Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTER/S&I BILAT

Facility

$12,526.00

Service Code	HCPCS 36254
Hospital Charge Code	3613625401
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,778.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,891.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$12,150.22
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$9,130.20

HC SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTER/S&I BILAT

Facility

$12,526.00

Service Code	HCPCS 36254
Hospital Charge Code	3613625401
Hospital Revenue Code	361
Min. Negotiated Rate	$10,647.10
Max. Negotiated Rate	$12,150.22
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: MDX Hawaii PPO	$12,150.22

HC SURG PATH,GROSS,LEVEL I - LAB SURG PATH,GROSS,LEVEL I

Facility

$243.00

Service Code	HCPCS 88300 TC
Hospital Charge Code	3128830001
Hospital Revenue Code	312
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Cash Price	$145.80
Rate for Payer: Hawaii Medical Service Association ABD	$13.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.32
Rate for Payer: Hawaii Western Management Group Commercial	$230.85
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$153.09
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: UnitedHealthcare Medicaid	$13.56
Rate for Payer: University Health Alliance Commercial	$38.96

HC SURG PATH,GROSS,LEVEL I - LAB SURG PATH,GROSS,LEVEL I

Facility

$243.00

Service Code	HCPCS 88300 TC
Hospital Charge Code	3128830001
Hospital Revenue Code	312
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: MDX Hawaii PPO	$235.71

HC SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III

Facility

$529.00

Service Code	HCPCS 88304 TC
Hospital Charge Code	3128830401
Hospital Revenue Code	312
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

HC SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III

Facility

$529.00

Service Code	HCPCS 88304 TC
Hospital Charge Code	3128830401
Hospital Revenue Code	312
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Hawaii Medical Service Association ABD	$38.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.72
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: UnitedHealthcare Medicaid	$38.92
Rate for Payer: University Health Alliance Commercial	$106.78

HC SURG PATH,LEVEL II - LAB SURG PATH,LEVEL II

Facility

$389.00

Service Code	HCPCS 88302 TC
Hospital Charge Code	3128830201
Hospital Revenue Code	312
Min. Negotiated Rate	$330.65
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$233.40
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: MDX Hawaii PPO	$377.33

HC SURG PATH,LEVEL II - LAB SURG PATH,LEVEL II

Facility

$389.00

Service Code	HCPCS 88302 TC
Hospital Charge Code	3128830201
Hospital Revenue Code	312
Min. Negotiated Rate	$29.54
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$233.40
Rate for Payer: Cash Price	$233.40
Rate for Payer: Hawaii Medical Service Association ABD	$29.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.08
Rate for Payer: Hawaii Western Management Group Commercial	$369.55
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: Kaiser Permanente Commercial	$245.07
Rate for Payer: Kaiser Permanente Medicaid	$198.39
Rate for Payer: MDX Hawaii PPO	$377.33
Rate for Payer: UnitedHealthcare Medicaid	$29.54
Rate for Payer: University Health Alliance Commercial	$89.95

HC SURG PATH,LEVEL IV - LAB SURG PATH,LEVEL IV

Facility

$529.00

Service Code	HCPCS 88305 TC
Hospital Charge Code	3128830501
Hospital Revenue Code	312
Min. Negotiated Rate	$40.64
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Hawaii Medical Service Association ABD	$40.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$49.53
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: UnitedHealthcare Medicaid	$40.64
Rate for Payer: University Health Alliance Commercial	$139.05

HC SURG PATH,LEVEL IV - LAB SURG PATH,LEVEL IV

Facility

$529.00

Service Code	HCPCS 88305 TC
Hospital Charge Code	3128830501
Hospital Revenue Code	312
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

HC SURG PATH,LEVEL VI - LAB SURG PATH,LEVEL VI

Facility

$8,094.00

Service Code	HCPCS 88309 TC
Hospital Charge Code	3128830901
Hospital Revenue Code	312
Min. Negotiated Rate	$6,879.90
Max. Negotiated Rate	$7,851.18
Rate for Payer: Cash Price	$4,856.40
Rate for Payer: Health Management Network Commercial	$6,879.90
Rate for Payer: MDX Hawaii PPO	$7,851.18

HC SURG PATH,LEVEL VI - LAB SURG PATH,LEVEL VI

Facility

$8,094.00

Service Code	HCPCS 88309 TC
Hospital Charge Code	3128830901
Hospital Revenue Code	312
Min. Negotiated Rate	$112.06
Max. Negotiated Rate	$7,851.18
Rate for Payer: Cash Price	$4,856.40
Rate for Payer: Cash Price	$4,856.40
Rate for Payer: Hawaii Medical Service Association ABD	$165.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$112.06
Rate for Payer: Hawaii Western Management Group Commercial	$7,689.30
Rate for Payer: Health Management Network Commercial	$6,879.90
Rate for Payer: Kaiser Permanente Commercial	$5,099.22
Rate for Payer: Kaiser Permanente Medicaid	$4,127.94
Rate for Payer: MDX Hawaii PPO	$7,851.18
Rate for Payer: UnitedHealthcare Medicaid	$165.80
Rate for Payer: University Health Alliance Commercial	$353.96

HC SURG PATH,LEVEL V - LAB SURG PATH,LEVEL V

Facility

$3,564.00

Service Code	HCPCS 88307 TC
Hospital Charge Code	3128830701
Hospital Revenue Code	312
Min. Negotiated Rate	$81.42
Max. Negotiated Rate	$3,457.08
Rate for Payer: Cash Price	$2,138.40
Rate for Payer: Cash Price	$2,138.40
Rate for Payer: Hawaii Medical Service Association ABD	$118.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$81.42
Rate for Payer: Hawaii Western Management Group Commercial	$3,385.80
Rate for Payer: Health Management Network Commercial	$3,029.40
Rate for Payer: Kaiser Permanente Commercial	$2,245.32
Rate for Payer: Kaiser Permanente Medicaid	$1,817.64
Rate for Payer: MDX Hawaii PPO	$3,457.08
Rate for Payer: UnitedHealthcare Medicaid	$118.35
Rate for Payer: University Health Alliance Commercial	$260.24

