Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG PHOSPHATYLSERINE IGG AB

Facility

$121.00

Service Code	HCPCS 86148
Hospital Charge Code	H3020674
Hospital Revenue Code	302
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$119.79
Rate for Payer: AlohaCare Medicaid	$60.50
Rate for Payer: AlohaCare Medicare	$108.90
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Devoted Health Medicare	$119.79
Rate for Payer: Hawaii Medical Service Association ABD	$22.20
Rate for Payer: Hawaii Medical Service Association Commercial	$20.09
Rate for Payer: Hawaii Medical Service Association Medicare	$108.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.31
Rate for Payer: Hawaii Western Management Group Commercial	$16.07
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Humana Medicare	$108.90
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: Kaiser Permanente Medicare	$108.90
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: Ohana Health Plan Medicaid	$108.90
Rate for Payer: Ohana Health Plan Medicare	$108.90
Rate for Payer: UnitedHealthcare Medicaid	$22.20
Rate for Payer: UnitedHealthcare Medicare	$108.90
Rate for Payer: University Health Alliance Commercial	$41.51

HCHG PHOSPHORUS

Facility

$71.00

Service Code	HCPCS 84100
Hospital Charge Code	H3011046
Hospital Revenue Code	301
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$70.29
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$63.90
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$70.29
Rate for Payer: Hawaii Medical Service Association ABD	$6.56
Rate for Payer: Hawaii Medical Service Association Commercial	$5.92
Rate for Payer: Hawaii Medical Service Association Medicare	$63.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$4.74
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$63.90
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$63.90
Rate for Payer: Ohana Health Plan Medicare	$63.90
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$63.90
Rate for Payer: University Health Alliance Commercial	$12.27

HCHG PHOSPHORUS

Facility

$71.00

Service Code	HCPCS 84100
Hospital Charge Code	H3011046
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

HCHG PHYSICAL PERFORMANCE TEST EA 15 MIN

Facility

$229.00

Service Code	HCPCS 97750
Hospital Charge Code	H4200314
Hospital Revenue Code	420
Min. Negotiated Rate	$19.83
Max. Negotiated Rate	$226.71
Rate for Payer: AlohaCare Medicaid	$114.50
Rate for Payer: AlohaCare Medicare	$206.10
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cash Price	$148.85
Rate for Payer: Devoted Health Medicare	$226.71
Rate for Payer: Hawaii Medical Service Association Medicare	$206.10
Rate for Payer: Hawaii Western Management Group Commercial	$217.55
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: Humana Medicare	$206.10
Rate for Payer: Kaiser Permanente Commercial	$206.10
Rate for Payer: Kaiser Permanente Medicaid	$116.79
Rate for Payer: Kaiser Permanente Medicare	$206.10
Rate for Payer: MDX Hawaii PPO	$222.13
Rate for Payer: Ohana Health Plan Medicaid	$206.10
Rate for Payer: Ohana Health Plan Medicare	$206.10
Rate for Payer: UnitedHealthcare Medicaid	$19.83
Rate for Payer: UnitedHealthcare Medicare	$206.10
Rate for Payer: University Health Alliance Commercial	$166.92

HCHG PHYSICAL PERFORMANCE TEST EA 15 MIN

Facility

$229.00

Service Code	HCPCS 97750
Hospital Charge Code	H4200314
Hospital Revenue Code	420
Min. Negotiated Rate	$194.65
Max. Negotiated Rate	$222.13
Rate for Payer: Cash Price	$148.85
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: Kaiser Permanente Commercial	$206.10
Rate for Payer: MDX Hawaii PPO	$222.13

HCHG PINWORM EXAM

Facility

$33.00

Service Code	HCPCS 87172
Hospital Charge Code	H3060344
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$32.67
Rate for Payer: AlohaCare Medicaid	$16.50
Rate for Payer: AlohaCare Medicare	$29.70
Rate for Payer: Cash Price	$21.45
Rate for Payer: Cash Price	$21.45
Rate for Payer: Devoted Health Medicare	$32.67
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$29.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Humana Medicare	$29.70
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: Kaiser Permanente Medicare	$29.70
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: Ohana Health Plan Medicaid	$29.70
Rate for Payer: Ohana Health Plan Medicare	$29.70
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$29.70
Rate for Payer: University Health Alliance Commercial	$11.03

HCHG PINWORM EXAM

Facility

$33.00

Service Code	HCPCS 87172
Hospital Charge Code	H3060344
Hospital Revenue Code	306
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$21.45
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: MDX Hawaii PPO	$32.01

HCHG PLATELET ASSOC IGG AB

Facility

$96.00

Service Code	HCPCS 86023
Hospital Charge Code	H3020686
Hospital Revenue Code	302
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

HCHG PLATELET ASSOC IGG AB

Facility

$96.00

Service Code	HCPCS 86023
Hospital Charge Code	H3020686
Hospital Revenue Code	302
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$95.04
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$86.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Devoted Health Medicare	$95.04
Rate for Payer: Hawaii Medical Service Association ABD	$15.20
Rate for Payer: Hawaii Medical Service Association Commercial	$15.57
Rate for Payer: Hawaii Medical Service Association Medicare	$86.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.21
Rate for Payer: Hawaii Western Management Group Commercial	$12.46
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$86.40
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$86.40
Rate for Payer: Ohana Health Plan Medicare	$86.40
Rate for Payer: UnitedHealthcare Medicaid	$15.20
Rate for Payer: UnitedHealthcare Medicare	$86.40
Rate for Payer: University Health Alliance Commercial	$32.19

