Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG DRAINAGE OF PILONIDAL CYST

Facility

$3,592.00

Service Code	HCPCS 10081
Hospital Charge Code	H4500919
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,556.08
Rate for Payer: AlohaCare Medicaid	$1,796.00
Rate for Payer: AlohaCare Medicare	$3,232.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Devoted Health Medicare	$3,556.08
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	$3,232.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,412.40
Rate for Payer: Health Management Network Commercial	$3,053.20
Rate for Payer: Humana Medicare	$3,232.80
Rate for Payer: Kaiser Permanente Commercial	$3,232.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,232.80
Rate for Payer: MDX Hawaii PPO	$3,484.24
Rate for Payer: Ohana Health Plan Medicaid	$3,232.80
Rate for Payer: Ohana Health Plan Medicare	$3,232.80
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,232.80
Rate for Payer: University Health Alliance Commercial	$2,618.21

HCHG DRAINAGE OF PILONIDAL CYST

Facility

$3,592.00

Service Code	HCPCS 10081
Hospital Charge Code	H4500919
Hospital Revenue Code	450
Min. Negotiated Rate	$3,053.20
Max. Negotiated Rate	$3,484.24
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Health Management Network Commercial	$3,053.20
Rate for Payer: Kaiser Permanente Commercial	$3,232.80
Rate for Payer: MDX Hawaii PPO	$3,484.24

HCHG DRAIN CEREBRO SPINAL FLUID

Facility

$3,543.00

Service Code	HCPCS 62272
Hospital Charge Code	H4500983
Hospital Revenue Code	450
Min. Negotiated Rate	$3,011.55
Max. Negotiated Rate	$3,436.71
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: Kaiser Permanente Commercial	$3,188.70
Rate for Payer: MDX Hawaii PPO	$3,436.71

HCHG DRAIN CEREBRO SPINAL FLUID

Facility

$3,543.00

Service Code	HCPCS 62272
Hospital Charge Code	H4500983
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,507.57
Rate for Payer: AlohaCare Medicaid	$1,771.50
Rate for Payer: AlohaCare Medicare	$3,188.70
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Devoted Health Medicare	$3,507.57
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	$3,188.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,365.85
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: Humana Medicare	$3,188.70
Rate for Payer: Kaiser Permanente Commercial	$3,188.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,188.70
Rate for Payer: MDX Hawaii PPO	$3,436.71
Rate for Payer: Ohana Health Plan Medicaid	$3,188.70
Rate for Payer: Ohana Health Plan Medicare	$3,188.70
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,188.70
Rate for Payer: University Health Alliance Commercial	$2,582.49

HCHG DRAIN DENTOALVEOL STRUC LESION

Facility

$816.00

Service Code	HCPCS 41800
Hospital Charge Code	H4500414
Hospital Revenue Code	450
Min. Negotiated Rate	$408.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$408.00
Rate for Payer: AlohaCare Medicare	$734.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Devoted Health Medicare	$807.84
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	$734.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$734.40
Rate for Payer: Kaiser Permanente Commercial	$734.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$734.40
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$734.40
Rate for Payer: Ohana Health Plan Medicare	$734.40
Rate for Payer: UnitedHealthcare Medicare	$734.40
Rate for Payer: University Health Alliance Commercial	$594.78

HCHG DRAIN DENTOALVEOL STRUC LESION

Facility

$816.00

Service Code	HCPCS 41800
Hospital Charge Code	H4500414
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Kaiser Permanente Commercial	$734.40
Rate for Payer: MDX Hawaii PPO	$791.52

HCHG DRAIN EXT EAR LESION SIMP

Facility

$3,592.00

Service Code	HCPCS 69000
Hospital Charge Code	H4500402
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,556.08
Rate for Payer: AlohaCare Medicaid	$1,796.00
Rate for Payer: AlohaCare Medicare	$3,232.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Devoted Health Medicare	$3,556.08
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	$3,232.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,412.40
Rate for Payer: Health Management Network Commercial	$3,053.20
Rate for Payer: Humana Medicare	$3,232.80
Rate for Payer: Kaiser Permanente Commercial	$3,232.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,232.80
Rate for Payer: MDX Hawaii PPO	$3,484.24
Rate for Payer: Ohana Health Plan Medicaid	$3,232.80
Rate for Payer: Ohana Health Plan Medicare	$3,232.80
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,232.80
Rate for Payer: University Health Alliance Commercial	$2,618.21

