Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

US Aorta Limited - Report

Professional

Both

$145.00

Service Code	HCPCS 76775 26
Hospital Charge Code	8110952
Hospital Revenue Code	972
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$38.88
Rate for Payer: AlohaCare Medicare	$27.59
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$30.35
Rate for Payer: Hawaii Medical Service Association Medicare	$27.59
Rate for Payer: Hawaii Western Management Group Commercial	$94.29
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$33.11
Rate for Payer: Kaiser Permanente Medicaid	$33.11
Rate for Payer: Kaiser Permanente Medicare	$33.11
Rate for Payer: Ohana Health Plan Medicaid	$38.88
Rate for Payer: Ohana Health Plan Medicare	$27.59
Rate for Payer: UnitedHealthcare Medicaid	$38.88
Rate for Payer: UnitedHealthcare Medicare	$27.59

US Appendix

Facility

$708.00

Service Code	HCPCS 76705
Hospital Charge Code	2425293
Hospital Revenue Code	402
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: MDX Hawaii PPO	$686.76

US Appendix

Facility

$708.00

Service Code	HCPCS 76705
Hospital Charge Code	2425293
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$354.00
Rate for Payer: AlohaCare Medicare	$354.00
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$389.40
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	$354.00
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	$601.80
Rate for Payer: Humana Medicare	$354.00
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$354.00
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$354.00
Rate for Payer: Ohana Health Plan Medicare	$354.00
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$354.00
Rate for Payer: University Health Alliance Commercial	$200.93

US Appendix - Report

Professional

Both

$144.00

Service Code	HCPCS 76705 26
Hospital Charge Code	2425295
Hospital Revenue Code	972
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$122.40
Rate for Payer: AlohaCare Medicaid	$57.67
Rate for Payer: AlohaCare Medicare	$27.93
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Devoted Health Medicare	$30.72
Rate for Payer: Hawaii Medical Service Association Medicare	$27.93
Rate for Payer: Hawaii Western Management Group Commercial	$94.64
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$33.52
Rate for Payer: Kaiser Permanente Medicaid	$33.52
Rate for Payer: Kaiser Permanente Medicare	$33.52
Rate for Payer: Ohana Health Plan Medicaid	$57.67
Rate for Payer: Ohana Health Plan Medicare	$27.93
Rate for Payer: UnitedHealthcare Medicaid	$57.67
Rate for Payer: UnitedHealthcare Medicare	$27.93

US Art/Vein Abd/Pelvis/Scrotal Complete

Facility

$1,401.00

Service Code	HCPCS 93975
Hospital Charge Code	1169581
Hospital Revenue Code	921
Min. Negotiated Rate	$1,190.85
Max. Negotiated Rate	$1,358.97
Rate for Payer: Cash Price	$910.65
Rate for Payer: Health Management Network Commercial	$1,190.85
Rate for Payer: Kaiser Permanente Commercial	$1,260.90
Rate for Payer: MDX Hawaii PPO	$1,358.97

US Art/Vein Abd/Pelvis/Scrotal Complete

Facility

$1,401.00

Service Code	HCPCS 93975
Hospital Charge Code	1169581
Hospital Revenue Code	921
Min. Negotiated Rate	$185.92
Max. Negotiated Rate	$1,358.97
Rate for Payer: AlohaCare Medicaid	$700.50
Rate for Payer: AlohaCare Medicare	$700.50
Rate for Payer: Cash Price	$910.65
Rate for Payer: Cash Price	$910.65
Rate for Payer: Devoted Health Medicare	$770.55
Rate for Payer: Hawaii Medical Service Association ABD	$185.92
Rate for Payer: Hawaii Medical Service Association Commercial	$304.71
Rate for Payer: Hawaii Medical Service Association Medicare	$700.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$222.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.95
Rate for Payer: Health Management Network Commercial	$1,190.85
Rate for Payer: Humana Medicare	$700.50
Rate for Payer: Kaiser Permanente Commercial	$1,260.90
Rate for Payer: Kaiser Permanente Medicaid	$714.51
Rate for Payer: Kaiser Permanente Medicare	$700.50
Rate for Payer: MDX Hawaii PPO	$1,358.97
Rate for Payer: Ohana Health Plan Medicaid	$700.50
Rate for Payer: Ohana Health Plan Medicare	$700.50
Rate for Payer: UnitedHealthcare Medicaid	$185.92
Rate for Payer: UnitedHealthcare Medicare	$700.50
Rate for Payer: University Health Alliance Commercial	$784.56

