Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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	$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 POTASSIUM - POTASSIUM RANDOM URINE

Facility

$40.00

Service Code	HCPCS 84133
Hospital Charge Code	3018413303
Hospital Revenue Code	301
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: MDX Hawaii PPO	$38.80

HC ASSAY OF URINE POTASSIUM - POTASSIUM RANDOM URINE

Facility

$40.00

Service Code	HCPCS 84133
Hospital Charge Code	3018413303
Hospital Revenue Code	301
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$4.73
Rate for Payer: AlohaCare Medicare	$4.73
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Devoted Health Medicare	$5.20
Rate for Payer: Hawaii Medical Service Association ABD	$5.94
Rate for Payer: Hawaii Medical Service Association Commercial	$5.91
Rate for Payer: Hawaii Medical Service Association Medicare	$4.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.24
Rate for Payer: Hawaii Western Management Group Commercial	$4.73
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$4.73
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$4.73
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$5.20
Rate for Payer: Ohana Health Plan Medicare	$4.73
Rate for Payer: UnitedHealthcare Medicaid	$5.94
Rate for Payer: UnitedHealthcare Medicare	$4.73
Rate for Payer: University Health Alliance Commercial	$11.12

HC ASSAY OF URINE SODIUM - SODIUM RANDOM URINE

Facility

$42.00

Service Code	HCPCS 84300
Hospital Charge Code	3018430001
Hospital Revenue Code	301
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$25.20
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: MDX Hawaii PPO	$40.74

HC ASSAY OF URINE SODIUM - SODIUM RANDOM URINE

Facility

$42.00

Service Code	HCPCS 84300
Hospital Charge Code	3018430001
Hospital Revenue Code	301
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$40.74
Rate for Payer: AlohaCare Medicaid	$5.06
Rate for Payer: AlohaCare Medicare	$5.06
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Devoted Health Medicare	$5.57
Rate for Payer: Hawaii Medical Service Association ABD	$6.72
Rate for Payer: Hawaii Medical Service Association Commercial	$6.33
Rate for Payer: Hawaii Medical Service Association Medicare	$5.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.06
Rate for Payer: Hawaii Western Management Group Commercial	$5.06
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Humana Medicare	$5.06
Rate for Payer: Kaiser Permanente Commercial	$26.46
Rate for Payer: Kaiser Permanente Medicaid	$21.42
Rate for Payer: Kaiser Permanente Medicare	$5.06
Rate for Payer: MDX Hawaii PPO	$40.74
Rate for Payer: Ohana Health Plan Medicaid	$5.57
Rate for Payer: Ohana Health Plan Medicare	$5.06
Rate for Payer: UnitedHealthcare Medicaid	$6.72
Rate for Payer: UnitedHealthcare Medicare	$5.06
Rate for Payer: University Health Alliance Commercial	$12.56

HC ASSAY OF VANCOMYCIN - VANCOMYCIN PEAK

Facility

$114.00

Service Code	HCPCS 80202
Hospital Charge Code	3018020203
Hospital Revenue Code	301
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$13.54
Rate for Payer: AlohaCare Medicare	$13.54
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Devoted Health Medicare	$14.89
Rate for Payer: Hawaii Medical Service Association ABD	$18.72
Rate for Payer: Hawaii Medical Service Association Commercial	$16.93
Rate for Payer: Hawaii Medical Service Association Medicare	$13.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.66
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$13.54
Rate for Payer: Kaiser Permanente Commercial	$71.82
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$13.54
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$14.89
Rate for Payer: Ohana Health Plan Medicare	$13.54
Rate for Payer: UnitedHealthcare Medicaid	$18.72
Rate for Payer: UnitedHealthcare Medicare	$13.54
Rate for Payer: University Health Alliance Commercial	$35.02

HC ASSAY OF VANCOMYCIN - VANCOMYCIN PEAK

Facility

$114.00

Service Code	HCPCS 80202
Hospital Charge Code	3018020203
Hospital Revenue Code	301
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: MDX Hawaii PPO	$110.58

