Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS

Facility

$510.00

Service Code	HCPCS 99151
Hospital Charge Code	3719915101
Hospital Revenue Code	371
Min. Negotiated Rate	$433.50
Max. Negotiated Rate	$494.70
Rate for Payer: Cash Price	$306.00
Rate for Payer: Health Management Network Commercial	$433.50
Rate for Payer: MDX Hawaii PPO	$494.70

HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS

Facility

$259.00

Service Code	HCPCS 99152
Hospital Charge Code	3719915201
Hospital Revenue Code	371
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 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS

Facility

$259.00

Service Code	HCPCS 99152
Hospital Charge Code	3719915201
Hospital Revenue Code	371
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$155.40
Rate for Payer: Cash Price	$155.40
Rate for Payer: Hawaii Western Management Group Commercial	$246.05
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$163.17
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: University Health Alliance Commercial	$188.79

HC MOD TRAUMA RESP W/O CRIT CARE

Facility

$5,998.00

Hospital Charge Code	4500000002
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$5,818.06
Rate for Payer: Cash Price	$3,598.80
Rate for Payer: Cash Price	$3,598.80
Rate for Payer: Cash Price	$3,598.80
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	$5,698.10
Rate for Payer: Health Management Network Commercial	$5,098.30
Rate for Payer: Kaiser Permanente Commercial	$3,778.74
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$5,818.06
Rate for Payer: University Health Alliance Commercial	$4,371.94

HC MOD TRAUMA RESP W/O CRIT CARE

Facility

$5,998.00

Hospital Charge Code	4500000002
Hospital Revenue Code	450
Min. Negotiated Rate	$5,098.30
Max. Negotiated Rate	$5,818.06
Rate for Payer: Cash Price	$3,598.80
Rate for Payer: Health Management Network Commercial	$5,098.30
Rate for Payer: MDX Hawaii PPO	$5,818.06

HC MONITORED ANESTHESIA CARE ANESTHESIA TIME - EACH INCREMENTAL 1 MINUTE

Facility

$30.00

Hospital Charge Code	3700000006
Hospital Revenue Code	370
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: University Health Alliance Commercial	$21.87

HC MONITORED ANESTHESIA CARE ANESTHESIA TIME - EACH INCREMENTAL 1 MINUTE

Facility

$30.00

Hospital Charge Code	3700000006
Hospital Revenue Code	370
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: MDX Hawaii PPO	$29.10

HC MONITORED ANESTHESIA CARE ANESTHESIA TIME - INITIAL BASE CHARGE

Facility

$559.00

Hospital Charge Code	3700000005
Hospital Revenue Code	370
Min. Negotiated Rate	$285.09
Max. Negotiated Rate	$542.23
Rate for Payer: Cash Price	$335.40
Rate for Payer: Hawaii Western Management Group Commercial	$531.05
Rate for Payer: Health Management Network Commercial	$475.15
Rate for Payer: Kaiser Permanente Commercial	$352.17
Rate for Payer: Kaiser Permanente Medicaid	$285.09
Rate for Payer: MDX Hawaii PPO	$542.23
Rate for Payer: University Health Alliance Commercial	$407.46

HC MONITORED ANESTHESIA CARE ANESTHESIA TIME - INITIAL BASE CHARGE

Facility

$559.00

Hospital Charge Code	3700000005
Hospital Revenue Code	370
Min. Negotiated Rate	$475.15
Max. Negotiated Rate	$542.23
Rate for Payer: Cash Price	$335.40
Rate for Payer: Health Management Network Commercial	$475.15
Rate for Payer: MDX Hawaii PPO	$542.23

HC MONKEYPOX VIRUS BY PCR SO

Facility

$430.00

Service Code	HCPCS 87593
Hospital Charge Code	3068759301
Hospital Revenue Code	306
Min. Negotiated Rate	$28.07
Max. Negotiated Rate	$417.10
Rate for Payer: AlohaCare Medicaid	$51.31
Rate for Payer: AlohaCare Medicare	$51.31
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Devoted Health Medicare	$56.44
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Medicare	$51.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.07
Rate for Payer: Hawaii Western Management Group Commercial	$51.31
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: Humana Medicare	$51.31
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$219.30
Rate for Payer: Kaiser Permanente Medicare	$51.31
Rate for Payer: MDX Hawaii PPO	$417.10
Rate for Payer: Ohana Health Plan Medicaid	$56.44
Rate for Payer: Ohana Health Plan Medicare	$51.31
Rate for Payer: UnitedHealthcare Medicaid	$38.48
Rate for Payer: UnitedHealthcare Medicare	$51.31
Rate for Payer: University Health Alliance Commercial	$313.43

