Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE

Facility

$217.00

Service Code	HCPCS 84403
Hospital Charge Code	3018440301
Hospital Revenue Code	301
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$130.20
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: MDX Hawaii PPO	$210.49

HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE

Facility

$217.00

Service Code	HCPCS 84403
Hospital Charge Code	3018440301
Hospital Revenue Code	301
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$210.49
Rate for Payer: AlohaCare Medicaid	$25.81
Rate for Payer: AlohaCare Medicare	$25.81
Rate for Payer: Cash Price	$130.20
Rate for Payer: Cash Price	$130.20
Rate for Payer: Devoted Health Medicare	$28.39
Rate for Payer: Hawaii Medical Service Association ABD	$35.68
Rate for Payer: Hawaii Medical Service Association Commercial	$32.26
Rate for Payer: Hawaii Medical Service Association Medicare	$25.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.46
Rate for Payer: Hawaii Western Management Group Commercial	$25.81
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Humana Medicare	$25.81
Rate for Payer: Kaiser Permanente Commercial	$136.71
Rate for Payer: Kaiser Permanente Medicaid	$110.67
Rate for Payer: Kaiser Permanente Medicare	$25.81
Rate for Payer: MDX Hawaii PPO	$210.49
Rate for Payer: Ohana Health Plan Medicaid	$28.39
Rate for Payer: Ohana Health Plan Medicare	$25.81
Rate for Payer: UnitedHealthcare Medicaid	$35.68
Rate for Payer: UnitedHealthcare Medicare	$25.81
Rate for Payer: University Health Alliance Commercial	$66.75

HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE)

Facility

$58.00

Service Code	HCPCS 84436
Hospital Charge Code	3018443601
Hospital Revenue Code	301
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$56.26
Rate for Payer: AlohaCare Medicaid	$6.87
Rate for Payer: AlohaCare Medicare	$6.87
Rate for Payer: Cash Price	$34.80
Rate for Payer: Cash Price	$34.80
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association ABD	$9.50
Rate for Payer: Hawaii Medical Service Association Commercial	$8.59
Rate for Payer: Hawaii Medical Service Association Medicare	$6.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.98
Rate for Payer: Hawaii Western Management Group Commercial	$6.87
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Humana Medicare	$6.87
Rate for Payer: Kaiser Permanente Commercial	$36.54
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: Kaiser Permanente Medicare	$6.87
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: Ohana Health Plan Medicaid	$7.56
Rate for Payer: Ohana Health Plan Medicare	$6.87
Rate for Payer: UnitedHealthcare Medicaid	$9.50
Rate for Payer: UnitedHealthcare Medicare	$6.87
Rate for Payer: University Health Alliance Commercial	$17.78

HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE)

Facility

$58.00

Service Code	HCPCS 84436
Hospital Charge Code	3018443601
Hospital Revenue Code	301
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: MDX Hawaii PPO	$56.26

HC ASSAY OF TRANSFERRIN - TRANSFERRIN

Facility

$107.00

Service Code	HCPCS 84466
Hospital Charge Code	3018446601
Hospital Revenue Code	301
Min. Negotiated Rate	$12.76
Max. Negotiated Rate	$103.79
Rate for Payer: AlohaCare Medicaid	$12.76
Rate for Payer: AlohaCare Medicare	$12.76
Rate for Payer: Cash Price	$64.20
Rate for Payer: Cash Price	$64.20
Rate for Payer: Devoted Health Medicare	$14.04
Rate for Payer: Hawaii Medical Service Association ABD	$17.65
Rate for Payer: Hawaii Medical Service Association Commercial	$15.95
Rate for Payer: Hawaii Medical Service Association Medicare	$12.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.53
Rate for Payer: Hawaii Western Management Group Commercial	$12.76
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Humana Medicare	$12.76
Rate for Payer: Kaiser Permanente Commercial	$67.41
Rate for Payer: Kaiser Permanente Medicaid	$54.57
Rate for Payer: Kaiser Permanente Medicare	$12.76
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: Ohana Health Plan Medicaid	$14.04
Rate for Payer: Ohana Health Plan Medicare	$12.76
Rate for Payer: UnitedHealthcare Medicaid	$17.65
Rate for Payer: UnitedHealthcare Medicare	$12.76
Rate for Payer: University Health Alliance Commercial	$33.00

HC ASSAY OF TRANSFERRIN - TRANSFERRIN

Facility

$107.00

Service Code	HCPCS 84466
Hospital Charge Code	3018446601
Hospital Revenue Code	301
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: MDX Hawaii PPO	$103.79

HC ASSAY OF TRIGLYCERIDES - TRIGLYCERIDES

Facility

$48.00

Service Code	HCPCS 84478
Hospital Charge Code	3018447801
Hospital Revenue Code	301
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: MDX Hawaii PPO	$46.56

