Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP

Facility

$243.00

Service Code	HCPCS 88160 TC
Hospital Charge Code	3118816001
Hospital Revenue Code	311
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Cash Price	$145.80
Rate for Payer: Hawaii Medical Service Association ABD	$33.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.75
Rate for Payer: Hawaii Western Management Group Commercial	$230.85
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$153.09
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: UnitedHealthcare Medicaid	$33.12
Rate for Payer: University Health Alliance Commercial	$57.11

HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP TZANK

Facility

$243.00

Service Code	HCPCS 88160 TC
Hospital Charge Code	3118816002
Hospital Revenue Code	311
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Cash Price	$145.80
Rate for Payer: Hawaii Medical Service Association ABD	$33.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.75
Rate for Payer: Hawaii Western Management Group Commercial	$230.85
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$153.09
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: UnitedHealthcare Medicaid	$33.12
Rate for Payer: University Health Alliance Commercial	$57.11

HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP TZANK

Facility

$243.00

Service Code	HCPCS 88160 TC
Hospital Charge Code	3118816002
Hospital Revenue Code	311
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: MDX Hawaii PPO	$235.71

HC CYTP DX EVAL FNA 1ST EA SITE - LAB EVALUATION OF FNA SMEAR, FIRST

Facility

$1,698.00

Service Code	HCPCS 88172 TC
Hospital Charge Code	3118817201
Hospital Revenue Code	311
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

HC CYTP DX EVAL FNA 1ST EA SITE - LAB EVALUATION OF FNA SMEAR, FIRST

Facility

$1,698.00

Service Code	HCPCS 88172 TC
Hospital Charge Code	3118817201
Hospital Revenue Code	311
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$1,647.06
Rate for Payer: Cash Price	$1,018.80
Rate for Payer: Cash Price	$1,018.80
Rate for Payer: Hawaii Medical Service Association ABD	$39.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,613.10
Rate for Payer: Health Management Network Commercial	$1,443.30
Rate for Payer: Kaiser Permanente Commercial	$1,069.74
Rate for Payer: Kaiser Permanente Medicaid	$865.98
Rate for Payer: MDX Hawaii PPO	$1,647.06
Rate for Payer: UnitedHealthcare Medicaid	$39.40
Rate for Payer: University Health Alliance Commercial	$45.08

HC CYTP FNA EVAL EA ADDL - LAB EVALUATION OF FNA SMEAR, EA ADD EVAL

Facility

$47.00

Service Code	HCPCS 88177 TC
Hospital Charge Code	3118817701
Hospital Revenue Code	311
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$45.59

HC CYTP FNA EVAL EA ADDL - LAB EVALUATION OF FNA SMEAR, EA ADD EVAL

Facility

$47.00

Service Code	HCPCS 88177 TC
Hospital Charge Code	3118817701
Hospital Revenue Code	311
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Cash Price	$28.20
Rate for Payer: Hawaii Medical Service Association ABD	$4.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.30
Rate for Payer: Hawaii Western Management Group Commercial	$44.65
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Kaiser Permanente Commercial	$29.61
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: UnitedHealthcare Medicaid	$4.54
Rate for Payer: University Health Alliance Commercial	$13.99

HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP CONVENTIONAL

Facility

$153.00

Service Code	HCPCS 88164
Hospital Charge Code	3118816401
Hospital Revenue Code	311
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$91.80
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: MDX Hawaii PPO	$148.41

HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP CONVENTIONAL

Facility

$153.00

Service Code	HCPCS 88164
Hospital Charge Code	3118816401
Hospital Revenue Code	311
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$18.54
Rate for Payer: AlohaCare Medicare	$18.54
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Devoted Health Medicare	$20.39
Rate for Payer: Hawaii Medical Service Association ABD	$14.60
Rate for Payer: Hawaii Medical Service Association Commercial	$23.18
Rate for Payer: Hawaii Medical Service Association Medicare	$18.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.23
Rate for Payer: Hawaii Western Management Group Commercial	$18.54
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$18.54
Rate for Payer: Kaiser Permanente Commercial	$96.39
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$18.54
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$20.39
Rate for Payer: Ohana Health Plan Medicare	$18.54
Rate for Payer: UnitedHealthcare Medicaid	$14.60
Rate for Payer: UnitedHealthcare Medicare	$18.54
Rate for Payer: University Health Alliance Commercial	$27.31

HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP DIAGNOSTIC MEDICARE

Facility

$153.00

Service Code	HCPCS 88164
Hospital Charge Code	3118816402
Hospital Revenue Code	311
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$91.80
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: MDX Hawaii PPO	$148.41

HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP DIAGNOSTIC MEDICARE

Facility

$153.00

Service Code	HCPCS 88164
Hospital Charge Code	3118816402
Hospital Revenue Code	311
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$18.54
Rate for Payer: AlohaCare Medicare	$18.54
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Devoted Health Medicare	$20.39
Rate for Payer: Hawaii Medical Service Association ABD	$14.60
Rate for Payer: Hawaii Medical Service Association Commercial	$23.18
Rate for Payer: Hawaii Medical Service Association Medicare	$18.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.23
Rate for Payer: Hawaii Western Management Group Commercial	$18.54
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$18.54
Rate for Payer: Kaiser Permanente Commercial	$96.39
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$18.54
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$20.39
Rate for Payer: Ohana Health Plan Medicare	$18.54
Rate for Payer: UnitedHealthcare Medicaid	$14.60
Rate for Payer: UnitedHealthcare Medicare	$18.54
Rate for Payer: University Health Alliance Commercial	$27.31

HC CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES

Facility

$518.00

Service Code	HCPCS 88162
Hospital Charge Code	3118816201
Hospital Revenue Code	311
Min. Negotiated Rate	$440.30
Max. Negotiated Rate	$502.46
Rate for Payer: Cash Price	$310.80
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: MDX Hawaii PPO	$502.46

HC CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES

Facility

$518.00

Service Code	HCPCS 88162
Hospital Charge Code	3118816201
Hospital Revenue Code	311
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$502.46
Rate for Payer: AlohaCare Medicaid	$61.56
Rate for Payer: AlohaCare Medicare	$61.56
Rate for Payer: Cash Price	$310.80
Rate for Payer: Cash Price	$310.80
Rate for Payer: Devoted Health Medicare	$67.72
Rate for Payer: Hawaii Medical Service Association ABD	$44.05
Rate for Payer: Hawaii Medical Service Association Commercial	$76.95
Rate for Payer: Hawaii Medical Service Association Medicare	$61.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.62
Rate for Payer: Hawaii Western Management Group Commercial	$61.56
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Humana Medicare	$61.56
Rate for Payer: Kaiser Permanente Commercial	$326.34
Rate for Payer: Kaiser Permanente Medicaid	$264.18
Rate for Payer: Kaiser Permanente Medicare	$61.56
Rate for Payer: MDX Hawaii PPO	$502.46
Rate for Payer: Ohana Health Plan Medicaid	$67.72
Rate for Payer: Ohana Health Plan Medicare	$61.56
Rate for Payer: UnitedHealthcare Medicaid	$44.05
Rate for Payer: UnitedHealthcare Medicare	$61.56
Rate for Payer: University Health Alliance Commercial	$153.96

HC CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ

Facility

$238.00

Service Code	HCPCS 88161
Hospital Charge Code	3118816101
Hospital Revenue Code	311
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$34.17
Rate for Payer: AlohaCare Medicare	$34.17
Rate for Payer: Cash Price	$142.80
Rate for Payer: Cash Price	$142.80
Rate for Payer: Devoted Health Medicare	$37.59
Rate for Payer: Hawaii Medical Service Association ABD	$35.90
Rate for Payer: Hawaii Medical Service Association Commercial	$42.71
Rate for Payer: Hawaii Medical Service Association Medicare	$34.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.01
Rate for Payer: Hawaii Western Management Group Commercial	$34.17
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$34.17
Rate for Payer: Kaiser Permanente Commercial	$149.94
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$34.17
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$37.59
Rate for Payer: Ohana Health Plan Medicare	$34.17
Rate for Payer: UnitedHealthcare Medicaid	$35.90
Rate for Payer: UnitedHealthcare Medicare	$34.17
Rate for Payer: University Health Alliance Commercial	$113.20

