear, CSF FSI

Facility

$80.00

Service Code	HCPCS 87206
Hospital Charge Code	8228830
Hospital Revenue Code	306
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$40.00
Rate for Payer: AlohaCare Medicare	$40.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Devoted Health Medicare	$44.00
Rate for Payer: Hawaii Medical Service Association ABD	$7.42
Rate for Payer: Hawaii Medical Service Association Commercial	$6.74
Rate for Payer: Hawaii Medical Service Association Medicare	$40.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.79
Rate for Payer: Hawaii Western Management Group Commercial	$5.39
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$40.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$40.00
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$40.00
Rate for Payer: Ohana Health Plan Medicare	$40.00
Rate for Payer: UnitedHealthcare Medicaid	$7.42
Rate for Payer: UnitedHealthcare Medicare	$40.00
Rate for Payer: University Health Alliance Commercial	$13.88

Culture, AFB with Smear, CSF FSI

Facility

$80.00

Service Code	HCPCS 87206
Hospital Charge Code	8228830
Hospital Revenue Code	306
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: MDX Hawaii PPO	$77.60

Culture, AFB with Smear FSI

Facility

$102.00

Service Code	HCPCS 87015
Hospital Charge Code	8228829
Hospital Revenue Code	306
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$66.30
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$98.94

Culture, AFB with Smear FSI

Facility

$102.00

Service Code	HCPCS 87015
Hospital Charge Code	8228829
Hospital Revenue Code	306
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$98.94
Rate for Payer: AlohaCare Medicaid	$51.00
Rate for Payer: AlohaCare Medicare	$51.00
Rate for Payer: Cash Price	$66.30
Rate for Payer: Cash Price	$66.30
Rate for Payer: Devoted Health Medicare	$56.10
Rate for Payer: Hawaii Medical Service Association ABD	$9.23
Rate for Payer: Hawaii Medical Service Association Commercial	$8.35
Rate for Payer: Hawaii Medical Service Association Medicare	$51.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.69
Rate for Payer: Hawaii Western Management Group Commercial	$6.68
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Humana Medicare	$51.00
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: Kaiser Permanente Medicare	$51.00
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: Ohana Health Plan Medicaid	$51.00
Rate for Payer: Ohana Health Plan Medicare	$51.00
Rate for Payer: UnitedHealthcare Medicaid	$9.23
Rate for Payer: UnitedHealthcare Medicare	$51.00
Rate for Payer: University Health Alliance Commercial	$17.26

Culture, AFB with Smear, Rfx TB RNA FSI

Facility

$115.00

Service Code	HCPCS 87116
Hospital Charge Code	8228831
Hospital Revenue Code	306
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$111.55
Rate for Payer: AlohaCare Medicaid	$57.50
Rate for Payer: AlohaCare Medicare	$57.50
Rate for Payer: Cash Price	$74.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Devoted Health Medicare	$63.25
Rate for Payer: Hawaii Medical Service Association ABD	$13.63
Rate for Payer: Hawaii Medical Service Association Commercial	$13.50
Rate for Payer: Hawaii Medical Service Association Medicare	$57.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.31
Rate for Payer: Hawaii Western Management Group Commercial	$10.80
Rate for Payer: Health Management Network Commercial	$97.75
Rate for Payer: Humana Medicare	$57.50
Rate for Payer: Kaiser Permanente Commercial	$103.50
Rate for Payer: Kaiser Permanente Medicaid	$58.65
Rate for Payer: Kaiser Permanente Medicare	$57.50
Rate for Payer: MDX Hawaii PPO	$111.55
Rate for Payer: Ohana Health Plan Medicaid	$57.50
Rate for Payer: Ohana Health Plan Medicare	$57.50
Rate for Payer: UnitedHealthcare Medicaid	$13.63
Rate for Payer: UnitedHealthcare Medicare	$57.50
Rate for Payer: University Health Alliance Commercial	$25.49

