Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC C-REACTIVE PROTEIN HIGH SENSITIVITY

Facility

$109.00

Service Code	HCPCS 86141
Hospital Charge Code	3028614101
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 CREATINE, MB FRACTION - CKMB

Facility

$97.00

Service Code	HCPCS 82553
Hospital Charge Code	3018255302
Hospital Revenue Code	301
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$11.55
Rate for Payer: AlohaCare Medicare	$11.55
Rate for Payer: Cash Price	$58.20
Rate for Payer: Cash Price	$58.20
Rate for Payer: Devoted Health Medicare	$12.71
Rate for Payer: Hawaii Medical Service Association ABD	$15.95
Rate for Payer: Hawaii Medical Service Association Commercial	$14.44
Rate for Payer: Hawaii Medical Service Association Medicare	$11.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.75
Rate for Payer: Hawaii Western Management Group Commercial	$11.55
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$11.55
Rate for Payer: Kaiser Permanente Commercial	$61.11
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$11.55
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$12.71
Rate for Payer: Ohana Health Plan Medicare	$11.55
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: UnitedHealthcare Medicare	$11.55
Rate for Payer: University Health Alliance Commercial	$29.84

HC CREATINE, MB FRACTION - CKMB

Facility

$97.00

Service Code	HCPCS 82553
Hospital Charge Code	3018255302
Hospital Revenue Code	301
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$58.20
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: MDX Hawaii PPO	$94.09

HC CREATININE CLEARANCE TEST - CREATININE CLEARANCE, URINE, 24 HOUR

Facility

$79.00

Service Code	HCPCS 82575
Hospital Charge Code	3018257501
Hospital Revenue Code	301
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: MDX Hawaii PPO	$76.63

HC CREATININE CLEARANCE TEST - CREATININE CLEARANCE, URINE, 24 HOUR

Facility

$79.00

Service Code	HCPCS 82575
Hospital Charge Code	3018257501
Hospital Revenue Code	301
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$9.46
Rate for Payer: AlohaCare Medicare	$9.46
Rate for Payer: Cash Price	$47.40
Rate for Payer: Cash Price	$47.40
Rate for Payer: Devoted Health Medicare	$10.41
Rate for Payer: Hawaii Medical Service Association ABD	$13.06
Rate for Payer: Hawaii Medical Service Association Commercial	$11.82
Rate for Payer: Hawaii Medical Service Association Medicare	$9.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.71
Rate for Payer: Hawaii Western Management Group Commercial	$9.46
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$9.46
Rate for Payer: Kaiser Permanente Commercial	$49.77
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$9.46
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$10.41
Rate for Payer: Ohana Health Plan Medicare	$9.46
Rate for Payer: UnitedHealthcare Medicaid	$13.06
Rate for Payer: UnitedHealthcare Medicare	$9.46
Rate for Payer: University Health Alliance Commercial	$24.42

HC CRITICAL CARE, ADDL 30 MIN

Facility

$1,894.00

Service Code	HCPCS 99292
Hospital Charge Code	6839929201
Hospital Revenue Code	450
Min. Negotiated Rate	$1,609.90
Max. Negotiated Rate	$1,837.18
Rate for Payer: Cash Price	$1,136.40
Rate for Payer: Health Management Network Commercial	$1,609.90
Rate for Payer: MDX Hawaii PPO	$1,837.18

HC CRITICAL CARE, ADDL 30 MIN

Facility

$1,894.00

Service Code	HCPCS 99292
Hospital Charge Code	6839929201
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,837.18
Rate for Payer: Cash Price	$1,136.40
Rate for Payer: Cash Price	$1,136.40
Rate for Payer: Cash Price	$1,136.40
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,799.30
Rate for Payer: Health Management Network Commercial	$1,609.90
Rate for Payer: Kaiser Permanente Commercial	$1,193.22
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$1,837.18
Rate for Payer: University Health Alliance Commercial	$1,380.54

HC CRITICAL CARE, ADDL 30 MIN

Facility

$2,368.00

Service Code	HCPCS 99292
Hospital Charge Code	4509929201
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,296.96
Rate for Payer: Cash Price	$1,420.80
Rate for Payer: Cash Price	$1,420.80
Rate for Payer: Cash Price	$1,420.80
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,249.60
Rate for Payer: Health Management Network Commercial	$2,012.80
Rate for Payer: Kaiser Permanente Commercial	$1,491.84
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$2,296.96
Rate for Payer: University Health Alliance Commercial	$1,726.04

HC CRITICAL CARE, ADDL 30 MIN

Facility

$2,368.00

Service Code	HCPCS 99292
Hospital Charge Code	4509929201
Hospital Revenue Code	450
Min. Negotiated Rate	$2,012.80
Max. Negotiated Rate	$2,296.96
Rate for Payer: Cash Price	$1,420.80
Rate for Payer: Health Management Network Commercial	$2,012.80
Rate for Payer: MDX Hawaii PPO	$2,296.96

