Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CULT SPUTUM

Facility

$72.00

Service Code	HCPCS 87070
Hospital Charge Code	3068707006
Hospital Revenue Code	306
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$69.84

HC CULT STOOL

Facility

$79.00

Service Code	HCPCS 87045
Hospital Charge Code	3068704501
Hospital Revenue Code	306
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$9.44
Rate for Payer: AlohaCare Medicare	$9.44
Rate for Payer: Cash Price	$47.40
Rate for Payer: Cash Price	$47.40
Rate for Payer: Devoted Health Medicare	$10.38
Rate for Payer: Hawaii Medical Service Association ABD	$13.04
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$9.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.69
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$9.44
Rate for Payer: Kaiser Permanente Commercial	$49.77
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$9.44
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$10.38
Rate for Payer: Ohana Health Plan Medicare	$9.44
Rate for Payer: UnitedHealthcare Medicaid	$13.04
Rate for Payer: UnitedHealthcare Medicare	$9.44
Rate for Payer: University Health Alliance Commercial	$24.38

HC CULT STOOL

Facility

$79.00

Service Code	HCPCS 87045
Hospital Charge Code	3068704501
Hospital Revenue Code	306
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: MDX Hawaii PPO	$76.63

HC CULT THROAT

Facility

$72.00

Service Code	HCPCS 87070
Hospital Charge Code	3068707008
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$8.62
Rate for Payer: AlohaCare Medicare	$8.62
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$9.48
Rate for Payer: Hawaii Medical Service Association ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$8.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$8.62
Rate for Payer: Kaiser Permanente Commercial	$45.36
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$8.62
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$9.48
Rate for Payer: Ohana Health Plan Medicare	$8.62
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$8.62
Rate for Payer: University Health Alliance Commercial	$22.26

HC CULT THROAT

Facility

$72.00

Service Code	HCPCS 87070
Hospital Charge Code	3068707008
Hospital Revenue Code	306
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$69.84

HC CULTURE ANAEROBIC ID #2

Facility

$68.00

Service Code	HCPCS 87076
Hospital Charge Code	3068707602
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	$13.95
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 CULTURE ANAEROBIC ID #2

Facility

$68.00

Service Code	HCPCS 87076
Hospital Charge Code	3068707602
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 CULTURE ANAEROBIC ID #3

Facility

$68.00

Service Code	HCPCS 87076
Hospital Charge Code	3068707603
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	$13.95
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 CULTURE ANAEROBIC ID #3

Facility

$68.00

Service Code	HCPCS 87076
Hospital Charge Code	3068707603
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 CULTURE HERPES SO

Facility

$219.00

Service Code	HCPCS 87252
Hospital Charge Code	3068725201
Hospital Revenue Code	306
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$26.07
Rate for Payer: AlohaCare Medicare	$26.07
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cash Price	$131.40
Rate for Payer: Devoted Health Medicare	$28.68
Rate for Payer: Hawaii Medical Service Association ABD	$36.02
Rate for Payer: Hawaii Medical Service Association Commercial	$32.59
Rate for Payer: Hawaii Medical Service Association Medicare	$26.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.82
Rate for Payer: Hawaii Western Management Group Commercial	$26.07
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Humana Medicare	$26.07
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$26.07
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$28.68
Rate for Payer: Ohana Health Plan Medicare	$26.07
Rate for Payer: UnitedHealthcare Medicaid	$36.02
Rate for Payer: UnitedHealthcare Medicare	$26.07
Rate for Payer: University Health Alliance Commercial	$67.38

HC CULTURE HERPES SO

Facility

$219.00

Service Code	HCPCS 87252
Hospital Charge Code	3068725201
Hospital Revenue Code	306
Min. Negotiated Rate	$186.15
Max. Negotiated Rate	$212.43
Rate for Payer: Cash Price	$131.40
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: MDX Hawaii PPO	$212.43

