Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG TEMP TRANSV PACEMKR INSERT+CF

Facility

$19,124.00

Service Code	HCPCS 33210
Hospital Charge Code	H4501036
Hospital Revenue Code	450
Min. Negotiated Rate	$16,255.40
Max. Negotiated Rate	$18,550.28
Rate for Payer: Cash Price	$12,430.60
Rate for Payer: Health Management Network Commercial	$16,255.40
Rate for Payer: Kaiser Permanente Commercial	$17,211.60
Rate for Payer: MDX Hawaii PPO	$18,550.28

HCHG TEMP TRANSV PACEMKR INSERT+CF

Facility

$19,124.00

Service Code	HCPCS 33210
Hospital Charge Code	H4501036
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$18,932.76
Rate for Payer: AlohaCare Medicaid	$9,562.00
Rate for Payer: AlohaCare Medicare	$17,211.60
Rate for Payer: Cash Price	$12,430.60
Rate for Payer: Cash Price	$12,430.60
Rate for Payer: Devoted Health Medicare	$18,932.76
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	$17,211.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$18,167.80
Rate for Payer: Health Management Network Commercial	$16,255.40
Rate for Payer: Humana Medicare	$17,211.60
Rate for Payer: Kaiser Permanente Commercial	$17,211.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$17,211.60
Rate for Payer: MDX Hawaii PPO	$18,550.28
Rate for Payer: Ohana Health Plan Medicaid	$17,211.60
Rate for Payer: Ohana Health Plan Medicare	$17,211.60
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$17,211.60
Rate for Payer: University Health Alliance Commercial	$13,939.48

HCHG TESTOSTERONE FREE 90

Facility

$182.00

Service Code	HCPCS 84402
Hospital Charge Code	H3011210
Hospital Revenue Code	301
Min. Negotiated Rate	$25.47
Max. Negotiated Rate	$180.18
Rate for Payer: AlohaCare Medicaid	$91.00
Rate for Payer: AlohaCare Medicare	$163.80
Rate for Payer: Cash Price	$118.30
Rate for Payer: Cash Price	$118.30
Rate for Payer: Devoted Health Medicare	$180.18
Rate for Payer: Hawaii Medical Service Association ABD	$35.19
Rate for Payer: Hawaii Medical Service Association Commercial	$31.84
Rate for Payer: Hawaii Medical Service Association Medicare	$163.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.95
Rate for Payer: Hawaii Western Management Group Commercial	$25.47
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Humana Medicare	$163.80
Rate for Payer: Kaiser Permanente Commercial	$163.80
Rate for Payer: Kaiser Permanente Medicaid	$92.82
Rate for Payer: Kaiser Permanente Medicare	$163.80
Rate for Payer: MDX Hawaii PPO	$176.54
Rate for Payer: Ohana Health Plan Medicaid	$163.80
Rate for Payer: Ohana Health Plan Medicare	$163.80
Rate for Payer: UnitedHealthcare Medicaid	$35.19
Rate for Payer: UnitedHealthcare Medicare	$163.80
Rate for Payer: University Health Alliance Commercial	$65.80

HCHG TESTOSTERONE FREE 90

Facility

$182.00

Service Code	HCPCS 84402
Hospital Charge Code	H3011210
Hospital Revenue Code	301
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$118.30
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Kaiser Permanente Commercial	$163.80
Rate for Payer: MDX Hawaii PPO	$176.54

HCHG TESTOSTERONE SERUM TOTAL

Facility

$184.00

Service Code	HCPCS 84403
Hospital Charge Code	H3011212
Hospital Revenue Code	301
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$182.16
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$165.60
Rate for Payer: Cash Price	$119.60
Rate for Payer: Cash Price	$119.60
Rate for Payer: Devoted Health Medicare	$182.16
Rate for Payer: Hawaii Medical Service Association ABD	$35.68
Rate for Payer: Hawaii Medical Service Association Commercial	$32.26
Rate for Payer: Hawaii Medical Service Association Medicare	$165.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.46
Rate for Payer: Hawaii Western Management Group Commercial	$25.81
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$165.60
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$165.60
Rate for Payer: Ohana Health Plan Medicare	$165.60
Rate for Payer: UnitedHealthcare Medicaid	$35.68
Rate for Payer: UnitedHealthcare Medicare	$165.60
Rate for Payer: University Health Alliance Commercial	$66.75

HCHG TESTOSTERONE SERUM TOTAL

Facility

$184.00

Service Code	HCPCS 84403
Hospital Charge Code	H3011212
Hospital Revenue Code	301
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$119.60
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48

