Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC OT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES

Facility

$159.00

Service Code	HCPCS 97535 GO
Hospital Charge Code	4309753501
Hospital Revenue Code	430
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cash Price	$95.40
Rate for Payer: Hawaii Western Management Group Commercial	$151.05
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Kaiser Permanente Commercial	$100.17
Rate for Payer: Kaiser Permanente Medicaid	$81.09
Rate for Payer: MDX Hawaii PPO	$154.23
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: University Health Alliance Commercial	$115.90

HC OT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES

Facility

$159.00

Service Code	HCPCS 97535 GO
Hospital Charge Code	4309753501
Hospital Revenue Code	430
Min. Negotiated Rate	$135.15
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$95.40
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: MDX Hawaii PPO	$154.23

HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN

Facility

$181.00

Service Code	HCPCS 97530 GO
Hospital Charge Code	4309753001
Hospital Revenue Code	430
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$108.60
Rate for Payer: Cash Price	$108.60
Rate for Payer: Hawaii Western Management Group Commercial	$171.95
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Kaiser Permanente Commercial	$114.03
Rate for Payer: Kaiser Permanente Medicaid	$92.31
Rate for Payer: MDX Hawaii PPO	$175.57
Rate for Payer: UnitedHealthcare Medicaid	$18.32
Rate for Payer: University Health Alliance Commercial	$131.93

HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN

Facility

$181.00

Service Code	HCPCS 97530 GO
Hospital Charge Code	4309753001
Hospital Revenue Code	430
Min. Negotiated Rate	$153.85
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$108.60
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: MDX Hawaii PPO	$175.57

HC OT THERAPEUTIC EXERCISES

Facility

$140.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	4309711001
Hospital Revenue Code	430
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: UnitedHealthcare Medicaid	$17.65
Rate for Payer: University Health Alliance Commercial	$102.05

HC OT THERAPEUTIC EXERCISES

Facility

$140.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	4309711001
Hospital Revenue Code	430
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: MDX Hawaii PPO	$135.80

HC OT ULTRASOUND THERAPY

Facility

$68.00

Service Code	HCPCS 97035 GO
Hospital Charge Code	4309703501
Hospital Revenue Code	430
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Hawaii Western Management Group Commercial	$64.60
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: UnitedHealthcare Medicaid	$9.52
Rate for Payer: University Health Alliance Commercial	$49.57

HC OT ULTRASOUND THERAPY

Facility

$68.00

Service Code	HCPCS 97035 GO
Hospital Charge Code	4309703501
Hospital Revenue Code	430
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION

Facility

$75.00

Service Code	HCPCS 87177
Hospital Charge Code	3068717701
Hospital Revenue Code	306
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$72.75
Rate for Payer: AlohaCare Medicaid	$8.90
Rate for Payer: AlohaCare Medicare	$8.90
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Devoted Health Medicare	$9.79
Rate for Payer: Hawaii Medical Service Association ABD	$12.30
Rate for Payer: Hawaii Medical Service Association Commercial	$11.12
Rate for Payer: Hawaii Medical Service Association Medicare	$8.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.92
Rate for Payer: Hawaii Western Management Group Commercial	$8.90
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: Humana Medicare	$8.90
Rate for Payer: Kaiser Permanente Commercial	$47.25
Rate for Payer: Kaiser Permanente Medicaid	$38.25
Rate for Payer: Kaiser Permanente Medicare	$8.90
Rate for Payer: MDX Hawaii PPO	$72.75
Rate for Payer: Ohana Health Plan Medicaid	$9.79
Rate for Payer: Ohana Health Plan Medicare	$8.90
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: UnitedHealthcare Medicare	$8.90
Rate for Payer: University Health Alliance Commercial	$23.00

HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION

Facility

$75.00

Service Code	HCPCS 87177
Hospital Charge Code	3068717701
Hospital Revenue Code	306
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: MDX Hawaii PPO	$72.75

HC OXYGEN HOURLY

Facility

$17.00

Hospital Charge Code	2700000026
Hospital Revenue Code	270
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: University Health Alliance Commercial	$12.39

HC OXYGEN HOURLY

Facility

$17.00

Hospital Charge Code	2700000026
Hospital Revenue Code	270
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: MDX Hawaii PPO	$16.49

