Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

US Chest - Report

Professional

Both

$145.00

Service Code	HCPCS 76604 26
Hospital Charge Code	629715
Hospital Revenue Code	972
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$37.02
Rate for Payer: AlohaCare Medicare	$28.12
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$30.93
Rate for Payer: Hawaii Medical Service Association Medicare	$28.12
Rate for Payer: Hawaii Western Management Group Commercial	$87.58
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$30.93
Rate for Payer: Kaiser Permanente Medicaid	$30.93
Rate for Payer: Kaiser Permanente Medicare	$30.93
Rate for Payer: Ohana Health Plan Medicaid	$37.02
Rate for Payer: Ohana Health Plan Medicare	$28.12
Rate for Payer: UnitedHealthcare Medicaid	$37.02
Rate for Payer: UnitedHealthcare Medicare	$28.12

US Doppler Middle Cerebral Artery

Facility

$579.00

Service Code	HCPCS 76821
Hospital Charge Code	8211666
Hospital Revenue Code	402
Min. Negotiated Rate	$492.15
Max. Negotiated Rate	$561.63
Rate for Payer: Cash Price	$376.35
Rate for Payer: Health Management Network Commercial	$492.15
Rate for Payer: Kaiser Permanente Commercial	$521.10
Rate for Payer: MDX Hawaii PPO	$561.63

US Doppler Middle Cerebral Artery

Facility

$579.00

Service Code	HCPCS 76821
Hospital Charge Code	8211666
Hospital Revenue Code	402
Min. Negotiated Rate	$51.43
Max. Negotiated Rate	$561.63
Rate for Payer: AlohaCare Medicaid	$289.50
Rate for Payer: AlohaCare Medicare	$289.50
Rate for Payer: Cash Price	$376.35
Rate for Payer: Cash Price	$376.35
Rate for Payer: Devoted Health Medicare	$318.45
Rate for Payer: Hawaii Medical Service Association ABD	$51.43
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$289.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$60.49
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$492.15
Rate for Payer: Humana Medicare	$289.50
Rate for Payer: Kaiser Permanente Commercial	$521.10
Rate for Payer: Kaiser Permanente Medicaid	$295.29
Rate for Payer: Kaiser Permanente Medicare	$289.50
Rate for Payer: MDX Hawaii PPO	$561.63
Rate for Payer: Ohana Health Plan Medicaid	$289.50
Rate for Payer: Ohana Health Plan Medicare	$289.50
Rate for Payer: UnitedHealthcare Medicaid	$51.43
Rate for Payer: UnitedHealthcare Medicare	$289.50
Rate for Payer: University Health Alliance Commercial	$202.02

US Doppler Middle Cerebral Artery - Report

Professional

Both

$145.00

Service Code	HCPCS 76821 26
Hospital Charge Code	8211668
Hospital Revenue Code	976
Min. Negotiated Rate	$34.31
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$58.84
Rate for Payer: AlohaCare Medicare	$34.31
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$37.74
Rate for Payer: Hawaii Medical Service Association Medicare	$34.31
Rate for Payer: Hawaii Western Management Group Commercial	$110.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$37.74
Rate for Payer: Kaiser Permanente Medicaid	$37.74
Rate for Payer: Kaiser Permanente Medicare	$37.74
Rate for Payer: Ohana Health Plan Medicaid	$58.84
Rate for Payer: Ohana Health Plan Medicare	$34.31
Rate for Payer: UnitedHealthcare Medicaid	$58.84
Rate for Payer: UnitedHealthcare Medicare	$34.31

US Doppler Umbilical Artery

Facility

$678.00

Service Code	HCPCS 76820
Hospital Charge Code	8111073
Hospital Revenue Code	402
Min. Negotiated Rate	$576.30
Max. Negotiated Rate	$657.66
Rate for Payer: Cash Price	$440.70
Rate for Payer: Health Management Network Commercial	$576.30
Rate for Payer: Kaiser Permanente Commercial	$610.20
Rate for Payer: MDX Hawaii PPO	$657.66

