Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG NASAL HEMORR POST INITIAL

Facility

$813.00

Service Code	HCPCS 30905
Hospital Charge Code	H4500572
Hospital Revenue Code	450
Min. Negotiated Rate	$691.05
Max. Negotiated Rate	$788.61
Rate for Payer: Cash Price	$528.45
Rate for Payer: Health Management Network Commercial	$691.05
Rate for Payer: Kaiser Permanente Commercial	$731.70
Rate for Payer: MDX Hawaii PPO	$788.61

HCHG NASAL HEMORR POST INITIAL

Facility

$813.00

Service Code	HCPCS 30905
Hospital Charge Code	H4500572
Hospital Revenue Code	450
Min. Negotiated Rate	$406.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$406.50
Rate for Payer: AlohaCare Medicare	$731.70
Rate for Payer: Cash Price	$528.45
Rate for Payer: Cash Price	$528.45
Rate for Payer: Devoted Health Medicare	$804.87
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	$731.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$772.35
Rate for Payer: Health Management Network Commercial	$691.05
Rate for Payer: Humana Medicare	$731.70
Rate for Payer: Kaiser Permanente Commercial	$731.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$731.70
Rate for Payer: MDX Hawaii PPO	$788.61
Rate for Payer: Ohana Health Plan Medicaid	$731.70
Rate for Payer: Ohana Health Plan Medicare	$731.70
Rate for Payer: UnitedHealthcare Medicare	$731.70
Rate for Payer: University Health Alliance Commercial	$592.60

HCHG NASO/ORO G TUBE PLCMT MD

Facility

$2,008.00

Service Code	HCPCS 43752
Hospital Charge Code	H4500574
Hospital Revenue Code	450
Min. Negotiated Rate	$1,706.80
Max. Negotiated Rate	$1,947.76
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Health Management Network Commercial	$1,706.80
Rate for Payer: Kaiser Permanente Commercial	$1,807.20
Rate for Payer: MDX Hawaii PPO	$1,947.76

HCHG NASO/ORO G TUBE PLCMT MD

Facility

$2,008.00

Service Code	HCPCS 43752
Hospital Charge Code	H4500574
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,987.92
Rate for Payer: AlohaCare Medicaid	$1,004.00
Rate for Payer: AlohaCare Medicare	$1,807.20
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Devoted Health Medicare	$1,987.92
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	$1,807.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,907.60
Rate for Payer: Health Management Network Commercial	$1,706.80
Rate for Payer: Humana Medicare	$1,807.20
Rate for Payer: Kaiser Permanente Commercial	$1,807.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,807.20
Rate for Payer: MDX Hawaii PPO	$1,947.76
Rate for Payer: Ohana Health Plan Medicaid	$1,807.20
Rate for Payer: Ohana Health Plan Medicare	$1,807.20
Rate for Payer: UnitedHealthcare Medicare	$1,807.20
Rate for Payer: University Health Alliance Commercial	$1,463.63

HCHG NASOTRACHEAL SXN/AIRWAY MGMT

Facility

$418.00

Service Code	HCPCS 31720
Hospital Charge Code	H4100304
Hospital Revenue Code	410
Min. Negotiated Rate	$47.17
Max. Negotiated Rate	$413.82
Rate for Payer: AlohaCare Medicaid	$209.00
Rate for Payer: AlohaCare Medicare	$376.20
Rate for Payer: Cash Price	$271.70
Rate for Payer: Cash Price	$271.70
Rate for Payer: Devoted Health Medicare	$413.82
Rate for Payer: Hawaii Medical Service Association Commercial	$279.65
Rate for Payer: Hawaii Medical Service Association Medicare	$376.20
Rate for Payer: Hawaii Western Management Group Commercial	$397.10
Rate for Payer: Health Management Network Commercial	$355.30
Rate for Payer: Humana Medicare	$376.20
Rate for Payer: Kaiser Permanente Commercial	$376.20
Rate for Payer: Kaiser Permanente Medicaid	$213.18
Rate for Payer: Kaiser Permanente Medicare	$376.20
Rate for Payer: MDX Hawaii PPO	$405.46
Rate for Payer: Ohana Health Plan Medicaid	$376.20
Rate for Payer: Ohana Health Plan Medicare	$376.20
Rate for Payer: UnitedHealthcare Medicaid	$47.17
Rate for Payer: UnitedHealthcare Medicare	$376.20
Rate for Payer: University Health Alliance Commercial	$304.68