HC PACEMAKER EVAL - IN PERSON

Facility

$185.00

Service Code	HCPCS 93288
Hospital Charge Code	4809328801
Hospital Revenue Code	480
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$44.09
Rate for Payer: AlohaCare Medicare	$44.09
Rate for Payer: Cash Price	$111.00
Rate for Payer: Cash Price	$111.00
Rate for Payer: Devoted Health Medicare	$48.50
Rate for Payer: Hawaii Medical Service Association ABD	$12.89
Rate for Payer: Hawaii Medical Service Association Commercial	$55.11
Rate for Payer: Hawaii Medical Service Association Medicare	$44.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.53
Rate for Payer: Hawaii Western Management Group Commercial	$175.75
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$44.09
Rate for Payer: Kaiser Permanente Commercial	$116.55
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$44.09
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$48.50
Rate for Payer: Ohana Health Plan Medicare	$44.09
Rate for Payer: UnitedHealthcare Medicaid	$12.89
Rate for Payer: UnitedHealthcare Medicare	$44.09
Rate for Payer: University Health Alliance Commercial	$134.85

HC PACEMAKER EVAL - IN PERSON

Facility

$185.00

Service Code	HCPCS 93288
Hospital Charge Code	4809328801
Hospital Revenue Code	480
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$111.00
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: MDX Hawaii PPO	$179.45

HC PACEMAKER EVAL MULTI - IN PERSON

Facility

$185.00

Service Code	HCPCS 93281
Hospital Charge Code	4809328101
Hospital Revenue Code	480
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$44.09
Rate for Payer: AlohaCare Medicare	$44.09
Rate for Payer: Cash Price	$111.00
Rate for Payer: Cash Price	$111.00
Rate for Payer: Devoted Health Medicare	$48.50
Rate for Payer: Hawaii Medical Service Association ABD	$18.16
Rate for Payer: Hawaii Medical Service Association Commercial	$55.11
Rate for Payer: Hawaii Medical Service Association Medicare	$44.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.13
Rate for Payer: Hawaii Western Management Group Commercial	$175.75
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$44.09
Rate for Payer: Kaiser Permanente Commercial	$116.55
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$44.09
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$48.50
Rate for Payer: Ohana Health Plan Medicare	$44.09
Rate for Payer: UnitedHealthcare Medicaid	$18.16
Rate for Payer: UnitedHealthcare Medicare	$44.09
Rate for Payer: University Health Alliance Commercial	$134.85

HC PACEMAKER EVAL MULTI - IN PERSON

Facility

$185.00

Service Code	HCPCS 93281
Hospital Charge Code	4809328101
Hospital Revenue Code	480
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$111.00
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: MDX Hawaii PPO	$179.45

HC PACEMAKER EVAL SINGLE/LEADLESS - IN PERSON

Facility

$185.00

Service Code	HCPCS 93279
Hospital Charge Code	4809327901
Hospital Revenue Code	480
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$44.09
Rate for Payer: AlohaCare Medicare	$44.09
Rate for Payer: Cash Price	$111.00
Rate for Payer: Cash Price	$111.00
Rate for Payer: Devoted Health Medicare	$48.50
Rate for Payer: Hawaii Medical Service Association ABD	$13.38
Rate for Payer: Hawaii Medical Service Association Commercial	$55.11
Rate for Payer: Hawaii Medical Service Association Medicare	$44.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.34
Rate for Payer: Hawaii Western Management Group Commercial	$175.75
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$44.09
Rate for Payer: Kaiser Permanente Commercial	$116.55
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$44.09
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$48.50
Rate for Payer: Ohana Health Plan Medicare	$44.09
Rate for Payer: UnitedHealthcare Medicaid	$13.38
Rate for Payer: UnitedHealthcare Medicare	$44.09
Rate for Payer: University Health Alliance Commercial	$134.85

HC PACEMAKER EVAL SINGLE/LEADLESS - IN PERSON

Facility

$185.00

Service Code	HCPCS 93279
Hospital Charge Code	4809327901
Hospital Revenue Code	480
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$111.00
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: MDX Hawaii PPO	$179.45