HC CRITICAL CARE, E/M 30-74 MINUTES

Facility

$6,257.00

Service Code	HCPCS 99291
Hospital Charge Code	6839929101
Hospital Revenue Code	450
Min. Negotiated Rate	$5,318.45
Max. Negotiated Rate	$6,069.29
Rate for Payer: Cash Price	$3,754.20
Rate for Payer: Health Management Network Commercial	$5,318.45
Rate for Payer: MDX Hawaii PPO	$6,069.29

HC CRITICAL CARE, E/M 30-74 MINUTES

Facility

$6,883.00

Service Code	HCPCS 99291
Hospital Charge Code	4509929101
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$6,676.51
Rate for Payer: AlohaCare Medicaid	$975.82
Rate for Payer: AlohaCare Medicare	$975.82
Rate for Payer: Cash Price	$4,129.80
Rate for Payer: Cash Price	$4,129.80
Rate for Payer: Cash Price	$4,129.80
Rate for Payer: Cash Price	$4,129.80
Rate for Payer: Devoted Health Medicare	$1,073.40
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$975.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,538.85
Rate for Payer: Health Management Network Commercial	$5,850.55
Rate for Payer: Humana Medicare	$975.82
Rate for Payer: Kaiser Permanente Commercial	$4,336.29
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$975.82
Rate for Payer: MDX Hawaii PPO	$6,676.51
Rate for Payer: Ohana Health Plan Medicaid	$1,073.40
Rate for Payer: Ohana Health Plan Medicare	$975.82
Rate for Payer: UnitedHealthcare Medicare	$975.82
Rate for Payer: University Health Alliance Commercial	$5,017.02

HC CRITICAL CARE, E/M 30-74 MINUTES

Facility

$6,257.00

Service Code	HCPCS 99291
Hospital Charge Code	6839929101
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$6,069.29
Rate for Payer: AlohaCare Medicaid	$975.82
Rate for Payer: AlohaCare Medicare	$975.82
Rate for Payer: Cash Price	$3,754.20
Rate for Payer: Cash Price	$3,754.20
Rate for Payer: Cash Price	$3,754.20
Rate for Payer: Cash Price	$3,754.20
Rate for Payer: Devoted Health Medicare	$1,073.40
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$975.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,944.15
Rate for Payer: Health Management Network Commercial	$5,318.45
Rate for Payer: Humana Medicare	$975.82
Rate for Payer: Kaiser Permanente Commercial	$3,941.91
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$975.82
Rate for Payer: MDX Hawaii PPO	$6,069.29
Rate for Payer: Ohana Health Plan Medicaid	$1,073.40
Rate for Payer: Ohana Health Plan Medicare	$975.82
Rate for Payer: UnitedHealthcare Medicare	$975.82
Rate for Payer: University Health Alliance Commercial	$4,560.73

HC CRITICAL CARE, E/M 30-74 MINUTES

Facility

$6,883.00

Service Code	HCPCS 99291
Hospital Charge Code	4509929101
Hospital Revenue Code	450
Min. Negotiated Rate	$5,850.55
Max. Negotiated Rate	$6,676.51
Rate for Payer: Cash Price	$4,129.80
Rate for Payer: Health Management Network Commercial	$5,850.55
Rate for Payer: MDX Hawaii PPO	$6,676.51

HC CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF

Facility

$21,065.00

Service Code	HCPCS 36825
Hospital Charge Code	3613682501
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$20,433.05
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Devoted Health Medicare	$7,230.94
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$17,905.25
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Commercial	$13,270.95
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: MDX Hawaii PPO	$20,433.05
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF

Facility

$21,065.00

Service Code	HCPCS 36825
Hospital Charge Code	3613682501
Hospital Revenue Code	361
Min. Negotiated Rate	$17,905.25
Max. Negotiated Rate	$20,433.05
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Health Management Network Commercial	$17,905.25
Rate for Payer: MDX Hawaii PPO	$20,433.05

HC CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF

Facility

$21,065.00

Service Code	HCPCS 36830
Hospital Charge Code	3613683001
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$20,433.05
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Devoted Health Medicare	$7,230.94
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	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$17,905.25
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Commercial	$13,270.95
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: MDX Hawaii PPO	$20,433.05
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF

Facility

$21,065.00

Service Code	HCPCS 36830
Hospital Charge Code	3613683001
Hospital Revenue Code	361
Min. Negotiated Rate	$17,905.25
Max. Negotiated Rate	$20,433.05
Rate for Payer: Cash Price	$12,639.00
Rate for Payer: Health Management Network Commercial	$17,905.25
Rate for Payer: MDX Hawaii PPO	$20,433.05

HC CRYO EA UNIT (MULTI/POOLED)

