Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Ident, Anaerobic Isol, 4

Facility

$213.00

Service Code	HCPCS 87076
Hospital Charge Code	12540203
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$206.61
Rate for Payer: AlohaCare Medicaid	$106.50
Rate for Payer: AlohaCare Medicare	$106.50
Rate for Payer: Cash Price	$138.45
Rate for Payer: Cash Price	$138.45
Rate for Payer: Devoted Health Medicare	$117.15
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$106.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.95
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Humana Medicare	$106.50
Rate for Payer: Kaiser Permanente Commercial	$191.70
Rate for Payer: Kaiser Permanente Medicaid	$108.63
Rate for Payer: Kaiser Permanente Medicare	$106.50
Rate for Payer: MDX Hawaii PPO	$206.61
Rate for Payer: Ohana Health Plan Medicaid	$106.50
Rate for Payer: Ohana Health Plan Medicare	$106.50
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$106.50
Rate for Payer: University Health Alliance Commercial	$20.89

Ident, Anaerobic Isol, 6

Facility

$317.00

Service Code	HCPCS 87076
Hospital Charge Code	12539001
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$307.49
Rate for Payer: AlohaCare Medicaid	$158.50
Rate for Payer: AlohaCare Medicare	$158.50
Rate for Payer: Cash Price	$206.05
Rate for Payer: Cash Price	$206.05
Rate for Payer: Devoted Health Medicare	$174.35
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$158.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.95
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Humana Medicare	$158.50
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: Kaiser Permanente Medicaid	$161.67
Rate for Payer: Kaiser Permanente Medicare	$158.50
Rate for Payer: MDX Hawaii PPO	$307.49
Rate for Payer: Ohana Health Plan Medicaid	$158.50
Rate for Payer: Ohana Health Plan Medicare	$158.50
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$158.50
Rate for Payer: University Health Alliance Commercial	$20.89

Ident, Anaerobic Isol, 6

Facility

$317.00

Service Code	HCPCS 87076
Hospital Charge Code	12539001
Hospital Revenue Code	306
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$307.49
Rate for Payer: Cash Price	$206.05
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: MDX Hawaii PPO	$307.49

IGF1 w/ Calc Z-Score FSI

Facility

$242.00

Service Code	HCPCS 84305
Hospital Charge Code	8846615
Hospital Revenue Code	300
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$234.74
Rate for Payer: Cash Price	$157.30
Rate for Payer: Health Management Network Commercial	$205.70
Rate for Payer: Kaiser Permanente Commercial	$217.80
Rate for Payer: MDX Hawaii PPO	$234.74

IGF1 w/ Calc Z-Score FSI

Facility

$242.00

Service Code	HCPCS 84305
Hospital Charge Code	8846615
Hospital Revenue Code	300
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$234.74
Rate for Payer: AlohaCare Medicaid	$121.00
Rate for Payer: AlohaCare Medicare	$121.00
Rate for Payer: Cash Price	$157.30
Rate for Payer: Cash Price	$157.30
Rate for Payer: Devoted Health Medicare	$133.10
Rate for Payer: Hawaii Medical Service Association ABD	$29.38
Rate for Payer: Hawaii Medical Service Association Commercial	$26.57
Rate for Payer: Hawaii Medical Service Association Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.85
Rate for Payer: Hawaii Western Management Group Commercial	$21.26
Rate for Payer: Health Management Network Commercial	$205.70
Rate for Payer: Humana Medicare	$121.00
Rate for Payer: Kaiser Permanente Commercial	$217.80
Rate for Payer: Kaiser Permanente Medicaid	$123.42
Rate for Payer: Kaiser Permanente Medicare	$121.00
Rate for Payer: MDX Hawaii PPO	$234.74
Rate for Payer: Ohana Health Plan Medicaid	$121.00
Rate for Payer: Ohana Health Plan Medicare	$121.00
Rate for Payer: UnitedHealthcare Medicaid	$29.38
Rate for Payer: UnitedHealthcare Medicare	$121.00
Rate for Payer: University Health Alliance Commercial	$54.95

