Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CPR

Facility

$1,800.00

Service Code	HCPCS 92950
Hospital Charge Code	H4500352
Hospital Revenue Code	450
Min. Negotiated Rate	$255.08
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,710.00
Rate for Payer: Health Management Network Commercial	$1,530.00
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$1,134.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,746.00
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$1,312.02

HCHG C-REACTIVE PROTEIN (CRP)

Facility

$80.00

Service Code	HCPCS 86140
Hospital Charge Code	H3020474
Hospital Revenue Code	302
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG C-REACTIVE PROTEIN (CRP)

Facility

$80.00

Service Code	HCPCS 86140
Hospital Charge Code	H3020474
Hospital Revenue Code	302
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: MDX Hawaii PPO	$77.60

HCHG CREATINE CLEARANCE

Facility

$72.00

Service Code	HCPCS 82575
Hospital Charge Code	H3010428
Hospital Revenue Code	301
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: MDX Hawaii PPO	$69.84

HCHG CREATINE CLEARANCE

Facility

$72.00

Service Code	HCPCS 82575
Hospital Charge Code	H3010428
Hospital Revenue Code	301
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$9.46
Rate for Payer: AlohaCare Medicare	$9.46
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$10.41
Rate for Payer: Hawaii Medical Service Association ABD	$13.06
Rate for Payer: Hawaii Medical Service Association Commercial	$11.82
Rate for Payer: Hawaii Medical Service Association Medicare	$9.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.71
Rate for Payer: Hawaii Western Management Group Commercial	$9.46
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$9.46
Rate for Payer: Kaiser Permanente Commercial	$45.36
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$9.46
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$10.41
Rate for Payer: Ohana Health Plan Medicare	$9.46
Rate for Payer: UnitedHealthcare Medicaid	$13.06
Rate for Payer: UnitedHealthcare Medicare	$9.46
Rate for Payer: University Health Alliance Commercial	$24.42

HCHG CREATININE BLOOD

Facility

$69.00

Service Code	HCPCS 82565
Hospital Charge Code	H3010432
Hospital Revenue Code	301
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$5.12
Rate for Payer: AlohaCare Medicare	$5.12
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Devoted Health Medicare	$5.63
Rate for Payer: Hawaii Medical Service Association ABD	$7.07
Rate for Payer: Hawaii Medical Service Association Commercial	$6.40
Rate for Payer: Hawaii Medical Service Association Medicare	$5.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.42
Rate for Payer: Hawaii Western Management Group Commercial	$5.12
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$5.12
Rate for Payer: Kaiser Permanente Commercial	$43.47
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$5.12
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$5.63
Rate for Payer: Ohana Health Plan Medicare	$5.12
Rate for Payer: UnitedHealthcare Medicaid	$7.07
Rate for Payer: UnitedHealthcare Medicare	$5.12
Rate for Payer: University Health Alliance Commercial	$13.25

HCHG CREATININE BLOOD

Facility

$69.00

Service Code	HCPCS 82565
Hospital Charge Code	H3010432
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: MDX Hawaii PPO	$66.93

HCHG CREATININE BODY FLUID

Facility

$71.00

Service Code	HCPCS 82570
Hospital Charge Code	H3010442
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG CREATININE BODY FLUID

Facility

$71.00

Service Code	HCPCS 82570
Hospital Charge Code	H3010434
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG CREATININE BODY FLUID

Facility

$71.00

Service Code	HCPCS 82570
Hospital Charge Code	H3010434
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: MDX Hawaii PPO	$68.87

HCHG CREATININE BODY FLUID

Facility

$71.00

Service Code	HCPCS 82570
Hospital Charge Code	H3010442
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: MDX Hawaii PPO	$68.87

HCHG CREATININE URINE

Facility

$149.00

Service Code	HCPCS 82570
Hospital Charge Code	H3010444
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$93.87
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG CREATININE URINE

Facility

$71.00

Service Code	HCPCS 82570
Hospital Charge Code	H3010440
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG CREATININE URINE

Facility

$149.00

Service Code	HCPCS 82570
Hospital Charge Code	H3010444
Hospital Revenue Code	301
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: MDX Hawaii PPO	$144.53

HCHG CREATININE URINE

Facility

$71.00

Service Code	HCPCS 82570
Hospital Charge Code	H3010440
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: MDX Hawaii PPO	$68.87

HCHG CRYOGLOBULIN QUAL REFLEX

Facility

$84.00

Service Code	HCPCS 82595
Hospital Charge Code	H3010450
Hospital Revenue Code	301
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$6.47
Rate for Payer: AlohaCare Medicare	$6.47
Rate for Payer: Cash Price	$54.60
Rate for Payer: Cash Price	$54.60
Rate for Payer: Devoted Health Medicare	$7.12
Rate for Payer: Hawaii Medical Service Association ABD	$8.95
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Medicare	$6.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.40
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$6.47
Rate for Payer: Kaiser Permanente Commercial	$52.92
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$6.47
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$7.12
Rate for Payer: Ohana Health Plan Medicare	$6.47
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$6.47
Rate for Payer: University Health Alliance Commercial	$16.72

