Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG HERPES SIMPLEX TYPE 2 AB, IGG

Facility

$142.00

Service Code	HCPCS 86696
Hospital Charge Code	H3020920
Hospital Revenue Code	302
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

HCHG HERPES VIRUS 6 PANEL 90

Facility

$99.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020564
Hospital Revenue Code	302
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$64.35
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: MDX Hawaii PPO	$96.03

HCHG HERPES VIRUS 6 PANEL 90

Facility

$99.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020562
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$98.01
Rate for Payer: AlohaCare Medicaid	$49.50
Rate for Payer: AlohaCare Medicare	$89.10
Rate for Payer: Cash Price	$64.35
Rate for Payer: Cash Price	$64.35
Rate for Payer: Devoted Health Medicare	$98.01
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$89.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Humana Medicare	$89.10
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: Kaiser Permanente Medicare	$89.10
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: Ohana Health Plan Medicaid	$89.10
Rate for Payer: Ohana Health Plan Medicare	$89.10
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$89.10
Rate for Payer: University Health Alliance Commercial	$33.30

HCHG HERPES VIRUS 6 PANEL 90

Facility

$99.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020562
Hospital Revenue Code	302
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$64.35
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: MDX Hawaii PPO	$96.03

HCHG HERPES VIRUS 6 PANEL 90

Facility

$99.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020564
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$98.01
Rate for Payer: AlohaCare Medicaid	$49.50
Rate for Payer: AlohaCare Medicare	$89.10
Rate for Payer: Cash Price	$64.35
Rate for Payer: Cash Price	$64.35
Rate for Payer: Devoted Health Medicare	$98.01
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$89.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Humana Medicare	$89.10
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: Kaiser Permanente Medicare	$89.10
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: Ohana Health Plan Medicaid	$89.10
Rate for Payer: Ohana Health Plan Medicare	$89.10
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$89.10
Rate for Payer: University Health Alliance Commercial	$33.30

HCHG HHV-6 DNA AMP PROBE - 90

Facility

$238.00

Service Code	HCPCS 87532
Hospital Charge Code	H3060796
Hospital Revenue Code	306
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$235.62
Rate for Payer: AlohaCare Medicaid	$119.00
Rate for Payer: AlohaCare Medicare	$214.20
Rate for Payer: Cash Price	$154.70
Rate for Payer: Cash Price	$154.70
Rate for Payer: Devoted Health Medicare	$235.62
Rate for Payer: Hawaii Medical Service Association ABD	$29.42
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$214.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$214.20
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$214.20
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$214.20
Rate for Payer: Ohana Health Plan Medicare	$214.20
Rate for Payer: UnitedHealthcare Medicaid	$29.42
Rate for Payer: UnitedHealthcare Medicare	$214.20
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG HHV-6 DNA AMP PROBE - 90

Facility

$238.00

Service Code	HCPCS 87532
Hospital Charge Code	H3060796
Hospital Revenue Code	306
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$154.70
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: MDX Hawaii PPO	$230.86

HCHG HIPS BILAT W/ OR W/O PELVIS 2 VIEWS

Facility

$726.00

Service Code	HCPCS 73521
Hospital Charge Code	H3200989
Hospital Revenue Code	320
Min. Negotiated Rate	$19.61
Max. Negotiated Rate	$718.74
Rate for Payer: AlohaCare Medicaid	$363.00
Rate for Payer: AlohaCare Medicare	$653.40
Rate for Payer: Cash Price	$471.90
Rate for Payer: Cash Price	$471.90
Rate for Payer: Devoted Health Medicare	$718.74
Rate for Payer: Hawaii Medical Service Association ABD	$19.61
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$653.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.81
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$617.10
Rate for Payer: Humana Medicare	$653.40
Rate for Payer: Kaiser Permanente Commercial	$653.40
Rate for Payer: Kaiser Permanente Medicaid	$370.26
Rate for Payer: Kaiser Permanente Medicare	$653.40
Rate for Payer: MDX Hawaii PPO	$704.22
Rate for Payer: Ohana Health Plan Medicaid	$653.40
Rate for Payer: Ohana Health Plan Medicare	$653.40
Rate for Payer: UnitedHealthcare Medicaid	$27.57
Rate for Payer: UnitedHealthcare Medicare	$653.40
Rate for Payer: University Health Alliance Commercial	$82.40

