Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

81002 URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP TechFee

Facility

$42.00

Service Code	HCPCS 81002
Hospital Charge Code	8023432
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$40.74
Rate for Payer: AlohaCare Medicaid	$21.00
Rate for Payer: AlohaCare Medicare	$21.00
Rate for Payer: Cash Price	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Devoted Health Medicare	$23.10
Rate for Payer: Hawaii Medical Service Association ABD	$3.54
Rate for Payer: Hawaii Medical Service Association Commercial	$4.35
Rate for Payer: Hawaii Medical Service Association Medicare	$21.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.48
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Humana Medicare	$21.00
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Medicaid	$21.42
Rate for Payer: Kaiser Permanente Medicare	$21.00
Rate for Payer: MDX Hawaii PPO	$40.74
Rate for Payer: Ohana Health Plan Medicaid	$21.00
Rate for Payer: Ohana Health Plan Medicare	$21.00
Rate for Payer: UnitedHealthcare Medicaid	$3.54
Rate for Payer: UnitedHealthcare Medicare	$21.00
Rate for Payer: University Health Alliance Commercial	$6.60

81002 URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP TechFee

Facility

$42.00

Service Code	HCPCS 81002
Hospital Charge Code	8023432
Hospital Revenue Code	307
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$27.30
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: MDX Hawaii PPO	$40.74

8100937 US Scrotum (Contents)

Facility

$861.00

Service Code	HCPCS 76870
Hospital Charge Code	9279261
Hospital Revenue Code	402
Min. Negotiated Rate	$50.35
Max. Negotiated Rate	$835.17
Rate for Payer: AlohaCare Medicaid	$430.50
Rate for Payer: AlohaCare Medicare	$430.50
Rate for Payer: Cash Price	$559.65
Rate for Payer: Cash Price	$559.65
Rate for Payer: Devoted Health Medicare	$473.55
Rate for Payer: Hawaii Medical Service Association ABD	$50.35
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$430.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$54.65
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$731.85
Rate for Payer: Humana Medicare	$430.50
Rate for Payer: Kaiser Permanente Commercial	$774.90
Rate for Payer: Kaiser Permanente Medicaid	$439.11
Rate for Payer: Kaiser Permanente Medicare	$430.50
Rate for Payer: MDX Hawaii PPO	$835.17
Rate for Payer: Ohana Health Plan Medicaid	$430.50
Rate for Payer: Ohana Health Plan Medicare	$430.50
Rate for Payer: UnitedHealthcare Medicaid	$50.35
Rate for Payer: UnitedHealthcare Medicare	$430.50
Rate for Payer: University Health Alliance Commercial	$228.81

8100937 US Scrotum (Contents)

Facility

$861.00

Service Code	HCPCS 76870
Hospital Charge Code	9279261
Hospital Revenue Code	402
Min. Negotiated Rate	$731.85
Max. Negotiated Rate	$835.17
Rate for Payer: Cash Price	$559.65
Rate for Payer: Health Management Network Commercial	$731.85
Rate for Payer: Kaiser Permanente Commercial	$774.90
Rate for Payer: MDX Hawaii PPO	$835.17

81025 URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS TechFee

Facility

$95.00

Service Code	HCPCS 81025 QW
Hospital Charge Code	8023433
Hospital Revenue Code	307
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$47.50
Rate for Payer: AlohaCare Medicare	$47.50
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Devoted Health Medicare	$52.25
Rate for Payer: Hawaii Medical Service Association ABD	$8.74
Rate for Payer: Hawaii Medical Service Association Medicare	$47.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.18
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$47.50
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$47.50
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$47.50
Rate for Payer: Ohana Health Plan Medicare	$47.50
Rate for Payer: UnitedHealthcare Medicaid	$8.74
Rate for Payer: UnitedHealthcare Medicare	$47.50
Rate for Payer: University Health Alliance Commercial	$16.35

81025 URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS TechFee

Facility

$95.00

Service Code	HCPCS 81025 QW
Hospital Charge Code	8023433
Hospital Revenue Code	307
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$61.75
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: MDX Hawaii PPO	$92.15

81513 Inf Dis Bact Vaginosis Qt

Facility

$681.00

Service Code	HCPCS 81513
Hospital Charge Code	11187143
Hospital Revenue Code	300
Min. Negotiated Rate	$106.97
Max. Negotiated Rate	$660.57
Rate for Payer: AlohaCare Medicaid	$340.50
Rate for Payer: AlohaCare Medicare	$340.50
Rate for Payer: Cash Price	$442.65
Rate for Payer: Cash Price	$442.65
Rate for Payer: Devoted Health Medicare	$374.55
Rate for Payer: Hawaii Medical Service Association ABD	$174.58
Rate for Payer: Hawaii Medical Service Association Commercial	$178.29
Rate for Payer: Hawaii Medical Service Association Medicare	$340.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$177.81
Rate for Payer: Hawaii Western Management Group Commercial	$142.63
Rate for Payer: Health Management Network Commercial	$578.85
Rate for Payer: Humana Medicare	$340.50
Rate for Payer: Kaiser Permanente Commercial	$612.90
Rate for Payer: Kaiser Permanente Medicaid	$347.31
Rate for Payer: Kaiser Permanente Medicare	$340.50
Rate for Payer: MDX Hawaii PPO	$660.57
Rate for Payer: Ohana Health Plan Medicaid	$340.50
Rate for Payer: Ohana Health Plan Medicare	$340.50
Rate for Payer: UnitedHealthcare Medicaid	$106.97
Rate for Payer: UnitedHealthcare Medicare	$340.50
Rate for Payer: University Health Alliance Commercial	$496.38

