Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL QUAL SERUM SO

Facility

$36.00

Service Code	HCPCS 86592
Hospital Charge Code	3028659201
Hospital Revenue Code	302
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

HC SYPHILIS TEST, QUANTITATIVE - VDRL/RPR QUANT

Facility

$37.00

Service Code	HCPCS 86593
Hospital Charge Code	3028659302
Hospital Revenue Code	302
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: MDX Hawaii PPO	$35.89

HC SYPHILIS TEST, QUANTITATIVE - VDRL/RPR QUANT

Facility

$37.00

Service Code	HCPCS 86593
Hospital Charge Code	3028659302
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$4.40
Rate for Payer: AlohaCare Medicare	$4.40
Rate for Payer: Cash Price	$22.20
Rate for Payer: Cash Price	$22.20
Rate for Payer: Devoted Health Medicare	$4.84
Rate for Payer: Hawaii Medical Service Association ABD	$6.09
Rate for Payer: Hawaii Medical Service Association Commercial	$5.50
Rate for Payer: Hawaii Medical Service Association Medicare	$4.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.39
Rate for Payer: Hawaii Western Management Group Commercial	$4.40
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$4.40
Rate for Payer: Kaiser Permanente Commercial	$23.31
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$4.40
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$4.84
Rate for Payer: Ohana Health Plan Medicare	$4.40
Rate for Payer: UnitedHealthcare Medicaid	$6.09
Rate for Payer: UnitedHealthcare Medicare	$4.40
Rate for Payer: University Health Alliance Commercial	$11.40

HC SYPHILIS TEST, QUANTITATIVE - VDRL TITER SO

Facility

$37.00

Service Code	HCPCS 86593
Hospital Charge Code	3028659301
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$4.40
Rate for Payer: AlohaCare Medicare	$4.40
Rate for Payer: Cash Price	$22.20
Rate for Payer: Cash Price	$22.20
Rate for Payer: Devoted Health Medicare	$4.84
Rate for Payer: Hawaii Medical Service Association ABD	$6.09
Rate for Payer: Hawaii Medical Service Association Commercial	$5.50
Rate for Payer: Hawaii Medical Service Association Medicare	$4.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.39
Rate for Payer: Hawaii Western Management Group Commercial	$4.40
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$4.40
Rate for Payer: Kaiser Permanente Commercial	$23.31
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$4.40
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$4.84
Rate for Payer: Ohana Health Plan Medicare	$4.40
Rate for Payer: UnitedHealthcare Medicaid	$6.09
Rate for Payer: UnitedHealthcare Medicare	$4.40
Rate for Payer: University Health Alliance Commercial	$11.40

HC SYPHILIS TEST, QUANTITATIVE - VDRL TITER SO

Facility

$37.00

Service Code	HCPCS 86593
Hospital Charge Code	3028659301
Hospital Revenue Code	302
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: MDX Hawaii PPO	$35.89

HC TANGENTIAL BIOPSY SKIN SINGLE LESION

Facility

$791.00

Service Code	HCPCS 11102
Hospital Charge Code	3611110201
Hospital Revenue Code	361
Min. Negotiated Rate	$38.19
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$498.33
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$38.19
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$576.56

HC TANGENTIAL BIOPSY SKIN SINGLE LESION

Facility

$791.00

Service Code	HCPCS 11102
Hospital Charge Code	3611110201
Hospital Revenue Code	361
Min. Negotiated Rate	$672.35
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: MDX Hawaii PPO	$767.27

HC TAP BLOCK BILATERAL BY INJECTION(S)

Facility

$3,005.00

Service Code	HCPCS 64488
Hospital Charge Code	3616448801
Hospital Revenue Code	361
Min. Negotiated Rate	$67.16
Max. Negotiated Rate	$2,914.85
Rate for Payer: Cash Price	$1,803.00
Rate for Payer: Cash Price	$1,803.00
Rate for Payer: Cash Price	$1,803.00
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 Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$2,554.25
Rate for Payer: Kaiser Permanente Commercial	$1,893.15
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$2,914.85
Rate for Payer: UnitedHealthcare Medicaid	$67.16
Rate for Payer: University Health Alliance Commercial	$2,190.34

HC TAP BLOCK BILATERAL BY INJECTION(S)

