Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

US Biopsy Liver - Report

Professional

Both

$2,299.00

Service Code	HCPCS 47000
Hospital Charge Code	631304
Hospital Revenue Code	972
Min. Negotiated Rate	$76.43
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$87.17
Rate for Payer: AlohaCare Medicare	$76.43
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
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	$1,954.15
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

US Biopsy Lymph Node Bilateral

Facility

$3,181.00

Service Code	HCPCS 38505
Hospital Charge Code	9452077
Hospital Revenue Code	402
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

US Biopsy Lymph Node Bilateral

Facility

$3,181.00

Service Code	HCPCS 38505
Hospital Charge Code	9452077
Hospital Revenue Code	402
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

US Biopsy Lymph Node Bilateral - Report

Professional

Both

$2,299.00

Service Code	HCPCS 38505
Hospital Charge Code	9452079
Hospital Revenue Code	972
Min. Negotiated Rate	$74.81
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$85.75
Rate for Payer: AlohaCare Medicare	$74.81
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$82.29
Rate for Payer: Hawaii Medical Service Association ABD	$85.75
Rate for Payer: Hawaii Medical Service Association Commercial	$140.72
Rate for Payer: Hawaii Medical Service Association Medicare	$74.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$85.75
Rate for Payer: Hawaii Western Management Group Commercial	$105.30
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$82.29
Rate for Payer: Kaiser Permanente Medicaid	$82.29
Rate for Payer: Kaiser Permanente Medicare	$82.29
Rate for Payer: Ohana Health Plan Medicaid	$85.75
Rate for Payer: Ohana Health Plan Medicare	$74.81
Rate for Payer: UnitedHealthcare Medicaid	$85.75
Rate for Payer: UnitedHealthcare Medicare	$74.81
Rate for Payer: University Health Alliance Commercial	$106.77

US Biopsy Lymph Node Left

Facility

$2,562.00

Service Code	HCPCS 38505
Hospital Charge Code	9452080
Hospital Revenue Code	402
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$2,485.14
Rate for Payer: AlohaCare Medicaid	$1,281.00
Rate for Payer: AlohaCare Medicare	$1,281.00
Rate for Payer: Cash Price	$1,665.30
Rate for Payer: Cash Price	$1,665.30
Rate for Payer: Cash Price	$1,665.30
Rate for Payer: Devoted Health Medicare	$1,409.10
Rate for Payer: Hawaii Medical Service Association Commercial	$2,109.21
Rate for Payer: Hawaii Medical Service Association Medicare	$1,281.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,433.90
Rate for Payer: Health Management Network Commercial	$2,177.70
Rate for Payer: Humana Medicare	$1,281.00
Rate for Payer: Kaiser Permanente Commercial	$2,305.80
Rate for Payer: Kaiser Permanente Medicaid	$1,306.62
Rate for Payer: Kaiser Permanente Medicare	$1,281.00
Rate for Payer: MDX Hawaii PPO	$2,485.14
Rate for Payer: Ohana Health Plan Medicaid	$1,281.00
Rate for Payer: Ohana Health Plan Medicare	$1,281.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,281.00
Rate for Payer: University Health Alliance Commercial	$1,867.44

US Biopsy Lymph Node Left

Facility

$2,562.00

Service Code	HCPCS 38505
Hospital Charge Code	9452080
Hospital Revenue Code	402
Min. Negotiated Rate	$2,177.70
Max. Negotiated Rate	$2,485.14
Rate for Payer: Cash Price	$1,665.30
Rate for Payer: Health Management Network Commercial	$2,177.70
Rate for Payer: Kaiser Permanente Commercial	$2,305.80
Rate for Payer: MDX Hawaii PPO	$2,485.14

US Biopsy Lymph Node Left - Report

Professional

Both

$2,299.00

Service Code	HCPCS 38505
Hospital Charge Code	9452082
Hospital Revenue Code	972
Min. Negotiated Rate	$74.81
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$85.75
Rate for Payer: AlohaCare Medicare	$74.81
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$82.29
Rate for Payer: Hawaii Medical Service Association ABD	$85.75
Rate for Payer: Hawaii Medical Service Association Commercial	$140.72
Rate for Payer: Hawaii Medical Service Association Medicare	$74.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$85.75
Rate for Payer: Hawaii Western Management Group Commercial	$105.30
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$82.29
Rate for Payer: Kaiser Permanente Medicaid	$82.29
Rate for Payer: Kaiser Permanente Medicare	$82.29
Rate for Payer: Ohana Health Plan Medicaid	$85.75
Rate for Payer: Ohana Health Plan Medicare	$74.81
Rate for Payer: UnitedHealthcare Medicaid	$85.75
Rate for Payer: UnitedHealthcare Medicare	$74.81
Rate for Payer: University Health Alliance Commercial	$106.77

