Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME

Facility

$122.00

Service Code	HCPCS 82164
Hospital Charge Code	3018216401
Hospital Revenue Code	301
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$73.20
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: MDX Hawaii PPO	$118.34

HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME

Facility

$122.00

Service Code	HCPCS 82164
Hospital Charge Code	3018216401
Hospital Revenue Code	301
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$14.60
Rate for Payer: AlohaCare Medicare	$14.60
Rate for Payer: Cash Price	$73.20
Rate for Payer: Cash Price	$73.20
Rate for Payer: Devoted Health Medicare	$16.06
Rate for Payer: Hawaii Medical Service Association ABD	$20.17
Rate for Payer: Hawaii Medical Service Association Commercial	$18.25
Rate for Payer: Hawaii Medical Service Association Medicare	$14.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.18
Rate for Payer: Hawaii Western Management Group Commercial	$14.60
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$14.60
Rate for Payer: Kaiser Permanente Commercial	$76.86
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$14.60
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$16.06
Rate for Payer: Ohana Health Plan Medicare	$14.60
Rate for Payer: UnitedHealthcare Medicaid	$20.17
Rate for Payer: UnitedHealthcare Medicare	$14.60
Rate for Payer: University Health Alliance Commercial	$37.72

HC ANGIO VISCERAL SELECTV/SUBSELEC - IR ANGIO VISCERAL SELECTIVE

Facility

$26,891.00

Service Code	HCPCS 75726
Hospital Charge Code	3237572601
Hospital Revenue Code	323
Min. Negotiated Rate	$414.83
Max. Negotiated Rate	$26,084.27
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Cash Price	$16,134.60
Rate for Payer: Cash Price	$16,134.60
Rate for Payer: Cash Price	$16,134.60
Rate for Payer: Devoted Health Medicare	$7,230.94
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Hawaii Western Management Group Commercial	$6,573.58
Rate for Payer: Health Management Network Commercial	$22,857.35
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Commercial	$16,941.33
Rate for Payer: Kaiser Permanente Medicaid	$13,714.41
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: MDX Hawaii PPO	$26,084.27
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$414.83
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$776.89

HC ANGIO VISCERAL SELECTV/SUBSELEC - IR ANGIO VISCERAL SELECTIVE

Facility

$26,891.00

Service Code	HCPCS 75726
Hospital Charge Code	3237572601
Hospital Revenue Code	323
Min. Negotiated Rate	$22,857.35
Max. Negotiated Rate	$26,084.27
Rate for Payer: Cash Price	$16,134.60
Rate for Payer: Health Management Network Commercial	$22,857.35
Rate for Payer: MDX Hawaii PPO	$26,084.27

HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD

Facility

$513.00

Service Code	HCPCS 46600
Hospital Charge Code	7614660001
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD

Facility

$513.00

Service Code	HCPCS 46600
Hospital Charge Code	7614660001
Hospital Revenue Code	450
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS

Facility

$3,553.00

Service Code	HCPCS 46608
Hospital Charge Code	7504660801
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$3,446.41
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Cash Price	$2,131.80
Rate for Payer: Cash Price	$2,131.80
Rate for Payer: Cash Price	$2,131.80
Rate for Payer: Devoted Health Medicare	$1,208.46
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,375.35
Rate for Payer: Health Management Network Commercial	$3,020.05
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Commercial	$2,238.39
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: MDX Hawaii PPO	$3,446.41
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,098.60
Rate for Payer: University Health Alliance Commercial	$2,589.78

HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS

Facility

$3,553.00

Service Code	HCPCS 46608
Hospital Charge Code	7504660801
Hospital Revenue Code	450
Min. Negotiated Rate	$3,020.05
Max. Negotiated Rate	$3,446.41
Rate for Payer: Cash Price	$2,131.80
Rate for Payer: Health Management Network Commercial	$3,020.05
Rate for Payer: MDX Hawaii PPO	$3,446.41

