Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC SPECTROPHOTOMETRY - SPECTROPHOTOMETRY NOS SO

Facility

$68.00

Service Code	HCPCS 84311
Hospital Charge Code	3018431102
Hospital Revenue Code	301
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$8.10
Rate for Payer: AlohaCare Medicare	$8.10
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$8.91
Rate for Payer: Hawaii Medical Service Association ABD	$9.66
Rate for Payer: Hawaii Medical Service Association Commercial	$10.12
Rate for Payer: Hawaii Medical Service Association Medicare	$8.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.14
Rate for Payer: Hawaii Western Management Group Commercial	$8.10
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$8.10
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$8.10
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$8.91
Rate for Payer: Ohana Health Plan Medicare	$8.10
Rate for Payer: UnitedHealthcare Medicaid	$9.66
Rate for Payer: UnitedHealthcare Medicare	$8.10
Rate for Payer: University Health Alliance Commercial	$18.07

HC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC

Facility

$2,756.00

Service Code	HCPCS 62270
Hospital Charge Code	3616227001
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
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: Hawaii Western Management Group Commercial	$2,618.20
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	$1,405.56
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	$4,035.20

HC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC

Facility

$2,756.00

Service Code	HCPCS 62270
Hospital Charge Code	3616227001
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
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	$4,035.20

HC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC

Facility

$2,756.00

Service Code	HCPCS 62270
Hospital Charge Code	3616227001
Hospital Revenue Code	761
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 SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC

Facility

$2,756.00

Service Code	HCPCS 62270
Hospital Charge Code	3616227001
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 SPLEEN IMAGING - NM SPLEEN

Facility

$1,999.00

Service Code	HCPCS 78185
Hospital Charge Code	3417818501
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 SPLEEN IMAGING - NM SPLEEN

Facility

$1,999.00

Service Code	HCPCS 78185
Hospital Charge Code	3417818501
Hospital Revenue Code	341
Min. Negotiated Rate	$91.53
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	$94.46
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	$91.53
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	$94.46
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$340.81

HC SP TELETHER PORT PLAN PAR

Facility

$1,457.00

Service Code	HCPCS 77321
Hospital Charge Code	3337732101
Hospital Revenue Code	333
Min. Negotiated Rate	$146.41
Max. Negotiated Rate	$1,413.29
Rate for Payer: AlohaCare Medicaid	$442.33
Rate for Payer: AlohaCare Medicare	$442.33
Rate for Payer: Cash Price	$874.20
Rate for Payer: Cash Price	$874.20
Rate for Payer: Devoted Health Medicare	$486.56
Rate for Payer: Hawaii Medical Service Association ABD	$153.52
Rate for Payer: Hawaii Medical Service Association Commercial	$552.91
Rate for Payer: Hawaii Medical Service Association Medicare	$442.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$146.41
Rate for Payer: Hawaii Western Management Group Commercial	$442.33
Rate for Payer: Health Management Network Commercial	$1,238.45
Rate for Payer: Humana Medicare	$442.33
Rate for Payer: Kaiser Permanente Commercial	$917.91
Rate for Payer: Kaiser Permanente Medicaid	$743.07
Rate for Payer: Kaiser Permanente Medicare	$442.33
Rate for Payer: MDX Hawaii PPO	$1,413.29
Rate for Payer: Ohana Health Plan Medicaid	$486.56
Rate for Payer: Ohana Health Plan Medicare	$442.33
Rate for Payer: UnitedHealthcare Medicaid	$153.52
Rate for Payer: UnitedHealthcare Medicare	$442.33
Rate for Payer: University Health Alliance Commercial	$307.29

HC SP TELETHER PORT PLAN PAR

Facility

$1,457.00

Service Code	HCPCS 77321
Hospital Charge Code	3337732101
Hospital Revenue Code	333
Min. Negotiated Rate	$1,238.45
Max. Negotiated Rate	$1,413.29
Rate for Payer: Cash Price	$874.20
Rate for Payer: Health Management Network Commercial	$1,238.45
Rate for Payer: MDX Hawaii PPO	$1,413.29

HC STENT BARE METAL ADDL BRANCH

Facility

$12,745.00

Service Code	HCPCS C9601
Hospital Charge Code	481C960101
Hospital Revenue Code	481
Min. Negotiated Rate	$10,833.25
Max. Negotiated Rate	$12,362.65
Rate for Payer: Cash Price	$7,647.00
Rate for Payer: Health Management Network Commercial	$10,833.25
Rate for Payer: MDX Hawaii PPO	$12,362.65

HC STENT BARE METAL ADDL BRANCH

Facility

$12,745.00

Service Code	HCPCS C9601
Hospital Charge Code	481C960101
Hospital Revenue Code	481
Min. Negotiated Rate	$6,499.95
Max. Negotiated Rate	$12,362.65
Rate for Payer: Cash Price	$7,647.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,107.75
Rate for Payer: Health Management Network Commercial	$10,833.25
Rate for Payer: Kaiser Permanente Commercial	$8,029.35
Rate for Payer: Kaiser Permanente Medicaid	$6,499.95
Rate for Payer: MDX Hawaii PPO	$12,362.65
Rate for Payer: University Health Alliance Commercial	$9,289.83

HC STENT BARE METAL SINGLE VESSEL

Facility

$56,414.00

Service Code	HCPCS C9600
Hospital Charge Code	481C960001
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$54,721.58
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Devoted Health Medicare	$15,001.44
Rate for Payer: Hawaii Medical Service Association Commercial	$17,047.09
Rate for Payer: Hawaii Medical Service Association Medicare	$13,637.67
Rate for Payer: Hawaii Western Management Group Commercial	$53,593.30
Rate for Payer: Health Management Network Commercial	$47,951.90
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$35,540.82
Rate for Payer: Kaiser Permanente Medicaid	$28,771.14
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$54,721.58
Rate for Payer: Ohana Health Plan Medicaid	$15,001.44
Rate for Payer: Ohana Health Plan Medicare	$13,637.67
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$13,637.67
Rate for Payer: University Health Alliance Commercial	$24,500.00