Facility

$630.00

Service Code	HCPCS P9012
Hospital Charge Code	387P901201
Hospital Revenue Code	387
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$611.10
Rate for Payer: AlohaCare Medicaid	$83.20
Rate for Payer: AlohaCare Medicare	$83.20
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Devoted Health Medicare	$91.52
Rate for Payer: Hawaii Medical Service Association Commercial	$104.00
Rate for Payer: Hawaii Medical Service Association Medicare	$83.20
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Humana Medicare	$83.20
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: Kaiser Permanente Medicare	$83.20
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: Ohana Health Plan Medicaid	$91.52
Rate for Payer: Ohana Health Plan Medicare	$83.20
Rate for Payer: UnitedHealthcare Medicaid	$47.68
Rate for Payer: UnitedHealthcare Medicare	$83.20
Rate for Payer: University Health Alliance Commercial	$459.21

HC CRYO EA UNIT (MULTI/POOLED)

Facility

$882.00

Service Code	HCPCS P9012
Hospital Charge Code	390P901201
Hospital Revenue Code	390
Min. Negotiated Rate	$749.70
Max. Negotiated Rate	$855.54
Rate for Payer: Cash Price	$529.20
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: MDX Hawaii PPO	$855.54

HC CRYO EA UNIT (MULTI/POOLED)

Facility

$882.00

Service Code	HCPCS P9012
Hospital Charge Code	390P901201
Hospital Revenue Code	390
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$855.54
Rate for Payer: AlohaCare Medicaid	$83.20
Rate for Payer: AlohaCare Medicare	$83.20
Rate for Payer: Cash Price	$529.20
Rate for Payer: Cash Price	$529.20
Rate for Payer: Devoted Health Medicare	$91.52
Rate for Payer: Hawaii Medical Service Association Commercial	$104.00
Rate for Payer: Hawaii Medical Service Association Medicare	$83.20
Rate for Payer: Hawaii Western Management Group Commercial	$837.90
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: Humana Medicare	$83.20
Rate for Payer: Kaiser Permanente Commercial	$555.66
Rate for Payer: Kaiser Permanente Medicaid	$449.82
Rate for Payer: Kaiser Permanente Medicare	$83.20
Rate for Payer: MDX Hawaii PPO	$855.54
Rate for Payer: Ohana Health Plan Medicaid	$91.52
Rate for Payer: Ohana Health Plan Medicare	$83.20
Rate for Payer: UnitedHealthcare Medicaid	$47.68
Rate for Payer: UnitedHealthcare Medicare	$83.20
Rate for Payer: University Health Alliance Commercial	$642.89

HC CRYO EA UNIT (MULTI/POOLED)

Facility

$630.00

Service Code	HCPCS P9012
Hospital Charge Code	387P901201
Hospital Revenue Code	387
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: MDX Hawaii PPO	$611.10

HC CRYPTOSPORIDIUM AG

Facility

$101.00

Service Code	HCPCS 87272
Hospital Charge Code	3068727201
Hospital Revenue Code	306
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 CRYPTOSPORIDIUM AG

Facility

$101.00

Service Code	HCPCS 87272
Hospital Charge Code	3068727201
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HC CSF FLUID SCAN CISTERNOGRAPHY - NM BRAIN CISTERNOGRAM

Facility

$2,678.00

Service Code	HCPCS 78630
Hospital Charge Code	3417863001
Hospital Revenue Code	341
Min. Negotiated Rate	$166.08
Max. Negotiated Rate	$2,597.66
Rate for Payer: AlohaCare Medicaid	$641.43
Rate for Payer: AlohaCare Medicare	$641.43
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Devoted Health Medicare	$705.57
Rate for Payer: Hawaii Medical Service Association ABD	$166.08
Rate for Payer: Hawaii Medical Service Association Commercial	$801.79
Rate for Payer: Hawaii Medical Service Association Medicare	$641.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$180.41
Rate for Payer: Hawaii Western Management Group Commercial	$641.43
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Humana Medicare	$641.43
Rate for Payer: Kaiser Permanente Commercial	$1,687.14
Rate for Payer: Kaiser Permanente Medicaid	$1,365.78
Rate for Payer: Kaiser Permanente Medicare	$641.43
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: Ohana Health Plan Medicaid	$705.57
Rate for Payer: Ohana Health Plan Medicare	$641.43
Rate for Payer: UnitedHealthcare Medicaid	$166.08
Rate for Payer: UnitedHealthcare Medicare	$641.43
Rate for Payer: University Health Alliance Commercial	$615.25

HC CSF FLUID SCAN CISTERNOGRAPHY - NM BRAIN CISTERNOGRAM

Facility

$2,678.00

Service Code	HCPCS 78630
Hospital Charge Code	3417863001
Hospital Revenue Code	341
Min. Negotiated Rate	$2,276.30
Max. Negotiated Rate	$2,597.66
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: MDX Hawaii PPO	$2,597.66

Know your out-of-pocket cost for care.

All Charges