HCHG PLATELET ASSOC IGM AB

Facility

$96.00

Service Code	HCPCS 86023
Hospital Charge Code	H3020688
Hospital Revenue Code	302
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

HCHG PLATELET ASSOC IGM AB

Facility

$96.00

Service Code	HCPCS 86023
Hospital Charge Code	H3020688
Hospital Revenue Code	302
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$95.04
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$86.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Devoted Health Medicare	$95.04
Rate for Payer: Hawaii Medical Service Association ABD	$15.20
Rate for Payer: Hawaii Medical Service Association Commercial	$15.57
Rate for Payer: Hawaii Medical Service Association Medicare	$86.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.21
Rate for Payer: Hawaii Western Management Group Commercial	$12.46
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$86.40
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$86.40
Rate for Payer: Ohana Health Plan Medicare	$86.40
Rate for Payer: UnitedHealthcare Medicaid	$15.20
Rate for Payer: UnitedHealthcare Medicare	$86.40
Rate for Payer: University Health Alliance Commercial	$32.19

HCHG PLATELET COUNT AUTOMATED

Facility

$35.00

Service Code	HCPCS 85049
Hospital Charge Code	H3050206
Hospital Revenue Code	305
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$22.75
Rate for Payer: Health Management Network Commercial	$29.75
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: MDX Hawaii PPO	$33.95

HCHG PLATELET COUNT AUTOMATED

Facility

$35.00

Service Code	HCPCS 85049
Hospital Charge Code	H3050206
Hospital Revenue Code	305
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$34.65
Rate for Payer: AlohaCare Medicaid	$17.50
Rate for Payer: AlohaCare Medicare	$31.50
Rate for Payer: Cash Price	$22.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Devoted Health Medicare	$34.65
Rate for Payer: Hawaii Medical Service Association ABD	$6.25
Rate for Payer: Hawaii Medical Service Association Commercial	$5.60
Rate for Payer: Hawaii Medical Service Association Medicare	$31.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.56
Rate for Payer: Hawaii Western Management Group Commercial	$4.48
Rate for Payer: Health Management Network Commercial	$29.75
Rate for Payer: Humana Medicare	$31.50
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: Kaiser Permanente Medicaid	$17.85
Rate for Payer: Kaiser Permanente Medicare	$31.50
Rate for Payer: MDX Hawaii PPO	$33.95
Rate for Payer: Ohana Health Plan Medicaid	$31.50
Rate for Payer: Ohana Health Plan Medicare	$31.50
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: UnitedHealthcare Medicare	$31.50
Rate for Payer: University Health Alliance Commercial	$11.56

HCHG PNEUMOCOCCAL IGG VACC RESP 90

Facility

$99.00

Service Code	HCPCS 86609
Hospital Charge Code	H3020692
Hospital Revenue Code	302
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$64.35
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: MDX Hawaii PPO	$96.03

HCHG PNEUMOCOCCAL IGG VACC RESP 90

Facility

$99.00

Service Code	HCPCS 86609
Hospital Charge Code	H3020692
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$98.01
Rate for Payer: AlohaCare Medicaid	$49.50
Rate for Payer: AlohaCare Medicare	$89.10
Rate for Payer: Cash Price	$64.35
Rate for Payer: Cash Price	$64.35
Rate for Payer: Devoted Health Medicare	$98.01
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$89.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Humana Medicare	$89.10
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: Kaiser Permanente Medicare	$89.10
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: Ohana Health Plan Medicaid	$89.10
Rate for Payer: Ohana Health Plan Medicare	$89.10
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$89.10
Rate for Payer: University Health Alliance Commercial	$33.30

HCHG PNEUMOCYSTIS CARINII, FM

Facility

$91.00

Service Code	HCPCS 87281
Hospital Charge Code	H3011626
Hospital Revenue Code	300
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$90.09
Rate for Payer: AlohaCare Medicaid	$45.50
Rate for Payer: AlohaCare Medicare	$81.90
Rate for Payer: Cash Price	$59.15
Rate for Payer: Cash Price	$59.15
Rate for Payer: Devoted Health Medicare	$90.09
Rate for Payer: Hawaii Medical Service Association ABD	$10.06
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$81.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.57
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$81.90
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$81.90
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$81.90
Rate for Payer: Ohana Health Plan Medicare	$81.90
Rate for Payer: UnitedHealthcare Medicaid	$10.06
Rate for Payer: UnitedHealthcare Medicare	$81.90
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG PNEUMOCYSTIS CARINII, FM

Facility

$91.00

Service Code	HCPCS 87281
Hospital Charge Code	H3011626
Hospital Revenue Code	300
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$59.15
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: MDX Hawaii PPO	$88.27