HC ASSAY OF TRIGLYCERIDES - TRIGLYCERIDES

Facility

$48.00

Service Code	HCPCS 84478
Hospital Charge Code	3018447801
Hospital Revenue Code	301
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$5.74
Rate for Payer: AlohaCare Medicare	$5.74
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Devoted Health Medicare	$6.31
Rate for Payer: Hawaii Medical Service Association ABD	$7.95
Rate for Payer: Hawaii Medical Service Association Commercial	$7.17
Rate for Payer: Hawaii Medical Service Association Medicare	$5.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.35
Rate for Payer: Hawaii Western Management Group Commercial	$5.74
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$5.74
Rate for Payer: Kaiser Permanente Commercial	$30.24
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$5.74
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$6.31
Rate for Payer: Ohana Health Plan Medicare	$5.74
Rate for Payer: UnitedHealthcare Medicaid	$7.95
Rate for Payer: UnitedHealthcare Medicare	$5.74
Rate for Payer: University Health Alliance Commercial	$14.87

HC ASSAY OF TROPONIN, QUANT - TROPONIN T GEN 5

Facility

$105.00

Service Code	HCPCS 84484
Hospital Charge Code	3018448401
Hospital Revenue Code	301
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: MDX Hawaii PPO	$101.85

HC ASSAY OF TROPONIN, QUANT - TROPONIN T GEN 5

Facility

$105.00

Service Code	HCPCS 84484
Hospital Charge Code	3018448401
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$101.85
Rate for Payer: AlohaCare Medicaid	$12.47
Rate for Payer: AlohaCare Medicare	$12.47
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Devoted Health Medicare	$13.72
Rate for Payer: Hawaii Medical Service Association ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.59
Rate for Payer: Hawaii Medical Service Association Medicare	$12.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$12.47
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Humana Medicare	$12.47
Rate for Payer: Kaiser Permanente Commercial	$66.15
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: Kaiser Permanente Medicare	$12.47
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: Ohana Health Plan Medicaid	$13.72
Rate for Payer: Ohana Health Plan Medicare	$12.47
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$12.47
Rate for Payer: University Health Alliance Commercial	$25.44

HC ASSAY OF URIC ACID, BLOOD, OTHER SOURCE - URIC ACID, URINE

Facility

$43.00

Service Code	HCPCS 84560
Hospital Charge Code	3018456004
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 OF URIC ACID, BLOOD, OTHER SOURCE - URIC ACID, URINE

Facility

$43.00

Service Code	HCPCS 84560
Hospital Charge Code	3018456004
Hospital Revenue Code	301
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$5.08
Rate for Payer: AlohaCare Medicare	$5.08
Rate for Payer: Cash Price	$25.80
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$5.59
Rate for Payer: Hawaii Medical Service Association ABD	$6.56
Rate for Payer: Hawaii Medical Service Association Commercial	$6.35
Rate for Payer: Hawaii Medical Service Association Medicare	$5.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$5.08
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$5.08
Rate for Payer: Kaiser Permanente Commercial	$27.09
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$5.08
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$5.59
Rate for Payer: Ohana Health Plan Medicare	$5.08
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$5.08
Rate for Payer: University Health Alliance Commercial	$12.28

HC ASSAY OF URIC ACID, BLOOD - URIC ACID

Facility

$38.00

Service Code	HCPCS 84550
Hospital Charge Code	3018455001
Hospital Revenue Code	301
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$36.86
Rate for Payer: AlohaCare Medicaid	$4.52
Rate for Payer: AlohaCare Medicare	$4.52
Rate for Payer: Cash Price	$22.80
Rate for Payer: Cash Price	$22.80
Rate for Payer: Devoted Health Medicare	$4.97
Rate for Payer: Hawaii Medical Service Association ABD	$6.25
Rate for Payer: Hawaii Medical Service Association Commercial	$5.65
Rate for Payer: Hawaii Medical Service Association Medicare	$4.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.56
Rate for Payer: Hawaii Western Management Group Commercial	$4.52
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Humana Medicare	$4.52
Rate for Payer: Kaiser Permanente Commercial	$23.94
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: Kaiser Permanente Medicare	$4.52
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: Ohana Health Plan Medicaid	$4.97
Rate for Payer: Ohana Health Plan Medicare	$4.52
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: UnitedHealthcare Medicare	$4.52
Rate for Payer: University Health Alliance Commercial	$11.67

HC ASSAY OF URIC ACID, BLOOD - URIC ACID

Facility

$38.00

Service Code	HCPCS 84550
Hospital Charge Code	3018455001
Hospital Revenue Code	301
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$36.86

