Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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	$15.32
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$15.32
Rate for Payer: AlohaCare Medicare	$15.32
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cash Price	$77.40
Rate for Payer: Devoted Health Medicare	$16.85
Rate for Payer: Hawaii Medical Service Association ABD	$21.18
Rate for Payer: Hawaii Medical Service Association Commercial	$19.15
Rate for Payer: Hawaii Medical Service Association Medicare	$15.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.24
Rate for Payer: Hawaii Western Management Group Commercial	$15.32
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$15.32
Rate for Payer: Kaiser Permanente Commercial	$81.27
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$15.32
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$16.85
Rate for Payer: Ohana Health Plan Medicare	$15.32
Rate for Payer: UnitedHealthcare Medicaid	$21.18
Rate for Payer: UnitedHealthcare Medicare	$15.32
Rate for Payer: University Health Alliance Commercial	$39.61

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

Facility

$97.00

Service Code	HCPCS 85305
Hospital Charge Code	3058530502
Hospital Revenue Code	305
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$58.20
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: MDX Hawaii PPO	$94.09

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

Facility

$97.00

Service Code	HCPCS 85305
Hospital Charge Code	3058530502
Hospital Revenue Code	305
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$11.61
Rate for Payer: AlohaCare Medicare	$11.61
Rate for Payer: Cash Price	$58.20
Rate for Payer: Cash Price	$58.20
Rate for Payer: Devoted Health Medicare	$12.77
Rate for Payer: Hawaii Medical Service Association ABD	$16.02
Rate for Payer: Hawaii Medical Service Association Commercial	$14.51
Rate for Payer: Hawaii Medical Service Association Medicare	$11.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.82
Rate for Payer: Hawaii Western Management Group Commercial	$11.61
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$11.61
Rate for Payer: Kaiser Permanente Commercial	$61.11
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$11.61
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$12.77
Rate for Payer: Ohana Health Plan Medicare	$11.61
Rate for Payer: UnitedHealthcare Medicaid	$16.02
Rate for Payer: UnitedHealthcare Medicare	$11.61
Rate for Payer: University Health Alliance Commercial	$29.97

HC CLOZAPINE

Facility

$169.00

Service Code	HCPCS 80159
Hospital Charge Code	3018015901
Hospital Revenue Code	301
Min. Negotiated Rate	$15.14
Max. Negotiated Rate	$163.93
Rate for Payer: AlohaCare Medicaid	$20.15
Rate for Payer: AlohaCare Medicare	$20.15
Rate for Payer: Cash Price	$101.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$22.16
Rate for Payer: Hawaii Medical Service Association ABD	$25.56
Rate for Payer: Hawaii Medical Service Association Commercial	$25.19
Rate for Payer: Hawaii Medical Service Association Medicare	$20.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.84
Rate for Payer: Hawaii Western Management Group Commercial	$20.15
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Humana Medicare	$20.15
Rate for Payer: Kaiser Permanente Commercial	$106.47
Rate for Payer: Kaiser Permanente Medicaid	$86.19
Rate for Payer: Kaiser Permanente Medicare	$20.15
Rate for Payer: MDX Hawaii PPO	$163.93
Rate for Payer: Ohana Health Plan Medicaid	$22.16
Rate for Payer: Ohana Health Plan Medicare	$20.15
Rate for Payer: UnitedHealthcare Medicaid	$15.14
Rate for Payer: UnitedHealthcare Medicare	$20.15
Rate for Payer: University Health Alliance Commercial	$123.18

HC CLOZAPINE

Facility

$169.00

Service Code	HCPCS 80159
Hospital Charge Code	3018015901
Hospital Revenue Code	301
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: MDX Hawaii PPO	$163.93

HC CLSD TX METATARSAL WO/MAN EA

Facility

$955.00

Service Code	HCPCS 28470
Hospital Charge Code	4502847001
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 CLSD TX METATARSAL WO/MAN EA

Facility

$955.00

Service Code	HCPCS 28470
Hospital Charge Code	4502847001
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 CLTX CARPL SCAPHOID FX W/MANIP