US Biopsy Lymph Node Right

Facility

$2,562.00

Service Code	HCPCS 38505
Hospital Charge Code	9452083
Hospital Revenue Code	402
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$2,485.14
Rate for Payer: AlohaCare Medicaid	$1,281.00
Rate for Payer: AlohaCare Medicare	$1,281.00
Rate for Payer: Cash Price	$1,665.30
Rate for Payer: Cash Price	$1,665.30
Rate for Payer: Cash Price	$1,665.30
Rate for Payer: Devoted Health Medicare	$1,409.10
Rate for Payer: Hawaii Medical Service Association Commercial	$2,109.21
Rate for Payer: Hawaii Medical Service Association Medicare	$1,281.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,433.90
Rate for Payer: Health Management Network Commercial	$2,177.70
Rate for Payer: Humana Medicare	$1,281.00
Rate for Payer: Kaiser Permanente Commercial	$2,305.80
Rate for Payer: Kaiser Permanente Medicaid	$1,306.62
Rate for Payer: Kaiser Permanente Medicare	$1,281.00
Rate for Payer: MDX Hawaii PPO	$2,485.14
Rate for Payer: Ohana Health Plan Medicaid	$1,281.00
Rate for Payer: Ohana Health Plan Medicare	$1,281.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,281.00
Rate for Payer: University Health Alliance Commercial	$1,867.44

US Biopsy Lymph Node Right

Facility

$2,562.00

Service Code	HCPCS 38505
Hospital Charge Code	9452083
Hospital Revenue Code	402
Min. Negotiated Rate	$2,177.70
Max. Negotiated Rate	$2,485.14
Rate for Payer: Cash Price	$1,665.30
Rate for Payer: Health Management Network Commercial	$2,177.70
Rate for Payer: Kaiser Permanente Commercial	$2,305.80
Rate for Payer: MDX Hawaii PPO	$2,485.14

US Biopsy Lymph Node Right - Report

Professional

Both

$2,299.00

Service Code	HCPCS 38505
Hospital Charge Code	9452085
Hospital Revenue Code	972
Min. Negotiated Rate	$74.81
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$85.75
Rate for Payer: AlohaCare Medicare	$74.81
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$82.29
Rate for Payer: Hawaii Medical Service Association ABD	$85.75
Rate for Payer: Hawaii Medical Service Association Commercial	$140.72
Rate for Payer: Hawaii Medical Service Association Medicare	$74.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$85.75
Rate for Payer: Hawaii Western Management Group Commercial	$105.30
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$82.29
Rate for Payer: Kaiser Permanente Medicaid	$82.29
Rate for Payer: Kaiser Permanente Medicare	$82.29
Rate for Payer: Ohana Health Plan Medicaid	$85.75
Rate for Payer: Ohana Health Plan Medicare	$74.81
Rate for Payer: UnitedHealthcare Medicaid	$85.75
Rate for Payer: UnitedHealthcare Medicare	$74.81
Rate for Payer: University Health Alliance Commercial	$106.77

US Biopsy Muscle

Facility

$3,654.00

Service Code	HCPCS 20206
Hospital Charge Code	2425299
Hospital Revenue Code	761
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,827.00
Rate for Payer: AlohaCare Medicare	$1,827.00
Rate for Payer: Cash Price	$2,375.10
Rate for Payer: Cash Price	$2,375.10
Rate for Payer: Devoted Health Medicare	$2,009.70
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	$1,827.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,471.30
Rate for Payer: Health Management Network Commercial	$3,105.90
Rate for Payer: Humana Medicare	$1,827.00
Rate for Payer: Kaiser Permanente Commercial	$3,288.60
Rate for Payer: Kaiser Permanente Medicaid	$1,863.54
Rate for Payer: Kaiser Permanente Medicare	$1,827.00
Rate for Payer: MDX Hawaii PPO	$3,544.38
Rate for Payer: Ohana Health Plan Medicaid	$1,827.00
Rate for Payer: Ohana Health Plan Medicare	$1,827.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,827.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