HC AN SPINAL BLOCK CHARGE

Facility

$559.00

Hospital Charge Code	3700000016
Hospital Revenue Code	370
Min. Negotiated Rate	$285.09
Max. Negotiated Rate	$542.23
Rate for Payer: Cash Price	$335.40
Rate for Payer: Hawaii Western Management Group Commercial	$531.05
Rate for Payer: Health Management Network Commercial	$475.15
Rate for Payer: Kaiser Permanente Commercial	$352.17
Rate for Payer: Kaiser Permanente Medicaid	$285.09
Rate for Payer: MDX Hawaii PPO	$542.23
Rate for Payer: University Health Alliance Commercial	$407.46

HC AN SPINAL BLOCK CHARGE

Facility

$559.00

Hospital Charge Code	3700000016
Hospital Revenue Code	370
Min. Negotiated Rate	$475.15
Max. Negotiated Rate	$542.23
Rate for Payer: Cash Price	$335.40
Rate for Payer: Health Management Network Commercial	$475.15
Rate for Payer: MDX Hawaii PPO	$542.23

HC ANTIBIOTIC SENS,DISK,EACH - Susceptibility Charge

Facility

$63.00

Service Code	HCPCS 87184
Hospital Charge Code	3068718401
Hospital Revenue Code	306
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$61.11
Rate for Payer: AlohaCare Medicaid	$7.48
Rate for Payer: AlohaCare Medicare	$7.48
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Devoted Health Medicare	$8.23
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	$7.48
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	$53.55
Rate for Payer: Humana Medicare	$7.48
Rate for Payer: Kaiser Permanente Commercial	$39.69
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicare	$7.48
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$8.23
Rate for Payer: Ohana Health Plan Medicare	$7.48
Rate for Payer: UnitedHealthcare Medicaid	$9.53
Rate for Payer: UnitedHealthcare Medicare	$7.48
Rate for Payer: University Health Alliance Commercial	$17.82

HC ANTIBIOTIC SENS,DISK,EACH - Susceptibility Charge

Facility

$63.00

Service Code	HCPCS 87184
Hospital Charge Code	3068718401
Hospital Revenue Code	306
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: MDX Hawaii PPO	$61.11

HC ANTIBIOTIC SENS,MIC,EACH - AFB SUSC MIC SO

Facility

$73.00

Service Code	HCPCS 87186
Hospital Charge Code	3068718603
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$43.80
Rate for Payer: Cash Price	$43.80
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$45.99
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HC ANTIBIOTIC SENS,MIC,EACH - AFB SUSC MIC SO

Facility

$73.00

Service Code	HCPCS 87186
Hospital Charge Code	3068718603
Hospital Revenue Code	306
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: MDX Hawaii PPO	$70.81

HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE

Facility

$73.00

Service Code	HCPCS 87186
Hospital Charge Code	3068718604
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$43.80
Rate for Payer: Cash Price	$43.80
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$45.99
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE

Facility

$73.00

Service Code	HCPCS 87186
Hospital Charge Code	3068718604
Hospital Revenue Code	306
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: MDX Hawaii PPO	$70.81

HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE SO

Facility

$73.00

Service Code	HCPCS 87186
Hospital Charge Code	3068718601
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$43.80
Rate for Payer: Cash Price	$43.80
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$45.99
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE SO

Facility

$73.00

Service Code	HCPCS 87186
Hospital Charge Code	3068718601
Hospital Revenue Code	306
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: MDX Hawaii PPO	$70.81

HC ANTIBIOTIC SENS,MIC,EACH - SUSCEPTIBILITY MIC MOLD SO

Facility

$73.00

Service Code	HCPCS 87186
Hospital Charge Code	3068718602
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$43.80
Rate for Payer: Cash Price	$43.80
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$45.99
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HC ANTIBIOTIC SENS,MIC,EACH - SUSCEPTIBILITY MIC MOLD SO

Facility

$73.00

Service Code	HCPCS 87186
Hospital Charge Code	3068718602
Hospital Revenue Code	306
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: MDX Hawaii PPO	$70.81