HCHG DRAIN EXT EAR LESION SIMP

Facility

$3,592.00

Service Code	HCPCS 69000
Hospital Charge Code	H4500402
Hospital Revenue Code	450
Min. Negotiated Rate	$3,053.20
Max. Negotiated Rate	$3,484.24
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Health Management Network Commercial	$3,053.20
Rate for Payer: Kaiser Permanente Commercial	$3,232.80
Rate for Payer: MDX Hawaii PPO	$3,484.24

HCHG DRAIN EXTERNAL EAR LESION

Facility

$6,176.00

Service Code	HCPCS 69005
Hospital Charge Code	H4500989
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$6,114.24
Rate for Payer: AlohaCare Medicaid	$3,088.00
Rate for Payer: AlohaCare Medicare	$5,558.40
Rate for Payer: Cash Price	$4,014.40
Rate for Payer: Cash Price	$4,014.40
Rate for Payer: Devoted Health Medicare	$6,114.24
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	$5,558.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,867.20
Rate for Payer: Health Management Network Commercial	$5,249.60
Rate for Payer: Humana Medicare	$5,558.40
Rate for Payer: Kaiser Permanente Commercial	$5,558.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$5,558.40
Rate for Payer: MDX Hawaii PPO	$5,990.72
Rate for Payer: Ohana Health Plan Medicaid	$5,558.40
Rate for Payer: Ohana Health Plan Medicare	$5,558.40
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$5,558.40
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG DRAIN EXTERNAL EAR LESION

Facility

$6,176.00

Service Code	HCPCS 69005
Hospital Charge Code	H4500989
Hospital Revenue Code	450
Min. Negotiated Rate	$5,249.60
Max. Negotiated Rate	$5,990.72
Rate for Payer: Cash Price	$4,014.40
Rate for Payer: Health Management Network Commercial	$5,249.60
Rate for Payer: Kaiser Permanente Commercial	$5,558.40
Rate for Payer: MDX Hawaii PPO	$5,990.72

HCHG DRAIN FINGER ABSC COMPL

Facility

$4,919.00

Service Code	HCPCS 26011
Hospital Charge Code	H4500404
Hospital Revenue Code	450
Min. Negotiated Rate	$4,181.15
Max. Negotiated Rate	$4,771.43
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Health Management Network Commercial	$4,181.15
Rate for Payer: Kaiser Permanente Commercial	$4,427.10
Rate for Payer: MDX Hawaii PPO	$4,771.43

HCHG DRAIN FINGER ABSC COMPL

Facility

$4,919.00

Service Code	HCPCS 26011
Hospital Charge Code	H4500404
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$4,869.81
Rate for Payer: AlohaCare Medicaid	$2,459.50
Rate for Payer: AlohaCare Medicare	$4,427.10
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Devoted Health Medicare	$4,869.81
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	$4,427.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,673.05
Rate for Payer: Health Management Network Commercial	$4,181.15
Rate for Payer: Humana Medicare	$4,427.10
Rate for Payer: Kaiser Permanente Commercial	$4,427.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,427.10
Rate for Payer: MDX Hawaii PPO	$4,771.43
Rate for Payer: Ohana Health Plan Medicaid	$4,427.10
Rate for Payer: Ohana Health Plan Medicare	$4,427.10
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,427.10
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG DRAIN FINGER ABSC SIMP

Facility

$1,233.00

Service Code	HCPCS 26010
Hospital Charge Code	H4500406
Hospital Revenue Code	450
Min. Negotiated Rate	$1,048.05
Max. Negotiated Rate	$1,196.01
Rate for Payer: Cash Price	$801.45
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Kaiser Permanente Commercial	$1,109.70
Rate for Payer: MDX Hawaii PPO	$1,196.01

