Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG CLSD TX ULNAR FX PROX WO MANIP

Facility

$1,441.00

Service Code	HCPCS 24670
Hospital Charge Code	H4500340
Hospital Revenue Code	450
Min. Negotiated Rate	$1,224.85
Max. Negotiated Rate	$1,397.77
Rate for Payer: Cash Price	$936.65
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77

HCHG CLSD TX ULNAR SHAFT FX W MANIP

Facility

$1,441.00

Service Code	HCPCS 25535
Hospital Charge Code	H4500342
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$720.50
Rate for Payer: AlohaCare Medicare	$1,296.90
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Devoted Health Medicare	$1,426.59
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,296.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.95
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Humana Medicare	$1,296.90
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$1,296.90
Rate for Payer: Ohana Health Plan Medicare	$1,296.90
Rate for Payer: UnitedHealthcare Medicare	$1,296.90
Rate for Payer: University Health Alliance Commercial	$1,050.34

HCHG CLSD TX ULNAR SHAFT FX W MANIP

Facility

$1,441.00

Service Code	HCPCS 25535
Hospital Charge Code	H4500342
Hospital Revenue Code	450
Min. Negotiated Rate	$1,224.85
Max. Negotiated Rate	$1,397.77
Rate for Payer: Cash Price	$936.65
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77

HCHG CLSD TX ULNAR STYLOID FX

Facility

$1,441.00

Service Code	HCPCS 25650
Hospital Charge Code	H4500346
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$720.50
Rate for Payer: AlohaCare Medicare	$1,296.90
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Devoted Health Medicare	$1,426.59
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,296.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.95
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Humana Medicare	$1,296.90
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$1,296.90
Rate for Payer: Ohana Health Plan Medicare	$1,296.90
Rate for Payer: UnitedHealthcare Medicare	$1,296.90
Rate for Payer: University Health Alliance Commercial	$1,050.34

HCHG CLSD TX ULNAR STYLOID FX

Facility

$1,441.00

Service Code	HCPCS 25650
Hospital Charge Code	H4500346
Hospital Revenue Code	450
Min. Negotiated Rate	$1,224.85
Max. Negotiated Rate	$1,397.77
Rate for Payer: Cash Price	$936.65
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77

HCHG CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA

Facility

$4,705.00

Service Code	HCPCS 27252
Hospital Charge Code	H4501084
Hospital Revenue Code	450
Min. Negotiated Rate	$3,999.25
Max. Negotiated Rate	$4,563.85
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Health Management Network Commercial	$3,999.25
Rate for Payer: Kaiser Permanente Commercial	$4,234.50
Rate for Payer: MDX Hawaii PPO	$4,563.85

HCHG CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA

Facility

$4,705.00

Service Code	HCPCS 27252
Hospital Charge Code	H4501084
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$2,352.50
Rate for Payer: AlohaCare Medicare	$4,234.50
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Devoted Health Medicare	$4,657.95
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,234.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,469.75
Rate for Payer: Health Management Network Commercial	$3,999.25
Rate for Payer: Humana Medicare	$4,234.50
Rate for Payer: Kaiser Permanente Commercial	$4,234.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,234.50
Rate for Payer: MDX Hawaii PPO	$4,563.85
Rate for Payer: Ohana Health Plan Medicaid	$4,234.50
Rate for Payer: Ohana Health Plan Medicare	$4,234.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$4,234.50
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG CLTX INTERPHALAGEAL JOINT DISCLOSURE W/ ANES

Facility

$1,290.00

Service Code	HCPCS 28665
Hospital Charge Code	H4501140
Hospital Revenue Code	450
Min. Negotiated Rate	$1,096.50
Max. Negotiated Rate	$1,251.30
Rate for Payer: Cash Price	$838.50
Rate for Payer: Health Management Network Commercial	$1,096.50
Rate for Payer: Kaiser Permanente Commercial	$1,161.00
Rate for Payer: MDX Hawaii PPO	$1,251.30

HCHG CLTX INTERPHALAGEAL JOINT DISCLOSURE W/ ANES

Facility

$1,290.00

Service Code	HCPCS 28665
Hospital Charge Code	H4501140
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$645.00
Rate for Payer: AlohaCare Medicare	$1,161.00
Rate for Payer: Cash Price	$838.50
Rate for Payer: Cash Price	$838.50
Rate for Payer: Devoted Health Medicare	$1,277.10
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,161.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.50
Rate for Payer: Health Management Network Commercial	$1,096.50
Rate for Payer: Humana Medicare	$1,161.00
Rate for Payer: Kaiser Permanente Commercial	$1,161.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,161.00
Rate for Payer: MDX Hawaii PPO	$1,251.30
Rate for Payer: Ohana Health Plan Medicaid	$1,161.00
Rate for Payer: Ohana Health Plan Medicare	$1,161.00
Rate for Payer: UnitedHealthcare Medicare	$1,161.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG CL TX TROCH FEM FX W MANIPULATION

