Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC BILIRUBIN TOTAL - BILIRUBIN TOTAL

Facility

$42.00

Service Code	HCPCS 82247
Hospital Charge Code	3018224703
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 BILIRUBIN TOTAL - POCT BILIRUBINOMETRY

Facility

$42.00

Service Code	HCPCS 82247
Hospital Charge Code	3018224707
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$40.74
Rate for Payer: AlohaCare Medicaid	$5.02
Rate for Payer: AlohaCare Medicare	$5.02
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Devoted Health Medicare	$5.52
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$5.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Humana Medicare	$5.02
Rate for Payer: Kaiser Permanente Commercial	$26.46
Rate for Payer: Kaiser Permanente Medicaid	$21.42
Rate for Payer: Kaiser Permanente Medicare	$5.02
Rate for Payer: MDX Hawaii PPO	$40.74
Rate for Payer: Ohana Health Plan Medicaid	$5.52
Rate for Payer: Ohana Health Plan Medicare	$5.02
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$5.02
Rate for Payer: University Health Alliance Commercial	$12.99

HC BILIRUBIN TOTAL - POCT BILIRUBINOMETRY

Facility

$42.00

Service Code	HCPCS 82247
Hospital Charge Code	3018224707
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 BIOPSY OF KIDNEY,PERCUTANEOUS

Facility

$6,448.00

Service Code	HCPCS 50200
Hospital Charge Code	3615020001
Hospital Revenue Code	361
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC BIOPSY OF KIDNEY,PERCUTANEOUS

Facility

$6,448.00

Service Code	HCPCS 50200
Hospital Charge Code	3615020001
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,699.95

HC BIOPSY OF THYROID,PERCUT

Facility

$2,800.00

Service Code	HCPCS 60100
Hospital Charge Code	3616010001
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
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	$4,035.20

HC BIOPSY OF THYROID,PERCUT

Facility

$2,800.00

Service Code	HCPCS 60100
Hospital Charge Code	3616010001
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 BIOPSY PROSTATE INCISIONAL ANY APPROACH

Facility

$12,136.00

Service Code	HCPCS 55705
Hospital Charge Code	3615570501
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,771.92
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Commercial	$7,645.68
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: MDX Hawaii PPO	$11,771.92
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$8,845.93

HC BIOPSY PROSTATE INCISIONAL ANY APPROACH

Facility

$12,136.00

Service Code	HCPCS 55705
Hospital Charge Code	3615570501
Hospital Revenue Code	361
Min. Negotiated Rate	$10,315.60
Max. Negotiated Rate	$11,771.92
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: MDX Hawaii PPO	$11,771.92

HC BIOPSY PROSTATE TRANSRECTAL ULTRASOUND-GUIDED

Facility

$12,136.00

Service Code	HCPCS 55707
Hospital Charge Code	3615570701
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,771.92
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Commercial	$7,645.68
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: MDX Hawaii PPO	$11,771.92
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$8,845.93

HC BIOPSY PROSTATE TRANSRECTAL ULTRASOUND-GUIDED

Facility

$12,136.00

Service Code	HCPCS 55707
Hospital Charge Code	3615570701
Hospital Revenue Code	361
Min. Negotiated Rate	$10,315.60
Max. Negotiated Rate	$11,771.92
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: MDX Hawaii PPO	$11,771.92

HC BIOPSY SALIVARY GLAND,NEEDLE

Facility

$2,800.00

Service Code	HCPCS 42400
Hospital Charge Code	3614240001
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 BIOPSY SALIVARY GLAND,NEEDLE

Facility

$2,800.00

Service Code	HCPCS 42400
Hospital Charge Code	3614240001
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 BIOPSY SOFT TISSUE NECK/CHEST

Facility

$6,448.00

Service Code	HCPCS 21550
Hospital Charge Code	3612155001
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,699.95

HC BIOPSY SOFT TISSUE NECK/CHEST

Facility

$6,448.00

Service Code	HCPCS 21550
Hospital Charge Code	3612155001
Hospital Revenue Code	361
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL

Facility

$8,060.00

Service Code	HCPCS 27040
Hospital Charge Code	3612704001
Hospital Revenue Code	402
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$7,818.20
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$4,836.00
Rate for Payer: Cash Price	$4,836.00
Rate for Payer: Cash Price	$4,836.00
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Western Management Group Commercial	$7,657.00
Rate for Payer: Health Management Network Commercial	$6,851.00
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$5,077.80
Rate for Payer: Kaiser Permanente Medicaid	$4,110.60
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$7,818.20
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL

Facility

$8,060.00

Service Code	HCPCS 27040
Hospital Charge Code	3612704001
Hospital Revenue Code	402
Min. Negotiated Rate	$6,851.00
Max. Negotiated Rate	$7,818.20
Rate for Payer: Cash Price	$4,836.00
Rate for Payer: Health Management Network Commercial	$6,851.00
Rate for Payer: MDX Hawaii PPO	$7,818.20

HC BLOOD COUNT AUTO DIFF

Facility

$54.00

Service Code	HCPCS 85004
Hospital Charge Code	3058500401
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$52.38
Rate for Payer: AlohaCare Medicaid	$6.47
Rate for Payer: AlohaCare Medicare	$6.47
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Devoted Health Medicare	$7.12
Rate for Payer: Hawaii Medical Service Association ABD	$9.04
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Medicare	$6.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.49
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: Humana Medicare	$6.47
Rate for Payer: Kaiser Permanente Commercial	$34.02
Rate for Payer: Kaiser Permanente Medicaid	$27.54
Rate for Payer: Kaiser Permanente Medicare	$6.47
Rate for Payer: MDX Hawaii PPO	$52.38
Rate for Payer: Ohana Health Plan Medicaid	$7.12
Rate for Payer: Ohana Health Plan Medicare	$6.47
Rate for Payer: UnitedHealthcare Medicaid	$9.04
Rate for Payer: UnitedHealthcare Medicare	$6.47
Rate for Payer: University Health Alliance Commercial	$16.72

HC BLOOD COUNT AUTO DIFF

Facility

$54.00

Service Code	HCPCS 85004
Hospital Charge Code	3058500401
Hospital Revenue Code	305
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$32.40
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$52.38

HC BLOOD FOLIC ACID SERUM - FOLATE

Facility

$123.00

Service Code	HCPCS 82746
Hospital Charge Code	3018274601
Hospital Revenue Code	301
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$119.31
Rate for Payer: AlohaCare Medicaid	$14.70
Rate for Payer: AlohaCare Medicare	$14.70
Rate for Payer: Cash Price	$73.80
Rate for Payer: Cash Price	$73.80
Rate for Payer: Devoted Health Medicare	$16.17
Rate for Payer: Hawaii Medical Service Association ABD	$20.32
Rate for Payer: Hawaii Medical Service Association Commercial	$18.38
Rate for Payer: Hawaii Medical Service Association Medicare	$14.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.34
Rate for Payer: Hawaii Western Management Group Commercial	$14.70
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: Humana Medicare	$14.70
Rate for Payer: Kaiser Permanente Commercial	$77.49
Rate for Payer: Kaiser Permanente Medicaid	$62.73
Rate for Payer: Kaiser Permanente Medicare	$14.70
Rate for Payer: MDX Hawaii PPO	$119.31
Rate for Payer: Ohana Health Plan Medicaid	$16.17
Rate for Payer: Ohana Health Plan Medicare	$14.70
Rate for Payer: UnitedHealthcare Medicaid	$20.32
Rate for Payer: UnitedHealthcare Medicare	$14.70
Rate for Payer: University Health Alliance Commercial	$38.00

HC BLOOD FOLIC ACID SERUM - FOLATE

Facility

$123.00

Service Code	HCPCS 82746
Hospital Charge Code	3018274601
Hospital Revenue Code	301
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$119.31
Rate for Payer: Cash Price	$73.80
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: MDX Hawaii PPO	$119.31

