Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG REPAIR LACER TONGUE/MOUTH <2.6CM

Facility

$2,244.00

Service Code	HCPCS 41250
Hospital Charge Code	H4500640
Hospital Revenue Code	450
Min. Negotiated Rate	$1,907.40
Max. Negotiated Rate	$2,176.68
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Health Management Network Commercial	$1,907.40
Rate for Payer: MDX Hawaii PPO	$2,176.68

HCHG REPAIR LACER TONGUE/MOUTH <2.6CM

Facility

$2,244.00

Service Code	HCPCS 41250
Hospital Charge Code	H4500640
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Devoted Health Medicare	$580.51
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	$527.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,131.80
Rate for Payer: Health Management Network Commercial	$1,907.40
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$1,413.72
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$2,176.68
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$1,635.65

HCHG REPAIR LACER TONGUE/MOUTH >2.6CM

Facility

$1,402.00

Service Code	HCPCS 41252
Hospital Charge Code	H4500642
Hospital Revenue Code	450
Min. Negotiated Rate	$1,191.70
Max. Negotiated Rate	$1,359.94
Rate for Payer: Cash Price	$911.30
Rate for Payer: Health Management Network Commercial	$1,191.70
Rate for Payer: MDX Hawaii PPO	$1,359.94

HCHG REPAIR LACER TONGUE/MOUTH >2.6CM

Facility

$1,402.00

Service Code	HCPCS 41252
Hospital Charge Code	H4500642
Hospital Revenue Code	450
Min. Negotiated Rate	$279.80
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$279.80
Rate for Payer: AlohaCare Medicare	$279.80
Rate for Payer: Cash Price	$911.30
Rate for Payer: Cash Price	$911.30
Rate for Payer: Cash Price	$911.30
Rate for Payer: Devoted Health Medicare	$307.78
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	$279.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,331.90
Rate for Payer: Health Management Network Commercial	$1,191.70
Rate for Payer: Humana Medicare	$279.80
Rate for Payer: Kaiser Permanente Commercial	$883.26
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$279.80
Rate for Payer: MDX Hawaii PPO	$1,359.94
Rate for Payer: Ohana Health Plan Medicaid	$307.78
Rate for Payer: Ohana Health Plan Medicare	$279.80
Rate for Payer: UnitedHealthcare Medicare	$279.80
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG REPAIR LIP FULL THICKNESS

Facility

$2,864.00

Service Code	HCPCS 40650
Hospital Charge Code	H4500644
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,778.08
Rate for Payer: AlohaCare Medicaid	$637.13
Rate for Payer: AlohaCare Medicare	$637.13
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Devoted Health Medicare	$700.84
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	$637.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,720.80
Rate for Payer: Health Management Network Commercial	$2,434.40
Rate for Payer: Humana Medicare	$637.13
Rate for Payer: Kaiser Permanente Commercial	$1,804.32
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$637.13
Rate for Payer: MDX Hawaii PPO	$2,778.08
Rate for Payer: Ohana Health Plan Medicaid	$700.84
Rate for Payer: Ohana Health Plan Medicare	$637.13
Rate for Payer: UnitedHealthcare Medicare	$637.13
Rate for Payer: University Health Alliance Commercial	$2,087.57

HCHG REPAIR LIP FULL THICKNESS

Facility

$2,864.00

Service Code	HCPCS 40650
Hospital Charge Code	H4500644
Hospital Revenue Code	450
Min. Negotiated Rate	$2,434.40
Max. Negotiated Rate	$2,778.08
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Health Management Network Commercial	$2,434.40
Rate for Payer: MDX Hawaii PPO	$2,778.08

HCHG REPAIR OF EYE WOUND

Facility

$9,829.00

Service Code	HCPCS 65270
Hospital Charge Code	H4500984
Hospital Revenue Code	450
Min. Negotiated Rate	$8,354.65
Max. Negotiated Rate	$9,534.13
Rate for Payer: Cash Price	$6,388.85
Rate for Payer: Health Management Network Commercial	$8,354.65
Rate for Payer: MDX Hawaii PPO	$9,534.13

