Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC NEEDLE BIOPSY LIVER

Facility

$6,448.00

Service Code	HCPCS 47000
Hospital Charge Code	3614700001
Hospital Revenue Code	361
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 NEEDLE BIOPSY, LYMPH NODE(S)

Facility

$6,448.00

Service Code	HCPCS 38505
Hospital Charge Code	3613850501
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
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 Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
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	$2,837.00
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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,699.95

HC NEEDLE BIOPSY, LYMPH NODE(S)

Facility

$6,448.00

Service Code	HCPCS 38505
Hospital Charge Code	3613850501
Hospital Revenue Code	361
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 NEEDLE BIOPSY,MUSCLE

Facility

$6,448.00

Service Code	HCPCS 20206
Hospital Charge Code	3612020601
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$6,254.56
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	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
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	$2,837.00
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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC NEEDLE BIOPSY,MUSCLE

Facility

$6,448.00

Service Code	HCPCS 20206
Hospital Charge Code	3612020601
Hospital Revenue Code	361
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 NEEDLE BIOPSY OF PANCREAS

Facility

$6,448.00

Service Code	HCPCS 48102
Hospital Charge Code	3614810201
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
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	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
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	$2,837.00
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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,699.95

HC NEEDLE BIOPSY OF PANCREAS

Facility

$6,448.00

Service Code	HCPCS 48102
Hospital Charge Code	3614810201
Hospital Revenue Code	361
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 NEEDLE BIOPSY PLEURA

Facility

$6,448.00

Service Code	HCPCS 32400
Hospital Charge Code	3613240001
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$6,254.56
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	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
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	$2,837.00
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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC NEEDLE BIOPSY PLEURA

Facility

$6,448.00

Service Code	HCPCS 32400
Hospital Charge Code	3613240001
Hospital Revenue Code	361
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 NEEDLE LOCALIZATION BY XRAY - FL GUIDED NEEDLE PLACEMENT

Facility

$610.00

Service Code	HCPCS 77002
Hospital Charge Code	3207700288
Hospital Revenue Code	320
Min. Negotiated Rate	$38.07
Max. Negotiated Rate	$2,536.00
Rate for Payer: Cash Price	$366.00
Rate for Payer: Cash Price	$366.00
Rate for Payer: Cash Price	$366.00
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 Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$579.50
Rate for Payer: Health Management Network Commercial	$518.50
Rate for Payer: Kaiser Permanente Commercial	$384.30
Rate for Payer: Kaiser Permanente Medicaid	$311.10
Rate for Payer: MDX Hawaii PPO	$591.70
Rate for Payer: UnitedHealthcare Medicaid	$38.07
Rate for Payer: University Health Alliance Commercial	$146.61

HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED NEEDLE PLACEMENT

Facility

$610.00

Service Code	HCPCS 77002
Hospital Charge Code	3207700288
Hospital Revenue Code	320
Min. Negotiated Rate	$518.50
Max. Negotiated Rate	$591.70
Rate for Payer: Cash Price	$366.00
Rate for Payer: Health Management Network Commercial	$518.50
Rate for Payer: MDX Hawaii PPO	$591.70

HC NEEDLE LOCALIZATION BY XRAY - US GUIDED PERC NEEDLE BIOPSY MUSCLE

Facility

$610.00

Service Code	HCPCS 77002
Hospital Charge Code	4027700201
Hospital Revenue Code	402
Min. Negotiated Rate	$518.50
Max. Negotiated Rate	$591.70
Rate for Payer: Cash Price	$366.00
Rate for Payer: Health Management Network Commercial	$518.50
Rate for Payer: MDX Hawaii PPO	$591.70

HC NEEDLE LOCALIZATION BY XRAY - US GUIDED PERC NEEDLE BIOPSY MUSCLE

Facility

$610.00

Service Code	HCPCS 77002
Hospital Charge Code	4027700201
Hospital Revenue Code	402
Min. Negotiated Rate	$38.07
Max. Negotiated Rate	$2,536.00
Rate for Payer: Cash Price	$366.00
Rate for Payer: Cash Price	$366.00
Rate for Payer: Cash Price	$366.00
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 Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$579.50
Rate for Payer: Health Management Network Commercial	$518.50
Rate for Payer: Kaiser Permanente Commercial	$384.30
Rate for Payer: Kaiser Permanente Medicaid	$311.10
Rate for Payer: MDX Hawaii PPO	$591.70
Rate for Payer: UnitedHealthcare Medicaid	$38.07
Rate for Payer: University Health Alliance Commercial	$146.61

