Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CLOSE RX FINGR ARTICULAR FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 26742
Hospital Charge Code	4502674201
Hospital Revenue Code	450
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC CLOSE RX FINGR ARTICULAR FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 26742
Hospital Charge Code	4502674201
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$6,177.93
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,089.55
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,050.55
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$4,012.47
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$4,642.36

HC CLOSE RX PROX/MID FING SHFT FX

Facility

$955.00

Service Code	HCPCS 26720
Hospital Charge Code	7612672001
Hospital Revenue Code	450
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: MDX Hawaii PPO	$926.35

HC CLOSE RX PROX/MID FING SHFT FX

Facility

$955.00

Service Code	HCPCS 26720
Hospital Charge Code	7612672001
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$601.65
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$696.10

HC CLOSE RX PROX/MID FING SHFT FX,MANIP

Facility

$955.00

Service Code	HCPCS 26725
Hospital Charge Code	4502672501
Hospital Revenue Code	450
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: MDX Hawaii PPO	$926.35

HC CLOSE RX PROX/MID FING SHFT FX,MANIP

Facility

$955.00

Service Code	HCPCS 26725
Hospital Charge Code	4502672501
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$601.65
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$696.10

HC CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS

Facility

$924.00

Service Code	HCPCS 40830
Hospital Charge Code	4504083001
Hospital Revenue Code	450
Min. Negotiated Rate	$785.40
Max. Negotiated Rate	$896.28
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Management Network Commercial	$785.40
Rate for Payer: MDX Hawaii PPO	$896.28

HC CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS

Facility

$924.00

Service Code	HCPCS 40830
Hospital Charge Code	4504083001
Hospital Revenue Code	450
Min. Negotiated Rate	$279.80
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$279.80
Rate for Payer: AlohaCare Medicare	$279.80
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Devoted Health Medicare	$307.78
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	$279.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$877.80
Rate for Payer: Health Management Network Commercial	$785.40
Rate for Payer: Humana Medicare	$279.80
Rate for Payer: Kaiser Permanente Commercial	$582.12
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$279.80
Rate for Payer: MDX Hawaii PPO	$896.28
Rate for Payer: Ohana Health Plan Medicaid	$307.78
Rate for Payer: Ohana Health Plan Medicare	$279.80
Rate for Payer: UnitedHealthcare Medicare	$279.80
Rate for Payer: University Health Alliance Commercial	$673.50

HC CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM

Facility

$1,984.00

Service Code	HCPCS 40831
Hospital Charge Code	4504083101
Hospital Revenue Code	450
Min. Negotiated Rate	$1,686.40
Max. Negotiated Rate	$1,924.48
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: MDX Hawaii PPO	$1,924.48

HC CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM

Facility

$1,984.00

Service Code	HCPCS 40831
Hospital Charge Code	4504083101
Hospital Revenue Code	450
Min. Negotiated Rate	$637.13
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$637.13
Rate for Payer: AlohaCare Medicare	$637.13
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Devoted Health Medicare	$700.84
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	$637.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,884.80
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: Humana Medicare	$637.13
Rate for Payer: Kaiser Permanente Commercial	$1,249.92
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$637.13
Rate for Payer: MDX Hawaii PPO	$1,924.48
Rate for Payer: Ohana Health Plan Medicaid	$700.84
Rate for Payer: Ohana Health Plan Medicare	$637.13
Rate for Payer: UnitedHealthcare Medicare	$637.13
Rate for Payer: University Health Alliance Commercial	$1,446.14

HC CLOSURE OF SPLIT WOUND

Facility

$1,590.00

Service Code	HCPCS 12021
Hospital Charge Code	4501202101
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,510.50
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,001.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$1,542.30
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$1,158.95

HC CLOSURE OF SPLIT WOUND

Facility

$1,590.00

Service Code	HCPCS 12021
Hospital Charge Code	4501202101
Hospital Revenue Code	450
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$1,542.30
Rate for Payer: Cash Price	$954.00
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: MDX Hawaii PPO	$1,542.30

