Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I

Facility

$7,728.00

Service Code	HCPCS 36901
Hospital Charge Code	3613690101
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$7,496.16
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Devoted Health Medicare	$2,045.58
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	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$6,568.80
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$4,868.64
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$7,496.16
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$5,632.94

HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I

Facility

$7,728.00

Service Code	HCPCS 36901
Hospital Charge Code	3613690101
Hospital Revenue Code	361
Min. Negotiated Rate	$6,568.80
Max. Negotiated Rate	$7,496.16
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Health Management Network Commercial	$6,568.80
Rate for Payer: MDX Hawaii PPO	$7,496.16

HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT

Facility

$56,414.00

Service Code	HCPCS 36903
Hospital Charge Code	3613690301
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$54,721.58
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Devoted Health Medicare	$15,001.44
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	$13,637.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$47,951.90
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$35,540.82
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$54,721.58
Rate for Payer: Ohana Health Plan Medicaid	$15,001.44
Rate for Payer: Ohana Health Plan Medicare	$13,637.67
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$13,637.67
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT

Facility

$56,414.00

Service Code	HCPCS 36903
Hospital Charge Code	3613690301
Hospital Revenue Code	361
Min. Negotiated Rate	$47,951.90
Max. Negotiated Rate	$54,721.58
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Health Management Network Commercial	$47,951.90
Rate for Payer: MDX Hawaii PPO	$54,721.58

HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP

Facility

$22,690.00

Service Code	HCPCS 36902
Hospital Charge Code	3613690201
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$22,009.30
Rate for Payer: AlohaCare Medicaid	$6,723.70
Rate for Payer: AlohaCare Medicare	$6,723.70
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Devoted Health Medicare	$7,396.07
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	$6,723.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$19,286.50
Rate for Payer: Humana Medicare	$6,723.70
Rate for Payer: Kaiser Permanente Commercial	$14,294.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,723.70
Rate for Payer: MDX Hawaii PPO	$22,009.30
Rate for Payer: Ohana Health Plan Medicaid	$7,396.07
Rate for Payer: Ohana Health Plan Medicare	$6,723.70
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,723.70
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP

Facility

$22,690.00

Service Code	HCPCS 36902
Hospital Charge Code	3613690201
Hospital Revenue Code	361
Min. Negotiated Rate	$19,286.50
Max. Negotiated Rate	$22,009.30
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Health Management Network Commercial	$19,286.50
Rate for Payer: MDX Hawaii PPO	$22,009.30

HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL

Facility

$73.00

Service Code	HCPCS 83550
Hospital Charge Code	3018355001
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$8.74
Rate for Payer: AlohaCare Medicare	$8.74
Rate for Payer: Cash Price	$43.80
Rate for Payer: Cash Price	$43.80
Rate for Payer: Devoted Health Medicare	$9.61
Rate for Payer: Hawaii Medical Service Association ABD	$12.08
Rate for Payer: Hawaii Medical Service Association Commercial	$10.93
Rate for Payer: Hawaii Medical Service Association Medicare	$8.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.68
Rate for Payer: Hawaii Western Management Group Commercial	$8.74
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$8.74
Rate for Payer: Kaiser Permanente Commercial	$45.99
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$8.74
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$9.61
Rate for Payer: Ohana Health Plan Medicare	$8.74
Rate for Payer: UnitedHealthcare Medicaid	$12.08
Rate for Payer: UnitedHealthcare Medicare	$8.74
Rate for Payer: University Health Alliance Commercial	$22.59

HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL

Facility

$73.00

Service Code	HCPCS 83550
Hospital Charge Code	3018355001
Hospital Revenue Code	301
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: MDX Hawaii PPO	$70.81

