Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE

Facility

$6,161.00

Service Code	HCPCS 54700
Hospital Charge Code	H4501070
Hospital Revenue Code	450
Min. Negotiated Rate	$5,236.85
Max. Negotiated Rate	$5,976.17
Rate for Payer: Cash Price	$4,004.65
Rate for Payer: Health Management Network Commercial	$5,236.85
Rate for Payer: MDX Hawaii PPO	$5,976.17

HCHG I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE

Facility

$6,161.00

Service Code	HCPCS 54700
Hospital Charge Code	H4501070
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Cash Price	$4,004.65
Rate for Payer: Cash Price	$4,004.65
Rate for Payer: Cash Price	$4,004.65
Rate for Payer: Devoted Health Medicare	$2,716.41
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	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$5,852.95
Rate for Payer: Health Management Network Commercial	$5,236.85
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Commercial	$3,881.43
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: MDX Hawaii PPO	$5,976.17
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG ID FROM ISOLATE USING 16S RRNA SEQ

Facility

$653.00

Service Code	HCPCS 87153
Hospital Charge Code	H3060673
Hospital Revenue Code	306
Min. Negotiated Rate	$115.36
Max. Negotiated Rate	$633.41
Rate for Payer: AlohaCare Medicaid	$115.36
Rate for Payer: AlohaCare Medicare	$115.36
Rate for Payer: Cash Price	$424.45
Rate for Payer: Cash Price	$424.45
Rate for Payer: Devoted Health Medicare	$126.90
Rate for Payer: Hawaii Medical Service Association ABD	$165.22
Rate for Payer: Hawaii Medical Service Association Commercial	$144.20
Rate for Payer: Hawaii Medical Service Association Medicare	$115.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$150.38
Rate for Payer: Hawaii Western Management Group Commercial	$115.36
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Humana Medicare	$115.36
Rate for Payer: Kaiser Permanente Commercial	$411.39
Rate for Payer: Kaiser Permanente Medicaid	$333.03
Rate for Payer: Kaiser Permanente Medicare	$115.36
Rate for Payer: MDX Hawaii PPO	$633.41
Rate for Payer: Ohana Health Plan Medicaid	$126.90
Rate for Payer: Ohana Health Plan Medicare	$115.36
Rate for Payer: UnitedHealthcare Medicaid	$165.22
Rate for Payer: UnitedHealthcare Medicare	$115.36
Rate for Payer: University Health Alliance Commercial	$300.31

HCHG ID FROM ISOLATE USING 16S RRNA SEQ

Facility

$653.00

Service Code	HCPCS 87153
Hospital Charge Code	H3060673
Hospital Revenue Code	306
Min. Negotiated Rate	$555.05
Max. Negotiated Rate	$633.41
Rate for Payer: Cash Price	$424.45
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: MDX Hawaii PPO	$633.41

HCHG I&D HEMATOMA/SEROMA/FLUID

Facility

$4,919.00

Service Code	HCPCS 10140
Hospital Charge Code	H4500476
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
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	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$3,098.97
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$4,771.43
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG I&D HEMATOMA/SEROMA/FLUID

Facility

$4,919.00

Service Code	HCPCS 10140
Hospital Charge Code	H4500476
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: MDX Hawaii PPO	$4,771.43

HCHG I & D OF ABSCESS SIMPLE

Facility

$1,233.00

Service Code	HCPCS 10060
Hospital Charge Code	H3610540
Hospital Revenue Code	361
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Devoted Health Medicare	$260.72
Rate for Payer: Hawaii Medical Service Association Commercial	$296.27
Rate for Payer: Hawaii Medical Service Association Medicare	$237.02
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Commercial	$776.79
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicaid	$52.42
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG I & D OF ABSCESS SIMPLE

Facility

$1,233.00

Service Code	HCPCS 10060
Hospital Charge Code	H3610540
Hospital Revenue Code	361
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: MDX Hawaii PPO	$1,196.01

HCHG I&D PERIANAL ABSCESS SUPERFIC

Facility

$4,437.00

Service Code	HCPCS 46050
Hospital Charge Code	H4500478
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,303.89
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Cash Price	$2,884.05
Rate for Payer: Cash Price	$2,884.05
Rate for Payer: Cash Price	$2,884.05
Rate for Payer: Cash Price	$2,884.05
Rate for Payer: Devoted Health Medicare	$1,208.46
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,215.15
Rate for Payer: Health Management Network Commercial	$3,771.45
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Commercial	$2,795.31
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: MDX Hawaii PPO	$4,303.89
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,098.60
Rate for Payer: University Health Alliance Commercial	$3,234.13