HC MONKEYPOX VIRUS BY PCR SO

Facility

$430.00

Service Code	HCPCS 87593
Hospital Charge Code	3068759301
Hospital Revenue Code	306
Min. Negotiated Rate	$365.50
Max. Negotiated Rate	$417.10
Rate for Payer: Cash Price	$258.00
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: MDX Hawaii PPO	$417.10

HC MORPH ANALYSIS SO

Facility

$1,698.00

Service Code	HCPCS 88360
Hospital Charge Code	3108836001
Hospital Revenue Code	310
Min. Negotiated Rate	$38.87
Max. Negotiated Rate	$1,647.06
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$1,018.80
Rate for Payer: Cash Price	$1,018.80
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$38.87
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.44
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$1,443.30
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$1,069.74
Rate for Payer: Kaiser Permanente Medicaid	$865.98
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$1,647.06
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$38.87
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$231.14

HC MORPH ANALYSIS SO

Facility

$1,698.00

Service Code	HCPCS 88360
Hospital Charge Code	3108836001
Hospital Revenue Code	310
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 MORPH INSITU QN W/CAT MULTI EA

Facility

$1,698.00

Service Code	HCPCS 88374
Hospital Charge Code	3108837401
Hospital Revenue Code	310
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 MORPH INSITU QN W/CAT MULTI EA

Facility

$1,698.00

Service Code	HCPCS 88374
Hospital Charge Code	3108837401
Hospital Revenue Code	310
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$1,647.06
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$1,018.80
Rate for Payer: Cash Price	$1,018.80
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$28.79
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$160.01
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$1,443.30
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$1,069.74
Rate for Payer: Kaiser Permanente Medicaid	$865.98
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$1,647.06
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$195.04
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$736.61

HC MORPHOMETRIC ANALYSIS TUMOR

Facility

$1,662.00

Service Code	HCPCS 88358
Hospital Charge Code	3108835801
Hospital Revenue Code	310
Min. Negotiated Rate	$1,412.70
Max. Negotiated Rate	$1,612.14
Rate for Payer: Cash Price	$997.20
Rate for Payer: Health Management Network Commercial	$1,412.70
Rate for Payer: MDX Hawaii PPO	$1,612.14

HC MORPHOMETRIC ANALYSIS TUMOR

Facility

$1,662.00

Service Code	HCPCS 88358
Hospital Charge Code	3108835801
Hospital Revenue Code	310
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$1,612.14
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$997.20
Rate for Payer: Cash Price	$997.20
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$12.39
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43.60
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$1,412.70
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$1,047.06
Rate for Payer: Kaiser Permanente Medicaid	$847.62
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$1,612.14
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$12.39
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$145.65

HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH

Facility

$643.00

Service Code	HCPCS 88373
Hospital Charge Code	3108837301
Hospital Revenue Code	310
Min. Negotiated Rate	$38.89
Max. Negotiated Rate	$623.71
Rate for Payer: Cash Price	$385.80
Rate for Payer: Cash Price	$385.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$38.89
Rate for Payer: Hawaii Western Management Group Commercial	$610.85
Rate for Payer: Health Management Network Commercial	$546.55
Rate for Payer: Kaiser Permanente Commercial	$405.09
Rate for Payer: Kaiser Permanente Medicaid	$327.93
Rate for Payer: MDX Hawaii PPO	$623.71
Rate for Payer: UnitedHealthcare Medicaid	$44.74
Rate for Payer: University Health Alliance Commercial	$149.66

HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH

Facility

$643.00

Service Code	HCPCS 88373
Hospital Charge Code	3108837301
Hospital Revenue Code	310
Min. Negotiated Rate	$546.55
Max. Negotiated Rate	$623.71
Rate for Payer: Cash Price	$385.80
Rate for Payer: Health Management Network Commercial	$546.55
Rate for Payer: MDX Hawaii PPO	$623.71

HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST

Facility

$3,490.00

Service Code	HCPCS 88361
Hospital Charge Code	3108836101
Hospital Revenue Code	310
Min. Negotiated Rate	$67.41
Max. Negotiated Rate	$3,385.30
Rate for Payer: AlohaCare Medicaid	$423.45
Rate for Payer: AlohaCare Medicare	$423.45
Rate for Payer: Cash Price	$2,094.00
Rate for Payer: Cash Price	$2,094.00
Rate for Payer: Devoted Health Medicare	$465.80
Rate for Payer: Hawaii Medical Service Association ABD	$67.41
Rate for Payer: Hawaii Medical Service Association Commercial	$529.31
Rate for Payer: Hawaii Medical Service Association Medicare	$423.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$83.58
Rate for Payer: Hawaii Western Management Group Commercial	$423.45
Rate for Payer: Health Management Network Commercial	$2,966.50
Rate for Payer: Humana Medicare	$423.45
Rate for Payer: Kaiser Permanente Commercial	$2,198.70
Rate for Payer: Kaiser Permanente Medicaid	$1,779.90
Rate for Payer: Kaiser Permanente Medicare	$423.45
Rate for Payer: MDX Hawaii PPO	$3,385.30
Rate for Payer: Ohana Health Plan Medicaid	$465.80
Rate for Payer: Ohana Health Plan Medicare	$423.45
Rate for Payer: UnitedHealthcare Medicaid	$67.41
Rate for Payer: UnitedHealthcare Medicare	$423.45
Rate for Payer: University Health Alliance Commercial	$315.18

HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST

Facility

$3,490.00

Service Code	HCPCS 88361
Hospital Charge Code	3108836101
Hospital Revenue Code	310
Min. Negotiated Rate	$2,966.50
Max. Negotiated Rate	$3,385.30
Rate for Payer: Cash Price	$2,094.00
Rate for Payer: Health Management Network Commercial	$2,966.50
Rate for Payer: MDX Hawaii PPO	$3,385.30

HC MPL CODON ANALYSIS SO

Facility

$1,261.00

Service Code	HCPCS 81338
Hospital Charge Code	3108133801
Hospital Revenue Code	310
Min. Negotiated Rate	$1,071.85
Max. Negotiated Rate	$1,223.17
Rate for Payer: Cash Price	$756.60
Rate for Payer: Health Management Network Commercial	$1,071.85
Rate for Payer: MDX Hawaii PPO	$1,223.17

HC MPL CODON ANALYSIS SO

Facility

$1,261.00

Service Code	HCPCS 81338
Hospital Charge Code	3108133801
Hospital Revenue Code	310
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$1,223.17
Rate for Payer: AlohaCare Medicaid	$150.33
Rate for Payer: AlohaCare Medicare	$150.33
Rate for Payer: Cash Price	$756.60
Rate for Payer: Cash Price	$756.60
Rate for Payer: Devoted Health Medicare	$165.36
Rate for Payer: Hawaii Medical Service Association ABD	$150.33
Rate for Payer: Hawaii Medical Service Association Commercial	$187.91
Rate for Payer: Hawaii Medical Service Association Medicare	$150.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$150.33
Rate for Payer: Hawaii Western Management Group Commercial	$150.33
Rate for Payer: Health Management Network Commercial	$1,071.85
Rate for Payer: Humana Medicare	$150.33
Rate for Payer: Kaiser Permanente Commercial	$794.43
Rate for Payer: Kaiser Permanente Medicaid	$643.11
Rate for Payer: Kaiser Permanente Medicare	$150.33
Rate for Payer: MDX Hawaii PPO	$1,223.17
Rate for Payer: Ohana Health Plan Medicaid	$165.36
Rate for Payer: Ohana Health Plan Medicare	$150.33
Rate for Payer: UnitedHealthcare Medicaid	$90.20
Rate for Payer: UnitedHealthcare Medicare	$150.33
Rate for Payer: University Health Alliance Commercial	$919.14

HC MR ANGIO ABDOMEN (MRA) - MR ABDOMEN ANGIO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 74185
Hospital Charge Code	6187418501
Hospital Revenue Code	618
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,687.20
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$987.38

HC MR ANGIO ABDOMEN (MRA) - MR ABDOMEN ANGIO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 74185
Hospital Charge Code	6187418501
Hospital Revenue Code	618
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

Know your out-of-pocket cost for care.

All Charges