HC IRRIGAT CORPUS CAVERN,PRIAPISM

Facility

$968.00

Service Code	HCPCS 54220
Hospital Charge Code	4505422001
Hospital Revenue Code	450
Min. Negotiated Rate	$295.16
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$295.16
Rate for Payer: AlohaCare Medicare	$295.16
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$580.80
Rate for Payer: Devoted Health Medicare	$324.68
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	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$919.60
Rate for Payer: Health Management Network Commercial	$822.80
Rate for Payer: Humana Medicare	$295.16
Rate for Payer: Kaiser Permanente Commercial	$609.84
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$295.16
Rate for Payer: MDX Hawaii PPO	$938.96
Rate for Payer: Ohana Health Plan Medicaid	$324.68
Rate for Payer: Ohana Health Plan Medicare	$295.16
Rate for Payer: UnitedHealthcare Medicare	$295.16
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC IRRIGAT CORPUS CAVERN,PRIAPISM

Facility

$968.00

Service Code	HCPCS 54220
Hospital Charge Code	4505422001
Hospital Revenue Code	450
Min. Negotiated Rate	$822.80
Max. Negotiated Rate	$938.96
Rate for Payer: Cash Price	$580.80
Rate for Payer: Health Management Network Commercial	$822.80
Rate for Payer: MDX Hawaii PPO	$938.96

HC IRRIGATION OF BLADDER

Facility

$968.00

Service Code	HCPCS 51700
Hospital Charge Code	3615170001
Hospital Revenue Code	361
Min. Negotiated Rate	$822.80
Max. Negotiated Rate	$938.96
Rate for Payer: Cash Price	$580.80
Rate for Payer: Health Management Network Commercial	$822.80
Rate for Payer: MDX Hawaii PPO	$938.96

HC IRRIGATION OF BLADDER

Facility

$968.00

Service Code	HCPCS 51700
Hospital Charge Code	3615170001
Hospital Revenue Code	361
Min. Negotiated Rate	$30.96
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$295.16
Rate for Payer: AlohaCare Medicare	$295.16
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$580.80
Rate for Payer: Devoted Health Medicare	$324.68
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	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$822.80
Rate for Payer: Humana Medicare	$295.16
Rate for Payer: Kaiser Permanente Commercial	$609.84
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$295.16
Rate for Payer: MDX Hawaii PPO	$938.96
Rate for Payer: Ohana Health Plan Medicaid	$324.68
Rate for Payer: Ohana Health Plan Medicare	$295.16
Rate for Payer: UnitedHealthcare Medicaid	$30.96
Rate for Payer: UnitedHealthcare Medicare	$295.16
Rate for Payer: University Health Alliance Commercial	$705.58

HC IRRIG IMPLANTED DRUG DELIVERY DEVICE

Facility

$236.00

Service Code	HCPCS 96523
Hospital Charge Code	3359652301
Hospital Revenue Code	335
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$76.66
Rate for Payer: Hawaii Medical Service Association Commercial	$87.11
Rate for Payer: Hawaii Medical Service Association Medicare	$69.69
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$148.68
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicaid	$20.64
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$172.02

HC IRRIG IMPLANTED DRUG DELIVERY DEVICE

Facility

$236.00

Service Code	HCPCS 96523
Hospital Charge Code	3359652301
Hospital Revenue Code	335
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: MDX Hawaii PPO	$228.92

HC ISLET CELL ANTIBODY - ANTI-ISLET CELL AB

Facility

$198.00

Service Code	HCPCS 86341
Hospital Charge Code	3028634101
Hospital Revenue Code	302
Min. Negotiated Rate	$23.57
Max. Negotiated Rate	$192.06
Rate for Payer: AlohaCare Medicaid	$23.57
Rate for Payer: AlohaCare Medicare	$23.57
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
Rate for Payer: Devoted Health Medicare	$25.93
Rate for Payer: Hawaii Medical Service Association ABD	$25.15
Rate for Payer: Hawaii Medical Service Association Commercial	$29.46
Rate for Payer: Hawaii Medical Service Association Medicare	$23.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.41
Rate for Payer: Hawaii Western Management Group Commercial	$23.57
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Humana Medicare	$23.57
Rate for Payer: Kaiser Permanente Commercial	$124.74
Rate for Payer: Kaiser Permanente Medicaid	$100.98
Rate for Payer: Kaiser Permanente Medicare	$23.57
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: Ohana Health Plan Medicaid	$25.93
Rate for Payer: Ohana Health Plan Medicare	$23.57
Rate for Payer: UnitedHealthcare Medicaid	$25.15
Rate for Payer: UnitedHealthcare Medicare	$23.57
Rate for Payer: University Health Alliance Commercial	$47.05