HCHG REPAIR OF EYE WOUND

Facility

$9,829.00

Service Code	HCPCS 65270
Hospital Charge Code	H4500984
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,534.13
Rate for Payer: AlohaCare Medicaid	$2,808.63
Rate for Payer: AlohaCare Medicare	$2,808.63
Rate for Payer: Cash Price	$6,388.85
Rate for Payer: Cash Price	$6,388.85
Rate for Payer: Cash Price	$6,388.85
Rate for Payer: Devoted Health Medicare	$3,089.49
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	$2,808.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$9,337.55
Rate for Payer: Health Management Network Commercial	$8,354.65
Rate for Payer: Humana Medicare	$2,808.63
Rate for Payer: Kaiser Permanente Commercial	$6,192.27
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,808.63
Rate for Payer: MDX Hawaii PPO	$9,534.13
Rate for Payer: Ohana Health Plan Medicaid	$3,089.49
Rate for Payer: Ohana Health Plan Medicare	$2,808.63
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,808.63
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG REPAIR OF NAIL BED

Facility

$3,187.00

Service Code	HCPCS 11760
Hospital Charge Code	H4500650
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$873.10
Rate for Payer: AlohaCare Medicare	$873.10
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Devoted Health Medicare	$960.41
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	$873.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.65
Rate for Payer: Health Management Network Commercial	$2,708.95
Rate for Payer: Humana Medicare	$873.10
Rate for Payer: Kaiser Permanente Commercial	$2,007.81
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$873.10
Rate for Payer: MDX Hawaii PPO	$3,091.39
Rate for Payer: Ohana Health Plan Medicaid	$960.41
Rate for Payer: Ohana Health Plan Medicare	$873.10
Rate for Payer: UnitedHealthcare Medicare	$873.10
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG REPAIR OF NAIL BED

Facility

$3,187.00

Service Code	HCPCS 11760
Hospital Charge Code	H4500650
Hospital Revenue Code	450
Min. Negotiated Rate	$2,708.95
Max. Negotiated Rate	$3,091.39
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Health Management Network Commercial	$2,708.95
Rate for Payer: MDX Hawaii PPO	$3,091.39

HCHG REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ

Facility

$4,535.00

Service Code	HCPCS 49451
Hospital Charge Code	H4501069
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,398.95
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$2,947.75
Rate for Payer: Cash Price	$2,947.75
Rate for Payer: Cash Price	$2,947.75
Rate for Payer: Devoted Health Medicare	$1,178.61
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	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,308.25
Rate for Payer: Health Management Network Commercial	$3,854.75
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$2,857.05
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$4,398.95
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$3,305.56

HCHG REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ

Facility

$4,535.00

Service Code	HCPCS 49451
Hospital Charge Code	H4501069
Hospital Revenue Code	450
Min. Negotiated Rate	$3,854.75
Max. Negotiated Rate	$4,398.95
Rate for Payer: Cash Price	$2,947.75
Rate for Payer: Health Management Network Commercial	$3,854.75
Rate for Payer: MDX Hawaii PPO	$4,398.95

HCHG REPL GAST/CECO/OTHER TUBE, PERC, FLUORO GUIDE, INCL CONT INJ, IMAGE DOC/REPT

Facility

$4,312.00

Service Code	HCPCS 49450
Hospital Charge Code	H4501016
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,182.64
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$2,802.80
Rate for Payer: Cash Price	$2,802.80
Rate for Payer: Cash Price	$2,802.80
Rate for Payer: Devoted Health Medicare	$1,178.61
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	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,096.40
Rate for Payer: Health Management Network Commercial	$3,665.20
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$2,716.56
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$4,182.64
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$3,143.02

HCHG REPL GAST/CECO/OTHER TUBE, PERC, FLUORO GUIDE, INCL CONT INJ, IMAGE DOC/REPT

Facility

$4,312.00

Service Code	HCPCS 49450
Hospital Charge Code	H4501016
Hospital Revenue Code	450
Min. Negotiated Rate	$3,665.20
Max. Negotiated Rate	$4,182.64
Rate for Payer: Cash Price	$2,802.80
Rate for Payer: Health Management Network Commercial	$3,665.20
Rate for Payer: MDX Hawaii PPO	$4,182.64