Facility

$3,005.00

Service Code	HCPCS 64488
Hospital Charge Code	3616448801
Hospital Revenue Code	361
Min. Negotiated Rate	$2,554.25
Max. Negotiated Rate	$2,914.85
Rate for Payer: Cash Price	$1,803.00
Rate for Payer: Health Management Network Commercial	$2,554.25
Rate for Payer: MDX Hawaii PPO	$2,914.85

HC TAU PHOSPHORYLATED EACH

Facility

$46.00

Service Code	HCPCS 84393
Hospital Charge Code	3018439301
Hospital Revenue Code	301
Min. Negotiated Rate	$23.46
Max. Negotiated Rate	$161.15
Rate for Payer: AlohaCare Medicaid	$128.92
Rate for Payer: AlohaCare Medicare	$128.92
Rate for Payer: Cash Price	$27.60
Rate for Payer: Cash Price	$27.60
Rate for Payer: Devoted Health Medicare	$141.81
Rate for Payer: Hawaii Medical Service Association Commercial	$161.15
Rate for Payer: Hawaii Medical Service Association Medicare	$128.92
Rate for Payer: Hawaii Western Management Group Commercial	$128.92
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Humana Medicare	$128.92
Rate for Payer: Kaiser Permanente Commercial	$28.98
Rate for Payer: Kaiser Permanente Medicaid	$23.46
Rate for Payer: Kaiser Permanente Medicare	$128.92
Rate for Payer: MDX Hawaii PPO	$44.62
Rate for Payer: Ohana Health Plan Medicaid	$141.81
Rate for Payer: Ohana Health Plan Medicare	$128.92
Rate for Payer: UnitedHealthcare Medicare	$128.92
Rate for Payer: University Health Alliance Commercial	$33.53

HC TAU PHOSPHORYLATED EACH

Facility

$46.00

Service Code	HCPCS 84393
Hospital Charge Code	3018439301
Hospital Revenue Code	301
Min. Negotiated Rate	$39.10
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$27.60
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: MDX Hawaii PPO	$44.62

HC TB TEST, CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON - TB TEST - QUANTIFERON TB GOLD TUBE

Facility

$520.00

Service Code	HCPCS 86480
Hospital Charge Code	3028648001
Hospital Revenue Code	302
Min. Negotiated Rate	$51.95
Max. Negotiated Rate	$504.40
Rate for Payer: AlohaCare Medicaid	$61.98
Rate for Payer: AlohaCare Medicare	$61.98
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Devoted Health Medicare	$68.18
Rate for Payer: Hawaii Medical Service Association ABD	$51.95
Rate for Payer: Hawaii Medical Service Association Commercial	$77.47
Rate for Payer: Hawaii Medical Service Association Medicare	$61.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$68.87
Rate for Payer: Hawaii Western Management Group Commercial	$61.98
Rate for Payer: Health Management Network Commercial	$442.00
Rate for Payer: Humana Medicare	$61.98
Rate for Payer: Kaiser Permanente Commercial	$327.60
Rate for Payer: Kaiser Permanente Medicaid	$265.20
Rate for Payer: Kaiser Permanente Medicare	$61.98
Rate for Payer: MDX Hawaii PPO	$504.40
Rate for Payer: Ohana Health Plan Medicaid	$68.18
Rate for Payer: Ohana Health Plan Medicare	$61.98
Rate for Payer: UnitedHealthcare Medicaid	$51.95
Rate for Payer: UnitedHealthcare Medicare	$61.98
Rate for Payer: University Health Alliance Commercial	$160.19

HC TB TEST, CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON - TB TEST - QUANTIFERON TB GOLD TUBE

Facility

$520.00

Service Code	HCPCS 86480
Hospital Charge Code	3028648001
Hospital Revenue Code	302
Min. Negotiated Rate	$442.00
Max. Negotiated Rate	$504.40
Rate for Payer: Cash Price	$312.00
Rate for Payer: Health Management Network Commercial	$442.00
Rate for Payer: MDX Hawaii PPO	$504.40

