Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC PBB OFFICE OUTPATIENT NEW 45 MINUTES

Facility

$743.00

Service Code	HCPCS 99204
Hospital Charge Code	51099204PB
Hospital Revenue Code	510
Min. Negotiated Rate	$631.55
Max. Negotiated Rate	$720.71
Rate for Payer: Cash Price	$445.80
Rate for Payer: Health Management Network Commercial	$631.55
Rate for Payer: MDX Hawaii PPO	$720.71

HC PBB OFFICE OUTPATIENT NEW 60 MINUTES

Facility

$825.00

Service Code	HCPCS 99205
Hospital Charge Code	51099205PB
Hospital Revenue Code	510
Min. Negotiated Rate	$122.28
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Hawaii Western Management Group Commercial	$783.75
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Kaiser Permanente Commercial	$519.75
Rate for Payer: Kaiser Permanente Medicaid	$420.75
Rate for Payer: MDX Hawaii PPO	$800.25
Rate for Payer: UnitedHealthcare Medicaid	$122.28
Rate for Payer: University Health Alliance Commercial	$601.34

HC PBB OFFICE OUTPATIENT NEW 60 MINUTES

Facility

$825.00

Service Code	HCPCS 99205
Hospital Charge Code	51099205PB
Hospital Revenue Code	510
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: MDX Hawaii PPO	$800.25

HC PBB OFFICE OUTPATIENT VISIT 10 MINUTES

Facility

$574.00

Service Code	HCPCS 99212
Hospital Charge Code	51099212PB
Hospital Revenue Code	510
Min. Negotiated Rate	$24.13
Max. Negotiated Rate	$556.78
Rate for Payer: Cash Price	$344.40
Rate for Payer: Cash Price	$344.40
Rate for Payer: Hawaii Western Management Group Commercial	$545.30
Rate for Payer: Health Management Network Commercial	$487.90
Rate for Payer: Kaiser Permanente Commercial	$361.62
Rate for Payer: Kaiser Permanente Medicaid	$292.74
Rate for Payer: MDX Hawaii PPO	$556.78
Rate for Payer: UnitedHealthcare Medicaid	$24.13
Rate for Payer: University Health Alliance Commercial	$418.39

HC PBB OFFICE OUTPATIENT VISIT 10 MINUTES

Facility

$574.00

Service Code	HCPCS 99212
Hospital Charge Code	51099212PB
Hospital Revenue Code	510
Min. Negotiated Rate	$487.90
Max. Negotiated Rate	$556.78
Rate for Payer: Cash Price	$344.40
Rate for Payer: Health Management Network Commercial	$487.90
Rate for Payer: MDX Hawaii PPO	$556.78

HC PBB OFFICE OUTPATIENT VISIT 15 MINUTES

Facility

$627.00

Service Code	HCPCS 99213
Hospital Charge Code	51099213PB
Hospital Revenue Code	510
Min. Negotiated Rate	$36.31
Max. Negotiated Rate	$608.19
Rate for Payer: Cash Price	$376.20
Rate for Payer: Cash Price	$376.20
Rate for Payer: Hawaii Western Management Group Commercial	$595.65
Rate for Payer: Health Management Network Commercial	$532.95
Rate for Payer: Kaiser Permanente Commercial	$395.01
Rate for Payer: Kaiser Permanente Medicaid	$319.77
Rate for Payer: MDX Hawaii PPO	$608.19
Rate for Payer: UnitedHealthcare Medicaid	$36.31
Rate for Payer: University Health Alliance Commercial	$457.02

HC PBB OFFICE OUTPATIENT VISIT 15 MINUTES

Facility

$627.00

Service Code	HCPCS 99213
Hospital Charge Code	51099213PB
Hospital Revenue Code	510
Min. Negotiated Rate	$532.95
Max. Negotiated Rate	$608.19
Rate for Payer: Cash Price	$376.20
Rate for Payer: Health Management Network Commercial	$532.95
Rate for Payer: MDX Hawaii PPO	$608.19

HC PBB OFFICE OUTPATIENT VISIT 25 MINUTES

Facility

$680.00

Service Code	HCPCS 99214
Hospital Charge Code	51099214PB
Hospital Revenue Code	510
Min. Negotiated Rate	$56.46
Max. Negotiated Rate	$659.60
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cash Price	$408.00
Rate for Payer: Hawaii Western Management Group Commercial	$646.00
Rate for Payer: Health Management Network Commercial	$578.00
Rate for Payer: Kaiser Permanente Commercial	$428.40
Rate for Payer: Kaiser Permanente Medicaid	$346.80
Rate for Payer: MDX Hawaii PPO	$659.60
Rate for Payer: UnitedHealthcare Medicaid	$56.46
Rate for Payer: University Health Alliance Commercial	$495.65

HC PBB OFFICE OUTPATIENT VISIT 25 MINUTES

Facility

$680.00

Service Code	HCPCS 99214
Hospital Charge Code	51099214PB
Hospital Revenue Code	510
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$659.60
Rate for Payer: Cash Price	$408.00
Rate for Payer: Health Management Network Commercial	$578.00
Rate for Payer: MDX Hawaii PPO	$659.60

HC PBB OFFICE OUTPATIENT VISIT 40 MINUTES

Facility

$761.00

Service Code	HCPCS 99215
Hospital Charge Code	51099215PB
Hospital Revenue Code	510
Min. Negotiated Rate	$646.85
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$456.60
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: MDX Hawaii PPO	$738.17