HCHG THEOPHYLLINE

Facility

$108.00

Service Code	HCPCS 80198
Hospital Charge Code	H3011218
Hospital Revenue Code	301
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$70.20
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: MDX Hawaii PPO	$104.76

HCHG THEOPHYLLINE

Facility

$108.00

Service Code	HCPCS 80198
Hospital Charge Code	H3011218
Hospital Revenue Code	301
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$106.92
Rate for Payer: AlohaCare Medicaid	$54.00
Rate for Payer: AlohaCare Medicare	$97.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Devoted Health Medicare	$106.92
Rate for Payer: Hawaii Medical Service Association ABD	$19.56
Rate for Payer: Hawaii Medical Service Association Commercial	$17.68
Rate for Payer: Hawaii Medical Service Association Medicare	$97.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.54
Rate for Payer: Hawaii Western Management Group Commercial	$14.14
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Humana Medicare	$97.20
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: Kaiser Permanente Medicare	$97.20
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: Ohana Health Plan Medicaid	$97.20
Rate for Payer: Ohana Health Plan Medicare	$97.20
Rate for Payer: UnitedHealthcare Medicaid	$19.56
Rate for Payer: UnitedHealthcare Medicare	$97.20
Rate for Payer: University Health Alliance Commercial	$36.57

HCHG THIN SMEAR

Facility

$55.00

Service Code	HCPCS 87207
Hospital Charge Code	H3060670
Hospital Revenue Code	306
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$54.45
Rate for Payer: AlohaCare Medicaid	$27.50
Rate for Payer: AlohaCare Medicare	$49.50
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Devoted Health Medicare	$54.45
Rate for Payer: Hawaii Medical Service Association ABD	$8.37
Rate for Payer: Hawaii Medical Service Association Commercial	$7.49
Rate for Payer: Hawaii Medical Service Association Medicare	$49.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.79
Rate for Payer: Hawaii Western Management Group Commercial	$5.99
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Humana Medicare	$49.50
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: Kaiser Permanente Medicaid	$28.05
Rate for Payer: Kaiser Permanente Medicare	$49.50
Rate for Payer: MDX Hawaii PPO	$53.35
Rate for Payer: Ohana Health Plan Medicaid	$49.50
Rate for Payer: Ohana Health Plan Medicare	$49.50
Rate for Payer: UnitedHealthcare Medicaid	$8.37
Rate for Payer: UnitedHealthcare Medicare	$49.50
Rate for Payer: University Health Alliance Commercial	$15.48

HCHG THIN SMEAR

Facility

$55.00

Service Code	HCPCS 87207
Hospital Charge Code	H3060670
Hospital Revenue Code	306
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$35.75
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: MDX Hawaii PPO	$53.35

HCHG THORACIC/LUMB JCT 2 VIEWS

Facility

$493.00

Service Code	HCPCS 72080
Hospital Charge Code	H3200790
Hospital Revenue Code	320
Min. Negotiated Rate	$419.05
Max. Negotiated Rate	$478.21
Rate for Payer: Cash Price	$320.45
Rate for Payer: Health Management Network Commercial	$419.05
Rate for Payer: Kaiser Permanente Commercial	$443.70
Rate for Payer: MDX Hawaii PPO	$478.21

HCHG THORACIC/LUMB JCT 2 VIEWS

Facility

$493.00

Service Code	HCPCS 72080
Hospital Charge Code	H3200790
Hospital Revenue Code	320
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$488.07
Rate for Payer: AlohaCare Medicaid	$246.50
Rate for Payer: AlohaCare Medicare	$443.70
Rate for Payer: Cash Price	$320.45
Rate for Payer: Cash Price	$320.45
Rate for Payer: Devoted Health Medicare	$488.07
Rate for Payer: Hawaii Medical Service Association ABD	$21.96
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$443.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.13
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$419.05
Rate for Payer: Humana Medicare	$443.70
Rate for Payer: Kaiser Permanente Commercial	$443.70
Rate for Payer: Kaiser Permanente Medicaid	$251.43
Rate for Payer: Kaiser Permanente Medicare	$443.70
Rate for Payer: MDX Hawaii PPO	$478.21
Rate for Payer: Ohana Health Plan Medicaid	$443.70
Rate for Payer: Ohana Health Plan Medicare	$443.70
Rate for Payer: UnitedHealthcare Medicaid	$21.96
Rate for Payer: UnitedHealthcare Medicare	$443.70
Rate for Payer: University Health Alliance Commercial	$72.83