US Art/Vein Abd/Pelvis/Scrotal Complete - Report

Professional

Both

$363.00

Service Code	HCPCS 93975 26
Hospital Charge Code	625737
Hospital Revenue Code	972
Min. Negotiated Rate	$53.53
Max. Negotiated Rate	$308.55
Rate for Payer: AlohaCare Medicaid	$295.00
Rate for Payer: AlohaCare Medicare	$53.53
Rate for Payer: Cash Price	$235.95
Rate for Payer: Cash Price	$235.95
Rate for Payer: Devoted Health Medicare	$58.88
Rate for Payer: Hawaii Medical Service Association Medicare	$53.53
Rate for Payer: Hawaii Western Management Group Commercial	$264.52
Rate for Payer: Health Management Network Commercial	$308.55
Rate for Payer: Kaiser Permanente Commercial	$64.24
Rate for Payer: Kaiser Permanente Medicaid	$64.24
Rate for Payer: Kaiser Permanente Medicare	$64.24
Rate for Payer: Ohana Health Plan Medicaid	$295.00
Rate for Payer: Ohana Health Plan Medicare	$53.53
Rate for Payer: UnitedHealthcare Medicaid	$295.00
Rate for Payer: UnitedHealthcare Medicare	$53.53

US Art/Vein Abd/Pelvis/Scrotal Limited

Facility

$1,028.00

Service Code	HCPCS 93976
Hospital Charge Code	1169583
Hospital Revenue Code	921
Min. Negotiated Rate	$873.80
Max. Negotiated Rate	$997.16
Rate for Payer: Cash Price	$668.20
Rate for Payer: Health Management Network Commercial	$873.80
Rate for Payer: Kaiser Permanente Commercial	$925.20
Rate for Payer: MDX Hawaii PPO	$997.16

US Art/Vein Abd/Pelvis/Scrotal Limited

Facility

$1,028.00

Service Code	HCPCS 93976
Hospital Charge Code	1169583
Hospital Revenue Code	921
Min. Negotiated Rate	$106.34
Max. Negotiated Rate	$997.16
Rate for Payer: AlohaCare Medicaid	$514.00
Rate for Payer: AlohaCare Medicare	$514.00
Rate for Payer: Cash Price	$668.20
Rate for Payer: Cash Price	$668.20
Rate for Payer: Devoted Health Medicare	$565.40
Rate for Payer: Hawaii Medical Service Association ABD	$106.34
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$514.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$125.37
Rate for Payer: Hawaii Western Management Group Commercial	$976.60
Rate for Payer: Health Management Network Commercial	$873.80
Rate for Payer: Humana Medicare	$514.00
Rate for Payer: Kaiser Permanente Commercial	$925.20
Rate for Payer: Kaiser Permanente Medicaid	$524.28
Rate for Payer: Kaiser Permanente Medicare	$514.00
Rate for Payer: MDX Hawaii PPO	$997.16
Rate for Payer: Ohana Health Plan Medicaid	$514.00
Rate for Payer: Ohana Health Plan Medicare	$514.00
Rate for Payer: UnitedHealthcare Medicaid	$106.34
Rate for Payer: UnitedHealthcare Medicare	$514.00
Rate for Payer: University Health Alliance Commercial	$575.68

