Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC HT MUSCLE IMAGE SPECT SING - STRESS TEST DOBUTAMINE W MYOCARD PERF

Facility

$6,494.00

Service Code	HCPCS 78451
Hospital Charge Code	3417845102
Hospital Revenue Code	341
Min. Negotiated Rate	$5,519.90
Max. Negotiated Rate	$6,299.18
Rate for Payer: Cash Price	$3,896.40
Rate for Payer: Health Management Network Commercial	$5,519.90
Rate for Payer: MDX Hawaii PPO	$6,299.18

HC HT MUSCLE IMAGE SPECT SING - STRESS TEST EXERCISE W MYOCARD PERF

Facility

$6,494.00

Service Code	HCPCS 78451
Hospital Charge Code	3417845106
Hospital Revenue Code	341
Min. Negotiated Rate	$5,519.90
Max. Negotiated Rate	$6,299.18
Rate for Payer: Cash Price	$3,896.40
Rate for Payer: Health Management Network Commercial	$5,519.90
Rate for Payer: MDX Hawaii PPO	$6,299.18

HC HT MUSCLE IMAGE SPECT SING - STRESS TEST EXERCISE W MYOCARD PERF

Facility

$6,494.00

Service Code	HCPCS 78451
Hospital Charge Code	3417845106
Hospital Revenue Code	341
Min. Negotiated Rate	$85.15
Max. Negotiated Rate	$6,299.18
Rate for Payer: AlohaCare Medicaid	$1,529.43
Rate for Payer: AlohaCare Medicare	$1,529.43
Rate for Payer: Cash Price	$3,896.40
Rate for Payer: Cash Price	$3,896.40
Rate for Payer: Devoted Health Medicare	$1,682.37
Rate for Payer: Hawaii Medical Service Association ABD	$85.15
Rate for Payer: Hawaii Medical Service Association Commercial	$1,911.79
Rate for Payer: Hawaii Medical Service Association Medicare	$1,529.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$253.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,529.43
Rate for Payer: Health Management Network Commercial	$5,519.90
Rate for Payer: Humana Medicare	$1,529.43
Rate for Payer: Kaiser Permanente Commercial	$4,091.22
Rate for Payer: Kaiser Permanente Medicaid	$3,311.94
Rate for Payer: Kaiser Permanente Medicare	$1,529.43
Rate for Payer: MDX Hawaii PPO	$6,299.18
Rate for Payer: Ohana Health Plan Medicaid	$1,682.37
Rate for Payer: Ohana Health Plan Medicare	$1,529.43
Rate for Payer: UnitedHealthcare Medicaid	$85.15
Rate for Payer: UnitedHealthcare Medicare	$1,529.43
Rate for Payer: University Health Alliance Commercial	$461.20

HC IAAD IA CLOSTRIDIUM DIFFICILE TOXIN - C. DIFFICILE TOXINS (BY EIA)

Facility

$101.00

Service Code	HCPCS 87324
Hospital Charge Code	3068732401
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HC IAAD IA CLOSTRIDIUM DIFFICILE TOXIN - C. DIFFICILE TOXINS (BY EIA)

Facility

$101.00

Service Code	HCPCS 87324
Hospital Charge Code	3068732401
Hospital Revenue Code	306
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 IAAD IA GIARDIA - GIARDIA LAMBLIA ANTIGEN

Facility

$101.00

Service Code	HCPCS 87329
Hospital Charge Code	3068732901
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$12.02
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.57
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$12.02
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HC IAAD IA GIARDIA - GIARDIA LAMBLIA ANTIGEN

Facility

$101.00

Service Code	HCPCS 87329
Hospital Charge Code	3068732901
Hospital Revenue Code	306
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 IAAD IA HEPATITIS BE ANTIGEN - HEPATITIS B E ANTIGEN

Facility

$97.00

Service Code	HCPCS 87350
Hospital Charge Code	3068735001
Hospital Revenue Code	306
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 IAAD IA HEPATITIS BE ANTIGEN - HEPATITIS B E ANTIGEN

Facility

$97.00

Service Code	HCPCS 87350
Hospital Charge Code	3068735001
Hospital Revenue Code	306
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$11.53
Rate for Payer: AlohaCare Medicare	$11.53
Rate for Payer: Cash Price	$58.20
Rate for Payer: Cash Price	$58.20
Rate for Payer: Devoted Health Medicare	$12.68
Rate for Payer: Hawaii Medical Service Association ABD	$15.92
Rate for Payer: Hawaii Medical Service Association Commercial	$14.41
Rate for Payer: Hawaii Medical Service Association Medicare	$11.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.72
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$11.53
Rate for Payer: Kaiser Permanente Commercial	$61.11
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$11.53
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$12.68
Rate for Payer: Ohana Health Plan Medicare	$11.53
Rate for Payer: UnitedHealthcare Medicaid	$15.92
Rate for Payer: UnitedHealthcare Medicare	$11.53
Rate for Payer: University Health Alliance Commercial	$29.79

HC IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION - HEPATITIS B SURFACE

Facility

$87.00

Service Code	HCPCS 87341
Hospital Charge Code	3068734101
Hospital Revenue Code	306
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$10.33
Rate for Payer: AlohaCare Medicare	$10.33
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$11.36
Rate for Payer: Hawaii Medical Service Association ABD	$14.43
Rate for Payer: Hawaii Medical Service Association Commercial	$12.91
Rate for Payer: Hawaii Medical Service Association Medicare	$10.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.15
Rate for Payer: Hawaii Western Management Group Commercial	$10.33
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$10.33
Rate for Payer: Kaiser Permanente Commercial	$54.81
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$10.33
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$11.36
Rate for Payer: Ohana Health Plan Medicare	$10.33
Rate for Payer: UnitedHealthcare Medicaid	$14.43
Rate for Payer: UnitedHealthcare Medicare	$10.33
Rate for Payer: University Health Alliance Commercial	$26.70