HC TCAT INSJ/RPL PERM LDLS PM

Facility

$75,896.00

Service Code	HCPCS 33274
Hospital Charge Code	3613327401
Hospital Revenue Code	361
Min. Negotiated Rate	$465.19
Max. Negotiated Rate	$73,619.12
Rate for Payer: AlohaCare Medicaid	$22,754.70
Rate for Payer: AlohaCare Medicare	$22,754.70
Rate for Payer: Cash Price	$45,537.60
Rate for Payer: Cash Price	$45,537.60
Rate for Payer: Cash Price	$45,537.60
Rate for Payer: Devoted Health Medicare	$25,030.17
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$22,754.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$64,511.60
Rate for Payer: Humana Medicare	$22,754.70
Rate for Payer: Kaiser Permanente Commercial	$47,814.48
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$22,754.70
Rate for Payer: MDX Hawaii PPO	$73,619.12
Rate for Payer: Ohana Health Plan Medicaid	$25,030.17
Rate for Payer: Ohana Health Plan Medicare	$22,754.70
Rate for Payer: UnitedHealthcare Medicaid	$465.19
Rate for Payer: UnitedHealthcare Medicare	$22,754.70
Rate for Payer: University Health Alliance Commercial	$20,300.00

HC TCAT INSJ/RPL PERM LDLS PM

Facility

$75,896.00

Service Code	HCPCS 33274
Hospital Charge Code	3613327401
Hospital Revenue Code	361
Min. Negotiated Rate	$64,511.60
Max. Negotiated Rate	$73,619.12
Rate for Payer: Cash Price	$45,537.60
Rate for Payer: Health Management Network Commercial	$64,511.60
Rate for Payer: MDX Hawaii PPO	$73,619.12

HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ

Facility

$10,616.00

Service Code	HCPCS 37215
Hospital Charge Code	3603721501
Hospital Revenue Code	360
Min. Negotiated Rate	$812.13
Max. Negotiated Rate	$10,297.52
Rate for Payer: Cash Price	$6,369.60
Rate for Payer: Cash Price	$6,369.60
Rate for Payer: Cash Price	$6,369.60
Rate for Payer: Health Management Network Commercial	$9,023.60
Rate for Payer: Kaiser Permanente Commercial	$6,688.08
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$10,297.52
Rate for Payer: UnitedHealthcare Medicaid	$812.13
Rate for Payer: University Health Alliance Commercial	$7,738.00

HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ

Facility

$10,616.00

Service Code	HCPCS 37215
Hospital Charge Code	3603721501
Hospital Revenue Code	360
Min. Negotiated Rate	$9,023.60
Max. Negotiated Rate	$10,297.52
Rate for Payer: Cash Price	$6,369.60
Rate for Payer: Health Management Network Commercial	$9,023.60
Rate for Payer: MDX Hawaii PPO	$10,297.52

HC T CELL ABSOLUTE COUNT/RATIO - T-HELPER CELLS CD4/CD8 %

Facility

$394.00

Service Code	HCPCS 86360
Hospital Charge Code	3028636001
Hospital Revenue Code	302
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$46.98
Rate for Payer: AlohaCare Medicare	$46.98
Rate for Payer: Cash Price	$236.40
Rate for Payer: Cash Price	$236.40
Rate for Payer: Devoted Health Medicare	$51.68
Rate for Payer: Hawaii Medical Service Association ABD	$64.93
Rate for Payer: Hawaii Medical Service Association Commercial	$58.73
Rate for Payer: Hawaii Medical Service Association Medicare	$46.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$68.18
Rate for Payer: Hawaii Western Management Group Commercial	$46.98
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$46.98
Rate for Payer: Kaiser Permanente Commercial	$248.22
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$46.98
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$51.68
Rate for Payer: Ohana Health Plan Medicare	$46.98
Rate for Payer: UnitedHealthcare Medicaid	$64.93
Rate for Payer: UnitedHealthcare Medicare	$46.98
Rate for Payer: University Health Alliance Commercial	$121.45

HC T CELL ABSOLUTE COUNT/RATIO - T-HELPER CELLS CD4/CD8 %

Facility

$394.00

Service Code	HCPCS 86360
Hospital Charge Code	3028636001
Hospital Revenue Code	302
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: MDX Hawaii PPO	$382.18

HC T CELL ABSOLUTE COUNT - T-HELPER CELLS (CD4) COUNT

Facility

$225.00

Service Code	HCPCS 86361
Hospital Charge Code	3028636101
Hospital Revenue Code	302
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$26.78
Rate for Payer: AlohaCare Medicare	$26.78
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$29.46
Rate for Payer: Hawaii Medical Service Association ABD	$25.00
Rate for Payer: Hawaii Medical Service Association Commercial	$33.48
Rate for Payer: Hawaii Medical Service Association Medicare	$26.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.25
Rate for Payer: Hawaii Western Management Group Commercial	$26.78
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$26.78
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$26.78
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$29.46
Rate for Payer: Ohana Health Plan Medicare	$26.78
Rate for Payer: UnitedHealthcare Medicaid	$25.00
Rate for Payer: UnitedHealthcare Medicare	$26.78
Rate for Payer: University Health Alliance Commercial	$46.77