US Art/Vein Abd/Pelvis/Scrotal Limited - Report

Professional

Both

$197.00

Service Code	HCPCS 93976 26
Hospital Charge Code	625739
Hospital Revenue Code	972
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$176.72
Rate for Payer: AlohaCare Medicaid	$176.72
Rate for Payer: AlohaCare Medicare	$37.65
Rate for Payer: Cash Price	$128.05
Rate for Payer: Cash Price	$128.05
Rate for Payer: Devoted Health Medicare	$41.41
Rate for Payer: Hawaii Medical Service Association Medicare	$37.65
Rate for Payer: Hawaii Western Management Group Commercial	$171.97
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Kaiser Permanente Commercial	$45.18
Rate for Payer: Kaiser Permanente Medicaid	$45.18
Rate for Payer: Kaiser Permanente Medicare	$45.18
Rate for Payer: Ohana Health Plan Medicaid	$176.72
Rate for Payer: Ohana Health Plan Medicare	$37.65
Rate for Payer: UnitedHealthcare Medicaid	$176.72
Rate for Payer: UnitedHealthcare Medicare	$37.65

US Aspiration Abscess/Hematoma/Cyst

Facility

$1,030.00

Service Code	HCPCS 10160
Hospital Charge Code	2425296
Hospital Revenue Code	361
Min. Negotiated Rate	$875.50
Max. Negotiated Rate	$999.10
Rate for Payer: Cash Price	$669.50
Rate for Payer: Health Management Network Commercial	$875.50
Rate for Payer: Kaiser Permanente Commercial	$927.00
Rate for Payer: MDX Hawaii PPO	$999.10

US Aspiration Abscess/Hematoma/Cyst

Facility

$1,030.00

Service Code	HCPCS 10160
Hospital Charge Code	2425296
Hospital Revenue Code	361
Min. Negotiated Rate	$57.25
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$515.00
Rate for Payer: AlohaCare Medicare	$515.00
Rate for Payer: Cash Price	$669.50
Rate for Payer: Cash Price	$669.50
Rate for Payer: Cash Price	$669.50
Rate for Payer: Devoted Health Medicare	$566.50
Rate for Payer: Hawaii Medical Service Association Commercial	$519.15
Rate for Payer: Hawaii Medical Service Association Medicare	$515.00
Rate for Payer: Health Management Network Commercial	$875.50
Rate for Payer: Humana Medicare	$515.00
Rate for Payer: Kaiser Permanente Commercial	$927.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$515.00
Rate for Payer: MDX Hawaii PPO	$999.10
Rate for Payer: Ohana Health Plan Medicaid	$515.00
Rate for Payer: Ohana Health Plan Medicare	$515.00
Rate for Payer: UnitedHealthcare Medicaid	$57.25
Rate for Payer: UnitedHealthcare Medicare	$515.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

US Aspiration Abscess/Hematoma/Cyst - Report

Professional

Both

$566.00

Service Code	HCPCS 10160
Hospital Charge Code	2425298
Hospital Revenue Code	972
Min. Negotiated Rate	$47.58
Max. Negotiated Rate	$481.10
Rate for Payer: AlohaCare Medicaid	$101.97
Rate for Payer: AlohaCare Medicare	$95.49
Rate for Payer: Cash Price	$367.90
Rate for Payer: Cash Price	$367.90
Rate for Payer: Devoted Health Medicare	$105.04
Rate for Payer: Hawaii Medical Service Association ABD	$101.97
Rate for Payer: Hawaii Medical Service Association Commercial	$153.51
Rate for Payer: Hawaii Medical Service Association Medicare	$95.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$101.97
Rate for Payer: Hawaii Western Management Group Commercial	$47.58
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Kaiser Permanente Commercial	$114.59
Rate for Payer: Kaiser Permanente Medicaid	$114.59
Rate for Payer: Kaiser Permanente Medicare	$114.59
Rate for Payer: Ohana Health Plan Medicaid	$101.97
Rate for Payer: Ohana Health Plan Medicare	$95.49
Rate for Payer: UnitedHealthcare Medicaid	$101.97
Rate for Payer: UnitedHealthcare Medicare	$95.49
Rate for Payer: University Health Alliance Commercial	$110.81

