Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG INJ IM/SUBQ MOD XU

Facility

$220.00

Service Code	HCPCS 96372
Hospital Charge Code	H9400111
Hospital Revenue Code	940
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: MDX Hawaii PPO	$213.40

HCHG INJ IM/SUBQ MOD XU

Facility

$220.00

Service Code	HCPCS 96372
Hospital Charge Code	H9400111
Hospital Revenue Code	940
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$85.06
Rate for Payer: AlohaCare Medicare	$85.06
Rate for Payer: Cash Price	$143.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$93.57
Rate for Payer: Hawaii Medical Service Association Commercial	$106.33
Rate for Payer: Hawaii Medical Service Association Medicare	$85.06
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$85.06
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$85.06
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$93.57
Rate for Payer: Ohana Health Plan Medicare	$85.06
Rate for Payer: UnitedHealthcare Medicaid	$13.87
Rate for Payer: UnitedHealthcare Medicare	$85.06
Rate for Payer: University Health Alliance Commercial	$160.36

HCHG INJ NERVE BLOCK OTHER PERIPH

Facility

$3,543.00

Service Code	HCPCS 64450
Hospital Charge Code	H4500514
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Devoted Health Medicare	$917.28
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,365.85
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$2,232.09
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$3,436.71
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG INJ NERVE BLOCK OTHER PERIPH

Facility

$3,543.00

Service Code	HCPCS 64450
Hospital Charge Code	H4500514
Hospital Revenue Code	450
Min. Negotiated Rate	$3,011.55
Max. Negotiated Rate	$3,436.71
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: MDX Hawaii PPO	$3,436.71

HCHG INJ SNGL/MULT TRIGGER PTS 1-2 MUSC

Facility

$1,721.00

Service Code	HCPCS 20552
Hospital Charge Code	H4500520
Hospital Revenue Code	450
Min. Negotiated Rate	$362.62
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,634.95
Rate for Payer: Health Management Network Commercial	$1,462.85
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$1,084.23
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,669.37
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG INJ SNGL/MULT TRIGGER PTS 1-2 MUSC

Facility

$1,721.00

Service Code	HCPCS 20552
Hospital Charge Code	H4500520
Hospital Revenue Code	450
Min. Negotiated Rate	$1,462.85
Max. Negotiated Rate	$1,669.37
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Health Management Network Commercial	$1,462.85
Rate for Payer: MDX Hawaii PPO	$1,669.37

HCHG INJ THERAPEUTIC SUBQ/IM

Facility

$220.00

Service Code	HCPCS 96372
Hospital Charge Code	H2600148
Hospital Revenue Code	260
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$213.40
Rate for Payer: Kaiser Permanente Medicare	$85.06
Rate for Payer: AlohaCare Medicaid	$85.06
Rate for Payer: AlohaCare Medicare	$85.06
Rate for Payer: Cash Price	$143.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$93.57
Rate for Payer: Hawaii Medical Service Association Commercial	$106.33
Rate for Payer: Hawaii Medical Service Association Medicare	$85.06
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$85.06
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$93.57
Rate for Payer: Ohana Health Plan Medicare	$85.06
Rate for Payer: UnitedHealthcare Medicaid	$13.87
Rate for Payer: UnitedHealthcare Medicare	$85.06
Rate for Payer: University Health Alliance Commercial	$160.36

HCHG INJ THERAPEUTIC SUBQ/IM

Facility

$220.00

Service Code	HCPCS 96372
Hospital Charge Code	H2600148
Hospital Revenue Code	260
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: MDX Hawaii PPO	$213.40

HCHG INJ THERAPEUTIC SUBQ/IM

Facility

$220.00

Service Code	HCPCS 96372
Hospital Charge Code	H4500518
Hospital Revenue Code	450
Min. Negotiated Rate	$85.06
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$85.06
Rate for Payer: AlohaCare Medicare	$85.06
Rate for Payer: Cash Price	$143.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$93.57
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$85.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$85.06
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$85.06
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$93.57
Rate for Payer: Ohana Health Plan Medicare	$85.06
Rate for Payer: UnitedHealthcare Medicare	$85.06
Rate for Payer: University Health Alliance Commercial	$160.36

HCHG INJ THERAPEUTIC SUBQ/IM

Facility

$220.00

Service Code	HCPCS 96372
Hospital Charge Code	H4500518
Hospital Revenue Code	450
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: MDX Hawaii PPO	$213.40

