Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE - METHYLMALONIC ACID, SERUM

Facility

$178.00

Service Code	HCPCS 83921
Hospital Charge Code	3018392101
Hospital Revenue Code	301
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$172.66
Rate for Payer: AlohaCare Medicaid	$21.21
Rate for Payer: AlohaCare Medicare	$21.21
Rate for Payer: Cash Price	$106.80
Rate for Payer: Cash Price	$106.80
Rate for Payer: Devoted Health Medicare	$23.33
Rate for Payer: Hawaii Medical Service Association ABD	$22.75
Rate for Payer: Hawaii Medical Service Association Commercial	$26.51
Rate for Payer: Hawaii Medical Service Association Medicare	$21.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.89
Rate for Payer: Hawaii Western Management Group Commercial	$21.21
Rate for Payer: Health Management Network Commercial	$151.30
Rate for Payer: Humana Medicare	$21.21
Rate for Payer: Kaiser Permanente Commercial	$112.14
Rate for Payer: Kaiser Permanente Medicaid	$90.78
Rate for Payer: Kaiser Permanente Medicare	$21.21
Rate for Payer: MDX Hawaii PPO	$172.66
Rate for Payer: Ohana Health Plan Medicaid	$23.33
Rate for Payer: Ohana Health Plan Medicare	$21.21
Rate for Payer: UnitedHealthcare Medicaid	$22.75
Rate for Payer: UnitedHealthcare Medicare	$21.21
Rate for Payer: University Health Alliance Commercial	$42.55

HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE - METHYLMALONIC ACID, SERUM

Facility

$178.00

Service Code	HCPCS 83921
Hospital Charge Code	3018392101
Hospital Revenue Code	301
Min. Negotiated Rate	$151.30
Max. Negotiated Rate	$172.66
Rate for Payer: Cash Price	$106.80
Rate for Payer: Health Management Network Commercial	$151.30
Rate for Payer: MDX Hawaii PPO	$172.66

HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINE 24 HR URINE

Facility

$212.00

Service Code	HCPCS 82384
Hospital Charge Code	3018238401
Hospital Revenue Code	301
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$205.64
Rate for Payer: AlohaCare Medicaid	$25.25
Rate for Payer: AlohaCare Medicare	$25.25
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Devoted Health Medicare	$27.77
Rate for Payer: Hawaii Medical Service Association ABD	$34.90
Rate for Payer: Hawaii Medical Service Association Commercial	$31.56
Rate for Payer: Hawaii Medical Service Association Medicare	$25.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.65
Rate for Payer: Hawaii Western Management Group Commercial	$25.25
Rate for Payer: Health Management Network Commercial	$180.20
Rate for Payer: Humana Medicare	$25.25
Rate for Payer: Kaiser Permanente Commercial	$133.56
Rate for Payer: Kaiser Permanente Medicaid	$108.12
Rate for Payer: Kaiser Permanente Medicare	$25.25
Rate for Payer: MDX Hawaii PPO	$205.64
Rate for Payer: Ohana Health Plan Medicaid	$27.77
Rate for Payer: Ohana Health Plan Medicare	$25.25
Rate for Payer: UnitedHealthcare Medicaid	$34.90
Rate for Payer: UnitedHealthcare Medicare	$25.25
Rate for Payer: University Health Alliance Commercial	$65.27

HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINE 24 HR URINE

Facility

$212.00

Service Code	HCPCS 82384
Hospital Charge Code	3018238401
Hospital Revenue Code	301
Min. Negotiated Rate	$180.20
Max. Negotiated Rate	$205.64
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Management Network Commercial	$180.20
Rate for Payer: MDX Hawaii PPO	$205.64

HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINES FRACTIONATED PL

Facility

$212.00

Service Code	HCPCS 82384
Hospital Charge Code	3018238402
Hospital Revenue Code	301
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$205.64
Rate for Payer: AlohaCare Medicaid	$25.25
Rate for Payer: AlohaCare Medicare	$25.25
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Devoted Health Medicare	$27.77
Rate for Payer: Hawaii Medical Service Association ABD	$34.90
Rate for Payer: Hawaii Medical Service Association Commercial	$31.56
Rate for Payer: Hawaii Medical Service Association Medicare	$25.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.65
Rate for Payer: Hawaii Western Management Group Commercial	$25.25
Rate for Payer: Health Management Network Commercial	$180.20
Rate for Payer: Humana Medicare	$25.25
Rate for Payer: Kaiser Permanente Commercial	$133.56
Rate for Payer: Kaiser Permanente Medicaid	$108.12
Rate for Payer: Kaiser Permanente Medicare	$25.25
Rate for Payer: MDX Hawaii PPO	$205.64
Rate for Payer: Ohana Health Plan Medicaid	$27.77
Rate for Payer: Ohana Health Plan Medicare	$25.25
Rate for Payer: UnitedHealthcare Medicaid	$34.90
Rate for Payer: UnitedHealthcare Medicare	$25.25
Rate for Payer: University Health Alliance Commercial	$65.27

HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINES FRACTIONATED PL

Facility

$212.00

Service Code	HCPCS 82384
Hospital Charge Code	3018238402
Hospital Revenue Code	301
Min. Negotiated Rate	$180.20
Max. Negotiated Rate	$205.64
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Management Network Commercial	$180.20
Rate for Payer: MDX Hawaii PPO	$205.64

HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE

Facility

$141.00

Service Code	HCPCS 84443
Hospital Charge Code	3018444301
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$16.80
Rate for Payer: AlohaCare Medicare	$16.80
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cash Price	$84.60
Rate for Payer: Devoted Health Medicare	$18.48
Rate for Payer: Hawaii Medical Service Association ABD	$23.21
Rate for Payer: Hawaii Medical Service Association Commercial	$21.00
Rate for Payer: Hawaii Medical Service Association Medicare	$16.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.37
Rate for Payer: Hawaii Western Management Group Commercial	$16.80
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$16.80
Rate for Payer: Kaiser Permanente Commercial	$88.83
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$16.80
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$18.48
Rate for Payer: Ohana Health Plan Medicare	$16.80
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: UnitedHealthcare Medicare	$16.80
Rate for Payer: University Health Alliance Commercial	$43.42

HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE

Facility

$141.00

Service Code	HCPCS 84443
Hospital Charge Code	3018444301
Hospital Revenue Code	301
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: MDX Hawaii PPO	$136.77

HC ASSAY UREA NITROGEN, QUAN - BLOOD UREA NITROGEN

Facility

$33.00

Service Code	HCPCS 84520
Hospital Charge Code	3018452001
Hospital Revenue Code	301
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$32.01
Rate for Payer: AlohaCare Medicaid	$3.95
Rate for Payer: AlohaCare Medicare	$3.95
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Devoted Health Medicare	$4.34
Rate for Payer: Hawaii Medical Service Association ABD	$5.45
Rate for Payer: Hawaii Medical Service Association Commercial	$4.94
Rate for Payer: Hawaii Medical Service Association Medicare	$3.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.95
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Humana Medicare	$3.95
Rate for Payer: Kaiser Permanente Commercial	$20.79
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: Kaiser Permanente Medicare	$3.95
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: Ohana Health Plan Medicaid	$4.34
Rate for Payer: Ohana Health Plan Medicare	$3.95
Rate for Payer: UnitedHealthcare Medicaid	$5.45
Rate for Payer: UnitedHealthcare Medicare	$3.95
Rate for Payer: University Health Alliance Commercial	$10.19

HC ASSAY UREA NITROGEN, QUAN - BLOOD UREA NITROGEN

Facility

$33.00

Service Code	HCPCS 84520
Hospital Charge Code	3018452001
Hospital Revenue Code	301
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: MDX Hawaii PPO	$32.01

HC ASSAY URINE UREA-N - UREA NITROGEN URINE

Facility

$47.00

Service Code	HCPCS 84540
Hospital Charge Code	3018454001
Hospital Revenue Code	301
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$45.59

