Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC ASSAY OF FREE THYROXINE - T4 FREE

Facility

$76.00

Service Code	HCPCS 84439
Hospital Charge Code	3018443901
Hospital Revenue Code	301
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$9.02
Rate for Payer: AlohaCare Medicare	$9.02
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Devoted Health Medicare	$9.92
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	$9.02
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	$64.60
Rate for Payer: Humana Medicare	$9.02
Rate for Payer: Kaiser Permanente Commercial	$47.88
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$9.02
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$9.92
Rate for Payer: Ohana Health Plan Medicare	$9.02
Rate for Payer: UnitedHealthcare Medicaid	$12.46
Rate for Payer: UnitedHealthcare Medicare	$9.02
Rate for Payer: University Health Alliance Commercial	$23.31

HC ASSAY OF FREE THYROXINE - T4 FREE

Facility

$76.00

Service Code	HCPCS 84439
Hospital Charge Code	3018443901
Hospital Revenue Code	301
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: MDX Hawaii PPO	$73.72

HC ASSAY OF G6PD ENZYME - GLUCOSE 6 PHOSPHATE DEHYDROGENASE

Facility

$81.00

Service Code	HCPCS 82955
Hospital Charge Code	3018295501
Hospital Revenue Code	301
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: MDX Hawaii PPO	$78.57

HC ASSAY OF G6PD ENZYME - GLUCOSE 6 PHOSPHATE DEHYDROGENASE

Facility

$81.00

Service Code	HCPCS 82955
Hospital Charge Code	3018295501
Hospital Revenue Code	301
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$78.57
Rate for Payer: AlohaCare Medicaid	$9.70
Rate for Payer: AlohaCare Medicare	$9.70
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cash Price	$48.60
Rate for Payer: Devoted Health Medicare	$10.67
Rate for Payer: Hawaii Medical Service Association ABD	$13.40
Rate for Payer: Hawaii Medical Service Association Commercial	$12.12
Rate for Payer: Hawaii Medical Service Association Medicare	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.07
Rate for Payer: Hawaii Western Management Group Commercial	$9.70
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Humana Medicare	$9.70
Rate for Payer: Kaiser Permanente Commercial	$51.03
Rate for Payer: Kaiser Permanente Medicaid	$41.31
Rate for Payer: Kaiser Permanente Medicare	$9.70
Rate for Payer: MDX Hawaii PPO	$78.57
Rate for Payer: Ohana Health Plan Medicaid	$10.67
Rate for Payer: Ohana Health Plan Medicare	$9.70
Rate for Payer: UnitedHealthcare Medicaid	$13.40
Rate for Payer: UnitedHealthcare Medicare	$9.70
Rate for Payer: University Health Alliance Commercial	$25.07

HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA

Facility

$78.00

Service Code	HCPCS 82784
Hospital Charge Code	3018278404
Hospital Revenue Code	301
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: MDX Hawaii PPO	$75.66

HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA

Facility

$78.00

Service Code	HCPCS 82784
Hospital Charge Code	3018278404
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$9.30
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$10.23
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$11.62
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$9.30
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$49.14
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$10.23
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$19.74

HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG

Facility

$78.00

Service Code	HCPCS 82784
Hospital Charge Code	3018278402
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$9.30
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$10.23
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$11.62
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$9.30
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$49.14
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$10.23
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$19.74

HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG

Facility

$78.00

Service Code	HCPCS 82784
Hospital Charge Code	3018278402
Hospital Revenue Code	301
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: MDX Hawaii PPO	$75.66

HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM

Facility

$78.00

Service Code	HCPCS 82784
Hospital Charge Code	3018278403
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$9.30
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$10.23
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$11.62
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$9.30
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$49.14
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$10.23
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$19.74

HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM

Facility

$78.00

Service Code	HCPCS 82784
Hospital Charge Code	3018278403
Hospital Revenue Code	301
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: MDX Hawaii PPO	$75.66

HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULIN D (IGD) SO

Facility

$78.00

Service Code	HCPCS 82784
Hospital Charge Code	3018278401
Hospital Revenue Code	301
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: MDX Hawaii PPO	$75.66

HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULIN D (IGD) SO

Facility

$78.00

Service Code	HCPCS 82784
Hospital Charge Code	3018278401
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$9.30
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$10.23
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$11.62
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$9.30
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$49.14
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$10.23
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$19.74

HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN E SO

Facility

$138.00

Service Code	HCPCS 82785
Hospital Charge Code	3018278501
Hospital Revenue Code	301
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$16.46
Rate for Payer: AlohaCare Medicare	$16.46
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cash Price	$82.80
Rate for Payer: Devoted Health Medicare	$18.11
Rate for Payer: Hawaii Medical Service Association ABD	$22.76
Rate for Payer: Hawaii Medical Service Association Commercial	$20.57
Rate for Payer: Hawaii Medical Service Association Medicare	$16.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.90
Rate for Payer: Hawaii Western Management Group Commercial	$16.46
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$16.46
Rate for Payer: Kaiser Permanente Commercial	$86.94
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$16.46
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$18.11
Rate for Payer: Ohana Health Plan Medicare	$16.46
Rate for Payer: UnitedHealthcare Medicaid	$22.76
Rate for Payer: UnitedHealthcare Medicare	$16.46
Rate for Payer: University Health Alliance Commercial	$42.57

HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN E SO

Facility

$138.00

Service Code	HCPCS 82785
Hospital Charge Code	3018278501
Hospital Revenue Code	301
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: MDX Hawaii PPO	$133.86

HC ASSAY OF GASTRIN - GASTRIN

Facility

$148.00

Service Code	HCPCS 82941
Hospital Charge Code	3018294101
Hospital Revenue Code	301
Min. Negotiated Rate	$125.80
Max. Negotiated Rate	$143.56
Rate for Payer: Cash Price	$88.80
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: MDX Hawaii PPO	$143.56

HC ASSAY OF GASTRIN - GASTRIN

Facility

$148.00

Service Code	HCPCS 82941
Hospital Charge Code	3018294101
Hospital Revenue Code	301
Min. Negotiated Rate	$17.63
Max. Negotiated Rate	$143.56
Rate for Payer: AlohaCare Medicaid	$17.63
Rate for Payer: AlohaCare Medicare	$17.63
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cash Price	$88.80
Rate for Payer: Devoted Health Medicare	$19.39
Rate for Payer: Hawaii Medical Service Association ABD	$24.38
Rate for Payer: Hawaii Medical Service Association Commercial	$22.04
Rate for Payer: Hawaii Medical Service Association Medicare	$17.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25.60
Rate for Payer: Hawaii Western Management Group Commercial	$17.63
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Humana Medicare	$17.63
Rate for Payer: Kaiser Permanente Commercial	$93.24
Rate for Payer: Kaiser Permanente Medicaid	$75.48
Rate for Payer: Kaiser Permanente Medicare	$17.63
Rate for Payer: MDX Hawaii PPO	$143.56
Rate for Payer: Ohana Health Plan Medicaid	$19.39
Rate for Payer: Ohana Health Plan Medicare	$17.63
Rate for Payer: UnitedHealthcare Medicaid	$24.38
Rate for Payer: UnitedHealthcare Medicare	$17.63
Rate for Payer: University Health Alliance Commercial	$45.58

HC ASSAY OF GENTAMICIN - GENTAMICIN PEAK

Facility

$137.00

Service Code	HCPCS 80170
Hospital Charge Code	3018017003
Hospital Revenue Code	301
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$16.38
Rate for Payer: AlohaCare Medicare	$16.38
Rate for Payer: Cash Price	$82.20
Rate for Payer: Cash Price	$82.20
Rate for Payer: Devoted Health Medicare	$18.02
Rate for Payer: Hawaii Medical Service Association ABD	$22.65
Rate for Payer: Hawaii Medical Service Association Commercial	$20.48
Rate for Payer: Hawaii Medical Service Association Medicare	$16.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.78
Rate for Payer: Hawaii Western Management Group Commercial	$16.38
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$16.38
Rate for Payer: Kaiser Permanente Commercial	$86.31
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$16.38
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$18.02
Rate for Payer: Ohana Health Plan Medicare	$16.38
Rate for Payer: UnitedHealthcare Medicaid	$22.65
Rate for Payer: UnitedHealthcare Medicare	$16.38
Rate for Payer: University Health Alliance Commercial	$42.37

HC ASSAY OF GENTAMICIN - GENTAMICIN PEAK

Facility

$137.00

Service Code	HCPCS 80170
Hospital Charge Code	3018017003
Hospital Revenue Code	301
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$82.20
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: MDX Hawaii PPO	$132.89