HCHG INJ W FLUOR EVAL CV DEVICE

Facility

$1,415.00

Service Code	HCPCS 36598
Hospital Charge Code	H3200923
Hospital Revenue Code	361
Min. Negotiated Rate	$1,202.75
Max. Negotiated Rate	$1,372.55
Rate for Payer: Cash Price	$919.75
Rate for Payer: Health Management Network Commercial	$1,202.75
Rate for Payer: MDX Hawaii PPO	$1,372.55

HCHG INJ W FLUOR EVAL CV DEVICE

Facility

$1,415.00

Service Code	HCPCS 36598
Hospital Charge Code	H3200923
Hospital Revenue Code	361
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$251.28
Rate for Payer: AlohaCare Medicare	$251.28
Rate for Payer: Cash Price	$919.75
Rate for Payer: Cash Price	$919.75
Rate for Payer: Cash Price	$919.75
Rate for Payer: Devoted Health Medicare	$276.41
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$251.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$1,202.75
Rate for Payer: Humana Medicare	$251.28
Rate for Payer: Kaiser Permanente Commercial	$891.45
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$251.28
Rate for Payer: MDX Hawaii PPO	$1,372.55
Rate for Payer: Ohana Health Plan Medicaid	$276.41
Rate for Payer: Ohana Health Plan Medicare	$251.28
Rate for Payer: UnitedHealthcare Medicaid	$93.80
Rate for Payer: UnitedHealthcare Medicare	$251.28
Rate for Payer: University Health Alliance Commercial	$1,031.39

HCHG INSERT CATH PLEURA W/ IMAGE

Facility

$4,880.00

Service Code	HCPCS 32557
Hospital Charge Code	H4501062
Hospital Revenue Code	450
Min. Negotiated Rate	$4,148.00
Max. Negotiated Rate	$4,733.60
Rate for Payer: Cash Price	$3,172.00
Rate for Payer: Health Management Network Commercial	$4,148.00
Rate for Payer: MDX Hawaii PPO	$4,733.60

HCHG INSERT CATH PLEURA W/ IMAGE

Facility

$4,880.00

Service Code	HCPCS 32557
Hospital Charge Code	H4501062
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,733.60
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$3,172.00
Rate for Payer: Cash Price	$3,172.00
Rate for Payer: Cash Price	$3,172.00
Rate for Payer: Devoted Health Medicare	$2,045.58
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,636.00
Rate for Payer: Health Management Network Commercial	$4,148.00
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$3,074.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$4,733.60
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$3,557.03

HCHG INSERT CATH PLEURA W/O IMAGE

Facility

$6,081.00

Service Code	HCPCS 32556
Hospital Charge Code	K3610004
Hospital Revenue Code	361
Min. Negotiated Rate	$5,168.85
Max. Negotiated Rate	$5,898.57
Rate for Payer: Cash Price	$3,952.65
Rate for Payer: Health Management Network Commercial	$5,168.85
Rate for Payer: MDX Hawaii PPO	$5,898.57

HCHG INSERT CATH PLEURA W/O IMAGE

Facility

$6,081.00

Service Code	HCPCS 32556
Hospital Charge Code	H4501061
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,898.57
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Cash Price	$3,952.65
Rate for Payer: Cash Price	$3,952.65
Rate for Payer: Cash Price	$3,952.65
Rate for Payer: Cash Price	$3,952.65
Rate for Payer: Devoted Health Medicare	$2,493.58
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,776.95
Rate for Payer: Health Management Network Commercial	$5,168.85
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Commercial	$3,831.03
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: MDX Hawaii PPO	$5,898.57
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$4,432.44

HCHG INSERT CATH PLEURA W/O IMAGE

Facility

$6,081.00

Service Code	HCPCS 32556
Hospital Charge Code	K3610004
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,898.57
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Cash Price	$3,952.65
Rate for Payer: Cash Price	$3,952.65
Rate for Payer: Cash Price	$3,952.65
Rate for Payer: Devoted Health Medicare	$2,493.58
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.61
Rate for Payer: Hawaii Medical Service Association Medicare	$2,266.89
Rate for Payer: Health Management Network Commercial	$5,168.85
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Commercial	$3,831.03
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: MDX Hawaii PPO	$5,898.57
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$4,432.44

HCHG INSERT CATH PLEURA W/O IMAGE

Facility

$6,081.00

Service Code	HCPCS 32556
Hospital Charge Code	H4501061
Hospital Revenue Code	450
Min. Negotiated Rate	$5,168.85
Max. Negotiated Rate	$5,898.57
Rate for Payer: Cash Price	$3,952.65
Rate for Payer: Health Management Network Commercial	$5,168.85
Rate for Payer: MDX Hawaii PPO	$5,898.57

