Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CYP2C19 GENE MUT SO

Facility

$2,445.00

Service Code	HCPCS 81225
Hospital Charge Code	3108122501
Hospital Revenue Code	310
Min. Negotiated Rate	$191.47
Max. Negotiated Rate	$2,371.65
Rate for Payer: AlohaCare Medicaid	$291.36
Rate for Payer: AlohaCare Medicare	$291.36
Rate for Payer: Cash Price	$1,467.00
Rate for Payer: Cash Price	$1,467.00
Rate for Payer: Devoted Health Medicare	$320.50
Rate for Payer: Hawaii Medical Service Association ABD	$286.30
Rate for Payer: Hawaii Medical Service Association Commercial	$364.20
Rate for Payer: Hawaii Medical Service Association Medicare	$291.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$286.30
Rate for Payer: Hawaii Western Management Group Commercial	$291.36
Rate for Payer: Health Management Network Commercial	$2,078.25
Rate for Payer: Humana Medicare	$291.36
Rate for Payer: Kaiser Permanente Commercial	$1,540.35
Rate for Payer: Kaiser Permanente Medicaid	$1,246.95
Rate for Payer: Kaiser Permanente Medicare	$291.36
Rate for Payer: MDX Hawaii PPO	$2,371.65
Rate for Payer: Ohana Health Plan Medicaid	$320.50
Rate for Payer: Ohana Health Plan Medicare	$291.36
Rate for Payer: UnitedHealthcare Medicaid	$191.47
Rate for Payer: UnitedHealthcare Medicare	$291.36
Rate for Payer: University Health Alliance Commercial	$590.37

HC CYP2C19 GENE MUT SO

Facility

$2,445.00

Service Code	HCPCS 81225
Hospital Charge Code	3108122501
Hospital Revenue Code	310
Min. Negotiated Rate	$2,078.25
Max. Negotiated Rate	$2,371.65
Rate for Payer: Cash Price	$1,467.00
Rate for Payer: Health Management Network Commercial	$2,078.25
Rate for Payer: MDX Hawaii PPO	$2,371.65

HC CYTOGENETICS, 100-300 - BCR/ABL1, FISH - MOL CYTO INTERPHASE

Facility

$429.00

Service Code	HCPCS 88275
Hospital Charge Code	3118827501
Hospital Revenue Code	311
Min. Negotiated Rate	$51.19
Max. Negotiated Rate	$416.13
Rate for Payer: AlohaCare Medicaid	$51.19
Rate for Payer: AlohaCare Medicare	$51.19
Rate for Payer: Cash Price	$257.40
Rate for Payer: Cash Price	$257.40
Rate for Payer: Devoted Health Medicare	$56.31
Rate for Payer: Hawaii Medical Service Association ABD	$55.50
Rate for Payer: Hawaii Medical Service Association Commercial	$63.99
Rate for Payer: Hawaii Medical Service Association Medicare	$51.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58.28
Rate for Payer: Hawaii Western Management Group Commercial	$51.19
Rate for Payer: Health Management Network Commercial	$364.65
Rate for Payer: Humana Medicare	$51.19
Rate for Payer: Kaiser Permanente Commercial	$270.27
Rate for Payer: Kaiser Permanente Medicaid	$218.79
Rate for Payer: Kaiser Permanente Medicare	$51.19
Rate for Payer: MDX Hawaii PPO	$416.13
Rate for Payer: Ohana Health Plan Medicaid	$56.31
Rate for Payer: Ohana Health Plan Medicare	$51.19
Rate for Payer: UnitedHealthcare Medicaid	$55.50
Rate for Payer: UnitedHealthcare Medicare	$51.19
Rate for Payer: University Health Alliance Commercial	$103.80

HC CYTOGENETICS, 100-300 - BCR/ABL1, FISH - MOL CYTO INTERPHASE

Facility

$429.00

Service Code	HCPCS 88275
Hospital Charge Code	3118827501
Hospital Revenue Code	311
Min. Negotiated Rate	$364.65
Max. Negotiated Rate	$416.13
Rate for Payer: Cash Price	$257.40
Rate for Payer: Health Management Network Commercial	$364.65
Rate for Payer: MDX Hawaii PPO	$416.13

HC CYTOGENETICS, DNA PROBE - ALK, FISH - MOL CYTO DNA PROBE

Facility

$180.00

Service Code	HCPCS 88271
Hospital Charge Code	3118827101
Hospital Revenue Code	311
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$174.60

