Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (DIP + PIP extension; M)

Facility

$195.00

Service Code	HCPCS L3925
Hospital Charge Code	13358969
Hospital Revenue Code	274
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$126.75
Rate for Payer: Hawaii Western Management Group Commercial	$136.50
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: University Health Alliance Commercial	$109.20

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (DIP + PIP extension; M)

Facility

$195.00

Service Code	HCPCS L3925
Hospital Charge Code	13358969
Hospital Revenue Code	274
Min. Negotiated Rate	$51.93
Max. Negotiated Rate	$189.15
Rate for Payer: AlohaCare Medicaid	$97.50
Rate for Payer: AlohaCare Medicare	$97.50
Rate for Payer: Cash Price	$126.75
Rate for Payer: Cash Price	$126.75
Rate for Payer: Devoted Health Medicare	$107.25
Rate for Payer: Hawaii Medical Service Association Medicare	$97.50
Rate for Payer: Hawaii Western Management Group Commercial	$136.50
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Humana Medicare	$97.50
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: Kaiser Permanente Medicare	$97.50
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: Ohana Health Plan Medicaid	$97.50
Rate for Payer: Ohana Health Plan Medicare	$97.50
Rate for Payer: UnitedHealthcare Medicaid	$51.93
Rate for Payer: UnitedHealthcare Medicare	$97.50
Rate for Payer: University Health Alliance Commercial	$109.20

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (DIP + PIP extension; S)

Facility

$195.00

Service Code	HCPCS L3925
Hospital Charge Code	13358961
Hospital Revenue Code	274
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$126.75
Rate for Payer: Hawaii Western Management Group Commercial	$136.50
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: University Health Alliance Commercial	$109.20

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (DIP + PIP extension; S)

Facility

$195.00

Service Code	HCPCS L3925
Hospital Charge Code	13358961
Hospital Revenue Code	274
Min. Negotiated Rate	$51.93
Max. Negotiated Rate	$189.15
Rate for Payer: AlohaCare Medicaid	$97.50
Rate for Payer: AlohaCare Medicare	$97.50
Rate for Payer: Cash Price	$126.75
Rate for Payer: Cash Price	$126.75
Rate for Payer: Devoted Health Medicare	$107.25
Rate for Payer: Hawaii Medical Service Association Medicare	$97.50
Rate for Payer: Hawaii Western Management Group Commercial	$136.50
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Humana Medicare	$97.50
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: Kaiser Permanente Medicare	$97.50
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: Ohana Health Plan Medicaid	$97.50
Rate for Payer: Ohana Health Plan Medicare	$97.50
Rate for Payer: UnitedHealthcare Medicaid	$51.93
Rate for Payer: UnitedHealthcare Medicare	$97.50
Rate for Payer: University Health Alliance Commercial	$109.20

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (PIP extension; A)

Facility

$130.00

Service Code	HCPCS L3925
Hospital Charge Code	13358971
Hospital Revenue Code	274
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$84.50
Rate for Payer: Hawaii Western Management Group Commercial	$91.00
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: University Health Alliance Commercial	$72.80

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (PIP extension; A)

Facility

$130.00

Service Code	HCPCS L3925
Hospital Charge Code	13358971
Hospital Revenue Code	274
Min. Negotiated Rate	$51.93
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$65.00
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Devoted Health Medicare	$71.50
Rate for Payer: Hawaii Medical Service Association Medicare	$65.00
Rate for Payer: Hawaii Western Management Group Commercial	$91.00
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$65.00
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$65.00
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$65.00
Rate for Payer: Ohana Health Plan Medicare	$65.00
Rate for Payer: UnitedHealthcare Medicaid	$51.93
Rate for Payer: UnitedHealthcare Medicare	$65.00
Rate for Payer: University Health Alliance Commercial	$72.80

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (PIP extension; AA)

Facility

$136.00

Service Code	HCPCS L3925
Hospital Charge Code	13358966
Hospital Revenue Code	274
Min. Negotiated Rate	$76.16
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$88.40
Rate for Payer: Hawaii Western Management Group Commercial	$95.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: University Health Alliance Commercial	$76.16

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (PIP extension; AA)

Facility

$136.00

Service Code	HCPCS L3925
Hospital Charge Code	13358966
Hospital Revenue Code	274
Min. Negotiated Rate	$51.93
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$68.00
Rate for Payer: Cash Price	$88.40
Rate for Payer: Cash Price	$88.40
Rate for Payer: Devoted Health Medicare	$74.80
Rate for Payer: Hawaii Medical Service Association Medicare	$68.00
Rate for Payer: Hawaii Western Management Group Commercial	$95.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$68.00
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$68.00
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$68.00
Rate for Payer: Ohana Health Plan Medicare	$68.00
Rate for Payer: UnitedHealthcare Medicaid	$51.93
Rate for Payer: UnitedHealthcare Medicare	$68.00
Rate for Payer: University Health Alliance Commercial	$76.16