HC ASSAY OF URINE ALBUMIN - ALBUMIN BODY FLUID

Facility

$65.00

Service Code	HCPCS 82042
Hospital Charge Code	3018204201
Hospital Revenue Code	301
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$7.78
Rate for Payer: AlohaCare Medicare	$7.78
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$8.56
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$9.72
Rate for Payer: Hawaii Medical Service Association Medicare	$7.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$7.78
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$7.78
Rate for Payer: Kaiser Permanente Commercial	$40.95
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$7.78
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$8.56
Rate for Payer: Ohana Health Plan Medicare	$7.78
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$7.78
Rate for Payer: University Health Alliance Commercial	$13.38

HC ASSAY OF URINE ALBUMIN - ALBUMIN BODY FLUID

Facility

$65.00

Service Code	HCPCS 82042
Hospital Charge Code	3018204201
Hospital Revenue Code	301
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: MDX Hawaii PPO	$63.05

HC ASSAY OF URINE CHLORIDE - CHLORIDE URINE RANDOM

Facility

$48.00

Service Code	HCPCS 82436
Hospital Charge Code	3018243601
Hospital Revenue Code	301
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$5.75
Rate for Payer: AlohaCare Medicare	$5.75
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Devoted Health Medicare	$6.33
Rate for Payer: Hawaii Medical Service Association ABD	$6.95
Rate for Payer: Hawaii Medical Service Association Commercial	$7.19
Rate for Payer: Hawaii Medical Service Association Medicare	$5.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.30
Rate for Payer: Hawaii Western Management Group Commercial	$5.75
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$5.75
Rate for Payer: Kaiser Permanente Commercial	$30.24
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$5.75
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$6.33
Rate for Payer: Ohana Health Plan Medicare	$5.75
Rate for Payer: UnitedHealthcare Medicaid	$6.95
Rate for Payer: UnitedHealthcare Medicare	$5.75
Rate for Payer: University Health Alliance Commercial	$12.99

HC ASSAY OF URINE CHLORIDE - CHLORIDE URINE RANDOM

Facility

$48.00

Service Code	HCPCS 82436
Hospital Charge Code	3018243601
Hospital Revenue Code	301
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: MDX Hawaii PPO	$46.56

HC ASSAY OF URINE CREATININE - CREATININE BODY FLUID

Facility

$43.00

Service Code	HCPCS 82570
Hospital Charge Code	3018257001
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 OF URINE CREATININE - CREATININE BODY FLUID

Facility

$43.00

Service Code	HCPCS 82570
Hospital Charge Code	3018257001
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 OF URINE CREATININE - CREATININE RANDOM URINE

Facility

$43.00

Service Code	HCPCS 82570
Hospital Charge Code	3018257002
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 OF URINE CREATININE - CREATININE RANDOM URINE

Facility

$43.00

Service Code	HCPCS 82570
Hospital Charge Code	3018257002
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 OF URINE OSMOLALITY - OSMOLALITY URINE

Facility

$57.00

Service Code	HCPCS 83935
Hospital Charge Code	3018393501
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$55.29
Rate for Payer: AlohaCare Medicaid	$6.82
Rate for Payer: AlohaCare Medicare	$6.82
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$34.20
Rate for Payer: Devoted Health Medicare	$7.50
Rate for Payer: Hawaii Medical Service Association ABD	$9.42
Rate for Payer: Hawaii Medical Service Association Commercial	$8.53
Rate for Payer: Hawaii Medical Service Association Medicare	$6.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.89
Rate for Payer: Hawaii Western Management Group Commercial	$6.82
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Humana Medicare	$6.82
Rate for Payer: Kaiser Permanente Commercial	$35.91
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: Kaiser Permanente Medicare	$6.82
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$7.50
Rate for Payer: Ohana Health Plan Medicare	$6.82
Rate for Payer: UnitedHealthcare Medicaid	$9.42
Rate for Payer: UnitedHealthcare Medicare	$6.82
Rate for Payer: University Health Alliance Commercial	$17.61

HC ASSAY OF URINE OSMOLALITY - OSMOLALITY URINE

Facility

$57.00

Service Code	HCPCS 83935
Hospital Charge Code	3018393501
Hospital Revenue Code	301
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$34.20
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: MDX Hawaii PPO	$55.29

HC ASSAY OF URINE PHOSPHORUS - PHOSPHORUS URINE

Facility

$48.00

Service Code	HCPCS 84105
Hospital Charge Code	3018410501
Hospital Revenue Code	301
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$5.78
Rate for Payer: AlohaCare Medicare	$5.78
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Devoted Health Medicare	$6.36
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$7.22
Rate for Payer: Hawaii Medical Service Association Medicare	$5.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.78
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$5.78
Rate for Payer: Kaiser Permanente Commercial	$30.24
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$5.78
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$6.36
Rate for Payer: Ohana Health Plan Medicare	$5.78
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.78
Rate for Payer: University Health Alliance Commercial	$13.38

Know your out-of-pocket cost for care.

All Charges