Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC SLP ENDOSCOPIC EVAL,SWALLOW,CINE/VIDEO

Facility

$308.00

Service Code	HCPCS 92612 GN
Hospital Charge Code	4449261201
Hospital Revenue Code	444
Min. Negotiated Rate	$49.97
Max. Negotiated Rate	$298.76
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cash Price	$184.80
Rate for Payer: Hawaii Western Management Group Commercial	$292.60
Rate for Payer: Health Management Network Commercial	$261.80
Rate for Payer: Kaiser Permanente Commercial	$194.04
Rate for Payer: Kaiser Permanente Medicaid	$157.08
Rate for Payer: MDX Hawaii PPO	$298.76
Rate for Payer: UnitedHealthcare Medicaid	$49.97
Rate for Payer: University Health Alliance Commercial	$224.50

HC SLP ENDOSCOPIC EVAL,SWALLOW,CINE/VIDEO

Facility

$308.00

Service Code	HCPCS 92612 GN
Hospital Charge Code	4449261201
Hospital Revenue Code	444
Min. Negotiated Rate	$261.80
Max. Negotiated Rate	$298.76
Rate for Payer: Cash Price	$184.80
Rate for Payer: Health Management Network Commercial	$261.80
Rate for Payer: MDX Hawaii PPO	$298.76

HC SLP EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION

Facility

$328.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	4449261001
Hospital Revenue Code	444
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$318.16
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Hawaii Western Management Group Commercial	$311.60
Rate for Payer: Health Management Network Commercial	$278.80
Rate for Payer: Kaiser Permanente Commercial	$206.64
Rate for Payer: Kaiser Permanente Medicaid	$167.28
Rate for Payer: MDX Hawaii PPO	$318.16
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: University Health Alliance Commercial	$239.08

HC SLP EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION

Facility

$328.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	4449261001
Hospital Revenue Code	444
Min. Negotiated Rate	$278.80
Max. Negotiated Rate	$318.16
Rate for Payer: Cash Price	$196.80
Rate for Payer: Health Management Network Commercial	$278.80
Rate for Payer: MDX Hawaii PPO	$318.16

HC SLP EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION

Facility

$1,095.00

Service Code	HCPCS 92523 GN
Hospital Charge Code	4449252301
Hospital Revenue Code	444
Min. Negotiated Rate	$240.61
Max. Negotiated Rate	$1,062.15
Rate for Payer: Cash Price	$657.00
Rate for Payer: Cash Price	$657.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,040.25
Rate for Payer: Health Management Network Commercial	$930.75
Rate for Payer: Kaiser Permanente Commercial	$689.85
Rate for Payer: Kaiser Permanente Medicaid	$558.45
Rate for Payer: MDX Hawaii PPO	$1,062.15
Rate for Payer: UnitedHealthcare Medicaid	$240.61
Rate for Payer: University Health Alliance Commercial	$798.15

HC SLP EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION

Facility

$1,095.00

Service Code	HCPCS 92523 GN
Hospital Charge Code	4449252301
Hospital Revenue Code	444
Min. Negotiated Rate	$930.75
Max. Negotiated Rate	$1,062.15
Rate for Payer: Cash Price	$657.00
Rate for Payer: Health Management Network Commercial	$930.75
Rate for Payer: MDX Hawaii PPO	$1,062.15

HC SLP EVAL,SWALLOW FUNCTION,CINE/VIDEO RECORD

Facility

$436.00

Service Code	HCPCS 92611 GN
Hospital Charge Code	4449261101
Hospital Revenue Code	444
Min. Negotiated Rate	$370.60
Max. Negotiated Rate	$422.92
Rate for Payer: Cash Price	$261.60
Rate for Payer: Health Management Network Commercial	$370.60
Rate for Payer: MDX Hawaii PPO	$422.92

HC SLP EVAL,SWALLOW FUNCTION,CINE/VIDEO RECORD

Facility

$436.00

Service Code	HCPCS 92611 GN
Hospital Charge Code	4449261101
Hospital Revenue Code	444
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$422.92
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cash Price	$261.60
Rate for Payer: Hawaii Western Management Group Commercial	$414.20
Rate for Payer: Health Management Network Commercial	$370.60
Rate for Payer: Kaiser Permanente Commercial	$274.68
Rate for Payer: Kaiser Permanente Medicaid	$222.36
Rate for Payer: MDX Hawaii PPO	$422.92
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: University Health Alliance Commercial	$317.80

HC SLP EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)

Facility

$639.00

Service Code	HCPCS 92521
Hospital Charge Code	4449252101
Hospital Revenue Code	444
Min. Negotiated Rate	$140.32
Max. Negotiated Rate	$619.83
Rate for Payer: Cash Price	$383.40
Rate for Payer: Cash Price	$383.40
Rate for Payer: Hawaii Western Management Group Commercial	$607.05
Rate for Payer: Health Management Network Commercial	$543.15
Rate for Payer: Kaiser Permanente Commercial	$402.57
Rate for Payer: Kaiser Permanente Medicaid	$325.89
Rate for Payer: MDX Hawaii PPO	$619.83
Rate for Payer: UnitedHealthcare Medicaid	$140.32
Rate for Payer: University Health Alliance Commercial	$465.77

