Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG METANEPHRINE PLASMA

Facility

$127.00

Service Code	HCPCS 83835
Hospital Charge Code	H3010880
Hospital Revenue Code	301
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

HCHG METANEPHRINE RANDOM UR 90

Facility

$127.00

Service Code	HCPCS 83835
Hospital Charge Code	H3000302
Hospital Revenue Code	301
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

HCHG METANEPHRINE RANDOM UR 90

Facility

$127.00

Service Code	HCPCS 83835
Hospital Charge Code	H3000302
Hospital Revenue Code	301
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$125.73
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$114.30
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Devoted Health Medicare	$125.73
Rate for Payer: Hawaii Medical Service Association ABD	$23.41
Rate for Payer: Hawaii Medical Service Association Commercial	$21.18
Rate for Payer: Hawaii Medical Service Association Medicare	$114.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.58
Rate for Payer: Hawaii Western Management Group Commercial	$16.94
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$114.30
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$114.30
Rate for Payer: Ohana Health Plan Medicare	$114.30
Rate for Payer: UnitedHealthcare Medicaid	$23.41
Rate for Payer: UnitedHealthcare Medicare	$114.30
Rate for Payer: University Health Alliance Commercial	$43.79

HCHG METHEMOGLOBIN

Facility

$60.00

Service Code	HCPCS 83050
Hospital Charge Code	H3010894
Hospital Revenue Code	301
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

HCHG METHEMOGLOBIN

Facility

$60.00

Service Code	HCPCS 83050
Hospital Charge Code	H3010894
Hospital Revenue Code	301
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$59.40
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$54.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$59.40
Rate for Payer: Hawaii Medical Service Association ABD	$10.12
Rate for Payer: Hawaii Medical Service Association Commercial	$10.25
Rate for Payer: Hawaii Medical Service Association Medicare	$54.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.63
Rate for Payer: Hawaii Western Management Group Commercial	$8.20
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$54.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$54.00
Rate for Payer: Ohana Health Plan Medicare	$54.00
Rate for Payer: UnitedHealthcare Medicaid	$10.12
Rate for Payer: UnitedHealthcare Medicare	$54.00
Rate for Payer: University Health Alliance Commercial	$18.93

HCHG METHYLMALONIC ACID SERUM QUANT

Facility

$154.00

Service Code	HCPCS 83921
Hospital Charge Code	H3010900
Hospital Revenue Code	301
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$152.46
Rate for Payer: AlohaCare Medicaid	$77.00
Rate for Payer: AlohaCare Medicare	$138.60
Rate for Payer: Cash Price	$100.10
Rate for Payer: Cash Price	$100.10
Rate for Payer: Devoted Health Medicare	$152.46
Rate for Payer: Hawaii Medical Service Association ABD	$22.75
Rate for Payer: Hawaii Medical Service Association Commercial	$26.51
Rate for Payer: Hawaii Medical Service Association Medicare	$138.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.89
Rate for Payer: Hawaii Western Management Group Commercial	$21.21
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$138.60
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$138.60
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$138.60
Rate for Payer: Ohana Health Plan Medicare	$138.60
Rate for Payer: UnitedHealthcare Medicaid	$22.75
Rate for Payer: UnitedHealthcare Medicare	$138.60
Rate for Payer: University Health Alliance Commercial	$42.55

HCHG METHYLMALONIC ACID SERUM QUANT

Facility

$154.00

Service Code	HCPCS 83921
Hospital Charge Code	H3010900
Hospital Revenue Code	301
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$100.10
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: MDX Hawaii PPO	$149.38

HCHG M GENTIALIUM AMP PROBE

Facility

$244.00

Service Code	HCPCS 87563
Hospital Charge Code	K3060051
Hospital Revenue Code	306
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$241.56
Rate for Payer: AlohaCare Medicaid	$122.00
Rate for Payer: AlohaCare Medicare	$219.60
Rate for Payer: Cash Price	$158.60
Rate for Payer: Cash Price	$158.60
Rate for Payer: Devoted Health Medicare	$241.56
Rate for Payer: Hawaii Medical Service Association ABD	$33.68
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$219.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.68
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Humana Medicare	$219.60
Rate for Payer: Kaiser Permanente Commercial	$219.60
Rate for Payer: Kaiser Permanente Medicaid	$124.44
Rate for Payer: Kaiser Permanente Medicare	$219.60
Rate for Payer: MDX Hawaii PPO	$236.68
Rate for Payer: Ohana Health Plan Medicaid	$219.60
Rate for Payer: Ohana Health Plan Medicare	$219.60
Rate for Payer: UnitedHealthcare Medicaid	$21.05
Rate for Payer: UnitedHealthcare Medicare	$219.60
Rate for Payer: University Health Alliance Commercial	$177.85