HC CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ

Facility

$238.00

Service Code	HCPCS 88161
Hospital Charge Code	3118816101
Hospital Revenue Code	311
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$142.80
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: MDX Hawaii PPO	$230.86

HC DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA

Facility

$2,436.00

Service Code	HCPCS 11000
Hospital Charge Code	4501100001
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$2,362.92
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,314.20
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,534.68
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$2,362.92
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$1,775.60

HC DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA

Facility

$2,436.00

Service Code	HCPCS 11000
Hospital Charge Code	4501100001
Hospital Revenue Code	450
Min. Negotiated Rate	$2,070.60
Max. Negotiated Rate	$2,362.92
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: MDX Hawaii PPO	$2,362.92

HC DEBRIDEMENT OPEN WOUND 20 SQ CM<

Facility

$791.00

Service Code	HCPCS 97597
Hospital Charge Code	7619759701
Hospital Revenue Code	761
Min. Negotiated Rate	$37.07
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
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	$260.72
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	$237.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$751.45
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Commercial	$498.33
Rate for Payer: Kaiser Permanente Medicaid	$403.41
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicaid	$37.07
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$576.56

HC DEBRIDEMENT OPEN WOUND 20 SQ CM<

Facility

$791.00

Service Code	HCPCS 97597
Hospital Charge Code	7619759701
Hospital Revenue Code	761
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 DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM

Facility

$1,590.00

Service Code	HCPCS 11042
Hospital Charge Code	4501104201
Hospital Revenue Code	450
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$1,542.30
Rate for Payer: Cash Price	$954.00
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: MDX Hawaii PPO	$1,542.30

HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM

Facility

$1,590.00

Service Code	HCPCS 11042
Hospital Charge Code	4501104201
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,510.50
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,001.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$1,542.30
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM

Facility

$1,039.00

Service Code	HCPCS 11045
Hospital Charge Code	7611104501
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$623.40
Rate for Payer: Cash Price	$623.40
Rate for Payer: Cash Price	$623.40
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	$987.05
Rate for Payer: Health Management Network Commercial	$883.15
Rate for Payer: Kaiser Permanente Commercial	$654.57
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$1,007.83
Rate for Payer: University Health Alliance Commercial	$757.33

HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM

Facility

$1,039.00

Service Code	HCPCS 11045
Hospital Charge Code	7611104501
Hospital Revenue Code	450
Min. Negotiated Rate	$883.15
Max. Negotiated Rate	$1,007.83
Rate for Payer: Cash Price	$623.40
Rate for Payer: Health Management Network Commercial	$883.15
Rate for Payer: MDX Hawaii PPO	$1,007.83

HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM

Facility

$2,436.00

Service Code	HCPCS 11043
Hospital Charge Code	7611104301
Hospital Revenue Code	450
Min. Negotiated Rate	$2,070.60
Max. Negotiated Rate	$2,362.92
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: MDX Hawaii PPO	$2,362.92

HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM

Facility

$2,436.00

Service Code	HCPCS 11043
Hospital Charge Code	7611104301
Hospital Revenue Code	450
Min. Negotiated Rate	$848.00
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$873.10
Rate for Payer: AlohaCare Medicare	$873.10
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Devoted Health Medicare	$960.41
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	$873.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$2,314.20
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: Humana Medicare	$873.10
Rate for Payer: Kaiser Permanente Commercial	$1,534.68
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$873.10
Rate for Payer: MDX Hawaii PPO	$2,362.92
Rate for Payer: Ohana Health Plan Medicaid	$960.41
Rate for Payer: Ohana Health Plan Medicare	$873.10
Rate for Payer: UnitedHealthcare Medicare	$873.10
Rate for Payer: University Health Alliance Commercial	$4,035.20

Know your out-of-pocket cost for care.

All Charges