HCHG THROMB COAG TIME

Facility

$44.00

Service Code	HCPCS 85670
Hospital Charge Code	H3050256
Hospital Revenue Code	305
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$43.56
Rate for Payer: AlohaCare Medicaid	$22.00
Rate for Payer: AlohaCare Medicare	$39.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Devoted Health Medicare	$43.56
Rate for Payer: Hawaii Medical Service Association ABD	$7.98
Rate for Payer: Hawaii Medical Service Association Commercial	$7.21
Rate for Payer: Hawaii Medical Service Association Medicare	$39.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.38
Rate for Payer: Hawaii Western Management Group Commercial	$5.77
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Humana Medicare	$39.60
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: Kaiser Permanente Medicare	$39.60
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: Ohana Health Plan Medicaid	$39.60
Rate for Payer: Ohana Health Plan Medicare	$39.60
Rate for Payer: UnitedHealthcare Medicaid	$7.98
Rate for Payer: UnitedHealthcare Medicare	$39.60
Rate for Payer: University Health Alliance Commercial	$14.93

HCHG THROMB COAG TIME

Facility

$44.00

Service Code	HCPCS 85670
Hospital Charge Code	H3050256
Hospital Revenue Code	305
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$28.60
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: MDX Hawaii PPO	$42.68

HCHG THROMBOLYSIS CEREBRAL IV INF

Facility

$1,906.00

Service Code	HCPCS 37195
Hospital Charge Code	H4500818
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,886.94
Rate for Payer: AlohaCare Medicaid	$953.00
Rate for Payer: AlohaCare Medicare	$1,715.40
Rate for Payer: Cash Price	$1,238.90
Rate for Payer: Cash Price	$1,238.90
Rate for Payer: Devoted Health Medicare	$1,886.94
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	$1,715.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,810.70
Rate for Payer: Health Management Network Commercial	$1,620.10
Rate for Payer: Humana Medicare	$1,715.40
Rate for Payer: Kaiser Permanente Commercial	$1,715.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,715.40
Rate for Payer: MDX Hawaii PPO	$1,848.82
Rate for Payer: Ohana Health Plan Medicaid	$1,715.40
Rate for Payer: Ohana Health Plan Medicare	$1,715.40
Rate for Payer: UnitedHealthcare Medicare	$1,715.40
Rate for Payer: University Health Alliance Commercial	$1,389.28

HCHG THROMBOLYSIS CEREBRAL IV INF

Facility

$1,906.00

Service Code	HCPCS 37195
Hospital Charge Code	H4500818
Hospital Revenue Code	450
Min. Negotiated Rate	$1,620.10
Max. Negotiated Rate	$1,848.82
Rate for Payer: Cash Price	$1,238.90
Rate for Payer: Health Management Network Commercial	$1,620.10
Rate for Payer: Kaiser Permanente Commercial	$1,715.40
Rate for Payer: MDX Hawaii PPO	$1,848.82

HCHG THYROGLOBULIN

Facility

$121.00

Service Code	HCPCS 84432
Hospital Charge Code	H3011226
Hospital Revenue Code	301
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$78.65
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: MDX Hawaii PPO	$117.37

HCHG THYROGLOBULIN

Facility

$121.00

Service Code	HCPCS 84432
Hospital Charge Code	H3011226
Hospital Revenue Code	301
Min. Negotiated Rate	$16.06
Max. Negotiated Rate	$119.79
Rate for Payer: AlohaCare Medicaid	$60.50
Rate for Payer: AlohaCare Medicare	$108.90
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Devoted Health Medicare	$119.79
Rate for Payer: Hawaii Medical Service Association ABD	$22.20
Rate for Payer: Hawaii Medical Service Association Commercial	$20.07
Rate for Payer: Hawaii Medical Service Association Medicare	$108.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.31
Rate for Payer: Hawaii Western Management Group Commercial	$16.06
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Humana Medicare	$108.90
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: Kaiser Permanente Medicare	$108.90
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: Ohana Health Plan Medicaid	$108.90
Rate for Payer: Ohana Health Plan Medicare	$108.90
Rate for Payer: UnitedHealthcare Medicaid	$22.20
Rate for Payer: UnitedHealthcare Medicare	$108.90
Rate for Payer: University Health Alliance Commercial	$41.51