HCHG REPL GAST/CECO TUBE, PERC, FLUOR GUIDE

Facility

$1,691.00

Service Code	HCPCS 49450
Hospital Charge Code	H3600695
Hospital Revenue Code	360
Min. Negotiated Rate	$1,437.35
Max. Negotiated Rate	$1,640.27
Rate for Payer: Cash Price	$1,099.15
Rate for Payer: Health Management Network Commercial	$1,437.35
Rate for Payer: MDX Hawaii PPO	$1,640.27

HCHG REPL GAST/CECO TUBE, PERC, FLUOR GUIDE

Facility

$1,691.00

Service Code	HCPCS 49450
Hospital Charge Code	H3600695
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$1,099.15
Rate for Payer: Cash Price	$1,099.15
Rate for Payer: Cash Price	$1,099.15
Rate for Payer: Devoted Health Medicare	$1,178.61
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	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$1,437.35
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$1,065.33
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$1,640.27
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$1,232.57

HCHG REPL GASTRO/JEJUNO TUBE PERC UNDER FLUORO

Facility

$4,779.00

Service Code	HCPCS 49452
Hospital Charge Code	H3600698
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,635.63
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$3,106.35
Rate for Payer: Cash Price	$3,106.35
Rate for Payer: Cash Price	$3,106.35
Rate for Payer: Devoted Health Medicare	$1,178.61
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	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$4,062.15
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$3,010.77
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$4,635.63
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$3,483.41

HCHG REPL GASTRO/JEJUNO TUBE PERC UNDER FLUORO

Facility

$4,779.00

Service Code	HCPCS 49452
Hospital Charge Code	H3600698
Hospital Revenue Code	360
Min. Negotiated Rate	$4,062.15
Max. Negotiated Rate	$4,635.63
Rate for Payer: Cash Price	$3,106.35
Rate for Payer: Health Management Network Commercial	$4,062.15
Rate for Payer: MDX Hawaii PPO	$4,635.63

HCHG REPTILASE TIME-90

Facility

$98.00

Service Code	HCPCS 85635
Hospital Charge Code	H3050295
Hospital Revenue Code	305
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$63.70
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: MDX Hawaii PPO	$95.06

HCHG REPTILASE TIME-90

Facility

$98.00

Service Code	HCPCS 85635
Hospital Charge Code	H3050295
Hospital Revenue Code	305
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$95.06
Rate for Payer: AlohaCare Medicaid	$9.85
Rate for Payer: AlohaCare Medicare	$9.85
Rate for Payer: Cash Price	$63.70
Rate for Payer: Cash Price	$63.70
Rate for Payer: Devoted Health Medicare	$10.84
Rate for Payer: Hawaii Medical Service Association ABD	$8.26
Rate for Payer: Hawaii Medical Service Association Commercial	$12.31
Rate for Payer: Hawaii Medical Service Association Medicare	$9.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.61
Rate for Payer: Hawaii Western Management Group Commercial	$9.85
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Humana Medicare	$9.85
Rate for Payer: Kaiser Permanente Commercial	$61.74
Rate for Payer: Kaiser Permanente Medicaid	$49.98
Rate for Payer: Kaiser Permanente Medicare	$9.85
Rate for Payer: MDX Hawaii PPO	$95.06
Rate for Payer: Ohana Health Plan Medicaid	$10.84
Rate for Payer: Ohana Health Plan Medicare	$9.85
Rate for Payer: UnitedHealthcare Medicaid	$8.26
Rate for Payer: UnitedHealthcare Medicare	$9.85
Rate for Payer: University Health Alliance Commercial	$25.46