HC BLOOD GAS CORD ART BLD WO2

Facility

$661.00

Service Code	HCPCS 82805
Hospital Charge Code	3018280503
Hospital Revenue Code	301
Min. Negotiated Rate	$561.85
Max. Negotiated Rate	$641.17
Rate for Payer: Cash Price	$396.60
Rate for Payer: Health Management Network Commercial	$561.85
Rate for Payer: MDX Hawaii PPO	$641.17

HC BLOOD GAS CORD ART BLD WO2

Facility

$661.00

Service Code	HCPCS 82805
Hospital Charge Code	3018280503
Hospital Revenue Code	301
Min. Negotiated Rate	$39.21
Max. Negotiated Rate	$641.17
Rate for Payer: AlohaCare Medicaid	$78.77
Rate for Payer: AlohaCare Medicare	$78.77
Rate for Payer: Cash Price	$396.60
Rate for Payer: Cash Price	$396.60
Rate for Payer: Devoted Health Medicare	$86.65
Rate for Payer: Hawaii Medical Service Association ABD	$39.21
Rate for Payer: Hawaii Medical Service Association Commercial	$98.46
Rate for Payer: Hawaii Medical Service Association Medicare	$78.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.17
Rate for Payer: Hawaii Western Management Group Commercial	$78.77
Rate for Payer: Health Management Network Commercial	$561.85
Rate for Payer: Humana Medicare	$78.77
Rate for Payer: Kaiser Permanente Commercial	$416.43
Rate for Payer: Kaiser Permanente Medicaid	$337.11
Rate for Payer: Kaiser Permanente Medicare	$78.77
Rate for Payer: MDX Hawaii PPO	$641.17
Rate for Payer: Ohana Health Plan Medicaid	$86.65
Rate for Payer: Ohana Health Plan Medicare	$78.77
Rate for Payer: UnitedHealthcare Medicaid	$39.21
Rate for Payer: UnitedHealthcare Medicare	$78.77
Rate for Payer: University Health Alliance Commercial	$73.35

HC BLOOD GAS CORD VENOUS WO2

Facility

$661.00

Service Code	HCPCS 82805
Hospital Charge Code	3018280504
Hospital Revenue Code	301
Min. Negotiated Rate	$39.21
Max. Negotiated Rate	$641.17
Rate for Payer: AlohaCare Medicaid	$78.77
Rate for Payer: AlohaCare Medicare	$78.77
Rate for Payer: Cash Price	$396.60
Rate for Payer: Cash Price	$396.60
Rate for Payer: Devoted Health Medicare	$86.65
Rate for Payer: Hawaii Medical Service Association ABD	$39.21
Rate for Payer: Hawaii Medical Service Association Commercial	$98.46
Rate for Payer: Hawaii Medical Service Association Medicare	$78.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.17
Rate for Payer: Hawaii Western Management Group Commercial	$78.77
Rate for Payer: Health Management Network Commercial	$561.85
Rate for Payer: Humana Medicare	$78.77
Rate for Payer: Kaiser Permanente Commercial	$416.43
Rate for Payer: Kaiser Permanente Medicaid	$337.11
Rate for Payer: Kaiser Permanente Medicare	$78.77
Rate for Payer: MDX Hawaii PPO	$641.17
Rate for Payer: Ohana Health Plan Medicaid	$86.65
Rate for Payer: Ohana Health Plan Medicare	$78.77
Rate for Payer: UnitedHealthcare Medicaid	$39.21
Rate for Payer: UnitedHealthcare Medicare	$78.77
Rate for Payer: University Health Alliance Commercial	$73.35

HC BLOOD GAS CORD VENOUS WO2

Facility

$661.00

Service Code	HCPCS 82805
Hospital Charge Code	3018280504
Hospital Revenue Code	301
Min. Negotiated Rate	$561.85
Max. Negotiated Rate	$641.17
Rate for Payer: Cash Price	$396.60
Rate for Payer: Health Management Network Commercial	$561.85
Rate for Payer: MDX Hawaii PPO	$641.17

Know your out-of-pocket cost for care.

All Charges