Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC ABLTJ PERC PLEX/TRNCL NRV

Facility

$25,486.00

Service Code	HCPCS 0442T
Hospital Charge Code	3610442T01
Hospital Revenue Code	361
Min. Negotiated Rate	$21,663.10
Max. Negotiated Rate	$24,721.42
Rate for Payer: Cash Price	$15,291.60
Rate for Payer: Health Management Network Commercial	$21,663.10
Rate for Payer: MDX Hawaii PPO	$24,721.42

HC ABSCESS DRAINAGE UNDER X-RAY - CT GUIDANCE FOR ABSCESS DRAIN

Facility

$1,336.00

Service Code	HCPCS 75989
Hospital Charge Code	3207598901
Hospital Revenue Code	320
Min. Negotiated Rate	$103.94
Max. Negotiated Rate	$1,295.92
Rate for Payer: Cash Price	$801.60
Rate for Payer: Cash Price	$801.60
Rate for Payer: Hawaii Medical Service Association ABD	$103.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$112.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,269.20
Rate for Payer: Health Management Network Commercial	$1,135.60
Rate for Payer: Kaiser Permanente Commercial	$841.68
Rate for Payer: Kaiser Permanente Medicaid	$681.36
Rate for Payer: MDX Hawaii PPO	$1,295.92
Rate for Payer: UnitedHealthcare Medicaid	$103.94
Rate for Payer: University Health Alliance Commercial	$317.64

HC ABSCESS DRAINAGE UNDER X-RAY - CT GUIDANCE FOR ABSCESS DRAIN

Facility

$1,336.00

Service Code	HCPCS 75989
Hospital Charge Code	3207598901
Hospital Revenue Code	320
Min. Negotiated Rate	$1,135.60
Max. Negotiated Rate	$1,295.92
Rate for Payer: Cash Price	$801.60
Rate for Payer: Health Management Network Commercial	$1,135.60
Rate for Payer: MDX Hawaii PPO	$1,295.92

HC ABSCESS DRAINAGE UNDER X-RAY - CT GUIDANCE FOR ABSCESS DRAIN

Facility

$1,336.00

Service Code	HCPCS 75989
Hospital Charge Code	3507598901
Hospital Revenue Code	350
Min. Negotiated Rate	$103.94
Max. Negotiated Rate	$1,295.92
Rate for Payer: Cash Price	$801.60
Rate for Payer: Cash Price	$801.60
Rate for Payer: Hawaii Medical Service Association ABD	$103.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$112.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,269.20
Rate for Payer: Health Management Network Commercial	$1,135.60
Rate for Payer: Kaiser Permanente Commercial	$841.68
Rate for Payer: Kaiser Permanente Medicaid	$681.36
Rate for Payer: MDX Hawaii PPO	$1,295.92
Rate for Payer: UnitedHealthcare Medicaid	$103.94
Rate for Payer: University Health Alliance Commercial	$317.64

HC ABSCESS DRAINAGE UNDER X-RAY - CT GUIDANCE FOR ABSCESS DRAIN

Facility

$1,336.00

Service Code	HCPCS 75989
Hospital Charge Code	3507598901
Hospital Revenue Code	350
Min. Negotiated Rate	$1,135.60
Max. Negotiated Rate	$1,295.92
Rate for Payer: Cash Price	$801.60
Rate for Payer: Health Management Network Commercial	$1,135.60
Rate for Payer: MDX Hawaii PPO	$1,295.92

HC ABSCESS DRAINAGE UNDER X-RAY - US GUIDED ABSCESS DRAIN

Facility

$1,336.00

Service Code	HCPCS 75989
Hospital Charge Code	4027598901
Hospital Revenue Code	402
Min. Negotiated Rate	$103.94
Max. Negotiated Rate	$1,295.92
Rate for Payer: Cash Price	$801.60
Rate for Payer: Cash Price	$801.60
Rate for Payer: Hawaii Medical Service Association ABD	$103.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$112.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,269.20
Rate for Payer: Health Management Network Commercial	$1,135.60
Rate for Payer: Kaiser Permanente Commercial	$841.68
Rate for Payer: Kaiser Permanente Medicaid	$681.36
Rate for Payer: MDX Hawaii PPO	$1,295.92
Rate for Payer: UnitedHealthcare Medicaid	$103.94
Rate for Payer: University Health Alliance Commercial	$317.64

HC ABSCESS DRAINAGE UNDER X-RAY - US GUIDED ABSCESS DRAIN

Facility

$1,336.00

Service Code	HCPCS 75989
Hospital Charge Code	4027598901
Hospital Revenue Code	402
Min. Negotiated Rate	$1,135.60
Max. Negotiated Rate	$1,295.92
Rate for Payer: Cash Price	$801.60
Rate for Payer: Health Management Network Commercial	$1,135.60
Rate for Payer: MDX Hawaii PPO	$1,295.92

HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY

Facility

$154.00

Service Code	HCPCS 86042
Hospital Charge Code	3028604201
Hospital Revenue Code	302
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$92.40
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: MDX Hawaii PPO	$149.38

HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY

Facility

$154.00

Service Code	HCPCS 86042
Hospital Charge Code	3028604201
Hospital Revenue Code	302
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$18.40
Rate for Payer: AlohaCare Medicare	$18.40
Rate for Payer: Cash Price	$92.40
Rate for Payer: Cash Price	$92.40
Rate for Payer: Devoted Health Medicare	$20.24
Rate for Payer: Hawaii Medical Service Association Commercial	$23.00
Rate for Payer: Hawaii Medical Service Association Medicare	$18.40
Rate for Payer: Hawaii Western Management Group Commercial	$18.40
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$18.40
Rate for Payer: Kaiser Permanente Commercial	$97.02
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$18.40
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$20.24
Rate for Payer: Ohana Health Plan Medicare	$18.40
Rate for Payer: UnitedHealthcare Medicaid	$13.80
Rate for Payer: UnitedHealthcare Medicare	$18.40
Rate for Payer: University Health Alliance Commercial	$112.25

HC ACETYLCHOLIN REC BIND SO

Facility

$154.00

Service Code	HCPCS 86041
Hospital Charge Code	3028604101
Hospital Revenue Code	302
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$92.40
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: MDX Hawaii PPO	$149.38

HC ACETYLCHOLIN REC BIND SO

Facility

$154.00

Service Code	HCPCS 86041
Hospital Charge Code	3028604101
Hospital Revenue Code	302
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$18.40
Rate for Payer: AlohaCare Medicare	$18.40
Rate for Payer: Cash Price	$92.40
Rate for Payer: Cash Price	$92.40
Rate for Payer: Devoted Health Medicare	$20.24
Rate for Payer: Hawaii Medical Service Association Commercial	$23.00
Rate for Payer: Hawaii Medical Service Association Medicare	$18.40
Rate for Payer: Hawaii Western Management Group Commercial	$18.40
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$18.40
Rate for Payer: Kaiser Permanente Commercial	$97.02
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$18.40
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$20.24
Rate for Payer: Ohana Health Plan Medicare	$18.40
Rate for Payer: UnitedHealthcare Medicaid	$13.80
Rate for Payer: UnitedHealthcare Medicare	$18.40
Rate for Payer: University Health Alliance Commercial	$112.25

HC ACETYLCHOLIN REC MOD SO

Facility

$101.00

Service Code	HCPCS 86043
Hospital Charge Code	3028604301
Hospital Revenue Code	302
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: MDX Hawaii PPO	$97.97

HC ACETYLCHOLIN REC MOD SO

Facility

$101.00

Service Code	HCPCS 86043
Hospital Charge Code	3028604301
Hospital Revenue Code	302
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$12.05
Rate for Payer: AlohaCare Medicare	$12.05
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.26
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$12.05
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$12.05
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$12.05
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.26
Rate for Payer: Ohana Health Plan Medicare	$12.05
Rate for Payer: UnitedHealthcare Medicaid	$9.04
Rate for Payer: UnitedHealthcare Medicare	$12.05
Rate for Payer: University Health Alliance Commercial	$73.62

HC ACUTE GI BLOOD LOSS IMAGING - NM GASTROINTESTINAL BLEEDING

Facility

$1,999.00

Service Code	HCPCS 78278
Hospital Charge Code	3417827801
Hospital Revenue Code	341
Min. Negotiated Rate	$160.53
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$160.53
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$174.65
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$160.53
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$591.91

HC ACUTE GI BLOOD LOSS IMAGING - NM GASTROINTESTINAL BLEEDING

Facility

$1,999.00

Service Code	HCPCS 78278
Hospital Charge Code	3417827801
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC ACYLCARNITINES,QUANT,EACH SPEC - ACYLCARNITINES QUANT SO