HC ASSAY URINE UREA-N - UREA NITROGEN URINE

Facility

$47.00

Service Code	HCPCS 84540
Hospital Charge Code	3018454001
Hospital Revenue Code	301
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$45.59
Rate for Payer: AlohaCare Medicaid	$5.56
Rate for Payer: AlohaCare Medicare	$5.56
Rate for Payer: Cash Price	$28.20
Rate for Payer: Cash Price	$28.20
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Hawaii Medical Service Association ABD	$6.56
Rate for Payer: Hawaii Medical Service Association Commercial	$6.95
Rate for Payer: Hawaii Medical Service Association Medicare	$5.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$5.56
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$5.56
Rate for Payer: Kaiser Permanente Commercial	$29.61
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$5.56
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$6.12
Rate for Payer: Ohana Health Plan Medicare	$5.56
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$5.56
Rate for Payer: University Health Alliance Commercial	$12.28

HC ASSAY URINE UREA-N - UREA NITROGEN UR RANDOM

Facility

$47.00

Service Code	HCPCS 84540
Hospital Charge Code	3018454002
Hospital Revenue Code	301
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$45.59

HC ASSAY URINE UREA-N - UREA NITROGEN UR RANDOM

Facility

$47.00

Service Code	HCPCS 84540
Hospital Charge Code	3018454002
Hospital Revenue Code	301
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$45.59
Rate for Payer: AlohaCare Medicaid	$5.56
Rate for Payer: AlohaCare Medicare	$5.56
Rate for Payer: Cash Price	$28.20
Rate for Payer: Cash Price	$28.20
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Hawaii Medical Service Association ABD	$6.56
Rate for Payer: Hawaii Medical Service Association Commercial	$6.95
Rate for Payer: Hawaii Medical Service Association Medicare	$5.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$5.56
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$5.56
Rate for Payer: Kaiser Permanente Commercial	$29.61
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$5.56
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$6.12
Rate for Payer: Ohana Health Plan Medicare	$5.56
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$5.56
Rate for Payer: University Health Alliance Commercial	$12.28

HC ATHERECTOMY+STENT DE ADDL BR

Facility

$59,939.00

Service Code	HCPCS C9603
Hospital Charge Code	481C960301
Hospital Revenue Code	481
Min. Negotiated Rate	$30,568.89
Max. Negotiated Rate	$58,140.83
Rate for Payer: Cash Price	$35,963.40
Rate for Payer: Hawaii Western Management Group Commercial	$56,942.05
Rate for Payer: Health Management Network Commercial	$50,948.15
Rate for Payer: Kaiser Permanente Commercial	$37,761.57
Rate for Payer: Kaiser Permanente Medicaid	$30,568.89
Rate for Payer: MDX Hawaii PPO	$58,140.83
Rate for Payer: University Health Alliance Commercial	$43,689.54

HC ATHERECTOMY+STENT DE ADDL BR

Facility

$59,939.00

Service Code	HCPCS C9603
Hospital Charge Code	481C960301
Hospital Revenue Code	481
Min. Negotiated Rate	$50,948.15
Max. Negotiated Rate	$58,140.83
Rate for Payer: Cash Price	$35,963.40
Rate for Payer: Health Management Network Commercial	$50,948.15
Rate for Payer: MDX Hawaii PPO	$58,140.83

HC ATHERECTOMY+STENT DE SNGL VSL

Facility

$89,326.00

Service Code	HCPCS C9602
Hospital Charge Code	481C960201
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$86,646.22
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Cash Price	$53,595.60
Rate for Payer: Cash Price	$53,595.60
Rate for Payer: Cash Price	$53,595.60
Rate for Payer: Devoted Health Medicare	$23,821.58
Rate for Payer: Hawaii Medical Service Association Commercial	$27,069.97
Rate for Payer: Hawaii Medical Service Association Medicare	$21,655.98
Rate for Payer: Hawaii Western Management Group Commercial	$84,859.70
Rate for Payer: Health Management Network Commercial	$75,927.10
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Commercial	$56,275.38
Rate for Payer: Kaiser Permanente Medicaid	$45,556.26
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: MDX Hawaii PPO	$86,646.22
Rate for Payer: Ohana Health Plan Medicaid	$23,821.58
Rate for Payer: Ohana Health Plan Medicare	$21,655.98
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$21,655.98
Rate for Payer: University Health Alliance Commercial	$65,109.72