Culture, AFB with Smear, Rfx TB RNA FSI

Facility

$115.00

Service Code	HCPCS 87116
Hospital Charge Code	8228831
Hospital Revenue Code	306
Min. Negotiated Rate	$97.75
Max. Negotiated Rate	$111.55
Rate for Payer: Cash Price	$74.75
Rate for Payer: Health Management Network Commercial	$97.75
Rate for Payer: Kaiser Permanente Commercial	$103.50
Rate for Payer: MDX Hawaii PPO	$111.55

Culture, Anaerobic FSI

Facility

$137.00

Service Code	HCPCS 87075
Hospital Charge Code	8228838
Hospital Revenue Code	306
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$68.50
Rate for Payer: AlohaCare Medicare	$68.50
Rate for Payer: Cash Price	$89.05
Rate for Payer: Cash Price	$89.05
Rate for Payer: Devoted Health Medicare	$75.35
Rate for Payer: Hawaii Medical Service Association ABD	$13.08
Rate for Payer: Hawaii Medical Service Association Commercial	$11.84
Rate for Payer: Hawaii Medical Service Association Medicare	$68.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.73
Rate for Payer: Hawaii Western Management Group Commercial	$9.47
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$68.50
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$68.50
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$68.50
Rate for Payer: Ohana Health Plan Medicare	$68.50
Rate for Payer: UnitedHealthcare Medicaid	$13.08
Rate for Payer: UnitedHealthcare Medicare	$68.50
Rate for Payer: University Health Alliance Commercial	$24.46

Culture, Anaerobic FSI

Facility

$137.00

Service Code	HCPCS 87075
Hospital Charge Code	8228838
Hospital Revenue Code	306
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$89.05
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: MDX Hawaii PPO	$132.89

Culture, Beta Strep Throat Screen FSI

Facility

$90.00

Service Code	HCPCS 87081
Hospital Charge Code	8228841
Hospital Revenue Code	306
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$58.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

Culture, Beta Strep Throat Screen FSI

Facility

$90.00

Service Code	HCPCS 87081
Hospital Charge Code	8228841
Hospital Revenue Code	306
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$45.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$49.50
Rate for Payer: Hawaii Medical Service Association ABD	$9.16
Rate for Payer: Hawaii Medical Service Association Commercial	$8.29
Rate for Payer: Hawaii Medical Service Association Medicare	$45.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.62
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$45.00
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$45.00
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$45.00
Rate for Payer: Ohana Health Plan Medicare	$45.00
Rate for Payer: UnitedHealthcare Medicaid	$9.16
Rate for Payer: UnitedHealthcare Medicare	$45.00
Rate for Payer: University Health Alliance Commercial	$17.13

Culture, Cath Tip FSI

Facility

$127.00

Service Code	HCPCS 87070
Hospital Charge Code	8228849
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$63.50
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Devoted Health Medicare	$69.85
Rate for Payer: Hawaii Medical Service Association ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$63.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$63.50
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$63.50
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$63.50
Rate for Payer: Ohana Health Plan Medicare	$63.50
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$63.50
Rate for Payer: University Health Alliance Commercial	$22.26

Culture, Cath Tip FSI

Facility

$127.00

Service Code	HCPCS 87070
Hospital Charge Code	8228849
Hospital Revenue Code	306
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

Culture, CSF FSI

Facility

$86.00

Service Code	HCPCS 87070
Hospital Charge Code	8416046
Hospital Revenue Code	300
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Culture, CSF FSI

Facility

$86.00

Service Code	HCPCS 87070
Hospital Charge Code	8416046
Hospital Revenue Code	300
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$22.26

Culture, CSF REF

Facility

$127.00

Service Code	HCPCS 87070
Hospital Charge Code	8159897
Hospital Revenue Code	306
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

Culture, CSF REF

Facility

$127.00

Service Code	HCPCS 87070
Hospital Charge Code	8159897
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$63.50
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Devoted Health Medicare	$69.85
Rate for Payer: Hawaii Medical Service Association ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$63.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$63.50
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$63.50
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$63.50
Rate for Payer: Ohana Health Plan Medicare	$63.50
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$63.50
Rate for Payer: University Health Alliance Commercial	$22.26