IMMOBILIZER SHOULDER ELASTIC FEMALE LARGE

Facility

$36.00

Service Code	HCPCS L3650
Hospital Charge Code	8266983
Hospital Revenue Code	274
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$41.53
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: AlohaCare Medicare	$18.00
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$19.80
Rate for Payer: Hawaii Medical Service Association Medicare	$18.00
Rate for Payer: Hawaii Western Management Group Commercial	$25.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$18.00
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$18.00
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$18.00
Rate for Payer: Ohana Health Plan Medicare	$18.00
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: UnitedHealthcare Medicare	$18.00
Rate for Payer: University Health Alliance Commercial	$20.16

IMMOBILIZER SHOULDER ELASTIC FEMALE LARGE

Facility

$36.00

Service Code	HCPCS L3650
Hospital Charge Code	8266983
Hospital Revenue Code	274
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$23.40
Rate for Payer: Hawaii Western Management Group Commercial	$25.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: University Health Alliance Commercial	$20.16

IMMOBILIZER SHOULDER ELASTIC FEMALE MEDIUM

Facility

$44.00

Service Code	HCPCS L3650
Hospital Charge Code	8266994
Hospital Revenue Code	274
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$42.68
Rate for Payer: AlohaCare Medicaid	$22.00
Rate for Payer: AlohaCare Medicare	$22.00
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Devoted Health Medicare	$24.20
Rate for Payer: Hawaii Medical Service Association Medicare	$22.00
Rate for Payer: Hawaii Western Management Group Commercial	$30.80
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Humana Medicare	$22.00
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: Kaiser Permanente Medicare	$22.00
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: Ohana Health Plan Medicaid	$22.00
Rate for Payer: Ohana Health Plan Medicare	$22.00
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: UnitedHealthcare Medicare	$22.00
Rate for Payer: University Health Alliance Commercial	$24.64

IMMOBILIZER SHOULDER ELASTIC FEMALE MEDIUM

Facility

$44.00

Service Code	HCPCS L3650
Hospital Charge Code	8266994
Hospital Revenue Code	274
Min. Negotiated Rate	$24.64
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$28.60
Rate for Payer: Hawaii Western Management Group Commercial	$30.80
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: University Health Alliance Commercial	$24.64

IMMOBILIZER SHOULDER ELASTIC FEMALE SMALL

Facility

$41.00

Service Code	HCPCS L3650
Hospital Charge Code	8266667
Hospital Revenue Code	274
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$26.65
Rate for Payer: Hawaii Western Management Group Commercial	$28.70
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: University Health Alliance Commercial	$22.96

IMMOBILIZER SHOULDER ELASTIC FEMALE SMALL

Facility

$41.00

Service Code	HCPCS L3650
Hospital Charge Code	8266667
Hospital Revenue Code	274
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$41.53
Rate for Payer: AlohaCare Medicaid	$20.50
Rate for Payer: AlohaCare Medicare	$20.50
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Devoted Health Medicare	$22.55
Rate for Payer: Hawaii Medical Service Association Medicare	$20.50
Rate for Payer: Hawaii Western Management Group Commercial	$28.70
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Humana Medicare	$20.50
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$20.50
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: Ohana Health Plan Medicaid	$20.50
Rate for Payer: Ohana Health Plan Medicare	$20.50
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: UnitedHealthcare Medicare	$20.50
Rate for Payer: University Health Alliance Commercial	$22.96

IMMOBILIZER SHOULDER ELASTIC MALE LARGE

Facility

$36.00

Service Code	HCPCS L3650
Hospital Charge Code	8266984
Hospital Revenue Code	274
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$23.40
Rate for Payer: Hawaii Western Management Group Commercial	$25.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: University Health Alliance Commercial	$20.16

IMMOBILIZER SHOULDER ELASTIC MALE LARGE

Facility

$36.00

Service Code	HCPCS L3650
Hospital Charge Code	8266984
Hospital Revenue Code	274
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$41.53
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: AlohaCare Medicare	$18.00
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$19.80
Rate for Payer: Hawaii Medical Service Association Medicare	$18.00
Rate for Payer: Hawaii Western Management Group Commercial	$25.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$18.00
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$18.00
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$18.00
Rate for Payer: Ohana Health Plan Medicare	$18.00
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: UnitedHealthcare Medicare	$18.00
Rate for Payer: University Health Alliance Commercial	$20.16

