Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC EXAM,SYNOVIAL FLUID CRYSTALS - SYNOVIAL FLUID CRYSTAL

Facility

$61.00

Service Code	HCPCS 89060
Hospital Charge Code	3008906001
Hospital Revenue Code	300
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$7.33
Rate for Payer: AlohaCare Medicare	$7.33
Rate for Payer: Cash Price	$36.60
Rate for Payer: Cash Price	$36.60
Rate for Payer: Devoted Health Medicare	$8.06
Rate for Payer: Hawaii Medical Service Association ABD	$9.88
Rate for Payer: Hawaii Medical Service Association Commercial	$9.16
Rate for Payer: Hawaii Medical Service Association Medicare	$7.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.37
Rate for Payer: Hawaii Western Management Group Commercial	$7.33
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$7.33
Rate for Payer: Kaiser Permanente Commercial	$38.43
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$7.33
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$8.06
Rate for Payer: Ohana Health Plan Medicare	$7.33
Rate for Payer: UnitedHealthcare Medicaid	$9.88
Rate for Payer: UnitedHealthcare Medicare	$7.33
Rate for Payer: University Health Alliance Commercial	$18.48

HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<

Facility

$6,314.00

Service Code	HCPCS 11420
Hospital Charge Code	4501142001
Hospital Revenue Code	450
Min. Negotiated Rate	$5,366.90
Max. Negotiated Rate	$6,124.58
Rate for Payer: Cash Price	$3,788.40
Rate for Payer: Health Management Network Commercial	$5,366.90
Rate for Payer: MDX Hawaii PPO	$6,124.58

HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<

Facility

$6,314.00

Service Code	HCPCS 11420
Hospital Charge Code	4501142001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,124.58
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,788.40
Rate for Payer: Cash Price	$3,788.40
Rate for Payer: Cash Price	$3,788.40
Rate for Payer: Cash Price	$3,788.40
Rate for Payer: Devoted Health Medicare	$2,146.22
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 Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,998.30
Rate for Payer: Health Management Network Commercial	$5,366.90
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$3,977.82
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,124.58
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I

Facility

$14,044.00

Service Code	HCPCS 47536
Hospital Charge Code	3614753601
Hospital Revenue Code	361
Min. Negotiated Rate	$11,937.40
Max. Negotiated Rate	$13,622.68
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Health Management Network Commercial	$11,937.40
Rate for Payer: MDX Hawaii PPO	$13,622.68

HC EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I

Facility

$14,044.00

Service Code	HCPCS 47536
Hospital Charge Code	3614753601
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,622.68
Rate for Payer: AlohaCare Medicaid	$4,229.69
Rate for Payer: AlohaCare Medicare	$4,229.69
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Devoted Health Medicare	$4,652.66
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,229.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$11,937.40
Rate for Payer: Humana Medicare	$4,229.69
Rate for Payer: Kaiser Permanente Commercial	$8,847.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,229.69
Rate for Payer: MDX Hawaii PPO	$13,622.68
Rate for Payer: Ohana Health Plan Medicaid	$4,652.66
Rate for Payer: Ohana Health Plan Medicare	$4,229.69
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,229.69
Rate for Payer: University Health Alliance Commercial	$10,236.67

HC EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I

Facility

$8,152.00

Service Code	HCPCS 50435
Hospital Charge Code	3615043501
Hospital Revenue Code	361
Min. Negotiated Rate	$6,929.20
Max. Negotiated Rate	$7,907.44
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Health Management Network Commercial	$6,929.20
Rate for Payer: MDX Hawaii PPO	$7,907.44

HC EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I

Facility

$8,152.00

Service Code	HCPCS 50435
Hospital Charge Code	3615043501
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$7,907.44
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Devoted Health Medicare	$2,716.41
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$6,929.20
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Commercial	$5,135.76
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: MDX Hawaii PPO	$7,907.44
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,469.46
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC EXCISION OF NAIL FOLD, TOE

Facility

$1,590.00

Service Code	HCPCS 11765
Hospital Charge Code	4501176501
Hospital Revenue Code	450
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$1,542.30
Rate for Payer: Cash Price	$954.00
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: MDX Hawaii PPO	$1,542.30

HC EXCISION OF NAIL FOLD, TOE

Facility

$1,590.00

Service Code	HCPCS 11765
Hospital Charge Code	4501176501
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Devoted Health Medicare	$528.25
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 Medicare	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,510.50
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,001.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$1,542.30
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$1,158.95

HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL

Facility

$4,692.00

Service Code	HCPCS 46320
Hospital Charge Code	4504632001
Hospital Revenue Code	450
Min. Negotiated Rate	$3,988.20
Max. Negotiated Rate	$4,551.24
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Health Management Network Commercial	$3,988.20
Rate for Payer: MDX Hawaii PPO	$4,551.24

HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL

Facility

$4,692.00

Service Code	HCPCS 46320
Hospital Charge Code	4504632001
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$4,551.24
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Devoted Health Medicare	$1,555.02
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 Medicare	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,457.40
Rate for Payer: Health Management Network Commercial	$3,988.20
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Commercial	$2,955.96
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: MDX Hawaii PPO	$4,551.24
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65
Rate for Payer: University Health Alliance Commercial	$3,420.00

HC EXC SKIN BENIG 1.1-2 CM REMAINDR BODY

Facility

$6,448.00

Service Code	HCPCS 11422
Hospital Charge Code	7611142201
Hospital Revenue Code	761
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC EXC SKIN BENIG 1.1-2 CM REMAINDR BODY

Facility

$6,448.00

Service Code	HCPCS 11422
Hospital Charge Code	7611142201
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.60
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$3,288.48
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC EXPLO/DRAIN BREAST ABSCESS