HC CYTOGENETICS, DNA PROBE - ALK, FISH - MOL CYTO DNA PROBE

Facility

$180.00

Service Code	HCPCS 88271
Hospital Charge Code	3118827101
Hospital Revenue Code	311
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$21.42
Rate for Payer: AlohaCare Medicare	$21.42
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Devoted Health Medicare	$23.56
Rate for Payer: Hawaii Medical Service Association ABD	$29.60
Rate for Payer: Hawaii Medical Service Association Commercial	$26.77
Rate for Payer: Hawaii Medical Service Association Medicare	$21.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.08
Rate for Payer: Hawaii Western Management Group Commercial	$21.42
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$21.42
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$21.42
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$23.56
Rate for Payer: Ohana Health Plan Medicare	$21.42
Rate for Payer: UnitedHealthcare Medicaid	$29.60
Rate for Payer: UnitedHealthcare Medicare	$21.42
Rate for Payer: University Health Alliance Commercial	$55.37

HC CYTOMEG, DNA, AMP PROBE - CMV QUAL PCR SALIVA SO

Facility

$294.00

Service Code	HCPCS 87496
Hospital Charge Code	3068749602
Hospital Revenue Code	306
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HC CYTOMEG, DNA, AMP PROBE - CMV QUAL PCR SALIVA SO

Facility

$294.00

Service Code	HCPCS 87496
Hospital Charge Code	3068749602
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED

Facility

$294.00

Service Code	HCPCS 87496
Hospital Charge Code	3068749601
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED

Facility

$294.00

Service Code	HCPCS 87496
Hospital Charge Code	3068749601
Hospital Revenue Code	306
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED

Facility

$294.00

Service Code	HCPCS 87496
Hospital Charge Code	3068749603
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED

Facility

$294.00

Service Code	HCPCS 87496
Hospital Charge Code	3068749603
Hospital Revenue Code	306
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HC CYTOMEG, DNA, QUANT - CMV DNA, QUANTITATIVE, PCR

Facility

$359.00

Service Code	HCPCS 87497
Hospital Charge Code	3068749701
Hospital Revenue Code	306
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$348.23
Rate for Payer: AlohaCare Medicaid	$42.84
Rate for Payer: AlohaCare Medicare	$42.84
Rate for Payer: Cash Price	$215.40
Rate for Payer: Cash Price	$215.40
Rate for Payer: Devoted Health Medicare	$47.12
Rate for Payer: Hawaii Medical Service Association ABD	$59.20
Rate for Payer: Hawaii Medical Service Association Commercial	$53.55
Rate for Payer: Hawaii Medical Service Association Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$62.16
Rate for Payer: Hawaii Western Management Group Commercial	$42.84
Rate for Payer: Health Management Network Commercial	$305.15
Rate for Payer: Humana Medicare	$42.84
Rate for Payer: Kaiser Permanente Commercial	$226.17
Rate for Payer: Kaiser Permanente Medicaid	$183.09
Rate for Payer: Kaiser Permanente Medicare	$42.84
Rate for Payer: MDX Hawaii PPO	$348.23
Rate for Payer: Ohana Health Plan Medicaid	$47.12
Rate for Payer: Ohana Health Plan Medicare	$42.84
Rate for Payer: UnitedHealthcare Medicaid	$59.20
Rate for Payer: UnitedHealthcare Medicare	$42.84
Rate for Payer: University Health Alliance Commercial	$110.72

HC CYTOMEG, DNA, QUANT - CMV DNA, QUANTITATIVE, PCR

Facility

$359.00

Service Code	HCPCS 87497
Hospital Charge Code	3068749701
Hospital Revenue Code	306
Min. Negotiated Rate	$305.15
Max. Negotiated Rate	$348.23
Rate for Payer: Cash Price	$215.40
Rate for Payer: Health Management Network Commercial	$305.15
Rate for Payer: MDX Hawaii PPO	$348.23

HC CYTOPATH CONCENTRATE TECH - LAB CYTOPATH FLUIDS,CONCENTRATN,INTERP

Facility

$389.00

Service Code	HCPCS 88108 TC
Hospital Charge Code	3118810801
Hospital Revenue Code	311
Min. Negotiated Rate	$31.77
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$233.40
Rate for Payer: Cash Price	$233.40
Rate for Payer: Hawaii Medical Service Association ABD	$44.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.77
Rate for Payer: Hawaii Western Management Group Commercial	$369.55
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: Kaiser Permanente Commercial	$245.07
Rate for Payer: Kaiser Permanente Medicaid	$198.39
Rate for Payer: MDX Hawaii PPO	$377.33
Rate for Payer: UnitedHealthcare Medicaid	$44.09
Rate for Payer: University Health Alliance Commercial	$92.35