US Doppler Umbilical Artery

Facility

$678.00

Service Code	HCPCS 76820
Hospital Charge Code	8111073
Hospital Revenue Code	402
Min. Negotiated Rate	$51.43
Max. Negotiated Rate	$657.66
Rate for Payer: AlohaCare Medicaid	$339.00
Rate for Payer: AlohaCare Medicare	$339.00
Rate for Payer: Cash Price	$440.70
Rate for Payer: Cash Price	$440.70
Rate for Payer: Devoted Health Medicare	$372.90
Rate for Payer: Hawaii Medical Service Association ABD	$51.43
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$339.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$57.07
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$576.30
Rate for Payer: Humana Medicare	$339.00
Rate for Payer: Kaiser Permanente Commercial	$610.20
Rate for Payer: Kaiser Permanente Medicaid	$345.78
Rate for Payer: Kaiser Permanente Medicare	$339.00
Rate for Payer: MDX Hawaii PPO	$657.66
Rate for Payer: Ohana Health Plan Medicaid	$339.00
Rate for Payer: Ohana Health Plan Medicare	$339.00
Rate for Payer: UnitedHealthcare Medicaid	$51.43
Rate for Payer: UnitedHealthcare Medicare	$339.00
Rate for Payer: University Health Alliance Commercial	$133.24

US Doppler Umbilical Artery - Report

Professional

Both

$145.00

Service Code	HCPCS 76820 26
Hospital Charge Code	8111075
Hospital Revenue Code	972
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$29.03
Rate for Payer: AlohaCare Medicare	$24.73
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$27.20
Rate for Payer: Hawaii Medical Service Association Medicare	$24.73
Rate for Payer: Hawaii Western Management Group Commercial	$99.77
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$27.20
Rate for Payer: Kaiser Permanente Medicaid	$27.20
Rate for Payer: Kaiser Permanente Medicare	$27.20
Rate for Payer: Ohana Health Plan Medicaid	$29.03
Rate for Payer: Ohana Health Plan Medicare	$24.73
Rate for Payer: UnitedHealthcare Medicaid	$29.03
Rate for Payer: UnitedHealthcare Medicare	$24.73

US Drain Per/Retr Fld w/Cath Perc

Facility

$721.00

Service Code	HCPCS 10060
Hospital Charge Code	1169657
Hospital Revenue Code	761
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$360.50
Rate for Payer: AlohaCare Medicare	$360.50
Rate for Payer: Cash Price	$468.65
Rate for Payer: Cash Price	$468.65
Rate for Payer: Cash Price	$468.65
Rate for Payer: Devoted Health Medicare	$396.55
Rate for Payer: Hawaii Medical Service Association Commercial	$256.23
Rate for Payer: Hawaii Medical Service Association Medicare	$360.50
Rate for Payer: Hawaii Western Management Group Commercial	$684.95
Rate for Payer: Health Management Network Commercial	$612.85
Rate for Payer: Humana Medicare	$360.50
Rate for Payer: Kaiser Permanente Commercial	$648.90
Rate for Payer: Kaiser Permanente Medicaid	$367.71
Rate for Payer: Kaiser Permanente Medicare	$360.50
Rate for Payer: MDX Hawaii PPO	$699.37
Rate for Payer: Ohana Health Plan Medicaid	$360.50
Rate for Payer: Ohana Health Plan Medicare	$360.50
Rate for Payer: UnitedHealthcare Medicaid	$52.42
Rate for Payer: UnitedHealthcare Medicare	$360.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

US Drain Per/Retr Fld w/Cath Perc

Facility

$721.00

Service Code	HCPCS 10060
Hospital Charge Code	1169657
Hospital Revenue Code	761
Min. Negotiated Rate	$612.85
Max. Negotiated Rate	$699.37
Rate for Payer: Cash Price	$468.65
Rate for Payer: Health Management Network Commercial	$612.85
Rate for Payer: Kaiser Permanente Commercial	$648.90
Rate for Payer: MDX Hawaii PPO	$699.37

US Echo 2D Complete

Facility

$1,450.00

Service Code	HCPCS 93307
Hospital Charge Code	8111076
Hospital Revenue Code	483
Min. Negotiated Rate	$127.90
Max. Negotiated Rate	$1,406.50
Rate for Payer: AlohaCare Medicaid	$725.00
Rate for Payer: AlohaCare Medicare	$725.00
Rate for Payer: Cash Price	$942.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Devoted Health Medicare	$797.50
Rate for Payer: Hawaii Medical Service Association ABD	$127.90
Rate for Payer: Hawaii Medical Service Association Commercial	$304.71
Rate for Payer: Hawaii Medical Service Association Medicare	$725.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$134.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,377.50
Rate for Payer: Health Management Network Commercial	$1,232.50
Rate for Payer: Humana Medicare	$725.00
Rate for Payer: Kaiser Permanente Commercial	$1,305.00
Rate for Payer: Kaiser Permanente Medicaid	$739.50
Rate for Payer: Kaiser Permanente Medicare	$725.00
Rate for Payer: MDX Hawaii PPO	$1,406.50
Rate for Payer: Ohana Health Plan Medicaid	$725.00
Rate for Payer: Ohana Health Plan Medicare	$725.00
Rate for Payer: UnitedHealthcare Medicaid	$127.90
Rate for Payer: UnitedHealthcare Medicare	$725.00
Rate for Payer: University Health Alliance Commercial	$1,056.90