HC ISLET CELL ANTIBODY - ANTI-ISLET CELL AB

Facility

$198.00

Service Code	HCPCS 86341
Hospital Charge Code	3028634101
Hospital Revenue Code	302
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$118.80
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: MDX Hawaii PPO	$192.06

HC ISLET CELL ANTIBODY - GAD 65 ANTIBODY SO

Facility

$198.00

Service Code	HCPCS 86341
Hospital Charge Code	3028634102
Hospital Revenue Code	302
Min. Negotiated Rate	$23.57
Max. Negotiated Rate	$192.06
Rate for Payer: AlohaCare Medicaid	$23.57
Rate for Payer: AlohaCare Medicare	$23.57
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
Rate for Payer: Devoted Health Medicare	$25.93
Rate for Payer: Hawaii Medical Service Association ABD	$25.15
Rate for Payer: Hawaii Medical Service Association Commercial	$29.46
Rate for Payer: Hawaii Medical Service Association Medicare	$23.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.41
Rate for Payer: Hawaii Western Management Group Commercial	$23.57
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Humana Medicare	$23.57
Rate for Payer: Kaiser Permanente Commercial	$124.74
Rate for Payer: Kaiser Permanente Medicaid	$100.98
Rate for Payer: Kaiser Permanente Medicare	$23.57
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: Ohana Health Plan Medicaid	$25.93
Rate for Payer: Ohana Health Plan Medicare	$23.57
Rate for Payer: UnitedHealthcare Medicaid	$25.15
Rate for Payer: UnitedHealthcare Medicare	$23.57
Rate for Payer: University Health Alliance Commercial	$47.05

HC ISLET CELL ANTIBODY - GAD 65 ANTIBODY SO

Facility

$198.00

Service Code	HCPCS 86341
Hospital Charge Code	3028634102
Hospital Revenue Code	302
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$118.80
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: MDX Hawaii PPO	$192.06

HC ISOLATION ROOM DAILY

Facility

$5,625.00

Hospital Charge Code	1640000001
Hospital Revenue Code	164
Min. Negotiated Rate	$4,781.25
Max. Negotiated Rate	$7,250.00
Rate for Payer: Cash Price	$3,375.00
Rate for Payer: Cash Price	$3,375.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$4,781.25
Rate for Payer: MDX Hawaii PPO	$5,456.25
Rate for Payer: University Health Alliance Commercial	$5,923.00

HC IV INFUSION, HYDRATION, 31-60 MIN

Facility

$1,089.00

Service Code	HCPCS 96360
Hospital Charge Code	9409636001
Hospital Revenue Code	940
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$1,056.33
Rate for Payer: AlohaCare Medicaid	$251.28
Rate for Payer: AlohaCare Medicare	$251.28
Rate for Payer: Cash Price	$653.40
Rate for Payer: Cash Price	$653.40
Rate for Payer: Devoted Health Medicare	$276.41
Rate for Payer: Hawaii Medical Service Association Commercial	$314.10
Rate for Payer: Hawaii Medical Service Association Medicare	$251.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,034.55
Rate for Payer: Health Management Network Commercial	$925.65
Rate for Payer: Humana Medicare	$251.28
Rate for Payer: Kaiser Permanente Commercial	$686.07
Rate for Payer: Kaiser Permanente Medicaid	$555.39
Rate for Payer: Kaiser Permanente Medicare	$251.28
Rate for Payer: MDX Hawaii PPO	$1,056.33
Rate for Payer: Ohana Health Plan Medicaid	$276.41
Rate for Payer: Ohana Health Plan Medicare	$251.28
Rate for Payer: UnitedHealthcare Medicaid	$38.10
Rate for Payer: UnitedHealthcare Medicare	$251.28
Rate for Payer: University Health Alliance Commercial	$793.77