HC CYTOPATH CONCENTRATE TECH - LAB CYTOPATH FLUIDS,CONCENTRATN,INTERP

Facility

$389.00

Service Code	HCPCS 88108 TC
Hospital Charge Code	3118810801
Hospital Revenue Code	311
Min. Negotiated Rate	$330.65
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$233.40
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: MDX Hawaii PPO	$377.33

HC CYTOPATH C/V AUTO FLUID REDO - LAB CYTOPAT,CER/VAG,THIN LAYER,INTER

Facility

$223.00

Service Code	HCPCS 88175 TC
Hospital Charge Code	3118817501
Hospital Revenue Code	311
Min. Negotiated Rate	$30.96
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$133.80
Rate for Payer: Cash Price	$133.80
Rate for Payer: Hawaii Medical Service Association ABD	$37.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.96
Rate for Payer: Hawaii Western Management Group Commercial	$211.85
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Kaiser Permanente Commercial	$140.49
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: UnitedHealthcare Medicaid	$37.01
Rate for Payer: University Health Alliance Commercial	$68.47

HC CYTOPATH C/V AUTO FLUID REDO - LAB CYTOPAT,CER/VAG,THIN LAYER,INTER

Facility

$223.00

Service Code	HCPCS 88175 TC
Hospital Charge Code	3118817501
Hospital Revenue Code	311
Min. Negotiated Rate	$189.55
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$133.80
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: MDX Hawaii PPO	$216.31

HC CYTOPATH C/V THIN LAYER - LAB CYTOPATH CERV/VAG THIN LAYER

Facility

$170.00

Service Code	HCPCS 88142 TC
Hospital Charge Code	3118814201
Hospital Revenue Code	311
Min. Negotiated Rate	$144.50
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$102.00
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: MDX Hawaii PPO	$164.90

HC CYTOPATH C/V THIN LAYER - LAB CYTOPATH CERV/VAG THIN LAYER

Facility

$170.00

Service Code	HCPCS 88142 TC
Hospital Charge Code	3118814201
Hospital Revenue Code	311
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cash Price	$102.00
Rate for Payer: Hawaii Medical Service Association ABD	$28.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.40
Rate for Payer: Hawaii Western Management Group Commercial	$161.50
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: Kaiser Permanente Medicaid	$86.70
Rate for Payer: MDX Hawaii PPO	$164.90
Rate for Payer: UnitedHealthcare Medicaid	$28.00
Rate for Payer: University Health Alliance Commercial	$52.37

HC CYTOPATH EVAL FNA REPORT - LAB INTERPRETATION OF FNA SMEAR

Facility

$529.00

Service Code	HCPCS 88173 TC
Hospital Charge Code	3118817301
Hospital Revenue Code	311
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

HC CYTOPATH EVAL FNA REPORT - LAB INTERPRETATION OF FNA SMEAR

Facility

$529.00

Service Code	HCPCS 88173 TC
Hospital Charge Code	3118817301
Hospital Revenue Code	311
Min. Negotiated Rate	$50.48
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Hawaii Medical Service Association ABD	$87.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.48
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: UnitedHealthcare Medicaid	$87.10
Rate for Payer: University Health Alliance Commercial	$135.62

HC CYTOPATH FL NONGYN SMEARS - LAB CYTOPATH FLUIDS,SMEAR,INTERP

Facility

$389.00

Service Code	HCPCS 88104 TC
Hospital Charge Code	3118810401
Hospital Revenue Code	311
Min. Negotiated Rate	$20.15
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$233.40
Rate for Payer: Cash Price	$233.40
Rate for Payer: Hawaii Medical Service Association ABD	$35.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.15
Rate for Payer: Hawaii Western Management Group Commercial	$369.55
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: Kaiser Permanente Commercial	$245.07
Rate for Payer: Kaiser Permanente Medicaid	$198.39
Rate for Payer: MDX Hawaii PPO	$377.33
Rate for Payer: UnitedHealthcare Medicaid	$35.00
Rate for Payer: University Health Alliance Commercial	$66.71

HC CYTOPATH FL NONGYN SMEARS - LAB CYTOPATH FLUIDS,SMEAR,INTERP

Facility

$389.00

Service Code	HCPCS 88104 TC
Hospital Charge Code	3118810401
Hospital Revenue Code	311
Min. Negotiated Rate	$330.65
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$233.40
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: MDX Hawaii PPO	$377.33

HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP

Facility

$243.00

Service Code	HCPCS 88160 TC
Hospital Charge Code	3118816001
Hospital Revenue Code	311
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: MDX Hawaii PPO	$235.71

Know your out-of-pocket cost for care.

All Charges