HC NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM

Facility

$1,950.00

Service Code	HCPCS 97608
Hospital Charge Code	3619760801
Hospital Revenue Code	361
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$2,837.00
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Health Management Network Commercial	$1,657.50
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,228.50
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$1,891.50
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$24.26
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$1,421.36

HC NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM

Facility

$1,950.00

Service Code	HCPCS 97608
Hospital Charge Code	3619760801
Hospital Revenue Code	361
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$1,891.50
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Health Management Network Commercial	$1,657.50
Rate for Payer: MDX Hawaii PPO	$1,891.50

HC N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR

Facility

$294.00

Service Code	HCPCS 87591
Hospital Charge Code	3068759101
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 N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR

Facility

$294.00

Service Code	HCPCS 87591
Hospital Charge Code	3068759101
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 NJX AA&/STRD GNCLR NRV BRNCH

Facility

$2,756.00

Service Code	HCPCS 64454
Hospital Charge Code	3616445401
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$917.28
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	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$1,736.28
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$2,008.85

HC NJX AA&/STRD GNCLR NRV BRNCH

Facility

$2,756.00

Service Code	HCPCS 64454
Hospital Charge Code	3616445401
Hospital Revenue Code	361
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: MDX Hawaii PPO	$2,673.32

HC NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS

Facility

$14,044.00

Service Code	HCPCS 47531
Hospital Charge Code	3614753101
Hospital Revenue Code	361
Min. Negotiated Rate	$11,937.40
Max. Negotiated Rate	$13,622.68
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Health Management Network Commercial	$11,937.40
Rate for Payer: MDX Hawaii PPO	$13,622.68

HC NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS

Facility

$14,044.00

Service Code	HCPCS 47531
Hospital Charge Code	3614753101
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$13,622.68
Rate for Payer: AlohaCare Medicaid	$4,229.69
Rate for Payer: AlohaCare Medicare	$4,229.69
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Cash Price	$8,426.40
Rate for Payer: Devoted Health Medicare	$4,652.66
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	$4,229.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$11,937.40
Rate for Payer: Humana Medicare	$4,229.69
Rate for Payer: Kaiser Permanente Commercial	$8,847.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,229.69
Rate for Payer: MDX Hawaii PPO	$13,622.68
Rate for Payer: Ohana Health Plan Medicaid	$4,652.66
Rate for Payer: Ohana Health Plan Medicare	$4,229.69
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,229.69
Rate for Payer: University Health Alliance Commercial	$10,236.67

HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS

Facility

$2,656.00

Service Code	HCPCS 50431
Hospital Charge Code	3615043101
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$823.75
Rate for Payer: AlohaCare Medicare	$823.75
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Devoted Health Medicare	$906.12
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	$823.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$2,257.60
Rate for Payer: Humana Medicare	$823.75
Rate for Payer: Kaiser Permanente Commercial	$1,673.28
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$823.75
Rate for Payer: MDX Hawaii PPO	$2,576.32
Rate for Payer: Ohana Health Plan Medicaid	$906.12
Rate for Payer: Ohana Health Plan Medicare	$823.75
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$823.75
Rate for Payer: University Health Alliance Commercial	$1,935.96

HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS

Facility

$2,656.00

Service Code	HCPCS 50431
Hospital Charge Code	3615043101
Hospital Revenue Code	361
Min. Negotiated Rate	$2,257.60
Max. Negotiated Rate	$2,576.32
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Health Management Network Commercial	$2,257.60
Rate for Payer: MDX Hawaii PPO	$2,576.32

HC NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS

Facility

$1,999.00

Service Code	HCPCS 78808
Hospital Charge Code	3427880801
Hospital Revenue Code	342
Min. Negotiated Rate	$29.84
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$29.84
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$85.66

HC NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS

Facility

$1,999.00

Service Code	HCPCS 78808
Hospital Charge Code	3427880801
Hospital Revenue Code	342
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

Know your out-of-pocket cost for care.

All Charges