HC PBB OFFICE OUTPATIENT VISIT 40 MINUTES

Facility

$761.00

Service Code	HCPCS 99215
Hospital Charge Code	51099215PB
Hospital Revenue Code	510
Min. Negotiated Rate	$83.57
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$456.60
Rate for Payer: Cash Price	$456.60
Rate for Payer: Hawaii Western Management Group Commercial	$722.95
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Kaiser Permanente Commercial	$479.43
Rate for Payer: Kaiser Permanente Medicaid	$388.11
Rate for Payer: MDX Hawaii PPO	$738.17
Rate for Payer: UnitedHealthcare Medicaid	$83.57
Rate for Payer: University Health Alliance Commercial	$554.69

HC PBB OFFICE OUTPATIENT VISIT 5 MINUTES

Facility

$528.00

Service Code	HCPCS 99211
Hospital Charge Code	51099211PB
Hospital Revenue Code	510
Min. Negotiated Rate	$9.17
Max. Negotiated Rate	$512.16
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Hawaii Western Management Group Commercial	$501.60
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Kaiser Permanente Commercial	$332.64
Rate for Payer: Kaiser Permanente Medicaid	$269.28
Rate for Payer: MDX Hawaii PPO	$512.16
Rate for Payer: UnitedHealthcare Medicaid	$9.17
Rate for Payer: University Health Alliance Commercial	$384.86

HC PBB OFFICE OUTPATIENT VISIT 5 MINUTES

Facility

$528.00

Service Code	HCPCS 99211
Hospital Charge Code	51099211PB
Hospital Revenue Code	510
Min. Negotiated Rate	$448.80
Max. Negotiated Rate	$512.16
Rate for Payer: Cash Price	$316.80
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: MDX Hawaii PPO	$512.16

HC PBB POSTOP FOLLOW-UP VISIT TC

Facility

$513.00

Service Code	HCPCS 99024
Hospital Charge Code	51099024PB
Hospital Revenue Code	510
Min. Negotiated Rate	$261.63
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$261.63
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: University Health Alliance Commercial	$373.93

HC PBB POSTOP FOLLOW-UP VISIT TC

Facility

$513.00

Service Code	HCPCS 99024
Hospital Charge Code	51099024PB
Hospital Revenue Code	510
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC PBB REFOREARM TEND/MUSC,EXTEN,PRIM,EA

Facility

$12,643.00

Service Code	HCPCS 25270
Hospital Charge Code	76125270PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,263.71
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Devoted Health Medicare	$4,251.90
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	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$12,010.85
Rate for Payer: Health Management Network Commercial	$10,746.55
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Commercial	$7,965.09
Rate for Payer: Kaiser Permanente Medicaid	$6,447.93
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: MDX Hawaii PPO	$12,263.71
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC PBB REFOREARM TEND/MUSC,EXTEN,PRIM,EA

Facility

$12,643.00

Service Code	HCPCS 25270
Hospital Charge Code	76125270PB
Hospital Revenue Code	761
Min. Negotiated Rate	$10,746.55
Max. Negotiated Rate	$12,263.71
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Health Management Network Commercial	$10,746.55
Rate for Payer: MDX Hawaii PPO	$12,263.71

HC PBB REFOREARM TEND/MUSC,FLEX,PRIM,EA

Facility

$12,912.00

Service Code	HCPCS 25260
Hospital Charge Code	76125260PB
Hospital Revenue Code	761
Min. Negotiated Rate	$10,975.20
Max. Negotiated Rate	$12,524.64
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Health Management Network Commercial	$10,975.20
Rate for Payer: MDX Hawaii PPO	$12,524.64

HC PBB REFOREARM TEND/MUSC,FLEX,PRIM,EA

Facility

$12,912.00

Service Code	HCPCS 25260
Hospital Charge Code	76125260PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,524.64
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Devoted Health Medicare	$4,251.90
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	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$12,266.40
Rate for Payer: Health Management Network Commercial	$10,975.20
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Commercial	$8,134.56
Rate for Payer: Kaiser Permanente Medicaid	$6,585.12
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: MDX Hawaii PPO	$12,524.64
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC PBB REMOVE FOREARM/WRIST FOREIGN BODY

Facility

$6,369.00

Service Code	HCPCS 25248
Hospital Charge Code	76125248PB
Hospital Revenue Code	761
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC PBB REMOVE FOREARM/WRIST FOREIGN BODY

Facility

$6,369.00

Service Code	HCPCS 25248
Hospital Charge Code	76125248PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,177.93
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,089.55
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	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$6,050.55
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$4,012.47
Rate for Payer: Kaiser Permanente Medicaid	$3,248.19
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC PBB REMV FOOT FOREIGN BODY,COMPLEX

Facility

$6,448.00

Service Code	HCPCS 28193
Hospital Charge Code	76128193PB
Hospital Revenue Code	761
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	$3,288.48
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 PBB REMV FOOT FOREIGN BODY,COMPLEX

Facility

$6,448.00

Service Code	HCPCS 28193
Hospital Charge Code	76128193PB
Hospital Revenue Code	761
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 PBB REMV FOOT FOREIGN BODY,DEEP

Facility

$6,448.00

Service Code	HCPCS 28192
Hospital Charge Code	76128192PB
Hospital Revenue Code	761
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 PBB REMV FOOT FOREIGN BODY,DEEP

Facility

$6,448.00

Service Code	HCPCS 28192
Hospital Charge Code	76128192PB
Hospital Revenue Code	761
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: 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	$3,288.48
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	$5,160.40

Know your out-of-pocket cost for care.

All Charges