Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC THER SIM FIELD SET CMPLX

Facility

$1,489.00

Service Code	HCPCS 77290
Hospital Charge Code	3337729001
Hospital Revenue Code	333
Min. Negotiated Rate	$1,265.65
Max. Negotiated Rate	$1,444.33
Rate for Payer: Cash Price	$893.40
Rate for Payer: Health Management Network Commercial	$1,265.65
Rate for Payer: MDX Hawaii PPO	$1,444.33

HC THER SPI PNXR CSF FLUOR/CT

Facility

$2,756.00

Service Code	HCPCS 62329
Hospital Charge Code	3616232901
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$917.28
Rate for Payer: Hawaii Medical Service Association Commercial	$1,042.36
Rate for Payer: Hawaii Medical Service Association Medicare	$833.89
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$1,736.28
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$2,008.85

HC THER SPI PNXR CSF FLUOR/CT

Facility

$2,756.00

Service Code	HCPCS 62329
Hospital Charge Code	3616232901
Hospital Revenue Code	361
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: MDX Hawaii PPO	$2,673.32

HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING

Facility

$3,075.00

Service Code	HCPCS 32555
Hospital Charge Code	3613255501
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$741.06
Rate for Payer: AlohaCare Medicare	$741.06
Rate for Payer: Cash Price	$1,845.00
Rate for Payer: Cash Price	$1,845.00
Rate for Payer: Cash Price	$1,845.00
Rate for Payer: Devoted Health Medicare	$815.17
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	$741.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$2,613.75
Rate for Payer: Humana Medicare	$741.06
Rate for Payer: Kaiser Permanente Commercial	$1,937.25
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$741.06
Rate for Payer: MDX Hawaii PPO	$2,982.75
Rate for Payer: Ohana Health Plan Medicaid	$815.17
Rate for Payer: Ohana Health Plan Medicare	$741.06
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$741.06
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING

Facility

$3,075.00

Service Code	HCPCS 32555
Hospital Charge Code	3613255501
Hospital Revenue Code	361
Min. Negotiated Rate	$2,613.75
Max. Negotiated Rate	$2,982.75
Rate for Payer: Cash Price	$1,845.00
Rate for Payer: Health Management Network Commercial	$2,613.75
Rate for Payer: MDX Hawaii PPO	$2,982.75

HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING

Facility

$2,460.00

Service Code	HCPCS 32554
Hospital Charge Code	3613255401
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$741.06
Rate for Payer: AlohaCare Medicare	$741.06
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Devoted Health Medicare	$815.17
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	$741.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: Humana Medicare	$741.06
Rate for Payer: Kaiser Permanente Commercial	$1,549.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$741.06
Rate for Payer: MDX Hawaii PPO	$2,386.20
Rate for Payer: Ohana Health Plan Medicaid	$815.17
Rate for Payer: Ohana Health Plan Medicare	$741.06
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$741.06
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING

Facility

$2,460.00

Service Code	HCPCS 32554
Hospital Charge Code	3613255401
Hospital Revenue Code	361
Min. Negotiated Rate	$2,091.00
Max. Negotiated Rate	$2,386.20
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: MDX Hawaii PPO	$2,386.20

HC THROMBIN TIME, PLASMA - THROMBIN TIME

Facility

$48.00

Service Code	HCPCS 85670
Hospital Charge Code	3058567001
Hospital Revenue Code	305
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: MDX Hawaii PPO	$46.56

HC THROMBIN TIME, PLASMA - THROMBIN TIME

Facility

$48.00

Service Code	HCPCS 85670
Hospital Charge Code	3058567001
Hospital Revenue Code	305
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$5.77
Rate for Payer: AlohaCare Medicare	$5.77
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Devoted Health Medicare	$6.35
Rate for Payer: Hawaii Medical Service Association ABD	$7.98
Rate for Payer: Hawaii Medical Service Association Commercial	$7.21
Rate for Payer: Hawaii Medical Service Association Medicare	$5.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.38
Rate for Payer: Hawaii Western Management Group Commercial	$5.77
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$5.77
Rate for Payer: Kaiser Permanente Commercial	$30.24
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$5.77
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$6.35
Rate for Payer: Ohana Health Plan Medicare	$5.77
Rate for Payer: UnitedHealthcare Medicaid	$7.98
Rate for Payer: UnitedHealthcare Medicare	$5.77
Rate for Payer: University Health Alliance Commercial	$14.93

HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX

Facility

$21,513.00

Service Code	HCPCS 37211
Hospital Charge Code	3613721101
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$20,867.61
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Cash Price	$12,907.80
Rate for Payer: Cash Price	$12,907.80
Rate for Payer: Cash Price	$12,907.80
Rate for Payer: Devoted Health Medicare	$7,230.94
Rate for Payer: Hawaii Medical Service Association Commercial	$8,216.98
Rate for Payer: Hawaii Medical Service Association Medicare	$6,573.58
Rate for Payer: Health Management Network Commercial	$18,286.05
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Commercial	$13,553.19
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: MDX Hawaii PPO	$20,867.61
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$15,680.83

HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX

Facility

$21,513.00

Service Code	HCPCS 37211
Hospital Charge Code	3613721101
Hospital Revenue Code	361
Min. Negotiated Rate	$18,286.05
Max. Negotiated Rate	$20,867.61
Rate for Payer: Cash Price	$12,907.80
Rate for Payer: Health Management Network Commercial	$18,286.05
Rate for Payer: MDX Hawaii PPO	$20,867.61

HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX

Facility

$12,526.00

Service Code	HCPCS 37213
Hospital Charge Code	3613721301
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$12,150.22
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association Commercial	$4,662.59
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,891.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$12,150.22
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$9,130.20

HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX

Facility

$12,526.00

Service Code	HCPCS 37213
Hospital Charge Code	3613721301
Hospital Revenue Code	361
Min. Negotiated Rate	$10,647.10
Max. Negotiated Rate	$12,150.22
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: MDX Hawaii PPO	$12,150.22

HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX

Facility

$12,526.00

Service Code	HCPCS 37212
Hospital Charge Code	3613721201
Hospital Revenue Code	361
Min. Negotiated Rate	$10,647.10
Max. Negotiated Rate	$12,150.22
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: MDX Hawaii PPO	$12,150.22

HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX

Facility

$12,526.00

Service Code	HCPCS 37212
Hospital Charge Code	3613721201
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,150.22
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association Commercial	$4,662.59
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,891.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$12,150.22
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$9,130.20

HC THROMBOLYTIC THERAPY, STROKE

Facility

$1,320.00

Service Code	HCPCS 37195
Hospital Charge Code	4503719501
Hospital Revenue Code	450
Min. Negotiated Rate	$390.20
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$390.20
Rate for Payer: AlohaCare Medicare	$390.20
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Devoted Health Medicare	$429.22
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	$390.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,254.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: Humana Medicare	$390.20
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$390.20
Rate for Payer: MDX Hawaii PPO	$1,280.40
Rate for Payer: Ohana Health Plan Medicaid	$429.22
Rate for Payer: Ohana Health Plan Medicare	$390.20
Rate for Payer: UnitedHealthcare Medicare	$390.20
Rate for Payer: University Health Alliance Commercial	$962.15

HC THROMBOLYTIC THERAPY, STROKE

Facility

$1,320.00

Service Code	HCPCS 37195
Hospital Charge Code	4503719501
Hospital Revenue Code	450
Min. Negotiated Rate	$1,122.00
Max. Negotiated Rate	$1,280.40
Rate for Payer: Cash Price	$792.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: MDX Hawaii PPO	$1,280.40

HC THROMBOPLAS TIME PARTIAL - PTT

Facility

$50.00

Service Code	HCPCS 85730
Hospital Charge Code	3058573002
Hospital Revenue Code	305
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$30.00
Rate for Payer: Health Management Network Commercial	$42.50
Rate for Payer: MDX Hawaii PPO	$48.50

HC THROMBOPLAS TIME PARTIAL - PTT

Facility

$50.00

Service Code	HCPCS 85730
Hospital Charge Code	3058573002
Hospital Revenue Code	305
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$48.50
Rate for Payer: AlohaCare Medicaid	$6.01
Rate for Payer: AlohaCare Medicare	$6.01
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Devoted Health Medicare	$6.61
Rate for Payer: Hawaii Medical Service Association ABD	$8.30
Rate for Payer: Hawaii Medical Service Association Commercial	$7.51
Rate for Payer: Hawaii Medical Service Association Medicare	$6.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.72
Rate for Payer: Hawaii Western Management Group Commercial	$6.01
Rate for Payer: Health Management Network Commercial	$42.50
Rate for Payer: Humana Medicare	$6.01
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: Kaiser Permanente Medicaid	$25.50
Rate for Payer: Kaiser Permanente Medicare	$6.01
Rate for Payer: MDX Hawaii PPO	$48.50
Rate for Payer: Ohana Health Plan Medicaid	$6.61
Rate for Payer: Ohana Health Plan Medicare	$6.01
Rate for Payer: UnitedHealthcare Medicaid	$8.30
Rate for Payer: UnitedHealthcare Medicare	$6.01
Rate for Payer: University Health Alliance Commercial	$15.50