HCHG POCT SKIN TEST TUBERCULOSIS INTRADERMAL

Facility

$162.00

Service Code	HCPCS 86580
Hospital Charge Code	H3021054
Hospital Revenue Code	302
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$160.38
Rate for Payer: AlohaCare Medicaid	$81.00
Rate for Payer: AlohaCare Medicare	$145.80
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cash Price	$105.30
Rate for Payer: Devoted Health Medicare	$160.38
Rate for Payer: Hawaii Medical Service Association ABD	$6.68
Rate for Payer: Hawaii Medical Service Association Commercial	$36.94
Rate for Payer: Hawaii Medical Service Association Medicare	$145.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.23
Rate for Payer: Hawaii Western Management Group Commercial	$29.55
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Humana Medicare	$145.80
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: Kaiser Permanente Medicaid	$82.62
Rate for Payer: Kaiser Permanente Medicare	$145.80
Rate for Payer: MDX Hawaii PPO	$157.14
Rate for Payer: Ohana Health Plan Medicaid	$145.80
Rate for Payer: Ohana Health Plan Medicare	$145.80
Rate for Payer: UnitedHealthcare Medicaid	$6.68
Rate for Payer: UnitedHealthcare Medicare	$145.80
Rate for Payer: University Health Alliance Commercial	$17.04

HCHG POCT SKIN TEST TUBERCULOSIS INTRADERMAL

Facility

$162.00

Service Code	HCPCS 86580
Hospital Charge Code	H3021054
Hospital Revenue Code	302
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$105.30
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: MDX Hawaii PPO	$157.14

HCHG PORPHOBILINOGEN QNT URINE 90

Facility

$65.00

Service Code	HCPCS 84110
Hospital Charge Code	H3011056
Hospital Revenue Code	301
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: MDX Hawaii PPO	$63.05

HCHG PORPHOBILINOGEN QNT URINE 90

Facility

$65.00

Service Code	HCPCS 84110
Hospital Charge Code	H3011056
Hospital Revenue Code	301
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$64.35
Rate for Payer: AlohaCare Medicaid	$32.50
Rate for Payer: AlohaCare Medicare	$58.50
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$64.35
Rate for Payer: Hawaii Medical Service Association ABD	$11.68
Rate for Payer: Hawaii Medical Service Association Commercial	$10.55
Rate for Payer: Hawaii Medical Service Association Medicare	$58.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.26
Rate for Payer: Hawaii Western Management Group Commercial	$8.44
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$58.50
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$58.50
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$58.50
Rate for Payer: Ohana Health Plan Medicare	$58.50
Rate for Payer: UnitedHealthcare Medicaid	$11.68
Rate for Payer: UnitedHealthcare Medicare	$58.50
Rate for Payer: University Health Alliance Commercial	$21.83

HCHG PORT / HICK / PICC REMOVE

Facility

$2,008.00

Service Code	HCPCS 36589
Hospital Charge Code	H3600450
Hospital Revenue Code	360
Min. Negotiated Rate	$1,706.80
Max. Negotiated Rate	$1,947.76
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Health Management Network Commercial	$1,706.80
Rate for Payer: Kaiser Permanente Commercial	$1,807.20
Rate for Payer: MDX Hawaii PPO	$1,947.76

HCHG PORT / HICK / PICC REMOVE

Facility

$2,008.00

Service Code	HCPCS 36589
Hospital Charge Code	H3600450
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,004.00
Rate for Payer: AlohaCare Medicare	$1,807.20
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Devoted Health Medicare	$1,987.92
Rate for Payer: Hawaii Medical Service Association Commercial	$801.11
Rate for Payer: Hawaii Medical Service Association Medicare	$1,807.20
Rate for Payer: Health Management Network Commercial	$1,706.80
Rate for Payer: Humana Medicare	$1,807.20
Rate for Payer: Kaiser Permanente Commercial	$1,807.20
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,807.20
Rate for Payer: MDX Hawaii PPO	$1,947.76
Rate for Payer: Ohana Health Plan Medicaid	$1,807.20
Rate for Payer: Ohana Health Plan Medicare	$1,807.20
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,807.20
Rate for Payer: University Health Alliance Commercial	$1,463.63

HCHG POTASSIUM FECES

Facility

$119.00

Service Code	HCPCS 84999
Hospital Charge Code	H3011072
Hospital Revenue Code	301
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$117.81
Rate for Payer: AlohaCare Medicaid	$59.50
Rate for Payer: AlohaCare Medicare	$107.10
Rate for Payer: Cash Price	$77.35
Rate for Payer: Devoted Health Medicare	$117.81
Rate for Payer: Hawaii Medical Service Association Medicare	$107.10
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$107.10
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$107.10
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$107.10
Rate for Payer: Ohana Health Plan Medicare	$107.10
Rate for Payer: UnitedHealthcare Medicare	$107.10
Rate for Payer: University Health Alliance Commercial	$86.74

HCHG POTASSIUM FECES

Facility

$119.00

Service Code	HCPCS 84999
Hospital Charge Code	H3011072
Hospital Revenue Code	301
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$77.35
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$115.43

Know your out-of-pocket cost for care.

All Charges