HCHG HIPS BILAT W/ OR W/O PELVIS 2 VIEWS

Facility

$726.00

Service Code	HCPCS 73521
Hospital Charge Code	H3200989
Hospital Revenue Code	320
Min. Negotiated Rate	$617.10
Max. Negotiated Rate	$704.22
Rate for Payer: Cash Price	$471.90
Rate for Payer: Health Management Network Commercial	$617.10
Rate for Payer: Kaiser Permanente Commercial	$653.40
Rate for Payer: MDX Hawaii PPO	$704.22

HCHG HIPS BILAT W/ OR W/O PELVIS 3-4 VIEWS

Facility

$726.00

Service Code	HCPCS 73522
Hospital Charge Code	H3200990
Hospital Revenue Code	320
Min. Negotiated Rate	$617.10
Max. Negotiated Rate	$704.22
Rate for Payer: Cash Price	$471.90
Rate for Payer: Health Management Network Commercial	$617.10
Rate for Payer: Kaiser Permanente Commercial	$653.40
Rate for Payer: MDX Hawaii PPO	$704.22

HCHG HIPS BILAT W/ OR W/O PELVIS 3-4 VIEWS

Facility

$726.00

Service Code	HCPCS 73522
Hospital Charge Code	H3200990
Hospital Revenue Code	320
Min. Negotiated Rate	$23.36
Max. Negotiated Rate	$718.74
Rate for Payer: AlohaCare Medicaid	$363.00
Rate for Payer: AlohaCare Medicare	$653.40
Rate for Payer: Cash Price	$471.90
Rate for Payer: Cash Price	$471.90
Rate for Payer: Devoted Health Medicare	$718.74
Rate for Payer: Hawaii Medical Service Association ABD	$23.36
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$653.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.91
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$617.10
Rate for Payer: Humana Medicare	$653.40
Rate for Payer: Kaiser Permanente Commercial	$653.40
Rate for Payer: Kaiser Permanente Medicaid	$370.26
Rate for Payer: Kaiser Permanente Medicare	$653.40
Rate for Payer: MDX Hawaii PPO	$704.22
Rate for Payer: Ohana Health Plan Medicaid	$653.40
Rate for Payer: Ohana Health Plan Medicare	$653.40
Rate for Payer: UnitedHealthcare Medicaid	$36.08
Rate for Payer: UnitedHealthcare Medicare	$653.40
Rate for Payer: University Health Alliance Commercial	$101.31

HCHG HIP UNILAT W/ OR W/O PELVIS 1 VIEW

Facility

$493.00

Service Code	HCPCS 73501
Hospital Charge Code	H3200986
Hospital Revenue Code	320
Min. Negotiated Rate	$14.12
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	$14.12
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	$19.28
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	$21.95
Rate for Payer: UnitedHealthcare Medicare	$443.70
Rate for Payer: University Health Alliance Commercial	$61.27

HCHG HIP UNILAT W/ OR W/O PELVIS 1 VIEW

Facility

$493.00

Service Code	HCPCS 73501
Hospital Charge Code	H3200986
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 HIP UNILAT W/ OR W/O PELVIS 2-3 VIEWS