HC THROMBOPLAS TIME PARTIAL - PTT SO

Facility

$50.00

Service Code	HCPCS 85730
Hospital Charge Code	3058573001
Hospital Revenue Code	305
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$48.50
Rate for Payer: AlohaCare Medicaid	$6.01
Rate for Payer: AlohaCare Medicare	$6.01
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Devoted Health Medicare	$6.61
Rate for Payer: Hawaii Medical Service Association ABD	$8.30
Rate for Payer: Hawaii Medical Service Association Commercial	$7.51
Rate for Payer: Hawaii Medical Service Association Medicare	$6.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.72
Rate for Payer: Hawaii Western Management Group Commercial	$6.01
Rate for Payer: Health Management Network Commercial	$42.50
Rate for Payer: Humana Medicare	$6.01
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: Kaiser Permanente Medicaid	$25.50
Rate for Payer: Kaiser Permanente Medicare	$6.01
Rate for Payer: MDX Hawaii PPO	$48.50
Rate for Payer: Ohana Health Plan Medicaid	$6.61
Rate for Payer: Ohana Health Plan Medicare	$6.01
Rate for Payer: UnitedHealthcare Medicaid	$8.30
Rate for Payer: UnitedHealthcare Medicare	$6.01
Rate for Payer: University Health Alliance Commercial	$15.50

HC THROMBOPLAS TIME PARTIAL - PTT SO

Facility

$50.00

Service Code	HCPCS 85730
Hospital Charge Code	3058573001
Hospital Revenue Code	305
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$30.00
Rate for Payer: Health Management Network Commercial	$42.50
Rate for Payer: MDX Hawaii PPO	$48.50

HC THROMBOPLAS TIME PART PLASMA FRAC - PTT MIXING STUDIES SO

Facility

$54.00

Service Code	HCPCS 85732
Hospital Charge Code	3058573201
Hospital Revenue Code	305
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$32.40
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$52.38

HC THROMBOPLAS TIME PART PLASMA FRAC - PTT MIXING STUDIES SO

Facility

$54.00

Service Code	HCPCS 85732
Hospital Charge Code	3058573201
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$52.38
Rate for Payer: AlohaCare Medicaid	$6.47
Rate for Payer: AlohaCare Medicare	$6.47
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Devoted Health Medicare	$7.12
Rate for Payer: Hawaii Medical Service Association ABD	$8.95
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Medicare	$6.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.40
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: Humana Medicare	$6.47
Rate for Payer: Kaiser Permanente Commercial	$34.02
Rate for Payer: Kaiser Permanente Medicaid	$27.54
Rate for Payer: Kaiser Permanente Medicare	$6.47
Rate for Payer: MDX Hawaii PPO	$52.38
Rate for Payer: Ohana Health Plan Medicaid	$7.12
Rate for Payer: Ohana Health Plan Medicare	$6.47
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$6.47
Rate for Payer: University Health Alliance Commercial	$16.72

HC THROMBOPLAS TIME PART PLASMA FRAC - PTT MIX STUDIES EA SO (PTTMIB)

Facility

$54.00

Service Code	HCPCS 85732
Hospital Charge Code	3058573202
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$52.38
Rate for Payer: AlohaCare Medicaid	$6.47
Rate for Payer: AlohaCare Medicare	$6.47
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Devoted Health Medicare	$7.12
Rate for Payer: Hawaii Medical Service Association ABD	$8.95
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Medicare	$6.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.40
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: Humana Medicare	$6.47
Rate for Payer: Kaiser Permanente Commercial	$34.02
Rate for Payer: Kaiser Permanente Medicaid	$27.54
Rate for Payer: Kaiser Permanente Medicare	$6.47
Rate for Payer: MDX Hawaii PPO	$52.38
Rate for Payer: Ohana Health Plan Medicaid	$7.12
Rate for Payer: Ohana Health Plan Medicare	$6.47
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$6.47
Rate for Payer: University Health Alliance Commercial	$16.72

HC THROMBOPLAS TIME PART PLASMA FRAC - PTT MIX STUDIES EA SO (PTTMIB)

Facility

$54.00

Service Code	HCPCS 85732
Hospital Charge Code	3058573202
Hospital Revenue Code	305
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$32.40
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$52.38

Know your out-of-pocket cost for care.

All Charges