Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC BLOOD TYPING SEROLOGIC ABO - BLD TYPING ABO

Facility

$1,277.00

Service Code	HCPCS 86900
Hospital Charge Code	3008690002
Hospital Revenue Code	300
Min. Negotiated Rate	$1,085.45
Max. Negotiated Rate	$1,238.69
Rate for Payer: Cash Price	$766.20
Rate for Payer: Health Management Network Commercial	$1,085.45
Rate for Payer: MDX Hawaii PPO	$1,238.69

HC BLOOD TYPING SEROLOGIC ABO - BLD TYPING ABO SO

Facility

$1,277.00

Service Code	HCPCS 86900
Hospital Charge Code	3008690001
Hospital Revenue Code	300
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$1,238.69
Rate for Payer: AlohaCare Medicaid	$2.99
Rate for Payer: AlohaCare Medicare	$2.99
Rate for Payer: Cash Price	$766.20
Rate for Payer: Cash Price	$766.20
Rate for Payer: Devoted Health Medicare	$3.29
Rate for Payer: Hawaii Medical Service Association ABD	$4.12
Rate for Payer: Hawaii Medical Service Association Commercial	$3.74
Rate for Payer: Hawaii Medical Service Association Medicare	$2.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.33
Rate for Payer: Hawaii Western Management Group Commercial	$2.99
Rate for Payer: Health Management Network Commercial	$1,085.45
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Kaiser Permanente Commercial	$804.51
Rate for Payer: Kaiser Permanente Medicaid	$651.27
Rate for Payer: Kaiser Permanente Medicare	$2.99
Rate for Payer: MDX Hawaii PPO	$1,238.69
Rate for Payer: Ohana Health Plan Medicaid	$3.29
Rate for Payer: Ohana Health Plan Medicare	$2.99
Rate for Payer: UnitedHealthcare Medicaid	$4.12
Rate for Payer: UnitedHealthcare Medicare	$2.99
Rate for Payer: University Health Alliance Commercial	$7.71

HC BLOOD TYPING SEROLOGIC ABO - BLD TYPING ABO SO

Facility

$1,277.00

Service Code	HCPCS 86900
Hospital Charge Code	3008690001
Hospital Revenue Code	300
Min. Negotiated Rate	$1,085.45
Max. Negotiated Rate	$1,238.69
Rate for Payer: Cash Price	$766.20
Rate for Payer: Health Management Network Commercial	$1,085.45
Rate for Payer: MDX Hawaii PPO	$1,238.69

HC BLOOD TYPING SEROLOGIC RH (D)

Facility

$389.00

Service Code	HCPCS 86901
Hospital Charge Code	3008690101
Hospital Revenue Code	300
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$377.33
Rate for Payer: AlohaCare Medicaid	$2.99
Rate for Payer: AlohaCare Medicare	$2.99
Rate for Payer: Cash Price	$233.40
Rate for Payer: Cash Price	$233.40
Rate for Payer: Devoted Health Medicare	$3.29
Rate for Payer: Hawaii Medical Service Association ABD	$8.22
Rate for Payer: Hawaii Medical Service Association Commercial	$3.74
Rate for Payer: Hawaii Medical Service Association Medicare	$2.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.63
Rate for Payer: Hawaii Western Management Group Commercial	$2.99
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Kaiser Permanente Commercial	$245.07
Rate for Payer: Kaiser Permanente Medicaid	$198.39
Rate for Payer: Kaiser Permanente Medicare	$2.99
Rate for Payer: MDX Hawaii PPO	$377.33
Rate for Payer: Ohana Health Plan Medicaid	$3.29
Rate for Payer: Ohana Health Plan Medicare	$2.99
Rate for Payer: UnitedHealthcare Medicaid	$8.22
Rate for Payer: UnitedHealthcare Medicare	$2.99
Rate for Payer: University Health Alliance Commercial	$7.71

HC BLOOD TYPING SEROLOGIC RH (D)

Facility

$389.00

Service Code	HCPCS 86901
Hospital Charge Code	3008690101
Hospital Revenue Code	300
Min. Negotiated Rate	$330.65
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$233.40
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: MDX Hawaii PPO	$377.33

