Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG TTE CONG ABN LIMITED/F-UP W/ CONTRAST

Facility

$2,905.00

Service Code	HCPCS 93304
Hospital Charge Code	H4800227
Hospital Revenue Code	480
Min. Negotiated Rate	$64.51
Max. Negotiated Rate	$2,817.85
Rate for Payer: AlohaCare Medicaid	$645.50
Rate for Payer: AlohaCare Medicare	$645.50
Rate for Payer: Cash Price	$1,888.25
Rate for Payer: Cash Price	$1,888.25
Rate for Payer: Devoted Health Medicare	$710.05
Rate for Payer: Hawaii Medical Service Association ABD	$64.51
Rate for Payer: Hawaii Medical Service Association Commercial	$806.88
Rate for Payer: Hawaii Medical Service Association Medicare	$645.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$67.74
Rate for Payer: Hawaii Western Management Group Commercial	$2,759.75
Rate for Payer: Health Management Network Commercial	$2,469.25
Rate for Payer: Humana Medicare	$645.50
Rate for Payer: Kaiser Permanente Commercial	$1,830.15
Rate for Payer: Kaiser Permanente Medicaid	$1,481.55
Rate for Payer: Kaiser Permanente Medicare	$645.50
Rate for Payer: MDX Hawaii PPO	$2,817.85
Rate for Payer: Ohana Health Plan Medicaid	$710.05
Rate for Payer: Ohana Health Plan Medicare	$645.50
Rate for Payer: UnitedHealthcare Medicaid	$64.51
Rate for Payer: UnitedHealthcare Medicare	$645.50
Rate for Payer: University Health Alliance Commercial	$2,117.45

HCHG TTE CONG ABN LIMITED/F-UP W/ CONTRAST

Facility

$2,905.00

Service Code	HCPCS 93304
Hospital Charge Code	H4800227
Hospital Revenue Code	480
Min. Negotiated Rate	$2,469.25
Max. Negotiated Rate	$2,817.85
Rate for Payer: Cash Price	$1,888.25
Rate for Payer: Health Management Network Commercial	$2,469.25
Rate for Payer: MDX Hawaii PPO	$2,817.85

HCHG TTE W/DOPPLER, COMPLETE

Facility

$3,040.00

Service Code	HCPCS 93306
Hospital Charge Code	H4800214
Hospital Revenue Code	483
Min. Negotiated Rate	$2,584.00
Max. Negotiated Rate	$2,948.80
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Health Management Network Commercial	$2,584.00
Rate for Payer: MDX Hawaii PPO	$2,948.80

HCHG TTE W/DOPPLER, COMPLETE

Facility

$3,040.00

Service Code	HCPCS 93306
Hospital Charge Code	H4800214
Hospital Revenue Code	483
Min. Negotiated Rate	$132.88
Max. Negotiated Rate	$2,948.80
Rate for Payer: AlohaCare Medicaid	$645.50
Rate for Payer: AlohaCare Medicare	$645.50
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Devoted Health Medicare	$710.05
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	$645.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,888.00
Rate for Payer: Health Management Network Commercial	$2,584.00
Rate for Payer: Humana Medicare	$645.50
Rate for Payer: Kaiser Permanente Commercial	$1,915.20
Rate for Payer: Kaiser Permanente Medicaid	$1,550.40
Rate for Payer: Kaiser Permanente Medicare	$645.50
Rate for Payer: MDX Hawaii PPO	$2,948.80
Rate for Payer: Ohana Health Plan Medicaid	$710.05
Rate for Payer: Ohana Health Plan Medicare	$645.50
Rate for Payer: UnitedHealthcare Medicaid	$132.88
Rate for Payer: UnitedHealthcare Medicare	$645.50
Rate for Payer: University Health Alliance Commercial	$2,215.86