IMMOBILIZER SHOULDER ELASTIC MALE MEDIUM

Facility

$34.00

Service Code	HCPCS L3650
Hospital Charge Code	8266996
Hospital Revenue Code	274
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$22.10
Rate for Payer: Hawaii Western Management Group Commercial	$23.80
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: University Health Alliance Commercial	$19.04

IMMOBILIZER SHOULDER ELASTIC MALE MEDIUM

Facility

$34.00

Service Code	HCPCS L3650
Hospital Charge Code	8266996
Hospital Revenue Code	274
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$41.53
Rate for Payer: AlohaCare Medicaid	$17.00
Rate for Payer: AlohaCare Medicare	$17.00
Rate for Payer: Cash Price	$22.10
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$18.70
Rate for Payer: Hawaii Medical Service Association Medicare	$17.00
Rate for Payer: Hawaii Western Management Group Commercial	$23.80
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$17.00
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$17.00
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$17.00
Rate for Payer: Ohana Health Plan Medicare	$17.00
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: UnitedHealthcare Medicare	$17.00
Rate for Payer: University Health Alliance Commercial	$19.04

IMMOBILIZER SHOULDER ELASTIC MALE SMALL

Facility

$34.00

Service Code	HCPCS L3650
Hospital Charge Code	8266995
Hospital Revenue Code	274
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$22.10
Rate for Payer: Hawaii Western Management Group Commercial	$23.80
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: University Health Alliance Commercial	$19.04

IMMOBILIZER SHOULDER ELASTIC MALE SMALL

Facility

$34.00

Service Code	HCPCS L3650
Hospital Charge Code	8266995
Hospital Revenue Code	274
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$41.53
Rate for Payer: AlohaCare Medicaid	$17.00
Rate for Payer: AlohaCare Medicare	$17.00
Rate for Payer: Cash Price	$22.10
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$18.70
Rate for Payer: Hawaii Medical Service Association Medicare	$17.00
Rate for Payer: Hawaii Western Management Group Commercial	$23.80
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$17.00
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$17.00
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$17.00
Rate for Payer: Ohana Health Plan Medicare	$17.00
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: UnitedHealthcare Medicare	$17.00
Rate for Payer: University Health Alliance Commercial	$19.04

IMMOBILIZER SHOULDER ELASTIC MALE X-LARGE

Facility

$36.00

Service Code	HCPCS L3650
Hospital Charge Code	8266985
Hospital Revenue Code	274
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$23.40
Rate for Payer: Hawaii Western Management Group Commercial	$25.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: University Health Alliance Commercial	$20.16

IMMOBILIZER SHOULDER ELASTIC MALE X-LARGE

Facility

$36.00

Service Code	HCPCS L3650
Hospital Charge Code	8266985
Hospital Revenue Code	274
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$41.53
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: AlohaCare Medicare	$18.00
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$19.80
Rate for Payer: Hawaii Medical Service Association Medicare	$18.00
Rate for Payer: Hawaii Western Management Group Commercial	$25.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$18.00
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$18.00
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$18.00
Rate for Payer: Ohana Health Plan Medicare	$18.00
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: UnitedHealthcare Medicare	$18.00
Rate for Payer: University Health Alliance Commercial	$20.16