81513 Inf Dis Bact Vaginosis Qt

Facility

$681.00

Service Code	HCPCS 81513
Hospital Charge Code	11187143
Hospital Revenue Code	300
Min. Negotiated Rate	$578.85
Max. Negotiated Rate	$660.57
Rate for Payer: Cash Price	$442.65
Rate for Payer: Health Management Network Commercial	$578.85
Rate for Payer: Kaiser Permanente Commercial	$612.90
Rate for Payer: MDX Hawaii PPO	$660.57

82330 Calcium Ionized POC

Facility

$163.00

Service Code	HCPCS 82330 QW
Hospital Charge Code	8343990
Hospital Revenue Code	301
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: MDX Hawaii PPO	$158.11

82330 Calcium Ionized POC

Facility

$163.00

Service Code	HCPCS 82330 QW
Hospital Charge Code	8343990
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$81.50
Rate for Payer: AlohaCare Medicare	$81.50
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$89.65
Rate for Payer: Hawaii Medical Service Association ABD	$18.88
Rate for Payer: Hawaii Medical Service Association Commercial	$17.10
Rate for Payer: Hawaii Medical Service Association Medicare	$81.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.82
Rate for Payer: Hawaii Western Management Group Commercial	$13.68
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$81.50
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$81.50
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$81.50
Rate for Payer: Ohana Health Plan Medicare	$81.50
Rate for Payer: UnitedHealthcare Medicaid	$18.88
Rate for Payer: UnitedHealthcare Medicare	$81.50
Rate for Payer: University Health Alliance Commercial	$35.32

82374 Total Carbon Dioxide Meas POC

Facility

$68.00

Service Code	HCPCS 82374 QW
Hospital Charge Code	8343993
Hospital Revenue Code	301
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$44.20
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

82374 Total Carbon Dioxide Meas POC

Facility

$68.00

Service Code	HCPCS 82374 QW
Hospital Charge Code	8343993
Hospital Revenue Code	301
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$34.00
Rate for Payer: AlohaCare Medicare	$34.00
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Devoted Health Medicare	$37.40
Rate for Payer: Hawaii Medical Service Association ABD	$6.76
Rate for Payer: Hawaii Medical Service Association Commercial	$6.10
Rate for Payer: Hawaii Medical Service Association Medicare	$34.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.10
Rate for Payer: Hawaii Western Management Group Commercial	$4.88
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$34.00
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$34.00
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$34.00
Rate for Payer: Ohana Health Plan Medicare	$34.00
Rate for Payer: UnitedHealthcare Medicaid	$6.76
Rate for Payer: UnitedHealthcare Medicare	$34.00
Rate for Payer: University Health Alliance Commercial	$12.64

82565 Creatinine Blood

Facility

$72.00

Service Code	HCPCS 82565 QW
Hospital Charge Code	8343991
Hospital Revenue Code	301
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

82565 Creatinine Blood

Facility

$72.00

Service Code	HCPCS 82565 QW
Hospital Charge Code	8343991
Hospital Revenue Code	301
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$36.00
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$39.60
Rate for Payer: Hawaii Medical Service Association ABD	$7.07
Rate for Payer: Hawaii Medical Service Association Commercial	$6.40
Rate for Payer: Hawaii Medical Service Association Medicare	$36.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.42
Rate for Payer: Hawaii Western Management Group Commercial	$5.12
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$36.00
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$36.00
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$36.00
Rate for Payer: Ohana Health Plan Medicare	$36.00
Rate for Payer: UnitedHealthcare Medicaid	$7.07
Rate for Payer: UnitedHealthcare Medicare	$36.00
Rate for Payer: University Health Alliance Commercial	$13.25

82570 Creatinine Other Sources KSO

Facility

$267.00

Service Code	HCPCS 82570
Hospital Charge Code	10288180
Hospital Revenue Code	301
Min. Negotiated Rate	$226.95
Max. Negotiated Rate	$258.99
Rate for Payer: Cash Price	$173.55
Rate for Payer: Health Management Network Commercial	$226.95
Rate for Payer: Kaiser Permanente Commercial	$240.30
Rate for Payer: MDX Hawaii PPO	$258.99

