Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG I&D PILONIDA CYST SIMP

Facility

$3,592.00

Service Code	HCPCS 10080
Hospital Charge Code	H4500480
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
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	$4,035.20

HCHG I&D SCROTAL WALL ABSCESS

Facility

$4,919.00

Service Code	HCPCS 55100
Hospital Charge Code	H4500482
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 I&D SCROTAL WALL ABSCESS

Facility

$4,919.00

Service Code	HCPCS 55100
Hospital Charge Code	H4500482
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 I&D SUBMUCOSAL ABSCESS RECTUM

Facility

$4,060.00

Service Code	HCPCS 45005
Hospital Charge Code	H4500484
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$2,030.00
Rate for Payer: AlohaCare Medicare	$3,654.00
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Devoted Health Medicare	$4,019.40
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	$3,654.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,857.00
Rate for Payer: Health Management Network Commercial	$3,451.00
Rate for Payer: Humana Medicare	$3,654.00
Rate for Payer: Kaiser Permanente Commercial	$3,654.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,654.00
Rate for Payer: MDX Hawaii PPO	$3,938.20
Rate for Payer: Ohana Health Plan Medicaid	$3,654.00
Rate for Payer: Ohana Health Plan Medicare	$3,654.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,654.00
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG I&D SUBMUCOSAL ABSCESS RECTUM

Facility

$4,060.00

Service Code	HCPCS 45005
Hospital Charge Code	H4500484
Hospital Revenue Code	450
Min. Negotiated Rate	$3,451.00
Max. Negotiated Rate	$3,938.20
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Health Management Network Commercial	$3,451.00
Rate for Payer: Kaiser Permanente Commercial	$3,654.00
Rate for Payer: MDX Hawaii PPO	$3,938.20

HCHG I&D UP ARM OR ELBOW AREA; BURSA

Facility

$4,919.00

Service Code	HCPCS 23931
Hospital Charge Code	H4500860
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$5,160.40
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	$5,160.40

HCHG I&D UP ARM OR ELBOW AREA; BURSA

Facility

$4,919.00

Service Code	HCPCS 23931
Hospital Charge Code	H4500860
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 I&D UP ARM OR ELBOW,DEEP ABSCESS/HEMATOMA

Facility

$9,564.00

Service Code	HCPCS 23930
Hospital Charge Code	H4500892
Hospital Revenue Code	450
Min. Negotiated Rate	$8,129.40
Max. Negotiated Rate	$9,277.08
Rate for Payer: Cash Price	$6,216.60
Rate for Payer: Health Management Network Commercial	$8,129.40
Rate for Payer: Kaiser Permanente Commercial	$8,607.60
Rate for Payer: MDX Hawaii PPO	$9,277.08

HCHG I&D UP ARM OR ELBOW,DEEP ABSCESS/HEMATOMA

Facility

$9,564.00

Service Code	HCPCS 23930
Hospital Charge Code	H4500892
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$9,468.36
Rate for Payer: AlohaCare Medicaid	$4,782.00
Rate for Payer: AlohaCare Medicare	$8,607.60
Rate for Payer: Cash Price	$6,216.60
Rate for Payer: Cash Price	$6,216.60
Rate for Payer: Devoted Health Medicare	$9,468.36
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	$8,607.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$9,085.80
Rate for Payer: Health Management Network Commercial	$8,129.40
Rate for Payer: Humana Medicare	$8,607.60
Rate for Payer: Kaiser Permanente Commercial	$8,607.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$8,607.60
Rate for Payer: MDX Hawaii PPO	$9,277.08
Rate for Payer: Ohana Health Plan Medicaid	$8,607.60
Rate for Payer: Ohana Health Plan Medicare	$8,607.60
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$8,607.60
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG I&D VULVA/PERINEAL ABSCESS

Facility

$1,766.00

Service Code	HCPCS 56405
Hospital Charge Code	H4500486
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,748.34
Rate for Payer: AlohaCare Medicaid	$883.00
Rate for Payer: AlohaCare Medicare	$1,589.40
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Devoted Health Medicare	$1,748.34
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	$1,589.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,677.70
Rate for Payer: Health Management Network Commercial	$1,501.10
Rate for Payer: Humana Medicare	$1,589.40
Rate for Payer: Kaiser Permanente Commercial	$1,589.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,589.40
Rate for Payer: MDX Hawaii PPO	$1,713.02
Rate for Payer: Ohana Health Plan Medicaid	$1,589.40
Rate for Payer: Ohana Health Plan Medicare	$1,589.40
Rate for Payer: UnitedHealthcare Medicare	$1,589.40
Rate for Payer: University Health Alliance Commercial	$1,287.24

