Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC COG SKILL DEV ADDL 15 MIN

Facility

$99.00

Service Code	HCPCS 97130
Hospital Charge Code	4409713001
Hospital Revenue Code	440
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$62.37
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: UnitedHealthcare Medicaid	$21.52
Rate for Payer: University Health Alliance Commercial	$72.16

HC COG SKILL DEV ADDL 15 MIN

Facility

$99.00

Service Code	HCPCS 97130
Hospital Charge Code	4309713001
Hospital Revenue Code	430
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: MDX Hawaii PPO	$96.03

HC COG SKILL DEV ADDL 15 MIN

Facility

$99.00

Service Code	HCPCS 97130
Hospital Charge Code	4409713001
Hospital Revenue Code	440
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: MDX Hawaii PPO	$96.03

HC COG SKILL DEV ADDL 15 MIN

Facility

$99.00

Service Code	HCPCS 97130
Hospital Charge Code	4309713001
Hospital Revenue Code	430
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$62.37
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: UnitedHealthcare Medicaid	$21.52
Rate for Payer: University Health Alliance Commercial	$72.16

HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - PTH RELATED POLYPEPTID QT SO

Facility

$202.00

Service Code	HCPCS 82542
Hospital Charge Code	3018254201
Hospital Revenue Code	301
Min. Negotiated Rate	$171.70
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$121.20
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: MDX Hawaii PPO	$195.94

HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - PTH RELATED POLYPEPTID QT SO

Facility

$202.00

Service Code	HCPCS 82542
Hospital Charge Code	3018254201
Hospital Revenue Code	301
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$195.94
Rate for Payer: AlohaCare Medicaid	$24.09
Rate for Payer: AlohaCare Medicare	$24.09
Rate for Payer: Cash Price	$121.20
Rate for Payer: Cash Price	$121.20
Rate for Payer: Devoted Health Medicare	$26.50
Rate for Payer: Hawaii Medical Service Association ABD	$24.96
Rate for Payer: Hawaii Medical Service Association Commercial	$30.11
Rate for Payer: Hawaii Medical Service Association Medicare	$24.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.21
Rate for Payer: Hawaii Western Management Group Commercial	$24.09
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Humana Medicare	$24.09
Rate for Payer: Kaiser Permanente Commercial	$127.26
Rate for Payer: Kaiser Permanente Medicaid	$103.02
Rate for Payer: Kaiser Permanente Medicare	$24.09
Rate for Payer: MDX Hawaii PPO	$195.94
Rate for Payer: Ohana Health Plan Medicaid	$26.50
Rate for Payer: Ohana Health Plan Medicare	$24.09
Rate for Payer: UnitedHealthcare Medicaid	$24.96
Rate for Payer: UnitedHealthcare Medicare	$24.09
Rate for Payer: University Health Alliance Commercial	$46.68

HC COLD AGGLUTININ, TITER - COLD AGGLUTININ TITER

Facility

$68.00

Service Code	HCPCS 86157
Hospital Charge Code	3028615701
Hospital Revenue Code	302
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$8.06
Rate for Payer: AlohaCare Medicare	$8.06
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$8.87
Rate for Payer: Hawaii Medical Service Association ABD	$11.14
Rate for Payer: Hawaii Medical Service Association Commercial	$10.07
Rate for Payer: Hawaii Medical Service Association Medicare	$8.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.70
Rate for Payer: Hawaii Western Management Group Commercial	$8.06
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$8.06
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$8.06
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$8.87
Rate for Payer: Ohana Health Plan Medicare	$8.06
Rate for Payer: UnitedHealthcare Medicaid	$11.14
Rate for Payer: UnitedHealthcare Medicare	$8.06
Rate for Payer: University Health Alliance Commercial	$20.85

HC COLD AGGLUTININ, TITER - COLD AGGLUTININ TITER

Facility

$68.00

Service Code	HCPCS 86157
Hospital Charge Code	3028615701
Hospital Revenue Code	302
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HC COLLECT BLOOD FROM CATHETER VENOUS NOS

Facility

$513.00

Service Code	HCPCS 36592
Hospital Charge Code	3613659201
Hospital Revenue Code	361
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC COLLECT BLOOD FROM CATHETER VENOUS NOS

Facility

$513.00

Service Code	HCPCS 36592
Hospital Charge Code	3613659201
Hospital Revenue Code	361
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$15.71
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC COLON CA SCRN NOT HI RSK IND

