Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG VITAMIN B2

Facility

$148.00

Service Code	HCPCS 84252
Hospital Charge Code	H3011284
Hospital Revenue Code	301
Min. Negotiated Rate	$125.80
Max. Negotiated Rate	$143.56
Rate for Payer: Cash Price	$96.20
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Kaiser Permanente Commercial	$133.20
Rate for Payer: MDX Hawaii PPO	$143.56

HCHG VITAMIN B2

Facility

$148.00

Service Code	HCPCS 84252
Hospital Charge Code	H3011284
Hospital Revenue Code	301
Min. Negotiated Rate	$15.99
Max. Negotiated Rate	$146.52
Rate for Payer: AlohaCare Medicaid	$74.00
Rate for Payer: AlohaCare Medicare	$133.20
Rate for Payer: Cash Price	$96.20
Rate for Payer: Cash Price	$96.20
Rate for Payer: Devoted Health Medicare	$146.52
Rate for Payer: Hawaii Medical Service Association ABD	$15.99
Rate for Payer: Hawaii Medical Service Association Commercial	$25.30
Rate for Payer: Hawaii Medical Service Association Medicare	$133.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.35
Rate for Payer: Hawaii Western Management Group Commercial	$20.24
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Humana Medicare	$133.20
Rate for Payer: Kaiser Permanente Commercial	$133.20
Rate for Payer: Kaiser Permanente Medicaid	$75.48
Rate for Payer: Kaiser Permanente Medicare	$133.20
Rate for Payer: MDX Hawaii PPO	$143.56
Rate for Payer: Ohana Health Plan Medicaid	$133.20
Rate for Payer: Ohana Health Plan Medicare	$133.20
Rate for Payer: UnitedHealthcare Medicaid	$15.99
Rate for Payer: UnitedHealthcare Medicare	$133.20
Rate for Payer: University Health Alliance Commercial	$49.30

HCHG VITAMIN B3 NIACIN

Facility

$229.00

Service Code	HCPCS 84591
Hospital Charge Code	H3011755
Hospital Revenue Code	301
Min. Negotiated Rate	$194.65
Max. Negotiated Rate	$222.13
Rate for Payer: Cash Price	$148.85
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: Kaiser Permanente Commercial	$206.10
Rate for Payer: MDX Hawaii PPO	$222.13

HCHG VITAMIN B3 NIACIN

Facility

$229.00

Service Code	HCPCS 84591
Hospital Charge Code	H3011755
Hospital Revenue Code	301
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$226.71
Rate for Payer: AlohaCare Medicaid	$114.50
Rate for Payer: AlohaCare Medicare	$206.10
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cash Price	$148.85
Rate for Payer: Devoted Health Medicare	$226.71
Rate for Payer: Hawaii Medical Service Association ABD	$9.72
Rate for Payer: Hawaii Medical Service Association Commercial	$21.32
Rate for Payer: Hawaii Medical Service Association Medicare	$206.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.01
Rate for Payer: Hawaii Western Management Group Commercial	$17.06
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: Humana Medicare	$206.10
Rate for Payer: Kaiser Permanente Commercial	$206.10
Rate for Payer: Kaiser Permanente Medicaid	$116.79
Rate for Payer: Kaiser Permanente Medicare	$206.10
Rate for Payer: MDX Hawaii PPO	$222.13
Rate for Payer: Ohana Health Plan Medicaid	$206.10
Rate for Payer: Ohana Health Plan Medicare	$206.10
Rate for Payer: UnitedHealthcare Medicaid	$9.72
Rate for Payer: UnitedHealthcare Medicare	$206.10
Rate for Payer: University Health Alliance Commercial	$29.97

HCHG VITAMIN B6

Facility

$197.00

Service Code	HCPCS 84207
Hospital Charge Code	H3011286
Hospital Revenue Code	301
Min. Negotiated Rate	$26.36
Max. Negotiated Rate	$195.03
Rate for Payer: AlohaCare Medicaid	$98.50
Rate for Payer: AlohaCare Medicare	$177.30
Rate for Payer: Cash Price	$128.05
Rate for Payer: Cash Price	$128.05
Rate for Payer: Devoted Health Medicare	$195.03
Rate for Payer: Hawaii Medical Service Association ABD	$26.36
Rate for Payer: Hawaii Medical Service Association Commercial	$35.12
Rate for Payer: Hawaii Medical Service Association Medicare	$177.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.68
Rate for Payer: Hawaii Western Management Group Commercial	$28.10
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Humana Medicare	$177.30
Rate for Payer: Kaiser Permanente Commercial	$177.30
Rate for Payer: Kaiser Permanente Medicaid	$100.47
Rate for Payer: Kaiser Permanente Medicare	$177.30
Rate for Payer: MDX Hawaii PPO	$191.09
Rate for Payer: Ohana Health Plan Medicaid	$177.30
Rate for Payer: Ohana Health Plan Medicare	$177.30
Rate for Payer: UnitedHealthcare Medicaid	$26.36
Rate for Payer: UnitedHealthcare Medicare	$177.30
Rate for Payer: University Health Alliance Commercial	$49.30