HC SURG PATH,LEVEL V - LAB SURG PATH,LEVEL V

Facility

$3,564.00

Service Code	HCPCS 88307 TC
Hospital Charge Code	3128830701
Hospital Revenue Code	312
Min. Negotiated Rate	$3,029.40
Max. Negotiated Rate	$3,457.08
Rate for Payer: Cash Price	$2,138.40
Rate for Payer: Health Management Network Commercial	$3,029.40
Rate for Payer: MDX Hawaii PPO	$3,457.08

HC SUSCEPTIBILITY PER AGENT

Facility

$40.00

Service Code	HCPCS 87181
Hospital Charge Code	3068718101
Hospital Revenue Code	306
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$4.75
Rate for Payer: AlohaCare Medicare	$4.75
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Devoted Health Medicare	$5.22
Rate for Payer: Hawaii Medical Service Association ABD	$2.57
Rate for Payer: Hawaii Medical Service Association Commercial	$5.94
Rate for Payer: Hawaii Medical Service Association Medicare	$4.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.70
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$4.75
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$4.75
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$5.22
Rate for Payer: Ohana Health Plan Medicare	$4.75
Rate for Payer: UnitedHealthcare Medicaid	$2.57
Rate for Payer: UnitedHealthcare Medicare	$4.75
Rate for Payer: University Health Alliance Commercial	$4.81

HC SUSCEPTIBILITY PER AGENT

Facility

$40.00

Service Code	HCPCS 87181
Hospital Charge Code	3068718101
Hospital Revenue Code	306
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: MDX Hawaii PPO	$38.80

HC SUTURE EYELID WOUND,FULL THICK

Facility

$9,091.00

Service Code	HCPCS 67935
Hospital Charge Code	3616793501
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,818.27
Rate for Payer: AlohaCare Medicaid	$2,808.63
Rate for Payer: AlohaCare Medicare	$2,808.63
Rate for Payer: Cash Price	$5,454.60
Rate for Payer: Cash Price	$5,454.60
Rate for Payer: Cash Price	$5,454.60
Rate for Payer: Devoted Health Medicare	$3,089.49
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	$2,808.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$8,636.45
Rate for Payer: Health Management Network Commercial	$7,727.35
Rate for Payer: Humana Medicare	$2,808.63
Rate for Payer: Kaiser Permanente Commercial	$5,727.33
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,808.63
Rate for Payer: MDX Hawaii PPO	$8,818.27
Rate for Payer: Ohana Health Plan Medicaid	$3,089.49
Rate for Payer: Ohana Health Plan Medicare	$2,808.63
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,808.63
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC SUTURE EYELID WOUND,FULL THICK

Facility

$9,091.00

Service Code	HCPCS 67935
Hospital Charge Code	3616793501
Hospital Revenue Code	450
Min. Negotiated Rate	$7,727.35
Max. Negotiated Rate	$8,818.27
Rate for Payer: Cash Price	$5,454.60
Rate for Payer: Health Management Network Commercial	$7,727.35
Rate for Payer: MDX Hawaii PPO	$8,818.27

HC SUTURE EYELID WOUND,PARTIAL THICK

Facility

$9,091.00

Service Code	HCPCS 67930
Hospital Charge Code	3616793001
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,818.27
Rate for Payer: AlohaCare Medicaid	$2,808.63
Rate for Payer: AlohaCare Medicare	$2,808.63
Rate for Payer: Cash Price	$5,454.60
Rate for Payer: Cash Price	$5,454.60
Rate for Payer: Cash Price	$5,454.60
Rate for Payer: Devoted Health Medicare	$3,089.49
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	$2,808.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$8,636.45
Rate for Payer: Health Management Network Commercial	$7,727.35
Rate for Payer: Humana Medicare	$2,808.63
Rate for Payer: Kaiser Permanente Commercial	$5,727.33
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,808.63
Rate for Payer: MDX Hawaii PPO	$8,818.27
Rate for Payer: Ohana Health Plan Medicaid	$3,089.49
Rate for Payer: Ohana Health Plan Medicare	$2,808.63
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,808.63
Rate for Payer: University Health Alliance Commercial	$6,626.43

HC SUTURE EYELID WOUND,PARTIAL THICK

Facility

$9,091.00

Service Code	HCPCS 67930
Hospital Charge Code	3616793001
Hospital Revenue Code	450
Min. Negotiated Rate	$7,727.35
Max. Negotiated Rate	$8,818.27
Rate for Payer: Cash Price	$5,454.60
Rate for Payer: Health Management Network Commercial	$7,727.35
Rate for Payer: MDX Hawaii PPO	$8,818.27

HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP

Facility

$36.00

Service Code	HCPCS 86592
Hospital Charge Code	3028659203
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$22.68
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$11.03

HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP

Facility

$36.00

Service Code	HCPCS 86592
Hospital Charge Code	3028659203
Hospital Revenue Code	302
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL CSF

Facility

$36.00

Service Code	HCPCS 86592
Hospital Charge Code	3028659202
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$22.68
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$11.03

HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL CSF

Facility

$36.00

Service Code	HCPCS 86592
Hospital Charge Code	3028659202
Hospital Revenue Code	302
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL QUAL SERUM SO

Facility

$36.00

Service Code	HCPCS 86592
Hospital Charge Code	3028659201
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$22.68
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$11.03

Know your out-of-pocket cost for care.

All Charges