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (PIP extension; B)

Facility

$136.00

Service Code	HCPCS L3925
Hospital Charge Code	13358967
Hospital Revenue Code	274
Min. Negotiated Rate	$51.93
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$68.00
Rate for Payer: Cash Price	$88.40
Rate for Payer: Cash Price	$88.40
Rate for Payer: Devoted Health Medicare	$74.80
Rate for Payer: Hawaii Medical Service Association Medicare	$68.00
Rate for Payer: Hawaii Western Management Group Commercial	$95.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$68.00
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$68.00
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$68.00
Rate for Payer: Ohana Health Plan Medicare	$68.00
Rate for Payer: UnitedHealthcare Medicaid	$51.93
Rate for Payer: UnitedHealthcare Medicare	$68.00
Rate for Payer: University Health Alliance Commercial	$76.16

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (PIP extension; B)

Facility

$136.00

Service Code	HCPCS L3925
Hospital Charge Code	13358967
Hospital Revenue Code	274
Min. Negotiated Rate	$76.16
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$88.40
Rate for Payer: Hawaii Western Management Group Commercial	$95.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: University Health Alliance Commercial	$76.16

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (PIP extension; C)

Facility

$136.00

Service Code	HCPCS L3925
Hospital Charge Code	13358972
Hospital Revenue Code	274
Min. Negotiated Rate	$76.16
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$88.40
Rate for Payer: Hawaii Western Management Group Commercial	$95.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: University Health Alliance Commercial	$76.16

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (PIP extension; C)

Facility

$136.00

Service Code	HCPCS L3925
Hospital Charge Code	13358972
Hospital Revenue Code	274
Min. Negotiated Rate	$51.93
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$68.00
Rate for Payer: Cash Price	$88.40
Rate for Payer: Cash Price	$88.40
Rate for Payer: Devoted Health Medicare	$74.80
Rate for Payer: Hawaii Medical Service Association Medicare	$68.00
Rate for Payer: Hawaii Western Management Group Commercial	$95.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$68.00
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$68.00
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$68.00
Rate for Payer: Ohana Health Plan Medicare	$68.00
Rate for Payer: UnitedHealthcare Medicaid	$51.93
Rate for Payer: UnitedHealthcare Medicare	$68.00
Rate for Payer: University Health Alliance Commercial	$76.16

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (PIP extension; D)

Facility

$136.00

Service Code	HCPCS L3925
Hospital Charge Code	13358968
Hospital Revenue Code	274
Min. Negotiated Rate	$76.16
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$88.40
Rate for Payer: Hawaii Western Management Group Commercial	$95.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: University Health Alliance Commercial	$76.16

Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (PIP extension; D)

Facility

$136.00

Service Code	HCPCS L3925
Hospital Charge Code	13358968
Hospital Revenue Code	274
Min. Negotiated Rate	$51.93
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$68.00
Rate for Payer: Cash Price	$88.40
Rate for Payer: Cash Price	$88.40
Rate for Payer: Devoted Health Medicare	$74.80
Rate for Payer: Hawaii Medical Service Association Medicare	$68.00
Rate for Payer: Hawaii Western Management Group Commercial	$95.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$68.00
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$68.00
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$68.00
Rate for Payer: Ohana Health Plan Medicare	$68.00
Rate for Payer: UnitedHealthcare Medicaid	$51.93
Rate for Payer: UnitedHealthcare Medicare	$68.00
Rate for Payer: University Health Alliance Commercial	$76.16

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 10)

Facility

$66.00

Service Code	HCPCS L3927
Hospital Charge Code	13369811
Hospital Revenue Code	274
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$33.00
Rate for Payer: Cash Price	$42.90
Rate for Payer: Devoted Health Medicare	$36.30
Rate for Payer: Hawaii Medical Service Association Medicare	$33.00
Rate for Payer: Hawaii Western Management Group Commercial	$46.20
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$33.00
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$33.00
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$33.00
Rate for Payer: Ohana Health Plan Medicare	$33.00
Rate for Payer: UnitedHealthcare Medicare	$33.00
Rate for Payer: University Health Alliance Commercial	$36.96

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 10)

Facility

$66.00

Service Code	HCPCS L3927
Hospital Charge Code	13369811
Hospital Revenue Code	274
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$42.90
Rate for Payer: Hawaii Western Management Group Commercial	$46.20
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: University Health Alliance Commercial	$36.96

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 11)