HC ATHERECTOMY+STENT DE SNGL VSL

Facility

$89,326.00

Service Code	HCPCS C9602
Hospital Charge Code	481C960201
Hospital Revenue Code	481
Min. Negotiated Rate	$75,927.10
Max. Negotiated Rate	$86,646.22
Rate for Payer: Cash Price	$53,595.60
Rate for Payer: Health Management Network Commercial	$75,927.10
Rate for Payer: MDX Hawaii PPO	$86,646.22

HC ATOMIC ABSRPJ SPECTROSCOPY EA ANALYTE

Facility

$133.00

Service Code	HCPCS 82190
Hospital Charge Code	3018219001
Hospital Revenue Code	301
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$79.80
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: MDX Hawaii PPO	$129.01

HC ATOMIC ABSRPJ SPECTROSCOPY EA ANALYTE

Facility

$133.00

Service Code	HCPCS 82190
Hospital Charge Code	3018219001
Hospital Revenue Code	301
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$15.90
Rate for Payer: AlohaCare Medicare	$15.90
Rate for Payer: Cash Price	$79.80
Rate for Payer: Cash Price	$79.80
Rate for Payer: Devoted Health Medicare	$17.49
Rate for Payer: Hawaii Medical Service Association ABD	$12.50
Rate for Payer: Hawaii Medical Service Association Commercial	$19.88
Rate for Payer: Hawaii Medical Service Association Medicare	$15.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.60
Rate for Payer: Hawaii Western Management Group Commercial	$15.90
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$15.90
Rate for Payer: Kaiser Permanente Commercial	$83.79
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$15.90
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$17.49
Rate for Payer: Ohana Health Plan Medicare	$15.90
Rate for Payer: UnitedHealthcare Medicaid	$12.50
Rate for Payer: UnitedHealthcare Medicare	$15.90
Rate for Payer: University Health Alliance Commercial	$38.54

HC AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, EACH ADDITIONAL NAIL PLATE

Facility

$268.00

Service Code	HCPCS 11732
Hospital Charge Code	4501173201
Hospital Revenue Code	450
Min. Negotiated Rate	$168.84
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
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 Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$254.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Kaiser Permanente Commercial	$168.84
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: University Health Alliance Commercial	$195.35

HC AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, EACH ADDITIONAL NAIL PLATE

Facility

$268.00

Service Code	HCPCS 11732
Hospital Charge Code	4501173201
Hospital Revenue Code	450
Min. Negotiated Rate	$227.80
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$160.80
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: MDX Hawaii PPO	$259.96

HC BACTERIA CULTURE SCREEN - CULT BORDETELLA SCREEN

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708106
Hospital Revenue Code	306
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$54.32
Rate for Payer: AlohaCare Medicaid	$6.63
Rate for Payer: AlohaCare Medicare	$6.63
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Devoted Health Medicare	$7.29
Rate for Payer: Hawaii Medical Service Association ABD	$9.16
Rate for Payer: Hawaii Medical Service Association Commercial	$8.29
Rate for Payer: Hawaii Medical Service Association Medicare	$6.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.62
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Humana Medicare	$6.63
Rate for Payer: Kaiser Permanente Commercial	$35.28
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: Kaiser Permanente Medicare	$6.63
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: Ohana Health Plan Medicaid	$7.29
Rate for Payer: Ohana Health Plan Medicare	$6.63
Rate for Payer: UnitedHealthcare Medicaid	$9.16
Rate for Payer: UnitedHealthcare Medicare	$6.63
Rate for Payer: University Health Alliance Commercial	$17.13

HC BACTERIA CULTURE SCREEN - CULT BORDETELLA SCREEN

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708106
Hospital Revenue Code	306
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$33.60
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: MDX Hawaii PPO	$54.32

HC BACTERIA CULTURE SCREEN - CULT GC SCREEN

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708104
Hospital Revenue Code	306
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$33.60
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: MDX Hawaii PPO	$54.32

Know your out-of-pocket cost for care.

All Charges