US Echo 2D Complete

Facility

$1,450.00

Service Code	HCPCS 93307
Hospital Charge Code	8111076
Hospital Revenue Code	483
Min. Negotiated Rate	$1,232.50
Max. Negotiated Rate	$1,406.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Health Management Network Commercial	$1,232.50
Rate for Payer: Kaiser Permanente Commercial	$1,305.00
Rate for Payer: MDX Hawaii PPO	$1,406.50

US Echo 2D Comp w/ Color Flow Doppler

Facility

$3,040.00

Service Code	HCPCS 93306
Hospital Charge Code	8207945
Hospital Revenue Code	483
Min. Negotiated Rate	$2,584.00
Max. Negotiated Rate	$2,948.80
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Health Management Network Commercial	$2,584.00
Rate for Payer: Kaiser Permanente Commercial	$2,736.00
Rate for Payer: MDX Hawaii PPO	$2,948.80

US Echo 2D Comp w/ Color Flow Doppler

Facility

$3,040.00

Service Code	HCPCS 93306
Hospital Charge Code	8207945
Hospital Revenue Code	483
Min. Negotiated Rate	$132.88
Max. Negotiated Rate	$2,948.80
Rate for Payer: AlohaCare Medicaid	$1,520.00
Rate for Payer: AlohaCare Medicare	$1,520.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Devoted Health Medicare	$1,672.00
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	$1,520.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,888.00
Rate for Payer: Health Management Network Commercial	$2,584.00
Rate for Payer: Humana Medicare	$1,520.00
Rate for Payer: Kaiser Permanente Commercial	$2,736.00
Rate for Payer: Kaiser Permanente Medicaid	$1,550.40
Rate for Payer: Kaiser Permanente Medicare	$1,520.00
Rate for Payer: MDX Hawaii PPO	$2,948.80
Rate for Payer: Ohana Health Plan Medicaid	$1,520.00
Rate for Payer: Ohana Health Plan Medicare	$1,520.00
Rate for Payer: UnitedHealthcare Medicaid	$132.88
Rate for Payer: UnitedHealthcare Medicare	$1,520.00
Rate for Payer: University Health Alliance Commercial	$2,215.86

US Echo 2D Comp w/ Color Flow Doppler EO

Facility

$3,040.00

Service Code	HCPCS 93306
Hospital Charge Code	8265208
Hospital Revenue Code	483
Min. Negotiated Rate	$2,584.00
Max. Negotiated Rate	$2,948.80
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Health Management Network Commercial	$2,584.00
Rate for Payer: Kaiser Permanente Commercial	$2,736.00
Rate for Payer: MDX Hawaii PPO	$2,948.80

US Echo 2D Comp w/ Color Flow Doppler EO

Facility

$3,040.00

Service Code	HCPCS 93306
Hospital Charge Code	8265208
Hospital Revenue Code	483
Min. Negotiated Rate	$132.88
Max. Negotiated Rate	$2,948.80
Rate for Payer: AlohaCare Medicaid	$1,520.00
Rate for Payer: AlohaCare Medicare	$1,520.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Devoted Health Medicare	$1,672.00
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	$1,520.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,888.00
Rate for Payer: Health Management Network Commercial	$2,584.00
Rate for Payer: Humana Medicare	$1,520.00
Rate for Payer: Kaiser Permanente Commercial	$2,736.00
Rate for Payer: Kaiser Permanente Medicaid	$1,550.40
Rate for Payer: Kaiser Permanente Medicare	$1,520.00
Rate for Payer: MDX Hawaii PPO	$2,948.80
Rate for Payer: Ohana Health Plan Medicaid	$1,520.00
Rate for Payer: Ohana Health Plan Medicare	$1,520.00
Rate for Payer: UnitedHealthcare Medicaid	$132.88
Rate for Payer: UnitedHealthcare Medicare	$1,520.00
Rate for Payer: University Health Alliance Commercial	$2,215.86