Facility

$6,369.00

Service Code	HCPCS 25624
Hospital Charge Code	4502562401
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 CLTX CARPL SCAPHOID FX W/MANIP

Facility

$6,369.00

Service Code	HCPCS 25624
Hospital Charge Code	4502562401
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
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: Devoted Health Medicare	$2,089.55
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	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
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 Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$4,642.36

HC CLTX POST HIP ARTHRP W/ANES

Facility

$6,369.00

Service Code	HCPCS 27266
Hospital Charge Code	4502726601
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 CLTX POST HIP ARTHRP W/ANES

Facility

$6,369.00

Service Code	HCPCS 27266
Hospital Charge Code	4502726601
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
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: Devoted Health Medicare	$2,089.55
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	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
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 Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC CMPLX RPR F/N/G/H/F EA ADDL <5

Facility

$719.00

Service Code	HCPCS 13133
Hospital Charge Code	4501313301
Hospital Revenue Code	450
Min. Negotiated Rate	$611.15
Max. Negotiated Rate	$697.43
Rate for Payer: Cash Price	$431.40
Rate for Payer: Health Management Network Commercial	$611.15
Rate for Payer: MDX Hawaii PPO	$697.43

HC CMPLX RPR F/N/G/H/F EA ADDL <5

Facility

$719.00

Service Code	HCPCS 13133
Hospital Charge Code	4501313301
Hospital Revenue Code	450
Min. Negotiated Rate	$452.97
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$431.40
Rate for Payer: Cash Price	$431.40
Rate for Payer: Cash Price	$431.40
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 Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$683.05
Rate for Payer: Health Management Network Commercial	$611.15
Rate for Payer: Kaiser Permanente Commercial	$452.97
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$697.43
Rate for Payer: University Health Alliance Commercial	$524.08

HC CMPLX RPR TRUNK 2.6-7.5

Facility

$2,436.00

Service Code	HCPCS 13101
Hospital Charge Code	4501310101
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 CMPLX RPR TRUNK 2.6-7.5

Facility

$2,436.00

Service Code	HCPCS 13101
Hospital Charge Code	4501310101
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 CMV ANTIBODY - CMV IGG

Facility

$121.00

Service Code	HCPCS 86644
Hospital Charge Code	3028664401
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$117.37
Rate for Payer: AlohaCare Medicaid	$14.39
Rate for Payer: AlohaCare Medicare	$14.39
Rate for Payer: Cash Price	$72.60
Rate for Payer: Cash Price	$72.60
Rate for Payer: Devoted Health Medicare	$15.83
Rate for Payer: Hawaii Medical Service Association ABD	$19.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17.99
Rate for Payer: Hawaii Medical Service Association Medicare	$14.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.88
Rate for Payer: Hawaii Western Management Group Commercial	$14.39
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Humana Medicare	$14.39
Rate for Payer: Kaiser Permanente Commercial	$76.23
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: Kaiser Permanente Medicare	$14.39
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: Ohana Health Plan Medicaid	$15.83
Rate for Payer: Ohana Health Plan Medicare	$14.39
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$14.39
Rate for Payer: University Health Alliance Commercial	$37.20

HC CMV ANTIBODY - CMV IGG

Facility

$121.00

Service Code	HCPCS 86644
Hospital Charge Code	3028664401
Hospital Revenue Code	302
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: MDX Hawaii PPO	$117.37

HC CMV ANTIBODY, IGM - CMV IGM

Facility

$141.00

Service Code	HCPCS 86645
Hospital Charge Code	3028664501
Hospital Revenue Code	302
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: MDX Hawaii PPO	$136.77

HC CMV ANTIBODY, IGM - CMV IGM

Facility

$141.00

Service Code	HCPCS 86645
Hospital Charge Code	3028664501
Hospital Revenue Code	302
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$16.85
Rate for Payer: AlohaCare Medicare	$16.85
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cash Price	$84.60
Rate for Payer: Devoted Health Medicare	$18.54
Rate for Payer: Hawaii Medical Service Association ABD	$23.28
Rate for Payer: Hawaii Medical Service Association Commercial	$21.06
Rate for Payer: Hawaii Medical Service Association Medicare	$16.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.44
Rate for Payer: Hawaii Western Management Group Commercial	$16.85
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$16.85
Rate for Payer: Kaiser Permanente Commercial	$88.83
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$16.85
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$18.54
Rate for Payer: Ohana Health Plan Medicare	$16.85
Rate for Payer: UnitedHealthcare Medicaid	$23.28
Rate for Payer: UnitedHealthcare Medicare	$16.85
Rate for Payer: University Health Alliance Commercial	$43.55