HC SLP EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)

Facility

$639.00

Service Code	HCPCS 92521
Hospital Charge Code	4449252101
Hospital Revenue Code	444
Min. Negotiated Rate	$543.15
Max. Negotiated Rate	$619.83
Rate for Payer: Cash Price	$383.40
Rate for Payer: Health Management Network Commercial	$543.15
Rate for Payer: MDX Hawaii PPO	$619.83

HC SLP EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE

Facility

$532.00

Service Code	HCPCS 92522 GN
Hospital Charge Code	4449252201
Hospital Revenue Code	444
Min. Negotiated Rate	$116.85
Max. Negotiated Rate	$516.04
Rate for Payer: Cash Price	$319.20
Rate for Payer: Cash Price	$319.20
Rate for Payer: Hawaii Western Management Group Commercial	$505.40
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: Kaiser Permanente Commercial	$335.16
Rate for Payer: Kaiser Permanente Medicaid	$271.32
Rate for Payer: MDX Hawaii PPO	$516.04
Rate for Payer: UnitedHealthcare Medicaid	$116.85
Rate for Payer: University Health Alliance Commercial	$387.77

HC SLP EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE

Facility

$532.00

Service Code	HCPCS 92522 GN
Hospital Charge Code	4449252201
Hospital Revenue Code	444
Min. Negotiated Rate	$452.20
Max. Negotiated Rate	$516.04
Rate for Payer: Cash Price	$319.20
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: MDX Hawaii PPO	$516.04

HC SLP FLX FIBOPT NDSC EVAL SWLNG C/V REC PHYS I&R

Facility

$259.00

Service Code	HCPCS 92613
Hospital Charge Code	4449261301
Hospital Revenue Code	444
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 SLP FLX FIBOPT NDSC EVAL SWLNG C/V REC PHYS I&R

Facility

$259.00

Service Code	HCPCS 92613
Hospital Charge Code	4449261301
Hospital Revenue Code	444
Min. Negotiated Rate	$26.99
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	$26.99
Rate for Payer: University Health Alliance Commercial	$188.79

HC SLP ORAL FUNCTION THERAPY

Facility

$409.00

Service Code	HCPCS 92526 GN
Hospital Charge Code	4409252601
Hospital Revenue Code	440
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$396.73
Rate for Payer: Cash Price	$245.40
Rate for Payer: Cash Price	$245.40
Rate for Payer: Hawaii Western Management Group Commercial	$388.55
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Kaiser Permanente Commercial	$257.67
Rate for Payer: Kaiser Permanente Medicaid	$208.59
Rate for Payer: MDX Hawaii PPO	$396.73
Rate for Payer: UnitedHealthcare Medicaid	$22.46
Rate for Payer: University Health Alliance Commercial	$298.12

HC SLP ORAL FUNCTION THERAPY

Facility

$409.00

Service Code	HCPCS 92526 GN
Hospital Charge Code	4409252601
Hospital Revenue Code	440
Min. Negotiated Rate	$347.65
Max. Negotiated Rate	$396.73
Rate for Payer: Cash Price	$245.40
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: MDX Hawaii PPO	$396.73

HC SLP SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES

Facility

$226.00

Service Code	HCPCS 97533
Hospital Charge Code	4409753301
Hospital Revenue Code	440
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$135.60
Rate for Payer: Cash Price	$135.60
Rate for Payer: Hawaii Western Management Group Commercial	$214.70
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Kaiser Permanente Commercial	$142.38
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: University Health Alliance Commercial	$164.73

HC SLP SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES

Facility

$226.00

Service Code	HCPCS 97533
Hospital Charge Code	4409753301
Hospital Revenue Code	440
Min. Negotiated Rate	$192.10
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$135.60
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: MDX Hawaii PPO	$219.22

HC SLP SPEECH/HEARING THERAPY, INDIVIDUAL

Facility

$366.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	4409250701
Hospital Revenue Code	440
Min. Negotiated Rate	$311.10
Max. Negotiated Rate	$355.02
Rate for Payer: Cash Price	$219.60
Rate for Payer: Health Management Network Commercial	$311.10
Rate for Payer: MDX Hawaii PPO	$355.02