HCHG THYROID STIMULATING IG 90

Facility

$322.00

Service Code	HCPCS 84445
Hospital Charge Code	H3011228
Hospital Revenue Code	301
Min. Negotiated Rate	$32.92
Max. Negotiated Rate	$318.78
Rate for Payer: AlohaCare Medicaid	$161.00
Rate for Payer: AlohaCare Medicare	$289.80
Rate for Payer: Cash Price	$209.30
Rate for Payer: Cash Price	$209.30
Rate for Payer: Devoted Health Medicare	$318.78
Rate for Payer: Hawaii Medical Service Association ABD	$32.92
Rate for Payer: Hawaii Medical Service Association Commercial	$63.58
Rate for Payer: Hawaii Medical Service Association Medicare	$289.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$34.57
Rate for Payer: Hawaii Western Management Group Commercial	$50.86
Rate for Payer: Health Management Network Commercial	$273.70
Rate for Payer: Humana Medicare	$289.80
Rate for Payer: Kaiser Permanente Commercial	$289.80
Rate for Payer: Kaiser Permanente Medicaid	$164.22
Rate for Payer: Kaiser Permanente Medicare	$289.80
Rate for Payer: MDX Hawaii PPO	$312.34
Rate for Payer: Ohana Health Plan Medicaid	$289.80
Rate for Payer: Ohana Health Plan Medicare	$289.80
Rate for Payer: UnitedHealthcare Medicaid	$32.92
Rate for Payer: UnitedHealthcare Medicare	$289.80
Rate for Payer: University Health Alliance Commercial	$61.57

HCHG THYROID STIMULATING IG 90

Facility

$322.00

Service Code	HCPCS 84445
Hospital Charge Code	H3011228
Hospital Revenue Code	301
Min. Negotiated Rate	$273.70
Max. Negotiated Rate	$312.34
Rate for Payer: Cash Price	$209.30
Rate for Payer: Health Management Network Commercial	$273.70
Rate for Payer: Kaiser Permanente Commercial	$289.80
Rate for Payer: MDX Hawaii PPO	$312.34

HCHG THYROXINE BINDING GLOBULIN 90

Facility

$112.00

Service Code	HCPCS 84442
Hospital Charge Code	H3011230
Hospital Revenue Code	301
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$108.64
Rate for Payer: Cash Price	$72.80
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: MDX Hawaii PPO	$108.64

HCHG THYROXINE BINDING GLOBULIN 90

Facility

$112.00

Service Code	HCPCS 84442
Hospital Charge Code	H3011230
Hospital Revenue Code	301
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$110.88
Rate for Payer: AlohaCare Medicaid	$56.00
Rate for Payer: AlohaCare Medicare	$100.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Devoted Health Medicare	$110.88
Rate for Payer: Hawaii Medical Service Association ABD	$20.44
Rate for Payer: Hawaii Medical Service Association Commercial	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$100.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.46
Rate for Payer: Hawaii Western Management Group Commercial	$14.78
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Humana Medicare	$100.80
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$57.12
Rate for Payer: Kaiser Permanente Medicare	$100.80
Rate for Payer: MDX Hawaii PPO	$108.64
Rate for Payer: Ohana Health Plan Medicaid	$100.80
Rate for Payer: Ohana Health Plan Medicare	$100.80
Rate for Payer: UnitedHealthcare Medicaid	$20.44
Rate for Payer: UnitedHealthcare Medicare	$100.80
Rate for Payer: University Health Alliance Commercial	$38.22

HCHG THYROXINE FREE T4

Facility

$150.00

Service Code	HCPCS 84439
Hospital Charge Code	H3011232
Hospital Revenue Code	301
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

HCHG THYROXINE FREE T4

Facility

$150.00

Service Code	HCPCS 84439
Hospital Charge Code	H3011232
Hospital Revenue Code	301
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$148.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$135.00
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Devoted Health Medicare	$148.50
Rate for Payer: Hawaii Medical Service Association ABD	$12.46
Rate for Payer: Hawaii Medical Service Association Commercial	$11.28
Rate for Payer: Hawaii Medical Service Association Medicare	$135.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.08
Rate for Payer: Hawaii Western Management Group Commercial	$9.02
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$135.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$135.00
Rate for Payer: Ohana Health Plan Medicare	$135.00
Rate for Payer: UnitedHealthcare Medicaid	$12.46
Rate for Payer: UnitedHealthcare Medicare	$135.00
Rate for Payer: University Health Alliance Commercial	$23.31

HCHG TIB/FIB, 2 VIEWS

Facility

$556.00

Service Code	HCPCS 73590
Hospital Charge Code	H3200538
Hospital Revenue Code	320
Min. Negotiated Rate	$472.60
Max. Negotiated Rate	$539.32
Rate for Payer: Cash Price	$361.40
Rate for Payer: Health Management Network Commercial	$472.60
Rate for Payer: Kaiser Permanente Commercial	$500.40
Rate for Payer: MDX Hawaii PPO	$539.32

Know your out-of-pocket cost for care.

All Charges