HC ASSAY OF VANCOMYCIN - VANCOMYCIN RANDOM

Facility

$114.00

Service Code	HCPCS 80202
Hospital Charge Code	3018020202
Hospital Revenue Code	301
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$13.54
Rate for Payer: AlohaCare Medicare	$13.54
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Devoted Health Medicare	$14.89
Rate for Payer: Hawaii Medical Service Association ABD	$18.72
Rate for Payer: Hawaii Medical Service Association Commercial	$16.93
Rate for Payer: Hawaii Medical Service Association Medicare	$13.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.66
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$13.54
Rate for Payer: Kaiser Permanente Commercial	$71.82
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$13.54
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$14.89
Rate for Payer: Ohana Health Plan Medicare	$13.54
Rate for Payer: UnitedHealthcare Medicaid	$18.72
Rate for Payer: UnitedHealthcare Medicare	$13.54
Rate for Payer: University Health Alliance Commercial	$35.02

HC ASSAY OF VANCOMYCIN - VANCOMYCIN RANDOM

Facility

$114.00

Service Code	HCPCS 80202
Hospital Charge Code	3018020202
Hospital Revenue Code	301
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: MDX Hawaii PPO	$110.58

HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH

Facility

$114.00

Service Code	HCPCS 80202
Hospital Charge Code	3018020201
Hospital Revenue Code	301
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$13.54
Rate for Payer: AlohaCare Medicare	$13.54
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Devoted Health Medicare	$14.89
Rate for Payer: Hawaii Medical Service Association ABD	$18.72
Rate for Payer: Hawaii Medical Service Association Commercial	$16.93
Rate for Payer: Hawaii Medical Service Association Medicare	$13.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.66
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$13.54
Rate for Payer: Kaiser Permanente Commercial	$71.82
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$13.54
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$14.89
Rate for Payer: Ohana Health Plan Medicare	$13.54
Rate for Payer: UnitedHealthcare Medicaid	$18.72
Rate for Payer: UnitedHealthcare Medicare	$13.54
Rate for Payer: University Health Alliance Commercial	$35.02

HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH

Facility

$114.00

Service Code	HCPCS 80202
Hospital Charge Code	3018020201
Hospital Revenue Code	301
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: MDX Hawaii PPO	$110.58

HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE

Facility

$285.00

Service Code	HCPCS 84588
Hospital Charge Code	3018458801
Hospital Revenue Code	301
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$276.45
Rate for Payer: AlohaCare Medicaid	$33.94
Rate for Payer: AlohaCare Medicare	$33.94
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Devoted Health Medicare	$37.33
Rate for Payer: Hawaii Medical Service Association ABD	$46.91
Rate for Payer: Hawaii Medical Service Association Commercial	$42.42
Rate for Payer: Hawaii Medical Service Association Medicare	$33.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$49.26
Rate for Payer: Hawaii Western Management Group Commercial	$33.94
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Humana Medicare	$33.94
Rate for Payer: Kaiser Permanente Commercial	$179.55
Rate for Payer: Kaiser Permanente Medicaid	$145.35
Rate for Payer: Kaiser Permanente Medicare	$33.94
Rate for Payer: MDX Hawaii PPO	$276.45
Rate for Payer: Ohana Health Plan Medicaid	$37.33
Rate for Payer: Ohana Health Plan Medicare	$33.94
Rate for Payer: UnitedHealthcare Medicaid	$46.91
Rate for Payer: UnitedHealthcare Medicare	$33.94
Rate for Payer: University Health Alliance Commercial	$87.75

HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE

Facility

$285.00

Service Code	HCPCS 84588
Hospital Charge Code	3018458801
Hospital Revenue Code	301
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$171.00
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: MDX Hawaii PPO	$276.45