HC SLP SPEECH/HEARING THERAPY, INDIVIDUAL

Facility

$366.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	4409250701
Hospital Revenue Code	440
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$355.02
Rate for Payer: Cash Price	$219.60
Rate for Payer: Cash Price	$219.60
Rate for Payer: Hawaii Western Management Group Commercial	$347.70
Rate for Payer: Health Management Network Commercial	$311.10
Rate for Payer: Kaiser Permanente Commercial	$230.58
Rate for Payer: Kaiser Permanente Medicaid	$186.66
Rate for Payer: MDX Hawaii PPO	$355.02
Rate for Payer: UnitedHealthcare Medicaid	$21.05
Rate for Payer: University Health Alliance Commercial	$266.78

HC SLP STANDARDIZED COGNITIVE PERFORMANCE TESTING

Facility

$490.00

Service Code	HCPCS 96125 GN
Hospital Charge Code	4449612501
Hospital Revenue Code	444
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$475.30
Rate for Payer: Cash Price	$294.00
Rate for Payer: Cash Price	$294.00
Rate for Payer: Hawaii Western Management Group Commercial	$465.50
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Kaiser Permanente Commercial	$308.70
Rate for Payer: Kaiser Permanente Medicaid	$249.90
Rate for Payer: MDX Hawaii PPO	$475.30
Rate for Payer: UnitedHealthcare Medicaid	$41.65
Rate for Payer: University Health Alliance Commercial	$357.16

HC SLP STANDARDIZED COGNITIVE PERFORMANCE TESTING

Facility

$490.00

Service Code	HCPCS 96125 GN
Hospital Charge Code	4449612501
Hospital Revenue Code	444
Min. Negotiated Rate	$416.50
Max. Negotiated Rate	$475.30
Rate for Payer: Cash Price	$294.00
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: MDX Hawaii PPO	$475.30

HC SMEAR COMPLEX W/INTERP O&P

Facility

$151.00

Service Code	HCPCS 87209
Hospital Charge Code	3068720901
Hospital Revenue Code	306
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$146.47
Rate for Payer: AlohaCare Medicaid	$17.98
Rate for Payer: AlohaCare Medicare	$17.98
Rate for Payer: Cash Price	$90.60
Rate for Payer: Cash Price	$90.60
Rate for Payer: Devoted Health Medicare	$19.78
Rate for Payer: Hawaii Medical Service Association ABD	$17.57
Rate for Payer: Hawaii Medical Service Association Commercial	$22.48
Rate for Payer: Hawaii Medical Service Association Medicare	$17.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.82
Rate for Payer: Hawaii Western Management Group Commercial	$17.98
Rate for Payer: Health Management Network Commercial	$128.35
Rate for Payer: Humana Medicare	$17.98
Rate for Payer: Kaiser Permanente Commercial	$95.13
Rate for Payer: Kaiser Permanente Medicaid	$77.01
Rate for Payer: Kaiser Permanente Medicare	$17.98
Rate for Payer: MDX Hawaii PPO	$146.47
Rate for Payer: Ohana Health Plan Medicaid	$19.78
Rate for Payer: Ohana Health Plan Medicare	$17.98
Rate for Payer: UnitedHealthcare Medicaid	$17.57
Rate for Payer: UnitedHealthcare Medicare	$17.98
Rate for Payer: University Health Alliance Commercial	$46.45

HC SMEAR COMPLEX W/INTERP O&P

Facility

$151.00

Service Code	HCPCS 87209
Hospital Charge Code	3068720901
Hospital Revenue Code	306
Min. Negotiated Rate	$128.35
Max. Negotiated Rate	$146.47
Rate for Payer: Cash Price	$90.60
Rate for Payer: Health Management Network Commercial	$128.35
Rate for Payer: MDX Hawaii PPO	$146.47

HC SMEAR,FLUOR STAIN,INTERP - AFB STAIN

Facility

$45.00

Service Code	HCPCS 87206
Hospital Charge Code	3068720601
Hospital Revenue Code	306
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$43.65
Rate for Payer: AlohaCare Medicaid	$5.39
Rate for Payer: AlohaCare Medicare	$5.39
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Devoted Health Medicare	$5.93
Rate for Payer: Hawaii Medical Service Association ABD	$7.42
Rate for Payer: Hawaii Medical Service Association Commercial	$6.74
Rate for Payer: Hawaii Medical Service Association Medicare	$5.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.79
Rate for Payer: Hawaii Western Management Group Commercial	$5.39
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Humana Medicare	$5.39
Rate for Payer: Kaiser Permanente Commercial	$28.35
Rate for Payer: Kaiser Permanente Medicaid	$22.95
Rate for Payer: Kaiser Permanente Medicare	$5.39
Rate for Payer: MDX Hawaii PPO	$43.65
Rate for Payer: Ohana Health Plan Medicaid	$5.93
Rate for Payer: Ohana Health Plan Medicare	$5.39
Rate for Payer: UnitedHealthcare Medicaid	$7.42
Rate for Payer: UnitedHealthcare Medicare	$5.39
Rate for Payer: University Health Alliance Commercial	$13.88

Know your out-of-pocket cost for care.

All Charges