82570 Creatinine Other Sources KSO

Facility

$267.00

Service Code	HCPCS 82570
Hospital Charge Code	10288180
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$258.99
Rate for Payer: AlohaCare Medicaid	$133.50
Rate for Payer: AlohaCare Medicare	$133.50
Rate for Payer: Cash Price	$173.55
Rate for Payer: Cash Price	$173.55
Rate for Payer: Devoted Health Medicare	$146.85
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$133.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$226.95
Rate for Payer: Humana Medicare	$133.50
Rate for Payer: Kaiser Permanente Commercial	$240.30
Rate for Payer: Kaiser Permanente Medicaid	$136.17
Rate for Payer: Kaiser Permanente Medicare	$133.50
Rate for Payer: MDX Hawaii PPO	$258.99
Rate for Payer: Ohana Health Plan Medicaid	$133.50
Rate for Payer: Ohana Health Plan Medicare	$133.50
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$133.50
Rate for Payer: University Health Alliance Commercial	$13.38

82595 - Cryoglobulin Evaluation FSI

Facility

$72.00

Service Code	HCPCS 82595
Hospital Charge Code	8857577
Hospital Revenue Code	301
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

82595 - Cryoglobulin Evaluation FSI

Facility

$72.00

Service Code	HCPCS 82595
Hospital Charge Code	8857577
Hospital Revenue Code	301
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$36.00
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$39.60
Rate for Payer: Hawaii Medical Service Association ABD	$8.95
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Medicare	$36.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.40
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$36.00
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$36.00
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$36.00
Rate for Payer: Ohana Health Plan Medicare	$36.00
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$36.00
Rate for Payer: University Health Alliance Commercial	$16.72

82803 Blood Gas PH pO2 pCO2 POC

Facility

$259.00

Service Code	HCPCS 82803
Hospital Charge Code	9364742
Hospital Revenue Code	301
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$251.23
Rate for Payer: AlohaCare Medicaid	$129.50
Rate for Payer: AlohaCare Medicare	$129.50
Rate for Payer: Cash Price	$168.35
Rate for Payer: Cash Price	$168.35
Rate for Payer: Devoted Health Medicare	$142.45
Rate for Payer: Hawaii Medical Service Association ABD	$26.74
Rate for Payer: Hawaii Medical Service Association Commercial	$32.59
Rate for Payer: Hawaii Medical Service Association Medicare	$129.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.08
Rate for Payer: Hawaii Western Management Group Commercial	$26.07
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Humana Medicare	$129.50
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: Kaiser Permanente Medicare	$129.50
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: Ohana Health Plan Medicaid	$129.50
Rate for Payer: Ohana Health Plan Medicare	$129.50
Rate for Payer: UnitedHealthcare Medicaid	$26.74
Rate for Payer: UnitedHealthcare Medicare	$129.50
Rate for Payer: University Health Alliance Commercial	$50.02

82803 Blood Gas PH pO2 pCO2 POC

Facility

$259.00

Service Code	HCPCS 82803
Hospital Charge Code	9364742
Hospital Revenue Code	301
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$168.35
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: MDX Hawaii PPO	$251.23

83497

Facility

$14.00

Service Code	HCPCS 83497
Hospital Charge Code	13416107
Hospital Revenue Code	300
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$33.32
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$7.00
Rate for Payer: Cash Price	$9.10
Rate for Payer: Cash Price	$9.10
Rate for Payer: Devoted Health Medicare	$7.70
Rate for Payer: Hawaii Medical Service Association ABD	$17.82
Rate for Payer: Hawaii Medical Service Association Commercial	$16.12
Rate for Payer: Hawaii Medical Service Association Medicare	$7.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.71
Rate for Payer: Hawaii Western Management Group Commercial	$12.90
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$7.00
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$7.00
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: Ohana Health Plan Medicaid	$7.00
Rate for Payer: Ohana Health Plan Medicare	$7.00
Rate for Payer: UnitedHealthcare Medicaid	$17.82
Rate for Payer: UnitedHealthcare Medicare	$7.00
Rate for Payer: University Health Alliance Commercial	$33.32

83497

Facility

$14.00

Service Code	HCPCS 83497
Hospital Charge Code	13416107
Hospital Revenue Code	300
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$9.10
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

83516-MyoMarker 3 Profile

Facility

$13.00

Service Code	HCPCS 83516
Hospital Charge Code	12540227
Hospital Revenue Code	302
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$29.82
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$6.50
Rate for Payer: Cash Price	$8.45
Rate for Payer: Cash Price	$8.45
Rate for Payer: Devoted Health Medicare	$7.15
Rate for Payer: Hawaii Medical Service Association ABD	$15.95
Rate for Payer: Hawaii Medical Service Association Commercial	$14.41
Rate for Payer: Hawaii Medical Service Association Medicare	$6.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.75
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$6.50
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$6.50
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$6.50
Rate for Payer: Ohana Health Plan Medicare	$6.50
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: UnitedHealthcare Medicare	$6.50
Rate for Payer: University Health Alliance Commercial	$29.82

83516-MyoMarker 3 Profile

Facility

$13.00

Service Code	HCPCS 83516
Hospital Charge Code	12540227
Hospital Revenue Code	302
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$8.45
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

83605 Lactic Acid POC

Facility

$159.00

Service Code	HCPCS 83605
Hospital Charge Code	9364741
Hospital Revenue Code	301
Min. Negotiated Rate	$135.15
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$103.35
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Kaiser Permanente Commercial	$143.10
Rate for Payer: MDX Hawaii PPO	$154.23

Know your out-of-pocket cost for care.

All Charges