Immunofixation, Serum FSI

Facility

$250.00

Service Code	HCPCS 86334
Hospital Charge Code	8117968
Hospital Revenue Code	302
Min. Negotiated Rate	$22.34
Max. Negotiated Rate	$242.50
Rate for Payer: AlohaCare Medicaid	$125.00
Rate for Payer: AlohaCare Medicare	$125.00
Rate for Payer: Cash Price	$162.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Devoted Health Medicare	$137.50
Rate for Payer: Hawaii Medical Service Association ABD	$30.87
Rate for Payer: Hawaii Medical Service Association Commercial	$27.93
Rate for Payer: Hawaii Medical Service Association Medicare	$125.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$32.41
Rate for Payer: Hawaii Western Management Group Commercial	$22.34
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Humana Medicare	$125.00
Rate for Payer: Kaiser Permanente Commercial	$225.00
Rate for Payer: Kaiser Permanente Medicaid	$127.50
Rate for Payer: Kaiser Permanente Medicare	$125.00
Rate for Payer: MDX Hawaii PPO	$242.50
Rate for Payer: Ohana Health Plan Medicaid	$125.00
Rate for Payer: Ohana Health Plan Medicare	$125.00
Rate for Payer: UnitedHealthcare Medicaid	$30.87
Rate for Payer: UnitedHealthcare Medicare	$125.00
Rate for Payer: University Health Alliance Commercial	$57.74

Immunofixation, Serum FSI

Facility

$250.00

Service Code	HCPCS 86334
Hospital Charge Code	8117968
Hospital Revenue Code	302
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Kaiser Permanente Commercial	$225.00
Rate for Payer: MDX Hawaii PPO	$242.50

Immunofixation, Urine FSI

Facility

$250.00

Service Code	HCPCS 86335
Hospital Charge Code	8117969
Hospital Revenue Code	302
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Kaiser Permanente Commercial	$225.00
Rate for Payer: MDX Hawaii PPO	$242.50

Immunofixation, Urine FSI

Facility

$250.00

Service Code	HCPCS 86335
Hospital Charge Code	8117969
Hospital Revenue Code	302
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$242.50
Rate for Payer: AlohaCare Medicaid	$125.00
Rate for Payer: AlohaCare Medicare	$125.00
Rate for Payer: Cash Price	$162.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Devoted Health Medicare	$137.50
Rate for Payer: Hawaii Medical Service Association ABD	$16.26
Rate for Payer: Hawaii Medical Service Association Commercial	$36.69
Rate for Payer: Hawaii Medical Service Association Medicare	$125.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40.53
Rate for Payer: Hawaii Western Management Group Commercial	$29.35
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Humana Medicare	$125.00
Rate for Payer: Kaiser Permanente Commercial	$225.00
Rate for Payer: Kaiser Permanente Medicaid	$127.50
Rate for Payer: Kaiser Permanente Medicare	$125.00
Rate for Payer: MDX Hawaii PPO	$242.50
Rate for Payer: Ohana Health Plan Medicaid	$125.00
Rate for Payer: Ohana Health Plan Medicare	$125.00
Rate for Payer: UnitedHealthcare Medicaid	$16.26
Rate for Payer: UnitedHealthcare Medicare	$125.00
Rate for Payer: University Health Alliance Commercial	$75.85

Immunoglobulin E, IgE FSI

Facility

$97.00

Service Code	HCPCS 82785
Hospital Charge Code	8117970
Hospital Revenue Code	301
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$48.50
Rate for Payer: AlohaCare Medicare	$48.50
Rate for Payer: Cash Price	$63.05
Rate for Payer: Cash Price	$63.05
Rate for Payer: Devoted Health Medicare	$53.35
Rate for Payer: Hawaii Medical Service Association ABD	$22.76
Rate for Payer: Hawaii Medical Service Association Commercial	$20.57
Rate for Payer: Hawaii Medical Service Association Medicare	$48.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.90
Rate for Payer: Hawaii Western Management Group Commercial	$16.46
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$48.50
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$48.50
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$48.50
Rate for Payer: Ohana Health Plan Medicare	$48.50
Rate for Payer: UnitedHealthcare Medicaid	$22.76
Rate for Payer: UnitedHealthcare Medicare	$48.50
Rate for Payer: University Health Alliance Commercial	$42.57

Immunoglobulin E, IgE FSI

Facility

$97.00

Service Code	HCPCS 82785
Hospital Charge Code	8117970
Hospital Revenue Code	301
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$63.05
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: MDX Hawaii PPO	$94.09

Know your out-of-pocket cost for care.

All Charges