HC ASSAY OF GENTAMICIN - GENTAMICIN RANDOM

Facility

$137.00

Service Code	HCPCS 80170
Hospital Charge Code	3018017002
Hospital Revenue Code	301
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$16.38
Rate for Payer: AlohaCare Medicare	$16.38
Rate for Payer: Cash Price	$82.20
Rate for Payer: Cash Price	$82.20
Rate for Payer: Devoted Health Medicare	$18.02
Rate for Payer: Hawaii Medical Service Association ABD	$22.65
Rate for Payer: Hawaii Medical Service Association Commercial	$20.48
Rate for Payer: Hawaii Medical Service Association Medicare	$16.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.78
Rate for Payer: Hawaii Western Management Group Commercial	$16.38
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$16.38
Rate for Payer: Kaiser Permanente Commercial	$86.31
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$16.38
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$18.02
Rate for Payer: Ohana Health Plan Medicare	$16.38
Rate for Payer: UnitedHealthcare Medicaid	$22.65
Rate for Payer: UnitedHealthcare Medicare	$16.38
Rate for Payer: University Health Alliance Commercial	$42.37

HC ASSAY OF GENTAMICIN - GENTAMICIN RANDOM

Facility

$137.00

Service Code	HCPCS 80170
Hospital Charge Code	3018017002
Hospital Revenue Code	301
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$82.20
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: MDX Hawaii PPO	$132.89

HC ASSAY OF GENTAMICIN - GENTAMICIN TROUGH

Facility

$137.00

Service Code	HCPCS 80170
Hospital Charge Code	3018017001
Hospital Revenue Code	301
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$16.38
Rate for Payer: AlohaCare Medicare	$16.38
Rate for Payer: Cash Price	$82.20
Rate for Payer: Cash Price	$82.20
Rate for Payer: Devoted Health Medicare	$18.02
Rate for Payer: Hawaii Medical Service Association ABD	$22.65
Rate for Payer: Hawaii Medical Service Association Commercial	$20.48
Rate for Payer: Hawaii Medical Service Association Medicare	$16.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.78
Rate for Payer: Hawaii Western Management Group Commercial	$16.38
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$16.38
Rate for Payer: Kaiser Permanente Commercial	$86.31
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$16.38
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$18.02
Rate for Payer: Ohana Health Plan Medicare	$16.38
Rate for Payer: UnitedHealthcare Medicaid	$22.65
Rate for Payer: UnitedHealthcare Medicare	$16.38
Rate for Payer: University Health Alliance Commercial	$42.37

HC ASSAY OF GENTAMICIN - GENTAMICIN TROUGH

Facility

$137.00

Service Code	HCPCS 80170
Hospital Charge Code	3018017001
Hospital Revenue Code	301
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$82.20
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: MDX Hawaii PPO	$132.89

HC ASSAY OF GGT - GAMMA GT

Facility

$60.00

Service Code	HCPCS 82977
Hospital Charge Code	3018297701
Hospital Revenue Code	301
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$7.20
Rate for Payer: AlohaCare Medicare	$7.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$7.92
Rate for Payer: Hawaii Medical Service Association ABD	$9.95
Rate for Payer: Hawaii Medical Service Association Commercial	$9.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.45
Rate for Payer: Hawaii Western Management Group Commercial	$7.20
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$7.20
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$7.20
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$7.92
Rate for Payer: Ohana Health Plan Medicare	$7.20
Rate for Payer: UnitedHealthcare Medicaid	$9.95
Rate for Payer: UnitedHealthcare Medicare	$7.20
Rate for Payer: University Health Alliance Commercial	$18.61

HC ASSAY OF GGT - GAMMA GT

Facility

$60.00

Service Code	HCPCS 82977
Hospital Charge Code	3018297701
Hospital Revenue Code	301
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: MDX Hawaii PPO	$58.20

HC ASSAY OF HAPTOGLOBIN, QUANT - HAPTOGLOBIN

Facility

$106.00

Service Code	HCPCS 83010
Hospital Charge Code	3018301001
Hospital Revenue Code	301
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$102.82
Rate for Payer: AlohaCare Medicaid	$12.58
Rate for Payer: AlohaCare Medicare	$12.58
Rate for Payer: Cash Price	$63.60
Rate for Payer: Cash Price	$63.60
Rate for Payer: Devoted Health Medicare	$13.84
Rate for Payer: Hawaii Medical Service Association ABD	$17.38
Rate for Payer: Hawaii Medical Service Association Commercial	$15.72
Rate for Payer: Hawaii Medical Service Association Medicare	$12.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.25
Rate for Payer: Hawaii Western Management Group Commercial	$12.58
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Humana Medicare	$12.58
Rate for Payer: Kaiser Permanente Commercial	$66.78
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: Kaiser Permanente Medicare	$12.58
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: Ohana Health Plan Medicaid	$13.84
Rate for Payer: Ohana Health Plan Medicare	$12.58
Rate for Payer: UnitedHealthcare Medicaid	$17.38
Rate for Payer: UnitedHealthcare Medicare	$12.58
Rate for Payer: University Health Alliance Commercial	$32.52

Know your out-of-pocket cost for care.

All Charges