HCHG M GENTIALIUM AMP PROBE

Facility

$244.00

Service Code	HCPCS 87563
Hospital Charge Code	K3060051
Hospital Revenue Code	306
Min. Negotiated Rate	$207.40
Max. Negotiated Rate	$236.68
Rate for Payer: Cash Price	$158.60
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Kaiser Permanente Commercial	$219.60
Rate for Payer: MDX Hawaii PPO	$236.68

HCHG MIC (E-TEST)

Facility

$36.00

Service Code	HCPCS 87181
Hospital Charge Code	H3060312
Hospital Revenue Code	306
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92

HCHG MIC (E-TEST)

Facility

$36.00

Service Code	HCPCS 87181
Hospital Charge Code	H3060312
Hospital Revenue Code	306
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$35.64
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: AlohaCare Medicare	$32.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$35.64
Rate for Payer: Hawaii Medical Service Association ABD	$2.57
Rate for Payer: Hawaii Medical Service Association Commercial	$5.94
Rate for Payer: Hawaii Medical Service Association Medicare	$32.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.70
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$32.40
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$32.40
Rate for Payer: Ohana Health Plan Medicare	$32.40
Rate for Payer: UnitedHealthcare Medicaid	$2.57
Rate for Payer: UnitedHealthcare Medicare	$32.40
Rate for Payer: University Health Alliance Commercial	$4.81

HCHG MICROALBUMIN URINE

Facility

$87.00

Service Code	HCPCS 82043
Hospital Charge Code	H3010904
Hospital Revenue Code	301
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$56.55
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

HCHG MICROALBUMIN URINE

Facility

$87.00

Service Code	HCPCS 82043
Hospital Charge Code	H3010904
Hospital Revenue Code	301
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$86.13
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$78.30
Rate for Payer: Cash Price	$56.55
Rate for Payer: Cash Price	$56.55
Rate for Payer: Devoted Health Medicare	$86.13
Rate for Payer: Hawaii Medical Service Association ABD	$8.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7.22
Rate for Payer: Hawaii Medical Service Association Medicare	$78.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.40
Rate for Payer: Hawaii Western Management Group Commercial	$5.78
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$78.30
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$78.30
Rate for Payer: Ohana Health Plan Medicare	$78.30
Rate for Payer: UnitedHealthcare Medicaid	$8.00
Rate for Payer: UnitedHealthcare Medicare	$78.30
Rate for Payer: University Health Alliance Commercial	$14.97

HCHG MITOCHONDRIAL AB

Facility

$172.00

Service Code	HCPCS 86381
Hospital Charge Code	H3021046
Hospital Revenue Code	302
Min. Negotiated Rate	$15.27
Max. Negotiated Rate	$170.28
Rate for Payer: AlohaCare Medicaid	$86.00
Rate for Payer: AlohaCare Medicare	$154.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Devoted Health Medicare	$170.28
Rate for Payer: Hawaii Medical Service Association ABD	$35.54
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$154.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.32
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Humana Medicare	$154.80
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: Kaiser Permanente Medicaid	$87.72
Rate for Payer: Kaiser Permanente Medicare	$154.80
Rate for Payer: MDX Hawaii PPO	$166.84
Rate for Payer: Ohana Health Plan Medicaid	$154.80
Rate for Payer: Ohana Health Plan Medicare	$154.80
Rate for Payer: UnitedHealthcare Medicaid	$15.27
Rate for Payer: UnitedHealthcare Medicare	$154.80
Rate for Payer: University Health Alliance Commercial	$125.37

HCHG MITOCHONDRIAL AB

Facility

$172.00

Service Code	HCPCS 86381
Hospital Charge Code	H3021046
Hospital Revenue Code	302
Min. Negotiated Rate	$146.20
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$111.80
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: MDX Hawaii PPO	$166.84

HCHG MLH1 HYPERMETHYLATION - 90

Facility

$810.00

Service Code	HCPCS 81288
Hospital Charge Code	H3100200
Hospital Revenue Code	310
Min. Negotiated Rate	$688.50
Max. Negotiated Rate	$785.70
Rate for Payer: Cash Price	$526.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Kaiser Permanente Commercial	$729.00
Rate for Payer: MDX Hawaii PPO	$785.70