HCHG I&D VULVA/PERINEAL ABSCESS

Facility

$1,766.00

Service Code	HCPCS 56405
Hospital Charge Code	H4500486
Hospital Revenue Code	450
Min. Negotiated Rate	$1,501.10
Max. Negotiated Rate	$1,713.02
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Health Management Network Commercial	$1,501.10
Rate for Payer: Kaiser Permanente Commercial	$1,589.40
Rate for Payer: MDX Hawaii PPO	$1,713.02

HCHG ID Y EAST ISOLATE

Facility

$72.00

Service Code	HCPCS 87106
Hospital Charge Code	H3060552
Hospital Revenue Code	306
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

HCHG ID Y EAST ISOLATE

Facility

$72.00

Service Code	HCPCS 87106
Hospital Charge Code	H3060552
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$71.28
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$64.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$71.28
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$64.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$64.80
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$64.80
Rate for Payer: Ohana Health Plan Medicare	$64.80
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$64.80
Rate for Payer: University Health Alliance Commercial	$26.68

HCHG ID YEAST ISOLATE

Facility

$191.00

Service Code	HCPCS 87106
Hospital Charge Code	H3060554
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$189.09
Rate for Payer: AlohaCare Medicaid	$95.50
Rate for Payer: AlohaCare Medicare	$171.90
Rate for Payer: Cash Price	$124.15
Rate for Payer: Cash Price	$124.15
Rate for Payer: Devoted Health Medicare	$189.09
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$171.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Humana Medicare	$171.90
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: Kaiser Permanente Medicaid	$97.41
Rate for Payer: Kaiser Permanente Medicare	$171.90
Rate for Payer: MDX Hawaii PPO	$185.27
Rate for Payer: Ohana Health Plan Medicaid	$171.90
Rate for Payer: Ohana Health Plan Medicare	$171.90
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$171.90
Rate for Payer: University Health Alliance Commercial	$26.68

HCHG ID YEAST ISOLATE

Facility

$191.00

Service Code	HCPCS 87106
Hospital Charge Code	H3060554
Hospital Revenue Code	306
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: MDX Hawaii PPO	$185.27

HCHG IFE URINE

Facility

$441.00

Service Code	HCPCS 86335
Hospital Charge Code	H3020606
Hospital Revenue Code	302
Min. Negotiated Rate	$374.85
Max. Negotiated Rate	$427.77
Rate for Payer: Cash Price	$286.65
Rate for Payer: Health Management Network Commercial	$374.85
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: MDX Hawaii PPO	$427.77

HCHG IFE URINE

Facility

$441.00

Service Code	HCPCS 86335
Hospital Charge Code	H3020606
Hospital Revenue Code	302
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$436.59
Rate for Payer: AlohaCare Medicaid	$220.50
Rate for Payer: AlohaCare Medicare	$396.90
Rate for Payer: Cash Price	$286.65
Rate for Payer: Cash Price	$286.65
Rate for Payer: Devoted Health Medicare	$436.59
Rate for Payer: Hawaii Medical Service Association ABD	$16.26
Rate for Payer: Hawaii Medical Service Association Commercial	$36.69
Rate for Payer: Hawaii Medical Service Association Medicare	$396.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40.53
Rate for Payer: Hawaii Western Management Group Commercial	$29.35
Rate for Payer: Health Management Network Commercial	$374.85
Rate for Payer: Humana Medicare	$396.90
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Medicaid	$224.91
Rate for Payer: Kaiser Permanente Medicare	$396.90
Rate for Payer: MDX Hawaii PPO	$427.77
Rate for Payer: Ohana Health Plan Medicaid	$396.90
Rate for Payer: Ohana Health Plan Medicare	$396.90
Rate for Payer: UnitedHealthcare Medicaid	$16.26
Rate for Payer: UnitedHealthcare Medicare	$396.90
Rate for Payer: University Health Alliance Commercial	$75.85

HCHG IGF-1 (SOMATOMEDIN)