HCHG TUMOR/INFLAMMATORY PLANAR/WB MULTI DAY

Facility

$5,191.00

Service Code	HCPCS 78804
Hospital Charge Code	H3410386
Hospital Revenue Code	341
Min. Negotiated Rate	$285.62
Max. Negotiated Rate	$5,035.27
Rate for Payer: AlohaCare Medicaid	$641.43
Rate for Payer: AlohaCare Medicare	$641.43
Rate for Payer: Cash Price	$3,374.15
Rate for Payer: Cash Price	$3,374.15
Rate for Payer: Devoted Health Medicare	$705.57
Rate for Payer: Hawaii Medical Service Association ABD	$285.62
Rate for Payer: Hawaii Medical Service Association Commercial	$801.79
Rate for Payer: Hawaii Medical Service Association Medicare	$641.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$341.04
Rate for Payer: Hawaii Western Management Group Commercial	$641.43
Rate for Payer: Health Management Network Commercial	$4,412.35
Rate for Payer: Humana Medicare	$641.43
Rate for Payer: Kaiser Permanente Commercial	$3,270.33
Rate for Payer: Kaiser Permanente Medicaid	$2,647.41
Rate for Payer: Kaiser Permanente Medicare	$641.43
Rate for Payer: MDX Hawaii PPO	$5,035.27
Rate for Payer: Ohana Health Plan Medicaid	$705.57
Rate for Payer: Ohana Health Plan Medicare	$641.43
Rate for Payer: UnitedHealthcare Medicaid	$285.62
Rate for Payer: UnitedHealthcare Medicare	$641.43
Rate for Payer: University Health Alliance Commercial	$1,136.40

HCHG TUMOR/INFLAMMATORY PLANAR/WB MULTI DAY

Facility

$5,191.00

Service Code	HCPCS 78804
Hospital Charge Code	H3410386
Hospital Revenue Code	341
Min. Negotiated Rate	$4,412.35
Max. Negotiated Rate	$5,035.27
Rate for Payer: Cash Price	$3,374.15
Rate for Payer: Health Management Network Commercial	$4,412.35
Rate for Payer: MDX Hawaii PPO	$5,035.27

HCHG TUMOR/INFLAMMATORY PLANAR/WB SINGLE DAY

Facility

$2,808.00

Service Code	HCPCS 78802
Hospital Charge Code	H3410322
Hospital Revenue Code	341
Min. Negotiated Rate	$182.43
Max. Negotiated Rate	$2,723.76
Rate for Payer: AlohaCare Medicaid	$641.43
Rate for Payer: AlohaCare Medicare	$641.43
Rate for Payer: Cash Price	$1,825.20
Rate for Payer: Cash Price	$1,825.20
Rate for Payer: Devoted Health Medicare	$705.57
Rate for Payer: Hawaii Medical Service Association ABD	$182.43
Rate for Payer: Hawaii Medical Service Association Commercial	$801.79
Rate for Payer: Hawaii Medical Service Association Medicare	$641.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$197.91
Rate for Payer: Hawaii Western Management Group Commercial	$641.43
Rate for Payer: Health Management Network Commercial	$2,386.80
Rate for Payer: Humana Medicare	$641.43
Rate for Payer: Kaiser Permanente Commercial	$1,769.04
Rate for Payer: Kaiser Permanente Medicaid	$1,432.08
Rate for Payer: Kaiser Permanente Medicare	$641.43
Rate for Payer: MDX Hawaii PPO	$2,723.76
Rate for Payer: Ohana Health Plan Medicaid	$705.57
Rate for Payer: Ohana Health Plan Medicare	$641.43
Rate for Payer: UnitedHealthcare Medicaid	$182.43
Rate for Payer: UnitedHealthcare Medicare	$641.43
Rate for Payer: University Health Alliance Commercial	$630.18

HCHG TUMOR/INFLAMMATORY PLANAR/WB SINGLE DAY

Facility

$2,808.00

Service Code	HCPCS 78802
Hospital Charge Code	H3410322
Hospital Revenue Code	341
Min. Negotiated Rate	$2,386.80
Max. Negotiated Rate	$2,723.76
Rate for Payer: Cash Price	$1,825.20
Rate for Payer: Health Management Network Commercial	$2,386.80
Rate for Payer: MDX Hawaii PPO	$2,723.76

HCHG TUMOR SCAN MULT

Facility

$2,064.00

Service Code	HCPCS 78801
Hospital Charge Code	H3410332
Hospital Revenue Code	341
Min. Negotiated Rate	$1,754.40
Max. Negotiated Rate	$2,002.08
Rate for Payer: Cash Price	$1,341.60
Rate for Payer: Health Management Network Commercial	$1,754.40
Rate for Payer: MDX Hawaii PPO	$2,002.08

HCHG TUMOR SCAN MULT

Facility

$2,064.00

Service Code	HCPCS 78801
Hospital Charge Code	H3410332
Hospital Revenue Code	341
Min. Negotiated Rate	$139.19
Max. Negotiated Rate	$2,002.08
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,341.60
Rate for Payer: Cash Price	$1,341.60
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$139.19
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$151.22
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,754.40
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,300.32
Rate for Payer: Kaiser Permanente Medicaid	$1,052.64
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$2,002.08
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$139.19
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$485.38