US Axilla Bilateral

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8426431
Hospital Revenue Code	402
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$379.00
Rate for Payer: AlohaCare Medicare	$379.00
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$416.90
Rate for Payer: Hawaii Medical Service Association ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$379.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.72
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$379.00
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$379.00
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$379.00
Rate for Payer: Ohana Health Plan Medicare	$379.00
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$379.00
Rate for Payer: University Health Alliance Commercial	$60.62

US Axilla Bilateral

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8426431
Hospital Revenue Code	402
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$492.70
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: MDX Hawaii PPO	$735.26

US Axilla Bilateral - Report

Professional

Both

$145.00

Service Code	HCPCS 76882 26
Hospital Charge Code	8426433
Hospital Revenue Code	972
Min. Negotiated Rate	$32.65
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$40.96
Rate for Payer: AlohaCare Medicare	$32.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$35.91
Rate for Payer: Hawaii Medical Service Association Medicare	$32.65
Rate for Payer: Hawaii Western Management Group Commercial	$32.77
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$39.18
Rate for Payer: Kaiser Permanente Medicaid	$39.18
Rate for Payer: Kaiser Permanente Medicare	$39.18
Rate for Payer: Ohana Health Plan Medicaid	$40.96
Rate for Payer: Ohana Health Plan Medicare	$32.65
Rate for Payer: UnitedHealthcare Medicaid	$40.96
Rate for Payer: UnitedHealthcare Medicare	$32.65

US Axilla Left

Facility

$1,073.00

Service Code	HCPCS 76882
Hospital Charge Code	8100913
Hospital Revenue Code	402
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$1,040.81
Rate for Payer: AlohaCare Medicaid	$536.50
Rate for Payer: AlohaCare Medicare	$536.50
Rate for Payer: Cash Price	$697.45
Rate for Payer: Cash Price	$697.45
Rate for Payer: Devoted Health Medicare	$590.15
Rate for Payer: Hawaii Medical Service Association ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$536.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.72
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$912.05
Rate for Payer: Humana Medicare	$536.50
Rate for Payer: Kaiser Permanente Commercial	$965.70
Rate for Payer: Kaiser Permanente Medicaid	$547.23
Rate for Payer: Kaiser Permanente Medicare	$536.50
Rate for Payer: MDX Hawaii PPO	$1,040.81
Rate for Payer: Ohana Health Plan Medicaid	$536.50
Rate for Payer: Ohana Health Plan Medicare	$536.50
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$536.50
Rate for Payer: University Health Alliance Commercial	$60.62

US Axilla Left

Facility

$1,073.00

Service Code	HCPCS 76882
Hospital Charge Code	8100913
Hospital Revenue Code	402
Min. Negotiated Rate	$912.05
Max. Negotiated Rate	$1,040.81
Rate for Payer: Cash Price	$697.45
Rate for Payer: Health Management Network Commercial	$912.05
Rate for Payer: Kaiser Permanente Commercial	$965.70
Rate for Payer: MDX Hawaii PPO	$1,040.81

US Axilla Left - Report

Professional

Both

$145.00

Service Code	HCPCS 76882 26
Hospital Charge Code	8100915
Hospital Revenue Code	972
Min. Negotiated Rate	$32.65
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$40.96
Rate for Payer: AlohaCare Medicare	$32.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$35.91
Rate for Payer: Hawaii Medical Service Association Medicare	$32.65
Rate for Payer: Hawaii Western Management Group Commercial	$32.77
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$39.18
Rate for Payer: Kaiser Permanente Medicaid	$39.18
Rate for Payer: Kaiser Permanente Medicare	$39.18
Rate for Payer: Ohana Health Plan Medicaid	$40.96
Rate for Payer: Ohana Health Plan Medicare	$32.65
Rate for Payer: UnitedHealthcare Medicaid	$40.96
Rate for Payer: UnitedHealthcare Medicare	$32.65