Facility

$3,628.00

Service Code	HCPCS G0121
Hospital Charge Code	361G012101
Hospital Revenue Code	361
Min. Negotiated Rate	$3,083.80
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: MDX Hawaii PPO	$3,519.16

HC COLON CA SCRN NOT HI RSK IND

Facility

$3,628.00

Service Code	HCPCS G0121
Hospital Charge Code	361G012101
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Devoted Health Medicare	$1,208.46
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	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Commercial	$2,285.64
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,098.60
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD - COLONOSCOPY

Facility

$3,628.00

Service Code	HCPCS 45378
Hospital Charge Code	3604537801
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Devoted Health Medicare	$1,208.46
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	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Commercial	$2,285.64
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,098.60
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD - COLONOSCOPY

Facility

$3,628.00

Service Code	HCPCS 45378
Hospital Charge Code	3604537801
Hospital Revenue Code	360
Min. Negotiated Rate	$3,083.80
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: MDX Hawaii PPO	$3,519.16

HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION - COLONOSCOPY

Facility

$11,050.00

Service Code	HCPCS 45390
Hospital Charge Code	3604539001
Hospital Revenue Code	360
Min. Negotiated Rate	$9,392.50
Max. Negotiated Rate	$10,718.50
Rate for Payer: Cash Price	$6,630.00
Rate for Payer: Health Management Network Commercial	$9,392.50
Rate for Payer: MDX Hawaii PPO	$10,718.50

HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION - COLONOSCOPY

Facility

$11,050.00

Service Code	HCPCS 45390
Hospital Charge Code	3604539001
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,718.50
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Cash Price	$6,630.00
Rate for Payer: Cash Price	$6,630.00
Rate for Payer: Cash Price	$6,630.00
Rate for Payer: Devoted Health Medicare	$3,606.91
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	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$9,392.50
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Commercial	$6,961.50
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: MDX Hawaii PPO	$10,718.50
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01
Rate for Payer: University Health Alliance Commercial	$8,054.35

HC COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE - COLONOSCOPY

Facility

$4,692.00

Service Code	HCPCS 45380
Hospital Charge Code	3604538001
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
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: Devoted Health Medicare	$1,555.02
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	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
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	$2,837.00
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	$5,160.40

HC COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE - COLONOSCOPY

Facility

$4,692.00

Service Code	HCPCS 45380
Hospital Charge Code	3604538001
Hospital Revenue Code	360
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 COLORECTAL SCRN; HI RISK IND

Facility

$3,628.00

Service Code	HCPCS G0105
Hospital Charge Code	361G010501
Hospital Revenue Code	361
Min. Negotiated Rate	$3,083.80
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: MDX Hawaii PPO	$3,519.16

HC COLORECTAL SCRN; HI RISK IND

Facility

$3,628.00

Service Code	HCPCS G0105
Hospital Charge Code	361G010501
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Devoted Health Medicare	$1,208.46
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	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Commercial	$2,285.64
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,098.60
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST - COLONOSCOPY

Facility

$4,692.00

Service Code	HCPCS 45381
Hospital Charge Code	3604538101
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
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: Devoted Health Medicare	$1,555.02
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	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
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	$2,837.00
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	$5,160.40

HC COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST - COLONOSCOPY

Facility

$4,692.00

Service Code	HCPCS 45381
Hospital Charge Code	3604538101
Hospital Revenue Code	360
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 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ - COLONOSCOPY

Facility

$4,692.00

Service Code	HCPCS 45385
Hospital Charge Code	3604538501
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
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: Devoted Health Medicare	$1,555.02
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	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
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	$2,837.00
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	$5,160.40

HC COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ - COLONOSCOPY

Facility

$4,692.00

Service Code	HCPCS 45385
Hospital Charge Code	3604538501
Hospital Revenue Code	360
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 COMPATIB AHG

Facility

$1,698.00

Service Code	HCPCS 86922
Hospital Charge Code	3008692201
Hospital Revenue Code	300
Min. Negotiated Rate	$1,443.30
Max. Negotiated Rate	$1,647.06
Rate for Payer: Cash Price	$1,018.80
Rate for Payer: Health Management Network Commercial	$1,443.30
Rate for Payer: MDX Hawaii PPO	$1,647.06

Know your out-of-pocket cost for care.

All Charges