Facility

$66.00

Service Code	HCPCS L3927
Hospital Charge Code	13371696
Hospital Revenue Code	274
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$33.00
Rate for Payer: Cash Price	$42.90
Rate for Payer: Devoted Health Medicare	$36.30
Rate for Payer: Hawaii Medical Service Association Medicare	$33.00
Rate for Payer: Hawaii Western Management Group Commercial	$46.20
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$33.00
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$33.00
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$33.00
Rate for Payer: Ohana Health Plan Medicare	$33.00
Rate for Payer: UnitedHealthcare Medicare	$33.00
Rate for Payer: University Health Alliance Commercial	$36.96

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 11)

Facility

$66.00

Service Code	HCPCS L3927
Hospital Charge Code	13371696
Hospital Revenue Code	274
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$42.90
Rate for Payer: Hawaii Western Management Group Commercial	$46.20
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: University Health Alliance Commercial	$36.96

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 12)

Facility

$66.00

Service Code	HCPCS L3927
Hospital Charge Code	13371695
Hospital Revenue Code	274
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$33.00
Rate for Payer: Cash Price	$42.90
Rate for Payer: Devoted Health Medicare	$36.30
Rate for Payer: Hawaii Medical Service Association Medicare	$33.00
Rate for Payer: Hawaii Western Management Group Commercial	$46.20
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$33.00
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$33.00
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$33.00
Rate for Payer: Ohana Health Plan Medicare	$33.00
Rate for Payer: UnitedHealthcare Medicare	$33.00
Rate for Payer: University Health Alliance Commercial	$36.96

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 12)

Facility

$66.00

Service Code	HCPCS L3927
Hospital Charge Code	13371695
Hospital Revenue Code	274
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$42.90
Rate for Payer: Hawaii Western Management Group Commercial	$46.20
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: University Health Alliance Commercial	$36.96

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 13)

Facility

$131.00

Service Code	HCPCS L3927
Hospital Charge Code	13369310
Hospital Revenue Code	274
Min. Negotiated Rate	$65.50
Max. Negotiated Rate	$127.07
Rate for Payer: AlohaCare Medicaid	$65.50
Rate for Payer: AlohaCare Medicare	$65.50
Rate for Payer: Cash Price	$85.15
Rate for Payer: Devoted Health Medicare	$72.05
Rate for Payer: Hawaii Medical Service Association Medicare	$65.50
Rate for Payer: Hawaii Western Management Group Commercial	$91.70
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$65.50
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$65.50
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$65.50
Rate for Payer: Ohana Health Plan Medicare	$65.50
Rate for Payer: UnitedHealthcare Medicare	$65.50
Rate for Payer: University Health Alliance Commercial	$73.36

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 13)

Facility

$131.00

Service Code	HCPCS L3927
Hospital Charge Code	13369310
Hospital Revenue Code	274
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$85.15
Rate for Payer: Hawaii Western Management Group Commercial	$91.70
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: University Health Alliance Commercial	$73.36

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 14)

Facility

$131.00

Service Code	HCPCS L3927
Hospital Charge Code	13381763
Hospital Revenue Code	274
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$85.15
Rate for Payer: Hawaii Western Management Group Commercial	$91.70
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: University Health Alliance Commercial	$73.36

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 14)

Facility

$131.00

Service Code	HCPCS L3927
Hospital Charge Code	13381763
Hospital Revenue Code	274
Min. Negotiated Rate	$65.50
Max. Negotiated Rate	$127.07
Rate for Payer: AlohaCare Medicaid	$65.50
Rate for Payer: AlohaCare Medicare	$65.50
Rate for Payer: Cash Price	$85.15
Rate for Payer: Devoted Health Medicare	$72.05
Rate for Payer: Hawaii Medical Service Association Medicare	$65.50
Rate for Payer: Hawaii Western Management Group Commercial	$91.70
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$65.50
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$65.50
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$65.50
Rate for Payer: Ohana Health Plan Medicare	$65.50
Rate for Payer: UnitedHealthcare Medicare	$65.50
Rate for Payer: University Health Alliance Commercial	$73.36

Finger Orthosis, DIP, PIP, w/o Joint/spring, Prefab, OTS (oval - 8; 15)

Facility

$131.00

Service Code	HCPCS L3927
Hospital Charge Code	13381760
Hospital Revenue Code	274
Min. Negotiated Rate	$65.50
Max. Negotiated Rate	$127.07
Rate for Payer: AlohaCare Medicaid	$65.50
Rate for Payer: AlohaCare Medicare	$65.50
Rate for Payer: Cash Price	$85.15
Rate for Payer: Devoted Health Medicare	$72.05
Rate for Payer: Hawaii Medical Service Association Medicare	$65.50
Rate for Payer: Hawaii Western Management Group Commercial	$91.70
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$65.50
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$65.50
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$65.50
Rate for Payer: Ohana Health Plan Medicare	$65.50
Rate for Payer: UnitedHealthcare Medicare	$65.50
Rate for Payer: University Health Alliance Commercial	$73.36

Know your out-of-pocket cost for care.

All Charges