Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG SUTURE SIMP-SCALP+-20.1-30.0

Facility

$2,246.00

Service Code	HCPCS 12006
Hospital Charge Code	H4500798
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 SUTURE SIMP-SCALP+-20.1-30.0

Facility

$2,246.00

Service Code	HCPCS 12006
Hospital Charge Code	H4500798
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 SUTURE SIMP-SCALP+-2.5 OR LESS

Facility

$1,233.00

Service Code	HCPCS 12001
Hospital Charge Code	H4500794
Hospital Revenue Code	450
Min. Negotiated Rate	$1,048.05
Max. Negotiated Rate	$1,196.01
Rate for Payer: Cash Price	$801.45
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: MDX Hawaii PPO	$1,196.01

HCHG SUTURE SIMP-SCALP+-2.5 OR LESS

Facility

$1,233.00

Service Code	HCPCS 12001
Hospital Charge Code	H4500794
Hospital Revenue Code	450
Min. Negotiated Rate	$237.02
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Devoted Health Medicare	$260.72
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	$237.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.35
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Commercial	$776.79
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$898.73

HCHG SUTURE SIMP-SCALP+-2.6-7.5

Facility

$1,233.00

Service Code	HCPCS 12002
Hospital Charge Code	H4500796
Hospital Revenue Code	450
Min. Negotiated Rate	$237.02
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Devoted Health Medicare	$260.72
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	$237.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.35
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Commercial	$776.79
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$898.73

HCHG SUTURE SIMP-SCALP+-2.6-7.5

Facility

$1,233.00

Service Code	HCPCS 12002
Hospital Charge Code	H4500796
Hospital Revenue Code	450
Min. Negotiated Rate	$1,048.05
Max. Negotiated Rate	$1,196.01
Rate for Payer: Cash Price	$801.45
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: MDX Hawaii PPO	$1,196.01

HCHG SUTURE SIMP-SCALP+-7.6-12.5

Facility

$1,233.00

Service Code	HCPCS 12004
Hospital Charge Code	H4500800
Hospital Revenue Code	450
Min. Negotiated Rate	$237.02
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Devoted Health Medicare	$260.72
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	$237.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.35
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Commercial	$776.79
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$898.73

HCHG SUTURE SIMP-SCALP+-7.6-12.5

Facility

$1,233.00

Service Code	HCPCS 12004
Hospital Charge Code	H4500800
Hospital Revenue Code	450
Min. Negotiated Rate	$1,048.05
Max. Negotiated Rate	$1,196.01
Rate for Payer: Cash Price	$801.45
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: MDX Hawaii PPO	$1,196.01

HCHG SUTURE SIMP-SCALP+-OVER 30.0

Facility

$1,233.00

Service Code	HCPCS 12007
Hospital Charge Code	H4500802
Hospital Revenue Code	450
Min. Negotiated Rate	$237.02
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Cash Price	$801.45
Rate for Payer: Devoted Health Medicare	$260.72
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	$237.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.35
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Commercial	$776.79
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$898.73

HCHG SUTURE SIMP-SCALP+-OVER 30.0

Facility

$1,233.00

Service Code	HCPCS 12007
Hospital Charge Code	H4500802
Hospital Revenue Code	450
Min. Negotiated Rate	$1,048.05
Max. Negotiated Rate	$1,196.01
Rate for Payer: Cash Price	$801.45
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: MDX Hawaii PPO	$1,196.01

HCHG SUTURE WND EYELID FULL THICK

Facility

$9,829.00

Service Code	HCPCS 67935
Hospital Charge Code	H4500804
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 SUTURE WND EYELID FULL THICK

Facility

$9,829.00

Service Code	HCPCS 67935
Hospital Charge Code	H4500804
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 SVN SUB TX

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100273
Hospital Revenue Code	410
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Devoted Health Medicare	$284.56
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	$258.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,292.95
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$857.43
Rate for Payer: Kaiser Permanente Medicaid	$694.11
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$1,320.17
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$13.32
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$992.03

