Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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	$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 GRP B STREP SCREEN

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708102
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 GRP B STREP SCREEN

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708102
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 METH RESI STAPH SCRN

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708103
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 METH RESI STAPH SCRN

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708103
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 STREP SCREEN

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708105
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 STREP SCREEN

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708105
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 - LEGIONELLA CULTURE

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708101
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 - LEGIONELLA CULTURE

Facility

$56.00

Service Code	HCPCS 87081
Hospital Charge Code	3068708101
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 IDENTIFICATION, AEROBIC ISOLATE - CULT AEROBIC ID EA

Facility

$68.00

Service Code	HCPCS 87077
Hospital Charge Code	3068707701
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$8.08
Rate for Payer: AlohaCare Medicare	$8.08
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$8.89
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$8.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$8.08
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$8.08
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$8.89
Rate for Payer: Ohana Health Plan Medicare	$8.08
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$8.08
Rate for Payer: University Health Alliance Commercial	$20.89

HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULT AEROBIC ID EA

Facility

$68.00

Service Code	HCPCS 87077
Hospital Charge Code	3068707701
Hospital Revenue Code	306
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULTURE AEROBIC ID #4

Facility

$68.00

Service Code	HCPCS 87077
Hospital Charge Code	3068707704
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$8.08
Rate for Payer: AlohaCare Medicare	$8.08
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$8.89
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$8.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$8.08
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$8.08
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$8.89
Rate for Payer: Ohana Health Plan Medicare	$8.08
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$8.08
Rate for Payer: University Health Alliance Commercial	$20.89

HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULTURE AEROBIC ID #4

Facility

$68.00

Service Code	HCPCS 87077
Hospital Charge Code	3068707704
Hospital Revenue Code	306
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULTURE AEROBIC ID ORG #2

Facility

$68.00

Service Code	HCPCS 87077
Hospital Charge Code	3068707702
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$8.08
Rate for Payer: AlohaCare Medicare	$8.08
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$8.89
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$8.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$8.08
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$8.08
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$8.89
Rate for Payer: Ohana Health Plan Medicare	$8.08
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$8.08
Rate for Payer: University Health Alliance Commercial	$20.89

HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULTURE AEROBIC ID ORG #2

Facility

$68.00

Service Code	HCPCS 87077
Hospital Charge Code	3068707702
Hospital Revenue Code	306
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULTURE AEROBIC ID ORG #3

Facility

$68.00

Service Code	HCPCS 87077
Hospital Charge Code	3068707703
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$8.08
Rate for Payer: AlohaCare Medicare	$8.08
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$8.89
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$8.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$8.08
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$8.08
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$8.89
Rate for Payer: Ohana Health Plan Medicare	$8.08
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$8.08
Rate for Payer: University Health Alliance Commercial	$20.89

HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULTURE AEROBIC ID ORG #3

Facility

$68.00

Service Code	HCPCS 87077
Hospital Charge Code	3068707703
Hospital Revenue Code	306
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - H PYLORI UREASE

Facility

$68.00

Service Code	HCPCS 87077
Hospital Charge Code	3068707705
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$8.08
Rate for Payer: AlohaCare Medicare	$8.08
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$8.89
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$8.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$8.08
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$8.08
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$8.89
Rate for Payer: Ohana Health Plan Medicare	$8.08
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$8.08
Rate for Payer: University Health Alliance Commercial	$20.89

HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - H PYLORI UREASE

Facility

$68.00

Service Code	HCPCS 87077
Hospital Charge Code	3068707705
Hospital Revenue Code	306
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HC BARTONELLA, ANTIBODY - CAT SCRATCH FEVER AB SO