Facility

$523.00

Service Code	HCPCS 73502
Hospital Charge Code	H3200987
Hospital Revenue Code	320
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$517.77
Rate for Payer: AlohaCare Medicaid	$261.50
Rate for Payer: AlohaCare Medicare	$470.70
Rate for Payer: Cash Price	$339.95
Rate for Payer: Cash Price	$339.95
Rate for Payer: Devoted Health Medicare	$517.77
Rate for Payer: Hawaii Medical Service Association ABD	$20.87
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$470.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.52
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Humana Medicare	$470.70
Rate for Payer: Kaiser Permanente Commercial	$470.70
Rate for Payer: Kaiser Permanente Medicaid	$266.73
Rate for Payer: Kaiser Permanente Medicare	$470.70
Rate for Payer: MDX Hawaii PPO	$507.31
Rate for Payer: Ohana Health Plan Medicaid	$470.70
Rate for Payer: Ohana Health Plan Medicare	$470.70
Rate for Payer: UnitedHealthcare Medicaid	$31.93
Rate for Payer: UnitedHealthcare Medicare	$470.70
Rate for Payer: University Health Alliance Commercial	$86.21

HCHG HIP UNILAT W/ OR W/O PELVIS 2-3 VIEWS

Facility

$523.00

Service Code	HCPCS 73502
Hospital Charge Code	H3200987
Hospital Revenue Code	320
Min. Negotiated Rate	$444.55
Max. Negotiated Rate	$507.31
Rate for Payer: Cash Price	$339.95
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Kaiser Permanente Commercial	$470.70
Rate for Payer: MDX Hawaii PPO	$507.31

HCHG HISTOPLASMA AB EA AB

Facility

$105.00

Service Code	HCPCS 86698
Hospital Charge Code	H3020568
Hospital Revenue Code	302
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$68.25
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85

HCHG HISTOPLASMA AB EA AB

Facility

$105.00

Service Code	HCPCS 86698
Hospital Charge Code	H3020566
Hospital Revenue Code	302
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$103.95
Rate for Payer: AlohaCare Medicaid	$52.50
Rate for Payer: AlohaCare Medicare	$94.50
Rate for Payer: Cash Price	$68.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Devoted Health Medicare	$103.95
Rate for Payer: Hawaii Medical Service Association ABD	$10.48
Rate for Payer: Hawaii Medical Service Association Commercial	$17.24
Rate for Payer: Hawaii Medical Service Association Medicare	$94.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.26
Rate for Payer: Hawaii Western Management Group Commercial	$13.79
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Humana Medicare	$94.50
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: Kaiser Permanente Medicare	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: Ohana Health Plan Medicaid	$94.50
Rate for Payer: Ohana Health Plan Medicare	$94.50
Rate for Payer: UnitedHealthcare Medicaid	$10.48
Rate for Payer: UnitedHealthcare Medicare	$94.50
Rate for Payer: University Health Alliance Commercial	$32.30

HCHG HISTOPLASMA AB EA AB

Facility

$105.00

Service Code	HCPCS 86698
Hospital Charge Code	H3020568
Hospital Revenue Code	302
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$103.95
Rate for Payer: AlohaCare Medicaid	$52.50
Rate for Payer: AlohaCare Medicare	$94.50
Rate for Payer: Cash Price	$68.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Devoted Health Medicare	$103.95
Rate for Payer: Hawaii Medical Service Association ABD	$10.48
Rate for Payer: Hawaii Medical Service Association Commercial	$17.24
Rate for Payer: Hawaii Medical Service Association Medicare	$94.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.26
Rate for Payer: Hawaii Western Management Group Commercial	$13.79
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Humana Medicare	$94.50
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: Kaiser Permanente Medicare	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: Ohana Health Plan Medicaid	$94.50
Rate for Payer: Ohana Health Plan Medicare	$94.50
Rate for Payer: UnitedHealthcare Medicaid	$10.48
Rate for Payer: UnitedHealthcare Medicare	$94.50
Rate for Payer: University Health Alliance Commercial	$32.30

HCHG HISTOPLASMA AB EA AB

Facility

$105.00

Service Code	HCPCS 86698
Hospital Charge Code	H3020566
Hospital Revenue Code	302
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$68.25
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85

