Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

US Soft Tissue Chest or Upper Back

Facility

$1,295.00

Service Code	HCPCS 76604
Hospital Charge Code	8463496
Hospital Revenue Code	402
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$1,256.15
Rate for Payer: AlohaCare Medicaid	$647.50
Rate for Payer: AlohaCare Medicare	$647.50
Rate for Payer: Cash Price	$841.75
Rate for Payer: Cash Price	$841.75
Rate for Payer: Devoted Health Medicare	$712.25
Rate for Payer: Hawaii Medical Service Association ABD	$42.98
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$647.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$46.81
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Humana Medicare	$647.50
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: Kaiser Permanente Medicaid	$660.45
Rate for Payer: Kaiser Permanente Medicare	$647.50
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: Ohana Health Plan Medicaid	$647.50
Rate for Payer: Ohana Health Plan Medicare	$647.50
Rate for Payer: UnitedHealthcare Medicaid	$42.98
Rate for Payer: UnitedHealthcare Medicare	$647.50
Rate for Payer: University Health Alliance Commercial	$171.44

US Soft Tissue Chest or Upper Back - Report

Professional

Both

$145.00

Service Code	HCPCS 76604 26
Hospital Charge Code	8463498
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	$33.74
Rate for Payer: Kaiser Permanente Medicaid	$33.74
Rate for Payer: Kaiser Permanente Medicare	$33.74
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 Soft Tissue Groin

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8463499
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 Soft Tissue Groin

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8463499
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 Soft Tissue Groin - Report

Professional

Both

$145.00

Service Code	HCPCS 76882 26
Hospital Charge Code	8463501
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 Soft Tissue Head/Neck POC

Facility

$708.00

Service Code	HCPCS 76536
Hospital Charge Code	10234943
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	$211.12

US Soft Tissue Head/Neck POC

Facility

$708.00

Service Code	HCPCS 76536
Hospital Charge Code	10234943
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 Soft Tissue Lower Ext Left

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8472457
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 Soft Tissue Lower Ext Left

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8472457
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 Soft Tissue Lower Ext Left - Report

Professional

Both

$145.00

Service Code	HCPCS 76882 26
Hospital Charge Code	8472459
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 Soft Tissue Lower Ext Right

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8472460
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 Soft Tissue Lower Ext Right

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8472460
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 Soft Tissue Lower Ext Right - Report

Professional

Both

$145.00

Service Code	HCPCS 76882 26
Hospital Charge Code	8472462
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 Soft Tissue Upper Ext Left

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8472463
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 Soft Tissue Upper Ext Left

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8472463
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 Soft Tissue Upper Ext Left - Report

Professional

Both

$145.00

Service Code	HCPCS 76882 26
Hospital Charge Code	8472465
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 Soft Tissue Upper Ext Right

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8472466
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 Soft Tissue Upper Ext Right

Facility

$758.00

Service Code	HCPCS 76882
Hospital Charge Code	8472466
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 Soft Tissue Upper Ext Right - Report

Professional

Both

$145.00

Service Code	HCPCS 76882 26
Hospital Charge Code	8472468
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 Spinal Canal

Facility

$1,260.00

Service Code	HCPCS 76800
Hospital Charge Code	1169879
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$1,222.20
Rate for Payer: AlohaCare Medicaid	$630.00
Rate for Payer: AlohaCare Medicare	$630.00
Rate for Payer: Cash Price	$819.00
Rate for Payer: Cash Price	$819.00
Rate for Payer: Devoted Health Medicare	$693.00
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	$630.00
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	$1,071.00
Rate for Payer: Humana Medicare	$630.00
Rate for Payer: Kaiser Permanente Commercial	$1,134.00
Rate for Payer: Kaiser Permanente Medicaid	$642.60
Rate for Payer: Kaiser Permanente Medicare	$630.00
Rate for Payer: MDX Hawaii PPO	$1,222.20
Rate for Payer: Ohana Health Plan Medicaid	$630.00
Rate for Payer: Ohana Health Plan Medicare	$630.00
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$630.00
Rate for Payer: University Health Alliance Commercial	$239.82