Culture, Gonorrhea GC FSI

Facility

$90.00

Service Code	HCPCS 87081
Hospital Charge Code	8228873
Hospital Revenue Code	306
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$58.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

Culture, Gonorrhea GC FSI

Facility

$90.00

Service Code	HCPCS 87081
Hospital Charge Code	8228873
Hospital Revenue Code	306
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$45.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$49.50
Rate for Payer: Hawaii Medical Service Association ABD	$9.16
Rate for Payer: Hawaii Medical Service Association Commercial	$8.29
Rate for Payer: Hawaii Medical Service Association Medicare	$45.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.62
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$45.00
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$45.00
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$45.00
Rate for Payer: Ohana Health Plan Medicare	$45.00
Rate for Payer: UnitedHealthcare Medicaid	$9.16
Rate for Payer: UnitedHealthcare Medicare	$45.00
Rate for Payer: University Health Alliance Commercial	$17.13

Culture, Group A Strep Ag Rapid Rfx FSI

Facility

$139.00

Service Code	HCPCS 87880 QW
Hospital Charge Code	8228875
Hospital Revenue Code	306
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$69.50
Rate for Payer: Cash Price	$90.35
Rate for Payer: Cash Price	$90.35
Rate for Payer: Devoted Health Medicare	$76.45
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.66
Rate for Payer: Hawaii Medical Service Association Medicare	$69.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.53
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$69.50
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$69.50
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$69.50
Rate for Payer: Ohana Health Plan Medicare	$69.50
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$69.50
Rate for Payer: University Health Alliance Commercial	$31.01

Culture, Group A Strep Ag Rapid Rfx FSI

Facility

$139.00

Service Code	HCPCS 87880 QW
Hospital Charge Code	8228875
Hospital Revenue Code	306
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$90.35
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

Culture, Methicillin Resistant Staph Aureus (MRSA) FSI

Facility

$90.00

Service Code	HCPCS 87081
Hospital Charge Code	8228896
Hospital Revenue Code	306
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$58.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

Culture, Methicillin Resistant Staph Aureus (MRSA) FSI

Facility

$90.00

Service Code	HCPCS 87081
Hospital Charge Code	8228896
Hospital Revenue Code	306
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$45.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$49.50
Rate for Payer: Hawaii Medical Service Association ABD	$9.16
Rate for Payer: Hawaii Medical Service Association Commercial	$8.29
Rate for Payer: Hawaii Medical Service Association Medicare	$45.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.62
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$45.00
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$45.00
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$45.00
Rate for Payer: Ohana Health Plan Medicare	$45.00
Rate for Payer: UnitedHealthcare Medicaid	$9.16
Rate for Payer: UnitedHealthcare Medicare	$45.00
Rate for Payer: University Health Alliance Commercial	$17.13

Culture, Nasal FSI

Facility

$127.00

Service Code	HCPCS 87070
Hospital Charge Code	8228901
Hospital Revenue Code	306
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

Culture, Nasal FSI

Facility

$127.00

Service Code	HCPCS 87070
Hospital Charge Code	8228901
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$63.50
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Devoted Health Medicare	$69.85
Rate for Payer: Hawaii Medical Service Association ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$63.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$63.50
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$63.50
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$63.50
Rate for Payer: Ohana Health Plan Medicare	$63.50
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$63.50
Rate for Payer: University Health Alliance Commercial	$22.26

Culture, Pertussis FSI

Facility

$90.00

Service Code	HCPCS 87081
Hospital Charge Code	8228906
Hospital Revenue Code	306
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$45.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$49.50
Rate for Payer: Hawaii Medical Service Association ABD	$9.16
Rate for Payer: Hawaii Medical Service Association Commercial	$8.29
Rate for Payer: Hawaii Medical Service Association Medicare	$45.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.62
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$45.00
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$45.00
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$45.00
Rate for Payer: Ohana Health Plan Medicare	$45.00
Rate for Payer: UnitedHealthcare Medicaid	$9.16
Rate for Payer: UnitedHealthcare Medicare	$45.00
Rate for Payer: University Health Alliance Commercial	$17.13

Know your out-of-pocket cost for care.

All Charges