HC ASSAY OF VITAMIN B-1 - THIAMINE/VITAMIN B1 SO

Facility

$178.00

Service Code	HCPCS 84425
Hospital Charge Code	3018442501
Hospital Revenue Code	301
Min. Negotiated Rate	$21.23
Max. Negotiated Rate	$172.66
Rate for Payer: AlohaCare Medicaid	$21.23
Rate for Payer: AlohaCare Medicare	$21.23
Rate for Payer: Cash Price	$106.80
Rate for Payer: Cash Price	$106.80
Rate for Payer: Devoted Health Medicare	$23.35
Rate for Payer: Hawaii Medical Service Association ABD	$26.36
Rate for Payer: Hawaii Medical Service Association Commercial	$26.54
Rate for Payer: Hawaii Medical Service Association Medicare	$21.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.68
Rate for Payer: Hawaii Western Management Group Commercial	$21.23
Rate for Payer: Health Management Network Commercial	$151.30
Rate for Payer: Humana Medicare	$21.23
Rate for Payer: Kaiser Permanente Commercial	$112.14
Rate for Payer: Kaiser Permanente Medicaid	$90.78
Rate for Payer: Kaiser Permanente Medicare	$21.23
Rate for Payer: MDX Hawaii PPO	$172.66
Rate for Payer: Ohana Health Plan Medicaid	$23.35
Rate for Payer: Ohana Health Plan Medicare	$21.23
Rate for Payer: UnitedHealthcare Medicaid	$26.36
Rate for Payer: UnitedHealthcare Medicare	$21.23
Rate for Payer: University Health Alliance Commercial	$49.30

HC ASSAY OF VITAMIN B-1 - THIAMINE/VITAMIN B1 SO

Facility

$178.00

Service Code	HCPCS 84425
Hospital Charge Code	3018442501
Hospital Revenue Code	301
Min. Negotiated Rate	$151.30
Max. Negotiated Rate	$172.66
Rate for Payer: Cash Price	$106.80
Rate for Payer: Health Management Network Commercial	$151.30
Rate for Payer: MDX Hawaii PPO	$172.66

HC ASSAY OF VITAMIN B-6 - VITAMIN B6

Facility

$236.00

Service Code	HCPCS 84207
Hospital Charge Code	3018420701
Hospital Revenue Code	301
Min. Negotiated Rate	$26.36
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$28.10
Rate for Payer: AlohaCare Medicare	$28.10
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$30.91
Rate for Payer: Hawaii Medical Service Association ABD	$26.36
Rate for Payer: Hawaii Medical Service Association Commercial	$35.12
Rate for Payer: Hawaii Medical Service Association Medicare	$28.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.68
Rate for Payer: Hawaii Western Management Group Commercial	$28.10
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$28.10
Rate for Payer: Kaiser Permanente Commercial	$148.68
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$28.10
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$30.91
Rate for Payer: Ohana Health Plan Medicare	$28.10
Rate for Payer: UnitedHealthcare Medicaid	$26.36
Rate for Payer: UnitedHealthcare Medicare	$28.10
Rate for Payer: University Health Alliance Commercial	$49.30

HC ASSAY OF VITAMIN B-6 - VITAMIN B6

Facility

$236.00

Service Code	HCPCS 84207
Hospital Charge Code	3018420701
Hospital Revenue Code	301
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: MDX Hawaii PPO	$228.92

HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VIT D 250H D2 D3 SO

Facility

$248.00

Service Code	HCPCS 82306
Hospital Charge Code	3018230601
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$29.60
Rate for Payer: AlohaCare Medicare	$29.60
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Devoted Health Medicare	$32.56
Rate for Payer: Hawaii Medical Service Association ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Medicare	$29.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.96
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$29.60
Rate for Payer: Kaiser Permanente Commercial	$156.24
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$29.60
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$32.56
Rate for Payer: Ohana Health Plan Medicare	$29.60
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: UnitedHealthcare Medicare	$29.60
Rate for Payer: University Health Alliance Commercial	$76.52

HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VIT D 250H D2 D3 SO

Facility

$248.00

Service Code	HCPCS 82306
Hospital Charge Code	3018230601
Hospital Revenue Code	301
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$148.80
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: MDX Hawaii PPO	$240.56

HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VIT D 25OH INC FRAC

Facility

$248.00

Service Code	HCPCS 82306
Hospital Charge Code	3018230602
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$29.60
Rate for Payer: AlohaCare Medicare	$29.60
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Devoted Health Medicare	$32.56
Rate for Payer: Hawaii Medical Service Association ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Medicare	$29.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.96
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$29.60
Rate for Payer: Kaiser Permanente Commercial	$156.24
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$29.60
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$32.56
Rate for Payer: Ohana Health Plan Medicare	$29.60
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: UnitedHealthcare Medicare	$29.60
Rate for Payer: University Health Alliance Commercial	$76.52

HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VIT D 25OH INC FRAC

Facility

$248.00

Service Code	HCPCS 82306
Hospital Charge Code	3018230602
Hospital Revenue Code	301
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$148.80
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: MDX Hawaii PPO	$240.56

HC ASSAY OTHER FLUID CHLORIDES - CHLORIDE, CSF

Facility

$42.00

Service Code	HCPCS 82438
Hospital Charge Code	3018243802
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$40.74
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$5.00
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Devoted Health Medicare	$5.50
Rate for Payer: Hawaii Medical Service Association ABD	$6.76
Rate for Payer: Hawaii Medical Service Association Commercial	$6.25
Rate for Payer: Hawaii Medical Service Association Medicare	$5.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.10
Rate for Payer: Hawaii Western Management Group Commercial	$5.00
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Humana Medicare	$5.00
Rate for Payer: Kaiser Permanente Commercial	$26.46
Rate for Payer: Kaiser Permanente Medicaid	$21.42
Rate for Payer: Kaiser Permanente Medicare	$5.00
Rate for Payer: MDX Hawaii PPO	$40.74
Rate for Payer: Ohana Health Plan Medicaid	$5.50
Rate for Payer: Ohana Health Plan Medicare	$5.00
Rate for Payer: UnitedHealthcare Medicaid	$6.76
Rate for Payer: UnitedHealthcare Medicare	$5.00
Rate for Payer: University Health Alliance Commercial	$12.64

HC ASSAY OTHER FLUID CHLORIDES - CHLORIDE, CSF

Facility

$42.00

Service Code	HCPCS 82438
Hospital Charge Code	3018243802
Hospital Revenue Code	301
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$25.20
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: MDX Hawaii PPO	$40.74

HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE BLOOD QT

Facility

$33.00

Service Code	HCPCS 82947
Hospital Charge Code	3018294701
Hospital Revenue Code	301
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$32.01
Rate for Payer: AlohaCare Medicaid	$3.93
Rate for Payer: AlohaCare Medicare	$3.93
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Devoted Health Medicare	$4.32
Rate for Payer: Hawaii Medical Service Association ABD	$5.42
Rate for Payer: Hawaii Medical Service Association Commercial	$4.91
Rate for Payer: Hawaii Medical Service Association Medicare	$3.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.69
Rate for Payer: Hawaii Western Management Group Commercial	$3.93
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Humana Medicare	$3.93
Rate for Payer: Kaiser Permanente Commercial	$20.79
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: Kaiser Permanente Medicare	$3.93
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: Ohana Health Plan Medicaid	$4.32
Rate for Payer: Ohana Health Plan Medicare	$3.93
Rate for Payer: UnitedHealthcare Medicaid	$5.42
Rate for Payer: UnitedHealthcare Medicare	$3.93
Rate for Payer: University Health Alliance Commercial	$10.14

HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE BLOOD QT

Facility

$33.00

Service Code	HCPCS 82947
Hospital Charge Code	3018294701
Hospital Revenue Code	301
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: MDX Hawaii PPO	$32.01

Know your out-of-pocket cost for care.

All Charges