Facility

$3,448.00

Service Code	HCPCS 27240
Hospital Charge Code	H4501035
Hospital Revenue Code	450
Min. Negotiated Rate	$2,930.80
Max. Negotiated Rate	$3,344.56
Rate for Payer: Cash Price	$2,241.20
Rate for Payer: Health Management Network Commercial	$2,930.80
Rate for Payer: Kaiser Permanente Commercial	$3,103.20
Rate for Payer: MDX Hawaii PPO	$3,344.56

HCHG CL TX TROCH FEM FX W MANIPULATION

Facility

$3,448.00

Service Code	HCPCS 27240
Hospital Charge Code	H4501035
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$3,413.52
Rate for Payer: AlohaCare Medicaid	$1,724.00
Rate for Payer: AlohaCare Medicare	$3,103.20
Rate for Payer: Cash Price	$2,241.20
Rate for Payer: Cash Price	$2,241.20
Rate for Payer: Devoted Health Medicare	$3,413.52
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,103.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,275.60
Rate for Payer: Health Management Network Commercial	$2,930.80
Rate for Payer: Humana Medicare	$3,103.20
Rate for Payer: Kaiser Permanente Commercial	$3,103.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,103.20
Rate for Payer: MDX Hawaii PPO	$3,344.56
Rate for Payer: Ohana Health Plan Medicaid	$3,103.20
Rate for Payer: Ohana Health Plan Medicare	$3,103.20
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,103.20
Rate for Payer: University Health Alliance Commercial	$2,513.25

HCHG CMV AB IGM

Facility

$126.00

Service Code	HCPCS 86645
Hospital Charge Code	H3020416
Hospital Revenue Code	302
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$81.90
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

HCHG CMV AB IGM

Facility

$126.00

Service Code	HCPCS 86645
Hospital Charge Code	H3020416
Hospital Revenue Code	302
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$124.74
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$113.40
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Devoted Health Medicare	$124.74
Rate for Payer: Hawaii Medical Service Association ABD	$23.28
Rate for Payer: Hawaii Medical Service Association Commercial	$21.06
Rate for Payer: Hawaii Medical Service Association Medicare	$113.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.44
Rate for Payer: Hawaii Western Management Group Commercial	$16.85
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$113.40
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$113.40
Rate for Payer: Ohana Health Plan Medicare	$113.40
Rate for Payer: UnitedHealthcare Medicaid	$23.28
Rate for Payer: UnitedHealthcare Medicare	$113.40
Rate for Payer: University Health Alliance Commercial	$43.55

HCHG CMV IGG

Facility

$110.00

Service Code	HCPCS 86644
Hospital Charge Code	H3020432
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$108.90
Rate for Payer: AlohaCare Medicaid	$55.00
Rate for Payer: AlohaCare Medicare	$99.00
Rate for Payer: Cash Price	$71.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Devoted Health Medicare	$108.90
Rate for Payer: Hawaii Medical Service Association ABD	$19.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17.99
Rate for Payer: Hawaii Medical Service Association Medicare	$99.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.88
Rate for Payer: Hawaii Western Management Group Commercial	$14.39
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Humana Medicare	$99.00
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: Kaiser Permanente Medicare	$99.00
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: Ohana Health Plan Medicaid	$99.00
Rate for Payer: Ohana Health Plan Medicare	$99.00
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$99.00
Rate for Payer: University Health Alliance Commercial	$37.20

HCHG CMV IGG

Facility

$110.00

Service Code	HCPCS 86644
Hospital Charge Code	H3020432
Hospital Revenue Code	302
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$71.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: MDX Hawaii PPO	$106.70

HCHG CNS DNA AMP PROBE 12-25 - 90

Facility

$1,895.00

Service Code	HCPCS 87483
Hospital Charge Code	H3060808
Hospital Revenue Code	306
Min. Negotiated Rate	$343.03
Max. Negotiated Rate	$1,876.05
Rate for Payer: AlohaCare Medicaid	$947.50
Rate for Payer: AlohaCare Medicare	$1,705.50
Rate for Payer: Cash Price	$1,231.75
Rate for Payer: Cash Price	$1,231.75
Rate for Payer: Devoted Health Medicare	$1,876.05
Rate for Payer: Hawaii Medical Service Association ABD	$463.56
Rate for Payer: Hawaii Medical Service Association Commercial	$520.98
Rate for Payer: Hawaii Medical Service Association Medicare	$1,705.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$741.51
Rate for Payer: Hawaii Western Management Group Commercial	$416.78
Rate for Payer: Health Management Network Commercial	$1,610.75
Rate for Payer: Humana Medicare	$1,705.50
Rate for Payer: Kaiser Permanente Commercial	$1,705.50
Rate for Payer: Kaiser Permanente Medicaid	$966.45
Rate for Payer: Kaiser Permanente Medicare	$1,705.50
Rate for Payer: MDX Hawaii PPO	$1,838.15
Rate for Payer: Ohana Health Plan Medicaid	$1,705.50
Rate for Payer: Ohana Health Plan Medicare	$1,705.50
Rate for Payer: UnitedHealthcare Medicaid	$343.03
Rate for Payer: UnitedHealthcare Medicare	$1,705.50
Rate for Payer: University Health Alliance Commercial	$1,381.27