HCHG VITAMIN B6

Facility

$197.00

Service Code	HCPCS 84207
Hospital Charge Code	H3011286
Hospital Revenue Code	301
Min. Negotiated Rate	$167.45
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$128.05
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Kaiser Permanente Commercial	$177.30
Rate for Payer: MDX Hawaii PPO	$191.09

HCHG VITAMIN C 90

Facility

$76.00

Service Code	HCPCS 82180
Hospital Charge Code	H3011288
Hospital Revenue Code	301
Min. Negotiated Rate	$9.89
Max. Negotiated Rate	$75.24
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$68.40
Rate for Payer: Cash Price	$49.40
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$75.24
Rate for Payer: Hawaii Medical Service Association ABD	$13.66
Rate for Payer: Hawaii Medical Service Association Commercial	$12.36
Rate for Payer: Hawaii Medical Service Association Medicare	$68.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.34
Rate for Payer: Hawaii Western Management Group Commercial	$9.89
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$68.40
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$68.40
Rate for Payer: Ohana Health Plan Medicare	$68.40
Rate for Payer: UnitedHealthcare Medicaid	$13.66
Rate for Payer: UnitedHealthcare Medicare	$68.40
Rate for Payer: University Health Alliance Commercial	$25.55

HCHG VITAMIN C 90

Facility

$76.00

Service Code	HCPCS 82180
Hospital Charge Code	H3011288
Hospital Revenue Code	301
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$49.40
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

HCHG VITAMIN D (1 25 DIHYDROXY) 90

Facility

$569.00

Service Code	HCPCS 82652
Hospital Charge Code	H3011290
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$563.31
Rate for Payer: AlohaCare Medicaid	$284.50
Rate for Payer: AlohaCare Medicare	$512.10
Rate for Payer: Cash Price	$369.85
Rate for Payer: Cash Price	$369.85
Rate for Payer: Devoted Health Medicare	$563.31
Rate for Payer: Hawaii Medical Service Association ABD	$53.19
Rate for Payer: Hawaii Medical Service Association Commercial	$48.12
Rate for Payer: Hawaii Medical Service Association Medicare	$512.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$55.85
Rate for Payer: Hawaii Western Management Group Commercial	$38.50
Rate for Payer: Health Management Network Commercial	$483.65
Rate for Payer: Humana Medicare	$512.10
Rate for Payer: Kaiser Permanente Commercial	$512.10
Rate for Payer: Kaiser Permanente Medicaid	$290.19
Rate for Payer: Kaiser Permanente Medicare	$512.10
Rate for Payer: MDX Hawaii PPO	$551.93
Rate for Payer: Ohana Health Plan Medicaid	$512.10
Rate for Payer: Ohana Health Plan Medicare	$512.10
Rate for Payer: UnitedHealthcare Medicaid	$53.19
Rate for Payer: UnitedHealthcare Medicare	$512.10
Rate for Payer: University Health Alliance Commercial	$99.49

HCHG VITAMIN D (1 25 DIHYDROXY) 90

Facility

$569.00

Service Code	HCPCS 82652
Hospital Charge Code	H3011290
Hospital Revenue Code	301
Min. Negotiated Rate	$483.65
Max. Negotiated Rate	$551.93
Rate for Payer: Cash Price	$369.85
Rate for Payer: Health Management Network Commercial	$483.65
Rate for Payer: Kaiser Permanente Commercial	$512.10
Rate for Payer: MDX Hawaii PPO	$551.93

HCHG VITAMIN D, 25- HYDROXY (D2 &D3)

Facility

$363.00

Service Code	HCPCS 82306
Hospital Charge Code	H3011292
Hospital Revenue Code	301
Min. Negotiated Rate	$308.55
Max. Negotiated Rate	$352.11
Rate for Payer: Cash Price	$235.95
Rate for Payer: Health Management Network Commercial	$308.55
Rate for Payer: Kaiser Permanente Commercial	$326.70
Rate for Payer: MDX Hawaii PPO	$352.11

HCHG VITAMIN D, 25- HYDROXY (D2 &D3)

