Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC TOTAL CORTISOL - ACTH STIMULATION 30 MINUTES

Facility

$137.00

Service Code	HCPCS 82533
Hospital Charge Code	3018253303
Hospital Revenue Code	301
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$82.20
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: MDX Hawaii PPO	$132.89

HC TOTAL CORTISOL - ACTH STIMULATION BASELINE

Facility

$137.00

Service Code	HCPCS 82533
Hospital Charge Code	3018253302
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$16.30
Rate for Payer: AlohaCare Medicare	$16.30
Rate for Payer: Cash Price	$82.20
Rate for Payer: Cash Price	$82.20
Rate for Payer: Devoted Health Medicare	$17.93
Rate for Payer: Hawaii Medical Service Association ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$16.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.66
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$16.30
Rate for Payer: Kaiser Permanente Commercial	$86.31
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$16.30
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$17.93
Rate for Payer: Ohana Health Plan Medicare	$16.30
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$16.30
Rate for Payer: University Health Alliance Commercial	$42.14

HC TOTAL CORTISOL - ACTH STIMULATION BASELINE

Facility

$137.00

Service Code	HCPCS 82533
Hospital Charge Code	3018253302
Hospital Revenue Code	301
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$82.20
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: MDX Hawaii PPO	$132.89

HC TOTAL CORTISOL - CORTISOL - CORTISOL TOTAL RANDOM

Facility

$137.00

Service Code	HCPCS 82533
Hospital Charge Code	3018253301
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$16.30
Rate for Payer: AlohaCare Medicare	$16.30
Rate for Payer: Cash Price	$82.20
Rate for Payer: Cash Price	$82.20
Rate for Payer: Devoted Health Medicare	$17.93
Rate for Payer: Hawaii Medical Service Association ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$16.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.66
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$16.30
Rate for Payer: Kaiser Permanente Commercial	$86.31
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$16.30
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$17.93
Rate for Payer: Ohana Health Plan Medicare	$16.30
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$16.30
Rate for Payer: University Health Alliance Commercial	$42.14

HC TOTAL CORTISOL - CORTISOL - CORTISOL TOTAL RANDOM

Facility

$137.00

Service Code	HCPCS 82533
Hospital Charge Code	3018253301
Hospital Revenue Code	301
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$82.20
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: MDX Hawaii PPO	$132.89

HC TOXOPLASMA, IGM - TOXOPLASMA GONDII ANTIBODY, IGM

Facility

$121.00

Service Code	HCPCS 86778
Hospital Charge Code	3028677801
Hospital Revenue Code	302
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: MDX Hawaii PPO	$117.37

HC TOXOPLASMA, IGM - TOXOPLASMA GONDII ANTIBODY, IGM

Facility

$121.00

Service Code	HCPCS 86778
Hospital Charge Code	3028677801
Hospital Revenue Code	302
Min. Negotiated Rate	$14.41
Max. Negotiated Rate	$117.37
Rate for Payer: AlohaCare Medicaid	$14.41
Rate for Payer: AlohaCare Medicare	$14.41
Rate for Payer: Cash Price	$72.60
Rate for Payer: Cash Price	$72.60
Rate for Payer: Devoted Health Medicare	$15.85
Rate for Payer: Hawaii Medical Service Association ABD	$19.90
Rate for Payer: Hawaii Medical Service Association Commercial	$18.01
Rate for Payer: Hawaii Medical Service Association Medicare	$14.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.90
Rate for Payer: Hawaii Western Management Group Commercial	$14.41
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Humana Medicare	$14.41
Rate for Payer: Kaiser Permanente Commercial	$76.23
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: Kaiser Permanente Medicare	$14.41
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: Ohana Health Plan Medicaid	$15.85
Rate for Payer: Ohana Health Plan Medicare	$14.41
Rate for Payer: UnitedHealthcare Medicaid	$19.90
Rate for Payer: UnitedHealthcare Medicare	$14.41
Rate for Payer: University Health Alliance Commercial	$37.22

HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY

Facility

$121.00

Service Code	HCPCS 86777
Hospital Charge Code	3028677701
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$117.37
Rate for Payer: AlohaCare Medicaid	$14.39
Rate for Payer: AlohaCare Medicare	$14.39
Rate for Payer: Cash Price	$72.60
Rate for Payer: Cash Price	$72.60
Rate for Payer: Devoted Health Medicare	$15.83
Rate for Payer: Hawaii Medical Service Association ABD	$19.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17.99
Rate for Payer: Hawaii Medical Service Association Medicare	$14.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.88
Rate for Payer: Hawaii Western Management Group Commercial	$14.39
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Humana Medicare	$14.39
Rate for Payer: Kaiser Permanente Commercial	$76.23
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: Kaiser Permanente Medicare	$14.39
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: Ohana Health Plan Medicaid	$15.83
Rate for Payer: Ohana Health Plan Medicare	$14.39
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$14.39
Rate for Payer: University Health Alliance Commercial	$37.20

HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY

Facility

$121.00

Service Code	HCPCS 86777
Hospital Charge Code	3028677701
Hospital Revenue Code	302
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: MDX Hawaii PPO	$117.37

HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)

Facility

$44.00

Service Code	HCPCS 84460
Hospital Charge Code	3018446001
Hospital Revenue Code	301
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$42.68
Rate for Payer: AlohaCare Medicaid	$5.30
Rate for Payer: AlohaCare Medicare	$5.30
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Devoted Health Medicare	$5.83
Rate for Payer: Hawaii Medical Service Association ABD	$7.32
Rate for Payer: Hawaii Medical Service Association Commercial	$6.62
Rate for Payer: Hawaii Medical Service Association Medicare	$5.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.69
Rate for Payer: Hawaii Western Management Group Commercial	$5.30
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Humana Medicare	$5.30
Rate for Payer: Kaiser Permanente Commercial	$27.72
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: Kaiser Permanente Medicare	$5.30
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: Ohana Health Plan Medicaid	$5.83
Rate for Payer: Ohana Health Plan Medicare	$5.30
Rate for Payer: UnitedHealthcare Medicaid	$7.32
Rate for Payer: UnitedHealthcare Medicare	$5.30
Rate for Payer: University Health Alliance Commercial	$13.69

HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)

Facility

$44.00

Service Code	HCPCS 84460
Hospital Charge Code	3018446001
Hospital Revenue Code	301
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: MDX Hawaii PPO	$42.68

HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT)

Facility

$43.00

Service Code	HCPCS 84450
Hospital Charge Code	3018445001
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$25.80
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.14
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.50
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$27.09
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.14
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.36

HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT)

Facility

$43.00

Service Code	HCPCS 84450
Hospital Charge Code	3018445001
Hospital Revenue Code	301
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: MDX Hawaii PPO	$41.71

HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL

Facility

$529.00

Service Code	HCPCS 76817
Hospital Charge Code	4027681701
Hospital Revenue Code	402
Min. Negotiated Rate	$46.06
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$46.06
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53.86
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$46.06
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$193.75

HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL

Facility

$529.00

Service Code	HCPCS 76817
Hospital Charge Code	4027681701
Hospital Revenue Code	402
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 TRAUMA CCU OVERFLOW

Facility

$6,875.00

Hospital Charge Code	2080000001
Hospital Revenue Code	208
Min. Negotiated Rate	$5,843.75
Max. Negotiated Rate	$12,050.00
Rate for Payer: Cash Price	$4,125.00
Rate for Payer: Cash Price	$4,125.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,050.00
Rate for Payer: Health Management Network Commercial	$5,843.75
Rate for Payer: MDX Hawaii PPO	$6,668.75
Rate for Payer: University Health Alliance Commercial	$5,923.00

HC TRAUMA ICU MONITORING CARE ACUTE

Facility

$6,875.00

Hospital Charge Code	2080000002
Hospital Revenue Code	208
Min. Negotiated Rate	$5,843.75
Max. Negotiated Rate	$12,050.00
Rate for Payer: Cash Price	$4,125.00
Rate for Payer: Cash Price	$4,125.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,050.00
Rate for Payer: Health Management Network Commercial	$5,843.75
Rate for Payer: MDX Hawaii PPO	$6,668.75
Rate for Payer: University Health Alliance Commercial	$5,923.00

HC TRAUMA RESPONS W/HOSP CRITI (FULL)

Facility

$7,350.00

Service Code	HCPCS G0390
Hospital Charge Code	683G039002
Hospital Revenue Code	683
Min. Negotiated Rate	$6,247.50
Max. Negotiated Rate	$7,129.50
Rate for Payer: Cash Price	$4,410.00
Rate for Payer: Health Management Network Commercial	$6,247.50
Rate for Payer: MDX Hawaii PPO	$7,129.50

HC TRAUMA RESPONS W/HOSP CRITI (FULL)

Facility

$7,350.00

Service Code	HCPCS G0390
Hospital Charge Code	683G039002
Hospital Revenue Code	683
Min. Negotiated Rate	$992.38
Max. Negotiated Rate	$7,129.50
Rate for Payer: AlohaCare Medicaid	$1,574.63
Rate for Payer: AlohaCare Medicare	$1,574.63
Rate for Payer: Cash Price	$4,410.00
Rate for Payer: Cash Price	$4,410.00
Rate for Payer: Devoted Health Medicare	$1,732.09
Rate for Payer: Hawaii Medical Service Association Commercial	$1,968.29
Rate for Payer: Hawaii Medical Service Association Medicare	$1,574.63
Rate for Payer: Hawaii Western Management Group Commercial	$6,982.50
Rate for Payer: Health Management Network Commercial	$6,247.50
Rate for Payer: Humana Medicare	$1,574.63
Rate for Payer: Kaiser Permanente Commercial	$4,630.50
Rate for Payer: Kaiser Permanente Medicaid	$3,748.50
Rate for Payer: Kaiser Permanente Medicare	$1,574.63
Rate for Payer: MDX Hawaii PPO	$7,129.50
Rate for Payer: Ohana Health Plan Medicaid	$1,732.09
Rate for Payer: Ohana Health Plan Medicare	$1,574.63
Rate for Payer: UnitedHealthcare Medicaid	$992.38
Rate for Payer: UnitedHealthcare Medicare	$1,574.63
Rate for Payer: University Health Alliance Commercial	$5,357.41