US Echo 2D Limited

Facility

$1,244.00

Service Code	HCPCS 93308
Hospital Charge Code	8106646
Hospital Revenue Code	483
Min. Negotiated Rate	$64.51
Max. Negotiated Rate	$1,206.68
Rate for Payer: AlohaCare Medicaid	$622.00
Rate for Payer: AlohaCare Medicare	$622.00
Rate for Payer: Cash Price	$808.60
Rate for Payer: Cash Price	$808.60
Rate for Payer: Devoted Health Medicare	$684.20
Rate for Payer: Hawaii Medical Service Association ABD	$64.51
Rate for Payer: Hawaii Medical Service Association Commercial	$304.71
Rate for Payer: Hawaii Medical Service Association Medicare	$622.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$67.74
Rate for Payer: Hawaii Western Management Group Commercial	$1,181.80
Rate for Payer: Health Management Network Commercial	$1,057.40
Rate for Payer: Humana Medicare	$622.00
Rate for Payer: Kaiser Permanente Commercial	$1,119.60
Rate for Payer: Kaiser Permanente Medicaid	$634.44
Rate for Payer: Kaiser Permanente Medicare	$622.00
Rate for Payer: MDX Hawaii PPO	$1,206.68
Rate for Payer: Ohana Health Plan Medicaid	$622.00
Rate for Payer: Ohana Health Plan Medicare	$622.00
Rate for Payer: UnitedHealthcare Medicaid	$64.51
Rate for Payer: UnitedHealthcare Medicare	$622.00
Rate for Payer: University Health Alliance Commercial	$906.75

US Echo 2D Limited

Facility

$1,244.00

Service Code	HCPCS 93308
Hospital Charge Code	8106646
Hospital Revenue Code	483
Min. Negotiated Rate	$1,057.40
Max. Negotiated Rate	$1,206.68
Rate for Payer: Cash Price	$808.60
Rate for Payer: Health Management Network Commercial	$1,057.40
Rate for Payer: Kaiser Permanente Commercial	$1,119.60
Rate for Payer: MDX Hawaii PPO	$1,206.68

US Echo 2D Limited EO

Facility

$1,244.00

Service Code	HCPCS 93308
Hospital Charge Code	8265211
Hospital Revenue Code	483
Min. Negotiated Rate	$64.51
Max. Negotiated Rate	$1,206.68
Rate for Payer: AlohaCare Medicaid	$622.00
Rate for Payer: AlohaCare Medicare	$622.00
Rate for Payer: Cash Price	$808.60
Rate for Payer: Cash Price	$808.60
Rate for Payer: Devoted Health Medicare	$684.20
Rate for Payer: Hawaii Medical Service Association ABD	$64.51
Rate for Payer: Hawaii Medical Service Association Commercial	$304.71
Rate for Payer: Hawaii Medical Service Association Medicare	$622.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$67.74
Rate for Payer: Hawaii Western Management Group Commercial	$1,181.80
Rate for Payer: Health Management Network Commercial	$1,057.40
Rate for Payer: Humana Medicare	$622.00
Rate for Payer: Kaiser Permanente Commercial	$1,119.60
Rate for Payer: Kaiser Permanente Medicaid	$634.44
Rate for Payer: Kaiser Permanente Medicare	$622.00
Rate for Payer: MDX Hawaii PPO	$1,206.68
Rate for Payer: Ohana Health Plan Medicaid	$622.00
Rate for Payer: Ohana Health Plan Medicare	$622.00
Rate for Payer: UnitedHealthcare Medicaid	$64.51
Rate for Payer: UnitedHealthcare Medicare	$622.00
Rate for Payer: University Health Alliance Commercial	$906.75

US Echo 2D Limited EO

Facility

$1,244.00

Service Code	HCPCS 93308
Hospital Charge Code	8265211
Hospital Revenue Code	483
Min. Negotiated Rate	$1,057.40
Max. Negotiated Rate	$1,206.68
Rate for Payer: Cash Price	$808.60
Rate for Payer: Health Management Network Commercial	$1,057.40
Rate for Payer: Kaiser Permanente Commercial	$1,119.60
Rate for Payer: MDX Hawaii PPO	$1,206.68

US Echocardiogram Complete - Report

Professional

Both

$96.00

Service Code	HCPCS 76930 26
Hospital Charge Code	8111087
Hospital Revenue Code	972
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$104.86
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Hawaii Western Management Group Commercial	$104.86
Rate for Payer: Health Management Network Commercial	$81.60