Facility

$363.00

Service Code	HCPCS 82306
Hospital Charge Code	H3011292
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$359.37
Rate for Payer: AlohaCare Medicaid	$181.50
Rate for Payer: AlohaCare Medicare	$326.70
Rate for Payer: Cash Price	$235.95
Rate for Payer: Cash Price	$235.95
Rate for Payer: Devoted Health Medicare	$359.37
Rate for Payer: Hawaii Medical Service Association ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Medicare	$326.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.96
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$308.55
Rate for Payer: Humana Medicare	$326.70
Rate for Payer: Kaiser Permanente Commercial	$326.70
Rate for Payer: Kaiser Permanente Medicaid	$185.13
Rate for Payer: Kaiser Permanente Medicare	$326.70
Rate for Payer: MDX Hawaii PPO	$352.11
Rate for Payer: Ohana Health Plan Medicaid	$326.70
Rate for Payer: Ohana Health Plan Medicare	$326.70
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: UnitedHealthcare Medicare	$326.70
Rate for Payer: University Health Alliance Commercial	$76.52

HCHG VITAMIN D, 25-HYDROXY, TOTAL

Facility

$363.00

Service Code	HCPCS 82306
Hospital Charge Code	H3011403
Hospital Revenue Code	301
Min. Negotiated Rate	$308.55
Max. Negotiated Rate	$352.11
Rate for Payer: Cash Price	$235.95
Rate for Payer: Health Management Network Commercial	$308.55
Rate for Payer: Kaiser Permanente Commercial	$326.70
Rate for Payer: MDX Hawaii PPO	$352.11

HCHG VITAMIN D, 25-HYDROXY, TOTAL

Facility

$363.00

Service Code	HCPCS 82306
Hospital Charge Code	H3011403
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$359.37
Rate for Payer: AlohaCare Medicaid	$181.50
Rate for Payer: AlohaCare Medicare	$326.70
Rate for Payer: Cash Price	$235.95
Rate for Payer: Cash Price	$235.95
Rate for Payer: Devoted Health Medicare	$359.37
Rate for Payer: Hawaii Medical Service Association ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Medicare	$326.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.96
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$308.55
Rate for Payer: Humana Medicare	$326.70
Rate for Payer: Kaiser Permanente Commercial	$326.70
Rate for Payer: Kaiser Permanente Medicaid	$185.13
Rate for Payer: Kaiser Permanente Medicare	$326.70
Rate for Payer: MDX Hawaii PPO	$352.11
Rate for Payer: Ohana Health Plan Medicaid	$326.70
Rate for Payer: Ohana Health Plan Medicare	$326.70
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: UnitedHealthcare Medicare	$326.70
Rate for Payer: University Health Alliance Commercial	$76.52

HCHG VITAMIN K PLASMA

Facility

$105.00

Service Code	HCPCS 84597
Hospital Charge Code	H3000400
Hospital Revenue Code	301
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$68.25
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85

HCHG VITAMIN K PLASMA

Facility

$105.00

Service Code	HCPCS 84597
Hospital Charge Code	H3000400
Hospital Revenue Code	301
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$103.95
Rate for Payer: AlohaCare Medicaid	$52.50
Rate for Payer: AlohaCare Medicare	$94.50
Rate for Payer: Cash Price	$68.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Devoted Health Medicare	$103.95
Rate for Payer: Hawaii Medical Service Association ABD	$18.94
Rate for Payer: Hawaii Medical Service Association Commercial	$17.15
Rate for Payer: Hawaii Medical Service Association Medicare	$94.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.89
Rate for Payer: Hawaii Western Management Group Commercial	$13.72
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Humana Medicare	$94.50
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: Kaiser Permanente Medicare	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: Ohana Health Plan Medicaid	$94.50
Rate for Payer: Ohana Health Plan Medicare	$94.50
Rate for Payer: UnitedHealthcare Medicaid	$18.94
Rate for Payer: UnitedHealthcare Medicare	$94.50
Rate for Payer: University Health Alliance Commercial	$35.43

HCHG VMA 24 HR URINE

Facility

$118.00

Service Code	HCPCS 84585
Hospital Charge Code	H3011296
Hospital Revenue Code	301
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$76.70
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

HCHG VMA 24 HR URINE

Facility

$118.00

Service Code	HCPCS 84585
Hospital Charge Code	H3011296
Hospital Revenue Code	301
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$116.82
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$106.20
Rate for Payer: Cash Price	$76.70
Rate for Payer: Cash Price	$76.70
Rate for Payer: Devoted Health Medicare	$116.82
Rate for Payer: Hawaii Medical Service Association ABD	$21.42
Rate for Payer: Hawaii Medical Service Association Commercial	$19.38
Rate for Payer: Hawaii Medical Service Association Medicare	$106.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.49
Rate for Payer: Hawaii Western Management Group Commercial	$15.50
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$106.20
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$106.20
Rate for Payer: Ohana Health Plan Medicare	$106.20
Rate for Payer: UnitedHealthcare Medicaid	$21.42
Rate for Payer: UnitedHealthcare Medicare	$106.20
Rate for Payer: University Health Alliance Commercial	$40.07

