Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC MRI, PELVIS, W/O CONTRAST - MRI PELVIS WO CONTRAST

Facility

$1,203.00

Service Code	HCPCS 72195
Hospital Charge Code	6147219501
Hospital Revenue Code	614
Min. Negotiated Rate	$1,022.55
Max. Negotiated Rate	$1,166.91
Rate for Payer: Cash Price	$721.80
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: MDX Hawaii PPO	$1,166.91

HC MRI SPECTROSCOPY - MR SPECTROSCOPY

Facility

$438.00

Service Code	HCPCS 76390
Hospital Charge Code	6107639001
Hospital Revenue Code	610
Min. Negotiated Rate	$102.81
Max. Negotiated Rate	$424.86
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$275.94
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$319.26

HC MRI SPECTROSCOPY - MR SPECTROSCOPY

Facility

$438.00

Service Code	HCPCS 76390
Hospital Charge Code	6107639001
Hospital Revenue Code	610
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$262.80
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: MDX Hawaii PPO	$424.86

HC MRI UPPER EXTREMITY COMBO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 73220
Hospital Charge Code	6107322002
Hospital Revenue Code	610
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$645.58
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$880.75
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$645.58
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,286.62

HC MRI UPPER EXTREMITY COMBO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 73220
Hospital Charge Code	6107322002
Hospital Revenue Code	610
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC MRI, UPPER EXTREMITY W/CONTRAST - MR HAND W IV CONTRAST

Facility

$3,553.00

Service Code	HCPCS 73219
Hospital Charge Code	6147321903
Hospital Revenue Code	614
Min. Negotiated Rate	$3,020.05
Max. Negotiated Rate	$3,446.41
Rate for Payer: Cash Price	$2,131.80
Rate for Payer: Health Management Network Commercial	$3,020.05
Rate for Payer: MDX Hawaii PPO	$3,446.41

HC MRI, UPPER EXTREMITY W/CONTRAST - MR HAND W IV CONTRAST

Facility

$3,553.00

Service Code	HCPCS 73219
Hospital Charge Code	6147321903
Hospital Revenue Code	614
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$3,446.41
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,131.80
Rate for Payer: Cash Price	$2,131.80
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$382.28
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$475.88
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$3,020.05
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$2,238.39
Rate for Payer: Kaiser Permanente Medicaid	$1,812.03
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,446.41
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$974.25

HC MRI, UPPER EXTREMITY W/CONTRAST - MR RADIUS ULNA W IV CONTRAST

Facility

$3,553.00

Service Code	HCPCS 73219
Hospital Charge Code	6147321901
Hospital Revenue Code	614
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$3,446.41
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,131.80
Rate for Payer: Cash Price	$2,131.80
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$382.28
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$475.88
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$3,020.05
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$2,238.39
Rate for Payer: Kaiser Permanente Medicaid	$1,812.03
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,446.41
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$974.25

HC MRI, UPPER EXTREMITY W/CONTRAST - MR RADIUS ULNA W IV CONTRAST

Facility

$3,553.00

Service Code	HCPCS 73219
Hospital Charge Code	6147321901
Hospital Revenue Code	614
Min. Negotiated Rate	$3,020.05
Max. Negotiated Rate	$3,446.41
Rate for Payer: Cash Price	$2,131.80
Rate for Payer: Health Management Network Commercial	$3,020.05
Rate for Payer: MDX Hawaii PPO	$3,446.41

HC MRI, UPPER EXTREMITY W/O CONTRAST

Facility

$1,203.00

Service Code	HCPCS 73218
Hospital Charge Code	6107321803
Hospital Revenue Code	610
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$1,166.91
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$721.80
Rate for Payer: Cash Price	$721.80
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$318.66
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$396.79
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$757.89
Rate for Payer: Kaiser Permanente Medicaid	$613.53
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,166.91
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$318.66
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$837.87

HC MRI, UPPER EXTREMITY W/O CONTRAST

Facility

$1,203.00

Service Code	HCPCS 73218
Hospital Charge Code	6107321803
Hospital Revenue Code	610
Min. Negotiated Rate	$1,022.55
Max. Negotiated Rate	$1,166.91
Rate for Payer: Cash Price	$721.80
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: MDX Hawaii PPO	$1,166.91

HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HUMERUS WO IV

Facility

$1,203.00

Service Code	HCPCS 73218
Hospital Charge Code	6147321805
Hospital Revenue Code	614
Min. Negotiated Rate	$1,022.55
Max. Negotiated Rate	$1,166.91
Rate for Payer: Cash Price	$721.80
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: MDX Hawaii PPO	$1,166.91

HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HUMERUS WO IV

Facility

$1,203.00

Service Code	HCPCS 73218
Hospital Charge Code	6147321805
Hospital Revenue Code	614
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$1,166.91
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$721.80
Rate for Payer: Cash Price	$721.80
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$318.66
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$396.79
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$757.89
Rate for Payer: Kaiser Permanente Medicaid	$613.53
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,166.91
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$318.66
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$837.87

HC M.TUBERCULO, DNA, AMP PROBE - M. TUBERCULOSIS DNA PROBE, AMPLIFIED

Facility

$350.00

Service Code	HCPCS 87556
Hospital Charge Code	3068755602
Hospital Revenue Code	306
Min. Negotiated Rate	$41.68
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$41.68
Rate for Payer: AlohaCare Medicare	$41.68
Rate for Payer: Cash Price	$210.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$45.85
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$52.10
Rate for Payer: Hawaii Medical Service Association Medicare	$41.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$41.68
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$41.68
Rate for Payer: Kaiser Permanente Commercial	$220.50
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$41.68
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$45.85
Rate for Payer: Ohana Health Plan Medicare	$41.68
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$41.68
Rate for Payer: University Health Alliance Commercial	$90.72

HC M.TUBERCULO, DNA, AMP PROBE - M. TUBERCULOSIS DNA PROBE, AMPLIFIED

Facility

$350.00

Service Code	HCPCS 87556
Hospital Charge Code	3068755602
Hospital Revenue Code	306
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: MDX Hawaii PPO	$339.50

HC M.TUBERCULO, DNA, AMP PROBE - M. TUBERCULOSIS DNA PROBE, AMPLIFIED - TB BY PCR SO

Facility

$350.00

Service Code	HCPCS 87556
Hospital Charge Code	3068755601
Hospital Revenue Code	306
Min. Negotiated Rate	$41.68
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$41.68
Rate for Payer: AlohaCare Medicare	$41.68
Rate for Payer: Cash Price	$210.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$45.85
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$52.10
Rate for Payer: Hawaii Medical Service Association Medicare	$41.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$41.68
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$41.68
Rate for Payer: Kaiser Permanente Commercial	$220.50
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$41.68
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$45.85
Rate for Payer: Ohana Health Plan Medicare	$41.68
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$41.68
Rate for Payer: University Health Alliance Commercial	$90.72

HC M.TUBERCULO, DNA, AMP PROBE - M. TUBERCULOSIS DNA PROBE, AMPLIFIED - TB BY PCR SO

Facility

$350.00

Service Code	HCPCS 87556
Hospital Charge Code	3068755601
Hospital Revenue Code	306
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: MDX Hawaii PPO	$339.50

HC MUMPS - MUMPS ANTIBODY

Facility

$109.00

Service Code	HCPCS 86735
Hospital Charge Code	3028673503
Hospital Revenue Code	302
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$105.73
Rate for Payer: AlohaCare Medicaid	$13.05
Rate for Payer: AlohaCare Medicare	$13.05
Rate for Payer: Cash Price	$65.40
Rate for Payer: Cash Price	$65.40
Rate for Payer: Devoted Health Medicare	$14.36
Rate for Payer: Hawaii Medical Service Association ABD	$18.03
Rate for Payer: Hawaii Medical Service Association Commercial	$16.31
Rate for Payer: Hawaii Medical Service Association Medicare	$13.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.93
Rate for Payer: Hawaii Western Management Group Commercial	$13.05
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Humana Medicare	$13.05
Rate for Payer: Kaiser Permanente Commercial	$68.67
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: Kaiser Permanente Medicare	$13.05
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: Ohana Health Plan Medicaid	$14.36
Rate for Payer: Ohana Health Plan Medicare	$13.05
Rate for Payer: UnitedHealthcare Medicaid	$18.03
Rate for Payer: UnitedHealthcare Medicare	$13.05
Rate for Payer: University Health Alliance Commercial	$33.73

HC MUMPS - MUMPS ANTIBODY

Facility

$109.00

Service Code	HCPCS 86735
Hospital Charge Code	3028673503
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 MUMPS - MUMPS IGG ANTIBODY

Facility

$109.00

Service Code	HCPCS 86735
Hospital Charge Code	3028673501
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 MUMPS - MUMPS IGG ANTIBODY