Facility

$142.00

Service Code	HCPCS 82017
Hospital Charge Code	3018201701
Hospital Revenue Code	301
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$16.87
Rate for Payer: AlohaCare Medicare	$16.87
Rate for Payer: Cash Price	$85.20
Rate for Payer: Cash Price	$85.20
Rate for Payer: Devoted Health Medicare	$18.56
Rate for Payer: Hawaii Medical Service Association ABD	$23.31
Rate for Payer: Hawaii Medical Service Association Commercial	$21.09
Rate for Payer: Hawaii Medical Service Association Medicare	$16.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.48
Rate for Payer: Hawaii Western Management Group Commercial	$16.87
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$16.87
Rate for Payer: Kaiser Permanente Commercial	$89.46
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$16.87
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$18.56
Rate for Payer: Ohana Health Plan Medicare	$16.87
Rate for Payer: UnitedHealthcare Medicaid	$23.31
Rate for Payer: UnitedHealthcare Medicare	$16.87
Rate for Payer: University Health Alliance Commercial	$43.60

HC ACYLCARNITINES,QUANT,EACH SPEC - ACYLCARNITINES QUANT SO

Facility

$142.00

Service Code	HCPCS 82017
Hospital Charge Code	3018201701
Hospital Revenue Code	301
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$85.20
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: MDX Hawaii PPO	$137.74

HC ADAMTS13 ACTIVITY

Facility

$259.00

Service Code	HCPCS 85397
Hospital Charge Code	3058539701
Hospital Revenue Code	305
Min. Negotiated Rate	$23.15
Max. Negotiated Rate	$251.23
Rate for Payer: AlohaCare Medicaid	$30.86
Rate for Payer: AlohaCare Medicare	$30.86
Rate for Payer: Cash Price	$155.40
Rate for Payer: Cash Price	$155.40
Rate for Payer: Devoted Health Medicare	$33.95
Rate for Payer: Hawaii Medical Service Association Commercial	$38.58
Rate for Payer: Hawaii Medical Service Association Medicare	$30.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.31
Rate for Payer: Hawaii Western Management Group Commercial	$30.86
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Humana Medicare	$30.86
Rate for Payer: Kaiser Permanente Commercial	$163.17
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: Kaiser Permanente Medicare	$30.86
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: Ohana Health Plan Medicaid	$33.95
Rate for Payer: Ohana Health Plan Medicare	$30.86
Rate for Payer: UnitedHealthcare Medicaid	$23.15
Rate for Payer: UnitedHealthcare Medicare	$30.86
Rate for Payer: University Health Alliance Commercial	$188.79

HC ADAMTS13 ACTIVITY

Facility

$259.00

Service Code	HCPCS 85397
Hospital Charge Code	3058539701
Hospital Revenue Code	305
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$155.40
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: MDX Hawaii PPO	$251.23

HC ADMIN HEPATITIS B VACCINE

Facility

$184.00

Service Code	HCPCS G0010
Hospital Charge Code	771G001001
Hospital Revenue Code	771
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$55.32
Rate for Payer: AlohaCare Medicare	$55.32
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$110.40
Rate for Payer: Devoted Health Medicare	$60.85
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Medical Service Association Medicare	$55.32
Rate for Payer: Hawaii Western Management Group Commercial	$174.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$55.32
Rate for Payer: Kaiser Permanente Commercial	$115.92
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$55.32
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$60.85
Rate for Payer: Ohana Health Plan Medicare	$55.32
Rate for Payer: UnitedHealthcare Medicaid	$34.61
Rate for Payer: UnitedHealthcare Medicare	$55.32
Rate for Payer: University Health Alliance Commercial	$134.12

HC ADMIN HEPATITIS B VACCINE

Facility

$184.00

Service Code	HCPCS G0010
Hospital Charge Code	771G001001
Hospital Revenue Code	771
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$110.40
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: MDX Hawaii PPO	$178.48

HC ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP

Facility

$283.00

Service Code	HCPCS 96380
Hospital Charge Code	7719638001
Hospital Revenue Code	771
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Cash Price	$169.80
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Kaiser Permanente Commercial	$178.29
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: UnitedHealthcare Medicaid	$14.77
Rate for Payer: University Health Alliance Commercial	$206.28

HC ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP

Facility

$283.00

Service Code	HCPCS 96380
Hospital Charge Code	7719638001
Hospital Revenue Code	771
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: MDX Hawaii PPO	$274.51

HC ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX

Facility

$283.00

Service Code	HCPCS 96381
Hospital Charge Code	7719638101
Hospital Revenue Code	771
Min. Negotiated Rate	$12.92
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Cash Price	$169.80
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Kaiser Permanente Commercial	$178.29
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: UnitedHealthcare Medicaid	$12.92
Rate for Payer: University Health Alliance Commercial	$206.28

HC ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX

Facility

$283.00

Service Code	HCPCS 96381
Hospital Charge Code	7719638101
Hospital Revenue Code	771
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: MDX Hawaii PPO	$274.51

Know your out-of-pocket cost for care.

All Charges