Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

Bilirubin, Direct FSI

Facility

$71.00

Service Code	HCPCS 82248
Hospital Charge Code	8117859
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bilirubin, Direct FSI

Facility

$71.00

Service Code	HCPCS 82248
Hospital Charge Code	8117859
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin, Fluid FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8404521
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bilirubin, Fluid FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8404521
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin, Neonatal Total Biliscreen FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117860
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bilirubin, Neonatal Total Biliscreen FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117860
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin Neonatal, Total/Direct FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117858
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin Neonatal, Total/Direct FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117858
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bilirubin, Total/Direct FSI

Facility

$47.00

Service Code	HCPCS 82247
Hospital Charge Code	8228844
Hospital Revenue Code	300
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$45.59
Rate for Payer: Devoted Health Medicare	$25.85
Rate for Payer: AlohaCare Medicaid	$23.50
Rate for Payer: AlohaCare Medicare	$23.50
Rate for Payer: Cash Price	$30.55
Rate for Payer: Cash Price	$30.55
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$23.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$23.50
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$23.50
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$23.50
Rate for Payer: Ohana Health Plan Medicare	$23.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$23.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin, Total/Direct FSI

Facility

$47.00

Service Code	HCPCS 82247
Hospital Charge Code	8228844
Hospital Revenue Code	300
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$30.55
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: MDX Hawaii PPO	$45.59

Bilirubin, Total FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117861
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bilirubin, Total FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117861
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bill DLS2ID Org ID, Ur, Presumptive, 2 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12138782
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$19.74

Bill DLS2ID Org ID, Ur, Presumptive, 2 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12138782
Hospital Revenue Code	306
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Bill DLS3ID Org ID, Ur, Presumptive, 3 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12147775
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$19.74

Bill DLS3ID Org ID, Ur, Presumptive, 3 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12147775
Hospital Revenue Code	306
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Bill DLS4ID Org ID, Ur, Presumptive, 4 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12138783
Hospital Revenue Code	306
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Bill DLS4ID Org ID, Ur, Presumptive, 4 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12138783
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$19.74

Bill DLS5ID Org ID, Ur, Presumptive, 5 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12147776
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$19.74

Bill DLS5ID Org ID, Ur, Presumptive, 5 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12147776
Hospital Revenue Code	306
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Bill DLS6ID Org ID, Ur, Presumptive, 6 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12138784
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$19.74

Bill DLS6ID Org ID, Ur, Presumptive, 6 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12138784
Hospital Revenue Code	306
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Bill Only 2 Hr Glucose Tolerance, Pregnancy

Facility

$95.00

Service Code	HCPCS 82951
Hospital Charge Code	12927335
Hospital Revenue Code	301
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$61.75
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: MDX Hawaii PPO	$92.15

Bill Only 2 Hr Glucose Tolerance, Pregnancy

Facility

$95.00

Service Code	HCPCS 82951
Hospital Charge Code	12927335
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$47.50
Rate for Payer: AlohaCare Medicare	$47.50
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Devoted Health Medicare	$52.25
Rate for Payer: Hawaii Medical Service Association ABD	$17.80
Rate for Payer: Hawaii Medical Service Association Commercial	$16.09
Rate for Payer: Hawaii Medical Service Association Medicare	$47.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.69
Rate for Payer: Hawaii Western Management Group Commercial	$12.87
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$47.50
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$47.50
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$47.50
Rate for Payer: Ohana Health Plan Medicare	$47.50
Rate for Payer: UnitedHealthcare Medicaid	$17.80
Rate for Payer: UnitedHealthcare Medicare	$47.50
Rate for Payer: University Health Alliance Commercial	$33.28

Bill Only 3 Hr Glucose Tol (Blood)

Facility

$91.00

Hospital Charge Code	12927337
Hospital Revenue Code	301
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$88.27
Rate for Payer: AlohaCare Medicaid	$45.50
Rate for Payer: AlohaCare Medicare	$45.50
Rate for Payer: Cash Price	$59.15
Rate for Payer: Devoted Health Medicare	$50.05
Rate for Payer: Hawaii Medical Service Association Medicare	$45.50
Rate for Payer: Hawaii Western Management Group Commercial	$86.45
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$45.50
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$45.50
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$45.50
Rate for Payer: Ohana Health Plan Medicare	$45.50
Rate for Payer: UnitedHealthcare Medicare	$45.50
Rate for Payer: University Health Alliance Commercial	$50.96

Know your out-of-pocket cost for care.

All Charges