HCHG HISTOPLASMA GALACTOMANNAN AG, URINE - 90

Facility

$208.00

Service Code	HCPCS 87385
Hospital Charge Code	H3021019
Hospital Revenue Code	302
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$135.20
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

HCHG HISTOPLASMA GALACTOMANNAN AG, URINE - 90

Facility

$208.00

Service Code	HCPCS 87385
Hospital Charge Code	H3021019
Hospital Revenue Code	302
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$205.92
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: AlohaCare Medicare	$187.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Devoted Health Medicare	$205.92
Rate for Payer: Hawaii Medical Service Association ABD	$10.06
Rate for Payer: Hawaii Medical Service Association Commercial	$16.56
Rate for Payer: Hawaii Medical Service Association Medicare	$187.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.57
Rate for Payer: Hawaii Western Management Group Commercial	$13.25
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$187.20
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$187.20
Rate for Payer: Ohana Health Plan Medicare	$187.20
Rate for Payer: UnitedHealthcare Medicaid	$10.06
Rate for Payer: UnitedHealthcare Medicare	$187.20
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG HIV 1/2 AB RAPID, REFLEX

Facility

$96.00

Service Code	HCPCS 86703
Hospital Charge Code	H3020923
Hospital Revenue Code	302
Min. Negotiated Rate	$13.71
Max. Negotiated Rate	$95.04
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$86.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Devoted Health Medicare	$95.04
Rate for Payer: Hawaii Medical Service Association ABD	$18.96
Rate for Payer: Hawaii Medical Service Association Commercial	$17.14
Rate for Payer: Hawaii Medical Service Association Medicare	$86.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.91
Rate for Payer: Hawaii Western Management Group Commercial	$13.71
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$86.40
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$86.40
Rate for Payer: Ohana Health Plan Medicare	$86.40
Rate for Payer: UnitedHealthcare Medicaid	$18.96
Rate for Payer: UnitedHealthcare Medicare	$86.40
Rate for Payer: University Health Alliance Commercial	$35.46

HCHG HIV 1/2 AB RAPID, REFLEX

Facility

$96.00

Service Code	HCPCS 86703
Hospital Charge Code	H3020923
Hospital Revenue Code	302
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

HCHG HIV-1/2 AG/AB WITH REFLEX - 90

Facility

$173.00

Service Code	HCPCS 87390
Hospital Charge Code	H3021052
Hospital Revenue Code	302
Min. Negotiated Rate	$20.92
Max. Negotiated Rate	$171.27
Rate for Payer: AlohaCare Medicaid	$86.50
Rate for Payer: AlohaCare Medicare	$155.70
Rate for Payer: Cash Price	$112.45
Rate for Payer: Cash Price	$112.45
Rate for Payer: Devoted Health Medicare	$171.27
Rate for Payer: Hawaii Medical Service Association ABD	$20.92
Rate for Payer: Hawaii Medical Service Association Commercial	$30.07
Rate for Payer: Hawaii Medical Service Association Medicare	$155.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.97
Rate for Payer: Hawaii Western Management Group Commercial	$24.06
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Humana Medicare	$155.70
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: Kaiser Permanente Medicaid	$88.23
Rate for Payer: Kaiser Permanente Medicare	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81
Rate for Payer: Ohana Health Plan Medicaid	$155.70
Rate for Payer: Ohana Health Plan Medicare	$155.70
Rate for Payer: UnitedHealthcare Medicaid	$20.92
Rate for Payer: UnitedHealthcare Medicare	$155.70
Rate for Payer: University Health Alliance Commercial	$39.13

HCHG HIV-1/2 AG/AB WITH REFLEX - 90

Facility

$173.00

Service Code	HCPCS 87390
Hospital Charge Code	H3021052
Hospital Revenue Code	302
Min. Negotiated Rate	$147.05
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$112.45
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81

Know your out-of-pocket cost for care.

All Charges