US Echo TEE

Facility

$3,040.00

Service Code	HCPCS 93312
Hospital Charge Code	8211773
Hospital Revenue Code	483
Min. Negotiated Rate	$2,584.00
Max. Negotiated Rate	$2,948.80
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Health Management Network Commercial	$2,584.00
Rate for Payer: Kaiser Permanente Commercial	$2,736.00
Rate for Payer: MDX Hawaii PPO	$2,948.80

US Echo TEE

Facility

$3,040.00

Service Code	HCPCS 93312
Hospital Charge Code	8211773
Hospital Revenue Code	483
Min. Negotiated Rate	$126.66
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$1,520.00
Rate for Payer: AlohaCare Medicare	$1,520.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Devoted Health Medicare	$1,672.00
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	$1,520.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,888.00
Rate for Payer: Health Management Network Commercial	$2,584.00
Rate for Payer: Humana Medicare	$1,520.00
Rate for Payer: Kaiser Permanente Commercial	$2,736.00
Rate for Payer: Kaiser Permanente Medicaid	$1,550.40
Rate for Payer: Kaiser Permanente Medicare	$1,520.00
Rate for Payer: MDX Hawaii PPO	$2,948.80
Rate for Payer: Ohana Health Plan Medicaid	$1,520.00
Rate for Payer: Ohana Health Plan Medicare	$1,520.00
Rate for Payer: UnitedHealthcare Medicaid	$126.66
Rate for Payer: UnitedHealthcare Medicare	$1,520.00
Rate for Payer: University Health Alliance Commercial	$2,215.86

US Encephalogram

Facility

$543.00

Service Code	HCPCS 76506
Hospital Charge Code	1169679
Hospital Revenue Code	402
Min. Negotiated Rate	$461.55
Max. Negotiated Rate	$526.71
Rate for Payer: Cash Price	$352.95
Rate for Payer: Health Management Network Commercial	$461.55
Rate for Payer: Kaiser Permanente Commercial	$488.70
Rate for Payer: MDX Hawaii PPO	$526.71

US Encephalogram

Facility

$543.00

Service Code	HCPCS 76506
Hospital Charge Code	1169679
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$526.71
Rate for Payer: AlohaCare Medicaid	$271.50
Rate for Payer: AlohaCare Medicare	$271.50
Rate for Payer: Cash Price	$352.95
Rate for Payer: Cash Price	$352.95
Rate for Payer: Devoted Health Medicare	$298.65
Rate for Payer: Hawaii Medical Service Association ABD	$46.98
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$271.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.90
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$461.55
Rate for Payer: Humana Medicare	$271.50
Rate for Payer: Kaiser Permanente Commercial	$488.70
Rate for Payer: Kaiser Permanente Medicaid	$276.93
Rate for Payer: Kaiser Permanente Medicare	$271.50
Rate for Payer: MDX Hawaii PPO	$526.71
Rate for Payer: Ohana Health Plan Medicaid	$271.50
Rate for Payer: Ohana Health Plan Medicare	$271.50
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$271.50
Rate for Payer: University Health Alliance Commercial	$185.93

US Encephalogram - Report

Professional

Both

$154.00

Service Code	HCPCS 76506 26
Hospital Charge Code	631057
Hospital Revenue Code	972
Min. Negotiated Rate	$29.88
Max. Negotiated Rate	$130.90
Rate for Payer: AlohaCare Medicaid	$75.10
Rate for Payer: AlohaCare Medicare	$29.88
Rate for Payer: Cash Price	$100.10
Rate for Payer: Cash Price	$100.10
Rate for Payer: Devoted Health Medicare	$32.87
Rate for Payer: Hawaii Medical Service Association Medicare	$29.88
Rate for Payer: Hawaii Western Management Group Commercial	$97.36
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Kaiser Permanente Commercial	$32.87
Rate for Payer: Kaiser Permanente Medicaid	$32.87
Rate for Payer: Kaiser Permanente Medicare	$32.87
Rate for Payer: Ohana Health Plan Medicaid	$75.10
Rate for Payer: Ohana Health Plan Medicare	$29.88
Rate for Payer: UnitedHealthcare Medicaid	$75.10
Rate for Payer: UnitedHealthcare Medicare	$29.88

Know your out-of-pocket cost for care.

All Charges