US Spinal Canal

Facility

$1,260.00

Service Code	HCPCS 76800
Hospital Charge Code	1169879
Hospital Revenue Code	402
Min. Negotiated Rate	$1,071.00
Max. Negotiated Rate	$1,222.20
Rate for Payer: Cash Price	$819.00
Rate for Payer: Health Management Network Commercial	$1,071.00
Rate for Payer: Kaiser Permanente Commercial	$1,134.00
Rate for Payer: MDX Hawaii PPO	$1,222.20

US Spinal Canal - Report

Professional

Both

$283.00

Service Code	HCPCS 76800 26
Hospital Charge Code	630848
Hospital Revenue Code	972
Min. Negotiated Rate	$63.98
Max. Negotiated Rate	$240.55
Rate for Payer: AlohaCare Medicaid	$113.39
Rate for Payer: AlohaCare Medicare	$63.98
Rate for Payer: Cash Price	$183.95
Rate for Payer: Cash Price	$183.95
Rate for Payer: Devoted Health Medicare	$70.38
Rate for Payer: Hawaii Medical Service Association Medicare	$63.98
Rate for Payer: Hawaii Western Management Group Commercial	$123.80
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Kaiser Permanente Commercial	$76.78
Rate for Payer: Kaiser Permanente Medicaid	$76.78
Rate for Payer: Kaiser Permanente Medicare	$76.78
Rate for Payer: Ohana Health Plan Medicaid	$113.39
Rate for Payer: Ohana Health Plan Medicare	$63.98
Rate for Payer: UnitedHealthcare Medicaid	$113.39
Rate for Payer: UnitedHealthcare Medicare	$63.98

US Stress Echo Treadmill

Facility

$1,940.00

Service Code	HCPCS 93017
Hospital Charge Code	8106655
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,881.80
Rate for Payer: AlohaCare Medicaid	$970.00
Rate for Payer: AlohaCare Medicare	$970.00
Rate for Payer: Cash Price	$1,261.00
Rate for Payer: Cash Price	$1,261.00
Rate for Payer: Devoted Health Medicare	$1,067.00
Rate for Payer: Hawaii Medical Service Association Commercial	$275.75
Rate for Payer: Hawaii Medical Service Association Medicare	$970.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,843.00
Rate for Payer: Health Management Network Commercial	$1,649.00
Rate for Payer: Humana Medicare	$970.00
Rate for Payer: Kaiser Permanente Commercial	$1,746.00
Rate for Payer: Kaiser Permanente Medicaid	$989.40
Rate for Payer: Kaiser Permanente Medicare	$970.00
Rate for Payer: MDX Hawaii PPO	$1,881.80
Rate for Payer: Ohana Health Plan Medicaid	$970.00
Rate for Payer: Ohana Health Plan Medicare	$970.00
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$970.00
Rate for Payer: University Health Alliance Commercial	$1,086.40

US Stress Echo Treadmill

Facility

$1,940.00

Service Code	HCPCS 93017
Hospital Charge Code	8106655
Hospital Revenue Code	482
Min. Negotiated Rate	$1,649.00
Max. Negotiated Rate	$1,881.80
Rate for Payer: Cash Price	$1,261.00
Rate for Payer: Health Management Network Commercial	$1,649.00
Rate for Payer: Kaiser Permanente Commercial	$1,746.00
Rate for Payer: MDX Hawaii PPO	$1,881.80

US Thoracentesis

Facility

$1,792.00

Service Code	HCPCS 32555
Hospital Charge Code	1169881
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$896.00
Rate for Payer: AlohaCare Medicare	$896.00
Rate for Payer: Cash Price	$1,164.80
Rate for Payer: Cash Price	$1,164.80
Rate for Payer: Cash Price	$1,164.80
Rate for Payer: Devoted Health Medicare	$985.60
Rate for Payer: Hawaii Medical Service Association Commercial	$801.11
Rate for Payer: Hawaii Medical Service Association Medicare	$896.00
Rate for Payer: Health Management Network Commercial	$1,523.20
Rate for Payer: Humana Medicare	$896.00
Rate for Payer: Kaiser Permanente Commercial	$1,612.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$896.00
Rate for Payer: MDX Hawaii PPO	$1,738.24
Rate for Payer: Ohana Health Plan Medicaid	$896.00
Rate for Payer: Ohana Health Plan Medicare	$896.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$896.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

Know your out-of-pocket cost for care.

All Charges