Facility

$109.00

Service Code	HCPCS 86735
Hospital Charge Code	3028673501
Hospital Revenue Code	302
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$105.73
Rate for Payer: AlohaCare Medicaid	$13.05
Rate for Payer: AlohaCare Medicare	$13.05
Rate for Payer: Cash Price	$65.40
Rate for Payer: Cash Price	$65.40
Rate for Payer: Devoted Health Medicare	$14.36
Rate for Payer: Hawaii Medical Service Association ABD	$18.03
Rate for Payer: Hawaii Medical Service Association Commercial	$16.31
Rate for Payer: Hawaii Medical Service Association Medicare	$13.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.93
Rate for Payer: Hawaii Western Management Group Commercial	$13.05
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Humana Medicare	$13.05
Rate for Payer: Kaiser Permanente Commercial	$68.67
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: Kaiser Permanente Medicare	$13.05
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: Ohana Health Plan Medicaid	$14.36
Rate for Payer: Ohana Health Plan Medicare	$13.05
Rate for Payer: UnitedHealthcare Medicaid	$18.03
Rate for Payer: UnitedHealthcare Medicare	$13.05
Rate for Payer: University Health Alliance Commercial	$33.73

HC MUMPS - MUMPS IGM ANTIBODY

Facility

$109.00

Service Code	HCPCS 86735
Hospital Charge Code	3028673502
Hospital Revenue Code	302
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$105.73
Rate for Payer: AlohaCare Medicaid	$13.05
Rate for Payer: AlohaCare Medicare	$13.05
Rate for Payer: Cash Price	$65.40
Rate for Payer: Cash Price	$65.40
Rate for Payer: Devoted Health Medicare	$14.36
Rate for Payer: Hawaii Medical Service Association ABD	$18.03
Rate for Payer: Hawaii Medical Service Association Commercial	$16.31
Rate for Payer: Hawaii Medical Service Association Medicare	$13.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.93
Rate for Payer: Hawaii Western Management Group Commercial	$13.05
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Humana Medicare	$13.05
Rate for Payer: Kaiser Permanente Commercial	$68.67
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: Kaiser Permanente Medicare	$13.05
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: Ohana Health Plan Medicaid	$14.36
Rate for Payer: Ohana Health Plan Medicare	$13.05
Rate for Payer: UnitedHealthcare Medicaid	$18.03
Rate for Payer: UnitedHealthcare Medicare	$13.05
Rate for Payer: University Health Alliance Commercial	$33.73

HC MUMPS - MUMPS IGM ANTIBODY

Facility

$109.00

Service Code	HCPCS 86735
Hospital Charge Code	3028673502
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 MYCOBACTERIA IDENTIFICATION - MYCOBACTERIA IDENTIFICATION

Facility

$123.00

Service Code	HCPCS 87118
Hospital Charge Code	3068711801
Hospital Revenue Code	306
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$119.31
Rate for Payer: AlohaCare Medicaid	$14.61
Rate for Payer: AlohaCare Medicare	$14.61
Rate for Payer: Cash Price	$73.80
Rate for Payer: Cash Price	$73.80
Rate for Payer: Devoted Health Medicare	$16.07
Rate for Payer: Hawaii Medical Service Association ABD	$15.13
Rate for Payer: Hawaii Medical Service Association Commercial	$18.26
Rate for Payer: Hawaii Medical Service Association Medicare	$14.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.89
Rate for Payer: Hawaii Western Management Group Commercial	$14.61
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: Humana Medicare	$14.61
Rate for Payer: Kaiser Permanente Commercial	$77.49
Rate for Payer: Kaiser Permanente Medicaid	$62.73
Rate for Payer: Kaiser Permanente Medicare	$14.61
Rate for Payer: MDX Hawaii PPO	$119.31
Rate for Payer: Ohana Health Plan Medicaid	$16.07
Rate for Payer: Ohana Health Plan Medicare	$14.61
Rate for Payer: UnitedHealthcare Medicaid	$15.13
Rate for Payer: UnitedHealthcare Medicare	$14.61
Rate for Payer: University Health Alliance Commercial	$28.29

HC MYCOBACTERIA IDENTIFICATION - MYCOBACTERIA IDENTIFICATION

Facility

$123.00

Service Code	HCPCS 87118
Hospital Charge Code	3068711801
Hospital Revenue Code	306
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$119.31
Rate for Payer: Cash Price	$73.80
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: MDX Hawaii PPO	$119.31

Know your out-of-pocket cost for care.

All Charges