HCHG INSERT CERVICAL DILATOR

Facility

$1,203.00

Service Code	HCPCS 59200
Hospital Charge Code	H7200189
Hospital Revenue Code	720
Min. Negotiated Rate	$29.09
Max. Negotiated Rate	$1,166.91
Rate for Payer: AlohaCare Medicaid	$359.99
Rate for Payer: AlohaCare Medicare	$359.99
Rate for Payer: Cash Price	$781.95
Rate for Payer: Cash Price	$781.95
Rate for Payer: Devoted Health Medicare	$395.99
Rate for Payer: Hawaii Medical Service Association Commercial	$449.99
Rate for Payer: Hawaii Medical Service Association Medicare	$359.99
Rate for Payer: Hawaii Western Management Group Commercial	$1,142.85
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: Humana Medicare	$359.99
Rate for Payer: Kaiser Permanente Commercial	$757.89
Rate for Payer: Kaiser Permanente Medicaid	$613.53
Rate for Payer: Kaiser Permanente Medicare	$359.99
Rate for Payer: MDX Hawaii PPO	$1,166.91
Rate for Payer: Ohana Health Plan Medicaid	$395.99
Rate for Payer: Ohana Health Plan Medicare	$359.99
Rate for Payer: UnitedHealthcare Medicaid	$29.09
Rate for Payer: UnitedHealthcare Medicare	$359.99
Rate for Payer: University Health Alliance Commercial	$876.87

HCHG INSERT CERVICAL DILATOR

Facility

$1,203.00

Service Code	HCPCS 59200
Hospital Charge Code	H7200189
Hospital Revenue Code	720
Min. Negotiated Rate	$1,022.55
Max. Negotiated Rate	$1,166.91
Rate for Payer: Cash Price	$781.95
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: MDX Hawaii PPO	$1,166.91

HCHG INSERT INDWELL BLAD CATH COMP

Facility

$993.00

Service Code	HCPCS 51703
Hospital Charge Code	H4500522
Hospital Revenue Code	450
Min. Negotiated Rate	$844.05
Max. Negotiated Rate	$963.21
Rate for Payer: Cash Price	$645.45
Rate for Payer: Health Management Network Commercial	$844.05
Rate for Payer: MDX Hawaii PPO	$963.21

HCHG INSERT INDWELL BLAD CATH COMP

Facility

$993.00

Service Code	HCPCS 51703
Hospital Charge Code	H4500522
Hospital Revenue Code	450
Min. Negotiated Rate	$152.01
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$152.01
Rate for Payer: AlohaCare Medicare	$152.01
Rate for Payer: Cash Price	$645.45
Rate for Payer: Cash Price	$645.45
Rate for Payer: Cash Price	$645.45
Rate for Payer: Devoted Health Medicare	$167.21
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$152.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$943.35
Rate for Payer: Health Management Network Commercial	$844.05
Rate for Payer: Humana Medicare	$152.01
Rate for Payer: Kaiser Permanente Commercial	$625.59
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$152.01
Rate for Payer: MDX Hawaii PPO	$963.21
Rate for Payer: Ohana Health Plan Medicaid	$167.21
Rate for Payer: Ohana Health Plan Medicare	$152.01
Rate for Payer: UnitedHealthcare Medicare	$152.01
Rate for Payer: University Health Alliance Commercial	$723.80

HCHG INSERT INDWELL BLAD CATH SIMP

Facility

$816.00

Service Code	HCPCS 51702
Hospital Charge Code	H4500524
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$514.08
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$594.78

HCHG INSERT INDWELL BLAD CATH SIMP

Facility

$816.00

Service Code	HCPCS 51702
Hospital Charge Code	H4500524
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: MDX Hawaii PPO	$791.52

HCHG INSERTION CATHETER ARTERY

Facility

$273.00

Service Code	HCPCS 36620
Hospital Charge Code	H7610177
Hospital Revenue Code	761
Min. Negotiated Rate	$47.24
Max. Negotiated Rate	$2,833.00
Rate for Payer: Cash Price	$177.45
Rate for Payer: Cash Price	$177.45
Rate for Payer: Cash Price	$177.45
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$259.35
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: Kaiser Permanente Commercial	$171.99
Rate for Payer: Kaiser Permanente Medicaid	$139.23
Rate for Payer: MDX Hawaii PPO	$264.81
Rate for Payer: UnitedHealthcare Medicaid	$47.24
Rate for Payer: University Health Alliance Commercial	$198.99

Know your out-of-pocket cost for care.

All Charges