HC PACEMARKER EVAL DUAL - IN PERSON

Facility

$185.00

Service Code	HCPCS 93280
Hospital Charge Code	4809328001
Hospital Revenue Code	480
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$44.09
Rate for Payer: AlohaCare Medicare	$44.09
Rate for Payer: Cash Price	$111.00
Rate for Payer: Cash Price	$111.00
Rate for Payer: Devoted Health Medicare	$48.50
Rate for Payer: Hawaii Medical Service Association ABD	$15.50
Rate for Payer: Hawaii Medical Service Association Commercial	$55.11
Rate for Payer: Hawaii Medical Service Association Medicare	$44.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.31
Rate for Payer: Hawaii Western Management Group Commercial	$175.75
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$44.09
Rate for Payer: Kaiser Permanente Commercial	$116.55
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$44.09
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$48.50
Rate for Payer: Ohana Health Plan Medicare	$44.09
Rate for Payer: UnitedHealthcare Medicaid	$15.50
Rate for Payer: UnitedHealthcare Medicare	$44.09
Rate for Payer: University Health Alliance Commercial	$134.85

HC PACEMARKER EVAL DUAL - IN PERSON

Facility

$185.00

Service Code	HCPCS 93280
Hospital Charge Code	4809328001
Hospital Revenue Code	480
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$111.00
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: MDX Hawaii PPO	$179.45

HC PAMG 1

Facility

$823.00

Service Code	HCPCS 84112
Hospital Charge Code	3018411201
Hospital Revenue Code	301
Min. Negotiated Rate	$699.55
Max. Negotiated Rate	$798.31
Rate for Payer: Cash Price	$493.80
Rate for Payer: Health Management Network Commercial	$699.55
Rate for Payer: MDX Hawaii PPO	$798.31

HC PAMG 1

Facility

$823.00

Service Code	HCPCS 84112
Hospital Charge Code	3018411201
Hospital Revenue Code	301
Min. Negotiated Rate	$86.99
Max. Negotiated Rate	$798.31
Rate for Payer: AlohaCare Medicaid	$98.11
Rate for Payer: AlohaCare Medicare	$98.11
Rate for Payer: Cash Price	$493.80
Rate for Payer: Cash Price	$493.80
Rate for Payer: Devoted Health Medicare	$107.92
Rate for Payer: Hawaii Medical Service Association ABD	$90.64
Rate for Payer: Hawaii Medical Service Association Commercial	$122.64
Rate for Payer: Hawaii Medical Service Association Medicare	$98.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$86.99
Rate for Payer: Hawaii Western Management Group Commercial	$98.11
Rate for Payer: Health Management Network Commercial	$699.55
Rate for Payer: Humana Medicare	$98.11
Rate for Payer: Kaiser Permanente Commercial	$518.49
Rate for Payer: Kaiser Permanente Medicaid	$419.73
Rate for Payer: Kaiser Permanente Medicare	$98.11
Rate for Payer: MDX Hawaii PPO	$798.31
Rate for Payer: Ohana Health Plan Medicaid	$107.92
Rate for Payer: Ohana Health Plan Medicare	$98.11
Rate for Payer: UnitedHealthcare Medicaid	$90.64
Rate for Payer: UnitedHealthcare Medicare	$98.11
Rate for Payer: University Health Alliance Commercial	$167.68

HC PARATHYROID PLANAR IMAGING - NM PARATHYROID

Facility

$1,999.00

Service Code	HCPCS 78070
Hospital Charge Code	3417807001
Hospital Revenue Code	341
Min. Negotiated Rate	$110.12
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 ABD	$110.12
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$131.50
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	$110.12
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$380.51

HC PARATHYROID PLANAR IMAGING - NM PARATHYROID

Facility

$1,999.00

Service Code	HCPCS 78070
Hospital Charge Code	3417807001
Hospital Revenue Code	341
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

HC PARATHYROID PLANAR IMAGING W/WO SUBTRACTION - NM PARATHYROID SPECT

Facility

$1,999.00

Service Code	HCPCS 78071
Hospital Charge Code	3417807101
Hospital Revenue Code	341
Min. Negotiated Rate	$217.03
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 ABD	$217.03
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$281.04
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	$425.81
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$757.91

Know your out-of-pocket cost for care.

All Charges