HCHG NASOTRACHEAL SXN/AIRWAY MGMT

Facility

$418.00

Service Code	HCPCS 31720
Hospital Charge Code	H4100304
Hospital Revenue Code	410
Min. Negotiated Rate	$355.30
Max. Negotiated Rate	$405.46
Rate for Payer: Cash Price	$271.70
Rate for Payer: Health Management Network Commercial	$355.30
Rate for Payer: Kaiser Permanente Commercial	$376.20
Rate for Payer: MDX Hawaii PPO	$405.46

HCHG NATURAL KILLER CELLS

Facility

$254.00

Service Code	HCPCS 86357
Hospital Charge Code	H3110224
Hospital Revenue Code	302
Min. Negotiated Rate	$31.62
Max. Negotiated Rate	$251.46
Rate for Payer: AlohaCare Medicaid	$127.00
Rate for Payer: AlohaCare Medicare	$228.60
Rate for Payer: Cash Price	$165.10
Rate for Payer: Cash Price	$165.10
Rate for Payer: Devoted Health Medicare	$251.46
Rate for Payer: Hawaii Medical Service Association ABD	$31.62
Rate for Payer: Hawaii Medical Service Association Commercial	$47.16
Rate for Payer: Hawaii Medical Service Association Medicare	$228.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$52.10
Rate for Payer: Hawaii Western Management Group Commercial	$37.73
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: Humana Medicare	$228.60
Rate for Payer: Kaiser Permanente Commercial	$228.60
Rate for Payer: Kaiser Permanente Medicaid	$129.54
Rate for Payer: Kaiser Permanente Medicare	$228.60
Rate for Payer: MDX Hawaii PPO	$246.38
Rate for Payer: Ohana Health Plan Medicaid	$228.60
Rate for Payer: Ohana Health Plan Medicare	$228.60
Rate for Payer: UnitedHealthcare Medicaid	$31.62
Rate for Payer: UnitedHealthcare Medicare	$228.60
Rate for Payer: University Health Alliance Commercial	$97.50

HCHG NATURAL KILLER CELLS

Facility

$254.00

Service Code	HCPCS 86357
Hospital Charge Code	H3110224
Hospital Revenue Code	302
Min. Negotiated Rate	$215.90
Max. Negotiated Rate	$246.38
Rate for Payer: Cash Price	$165.10
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: Kaiser Permanente Commercial	$228.60
Rate for Payer: MDX Hawaii PPO	$246.38

HCHG NECK SOFT TISSUE

Facility

$564.00

Service Code	HCPCS 70360
Hospital Charge Code	H3200582
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$558.36
Rate for Payer: AlohaCare Medicaid	$282.00
Rate for Payer: AlohaCare Medicare	$507.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Devoted Health Medicare	$558.36
Rate for Payer: Hawaii Medical Service Association ABD	$20.82
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$507.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.15
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Humana Medicare	$507.60
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: Kaiser Permanente Medicaid	$287.64
Rate for Payer: Kaiser Permanente Medicare	$507.60
Rate for Payer: MDX Hawaii PPO	$547.08
Rate for Payer: Ohana Health Plan Medicaid	$507.60
Rate for Payer: Ohana Health Plan Medicare	$507.60
Rate for Payer: UnitedHealthcare Medicaid	$20.82
Rate for Payer: UnitedHealthcare Medicare	$507.60
Rate for Payer: University Health Alliance Commercial	$53.78

HCHG NECK SOFT TISSUE

Facility

$564.00

Service Code	HCPCS 70360
Hospital Charge Code	H3200582
Hospital Revenue Code	320
Min. Negotiated Rate	$479.40
Max. Negotiated Rate	$547.08
Rate for Payer: Cash Price	$366.60
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: MDX Hawaii PPO	$547.08

HCHG NECK SOFT TISSUE PORT

Facility

$564.00

Service Code	HCPCS 70360
Hospital Charge Code	H3200584
Hospital Revenue Code	320
Min. Negotiated Rate	$479.40
Max. Negotiated Rate	$547.08
Rate for Payer: Cash Price	$366.60
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: MDX Hawaii PPO	$547.08

HCHG NECK SOFT TISSUE PORT

Facility

$564.00

Service Code	HCPCS 70360
Hospital Charge Code	H3200584
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$558.36
Rate for Payer: AlohaCare Medicaid	$282.00
Rate for Payer: AlohaCare Medicare	$507.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Devoted Health Medicare	$558.36
Rate for Payer: Hawaii Medical Service Association ABD	$20.82
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$507.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.15
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Humana Medicare	$507.60
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: Kaiser Permanente Medicaid	$287.64
Rate for Payer: Kaiser Permanente Medicare	$507.60
Rate for Payer: MDX Hawaii PPO	$547.08
Rate for Payer: Ohana Health Plan Medicaid	$507.60
Rate for Payer: Ohana Health Plan Medicare	$507.60
Rate for Payer: UnitedHealthcare Medicaid	$20.82
Rate for Payer: UnitedHealthcare Medicare	$507.60
Rate for Payer: University Health Alliance Commercial	$53.78