HCHG CNS DNA AMP PROBE 12-25 - 90

Facility

$1,895.00

Service Code	HCPCS 87483
Hospital Charge Code	H3060808
Hospital Revenue Code	306
Min. Negotiated Rate	$1,610.75
Max. Negotiated Rate	$1,838.15
Rate for Payer: Cash Price	$1,231.75
Rate for Payer: Health Management Network Commercial	$1,610.75
Rate for Payer: Kaiser Permanente Commercial	$1,705.50
Rate for Payer: MDX Hawaii PPO	$1,838.15

HCHG CO2

Facility

$34.00

Service Code	HCPCS 82374
Hospital Charge Code	H3010394
Hospital Revenue Code	301
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$33.66
Rate for Payer: AlohaCare Medicaid	$17.00
Rate for Payer: AlohaCare Medicare	$30.60
Rate for Payer: Cash Price	$22.10
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$33.66
Rate for Payer: Hawaii Medical Service Association ABD	$6.76
Rate for Payer: Hawaii Medical Service Association Commercial	$6.10
Rate for Payer: Hawaii Medical Service Association Medicare	$30.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.10
Rate for Payer: Hawaii Western Management Group Commercial	$4.88
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$30.60
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$30.60
Rate for Payer: Ohana Health Plan Medicare	$30.60
Rate for Payer: UnitedHealthcare Medicaid	$6.76
Rate for Payer: UnitedHealthcare Medicare	$30.60
Rate for Payer: University Health Alliance Commercial	$12.64

HCHG CO2

Facility

$34.00

Service Code	HCPCS 82374
Hospital Charge Code	H3010394
Hospital Revenue Code	301
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$22.10
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98

HCHG COCAINE DRUG CONFIRM 90

Facility

$20.00

Service Code	HCPCS 80353
Hospital Charge Code	H3011578
Hospital Revenue Code	301
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$22.76
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$18.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Devoted Health Medicare	$19.80
Rate for Payer: Hawaii Medical Service Association ABD	$21.67
Rate for Payer: Hawaii Medical Service Association Medicare	$18.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.76
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$18.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$18.00
Rate for Payer: Ohana Health Plan Medicare	$18.00
Rate for Payer: UnitedHealthcare Medicare	$18.00
Rate for Payer: University Health Alliance Commercial	$14.58

HCHG COCAINE DRUG CONFIRM 90

Facility

$20.00

Service Code	HCPCS 80353
Hospital Charge Code	H3011578
Hospital Revenue Code	301
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$13.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

HCHG COCCIDIOIDES AB 90

Facility

$87.00

Service Code	HCPCS 86635
Hospital Charge Code	H3020434
Hospital Revenue Code	302
Min. Negotiated Rate	$9.62
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	$9.62
Rate for Payer: Hawaii Medical Service Association Commercial	$14.34
Rate for Payer: Hawaii Medical Service Association Medicare	$78.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.85
Rate for Payer: Hawaii Western Management Group Commercial	$11.47
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	$9.62
Rate for Payer: UnitedHealthcare Medicare	$78.30
Rate for Payer: University Health Alliance Commercial	$29.66

HCHG COCCIDIOIDES AB 90

Facility

$87.00

Service Code	HCPCS 86635
Hospital Charge Code	H3020434
Hospital Revenue Code	302
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 COL CHROMOTOGRAPHY QUAL/QUAN

Facility

$173.00

Service Code	HCPCS 82542
Hospital Charge Code	H3011604
Hospital Revenue Code	301
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$171.27
Rate for Payer: AlohaCare Medicaid	$86.50
Rate for Payer: AlohaCare Medicare	$155.70
Rate for Payer: Cash Price	$112.45
Rate for Payer: Cash Price	$112.45
Rate for Payer: Devoted Health Medicare	$171.27
Rate for Payer: Hawaii Medical Service Association ABD	$24.96
Rate for Payer: Hawaii Medical Service Association Commercial	$30.11
Rate for Payer: Hawaii Medical Service Association Medicare	$155.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.21
Rate for Payer: Hawaii Western Management Group Commercial	$24.09
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Humana Medicare	$155.70
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: Kaiser Permanente Medicaid	$88.23
Rate for Payer: Kaiser Permanente Medicare	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81
Rate for Payer: Ohana Health Plan Medicaid	$155.70
Rate for Payer: Ohana Health Plan Medicare	$155.70
Rate for Payer: UnitedHealthcare Medicaid	$24.96
Rate for Payer: UnitedHealthcare Medicare	$155.70
Rate for Payer: University Health Alliance Commercial	$46.68

HCHG COL CHROMOTOGRAPHY QUAL/QUAN

Facility

$173.00

Service Code	HCPCS 82542
Hospital Charge Code	H3011604
Hospital Revenue Code	301
Min. Negotiated Rate	$147.05
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$112.45
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81

Know your out-of-pocket cost for care.

All Charges