HC CULTURE TYPING, FLUORESCENT - HERPES SIMPLEX TYPING

Facility

$47.00

Service Code	HCPCS 87140
Hospital Charge Code	3068714001
Hospital Revenue Code	306
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 CULTURE TYPING, FLUORESCENT - HERPES SIMPLEX TYPING

Facility

$47.00

Service Code	HCPCS 87140
Hospital Charge Code	3068714001
Hospital Revenue Code	306
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$45.59
Rate for Payer: AlohaCare Medicaid	$5.57
Rate for Payer: AlohaCare Medicare	$5.57
Rate for Payer: Cash Price	$28.20
Rate for Payer: Cash Price	$28.20
Rate for Payer: Devoted Health Medicare	$6.13
Rate for Payer: Hawaii Medical Service Association ABD	$7.71
Rate for Payer: Hawaii Medical Service Association Commercial	$6.96
Rate for Payer: Hawaii Medical Service Association Medicare	$5.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.10
Rate for Payer: Hawaii Western Management Group Commercial	$5.57
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$5.57
Rate for Payer: Kaiser Permanente Commercial	$29.61
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$5.57
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$6.13
Rate for Payer: Ohana Health Plan Medicare	$5.57
Rate for Payer: UnitedHealthcare Medicaid	$7.71
Rate for Payer: UnitedHealthcare Medicare	$5.57
Rate for Payer: University Health Alliance Commercial	$14.41

HC CULTURE VARICELLA ZOS SO

Facility

$164.00

Service Code	HCPCS 87254
Hospital Charge Code	3068725401
Hospital Revenue Code	306
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$159.08
Rate for Payer: AlohaCare Medicaid	$19.56
Rate for Payer: AlohaCare Medicare	$19.56
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Devoted Health Medicare	$21.52
Rate for Payer: Hawaii Medical Service Association ABD	$16.39
Rate for Payer: Hawaii Medical Service Association Commercial	$24.45
Rate for Payer: Hawaii Medical Service Association Medicare	$19.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.20
Rate for Payer: Hawaii Western Management Group Commercial	$19.56
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Humana Medicare	$19.56
Rate for Payer: Kaiser Permanente Commercial	$103.32
Rate for Payer: Kaiser Permanente Medicaid	$83.64
Rate for Payer: Kaiser Permanente Medicare	$19.56
Rate for Payer: MDX Hawaii PPO	$159.08
Rate for Payer: Ohana Health Plan Medicaid	$21.52
Rate for Payer: Ohana Health Plan Medicare	$19.56
Rate for Payer: UnitedHealthcare Medicaid	$16.39
Rate for Payer: UnitedHealthcare Medicare	$19.56
Rate for Payer: University Health Alliance Commercial	$50.54

HC CULTURE VARICELLA ZOS SO

Facility

$164.00

Service Code	HCPCS 87254
Hospital Charge Code	3068725401
Hospital Revenue Code	306
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$98.40
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: MDX Hawaii PPO	$159.08

HC CULT URINE

Facility

$68.00

Service Code	HCPCS 87086
Hospital Charge Code	3068708601
Hospital Revenue Code	306
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$8.07
Rate for Payer: AlohaCare Medicare	$8.07
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$8.88
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.09
Rate for Payer: Hawaii Medical Service Association Medicare	$8.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.07
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$8.07
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$8.07
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$8.88
Rate for Payer: Ohana Health Plan Medicare	$8.07
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$8.07
Rate for Payer: University Health Alliance Commercial	$20.87

HC CULT URINE

Facility

$68.00

Service Code	HCPCS 87086
Hospital Charge Code	3068708601
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 CULT URINE ID

Facility

$68.00

Service Code	HCPCS 87088
Hospital Charge Code	3068708801
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$8.09
Rate for Payer: AlohaCare Medicare	$8.09
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$8.90
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	$8.09
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	$57.80
Rate for Payer: Humana Medicare	$8.09
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$8.09
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$8.90
Rate for Payer: Ohana Health Plan Medicare	$8.09
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$8.09
Rate for Payer: University Health Alliance Commercial	$19.74