HC T CELL ABSOLUTE COUNT - T-HELPER CELLS (CD4) COUNT

Facility

$225.00

Service Code	HCPCS 86361
Hospital Charge Code	3028636101
Hospital Revenue Code	302
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25

HC T CELLS, TOTAL COUNT - T CELLS, TOTAL COUNT

Facility

$317.00

Service Code	HCPCS 86359
Hospital Charge Code	3028635901
Hospital Revenue Code	302
Min. Negotiated Rate	$37.73
Max. Negotiated Rate	$307.49
Rate for Payer: AlohaCare Medicaid	$37.73
Rate for Payer: AlohaCare Medicare	$37.73
Rate for Payer: Cash Price	$190.20
Rate for Payer: Cash Price	$190.20
Rate for Payer: Devoted Health Medicare	$41.50
Rate for Payer: Hawaii Medical Service Association ABD	$52.13
Rate for Payer: Hawaii Medical Service Association Commercial	$47.16
Rate for Payer: Hawaii Medical Service Association Medicare	$37.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$54.74
Rate for Payer: Hawaii Western Management Group Commercial	$37.73
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Humana Medicare	$37.73
Rate for Payer: Kaiser Permanente Commercial	$199.71
Rate for Payer: Kaiser Permanente Medicaid	$161.67
Rate for Payer: Kaiser Permanente Medicare	$37.73
Rate for Payer: MDX Hawaii PPO	$307.49
Rate for Payer: Ohana Health Plan Medicaid	$41.50
Rate for Payer: Ohana Health Plan Medicare	$37.73
Rate for Payer: UnitedHealthcare Medicaid	$52.13
Rate for Payer: UnitedHealthcare Medicare	$37.73
Rate for Payer: University Health Alliance Commercial	$97.50

HC T CELLS, TOTAL COUNT - T CELLS, TOTAL COUNT

Facility

$317.00

Service Code	HCPCS 86359
Hospital Charge Code	3028635901
Hospital Revenue Code	302
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$307.49
Rate for Payer: Cash Price	$190.20
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: MDX Hawaii PPO	$307.49

HC TEE REAL TIME 2D PROBE PLCMT

Facility

$3,930.00

Service Code	HCPCS C8925
Hospital Charge Code	483C892501
Hospital Revenue Code	483
Min. Negotiated Rate	$592.55
Max. Negotiated Rate	$3,812.10
Rate for Payer: AlohaCare Medicaid	$926.08
Rate for Payer: AlohaCare Medicare	$926.08
Rate for Payer: Cash Price	$2,358.00
Rate for Payer: Cash Price	$2,358.00
Rate for Payer: Devoted Health Medicare	$1,018.69
Rate for Payer: Hawaii Medical Service Association Commercial	$1,157.60
Rate for Payer: Hawaii Medical Service Association Medicare	$926.08
Rate for Payer: Hawaii Western Management Group Commercial	$3,733.50
Rate for Payer: Health Management Network Commercial	$3,340.50
Rate for Payer: Humana Medicare	$926.08
Rate for Payer: Kaiser Permanente Commercial	$2,475.90
Rate for Payer: Kaiser Permanente Medicaid	$2,004.30
Rate for Payer: Kaiser Permanente Medicare	$926.08
Rate for Payer: MDX Hawaii PPO	$3,812.10
Rate for Payer: Ohana Health Plan Medicaid	$1,018.69
Rate for Payer: Ohana Health Plan Medicare	$926.08
Rate for Payer: UnitedHealthcare Medicaid	$592.55
Rate for Payer: UnitedHealthcare Medicare	$926.08
Rate for Payer: University Health Alliance Commercial	$2,864.58

HC TEE REAL TIME 2D PROBE PLCMT

Facility

$3,930.00

Service Code	HCPCS C8925
Hospital Charge Code	483C892501
Hospital Revenue Code	483
Min. Negotiated Rate	$3,340.50
Max. Negotiated Rate	$3,812.10
Rate for Payer: Cash Price	$2,358.00
Rate for Payer: Health Management Network Commercial	$3,340.50
Rate for Payer: MDX Hawaii PPO	$3,812.10

Know your out-of-pocket cost for care.

All Charges