HC COAGULATION TIME, ACTIVATED – ACTIVATED CLOTTING TIME

Facility

$36.00

Service Code	HCPCS 85347
Hospital Charge Code	3058534701
Hospital Revenue Code	305
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

HC COAGULATION TIME, ACTIVATED – ACTIVATED CLOTTING TIME

Facility

$36.00

Service Code	HCPCS 85347
Hospital Charge Code	3058534701
Hospital Revenue Code	305
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$4.28
Rate for Payer: AlohaCare Medicare	$4.28
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Devoted Health Medicare	$4.71
Rate for Payer: Hawaii Medical Service Association ABD	$5.88
Rate for Payer: Hawaii Medical Service Association Commercial	$5.35
Rate for Payer: Hawaii Medical Service Association Medicare	$4.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.17
Rate for Payer: Hawaii Western Management Group Commercial	$4.28
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$4.28
Rate for Payer: Kaiser Permanente Commercial	$22.68
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$4.28
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$4.71
Rate for Payer: Ohana Health Plan Medicare	$4.28
Rate for Payer: UnitedHealthcare Medicaid	$5.88
Rate for Payer: UnitedHealthcare Medicare	$4.28
Rate for Payer: University Health Alliance Commercial	$11.01

HC COAGULATION TIME, ACTIVATED – POCT ACTIVATED CLOTTING TIME

Facility

$36.00

Service Code	HCPCS 85347
Hospital Charge Code	3058534702
Hospital Revenue Code	305
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$4.28
Rate for Payer: AlohaCare Medicare	$4.28
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Devoted Health Medicare	$4.71
Rate for Payer: Hawaii Medical Service Association ABD	$5.88
Rate for Payer: Hawaii Medical Service Association Commercial	$5.35
Rate for Payer: Hawaii Medical Service Association Medicare	$4.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.17
Rate for Payer: Hawaii Western Management Group Commercial	$4.28
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$4.28
Rate for Payer: Kaiser Permanente Commercial	$22.68
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$4.28
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$4.71
Rate for Payer: Ohana Health Plan Medicare	$4.28
Rate for Payer: UnitedHealthcare Medicaid	$5.88
Rate for Payer: UnitedHealthcare Medicare	$4.28
Rate for Payer: University Health Alliance Commercial	$11.01

HC COAGULATION TIME, ACTIVATED – POCT ACTIVATED CLOTTING TIME

Facility

$36.00

Service Code	HCPCS 85347
Hospital Charge Code	3058534702
Hospital Revenue Code	305
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES

Facility

$96.00

Service Code	HCPCS 86635
Hospital Charge Code	3028663501
Hospital Revenue Code	302
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$11.47
Rate for Payer: AlohaCare Medicare	$11.47
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Devoted Health Medicare	$12.62
Rate for Payer: Hawaii Medical Service Association ABD	$9.62
Rate for Payer: Hawaii Medical Service Association Commercial	$14.34
Rate for Payer: Hawaii Medical Service Association Medicare	$11.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.85
Rate for Payer: Hawaii Western Management Group Commercial	$11.47
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$11.47
Rate for Payer: Kaiser Permanente Commercial	$60.48
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$11.47
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$12.62
Rate for Payer: Ohana Health Plan Medicare	$11.47
Rate for Payer: UnitedHealthcare Medicaid	$9.62
Rate for Payer: UnitedHealthcare Medicare	$11.47
Rate for Payer: University Health Alliance Commercial	$29.66

HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES

Facility

$96.00

Service Code	HCPCS 86635
Hospital Charge Code	3028663501
Hospital Revenue Code	302
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: MDX Hawaii PPO	$93.12

Know your out-of-pocket cost for care.

All Charges