HC IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION - HEPATITIS B SURFACE

Facility

$87.00

Service Code	HCPCS 87341
Hospital Charge Code	3068734101
Hospital Revenue Code	306
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: MDX Hawaii PPO	$84.39

HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN

Facility

$87.00

Service Code	HCPCS 87340
Hospital Charge Code	3068734001
Hospital Revenue Code	306
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$10.33
Rate for Payer: AlohaCare Medicare	$10.33
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$11.36
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.91
Rate for Payer: Hawaii Medical Service Association Medicare	$10.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.33
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$10.33
Rate for Payer: Kaiser Permanente Commercial	$54.81
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$10.33
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$11.36
Rate for Payer: Ohana Health Plan Medicare	$10.33
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$10.33
Rate for Payer: University Health Alliance Commercial	$26.70

HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN

Facility

$87.00

Service Code	HCPCS 87340
Hospital Charge Code	3068734001
Hospital Revenue Code	306
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: MDX Hawaii PPO	$84.39

HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN URINE

Facility

$111.00

Service Code	HCPCS 87385
Hospital Charge Code	3068738501
Hospital Revenue Code	306
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: MDX Hawaii PPO	$107.67

HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN URINE

Facility

$111.00

Service Code	HCPCS 87385
Hospital Charge Code	3068738501
Hospital Revenue Code	306
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$107.67
Rate for Payer: AlohaCare Medicaid	$13.25
Rate for Payer: AlohaCare Medicare	$13.25
Rate for Payer: Cash Price	$66.60
Rate for Payer: Cash Price	$66.60
Rate for Payer: Devoted Health Medicare	$14.57
Rate for Payer: Hawaii Medical Service Association ABD	$10.06
Rate for Payer: Hawaii Medical Service Association Commercial	$16.56
Rate for Payer: Hawaii Medical Service Association Medicare	$13.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.57
Rate for Payer: Hawaii Western Management Group Commercial	$13.25
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Humana Medicare	$13.25
Rate for Payer: Kaiser Permanente Commercial	$69.93
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: Kaiser Permanente Medicare	$13.25
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: Ohana Health Plan Medicaid	$14.57
Rate for Payer: Ohana Health Plan Medicare	$13.25
Rate for Payer: UnitedHealthcare Medicaid	$10.06
Rate for Payer: UnitedHealthcare Medicare	$13.25
Rate for Payer: University Health Alliance Commercial	$31.01

HC IAAD IA HPYLORI STOOL - H PYLORI ANTIGEN STOOL

Facility

$121.00

Service Code	HCPCS 87338
Hospital Charge Code	3068733801
Hospital Revenue Code	306
Min. Negotiated Rate	$14.38
Max. Negotiated Rate	$117.37
Rate for Payer: AlohaCare Medicaid	$14.38
Rate for Payer: AlohaCare Medicare	$14.38
Rate for Payer: Cash Price	$72.60
Rate for Payer: Cash Price	$72.60
Rate for Payer: Devoted Health Medicare	$15.82
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$17.98
Rate for Payer: Hawaii Medical Service Association Medicare	$14.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.70
Rate for Payer: Hawaii Western Management Group Commercial	$14.38
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Humana Medicare	$14.38
Rate for Payer: Kaiser Permanente Commercial	$76.23
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: Kaiser Permanente Medicare	$14.38
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: Ohana Health Plan Medicaid	$15.82
Rate for Payer: Ohana Health Plan Medicare	$14.38
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$14.38
Rate for Payer: University Health Alliance Commercial	$31.01

HC IAAD IA HPYLORI STOOL - H PYLORI ANTIGEN STOOL

Facility

$121.00

Service Code	HCPCS 87338
Hospital Charge Code	3068733801
Hospital Revenue Code	306
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 IAAD IA MULT STEP METHOD NOS EACH ORGANISM - C DIFFICILE GDH AG

Facility

$101.00

Service Code	HCPCS 87449
Hospital Charge Code	3068744905
Hospital Revenue Code	306
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 IAAD IA MULT STEP METHOD NOS EACH ORGANISM - C DIFFICILE GDH AG

Facility

$101.00

Service Code	HCPCS 87449
Hospital Charge Code	3068744905
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM - FUNGITELL R (1-3)

Facility

$101.00

Service Code	HCPCS 87449
Hospital Charge Code	3018744901
Hospital Revenue Code	301
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 IAAD IA MULT STEP METHOD NOS EACH ORGANISM - FUNGITELL R (1-3)

Facility

$101.00

Service Code	HCPCS 87449
Hospital Charge Code	3018744901
Hospital Revenue Code	301
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM - LEGIONELLA PNEUMO AG EA

Facility

$101.00

Service Code	HCPCS 87449
Hospital Charge Code	3068744904
Hospital Revenue Code	306
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 IAAD IA MULT STEP METHOD NOS EACH ORGANISM - LEGIONELLA PNEUMO AG EA

Facility

$101.00

Service Code	HCPCS 87449
Hospital Charge Code	3068744904
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS - ASPERGILLUS GALACT

Facility

$101.00

Service Code	HCPCS 87305
Hospital Charge Code	3068730501
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS - ASPERGILLUS GALACT

Facility

$101.00

Service Code	HCPCS 87305
Hospital Charge Code	3068730501
Hospital Revenue Code	306
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

Know your out-of-pocket cost for care.

All Charges