HCHG DRAIN FINGER ABSC SIMP

Facility

$1,233.00

Service Code	HCPCS 26010
Hospital Charge Code	H4500406
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$616.50
Rate for Payer: AlohaCare Medicare	$1,109.70
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Devoted Health Medicare	$1,220.67
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	$1,109.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.35
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Humana Medicare	$1,109.70
Rate for Payer: Kaiser Permanente Commercial	$1,109.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,109.70
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: Ohana Health Plan Medicaid	$1,109.70
Rate for Payer: Ohana Health Plan Medicare	$1,109.70
Rate for Payer: UnitedHealthcare Medicare	$1,109.70
Rate for Payer: University Health Alliance Commercial	$898.73

HCHG DRAIN MOUTH LESION SIMP

Facility

$3,592.00

Service Code	HCPCS 40800
Hospital Charge Code	H4500410
Hospital Revenue Code	450
Min. Negotiated Rate	$3,053.20
Max. Negotiated Rate	$3,484.24
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Health Management Network Commercial	$3,053.20
Rate for Payer: Kaiser Permanente Commercial	$3,232.80
Rate for Payer: MDX Hawaii PPO	$3,484.24

HCHG DRAIN MOUTH LESION SIMP

Facility

$3,592.00

Service Code	HCPCS 40800
Hospital Charge Code	H4500410
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,556.08
Rate for Payer: AlohaCare Medicaid	$1,796.00
Rate for Payer: AlohaCare Medicare	$3,232.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Devoted Health Medicare	$3,556.08
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	$3,232.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,412.40
Rate for Payer: Health Management Network Commercial	$3,053.20
Rate for Payer: Humana Medicare	$3,232.80
Rate for Payer: Kaiser Permanente Commercial	$3,232.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,232.80
Rate for Payer: MDX Hawaii PPO	$3,484.24
Rate for Payer: Ohana Health Plan Medicaid	$3,232.80
Rate for Payer: Ohana Health Plan Medicare	$3,232.80
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,232.80
Rate for Payer: University Health Alliance Commercial	$2,618.21

HCHG DRUG SCREEN AMPHETAMINES 1/2-90

Facility

$648.00

Service Code	HCPCS 80324
Hospital Charge Code	H3011787
Hospital Revenue Code	301
Min. Negotiated Rate	$550.80
Max. Negotiated Rate	$628.56
Rate for Payer: Cash Price	$421.20
Rate for Payer: Health Management Network Commercial	$550.80
Rate for Payer: Kaiser Permanente Commercial	$583.20
Rate for Payer: MDX Hawaii PPO	$628.56

HCHG DRUG SCREEN AMPHETAMINES 1/2-90

Facility

$648.00

Service Code	HCPCS 80324
Hospital Charge Code	H3011787
Hospital Revenue Code	301
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$641.52
Rate for Payer: AlohaCare Medicaid	$324.00
Rate for Payer: AlohaCare Medicare	$583.20
Rate for Payer: Cash Price	$421.20
Rate for Payer: Cash Price	$421.20
Rate for Payer: Devoted Health Medicare	$641.52
Rate for Payer: Hawaii Medical Service Association ABD	$21.48
Rate for Payer: Hawaii Medical Service Association Medicare	$583.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.55
Rate for Payer: Hawaii Western Management Group Commercial	$615.60
Rate for Payer: Health Management Network Commercial	$550.80
Rate for Payer: Humana Medicare	$583.20
Rate for Payer: Kaiser Permanente Commercial	$583.20
Rate for Payer: Kaiser Permanente Medicaid	$330.48
Rate for Payer: Kaiser Permanente Medicare	$583.20
Rate for Payer: MDX Hawaii PPO	$628.56
Rate for Payer: Ohana Health Plan Medicaid	$583.20
Rate for Payer: Ohana Health Plan Medicare	$583.20
Rate for Payer: UnitedHealthcare Medicare	$583.20
Rate for Payer: University Health Alliance Commercial	$472.33

HCHG DRUG SCREEN ANY NUMBER OF CLASSES

Facility

$129.00

Service Code	HCPCS 80305
Hospital Charge Code	K3010004
Hospital Revenue Code	301
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$83.85
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: MDX Hawaii PPO	$125.13