HCHG NERVE BLOCK INJECTION, PLANTAR DIGIT

Facility

$1,721.00

Service Code	HCPCS 64455
Hospital Charge Code	H4501003
Hospital Revenue Code	450
Min. Negotiated Rate	$1,462.85
Max. Negotiated Rate	$1,669.37
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Health Management Network Commercial	$1,462.85
Rate for Payer: Kaiser Permanente Commercial	$1,548.90
Rate for Payer: MDX Hawaii PPO	$1,669.37

HCHG NERVE BLOCK INJECTION, PLANTAR DIGIT

Facility

$1,721.00

Service Code	HCPCS 64455
Hospital Charge Code	H4501003
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,703.79
Rate for Payer: AlohaCare Medicaid	$860.50
Rate for Payer: AlohaCare Medicare	$1,548.90
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Devoted Health Medicare	$1,703.79
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	$1,548.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,634.95
Rate for Payer: Health Management Network Commercial	$1,462.85
Rate for Payer: Humana Medicare	$1,548.90
Rate for Payer: Kaiser Permanente Commercial	$1,548.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,548.90
Rate for Payer: MDX Hawaii PPO	$1,669.37
Rate for Payer: Ohana Health Plan Medicaid	$1,548.90
Rate for Payer: Ohana Health Plan Medicare	$1,548.90
Rate for Payer: UnitedHealthcare Medicare	$1,548.90
Rate for Payer: University Health Alliance Commercial	$1,254.44

HCHG NEUROMUSCULAR RE-EDUC 15 MIN

Facility

$237.00

Service Code	HCPCS 97112
Hospital Charge Code	H4300118
Hospital Revenue Code	430
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$234.63
Rate for Payer: AlohaCare Medicaid	$118.50
Rate for Payer: AlohaCare Medicare	$213.30
Rate for Payer: Cash Price	$154.05
Rate for Payer: Cash Price	$154.05
Rate for Payer: Devoted Health Medicare	$234.63
Rate for Payer: Hawaii Medical Service Association Medicare	$213.30
Rate for Payer: Hawaii Western Management Group Commercial	$225.15
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Humana Medicare	$213.30
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: Kaiser Permanente Medicaid	$120.87
Rate for Payer: Kaiser Permanente Medicare	$213.30
Rate for Payer: MDX Hawaii PPO	$229.89
Rate for Payer: Ohana Health Plan Medicaid	$213.30
Rate for Payer: Ohana Health Plan Medicare	$213.30
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: UnitedHealthcare Medicare	$213.30
Rate for Payer: University Health Alliance Commercial	$172.75

HCHG NEUROMUSCULAR RE-EDUC 15 MIN

Facility

$237.00

Service Code	HCPCS 97112
Hospital Charge Code	H4300118
Hospital Revenue Code	430
Min. Negotiated Rate	$201.45
Max. Negotiated Rate	$229.89
Rate for Payer: Cash Price	$154.05
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: MDX Hawaii PPO	$229.89

HCHG NFCT DS BV RNA VAG FLU ALG - 90

Facility

$1,051.00

Service Code	HCPCS 81513
Hospital Charge Code	H3100256
Hospital Revenue Code	310
Min. Negotiated Rate	$893.35
Max. Negotiated Rate	$1,019.47
Rate for Payer: Cash Price	$683.15
Rate for Payer: Health Management Network Commercial	$893.35
Rate for Payer: Kaiser Permanente Commercial	$945.90
Rate for Payer: MDX Hawaii PPO	$1,019.47