HCHG TX INCOMPL AB COMPL SURGICALLY

Facility

$7,423.00

Service Code	HCPCS 59812
Hospital Charge Code	H4500832
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,157.19
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Cash Price	$4,824.95
Rate for Payer: Cash Price	$4,824.95
Rate for Payer: Cash Price	$4,824.95
Rate for Payer: Devoted Health Medicare	$4,206.58
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	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$7,051.85
Rate for Payer: Health Management Network Commercial	$6,309.55
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Commercial	$4,676.49
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: MDX Hawaii PPO	$7,200.31
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$11,157.19

HCHG TX INCOMPL AB COMPL SURGICALLY

Facility

$7,423.00

Service Code	HCPCS 59812
Hospital Charge Code	H4500832
Hospital Revenue Code	450
Min. Negotiated Rate	$6,309.55
Max. Negotiated Rate	$7,200.31
Rate for Payer: Cash Price	$4,824.95
Rate for Payer: Health Management Network Commercial	$6,309.55
Rate for Payer: MDX Hawaii PPO	$7,200.31

HCHG TX SPLIT WOUND SIMP CLOSURE

Facility

$3,187.00

Service Code	HCPCS 12020
Hospital Charge Code	H4500836
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 TX SPLIT WOUND SIMP CLOSURE

Facility

$3,187.00

Service Code	HCPCS 12020
Hospital Charge Code	H4500836
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$3,091.39
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: Cash Price	$2,071.55
Rate for Payer: Devoted Health Medicare	$960.41
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	$873.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
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	$2,323.00

HCHG TX WND DEHISCENCE W PACKING

Facility

$2,246.00

Service Code	HCPCS 12021
Hospital Charge Code	H4500838
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG TX WND DEHISCENCE W PACKING

Facility

$2,246.00

Service Code	HCPCS 12021
Hospital Charge Code	H4500838
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$2,178.62
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,414.98
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$1,637.11

HCHG TYROSINE SO

Facility

$294.00

Service Code	HCPCS 84510
Hospital Charge Code	K3010064
Hospital Revenue Code	301
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$10.63
Rate for Payer: AlohaCare Medicare	$10.63
Rate for Payer: Cash Price	$191.10
Rate for Payer: Cash Price	$191.10
Rate for Payer: Devoted Health Medicare	$11.69
Rate for Payer: Hawaii Medical Service Association ABD	$8.72
Rate for Payer: Hawaii Medical Service Association Commercial	$13.29
Rate for Payer: Hawaii Medical Service Association Medicare	$10.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.36
Rate for Payer: Hawaii Western Management Group Commercial	$10.63
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$10.63
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$10.63
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$11.69
Rate for Payer: Ohana Health Plan Medicare	$10.63
Rate for Payer: UnitedHealthcare Medicaid	$8.72
Rate for Payer: UnitedHealthcare Medicare	$10.63
Rate for Payer: University Health Alliance Commercial	$26.88

HCHG TYROSINE SO

Facility

$294.00

Service Code	HCPCS 84510
Hospital Charge Code	K3010064
Hospital Revenue Code	301
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$191.10
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HCHG UA, AUTOMATED W/MICRO, REFLEX TO CULTURE

Facility

$56.00

Service Code	HCPCS 81001
Hospital Charge Code	H3070116
Hospital Revenue Code	307
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$36.40
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: MDX Hawaii PPO	$54.32

HCHG UA, AUTOMATED W/MICRO, REFLEX TO CULTURE

Facility

$56.00

Service Code	HCPCS 81001
Hospital Charge Code	H3070116
Hospital Revenue Code	307
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$54.32
Rate for Payer: AlohaCare Medicaid	$3.17
Rate for Payer: AlohaCare Medicare	$3.17
Rate for Payer: Cash Price	$36.40
Rate for Payer: Cash Price	$36.40
Rate for Payer: Devoted Health Medicare	$3.49
Rate for Payer: Hawaii Medical Service Association ABD	$4.37
Rate for Payer: Hawaii Medical Service Association Commercial	$3.96
Rate for Payer: Hawaii Medical Service Association Medicare	$3.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.59
Rate for Payer: Hawaii Western Management Group Commercial	$3.17
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Humana Medicare	$3.17
Rate for Payer: Kaiser Permanente Commercial	$35.28
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: Kaiser Permanente Medicare	$3.17
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: Ohana Health Plan Medicaid	$3.49
Rate for Payer: Ohana Health Plan Medicare	$3.17
Rate for Payer: UnitedHealthcare Medicaid	$4.37
Rate for Payer: UnitedHealthcare Medicare	$3.17
Rate for Payer: University Health Alliance Commercial	$8.20