HCHG I&D PERIANAL ABSCESS SUPERFIC

Facility

$4,437.00

Service Code	HCPCS 46050
Hospital Charge Code	H4500478
Hospital Revenue Code	450
Min. Negotiated Rate	$3,771.45
Max. Negotiated Rate	$4,303.89
Rate for Payer: Cash Price	$2,884.05
Rate for Payer: Health Management Network Commercial	$3,771.45
Rate for Payer: MDX Hawaii PPO	$4,303.89

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	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Cash Price	$2,334.80
Rate for Payer: Devoted Health Medicare	$920.21
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
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	$836.55
Rate for Payer: Kaiser Permanente Commercial	$2,262.96
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$3,484.24
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55
Rate for Payer: University Health Alliance Commercial	$4,035.20

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	$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: MDX Hawaii PPO	$3,484.24

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	$456.03
Max. Negotiated Rate	$4,771.43
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
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	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$3,098.97
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$4,771.43
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
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: MDX Hawaii PPO	$4,771.43

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	$393.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Devoted Health Medicare	$1,555.02
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
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	$1,413.65
Rate for Payer: Kaiser Permanente Commercial	$2,557.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: MDX Hawaii PPO	$3,938.20
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65
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: 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	$393.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Cash Price	$3,197.35
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
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	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$3,098.97
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$4,771.43
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
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: MDX Hawaii PPO	$4,771.43

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	$359.99
Max. Negotiated Rate	$1,713.02
Rate for Payer: AlohaCare Medicaid	$359.99
Rate for Payer: AlohaCare Medicare	$359.99
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Devoted Health Medicare	$395.99
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$359.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
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	$359.99
Rate for Payer: Kaiser Permanente Commercial	$1,112.58
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$359.99
Rate for Payer: MDX Hawaii PPO	$1,713.02
Rate for Payer: Ohana Health Plan Medicaid	$395.99
Rate for Payer: Ohana Health Plan Medicare	$359.99
Rate for Payer: UnitedHealthcare Medicare	$359.99
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: 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	$10.32
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$10.32
Rate for Payer: AlohaCare Medicare	$10.32
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$11.35
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	$10.32
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	$10.32
Rate for Payer: Kaiser Permanente Commercial	$45.36
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$10.32
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$11.35
Rate for Payer: Ohana Health Plan Medicare	$10.32
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$10.32
Rate for Payer: University Health Alliance Commercial	$26.68

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: MDX Hawaii PPO	$69.84

HCHG ID YEAST ISOLATE

Facility

$175.00

Service Code	HCPCS 87106
Hospital Charge Code	H3060554
Hospital Revenue Code	306
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

HCHG ID YEAST ISOLATE

Facility

$175.00

Service Code	HCPCS 87106
Hospital Charge Code	H3060554
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$10.32
Rate for Payer: AlohaCare Medicare	$10.32
Rate for Payer: Cash Price	$113.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Devoted Health Medicare	$11.35
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	$10.32
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	$148.75
Rate for Payer: Humana Medicare	$10.32
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$10.32
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$11.35
Rate for Payer: Ohana Health Plan Medicare	$10.32
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$10.32
Rate for Payer: University Health Alliance Commercial	$26.68

HCHG IFE URINE

Facility

$385.00

Service Code	HCPCS 86335
Hospital Charge Code	H3020606
Hospital Revenue Code	302
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$373.45
Rate for Payer: AlohaCare Medicaid	$29.35
Rate for Payer: AlohaCare Medicare	$29.35
Rate for Payer: Cash Price	$250.25
Rate for Payer: Cash Price	$250.25
Rate for Payer: Devoted Health Medicare	$32.28
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	$29.35
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	$327.25
Rate for Payer: Humana Medicare	$29.35
Rate for Payer: Kaiser Permanente Commercial	$242.55
Rate for Payer: Kaiser Permanente Medicaid	$196.35
Rate for Payer: Kaiser Permanente Medicare	$29.35
Rate for Payer: MDX Hawaii PPO	$373.45
Rate for Payer: Ohana Health Plan Medicaid	$32.28
Rate for Payer: Ohana Health Plan Medicare	$29.35
Rate for Payer: UnitedHealthcare Medicaid	$16.26
Rate for Payer: UnitedHealthcare Medicare	$29.35
Rate for Payer: University Health Alliance Commercial	$75.85

Know your out-of-pocket cost for care.

All Charges