HC CULT URINE ID

Facility

$68.00

Service Code	HCPCS 87088
Hospital Charge Code	3068708801
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 CULT VIRAL SO

Facility

$219.00

Service Code	HCPCS 87252
Hospital Charge Code	3068725202
Hospital Revenue Code	306
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$26.07
Rate for Payer: AlohaCare Medicare	$26.07
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cash Price	$131.40
Rate for Payer: Devoted Health Medicare	$28.68
Rate for Payer: Hawaii Medical Service Association ABD	$36.02
Rate for Payer: Hawaii Medical Service Association Commercial	$32.59
Rate for Payer: Hawaii Medical Service Association Medicare	$26.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.82
Rate for Payer: Hawaii Western Management Group Commercial	$26.07
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Humana Medicare	$26.07
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$26.07
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$28.68
Rate for Payer: Ohana Health Plan Medicare	$26.07
Rate for Payer: UnitedHealthcare Medicaid	$36.02
Rate for Payer: UnitedHealthcare Medicare	$26.07
Rate for Payer: University Health Alliance Commercial	$67.38

HC CULT VIRAL SO

Facility

$219.00

Service Code	HCPCS 87252
Hospital Charge Code	3068725202
Hospital Revenue Code	306
Min. Negotiated Rate	$186.15
Max. Negotiated Rate	$212.43
Rate for Payer: Cash Price	$131.40
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: MDX Hawaii PPO	$212.43

HC CULT WOUND

Facility

$72.00

Service Code	HCPCS 87070
Hospital Charge Code	3068707003
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$8.62
Rate for Payer: AlohaCare Medicare	$8.62
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$9.48
Rate for Payer: Hawaii Medical Service Association ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$8.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$8.62
Rate for Payer: Kaiser Permanente Commercial	$45.36
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$8.62
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$9.48
Rate for Payer: Ohana Health Plan Medicare	$8.62
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$8.62
Rate for Payer: University Health Alliance Commercial	$22.26

HC CULT WOUND

Facility

$72.00

Service Code	HCPCS 87070
Hospital Charge Code	3068707003
Hospital Revenue Code	306
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$69.84

HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY

Facility

$109.00

Service Code	HCPCS 86200
Hospital Charge Code	3028620001
Hospital Revenue Code	302
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$65.40
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: MDX Hawaii PPO	$105.73

HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY

Facility

$109.00

Service Code	HCPCS 86200
Hospital Charge Code	3028620001
Hospital Revenue Code	302
Min. Negotiated Rate	$12.66
Max. Negotiated Rate	$105.73
Rate for Payer: AlohaCare Medicaid	$12.95
Rate for Payer: AlohaCare Medicare	$12.95
Rate for Payer: Cash Price	$65.40
Rate for Payer: Cash Price	$65.40
Rate for Payer: Devoted Health Medicare	$14.24
Rate for Payer: Hawaii Medical Service Association ABD	$12.66
Rate for Payer: Hawaii Medical Service Association Commercial	$16.19
Rate for Payer: Hawaii Medical Service Association Medicare	$12.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.88
Rate for Payer: Hawaii Western Management Group Commercial	$12.95
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Humana Medicare	$12.95
Rate for Payer: Kaiser Permanente Commercial	$68.67
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: Kaiser Permanente Medicare	$12.95
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: Ohana Health Plan Medicaid	$14.24
Rate for Payer: Ohana Health Plan Medicare	$12.95
Rate for Payer: UnitedHealthcare Medicaid	$12.66
Rate for Payer: UnitedHealthcare Medicare	$12.95
Rate for Payer: University Health Alliance Commercial	$33.47

Know your out-of-pocket cost for care.

All Charges