HC CLOSURE SUPERF WND DEHIS SIMPLE

Facility

$2,436.00

Service Code	HCPCS 12020
Hospital Charge Code	4501202001
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,362.92
Rate for Payer: AlohaCare Medicaid	$873.10
Rate for Payer: AlohaCare Medicare	$873.10
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Devoted Health Medicare	$960.41
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$873.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,314.20
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: Humana Medicare	$873.10
Rate for Payer: Kaiser Permanente Commercial	$1,534.68
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$873.10
Rate for Payer: MDX Hawaii PPO	$2,362.92
Rate for Payer: Ohana Health Plan Medicaid	$960.41
Rate for Payer: Ohana Health Plan Medicare	$873.10
Rate for Payer: UnitedHealthcare Medicare	$873.10
Rate for Payer: University Health Alliance Commercial	$1,775.60

HC CLOSURE SUPERF WND DEHIS SIMPLE

Facility

$2,436.00

Service Code	HCPCS 12020
Hospital Charge Code	4501202001
Hospital Revenue Code	450
Min. Negotiated Rate	$2,070.60
Max. Negotiated Rate	$2,362.92
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: MDX Hawaii PPO	$2,362.92

HC CLOT FACTOR IX PTC/CHRSTMAS - FACTOR 9 ACTIVITY

Facility

$160.00

Service Code	HCPCS 85250
Hospital Charge Code	3058525001
Hospital Revenue Code	305
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$19.04
Rate for Payer: AlohaCare Medicare	$19.04
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Devoted Health Medicare	$20.94
Rate for Payer: Hawaii Medical Service Association ABD	$26.31
Rate for Payer: Hawaii Medical Service Association Commercial	$23.80
Rate for Payer: Hawaii Medical Service Association Medicare	$19.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.63
Rate for Payer: Hawaii Western Management Group Commercial	$19.04
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$19.04
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$19.04
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$20.94
Rate for Payer: Ohana Health Plan Medicare	$19.04
Rate for Payer: UnitedHealthcare Medicaid	$26.31
Rate for Payer: UnitedHealthcare Medicare	$19.04
Rate for Payer: University Health Alliance Commercial	$49.21

HC CLOT FACTOR IX PTC/CHRSTMAS - FACTOR 9 ACTIVITY

Facility

$160.00

Service Code	HCPCS 85250
Hospital Charge Code	3058525001
Hospital Revenue Code	305
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: MDX Hawaii PPO	$155.20

HC CLOT FACTOR VIII AHG 1 STAGE - FACTOR VIII ONE STAGE

Facility

$150.00

Service Code	HCPCS 85240
Hospital Charge Code	3058524001
Hospital Revenue Code	305
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: MDX Hawaii PPO	$145.50

HC CLOT FACTOR VIII AHG 1 STAGE - FACTOR VIII ONE STAGE

Facility

$150.00

Service Code	HCPCS 85240
Hospital Charge Code	3058524001
Hospital Revenue Code	305
Min. Negotiated Rate	$17.90
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$17.90
Rate for Payer: AlohaCare Medicare	$17.90
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Devoted Health Medicare	$19.69
Rate for Payer: Hawaii Medical Service Association ABD	$24.75
Rate for Payer: Hawaii Medical Service Association Commercial	$22.38
Rate for Payer: Hawaii Medical Service Association Medicare	$17.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25.99
Rate for Payer: Hawaii Western Management Group Commercial	$17.90
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$17.90
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$17.90
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$19.69
Rate for Payer: Ohana Health Plan Medicare	$17.90
Rate for Payer: UnitedHealthcare Medicaid	$24.75
Rate for Payer: UnitedHealthcare Medicare	$17.90
Rate for Payer: University Health Alliance Commercial	$46.29

HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN

Facility

$192.00

Service Code	HCPCS 85246
Hospital Charge Code	3058524603
Hospital Revenue Code	305
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$22.94
Rate for Payer: AlohaCare Medicare	$22.94
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Devoted Health Medicare	$25.23
Rate for Payer: Hawaii Medical Service Association ABD	$31.72
Rate for Payer: Hawaii Medical Service Association Commercial	$28.68
Rate for Payer: Hawaii Medical Service Association Medicare	$22.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.31
Rate for Payer: Hawaii Western Management Group Commercial	$22.94
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$22.94
Rate for Payer: Kaiser Permanente Commercial	$120.96
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$22.94
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$25.23
Rate for Payer: Ohana Health Plan Medicare	$22.94
Rate for Payer: UnitedHealthcare Medicaid	$31.72
Rate for Payer: UnitedHealthcare Medicare	$22.94
Rate for Payer: University Health Alliance Commercial	$59.31

HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN

Facility

$192.00

Service Code	HCPCS 85246
Hospital Charge Code	3058524603
Hospital Revenue Code	305
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$115.20
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: MDX Hawaii PPO	$186.24

HC CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY

Facility

$116.00

Service Code	HCPCS 85303
Hospital Charge Code	3058530301
Hospital Revenue Code	305
Min. Negotiated Rate	$98.60
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$69.60
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: MDX Hawaii PPO	$112.52

HC CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY

Facility

$116.00

Service Code	HCPCS 85303
Hospital Charge Code	3058530301
Hospital Revenue Code	305
Min. Negotiated Rate	$13.84
Max. Negotiated Rate	$112.52
Rate for Payer: AlohaCare Medicaid	$13.84
Rate for Payer: AlohaCare Medicare	$13.84
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$69.60
Rate for Payer: Devoted Health Medicare	$15.22
Rate for Payer: Hawaii Medical Service Association ABD	$19.11
Rate for Payer: Hawaii Medical Service Association Commercial	$17.30
Rate for Payer: Hawaii Medical Service Association Medicare	$13.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.07
Rate for Payer: Hawaii Western Management Group Commercial	$13.84
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Humana Medicare	$13.84
Rate for Payer: Kaiser Permanente Commercial	$73.08
Rate for Payer: Kaiser Permanente Medicaid	$59.16
Rate for Payer: Kaiser Permanente Medicare	$13.84
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: Ohana Health Plan Medicaid	$15.22
Rate for Payer: Ohana Health Plan Medicare	$13.84
Rate for Payer: UnitedHealthcare Medicaid	$19.11
Rate for Payer: UnitedHealthcare Medicare	$13.84
Rate for Payer: University Health Alliance Commercial	$35.74

HC CLOT INHIB PROTEIN C,ANTIGEN - PROTEIN C ANTIGEN TOTAL

Facility

$101.00

Service Code	HCPCS 85302
Hospital Charge Code	3058530201
Hospital Revenue Code	305
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: MDX Hawaii PPO	$97.97

HC CLOT INHIB PROTEIN C,ANTIGEN - PROTEIN C ANTIGEN TOTAL

Facility

$101.00

Service Code	HCPCS 85302
Hospital Charge Code	3058530201
Hospital Revenue Code	305
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$12.01
Rate for Payer: AlohaCare Medicare	$12.01
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.21
Rate for Payer: Hawaii Medical Service Association ABD	$16.61
Rate for Payer: Hawaii Medical Service Association Commercial	$15.01
Rate for Payer: Hawaii Medical Service Association Medicare	$12.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.44
Rate for Payer: Hawaii Western Management Group Commercial	$12.01
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$12.01
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$12.01
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.21
Rate for Payer: Ohana Health Plan Medicare	$12.01
Rate for Payer: UnitedHealthcare Medicaid	$16.61
Rate for Payer: UnitedHealthcare Medicare	$12.01
Rate for Payer: University Health Alliance Commercial	$31.08

HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY

Facility

$129.00

Service Code	HCPCS 85306
Hospital Charge Code	3058530601
Hospital Revenue Code	305
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$77.40
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: MDX Hawaii PPO	$125.13

Know your out-of-pocket cost for care.

All Charges