HC TRAUMA RESPONS W/HOSP CRITI (MODERATE)

Facility

$5,998.00

Service Code	HCPCS G0390
Hospital Charge Code	683G039001
Hospital Revenue Code	683
Min. Negotiated Rate	$992.38
Max. Negotiated Rate	$5,818.06
Rate for Payer: AlohaCare Medicaid	$1,574.63
Rate for Payer: AlohaCare Medicare	$1,574.63
Rate for Payer: Cash Price	$3,598.80
Rate for Payer: Cash Price	$3,598.80
Rate for Payer: Devoted Health Medicare	$1,732.09
Rate for Payer: Hawaii Medical Service Association Commercial	$1,968.29
Rate for Payer: Hawaii Medical Service Association Medicare	$1,574.63
Rate for Payer: Hawaii Western Management Group Commercial	$5,698.10
Rate for Payer: Health Management Network Commercial	$5,098.30
Rate for Payer: Humana Medicare	$1,574.63
Rate for Payer: Kaiser Permanente Commercial	$3,778.74
Rate for Payer: Kaiser Permanente Medicaid	$3,058.98
Rate for Payer: Kaiser Permanente Medicare	$1,574.63
Rate for Payer: MDX Hawaii PPO	$5,818.06
Rate for Payer: Ohana Health Plan Medicaid	$1,732.09
Rate for Payer: Ohana Health Plan Medicare	$1,574.63
Rate for Payer: UnitedHealthcare Medicaid	$992.38
Rate for Payer: UnitedHealthcare Medicare	$1,574.63
Rate for Payer: University Health Alliance Commercial	$4,371.94

HC TRAUMA RESPONS W/HOSP CRITI (MODERATE)

Facility

$5,998.00

Service Code	HCPCS G0390
Hospital Charge Code	683G039001
Hospital Revenue Code	683
Min. Negotiated Rate	$5,098.30
Max. Negotiated Rate	$5,818.06
Rate for Payer: Cash Price	$3,598.80
Rate for Payer: Health Management Network Commercial	$5,098.30
Rate for Payer: MDX Hawaii PPO	$5,818.06

HC TRB GENE REARRANGE AMP SO

Facility

$1,753.00

Service Code	HCPCS 81340
Hospital Charge Code	3108134001
Hospital Revenue Code	310
Min. Negotiated Rate	$1,490.05
Max. Negotiated Rate	$1,700.41
Rate for Payer: Cash Price	$1,051.80
Rate for Payer: Health Management Network Commercial	$1,490.05
Rate for Payer: MDX Hawaii PPO	$1,700.41

HC TRB GENE REARRANGE AMP SO

Facility

$1,753.00

Service Code	HCPCS 81340
Hospital Charge Code	3108134001
Hospital Revenue Code	310
Min. Negotiated Rate	$88.87
Max. Negotiated Rate	$1,700.41
Rate for Payer: AlohaCare Medicaid	$208.92
Rate for Payer: AlohaCare Medicare	$208.92
Rate for Payer: Cash Price	$1,051.80
Rate for Payer: Cash Price	$1,051.80
Rate for Payer: Devoted Health Medicare	$229.81
Rate for Payer: Hawaii Medical Service Association Commercial	$261.15
Rate for Payer: Hawaii Medical Service Association Medicare	$208.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$279.65
Rate for Payer: Hawaii Western Management Group Commercial	$208.92
Rate for Payer: Health Management Network Commercial	$1,490.05
Rate for Payer: Humana Medicare	$208.92
Rate for Payer: Kaiser Permanente Commercial	$1,104.39
Rate for Payer: Kaiser Permanente Medicaid	$894.03
Rate for Payer: Kaiser Permanente Medicare	$208.92
Rate for Payer: MDX Hawaii PPO	$1,700.41
Rate for Payer: Ohana Health Plan Medicaid	$229.81
Rate for Payer: Ohana Health Plan Medicare	$208.92
Rate for Payer: UnitedHealthcare Medicaid	$88.87
Rate for Payer: UnitedHealthcare Medicare	$208.92
Rate for Payer: University Health Alliance Commercial	$1,277.76

HC TREAT THUMB FX/DISLOC,MANIP

Facility

$6,236.00

Service Code	HCPCS 26645
Hospital Charge Code	7612664501
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$6,048.92
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Devoted Health Medicare	$2,089.55
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	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$5,924.20
Rate for Payer: Health Management Network Commercial	$5,300.60
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$3,928.68
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$6,048.92
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$4,545.42

HC TREAT THUMB FX/DISLOC,MANIP

Facility

$6,236.00

Service Code	HCPCS 26645
Hospital Charge Code	7612664501
Hospital Revenue Code	450
Min. Negotiated Rate	$5,300.60
Max. Negotiated Rate	$6,048.92
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Health Management Network Commercial	$5,300.60
Rate for Payer: MDX Hawaii PPO	$6,048.92

Know your out-of-pocket cost for care.

All Charges