HCHG RESPIRATORY PANELBY FILMARRAY - 90

Facility

$3,366.00

Service Code	HCPCS 0202U
Hospital Charge Code	H3001125
Hospital Revenue Code	300
Min. Negotiated Rate	$416.78
Max. Negotiated Rate	$3,265.02
Rate for Payer: AlohaCare Medicaid	$416.78
Rate for Payer: AlohaCare Medicare	$416.78
Rate for Payer: Cash Price	$2,187.90
Rate for Payer: Cash Price	$2,187.90
Rate for Payer: Devoted Health Medicare	$458.46
Rate for Payer: Hawaii Medical Service Association Commercial	$520.98
Rate for Payer: Hawaii Medical Service Association Medicare	$416.78
Rate for Payer: Hawaii Western Management Group Commercial	$3,197.70
Rate for Payer: Health Management Network Commercial	$2,861.10
Rate for Payer: Humana Medicare	$416.78
Rate for Payer: Kaiser Permanente Commercial	$2,120.58
Rate for Payer: Kaiser Permanente Medicaid	$1,716.66
Rate for Payer: Kaiser Permanente Medicare	$416.78
Rate for Payer: MDX Hawaii PPO	$3,265.02
Rate for Payer: Ohana Health Plan Medicaid	$458.46
Rate for Payer: Ohana Health Plan Medicare	$416.78
Rate for Payer: UnitedHealthcare Medicaid	$416.78
Rate for Payer: UnitedHealthcare Medicare	$416.78
Rate for Payer: University Health Alliance Commercial	$2,453.48

HCHG RESPIRATORY PANELBY FILMARRAY - 90

Facility

$3,366.00

Service Code	HCPCS 0202U
Hospital Charge Code	H3001125
Hospital Revenue Code	300
Min. Negotiated Rate	$2,861.10
Max. Negotiated Rate	$3,265.02
Rate for Payer: Cash Price	$2,187.90
Rate for Payer: Health Management Network Commercial	$2,861.10
Rate for Payer: MDX Hawaii PPO	$3,265.02

HCHG RESPIRATORY PATHOGEN PNL

Facility

$3,366.00

Service Code	HCPCS 0202U
Hospital Charge Code	K3000001
Hospital Revenue Code	300
Min. Negotiated Rate	$416.78
Max. Negotiated Rate	$3,265.02
Rate for Payer: AlohaCare Medicaid	$416.78
Rate for Payer: AlohaCare Medicare	$416.78
Rate for Payer: Cash Price	$2,187.90
Rate for Payer: Cash Price	$2,187.90
Rate for Payer: Devoted Health Medicare	$458.46
Rate for Payer: Hawaii Medical Service Association Commercial	$520.98
Rate for Payer: Hawaii Medical Service Association Medicare	$416.78
Rate for Payer: Hawaii Western Management Group Commercial	$3,197.70
Rate for Payer: Health Management Network Commercial	$2,861.10
Rate for Payer: Humana Medicare	$416.78
Rate for Payer: Kaiser Permanente Commercial	$2,120.58
Rate for Payer: Kaiser Permanente Medicaid	$1,716.66
Rate for Payer: Kaiser Permanente Medicare	$416.78
Rate for Payer: MDX Hawaii PPO	$3,265.02
Rate for Payer: Ohana Health Plan Medicaid	$458.46
Rate for Payer: Ohana Health Plan Medicare	$416.78
Rate for Payer: UnitedHealthcare Medicaid	$416.78
Rate for Payer: UnitedHealthcare Medicare	$416.78
Rate for Payer: University Health Alliance Commercial	$2,453.48

HCHG RESPIRATORY PATHOGEN PNL

Facility

$3,366.00

Service Code	HCPCS 0202U
Hospital Charge Code	K3000001
Hospital Revenue Code	300
Min. Negotiated Rate	$2,861.10
Max. Negotiated Rate	$3,265.02
Rate for Payer: Cash Price	$2,187.90
Rate for Payer: Health Management Network Commercial	$2,861.10
Rate for Payer: MDX Hawaii PPO	$3,265.02

HCHG RESP MOTION MGMT-PHYSICS

Facility

$1,678.00

Service Code	HCPCS 77293
Hospital Charge Code	H3330239
Hospital Revenue Code	333
Min. Negotiated Rate	$1,426.30
Max. Negotiated Rate	$1,627.66
Rate for Payer: Cash Price	$1,090.70
Rate for Payer: Health Management Network Commercial	$1,426.30
Rate for Payer: MDX Hawaii PPO	$1,627.66

Know your out-of-pocket cost for care.

All Charges