HCHG MLH1 HYPERMETHYLATION - 90

Facility

$810.00

Service Code	HCPCS 81288
Hospital Charge Code	H3100200
Hospital Revenue Code	310
Min. Negotiated Rate	$144.24
Max. Negotiated Rate	$801.90
Rate for Payer: AlohaCare Medicaid	$405.00
Rate for Payer: AlohaCare Medicare	$729.00
Rate for Payer: Cash Price	$526.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Devoted Health Medicare	$801.90
Rate for Payer: Hawaii Medical Service Association ABD	$159.64
Rate for Payer: Hawaii Medical Service Association Commercial	$240.40
Rate for Payer: Hawaii Medical Service Association Medicare	$729.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$159.64
Rate for Payer: Hawaii Western Management Group Commercial	$192.32
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Humana Medicare	$729.00
Rate for Payer: Kaiser Permanente Commercial	$729.00
Rate for Payer: Kaiser Permanente Medicaid	$413.10
Rate for Payer: Kaiser Permanente Medicare	$729.00
Rate for Payer: MDX Hawaii PPO	$785.70
Rate for Payer: Ohana Health Plan Medicaid	$729.00
Rate for Payer: Ohana Health Plan Medicare	$729.00
Rate for Payer: UnitedHealthcare Medicaid	$144.24
Rate for Payer: UnitedHealthcare Medicare	$729.00
Rate for Payer: University Health Alliance Commercial	$590.41

HCHG MOLD IDENTIFICATION

Facility

$79.00

Service Code	HCPCS 87107
Hospital Charge Code	H3060290
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$78.21
Rate for Payer: AlohaCare Medicaid	$39.50
Rate for Payer: AlohaCare Medicare	$71.10
Rate for Payer: Cash Price	$51.35
Rate for Payer: Cash Price	$51.35
Rate for Payer: Devoted Health Medicare	$78.21
Rate for Payer: Hawaii Medical Service Association ABD	$14.42
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$71.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.14
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$71.10
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$71.10
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$71.10
Rate for Payer: Ohana Health Plan Medicare	$71.10
Rate for Payer: UnitedHealthcare Medicaid	$14.42
Rate for Payer: UnitedHealthcare Medicare	$71.10
Rate for Payer: University Health Alliance Commercial	$26.68

HCHG MOLD IDENTIFICATION

Facility

$79.00

Service Code	HCPCS 87107
Hospital Charge Code	H3060290
Hospital Revenue Code	306
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$51.35
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: MDX Hawaii PPO	$76.63

HCHG MOLEC INFECT AGENT DETECTION BY NUC ACID CHLAMYDIA

Facility

$231.00

Service Code	HCPCS 87491
Hospital Charge Code	H3060668
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$228.69
Rate for Payer: AlohaCare Medicaid	$115.50
Rate for Payer: AlohaCare Medicare	$207.90
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$228.69
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$207.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$207.90
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$207.90
Rate for Payer: Ohana Health Plan Medicare	$207.90
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$207.90
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG MOLEC INFECT AGENT DETECTION BY NUC ACID CHLAMYDIA

Facility

$231.00

Service Code	HCPCS 87491
Hospital Charge Code	H3060668
Hospital Revenue Code	306
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

HCHG MOLEC INFECT AGENT DETECTION BY NUC ACID GONORRHEA

Facility

$231.00

Service Code	HCPCS 87591
Hospital Charge Code	H3060669
Hospital Revenue Code	306
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

HCHG MOLEC INFECT AGENT DETECTION BY NUC ACID GONORRHEA

Facility

$231.00

Service Code	HCPCS 87591
Hospital Charge Code	H3060669
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$228.69
Rate for Payer: AlohaCare Medicaid	$115.50
Rate for Payer: AlohaCare Medicare	$207.90
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$228.69
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$207.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$207.90
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$207.90
Rate for Payer: Ohana Health Plan Medicare	$207.90
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$207.90
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG MOLECULAR CYTOGEN, DNA PROBE EA

Facility

$155.00

Service Code	HCPCS 88271
Hospital Charge Code	H3110291
Hospital Revenue Code	311
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$153.45
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$139.50
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Devoted Health Medicare	$153.45
Rate for Payer: Hawaii Medical Service Association ABD	$29.60
Rate for Payer: Hawaii Medical Service Association Commercial	$26.77
Rate for Payer: Hawaii Medical Service Association Medicare	$139.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.08
Rate for Payer: Hawaii Western Management Group Commercial	$21.42
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$139.50
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$139.50
Rate for Payer: Ohana Health Plan Medicare	$139.50
Rate for Payer: UnitedHealthcare Medicaid	$29.60
Rate for Payer: UnitedHealthcare Medicare	$139.50
Rate for Payer: University Health Alliance Commercial	$55.37

HCHG MOLECULAR CYTOGEN, DNA PROBE EA

Facility

$155.00

Service Code	HCPCS 88271
Hospital Charge Code	H3110291
Hospital Revenue Code	311
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

Know your out-of-pocket cost for care.

All Charges