HC BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM

Facility

$98.00

Service Code	HCPCS 85810
Hospital Charge Code	3058581001
Hospital Revenue Code	305
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$95.06
Rate for Payer: AlohaCare Medicaid	$11.67
Rate for Payer: AlohaCare Medicare	$11.67
Rate for Payer: Cash Price	$58.80
Rate for Payer: Cash Price	$58.80
Rate for Payer: Devoted Health Medicare	$12.84
Rate for Payer: Hawaii Medical Service Association ABD	$16.14
Rate for Payer: Hawaii Medical Service Association Commercial	$14.59
Rate for Payer: Hawaii Medical Service Association Medicare	$11.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.95
Rate for Payer: Hawaii Western Management Group Commercial	$11.67
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Humana Medicare	$11.67
Rate for Payer: Kaiser Permanente Commercial	$61.74
Rate for Payer: Kaiser Permanente Medicaid	$49.98
Rate for Payer: Kaiser Permanente Medicare	$11.67
Rate for Payer: MDX Hawaii PPO	$95.06
Rate for Payer: Ohana Health Plan Medicaid	$12.84
Rate for Payer: Ohana Health Plan Medicare	$11.67
Rate for Payer: UnitedHealthcare Medicaid	$16.14
Rate for Payer: UnitedHealthcare Medicare	$11.67
Rate for Payer: University Health Alliance Commercial	$30.19

HC BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM

Facility

$98.00

Service Code	HCPCS 85810
Hospital Charge Code	3058581001
Hospital Revenue Code	305
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$58.80
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: MDX Hawaii PPO	$95.06

HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF

Facility

$47.00

Service Code	HCPCS 89051
Hospital Charge Code	3008905102
Hospital Revenue Code	300
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$45.59
Rate for Payer: AlohaCare Medicaid	$5.60
Rate for Payer: AlohaCare Medicare	$5.60
Rate for Payer: Cash Price	$28.20
Rate for Payer: Cash Price	$28.20
Rate for Payer: Devoted Health Medicare	$6.16
Rate for Payer: Hawaii Medical Service Association ABD	$7.61
Rate for Payer: Hawaii Medical Service Association Commercial	$7.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.99
Rate for Payer: Hawaii Western Management Group Commercial	$5.60
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$5.60
Rate for Payer: Kaiser Permanente Commercial	$29.61
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$5.60
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$6.16
Rate for Payer: Ohana Health Plan Medicare	$5.60
Rate for Payer: UnitedHealthcare Medicaid	$7.61
Rate for Payer: UnitedHealthcare Medicare	$5.60
Rate for Payer: University Health Alliance Commercial	$14.24

HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF

Facility

$47.00

Service Code	HCPCS 89051
Hospital Charge Code	3008905102
Hospital Revenue Code	300
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$45.59

HC BODY FLUID CELL COUNT W DIFF - SYNOVIAL FLUID CELL COUNT

Facility

$47.00

Service Code	HCPCS 89051
Hospital Charge Code	3008905101
Hospital Revenue Code	300
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$45.59
Rate for Payer: AlohaCare Medicaid	$5.60
Rate for Payer: AlohaCare Medicare	$5.60
Rate for Payer: Cash Price	$28.20
Rate for Payer: Cash Price	$28.20
Rate for Payer: Devoted Health Medicare	$6.16
Rate for Payer: Hawaii Medical Service Association ABD	$7.61
Rate for Payer: Hawaii Medical Service Association Commercial	$7.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.99
Rate for Payer: Hawaii Western Management Group Commercial	$5.60
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$5.60
Rate for Payer: Kaiser Permanente Commercial	$29.61
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$5.60
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$6.16
Rate for Payer: Ohana Health Plan Medicare	$5.60
Rate for Payer: UnitedHealthcare Medicaid	$7.61
Rate for Payer: UnitedHealthcare Medicare	$5.60
Rate for Payer: University Health Alliance Commercial	$14.24

HC BODY FLUID CELL COUNT W DIFF - SYNOVIAL FLUID CELL COUNT

Facility

$47.00

Service Code	HCPCS 89051
Hospital Charge Code	3008905101
Hospital Revenue Code	300
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$45.59