HCHG CRYOGLOBULIN QUAL REFLEX

Facility

$84.00

Service Code	HCPCS 82595
Hospital Charge Code	H3010450
Hospital Revenue Code	301
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: MDX Hawaii PPO	$81.48

HCHG CRYOPRECIPITATE, EA UNIT

Facility

$394.00

Service Code	HCPCS P9012
Hospital Charge Code	H3900194
Hospital Revenue Code	390
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$83.20
Rate for Payer: AlohaCare Medicare	$83.20
Rate for Payer: Cash Price	$256.10
Rate for Payer: Cash Price	$256.10
Rate for Payer: Devoted Health Medicare	$91.52
Rate for Payer: Hawaii Medical Service Association Commercial	$104.00
Rate for Payer: Hawaii Medical Service Association Medicare	$83.20
Rate for Payer: Hawaii Western Management Group Commercial	$374.30
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$83.20
Rate for Payer: Kaiser Permanente Commercial	$248.22
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$83.20
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$91.52
Rate for Payer: Ohana Health Plan Medicare	$83.20
Rate for Payer: UnitedHealthcare Medicaid	$47.68
Rate for Payer: UnitedHealthcare Medicare	$83.20
Rate for Payer: University Health Alliance Commercial	$287.19

HCHG CRYOPRECIPITATE, EA UNIT

Facility

$394.00

Service Code	HCPCS P9012
Hospital Charge Code	H3900194
Hospital Revenue Code	390
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$256.10
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: MDX Hawaii PPO	$382.18

HCHG CRYPTOCOCCUS ANTIGEN, CSF

Facility

$125.00

Service Code	HCPCS 86403
Hospital Charge Code	H3020965
Hospital Revenue Code	302
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$11.54
Rate for Payer: AlohaCare Medicare	$11.54
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Devoted Health Medicare	$12.69
Rate for Payer: Hawaii Medical Service Association ABD	$14.08
Rate for Payer: Hawaii Medical Service Association Commercial	$14.43
Rate for Payer: Hawaii Medical Service Association Medicare	$11.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.78
Rate for Payer: Hawaii Western Management Group Commercial	$11.54
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$11.54
Rate for Payer: Kaiser Permanente Commercial	$78.75
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$11.54
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$12.69
Rate for Payer: Ohana Health Plan Medicare	$11.54
Rate for Payer: UnitedHealthcare Medicaid	$14.08
Rate for Payer: UnitedHealthcare Medicare	$11.54
Rate for Payer: University Health Alliance Commercial	$26.34

HCHG CRYPTOCOCCUS ANTIGEN, CSF

Facility

$125.00

Service Code	HCPCS 86403
Hospital Charge Code	H3020965
Hospital Revenue Code	302
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: MDX Hawaii PPO	$121.25

HCHG CRYPTOCOCCUS ANTIGEN, SERUM

Facility

$125.00

Service Code	HCPCS 86403
Hospital Charge Code	H3021038
Hospital Revenue Code	302
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$11.54
Rate for Payer: AlohaCare Medicare	$11.54
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Devoted Health Medicare	$12.69
Rate for Payer: Hawaii Medical Service Association ABD	$14.08
Rate for Payer: Hawaii Medical Service Association Commercial	$14.43
Rate for Payer: Hawaii Medical Service Association Medicare	$11.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.78
Rate for Payer: Hawaii Western Management Group Commercial	$11.54
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$11.54
Rate for Payer: Kaiser Permanente Commercial	$78.75
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$11.54
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$12.69
Rate for Payer: Ohana Health Plan Medicare	$11.54
Rate for Payer: UnitedHealthcare Medicaid	$14.08
Rate for Payer: UnitedHealthcare Medicare	$11.54
Rate for Payer: University Health Alliance Commercial	$26.34

HCHG CRYPTOCOCCUS ANTIGEN, SERUM

Facility

$125.00

Service Code	HCPCS 86403
Hospital Charge Code	H3021038
Hospital Revenue Code	302
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: MDX Hawaii PPO	$121.25

HCHG CRYPTOCOCCUS SCRN AG CSF

Facility

$125.00

Service Code	HCPCS 86403
Hospital Charge Code	K3060004
Hospital Revenue Code	306
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$11.54
Rate for Payer: AlohaCare Medicare	$11.54
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Devoted Health Medicare	$12.69
Rate for Payer: Hawaii Medical Service Association ABD	$14.08
Rate for Payer: Hawaii Medical Service Association Commercial	$14.43
Rate for Payer: Hawaii Medical Service Association Medicare	$11.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.78
Rate for Payer: Hawaii Western Management Group Commercial	$11.54
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$11.54
Rate for Payer: Kaiser Permanente Commercial	$78.75
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$11.54
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$12.69
Rate for Payer: Ohana Health Plan Medicare	$11.54
Rate for Payer: UnitedHealthcare Medicaid	$14.08
Rate for Payer: UnitedHealthcare Medicare	$11.54
Rate for Payer: University Health Alliance Commercial	$26.34

HCHG CRYPTOCOCCUS SCRN AG CSF

Facility

$125.00

Service Code	HCPCS 86403
Hospital Charge Code	K3060004
Hospital Revenue Code	306
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: MDX Hawaii PPO	$121.25

Know your out-of-pocket cost for care.

All Charges