US Biopsy Muscle

Facility

$3,654.00

Service Code	HCPCS 20206
Hospital Charge Code	2425299
Hospital Revenue Code	761
Min. Negotiated Rate	$3,105.90
Max. Negotiated Rate	$3,544.38
Rate for Payer: Cash Price	$2,375.10
Rate for Payer: Health Management Network Commercial	$3,105.90
Rate for Payer: Kaiser Permanente Commercial	$3,288.60
Rate for Payer: MDX Hawaii PPO	$3,544.38

US Biopsy Muscle - Report

Professional

Both

$2,299.00

Service Code	HCPCS 20206
Hospital Charge Code	2425301
Hospital Revenue Code	972
Min. Negotiated Rate	$51.62
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$57.77
Rate for Payer: AlohaCare Medicare	$51.62
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$56.78
Rate for Payer: Hawaii Medical Service Association ABD	$57.77
Rate for Payer: Hawaii Medical Service Association Commercial	$96.81
Rate for Payer: Hawaii Medical Service Association Medicare	$51.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$57.77
Rate for Payer: Hawaii Western Management Group Commercial	$95.68
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$56.78
Rate for Payer: Kaiser Permanente Medicaid	$56.78
Rate for Payer: Kaiser Permanente Medicare	$56.78
Rate for Payer: Ohana Health Plan Medicaid	$57.77
Rate for Payer: Ohana Health Plan Medicare	$51.62
Rate for Payer: UnitedHealthcare Medicaid	$57.77
Rate for Payer: UnitedHealthcare Medicare	$51.62
Rate for Payer: University Health Alliance Commercial	$76.25

US Biopsy Soft Tissue Neck/Thorax

Facility

$2,587.00

Service Code	HCPCS 21550
Hospital Charge Code	8207942
Hospital Revenue Code	761
Min. Negotiated Rate	$2,198.95
Max. Negotiated Rate	$2,509.39
Rate for Payer: Cash Price	$1,681.55
Rate for Payer: Health Management Network Commercial	$2,198.95
Rate for Payer: Kaiser Permanente Commercial	$2,328.30
Rate for Payer: MDX Hawaii PPO	$2,509.39

US Biopsy Soft Tissue Neck/Thorax

Facility

$2,587.00

Service Code	HCPCS 21550
Hospital Charge Code	8207942
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$2,509.39
Rate for Payer: AlohaCare Medicaid	$1,293.50
Rate for Payer: AlohaCare Medicare	$1,293.50
Rate for Payer: Cash Price	$1,681.55
Rate for Payer: Cash Price	$1,681.55
Rate for Payer: Cash Price	$1,681.55
Rate for Payer: Devoted Health Medicare	$1,422.85
Rate for Payer: Hawaii Medical Service Association Commercial	$2,109.21
Rate for Payer: Hawaii Medical Service Association Medicare	$1,293.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,457.65
Rate for Payer: Health Management Network Commercial	$2,198.95
Rate for Payer: Humana Medicare	$1,293.50
Rate for Payer: Kaiser Permanente Commercial	$2,328.30
Rate for Payer: Kaiser Permanente Medicaid	$1,319.37
Rate for Payer: Kaiser Permanente Medicare	$1,293.50
Rate for Payer: MDX Hawaii PPO	$2,509.39
Rate for Payer: Ohana Health Plan Medicaid	$1,293.50
Rate for Payer: Ohana Health Plan Medicare	$1,293.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,293.50
Rate for Payer: University Health Alliance Commercial	$1,885.66

US Biopsy Soft Tissue Neck/Thorax - Report

Professional

Both

$2,299.00

Service Code	HCPCS 21550
Hospital Charge Code	8207944
Hospital Revenue Code	972
Min. Negotiated Rate	$90.74
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$163.23
Rate for Payer: AlohaCare Medicare	$148.28
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$163.11
Rate for Payer: Hawaii Medical Service Association ABD	$163.23
Rate for Payer: Hawaii Medical Service Association Commercial	$270.16
Rate for Payer: Hawaii Medical Service Association Medicare	$148.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$163.23
Rate for Payer: Hawaii Western Management Group Commercial	$90.74
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$163.11
Rate for Payer: Kaiser Permanente Medicaid	$163.11
Rate for Payer: Kaiser Permanente Medicare	$163.11
Rate for Payer: Ohana Health Plan Medicaid	$163.23
Rate for Payer: Ohana Health Plan Medicare	$148.28
Rate for Payer: UnitedHealthcare Medicaid	$163.23
Rate for Payer: UnitedHealthcare Medicare	$148.28
Rate for Payer: University Health Alliance Commercial	$212.78