Facility

$154.00

Service Code	HCPCS 84305
Hospital Charge Code	H3011174
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 IGF-1 (SOMATOMEDIN)

Facility

$154.00

Service Code	HCPCS 84305
Hospital Charge Code	H3011174
Hospital Revenue Code	301
Min. Negotiated Rate	$21.26
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	$29.38
Rate for Payer: Hawaii Medical Service Association Commercial	$26.57
Rate for Payer: Hawaii Medical Service Association Medicare	$138.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.85
Rate for Payer: Hawaii Western Management Group Commercial	$21.26
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	$29.38
Rate for Payer: UnitedHealthcare Medicare	$138.60
Rate for Payer: University Health Alliance Commercial	$54.95

HCHG IGG-CSF 90

Facility

$71.00

Service Code	HCPCS 82784
Hospital Charge Code	H3010752
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
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	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$11.62
Rate for Payer: Hawaii Medical Service Association Medicare	$63.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$9.30
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	$10.55
Rate for Payer: UnitedHealthcare Medicare	$63.90
Rate for Payer: University Health Alliance Commercial	$19.74

HCHG IGG-CSF 90

Facility

$71.00

Service Code	HCPCS 82784
Hospital Charge Code	H3010752
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 IHC EA AB PER BLOCK 1ST AB PER SLIDE

Facility

$656.00

Service Code	HCPCS 88342
Hospital Charge Code	H3120318
Hospital Revenue Code	312
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$649.44
Rate for Payer: AlohaCare Medicaid	$328.00
Rate for Payer: AlohaCare Medicare	$590.40
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cash Price	$426.40
Rate for Payer: Devoted Health Medicare	$649.44
Rate for Payer: Hawaii Medical Service Association ABD	$28.15
Rate for Payer: Hawaii Medical Service Association Commercial	$217.57
Rate for Payer: Hawaii Medical Service Association Medicare	$590.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$35.96
Rate for Payer: Hawaii Western Management Group Commercial	$174.06
Rate for Payer: Health Management Network Commercial	$557.60
Rate for Payer: Humana Medicare	$590.40
Rate for Payer: Kaiser Permanente Commercial	$590.40
Rate for Payer: Kaiser Permanente Medicaid	$334.56
Rate for Payer: Kaiser Permanente Medicare	$590.40
Rate for Payer: MDX Hawaii PPO	$636.32
Rate for Payer: Ohana Health Plan Medicaid	$590.40
Rate for Payer: Ohana Health Plan Medicare	$590.40
Rate for Payer: UnitedHealthcare Medicaid	$28.15
Rate for Payer: UnitedHealthcare Medicare	$590.40
Rate for Payer: University Health Alliance Commercial	$193.25

HCHG IHC EA AB PER BLOCK 1ST AB PER SLIDE

Facility

$656.00

Service Code	HCPCS 88342
Hospital Charge Code	H3120318
Hospital Revenue Code	312
Min. Negotiated Rate	$557.60
Max. Negotiated Rate	$636.32
Rate for Payer: Cash Price	$426.40
Rate for Payer: Health Management Network Commercial	$557.60
Rate for Payer: Kaiser Permanente Commercial	$590.40
Rate for Payer: MDX Hawaii PPO	$636.32

HCHG IMMUNIZATION ADMIN EA ADDL

Facility

$135.00

Service Code	HCPCS 90472
Hospital Charge Code	H7710103
Hospital Revenue Code	771
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$133.65
Rate for Payer: AlohaCare Medicaid	$67.50
Rate for Payer: AlohaCare Medicare	$121.50
Rate for Payer: Cash Price	$87.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Devoted Health Medicare	$133.65
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Medicare	$121.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.28
Rate for Payer: Hawaii Western Management Group Commercial	$128.25
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$121.50
Rate for Payer: Kaiser Permanente Commercial	$121.50
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$121.50
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$121.50
Rate for Payer: Ohana Health Plan Medicare	$121.50
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$121.50
Rate for Payer: University Health Alliance Commercial	$98.40

HCHG IMMUNIZATION ADMIN EA ADDL

Facility

$135.00

Service Code	HCPCS 90472
Hospital Charge Code	H7710103
Hospital Revenue Code	771
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$87.75
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Kaiser Permanente Commercial	$121.50
Rate for Payer: MDX Hawaii PPO	$130.95

Know your out-of-pocket cost for care.

All Charges