HCHG UA, AUTOMATED, W/ MICROSCOPY

Facility

$56.00

Service Code	HCPCS 81001
Hospital Charge Code	H3070110
Hospital Revenue Code	307
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$54.32
Rate for Payer: AlohaCare Medicaid	$3.17
Rate for Payer: AlohaCare Medicare	$3.17
Rate for Payer: Cash Price	$36.40
Rate for Payer: Cash Price	$36.40
Rate for Payer: Devoted Health Medicare	$3.49
Rate for Payer: Hawaii Medical Service Association ABD	$4.37
Rate for Payer: Hawaii Medical Service Association Commercial	$3.96
Rate for Payer: Hawaii Medical Service Association Medicare	$3.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.59
Rate for Payer: Hawaii Western Management Group Commercial	$3.17
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Humana Medicare	$3.17
Rate for Payer: Kaiser Permanente Commercial	$35.28
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: Kaiser Permanente Medicare	$3.17
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: Ohana Health Plan Medicaid	$3.49
Rate for Payer: Ohana Health Plan Medicare	$3.17
Rate for Payer: UnitedHealthcare Medicaid	$4.37
Rate for Payer: UnitedHealthcare Medicare	$3.17
Rate for Payer: University Health Alliance Commercial	$8.20

HCHG UA, AUTOMATED, W/ MICROSCOPY

Facility

$56.00

Service Code	HCPCS 81001
Hospital Charge Code	H3070110
Hospital Revenue Code	307
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$36.40
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: MDX Hawaii PPO	$54.32

HCHG UA (DIPSTICK), NON-AUTOMATED, W/O MICROSCOPY

Facility

$25.00

Service Code	HCPCS 81002
Hospital Charge Code	H3070120
Hospital Revenue Code	307
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: MDX Hawaii PPO	$24.25

HCHG UA (DIPSTICK), NON-AUTOMATED, W/O MICROSCOPY

Facility

$25.00

Service Code	HCPCS 81002
Hospital Charge Code	H3070120
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$24.25
Rate for Payer: AlohaCare Medicaid	$3.48
Rate for Payer: AlohaCare Medicare	$3.48
Rate for Payer: Cash Price	$16.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Devoted Health Medicare	$3.83
Rate for Payer: Hawaii Medical Service Association ABD	$3.54
Rate for Payer: Hawaii Medical Service Association Commercial	$4.35
Rate for Payer: Hawaii Medical Service Association Medicare	$3.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.48
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$3.48
Rate for Payer: Kaiser Permanente Commercial	$15.75
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$3.48
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$3.83
Rate for Payer: Ohana Health Plan Medicare	$3.48
Rate for Payer: UnitedHealthcare Medicaid	$3.54
Rate for Payer: UnitedHealthcare Medicare	$3.48
Rate for Payer: University Health Alliance Commercial	$6.60

HCHG UA MICRO REFLEX CULT

Facility

$38.00

Service Code	HCPCS 81015
Hospital Charge Code	K3070004
Hospital Revenue Code	307
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$36.86
Rate for Payer: AlohaCare Medicaid	$3.05
Rate for Payer: AlohaCare Medicare	$3.05
Rate for Payer: Cash Price	$24.70
Rate for Payer: Cash Price	$24.70
Rate for Payer: Devoted Health Medicare	$3.35
Rate for Payer: Hawaii Medical Service Association ABD	$4.20
Rate for Payer: Hawaii Medical Service Association Commercial	$3.81
Rate for Payer: Hawaii Medical Service Association Medicare	$3.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.41
Rate for Payer: Hawaii Western Management Group Commercial	$3.05
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Humana Medicare	$3.05
Rate for Payer: Kaiser Permanente Commercial	$23.94
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: Kaiser Permanente Medicare	$3.05
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: Ohana Health Plan Medicaid	$3.35
Rate for Payer: Ohana Health Plan Medicare	$3.05
Rate for Payer: UnitedHealthcare Medicaid	$4.20
Rate for Payer: UnitedHealthcare Medicare	$3.05
Rate for Payer: University Health Alliance Commercial	$7.84

Know your out-of-pocket cost for care.

All Charges