HC ANTIBODY TREPONEMA PALLIDUM -FTA AB SO

Facility

$111.00

Service Code	HCPCS 86780
Hospital Charge Code	3028678001
Hospital Revenue Code	302
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$107.67
Rate for Payer: AlohaCare Medicaid	$13.24
Rate for Payer: AlohaCare Medicare	$13.24
Rate for Payer: Cash Price	$66.60
Rate for Payer: Cash Price	$66.60
Rate for Payer: Devoted Health Medicare	$14.56
Rate for Payer: Hawaii Medical Service Association ABD	$18.97
Rate for Payer: Hawaii Medical Service Association Commercial	$16.55
Rate for Payer: Hawaii Medical Service Association Medicare	$13.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.22
Rate for Payer: Hawaii Western Management Group Commercial	$13.24
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Humana Medicare	$13.24
Rate for Payer: Kaiser Permanente Commercial	$69.93
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: Kaiser Permanente Medicare	$13.24
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: Ohana Health Plan Medicaid	$14.56
Rate for Payer: Ohana Health Plan Medicare	$13.24
Rate for Payer: UnitedHealthcare Medicaid	$18.97
Rate for Payer: UnitedHealthcare Medicare	$13.24
Rate for Payer: University Health Alliance Commercial	$35.09

HC ANTIBODY TREPONEMA PALLIDUM -FTA AB SO

Facility

$111.00

Service Code	HCPCS 86780
Hospital Charge Code	3028678001
Hospital Revenue Code	302
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: MDX Hawaii PPO	$107.67

HC ANTIHUMAN GLOBULIN DIR EA ANTISERUM - COOMBS DIRECT

Facility

$589.00

Service Code	HCPCS 86880
Hospital Charge Code	3028688002
Hospital Revenue Code	302
Min. Negotiated Rate	$500.65
Max. Negotiated Rate	$571.33
Rate for Payer: Cash Price	$353.40
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: MDX Hawaii PPO	$571.33

HC ANTIHUMAN GLOBULIN DIR EA ANTISERUM - COOMBS DIRECT

Facility

$589.00

Service Code	HCPCS 86880
Hospital Charge Code	3028688002
Hospital Revenue Code	302
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$571.33
Rate for Payer: AlohaCare Medicaid	$5.39
Rate for Payer: AlohaCare Medicare	$5.39
Rate for Payer: Cash Price	$353.40
Rate for Payer: Cash Price	$353.40
Rate for Payer: Devoted Health Medicare	$5.93
Rate for Payer: Hawaii Medical Service Association ABD	$7.42
Rate for Payer: Hawaii Medical Service Association Commercial	$6.74
Rate for Payer: Hawaii Medical Service Association Medicare	$5.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.79
Rate for Payer: Hawaii Western Management Group Commercial	$5.39
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: Humana Medicare	$5.39
Rate for Payer: Kaiser Permanente Commercial	$371.07
Rate for Payer: Kaiser Permanente Medicaid	$300.39
Rate for Payer: Kaiser Permanente Medicare	$5.39
Rate for Payer: MDX Hawaii PPO	$571.33
Rate for Payer: Ohana Health Plan Medicaid	$5.93
Rate for Payer: Ohana Health Plan Medicare	$5.39
Rate for Payer: UnitedHealthcare Medicaid	$7.42
Rate for Payer: UnitedHealthcare Medicare	$5.39
Rate for Payer: University Health Alliance Commercial	$13.88

HC ANTIHUMAN GLOBULIN DIR EA ANTISERUM - COOMBS DIRECT SO

Facility

$589.00

Service Code	HCPCS 86880
Hospital Charge Code	3008688001
Hospital Revenue Code	300
Min. Negotiated Rate	$500.65
Max. Negotiated Rate	$571.33
Rate for Payer: Cash Price	$353.40
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: MDX Hawaii PPO	$571.33

Know your out-of-pocket cost for care.

All Charges