HC BODY FLUID SPECIFIC GRAVITY - SPECIFIC GRAVITY BODY FLUID

Facility

$28.00

Service Code	HCPCS 84315
Hospital Charge Code	3018431501
Hospital Revenue Code	301
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$3.28
Rate for Payer: AlohaCare Medicare	$3.28
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Devoted Health Medicare	$3.61
Rate for Payer: Hawaii Medical Service Association ABD	$2.10
Rate for Payer: Hawaii Medical Service Association Commercial	$4.10
Rate for Payer: Hawaii Medical Service Association Medicare	$3.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.46
Rate for Payer: Hawaii Western Management Group Commercial	$3.28
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$3.28
Rate for Payer: Kaiser Permanente Commercial	$17.64
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$3.28
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$3.61
Rate for Payer: Ohana Health Plan Medicare	$3.28
Rate for Payer: UnitedHealthcare Medicaid	$2.10
Rate for Payer: UnitedHealthcare Medicare	$3.28
Rate for Payer: University Health Alliance Commercial	$6.47

HC BODY FLUID SPECIFIC GRAVITY - SPECIFIC GRAVITY BODY FLUID

Facility

$28.00

Service Code	HCPCS 84315
Hospital Charge Code	3018431501
Hospital Revenue Code	301
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: MDX Hawaii PPO	$27.16

HC BONE BIOPSY,TROCAR/NEEDLE DEEP

Facility

$6,448.00

Service Code	HCPCS 20225
Hospital Charge Code	3612022501
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	$5,160.40

HC BONE BIOPSY,TROCAR/NEEDLE DEEP

Facility

$6,448.00

Service Code	HCPCS 20225
Hospital Charge Code	3612022501
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 BONE BIOPSY,TROCAR/NEEDLE SUPERF

Facility

$6,448.00

Service Code	HCPCS 20220
Hospital Charge Code	3612022001
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
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	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC BONE BIOPSY,TROCAR/NEEDLE SUPERF

Facility

$6,448.00

Service Code	HCPCS 20220
Hospital Charge Code	3612022001
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 BONE IMAGING, 3 PHASE - NM BONE WHOLE BODY 3 PHASE

Facility

$1,999.00

Service Code	HCPCS 78315
Hospital Charge Code	3417831501
Hospital Revenue Code	341
Min. Negotiated Rate	$157.41
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$157.41
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$171.14
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$157.41
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$596.94

HC BONE IMAGING, 3 PHASE - NM BONE WHOLE BODY 3 PHASE

Facility

$1,999.00

Service Code	HCPCS 78315
Hospital Charge Code	3417831501
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC BONE IMAGING, LIMITED AREA - NM BONE LIMITED

Facility

$1,999.00

Service Code	HCPCS 78300
Hospital Charge Code	3417830001
Hospital Revenue Code	341
Min. Negotiated Rate	$82.23
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$82.23
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$89.47
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$82.23
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$324.68

HC BONE IMAGING, LIMITED AREA - NM BONE LIMITED

Facility

$1,999.00

Service Code	HCPCS 78300
Hospital Charge Code	3417830001
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC BONE IMAGING, MULTIPLE AREAS - NM BONE MULTIPLE AREAS

Facility

$1,999.00

Service Code	HCPCS 78305
Hospital Charge Code	3417830501
Hospital Revenue Code	341
Min. Negotiated Rate	$120.66
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$120.66
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$131.22
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$120.66
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$440.60

HC BONE IMAGING, MULTIPLE AREAS - NM BONE MULTIPLE AREAS

Facility

$1,999.00

Service Code	HCPCS 78305
Hospital Charge Code	3417830501
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC BONE IMAGING, WHOLE BODY - NM BONE WHOLE BODY

Facility

$1,999.00

Service Code	HCPCS 78306
Hospital Charge Code	3417830601
Hospital Revenue Code	341
Min. Negotiated Rate	$140.75
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$140.75
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$152.96
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$140.75
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$493.12

HC BONE IMAGING, WHOLE BODY - NM BONE WHOLE BODY

Facility

$1,999.00

Service Code	HCPCS 78306
Hospital Charge Code	3417830601
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

Know your out-of-pocket cost for care.

All Charges