HC IV INFUSION, HYDRATION, 31-60 MIN

Facility

$1,089.00

Service Code	HCPCS 96360
Hospital Charge Code	9409636001
Hospital Revenue Code	940
Min. Negotiated Rate	$925.65
Max. Negotiated Rate	$1,056.33
Rate for Payer: Cash Price	$653.40
Rate for Payer: Health Management Network Commercial	$925.65
Rate for Payer: MDX Hawaii PPO	$1,056.33

HC IV INFUSION, HYDRATION, 31-60 MIN

Facility

$838.00

Service Code	HCPCS 96360
Hospital Charge Code	4509636001
Hospital Revenue Code	450
Min. Negotiated Rate	$712.30
Max. Negotiated Rate	$812.86
Rate for Payer: Cash Price	$502.80
Rate for Payer: Health Management Network Commercial	$712.30
Rate for Payer: MDX Hawaii PPO	$812.86

HC IV INFUSION, HYDRATION, 31-60 MIN

Facility

$838.00

Service Code	HCPCS 96360
Hospital Charge Code	4509636001
Hospital Revenue Code	450
Min. Negotiated Rate	$251.28
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$251.28
Rate for Payer: AlohaCare Medicare	$251.28
Rate for Payer: Cash Price	$502.80
Rate for Payer: Cash Price	$502.80
Rate for Payer: Cash Price	$502.80
Rate for Payer: Cash Price	$502.80
Rate for Payer: Devoted Health Medicare	$276.41
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	$251.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$796.10
Rate for Payer: Health Management Network Commercial	$712.30
Rate for Payer: Humana Medicare	$251.28
Rate for Payer: Kaiser Permanente Commercial	$527.94
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$251.28
Rate for Payer: MDX Hawaii PPO	$812.86
Rate for Payer: Ohana Health Plan Medicaid	$276.41
Rate for Payer: Ohana Health Plan Medicare	$251.28
Rate for Payer: UnitedHealthcare Medicare	$251.28
Rate for Payer: University Health Alliance Commercial	$610.82

HC IV INFUSION, HYDRATION, EA ADD HOUR

Facility

$239.00

Service Code	HCPCS 96361
Hospital Charge Code	9409636101
Hospital Revenue Code	940
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$231.83
Rate for Payer: AlohaCare Medicaid	$55.32
Rate for Payer: AlohaCare Medicare	$55.32
Rate for Payer: Cash Price	$143.40
Rate for Payer: Cash Price	$143.40
Rate for Payer: Devoted Health Medicare	$60.85
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Medical Service Association Medicare	$55.32
Rate for Payer: Hawaii Western Management Group Commercial	$227.05
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: Humana Medicare	$55.32
Rate for Payer: Kaiser Permanente Commercial	$150.57
Rate for Payer: Kaiser Permanente Medicaid	$121.89
Rate for Payer: Kaiser Permanente Medicare	$55.32
Rate for Payer: MDX Hawaii PPO	$231.83
Rate for Payer: Ohana Health Plan Medicaid	$60.85
Rate for Payer: Ohana Health Plan Medicare	$55.32
Rate for Payer: UnitedHealthcare Medicaid	$10.81
Rate for Payer: UnitedHealthcare Medicare	$55.32
Rate for Payer: University Health Alliance Commercial	$174.21

HC IV INFUSION, HYDRATION, EA ADD HOUR

Facility

$239.00

Service Code	HCPCS 96361
Hospital Charge Code	9409636101
Hospital Revenue Code	940
Min. Negotiated Rate	$203.15
Max. Negotiated Rate	$231.83
Rate for Payer: Cash Price	$143.40
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: MDX Hawaii PPO	$231.83

Know your out-of-pocket cost for care.

All Charges