HCHG NFCT DS BV RNA VAG FLU ALG - 90

Facility

$1,051.00

Service Code	HCPCS 81513
Hospital Charge Code	H3100256
Hospital Revenue Code	310
Min. Negotiated Rate	$106.97
Max. Negotiated Rate	$1,040.49
Rate for Payer: AlohaCare Medicaid	$525.50
Rate for Payer: AlohaCare Medicare	$945.90
Rate for Payer: Cash Price	$683.15
Rate for Payer: Cash Price	$683.15
Rate for Payer: Devoted Health Medicare	$1,040.49
Rate for Payer: Hawaii Medical Service Association ABD	$174.58
Rate for Payer: Hawaii Medical Service Association Commercial	$178.29
Rate for Payer: Hawaii Medical Service Association Medicare	$945.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$177.81
Rate for Payer: Hawaii Western Management Group Commercial	$142.63
Rate for Payer: Health Management Network Commercial	$893.35
Rate for Payer: Humana Medicare	$945.90
Rate for Payer: Kaiser Permanente Commercial	$945.90
Rate for Payer: Kaiser Permanente Medicaid	$536.01
Rate for Payer: Kaiser Permanente Medicare	$945.90
Rate for Payer: MDX Hawaii PPO	$1,019.47
Rate for Payer: Ohana Health Plan Medicaid	$945.90
Rate for Payer: Ohana Health Plan Medicare	$945.90
Rate for Payer: UnitedHealthcare Medicaid	$106.97
Rate for Payer: UnitedHealthcare Medicare	$945.90
Rate for Payer: University Health Alliance Commercial	$766.07

HCHG N.GONORRHOEAE DNA AMP PROB - 90

Facility

$231.00

Service Code	HCPCS 87591
Hospital Charge Code	H3060787
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$228.69
Rate for Payer: AlohaCare Medicaid	$115.50
Rate for Payer: AlohaCare Medicare	$207.90
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$228.69
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$207.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$207.90
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$207.90
Rate for Payer: Ohana Health Plan Medicare	$207.90
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$207.90
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG N.GONORRHOEAE DNA AMP PROB - 90

Facility

$231.00

Service Code	HCPCS 87591
Hospital Charge Code	H3060787
Hospital Revenue Code	306
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

HCHG NG TUBE PLCMT W FLUORO

Facility

$2,008.00

Service Code	HCPCS 43752
Hospital Charge Code	H3600328
Hospital Revenue Code	360
Min. Negotiated Rate	$36.91
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,004.00
Rate for Payer: AlohaCare Medicare	$1,807.20
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Devoted Health Medicare	$1,987.92
Rate for Payer: Hawaii Medical Service Association Commercial	$570.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,807.20
Rate for Payer: Health Management Network Commercial	$1,706.80
Rate for Payer: Humana Medicare	$1,807.20
Rate for Payer: Kaiser Permanente Commercial	$1,807.20
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,807.20
Rate for Payer: MDX Hawaii PPO	$1,947.76
Rate for Payer: Ohana Health Plan Medicaid	$1,807.20
Rate for Payer: Ohana Health Plan Medicare	$1,807.20
Rate for Payer: UnitedHealthcare Medicaid	$36.91
Rate for Payer: UnitedHealthcare Medicare	$1,807.20
Rate for Payer: University Health Alliance Commercial	$1,463.63

HCHG NG TUBE PLCMT W FLUORO

Facility

$2,008.00

Service Code	HCPCS 43752
Hospital Charge Code	H3600328
Hospital Revenue Code	360
Min. Negotiated Rate	$1,706.80
Max. Negotiated Rate	$1,947.76
Rate for Payer: Cash Price	$1,305.20
Rate for Payer: Health Management Network Commercial	$1,706.80
Rate for Payer: Kaiser Permanente Commercial	$1,807.20
Rate for Payer: MDX Hawaii PPO	$1,947.76

HCHG NON-ENTERIC ISO, DISK METHOD PER PLATE

Facility

$103.00

Service Code	HCPCS 87184
Hospital Charge Code	H3060695
Hospital Revenue Code	306
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$66.95
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91

HCHG NON-ENTERIC ISO, DISK METHOD PER PLATE

Facility

$103.00

Service Code	HCPCS 87184
Hospital Charge Code	H3060695
Hospital Revenue Code	306
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$101.97
Rate for Payer: AlohaCare Medicaid	$51.50
Rate for Payer: AlohaCare Medicare	$92.70
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Devoted Health Medicare	$101.97
Rate for Payer: Hawaii Medical Service Association ABD	$9.53
Rate for Payer: Hawaii Medical Service Association Commercial	$9.35
Rate for Payer: Hawaii Medical Service Association Medicare	$92.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.01
Rate for Payer: Hawaii Western Management Group Commercial	$7.48
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$92.70
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$92.70
Rate for Payer: Ohana Health Plan Medicare	$92.70
Rate for Payer: UnitedHealthcare Medicaid	$9.53
Rate for Payer: UnitedHealthcare Medicare	$92.70
Rate for Payer: University Health Alliance Commercial	$17.82

HCHG NON-ENTERIC SENSITIVITY ISO EA PER PLATE

Facility

$319.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060697
Hospital Revenue Code	306
Min. Negotiated Rate	$271.15
Max. Negotiated Rate	$309.43
Rate for Payer: Cash Price	$207.35
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: MDX Hawaii PPO	$309.43

Know your out-of-pocket cost for care.

All Charges