Facility

$6,448.00

Service Code	HCPCS 19020
Hospital Charge Code	7611902001
Hospital Revenue Code	450
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC EXPLO/DRAIN BREAST ABSCESS

Facility

$6,448.00

Service Code	HCPCS 19020
Hospital Charge Code	7611902001
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.60
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC EXPLORE WOUND,EXTREMITY

Facility

$6,448.00

Service Code	HCPCS 20103
Hospital Charge Code	7612010301
Hospital Revenue Code	761
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC EXPLORE WOUND,EXTREMITY

Facility

$6,448.00

Service Code	HCPCS 20103
Hospital Charge Code	7612010301
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.60
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$3,288.48
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,699.95

HC EXTERNAL CEPHALIC VERSION

Facility

$12,653.00

Service Code	HCPCS 59412
Hospital Charge Code	7205941201
Hospital Revenue Code	720
Min. Negotiated Rate	$10,755.05
Max. Negotiated Rate	$12,273.41
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Health Management Network Commercial	$10,755.05
Rate for Payer: MDX Hawaii PPO	$12,273.41

HC EXTERNAL CEPHALIC VERSION

Facility

$12,653.00

Service Code	HCPCS 59412
Hospital Charge Code	7205941201
Hospital Revenue Code	720
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$12,273.41
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Devoted Health Medicare	$4,206.58
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$12,020.35
Rate for Payer: Health Management Network Commercial	$10,755.05
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Commercial	$7,971.39
Rate for Payer: Kaiser Permanente Medicaid	$6,453.03
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: MDX Hawaii PPO	$12,273.41
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC EXTERNAL ECG REC>48HR<7D RECORDING

Facility

$153.00

Service Code	HCPCS 93242
Hospital Charge Code	7319324201
Hospital Revenue Code	731
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$91.80
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: MDX Hawaii PPO	$148.41

HC EXTERNAL ECG REC>48HR<7D RECORDING

Facility

$153.00

Service Code	HCPCS 93242
Hospital Charge Code	7319324201
Hospital Revenue Code	731
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$44.12
Rate for Payer: AlohaCare Medicare	$44.12
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Devoted Health Medicare	$48.53
Rate for Payer: Hawaii Medical Service Association Commercial	$55.15
Rate for Payer: Hawaii Medical Service Association Medicare	$44.12
Rate for Payer: Hawaii Western Management Group Commercial	$145.35
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$44.12
Rate for Payer: Kaiser Permanente Commercial	$96.39
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$44.12
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$48.53
Rate for Payer: Ohana Health Plan Medicare	$44.12
Rate for Payer: UnitedHealthcare Medicaid	$13.57
Rate for Payer: UnitedHealthcare Medicare	$44.12
Rate for Payer: University Health Alliance Commercial	$111.52

HC EXTERNAL ECG REC>7D<15D RECORDING

Facility

$153.00

Service Code	HCPCS 93246
Hospital Charge Code	7319324601
Hospital Revenue Code	731
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$44.12
Rate for Payer: AlohaCare Medicare	$44.12
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Devoted Health Medicare	$48.53
Rate for Payer: Hawaii Medical Service Association Commercial	$55.15
Rate for Payer: Hawaii Medical Service Association Medicare	$44.12
Rate for Payer: Hawaii Western Management Group Commercial	$145.35
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$44.12
Rate for Payer: Kaiser Permanente Commercial	$96.39
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$44.12
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$48.53
Rate for Payer: Ohana Health Plan Medicare	$44.12
Rate for Payer: UnitedHealthcare Medicaid	$13.57
Rate for Payer: UnitedHealthcare Medicare	$44.12
Rate for Payer: University Health Alliance Commercial	$111.52

HC EXTERNAL ECG REC>7D<15D RECORDING

Facility

$153.00

Service Code	HCPCS 93246
Hospital Charge Code	7319324601
Hospital Revenue Code	731
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$91.80
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: MDX Hawaii PPO	$148.41

HC F2 GENE ANALYSIS 20210G >A VARIANT - PROTHROMBIN GENE MUTATION

Facility

$551.00

Service Code	HCPCS 81240
Hospital Charge Code	3108124001
Hospital Revenue Code	310
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$534.47
Rate for Payer: AlohaCare Medicaid	$65.69
Rate for Payer: AlohaCare Medicare	$65.69
Rate for Payer: Cash Price	$330.60
Rate for Payer: Cash Price	$330.60
Rate for Payer: Devoted Health Medicare	$72.26
Rate for Payer: Hawaii Medical Service Association Commercial	$82.11
Rate for Payer: Hawaii Medical Service Association Medicare	$65.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$65.87
Rate for Payer: Hawaii Western Management Group Commercial	$65.69
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Humana Medicare	$65.69
Rate for Payer: Kaiser Permanente Commercial	$347.13
Rate for Payer: Kaiser Permanente Medicaid	$281.01
Rate for Payer: Kaiser Permanente Medicare	$65.69
Rate for Payer: MDX Hawaii PPO	$534.47
Rate for Payer: Ohana Health Plan Medicaid	$72.26
Rate for Payer: Ohana Health Plan Medicare	$65.69
Rate for Payer: UnitedHealthcare Medicaid	$24.85
Rate for Payer: UnitedHealthcare Medicare	$65.69
Rate for Payer: University Health Alliance Commercial	$124.19

HC F2 GENE ANALYSIS 20210G >A VARIANT - PROTHROMBIN GENE MUTATION

Facility

$551.00

Service Code	HCPCS 81240
Hospital Charge Code	3108124001
Hospital Revenue Code	310
Min. Negotiated Rate	$468.35
Max. Negotiated Rate	$534.47
Rate for Payer: Cash Price	$330.60
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: MDX Hawaii PPO	$534.47

Know your out-of-pocket cost for care.

All Charges