US Axilla Right

Facility

$1,073.00

Service Code	HCPCS 76882
Hospital Charge Code	8100916
Hospital Revenue Code	402
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$1,040.81
Rate for Payer: AlohaCare Medicaid	$536.50
Rate for Payer: AlohaCare Medicare	$536.50
Rate for Payer: Cash Price	$697.45
Rate for Payer: Cash Price	$697.45
Rate for Payer: Devoted Health Medicare	$590.15
Rate for Payer: Hawaii Medical Service Association ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$536.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.72
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$912.05
Rate for Payer: Humana Medicare	$536.50
Rate for Payer: Kaiser Permanente Commercial	$965.70
Rate for Payer: Kaiser Permanente Medicaid	$547.23
Rate for Payer: Kaiser Permanente Medicare	$536.50
Rate for Payer: MDX Hawaii PPO	$1,040.81
Rate for Payer: Ohana Health Plan Medicaid	$536.50
Rate for Payer: Ohana Health Plan Medicare	$536.50
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$536.50
Rate for Payer: University Health Alliance Commercial	$60.62

US Axilla Right

Facility

$1,073.00

Service Code	HCPCS 76882
Hospital Charge Code	8100916
Hospital Revenue Code	402
Min. Negotiated Rate	$912.05
Max. Negotiated Rate	$1,040.81
Rate for Payer: Cash Price	$697.45
Rate for Payer: Health Management Network Commercial	$912.05
Rate for Payer: Kaiser Permanente Commercial	$965.70
Rate for Payer: MDX Hawaii PPO	$1,040.81

US Axilla Right - Report

Professional

Both

$145.00

Service Code	HCPCS 76882 26
Hospital Charge Code	8100918
Hospital Revenue Code	972
Min. Negotiated Rate	$32.65
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$40.96
Rate for Payer: AlohaCare Medicare	$32.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$35.91
Rate for Payer: Hawaii Medical Service Association Medicare	$32.65
Rate for Payer: Hawaii Western Management Group Commercial	$32.77
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$39.18
Rate for Payer: Kaiser Permanente Medicaid	$39.18
Rate for Payer: Kaiser Permanente Medicare	$39.18
Rate for Payer: Ohana Health Plan Medicaid	$40.96
Rate for Payer: Ohana Health Plan Medicare	$32.65
Rate for Payer: UnitedHealthcare Medicaid	$40.96
Rate for Payer: UnitedHealthcare Medicare	$32.65

US Biopsy Abdomen

Facility

$3,181.00

Service Code	HCPCS 49180
Hospital Charge Code	1169591
Hospital Revenue Code	761
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 Abdomen

Facility

$3,181.00

Service Code	HCPCS 49180
Hospital Charge Code	1169591
Hospital Revenue Code	761
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	$1,781.36

US Biopsy Liver

Facility

$2,664.00

Service Code	HCPCS 47000
Hospital Charge Code	1169599
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,332.00
Rate for Payer: AlohaCare Medicare	$1,332.00
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Devoted Health Medicare	$1,465.20
Rate for Payer: Hawaii Medical Service Association Commercial	$2,109.21
Rate for Payer: Hawaii Medical Service Association Medicare	$1,332.00
Rate for Payer: Health Management Network Commercial	$2,264.40
Rate for Payer: Humana Medicare	$1,332.00
Rate for Payer: Kaiser Permanente Commercial	$2,397.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,332.00
Rate for Payer: MDX Hawaii PPO	$2,584.08
Rate for Payer: Ohana Health Plan Medicaid	$1,332.00
Rate for Payer: Ohana Health Plan Medicare	$1,332.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,332.00
Rate for Payer: University Health Alliance Commercial	$1,491.84

Know your out-of-pocket cost for care.

All Charges