US Bladder

Facility

$1,221.00

Service Code	HCPCS 76857
Hospital Charge Code	9042551
Hospital Revenue Code	402
Min. Negotiated Rate	$1,037.85
Max. Negotiated Rate	$1,184.37
Rate for Payer: Cash Price	$793.65
Rate for Payer: Health Management Network Commercial	$1,037.85
Rate for Payer: Kaiser Permanente Commercial	$1,098.90
Rate for Payer: MDX Hawaii PPO	$1,184.37

US Bladder

Facility

$1,221.00

Service Code	HCPCS 76857
Hospital Charge Code	9042551
Hospital Revenue Code	402
Min. Negotiated Rate	$44.29
Max. Negotiated Rate	$1,184.37
Rate for Payer: AlohaCare Medicaid	$610.50
Rate for Payer: AlohaCare Medicare	$610.50
Rate for Payer: Cash Price	$793.65
Rate for Payer: Cash Price	$793.65
Rate for Payer: Devoted Health Medicare	$671.55
Rate for Payer: Hawaii Medical Service Association ABD	$44.29
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$610.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$69.53
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$1,037.85
Rate for Payer: Humana Medicare	$610.50
Rate for Payer: Kaiser Permanente Commercial	$1,098.90
Rate for Payer: Kaiser Permanente Medicaid	$622.71
Rate for Payer: Kaiser Permanente Medicare	$610.50
Rate for Payer: MDX Hawaii PPO	$1,184.37
Rate for Payer: Ohana Health Plan Medicaid	$610.50
Rate for Payer: Ohana Health Plan Medicare	$610.50
Rate for Payer: UnitedHealthcare Medicaid	$44.29
Rate for Payer: UnitedHealthcare Medicare	$610.50
Rate for Payer: University Health Alliance Commercial	$161.45

US Bladder - Report

Professional

Both

$145.00

Service Code	HCPCS 76857 26
Hospital Charge Code	9042553
Hospital Revenue Code	972
Min. Negotiated Rate	$24.16
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$32.12
Rate for Payer: AlohaCare Medicare	$24.16
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$26.58
Rate for Payer: Hawaii Medical Service Association Medicare	$24.16
Rate for Payer: Hawaii Western Management Group Commercial	$66.85
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$26.58
Rate for Payer: Kaiser Permanente Medicaid	$26.58
Rate for Payer: Kaiser Permanente Medicare	$26.58
Rate for Payer: Ohana Health Plan Medicaid	$32.12
Rate for Payer: Ohana Health Plan Medicare	$24.16
Rate for Payer: UnitedHealthcare Medicaid	$32.12
Rate for Payer: UnitedHealthcare Medicare	$24.16

US Breast Biopsy w/ US Guide Left

Facility

$2,752.00

Service Code	HCPCS 19083
Hospital Charge Code	1169595
Hospital Revenue Code	361
Min. Negotiated Rate	$2,339.20
Max. Negotiated Rate	$2,669.44
Rate for Payer: Cash Price	$1,788.80
Rate for Payer: Health Management Network Commercial	$2,339.20
Rate for Payer: Kaiser Permanente Commercial	$2,476.80
Rate for Payer: MDX Hawaii PPO	$2,669.44

US Breast Biopsy w/ US Guide Left

Facility

$2,752.00

Service Code	HCPCS 19083
Hospital Charge Code	1169595
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,376.00
Rate for Payer: AlohaCare Medicare	$1,376.00
Rate for Payer: Cash Price	$1,788.80
Rate for Payer: Cash Price	$1,788.80
Rate for Payer: Devoted Health Medicare	$1,513.60
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	$1,376.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$2,339.20
Rate for Payer: Humana Medicare	$1,376.00
Rate for Payer: Kaiser Permanente Commercial	$2,476.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,376.00
Rate for Payer: MDX Hawaii PPO	$2,669.44
Rate for Payer: Ohana Health Plan Medicaid	$1,376.00
Rate for Payer: Ohana Health Plan Medicare	$1,376.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,376.00
Rate for Payer: University Health Alliance Commercial	$5,160.40

