Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC ARTHROGRAM OF KNEE JOINT - XR KNEE ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73580
Hospital Charge Code	3227358002
Hospital Revenue Code	322
Min. Negotiated Rate	$86.14
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$86.14
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$93.99
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$86.14
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$257.26

HC ARTHROGRAM OF KNEE JOINT - XR KNEE ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73580
Hospital Charge Code	3227358002
Hospital Revenue Code	322
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73040
Hospital Charge Code	3227304001
Hospital Revenue Code	322
Min. Negotiated Rate	$69.25
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$69.25
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.32
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$69.25
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$222.87

HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73040
Hospital Charge Code	3227304001
Hospital Revenue Code	322
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC ARTHROGRAM OF WRIST - XR WRIST ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73115
Hospital Charge Code	3227311501
Hospital Revenue Code	322
Min. Negotiated Rate	$52.22
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$52.22
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$56.72
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$52.22
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$203.43

HC ARTHROGRAM OF WRIST - XR WRIST ARTHROGRAM

Facility

$1,776.00

Service Code	HCPCS 73115
Hospital Charge Code	3227311501
Hospital Revenue Code	322
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS

Facility

$21,065.00

Service Code	HCPCS 36819
Hospital Charge Code	3613681901
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$20,433.05
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Devoted Health Medicare	$7,230.94
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$17,905.25
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Commercial	$13,270.95
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: MDX Hawaii PPO	$20,433.05
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	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS

Facility

$21,065.00

Service Code	HCPCS 36819
Hospital Charge Code	3613681901
Hospital Revenue Code	361
Min. Negotiated Rate	$17,905.25
Max. Negotiated Rate	$20,433.05
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Health Management Network Commercial	$17,905.25
Rate for Payer: MDX Hawaii PPO	$20,433.05

HC ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS

Facility

$21,065.00

Service Code	HCPCS 36818
Hospital Charge Code	3613681801
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$20,433.05
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Devoted Health Medicare	$7,230.94
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$17,905.25
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Commercial	$13,270.95
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: MDX Hawaii PPO	$20,433.05
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	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS

Facility

$21,065.00

Service Code	HCPCS 36818
Hospital Charge Code	3613681801
Hospital Revenue Code	361
Min. Negotiated Rate	$17,905.25
Max. Negotiated Rate	$20,433.05
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Health Management Network Commercial	$17,905.25
Rate for Payer: MDX Hawaii PPO	$20,433.05

HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS

Facility

$126.00

Service Code	HCPCS 86606
Hospital Charge Code	3028660601
Hospital Revenue Code	302
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$15.05
Rate for Payer: AlohaCare Medicare	$15.05
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$16.55
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
Rate for Payer: Hawaii Medical Service Association Commercial	$18.81
Rate for Payer: Hawaii Medical Service Association Medicare	$15.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.84
Rate for Payer: Hawaii Western Management Group Commercial	$15.05
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$15.05
Rate for Payer: Kaiser Permanente Commercial	$79.38
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$15.05
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$16.55
Rate for Payer: Ohana Health Plan Medicare	$15.05
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$15.05
Rate for Payer: University Health Alliance Commercial	$38.91

HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS

Facility

$126.00

Service Code	HCPCS 86606
Hospital Charge Code	3028660601
Hospital Revenue Code	302
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$122.22

HC ASPIRAT/INJECTION GANGLION CYST(S)

Facility

$1,175.00

Service Code	HCPCS 20612
Hospital Charge Code	3612061201
Hospital Revenue Code	450
Min. Negotiated Rate	$362.62
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
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	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,116.25
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$856.46

HC ASPIRAT/INJECTION GANGLION CYST(S)

Facility

$1,175.00

Service Code	HCPCS 20612
Hospital Charge Code	3612061201
Hospital Revenue Code	450
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER

Facility

$8,152.00

Service Code	HCPCS 51102
Hospital Charge Code	3615110201
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,907.44
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Devoted Health Medicare	$2,716.41
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$7,744.40
Rate for Payer: Health Management Network Commercial	$6,929.20
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Commercial	$5,135.76
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: MDX Hawaii PPO	$7,907.44
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46
Rate for Payer: University Health Alliance Commercial	$5,941.99

HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER

Facility

$8,152.00

Service Code	HCPCS 51102
Hospital Charge Code	3615110201
Hospital Revenue Code	450
Min. Negotiated Rate	$6,929.20
Max. Negotiated Rate	$7,907.44
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Health Management Network Commercial	$6,929.20
Rate for Payer: MDX Hawaii PPO	$7,907.44

HC ASPIRATION OF BLADDER; BY NEEDLE

Facility

$948.00

Service Code	HCPCS 51100
Hospital Charge Code	4505110001
Hospital Revenue Code	450
Min. Negotiated Rate	$295.16
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$295.16
Rate for Payer: AlohaCare Medicare	$295.16
Rate for Payer: Cash Price	$568.80
Rate for Payer: Cash Price	$568.80
Rate for Payer: Cash Price	$568.80
Rate for Payer: Devoted Health Medicare	$324.68
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$900.60
Rate for Payer: Health Management Network Commercial	$805.80
Rate for Payer: Humana Medicare	$295.16
Rate for Payer: Kaiser Permanente Commercial	$597.24
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$295.16
Rate for Payer: MDX Hawaii PPO	$919.56
Rate for Payer: Ohana Health Plan Medicaid	$324.68
Rate for Payer: Ohana Health Plan Medicare	$295.16
Rate for Payer: UnitedHealthcare Medicare	$295.16
Rate for Payer: University Health Alliance Commercial	$691.00

HC ASPIRATION OF BLADDER; BY NEEDLE

Facility

$948.00

Service Code	HCPCS 51100
Hospital Charge Code	4505110001
Hospital Revenue Code	450
Min. Negotiated Rate	$805.80
Max. Negotiated Rate	$919.56
Rate for Payer: Cash Price	$568.80
Rate for Payer: Health Management Network Commercial	$805.80
Rate for Payer: MDX Hawaii PPO	$919.56

HC ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER

Facility

$3,965.00

Service Code	HCPCS 51101
Hospital Charge Code	4505110101
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$3,846.05
Rate for Payer: AlohaCare Medicaid	$1,014.47
Rate for Payer: AlohaCare Medicare	$1,014.47
Rate for Payer: Cash Price	$2,379.00
Rate for Payer: Cash Price	$2,379.00
Rate for Payer: Cash Price	$2,379.00
Rate for Payer: Cash Price	$2,379.00
Rate for Payer: Devoted Health Medicare	$1,115.92
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	$1,014.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,766.75
Rate for Payer: Health Management Network Commercial	$3,370.25
Rate for Payer: Humana Medicare	$1,014.47
Rate for Payer: Kaiser Permanente Commercial	$2,497.95
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,014.47
Rate for Payer: MDX Hawaii PPO	$3,846.05
Rate for Payer: Ohana Health Plan Medicaid	$1,115.92
Rate for Payer: Ohana Health Plan Medicare	$1,014.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,014.47
Rate for Payer: University Health Alliance Commercial	$2,890.09

HC ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER

Facility

$3,965.00

Service Code	HCPCS 51101
Hospital Charge Code	4505110101
Hospital Revenue Code	450
Min. Negotiated Rate	$3,370.25
Max. Negotiated Rate	$3,846.05
Rate for Payer: Cash Price	$2,379.00
Rate for Payer: Health Management Network Commercial	$3,370.25
Rate for Payer: MDX Hawaii PPO	$3,846.05

HC ASPIR &/INJ THYROID CYST

Facility

$2,800.00

Service Code	HCPCS 60300
Hospital Charge Code	3616030001
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$920.21
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	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55
Rate for Payer: University Health Alliance Commercial	$2,040.92

HC ASPIR &/INJ THYROID CYST

Facility

$2,800.00

Service Code	HCPCS 60300
Hospital Charge Code	3616030001
Hospital Revenue Code	361
Min. Negotiated Rate	$2,380.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00

HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE

Facility

$43.00

Service Code	HCPCS 84075
Hospital Charge Code	3018407501
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$25.80
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$27.09
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.38

HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE

Facility

$43.00

Service Code	HCPCS 84075
Hospital Charge Code	3018407501
Hospital Revenue Code	301
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: MDX Hawaii PPO	$41.71

HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL

Facility

$36.00

Service Code	HCPCS 82465
Hospital Charge Code	3018246502
Hospital Revenue Code	301
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

Know your out-of-pocket cost for care.

All Charges