HC STENT BARE METAL SINGLE VESSEL

Facility

$56,414.00

Service Code	HCPCS C9600
Hospital Charge Code	481C960001
Hospital Revenue Code	481
Min. Negotiated Rate	$47,951.90
Max. Negotiated Rate	$54,721.58
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Health Management Network Commercial	$47,951.90
Rate for Payer: MDX Hawaii PPO	$54,721.58

HC STENT DRUG ELUTING ADDL BRANCH

Facility

$12,745.00

Service Code	HCPCS C9601
Hospital Charge Code	481C960102
Hospital Revenue Code	481
Min. Negotiated Rate	$6,499.95
Max. Negotiated Rate	$12,362.65
Rate for Payer: Cash Price	$7,647.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,107.75
Rate for Payer: Health Management Network Commercial	$10,833.25
Rate for Payer: Kaiser Permanente Commercial	$8,029.35
Rate for Payer: Kaiser Permanente Medicaid	$6,499.95
Rate for Payer: MDX Hawaii PPO	$12,362.65
Rate for Payer: University Health Alliance Commercial	$9,289.83

HC STENT DRUG ELUTING ADDL BRANCH

Facility

$12,745.00

Service Code	HCPCS C9601
Hospital Charge Code	481C960102
Hospital Revenue Code	481
Min. Negotiated Rate	$10,833.25
Max. Negotiated Rate	$12,362.65
Rate for Payer: Cash Price	$7,647.00
Rate for Payer: Health Management Network Commercial	$10,833.25
Rate for Payer: MDX Hawaii PPO	$12,362.65

HC STENT DRUG ELUTING SNGL VESSEL

Facility

$56,414.00

Service Code	HCPCS C9600
Hospital Charge Code	481C960002
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$54,721.58
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Devoted Health Medicare	$15,001.44
Rate for Payer: Hawaii Medical Service Association Commercial	$17,047.09
Rate for Payer: Hawaii Medical Service Association Medicare	$13,637.67
Rate for Payer: Hawaii Western Management Group Commercial	$53,593.30
Rate for Payer: Health Management Network Commercial	$47,951.90
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$35,540.82
Rate for Payer: Kaiser Permanente Medicaid	$28,771.14
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$54,721.58
Rate for Payer: Ohana Health Plan Medicaid	$15,001.44
Rate for Payer: Ohana Health Plan Medicare	$13,637.67
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$13,637.67
Rate for Payer: University Health Alliance Commercial	$24,500.00

HC STENT DRUG ELUTING SNGL VESSEL

Facility

$56,414.00

Service Code	HCPCS C9600
Hospital Charge Code	481C960002
Hospital Revenue Code	481
Min. Negotiated Rate	$47,951.90
Max. Negotiated Rate	$54,721.58
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Health Management Network Commercial	$47,951.90
Rate for Payer: MDX Hawaii PPO	$54,721.58

HC STOOL CULTURE, ADDL PATHOGENS - CULT STOOL ADD PATH EA

Facility

$79.00

Service Code	HCPCS 87046
Hospital Charge Code	3068704601
Hospital Revenue Code	306
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$9.44
Rate for Payer: AlohaCare Medicare	$9.44
Rate for Payer: Cash Price	$47.40
Rate for Payer: Cash Price	$47.40
Rate for Payer: Devoted Health Medicare	$10.38
Rate for Payer: Hawaii Medical Service Association ABD	$7.91
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$9.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.65
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$9.44
Rate for Payer: Kaiser Permanente Commercial	$49.77
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$9.44
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$10.38
Rate for Payer: Ohana Health Plan Medicare	$9.44
Rate for Payer: UnitedHealthcare Medicaid	$7.91
Rate for Payer: UnitedHealthcare Medicare	$9.44
Rate for Payer: University Health Alliance Commercial	$24.38

HC STOOL CULTURE, ADDL PATHOGENS - CULT STOOL ADD PATH EA

Facility

$79.00

Service Code	HCPCS 87046
Hospital Charge Code	3068704601
Hospital Revenue Code	306
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: MDX Hawaii PPO	$76.63

HC STRAP ELBOW/WRIST

Facility

$236.00

Service Code	HCPCS 29260
Hospital Charge Code	4202926001
Hospital Revenue Code	450
Min. Negotiated Rate	$69.69
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$76.66
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 Medicare	$69.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$148.68
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$172.02

HC STRAP ELBOW/WRIST

Facility

$236.00

Service Code	HCPCS 29260
Hospital Charge Code	4202926001
Hospital Revenue Code	450
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: MDX Hawaii PPO	$228.92

HC STRAP HAND/FINGER

Facility

$236.00

Service Code	HCPCS 29280
Hospital Charge Code	4202928001
Hospital Revenue Code	450
Min. Negotiated Rate	$69.69
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$76.66
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 Medicare	$69.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$148.68
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$172.02

HC STRAP HAND/FINGER

Facility

$236.00

Service Code	HCPCS 29280
Hospital Charge Code	4202928001
Hospital Revenue Code	450
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: MDX Hawaii PPO	$228.92

HC STRAP HIP

Facility

$513.00

Service Code	HCPCS 29520
Hospital Charge Code	4202952001
Hospital Revenue Code	450
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 STRAP HIP

Facility

$513.00

Service Code	HCPCS 29520
Hospital Charge Code	4202952001
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
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 Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

Know your out-of-pocket cost for care.

All Charges