Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$6,448.00

Service Code	HCPCS 11044
Hospital Charge Code	7611104401
Hospital Revenue Code	450
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

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

Facility

$6,448.00

Service Code	HCPCS 11044
Hospital Charge Code	7611104401
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.60
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,699.95

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

Facility

$2,374.00

Service Code	HCPCS 11047
Hospital Charge Code	7611104701
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,302.78
Rate for Payer: Cash Price	$1,424.40
Rate for Payer: Cash Price	$1,424.40
Rate for Payer: Cash Price	$1,424.40
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	$2,255.30
Rate for Payer: Health Management Network Commercial	$2,017.90
Rate for Payer: Kaiser Permanente Commercial	$1,495.62
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$2,302.78
Rate for Payer: University Health Alliance Commercial	$1,730.41

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

Facility

$2,374.00

Service Code	HCPCS 11047
Hospital Charge Code	7611104701
Hospital Revenue Code	450
Min. Negotiated Rate	$2,017.90
Max. Negotiated Rate	$2,302.78
Rate for Payer: Cash Price	$1,424.40
Rate for Payer: Health Management Network Commercial	$2,017.90
Rate for Payer: MDX Hawaii PPO	$2,302.78

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

Facility

$1,197.00

Service Code	HCPCS 11046
Hospital Charge Code	7611104601
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$718.20
Rate for Payer: Cash Price	$718.20
Rate for Payer: Cash Price	$718.20
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	$1,137.15
Rate for Payer: Health Management Network Commercial	$1,017.45
Rate for Payer: Kaiser Permanente Commercial	$754.11
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$1,161.09
Rate for Payer: University Health Alliance Commercial	$872.49

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

Facility

$1,197.00

Service Code	HCPCS 11046
Hospital Charge Code	7611104601
Hospital Revenue Code	450
Min. Negotiated Rate	$1,017.45
Max. Negotiated Rate	$1,161.09
Rate for Payer: Cash Price	$718.20
Rate for Payer: Health Management Network Commercial	$1,017.45
Rate for Payer: MDX Hawaii PPO	$1,161.09

HC DECALCIFY TISSUE - LAB DECALCIFY TISSUE

Facility

$54.00

Service Code	HCPCS 88311
Hospital Charge Code	3108831105
Hospital Revenue Code	310
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$32.40
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$52.38

HC DECALCIFY TISSUE - LAB DECALCIFY TISSUE

Facility

$54.00

Service Code	HCPCS 88311
Hospital Charge Code	3108831105
Hospital Revenue Code	310
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Hawaii Medical Service Association ABD	$12.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.27
Rate for Payer: Hawaii Western Management Group Commercial	$51.30
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: Kaiser Permanente Commercial	$34.02
Rate for Payer: Kaiser Permanente Medicaid	$27.54
Rate for Payer: MDX Hawaii PPO	$52.38
Rate for Payer: UnitedHealthcare Medicaid	$12.61
Rate for Payer: University Health Alliance Commercial	$34.26

HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH

Facility

$1,320.00

Service Code	HCPCS 36593
Hospital Charge Code	7613659301
Hospital Revenue Code	761
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$390.20
Rate for Payer: AlohaCare Medicare	$390.20
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Devoted Health Medicare	$429.22
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	$390.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,254.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: Humana Medicare	$390.20
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$673.20
Rate for Payer: Kaiser Permanente Medicare	$390.20
Rate for Payer: MDX Hawaii PPO	$1,280.40
Rate for Payer: Ohana Health Plan Medicaid	$429.22
Rate for Payer: Ohana Health Plan Medicare	$390.20
Rate for Payer: UnitedHealthcare Medicaid	$19.39
Rate for Payer: UnitedHealthcare Medicare	$390.20
Rate for Payer: University Health Alliance Commercial	$962.15

HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH

Facility

$1,320.00

Service Code	HCPCS 36593
Hospital Charge Code	7613659301
Hospital Revenue Code	761
Min. Negotiated Rate	$1,122.00
Max. Negotiated Rate	$1,280.40
Rate for Payer: Cash Price	$792.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: MDX Hawaii PPO	$1,280.40

HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH

Facility

$1,320.00

Service Code	HCPCS 36593
Hospital Charge Code	3613659301
Hospital Revenue Code	361
Min. Negotiated Rate	$1,122.00
Max. Negotiated Rate	$1,280.40
Rate for Payer: Cash Price	$792.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: MDX Hawaii PPO	$1,280.40

HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH

Facility

$1,320.00

Service Code	HCPCS 36593
Hospital Charge Code	3613659301
Hospital Revenue Code	361
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$390.20
Rate for Payer: AlohaCare Medicare	$390.20
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Devoted Health Medicare	$429.22
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	$390.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: Humana Medicare	$390.20
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$390.20
Rate for Payer: MDX Hawaii PPO	$1,280.40
Rate for Payer: Ohana Health Plan Medicaid	$429.22
Rate for Payer: Ohana Health Plan Medicare	$390.20
Rate for Payer: UnitedHealthcare Medicaid	$19.39
Rate for Payer: UnitedHealthcare Medicare	$390.20
Rate for Payer: University Health Alliance Commercial	$962.15

HC DELIVER PLACENTA

Facility

$12,653.00

Service Code	HCPCS 59414
Hospital Charge Code	7225941401
Hospital Revenue Code	722
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,273.41
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Devoted Health Medicare	$4,206.58
Rate for Payer: Hawaii Medical Service Association Commercial	$4,780.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3,824.16
Rate for Payer: Hawaii Western Management Group Commercial	$12,020.35
Rate for Payer: Health Management Network Commercial	$10,755.05
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Commercial	$7,971.39
Rate for Payer: Kaiser Permanente Medicaid	$6,453.03
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: MDX Hawaii PPO	$12,273.41
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$9,222.77

HC DELIVER PLACENTA

Facility

$12,653.00

Service Code	HCPCS 59414
Hospital Charge Code	7225941401
Hospital Revenue Code	722
Min. Negotiated Rate	$10,755.05
Max. Negotiated Rate	$12,273.41
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Health Management Network Commercial	$10,755.05
Rate for Payer: MDX Hawaii PPO	$12,273.41

HC DELIVERY VAGINAL/RECOVERY

Facility

$5,250.00

Hospital Charge Code	7220000001
Hospital Revenue Code	722
Min. Negotiated Rate	$2,677.50
Max. Negotiated Rate	$5,092.50
Rate for Payer: Cash Price	$3,150.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,987.50
Rate for Payer: Health Management Network Commercial	$4,462.50
Rate for Payer: Kaiser Permanente Commercial	$3,307.50
Rate for Payer: Kaiser Permanente Medicaid	$2,677.50
Rate for Payer: MDX Hawaii PPO	$5,092.50
Rate for Payer: University Health Alliance Commercial	$3,826.72

HC DELIVERY VAGINAL/RECOVERY

Facility

$5,250.00

Hospital Charge Code	7220000001
Hospital Revenue Code	722
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$5,092.50
Rate for Payer: Cash Price	$3,150.00
Rate for Payer: Health Management Network Commercial	$4,462.50
Rate for Payer: MDX Hawaii PPO	$5,092.50

HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - RAPID FLU

Facility

$139.00

Service Code	HCPCS 87804
Hospital Charge Code	3068780401
Hospital Revenue Code	306
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$83.40
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: MDX Hawaii PPO	$134.83

HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - RAPID FLU

Facility

$139.00

Service Code	HCPCS 87804
Hospital Charge Code	3068780401
Hospital Revenue Code	306
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$16.55
Rate for Payer: AlohaCare Medicare	$16.55
Rate for Payer: Cash Price	$83.40
Rate for Payer: Cash Price	$83.40
Rate for Payer: Devoted Health Medicare	$18.20
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.69
Rate for Payer: Hawaii Medical Service Association Medicare	$16.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.55
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$16.55
Rate for Payer: Kaiser Permanente Commercial	$87.57
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$16.55
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$18.20
Rate for Payer: Ohana Health Plan Medicare	$16.55
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$16.55
Rate for Payer: University Health Alliance Commercial	$31.01

HC DETECT AGENT NOS, DNA, AMP - B PERTUSSIS AMP PROBE DNA EA

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779807
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC DETECT AGENT NOS, DNA, AMP - B PERTUSSIS AMP PROBE DNA EA

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779807
Hospital Revenue Code	306
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HC DETECT AGENT NOS, DNA, AMP - EBV PCR SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779801
Hospital Revenue Code	306
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HC DETECT AGENT NOS, DNA, AMP - EBV PCR SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779801
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC DETECT AGENT NOS, DNA, AMP - INF AG AMP PROBE EACH

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779806
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC DETECT AGENT NOS, DNA, AMP - INF AG AMP PROBE EACH

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779806
Hospital Revenue Code	306
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HC DETECT AGENT NOS, DNA, AMP - M HOMINIS AMP PROBE SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779803
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

Know your out-of-pocket cost for care.

All Charges