HCHG VOL MEASURMENT FOR TIMED COLLECTION, EACH

Facility

$28.00

Service Code	HCPCS 81050
Hospital Charge Code	H3070124
Hospital Revenue Code	307
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$18.20
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

HCHG VOL MEASURMENT FOR TIMED COLLECTION, EACH

Facility

$28.00

Service Code	HCPCS 81050
Hospital Charge Code	H3070124
Hospital Revenue Code	307
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$27.72
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$25.20
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cash Price	$18.20
Rate for Payer: Devoted Health Medicare	$27.72
Rate for Payer: Hawaii Medical Service Association ABD	$2.70
Rate for Payer: Hawaii Medical Service Association Commercial	$4.55
Rate for Payer: Hawaii Medical Service Association Medicare	$25.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.14
Rate for Payer: Hawaii Western Management Group Commercial	$3.64
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$25.20
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$25.20
Rate for Payer: Ohana Health Plan Medicare	$25.20
Rate for Payer: UnitedHealthcare Medicaid	$2.70
Rate for Payer: UnitedHealthcare Medicare	$25.20
Rate for Payer: University Health Alliance Commercial	$7.75

HCHG VON WILLEBRAND FACTOR AG

Facility

$166.00

Service Code	HCPCS 85246
Hospital Charge Code	H3050260
Hospital Revenue Code	305
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$107.90
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: MDX Hawaii PPO	$161.02

HCHG VON WILLEBRAND FACTOR AG

Facility

$166.00

Service Code	HCPCS 85246
Hospital Charge Code	H3050260
Hospital Revenue Code	305
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$164.34
Rate for Payer: AlohaCare Medicaid	$83.00
Rate for Payer: AlohaCare Medicare	$149.40
Rate for Payer: Cash Price	$107.90
Rate for Payer: Cash Price	$107.90
Rate for Payer: Devoted Health Medicare	$164.34
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	$149.40
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	$141.10
Rate for Payer: Humana Medicare	$149.40
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: Kaiser Permanente Medicare	$149.40
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: Ohana Health Plan Medicaid	$149.40
Rate for Payer: Ohana Health Plan Medicare	$149.40
Rate for Payer: UnitedHealthcare Medicaid	$31.72
Rate for Payer: UnitedHealthcare Medicare	$149.40
Rate for Payer: University Health Alliance Commercial	$59.31

HCHG WBC & DIFF

Facility

$118.00

Service Code	HCPCS 85004
Hospital Charge Code	H3050262
Hospital Revenue Code	305
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$76.70
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

HCHG WBC & DIFF

Facility

$118.00

Service Code	HCPCS 85004
Hospital Charge Code	H3050262
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$116.82
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$106.20
Rate for Payer: Cash Price	$76.70
Rate for Payer: Cash Price	$76.70
Rate for Payer: Devoted Health Medicare	$116.82
Rate for Payer: Hawaii Medical Service Association ABD	$9.04
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Medicare	$106.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.49
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$106.20
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$106.20
Rate for Payer: Ohana Health Plan Medicare	$106.20
Rate for Payer: UnitedHealthcare Medicaid	$9.04
Rate for Payer: UnitedHealthcare Medicare	$106.20
Rate for Payer: University Health Alliance Commercial	$16.72

HCHG WHITE BLOOD COUNT AUTOMATED

Facility

$20.00

Service Code	HCPCS 85048
Hospital Charge Code	H3050264
Hospital Revenue Code	305
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$19.80
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$18.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Devoted Health Medicare	$19.80
Rate for Payer: Hawaii Medical Service Association ABD	$3.52
Rate for Payer: Hawaii Medical Service Association Commercial	$3.17
Rate for Payer: Hawaii Medical Service Association Medicare	$18.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.70
Rate for Payer: Hawaii Western Management Group Commercial	$2.54
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$18.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$18.00
Rate for Payer: Ohana Health Plan Medicare	$18.00
Rate for Payer: UnitedHealthcare Medicaid	$3.52
Rate for Payer: UnitedHealthcare Medicare	$18.00
Rate for Payer: University Health Alliance Commercial	$6.57

Know your out-of-pocket cost for care.

All Charges