Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC DRUG SCREENING CANNABINOIDS NATURAL - CANNABINOID CONFIRMATION UR

Facility

$960.00

Service Code	HCPCS 80349
Hospital Charge Code	3018034901
Hospital Revenue Code	301
Min. Negotiated Rate	$18.31
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Hawaii Medical Service Association ABD	$18.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.23
Rate for Payer: Hawaii Western Management Group Commercial	$912.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: Kaiser Permanente Commercial	$604.80
Rate for Payer: Kaiser Permanente Medicaid	$489.60
Rate for Payer: MDX Hawaii PPO	$931.20
Rate for Payer: University Health Alliance Commercial	$699.74

HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 - BUNDLED CHARGE

Facility

$960.00

Service Code	HCPCS 80321
Hospital Charge Code	3018032101
Hospital Revenue Code	301
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: MDX Hawaii PPO	$931.20

HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 - BUNDLED CHARGE

Facility

$960.00

Service Code	HCPCS 80321
Hospital Charge Code	3018032101
Hospital Revenue Code	301
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Hawaii Medical Service Association ABD	$14.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.68
Rate for Payer: Hawaii Western Management Group Commercial	$912.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: Kaiser Permanente Commercial	$604.80
Rate for Payer: Kaiser Permanente Medicaid	$489.60
Rate for Payer: MDX Hawaii PPO	$931.20
Rate for Payer: University Health Alliance Commercial	$699.74

HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 - AMPHETAMINE, BLOOD, QUANT

Facility

$960.00

Service Code	HCPCS 80324
Hospital Charge Code	3018032401
Hospital Revenue Code	301
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Hawaii Medical Service Association ABD	$21.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.55
Rate for Payer: Hawaii Western Management Group Commercial	$912.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: Kaiser Permanente Commercial	$604.80
Rate for Payer: Kaiser Permanente Medicaid	$489.60
Rate for Payer: MDX Hawaii PPO	$931.20
Rate for Payer: University Health Alliance Commercial	$699.74

HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 - AMPHETAMINE, BLOOD, QUANT

Facility

$960.00

Service Code	HCPCS 80324
Hospital Charge Code	3018032401
Hospital Revenue Code	301
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: MDX Hawaii PPO	$931.20

HC DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE - BUNDLED CHARGE

Facility

$960.00

Service Code	HCPCS 80326
Hospital Charge Code	3008032601
Hospital Revenue Code	300
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Hawaii Medical Service Association ABD	$21.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.55
Rate for Payer: Hawaii Western Management Group Commercial	$912.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: Kaiser Permanente Commercial	$604.80
Rate for Payer: Kaiser Permanente Medicaid	$489.60
Rate for Payer: MDX Hawaii PPO	$931.20
Rate for Payer: University Health Alliance Commercial	$699.74

HC DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE - BUNDLED CHARGE

Facility

$960.00

Service Code	HCPCS 80326
Hospital Charge Code	3008032601
Hospital Revenue Code	300
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: MDX Hawaii PPO	$931.20

HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID

Facility

$114.00

Service Code	HCPCS 80164
Hospital Charge Code	3018016401
Hospital Revenue Code	301
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$13.54
Rate for Payer: AlohaCare Medicare	$13.54
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Devoted Health Medicare	$14.89
Rate for Payer: Hawaii Medical Service Association ABD	$18.72
Rate for Payer: Hawaii Medical Service Association Commercial	$16.93
Rate for Payer: Hawaii Medical Service Association Medicare	$13.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.66
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$13.54
Rate for Payer: Kaiser Permanente Commercial	$71.82
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$13.54
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$14.89
Rate for Payer: Ohana Health Plan Medicare	$13.54
Rate for Payer: UnitedHealthcare Medicaid	$18.72
Rate for Payer: UnitedHealthcare Medicare	$13.54
Rate for Payer: University Health Alliance Commercial	$35.02

HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID

Facility

$114.00

Service Code	HCPCS 80164
Hospital Charge Code	3018016401
Hospital Revenue Code	301
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: MDX Hawaii PPO	$110.58

HC DRUG SCREEN QUANTITATIVE ALCOHOLS - METHANOL SO

Facility

$960.00

Service Code	HCPCS 80320
Hospital Charge Code	3018032002
Hospital Revenue Code	301
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Hawaii Medical Service Association ABD	$14.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.68
Rate for Payer: Hawaii Western Management Group Commercial	$912.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: Kaiser Permanente Commercial	$604.80
Rate for Payer: Kaiser Permanente Medicaid	$489.60
Rate for Payer: MDX Hawaii PPO	$931.20
Rate for Payer: University Health Alliance Commercial	$699.74

HC DRUG SCREEN QUANTITATIVE ALCOHOLS - METHANOL SO

Facility

$960.00

Service Code	HCPCS 80320
Hospital Charge Code	3018032002
Hospital Revenue Code	301
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: MDX Hawaii PPO	$931.20

HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL - DIGOXIN

Facility

$111.00

Service Code	HCPCS 80162
Hospital Charge Code	3018016201
Hospital Revenue Code	301
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$107.67
Rate for Payer: AlohaCare Medicaid	$13.28
Rate for Payer: AlohaCare Medicare	$13.28
Rate for Payer: Cash Price	$66.60
Rate for Payer: Cash Price	$66.60
Rate for Payer: Devoted Health Medicare	$14.61
Rate for Payer: Hawaii Medical Service Association ABD	$18.35
Rate for Payer: Hawaii Medical Service Association Commercial	$16.60
Rate for Payer: Hawaii Medical Service Association Medicare	$13.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.27
Rate for Payer: Hawaii Western Management Group Commercial	$13.28
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Humana Medicare	$13.28
Rate for Payer: Kaiser Permanente Commercial	$69.93
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: Kaiser Permanente Medicare	$13.28
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: Ohana Health Plan Medicaid	$14.61
Rate for Payer: Ohana Health Plan Medicare	$13.28
Rate for Payer: UnitedHealthcare Medicaid	$18.35
Rate for Payer: UnitedHealthcare Medicare	$13.28
Rate for Payer: University Health Alliance Commercial	$34.32

HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL - DIGOXIN

Facility

$111.00

Service Code	HCPCS 80162
Hospital Charge Code	3018016201
Hospital Revenue Code	301
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: MDX Hawaii PPO	$107.67

HC DRUG SCREEN QUANTITATIVE ZONISAMIDE

Facility

$103.00

Service Code	HCPCS 80203
Hospital Charge Code	3018020301
Hospital Revenue Code	301
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$61.80
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: MDX Hawaii PPO	$99.91

HC DRUG SCREEN QUANTITATIVE ZONISAMIDE

Facility

$103.00

Service Code	HCPCS 80203
Hospital Charge Code	3018020301
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$99.91
Rate for Payer: AlohaCare Medicaid	$13.25
Rate for Payer: AlohaCare Medicare	$13.25
Rate for Payer: Cash Price	$61.80
Rate for Payer: Cash Price	$61.80
Rate for Payer: Devoted Health Medicare	$14.57
Rate for Payer: Hawaii Medical Service Association ABD	$11.11
Rate for Payer: Hawaii Medical Service Association Commercial	$16.56
Rate for Payer: Hawaii Medical Service Association Medicare	$13.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.75
Rate for Payer: Hawaii Western Management Group Commercial	$13.25
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$13.25
Rate for Payer: Kaiser Permanente Commercial	$64.89
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$13.25
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$14.57
Rate for Payer: Ohana Health Plan Medicare	$13.25
Rate for Payer: UnitedHealthcare Medicaid	$10.85
Rate for Payer: UnitedHealthcare Medicare	$13.25
Rate for Payer: University Health Alliance Commercial	$75.08

HC DRUG TEST PRSMV CHEM ANLYZR - ACETAMINOPHEN/TYLENOL

Facility

$521.00

Service Code	HCPCS 80307
Hospital Charge Code	3018030704
Hospital Revenue Code	301
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: MDX Hawaii PPO	$505.37

HC DRUG TEST PRSMV CHEM ANLYZR - ACETAMINOPHEN/TYLENOL

Facility

$521.00

Service Code	HCPCS 80307
Hospital Charge Code	3018030704
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$312.60
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$68.35
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$62.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$328.23
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL BLOOD

Facility

$521.00

Service Code	HCPCS 80307
Hospital Charge Code	3018030706
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$312.60
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$68.35
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$62.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$328.23
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL BLOOD

Facility

$521.00

Service Code	HCPCS 80307
Hospital Charge Code	3018030706
Hospital Revenue Code	301
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: MDX Hawaii PPO	$505.37

HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN CLINICAL

Facility

$521.00

Service Code	HCPCS 80307
Hospital Charge Code	3018030702
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$312.60
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$68.35
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$62.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$328.23
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN CLINICAL

Facility

$521.00

Service Code	HCPCS 80307
Hospital Charge Code	3018030702
Hospital Revenue Code	301
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: MDX Hawaii PPO	$505.37

HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN URINE-8

Facility

$521.00

Service Code	HCPCS 80307
Hospital Charge Code	3018030703
Hospital Revenue Code	301
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: MDX Hawaii PPO	$505.37

HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN URINE-8

Facility

$521.00

Service Code	HCPCS 80307
Hospital Charge Code	3018030703
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$312.60
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$68.35
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$62.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$328.23
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HC DRUG TEST PRSMV CHEM ANLYZR - SALICYLATES BLOOD

Facility

$521.00

Service Code	HCPCS 80307
Hospital Charge Code	3018030705
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$312.60
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$68.35
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$62.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$328.23
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HC DRUG TEST PRSMV CHEM ANLYZR - SALICYLATES BLOOD

Facility

$521.00

Service Code	HCPCS 80307
Hospital Charge Code	3018030705
Hospital Revenue Code	301
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: MDX Hawaii PPO	$505.37

Know your out-of-pocket cost for care.

All Charges