US Breast Biopsy w/ US Guide Left - Report

Professional

Both

$1,990.00

Service Code	HCPCS 19083
Hospital Charge Code	627689
Hospital Revenue Code	972
Min. Negotiated Rate	$128.33
Max. Negotiated Rate	$1,691.50
Rate for Payer: AlohaCare Medicaid	$151.43
Rate for Payer: AlohaCare Medicare	$128.33
Rate for Payer: Cash Price	$1,293.50
Rate for Payer: Cash Price	$1,293.50
Rate for Payer: Devoted Health Medicare	$141.16
Rate for Payer: Hawaii Medical Service Association ABD	$151.43
Rate for Payer: Hawaii Medical Service Association Commercial	$260.24
Rate for Payer: Hawaii Medical Service Association Medicare	$128.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$151.43
Rate for Payer: Hawaii Western Management Group Commercial	$755.30
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$141.16
Rate for Payer: Kaiser Permanente Medicaid	$141.16
Rate for Payer: Kaiser Permanente Medicare	$141.16
Rate for Payer: Ohana Health Plan Medicaid	$151.43
Rate for Payer: Ohana Health Plan Medicare	$128.33
Rate for Payer: UnitedHealthcare Medicaid	$151.43
Rate for Payer: UnitedHealthcare Medicare	$128.33
Rate for Payer: University Health Alliance Commercial	$200.00

US Breast Biopsy w/ US Guide Right

Facility

$2,752.00

Service Code	HCPCS 19083
Hospital Charge Code	1169597
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,376.00
Rate for Payer: AlohaCare Medicare	$1,376.00
Rate for Payer: Cash Price	$1,788.80
Rate for Payer: Cash Price	$1,788.80
Rate for Payer: Devoted Health Medicare	$1,513.60
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	$1,376.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$2,339.20
Rate for Payer: Humana Medicare	$1,376.00
Rate for Payer: Kaiser Permanente Commercial	$2,476.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,376.00
Rate for Payer: MDX Hawaii PPO	$2,669.44
Rate for Payer: Ohana Health Plan Medicaid	$1,376.00
Rate for Payer: Ohana Health Plan Medicare	$1,376.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,376.00
Rate for Payer: University Health Alliance Commercial	$5,160.40

US Breast Biopsy w/ US Guide Right

Facility

$2,752.00

Service Code	HCPCS 19083
Hospital Charge Code	1169597
Hospital Revenue Code	361
Min. Negotiated Rate	$2,339.20
Max. Negotiated Rate	$2,669.44
Rate for Payer: Cash Price	$1,788.80
Rate for Payer: Health Management Network Commercial	$2,339.20
Rate for Payer: Kaiser Permanente Commercial	$2,476.80
Rate for Payer: MDX Hawaii PPO	$2,669.44

US Breast Biopsy w/ US Guide Right - Report

Professional

Both

$1,990.00

Service Code	HCPCS 19083
Hospital Charge Code	627691
Hospital Revenue Code	972
Min. Negotiated Rate	$128.33
Max. Negotiated Rate	$1,691.50
Rate for Payer: AlohaCare Medicaid	$151.43
Rate for Payer: AlohaCare Medicare	$128.33
Rate for Payer: Cash Price	$1,293.50
Rate for Payer: Cash Price	$1,293.50
Rate for Payer: Devoted Health Medicare	$141.16
Rate for Payer: Hawaii Medical Service Association ABD	$151.43
Rate for Payer: Hawaii Medical Service Association Commercial	$260.24
Rate for Payer: Hawaii Medical Service Association Medicare	$128.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$151.43
Rate for Payer: Hawaii Western Management Group Commercial	$755.30
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$141.16
Rate for Payer: Kaiser Permanente Medicaid	$141.16
Rate for Payer: Kaiser Permanente Medicare	$141.16
Rate for Payer: Ohana Health Plan Medicaid	$151.43
Rate for Payer: Ohana Health Plan Medicare	$128.33
Rate for Payer: UnitedHealthcare Medicaid	$151.43
Rate for Payer: UnitedHealthcare Medicare	$128.33
Rate for Payer: University Health Alliance Commercial	$200.00

Know your out-of-pocket cost for care.

All Charges