HCHG SVN SUB TX

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100273
Hospital Revenue Code	410
Min. Negotiated Rate	$1,156.85
Max. Negotiated Rate	$1,320.17
Rate for Payer: Cash Price	$884.65
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: MDX Hawaii PPO	$1,320.17

HCHG SVN TX, DAILY

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100272
Hospital Revenue Code	410
Min. Negotiated Rate	$1,156.85
Max. Negotiated Rate	$1,320.17
Rate for Payer: Cash Price	$884.65
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: MDX Hawaii PPO	$1,320.17

HCHG SVN TX, DAILY

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100272
Hospital Revenue Code	410
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Devoted Health Medicare	$284.56
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	$258.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,292.95
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$857.43
Rate for Payer: Kaiser Permanente Medicaid	$694.11
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$1,320.17
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$13.32
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$992.03

HCHG SVN W PEAK FLOW, DAILY

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100276
Hospital Revenue Code	410
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Devoted Health Medicare	$284.56
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	$258.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,292.95
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$857.43
Rate for Payer: Kaiser Permanente Medicaid	$694.11
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$1,320.17
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$13.32
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$992.03

HCHG SVN W PEAK FLOW, DAILY

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100276
Hospital Revenue Code	410
Min. Negotiated Rate	$1,156.85
Max. Negotiated Rate	$1,320.17
Rate for Payer: Cash Price	$884.65
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: MDX Hawaii PPO	$1,320.17

HCHG SVN W PEAK FLOW SUBSEQUENT

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100279
Hospital Revenue Code	410
Min. Negotiated Rate	$1,156.85
Max. Negotiated Rate	$1,320.17
Rate for Payer: Cash Price	$884.65
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: MDX Hawaii PPO	$1,320.17

HCHG SVN W PEAK FLOW SUBSEQUENT

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100279
Hospital Revenue Code	410
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Devoted Health Medicare	$284.56
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	$258.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,292.95
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$857.43
Rate for Payer: Kaiser Permanente Medicaid	$694.11
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$1,320.17
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$13.32
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$992.03

HCHG SYPHILIS TEST NON-TREP RPR, REFLEX TO TITER, QUAL

Facility

$59.00

Service Code	HCPCS 86592
Hospital Charge Code	H3020756
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$57.23
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cash Price	$38.35
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$37.17
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$11.03

HCHG SYPHILIS TEST NON-TREP RPR, REFLEX TO TITER, QUAL

Facility

$59.00

Service Code	HCPCS 86592
Hospital Charge Code	H3020756
Hospital Revenue Code	302
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$38.35
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: MDX Hawaii PPO	$57.23

HCHG SYPHILIS TEST NON-TREP RPR TITER, QUANT

Facility

$34.00

Service Code	HCPCS 86593
Hospital Charge Code	H3020995
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$32.98
Rate for Payer: AlohaCare Medicaid	$4.40
Rate for Payer: AlohaCare Medicare	$4.40
Rate for Payer: Cash Price	$22.10
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$4.84
Rate for Payer: Hawaii Medical Service Association ABD	$6.09
Rate for Payer: Hawaii Medical Service Association Commercial	$5.50
Rate for Payer: Hawaii Medical Service Association Medicare	$4.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.39
Rate for Payer: Hawaii Western Management Group Commercial	$4.40
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$4.40
Rate for Payer: Kaiser Permanente Commercial	$21.42
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$4.40
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$4.84
Rate for Payer: Ohana Health Plan Medicare	$4.40
Rate for Payer: UnitedHealthcare Medicaid	$6.09
Rate for Payer: UnitedHealthcare Medicare	$4.40
Rate for Payer: University Health Alliance Commercial	$11.40

HCHG SYPHILIS TEST NON-TREP RPR TITER, QUANT

Facility

$34.00

Service Code	HCPCS 86593
Hospital Charge Code	H3020995
Hospital Revenue Code	302
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$22.10
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: MDX Hawaii PPO	$32.98

HCHG T3 FREE

Facility

$209.00

Service Code	HCPCS 84481
Hospital Charge Code	H3011192
Hospital Revenue Code	301
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$135.85
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: MDX Hawaii PPO	$202.73

Know your out-of-pocket cost for care.

All Charges