Facility

$85.00

Service Code	HCPCS 86611
Hospital Charge Code	3028661101
Hospital Revenue Code	302
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$82.45
Rate for Payer: AlohaCare Medicaid	$10.18
Rate for Payer: AlohaCare Medicare	$10.18
Rate for Payer: Cash Price	$51.00
Rate for Payer: Cash Price	$51.00
Rate for Payer: Devoted Health Medicare	$11.20
Rate for Payer: Hawaii Medical Service Association ABD	$14.22
Rate for Payer: Hawaii Medical Service Association Commercial	$12.72
Rate for Payer: Hawaii Medical Service Association Medicare	$10.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.93
Rate for Payer: Hawaii Western Management Group Commercial	$10.18
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Humana Medicare	$10.18
Rate for Payer: Kaiser Permanente Commercial	$53.55
Rate for Payer: Kaiser Permanente Medicaid	$43.35
Rate for Payer: Kaiser Permanente Medicare	$10.18
Rate for Payer: MDX Hawaii PPO	$82.45
Rate for Payer: Ohana Health Plan Medicaid	$11.20
Rate for Payer: Ohana Health Plan Medicare	$10.18
Rate for Payer: UnitedHealthcare Medicaid	$14.22
Rate for Payer: UnitedHealthcare Medicare	$10.18
Rate for Payer: University Health Alliance Commercial	$26.31

HC BARTONELLA, ANTIBODY - CAT SCRATCH FEVER AB SO

Facility

$85.00

Service Code	HCPCS 86611
Hospital Charge Code	3028661101
Hospital Revenue Code	302
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: MDX Hawaii PPO	$82.45

HC BASIC METABOLIC PANEL CALCIUM TOTAL - BUNDLED CHARGE

Facility

$71.00

Service Code	HCPCS 80048
Hospital Charge Code	3018004801
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: MDX Hawaii PPO	$68.87

HC BASIC METABOLIC PANEL CALCIUM TOTAL - BUNDLED CHARGE

Facility

$71.00

Service Code	HCPCS 80048
Hospital Charge Code	3018004801
Hospital Revenue Code	301
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$8.46
Rate for Payer: AlohaCare Medicare	$8.46
Rate for Payer: Cash Price	$42.60
Rate for Payer: Cash Price	$42.60
Rate for Payer: Devoted Health Medicare	$9.31
Rate for Payer: Hawaii Medical Service Association ABD	$11.70
Rate for Payer: Hawaii Medical Service Association Commercial	$10.57
Rate for Payer: Hawaii Medical Service Association Medicare	$8.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.29
Rate for Payer: Hawaii Western Management Group Commercial	$8.46
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$8.46
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$8.46
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$9.31
Rate for Payer: Ohana Health Plan Medicare	$8.46
Rate for Payer: UnitedHealthcare Medicaid	$11.70
Rate for Payer: UnitedHealthcare Medicare	$8.46
Rate for Payer: University Health Alliance Commercial	$21.89

HC B CELL GENE REARRANGE SO

Facility

$514.00

Service Code	HCPCS 81479
Hospital Charge Code	3108147901
Hospital Revenue Code	310
Min. Negotiated Rate	$262.14
Max. Negotiated Rate	$498.58
Rate for Payer: Cash Price	$308.40
Rate for Payer: Hawaii Western Management Group Commercial	$488.30
Rate for Payer: Health Management Network Commercial	$436.90
Rate for Payer: Kaiser Permanente Commercial	$323.82
Rate for Payer: Kaiser Permanente Medicaid	$262.14
Rate for Payer: MDX Hawaii PPO	$498.58
Rate for Payer: University Health Alliance Commercial	$374.65

HC B CELL GENE REARRANGE SO

Facility

$514.00

Service Code	HCPCS 81479
Hospital Charge Code	3108147901
Hospital Revenue Code	310
Min. Negotiated Rate	$436.90
Max. Negotiated Rate	$498.58
Rate for Payer: Cash Price	$308.40
Rate for Payer: Health Management Network Commercial	$436.90
Rate for Payer: MDX Hawaii PPO	$498.58

Know your out-of-pocket cost for care.

All Charges