HCHG DRUG SCREEN ANY NUMBER OF CLASSES

Facility

$129.00

Service Code	HCPCS 80305
Hospital Charge Code	K3010004
Hospital Revenue Code	301
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$127.71
Rate for Payer: AlohaCare Medicaid	$64.50
Rate for Payer: AlohaCare Medicare	$116.10
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Devoted Health Medicare	$127.71
Rate for Payer: Hawaii Medical Service Association ABD	$19.03
Rate for Payer: Hawaii Medical Service Association Commercial	$15.75
Rate for Payer: Hawaii Medical Service Association Medicare	$116.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.11
Rate for Payer: Hawaii Western Management Group Commercial	$12.60
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$116.10
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$116.10
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$116.10
Rate for Payer: Ohana Health Plan Medicare	$116.10
Rate for Payer: UnitedHealthcare Medicaid	$8.98
Rate for Payer: UnitedHealthcare Medicare	$116.10
Rate for Payer: University Health Alliance Commercial	$27.68

HCHG DRUG SCREEN U CORD 18 SO

Facility

$624.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010067
Hospital Revenue Code	301
Min. Negotiated Rate	$530.40
Max. Negotiated Rate	$605.28
Rate for Payer: Cash Price	$405.60
Rate for Payer: Health Management Network Commercial	$530.40
Rate for Payer: Kaiser Permanente Commercial	$561.60
Rate for Payer: MDX Hawaii PPO	$605.28

HCHG DRUG SCREEN U CORD 18 SO

Facility

$624.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010067
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$617.76
Rate for Payer: AlohaCare Medicaid	$312.00
Rate for Payer: AlohaCare Medicare	$561.60
Rate for Payer: Cash Price	$405.60
Rate for Payer: Cash Price	$405.60
Rate for Payer: Devoted Health Medicare	$617.76
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$561.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$530.40
Rate for Payer: Humana Medicare	$561.60
Rate for Payer: Kaiser Permanente Commercial	$561.60
Rate for Payer: Kaiser Permanente Medicaid	$318.24
Rate for Payer: Kaiser Permanente Medicare	$561.60
Rate for Payer: MDX Hawaii PPO	$605.28
Rate for Payer: Ohana Health Plan Medicaid	$561.60
Rate for Payer: Ohana Health Plan Medicare	$561.60
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$561.60
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCREEN URINE-8

Facility

$699.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010017
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$692.01
Rate for Payer: AlohaCare Medicaid	$349.50
Rate for Payer: AlohaCare Medicare	$629.10
Rate for Payer: Cash Price	$454.35
Rate for Payer: Cash Price	$454.35
Rate for Payer: Devoted Health Medicare	$692.01
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$629.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$594.15
Rate for Payer: Humana Medicare	$629.10
Rate for Payer: Kaiser Permanente Commercial	$629.10
Rate for Payer: Kaiser Permanente Medicaid	$356.49
Rate for Payer: Kaiser Permanente Medicare	$629.10
Rate for Payer: MDX Hawaii PPO	$678.03
Rate for Payer: Ohana Health Plan Medicaid	$629.10
Rate for Payer: Ohana Health Plan Medicare	$629.10
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$629.10
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCREEN URINE-8

Facility

$699.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010017
Hospital Revenue Code	301
Min. Negotiated Rate	$594.15
Max. Negotiated Rate	$678.03
Rate for Payer: Cash Price	$454.35
Rate for Payer: Health Management Network Commercial	$594.15
Rate for Payer: Kaiser Permanente Commercial	$629.10
Rate for Payer: MDX Hawaii PPO	$678.03

HCHG DRUG SCRN FENTANYL SO

Facility

$699.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010005
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$692.01
Rate for Payer: AlohaCare Medicaid	$349.50
Rate for Payer: AlohaCare Medicare	$629.10
Rate for Payer: Cash Price	$454.35
Rate for Payer: Cash Price	$454.35
Rate for Payer: Devoted Health Medicare	$692.01
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$629.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$594.15
Rate for Payer: Humana Medicare	$629.10
Rate for Payer: Kaiser Permanente Commercial	$629.10
Rate for Payer: Kaiser Permanente Medicaid	$356.49
Rate for Payer: Kaiser Permanente Medicare	$629.10
Rate for Payer: MDX Hawaii PPO	$678.03
Rate for Payer: Ohana Health Plan Medicaid	$629.10
Rate for Payer: Ohana Health Plan Medicare	$629.10
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$629.10
Rate for Payer: University Health Alliance Commercial	$147.65

Know your out-of-pocket cost for care.

All Charges