Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC TRG GENE REARRANGEMENT SO

Facility

$1,691.00

Service Code	HCPCS 81342
Hospital Charge Code	3108134201
Hospital Revenue Code	310
Min. Negotiated Rate	$88.87
Max. Negotiated Rate	$1,640.27
Rate for Payer: AlohaCare Medicaid	$201.50
Rate for Payer: AlohaCare Medicare	$201.50
Rate for Payer: Cash Price	$1,014.60
Rate for Payer: Cash Price	$1,014.60
Rate for Payer: Devoted Health Medicare	$221.65
Rate for Payer: Hawaii Medical Service Association Commercial	$251.88
Rate for Payer: Hawaii Medical Service Association Medicare	$201.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$269.73
Rate for Payer: Hawaii Western Management Group Commercial	$201.50
Rate for Payer: Health Management Network Commercial	$1,437.35
Rate for Payer: Humana Medicare	$201.50
Rate for Payer: Kaiser Permanente Commercial	$1,065.33
Rate for Payer: Kaiser Permanente Medicaid	$862.41
Rate for Payer: Kaiser Permanente Medicare	$201.50
Rate for Payer: MDX Hawaii PPO	$1,640.27
Rate for Payer: Ohana Health Plan Medicaid	$221.65
Rate for Payer: Ohana Health Plan Medicare	$201.50
Rate for Payer: UnitedHealthcare Medicaid	$88.87
Rate for Payer: UnitedHealthcare Medicare	$201.50
Rate for Payer: University Health Alliance Commercial	$1,232.57

HC TRG GENE REARRANGEMENT SO

Facility

$1,691.00

Service Code	HCPCS 81342
Hospital Charge Code	3108134201
Hospital Revenue Code	310
Min. Negotiated Rate	$1,437.35
Max. Negotiated Rate	$1,640.27
Rate for Payer: Cash Price	$1,014.60
Rate for Payer: Health Management Network Commercial	$1,437.35
Rate for Payer: MDX Hawaii PPO	$1,640.27

HC TRICH VAGINALIS AMP PROBE

Facility

$294.00

Service Code	HCPCS 87661
Hospital Charge Code	3068766101
Hospital Revenue Code	306
Min. Negotiated Rate	$28.72
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$28.72
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$88.56

HC TRICH VAGINALIS AMP PROBE

Facility

$294.00

Service Code	HCPCS 87661
Hospital Charge Code	3068766101
Hospital Revenue Code	306
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE

Facility

$142.00

Service Code	HCPCS 84481
Hospital Charge Code	3018448101
Hospital Revenue Code	301
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$85.20
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: MDX Hawaii PPO	$137.74

HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE

Facility

$142.00

Service Code	HCPCS 84481
Hospital Charge Code	3018448101
Hospital Revenue Code	301
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$16.94
Rate for Payer: AlohaCare Medicare	$16.94
Rate for Payer: Cash Price	$85.20
Rate for Payer: Cash Price	$85.20
Rate for Payer: Devoted Health Medicare	$18.63
Rate for Payer: Hawaii Medical Service Association ABD	$23.41
Rate for Payer: Hawaii Medical Service Association Commercial	$21.18
Rate for Payer: Hawaii Medical Service Association Medicare	$16.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.58
Rate for Payer: Hawaii Western Management Group Commercial	$16.94
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$16.94
Rate for Payer: Kaiser Permanente Commercial	$89.46
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$16.94
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$18.63
Rate for Payer: Ohana Health Plan Medicare	$16.94
Rate for Payer: UnitedHealthcare Medicaid	$23.41
Rate for Payer: UnitedHealthcare Medicare	$16.94
Rate for Payer: University Health Alliance Commercial	$43.79

HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)

Facility

$119.00

Service Code	HCPCS 84480
Hospital Charge Code	3018448001
Hospital Revenue Code	301
Min. Negotiated Rate	$14.18
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$14.18
Rate for Payer: AlohaCare Medicare	$14.18
Rate for Payer: Cash Price	$71.40
Rate for Payer: Cash Price	$71.40
Rate for Payer: Devoted Health Medicare	$15.60
Rate for Payer: Hawaii Medical Service Association ABD	$19.60
Rate for Payer: Hawaii Medical Service Association Commercial	$17.73
Rate for Payer: Hawaii Medical Service Association Medicare	$14.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.58
Rate for Payer: Hawaii Western Management Group Commercial	$14.18
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$14.18
Rate for Payer: Kaiser Permanente Commercial	$74.97
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$14.18
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$15.60
Rate for Payer: Ohana Health Plan Medicare	$14.18
Rate for Payer: UnitedHealthcare Medicaid	$19.60
Rate for Payer: UnitedHealthcare Medicare	$14.18
Rate for Payer: University Health Alliance Commercial	$36.65

HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)

Facility

$119.00

Service Code	HCPCS 84480
Hospital Charge Code	3018448001
Hospital Revenue Code	301
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: MDX Hawaii PPO	$115.43

HC TRIM HYPERKERATOTIC SKIN LESION, ONE

Facility

$791.00

Service Code	HCPCS 11055
Hospital Charge Code	4501105501
Hospital Revenue Code	450
Min. Negotiated Rate	$237.02
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$260.72
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	$237.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$751.45
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Commercial	$498.33
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$576.56

HC TRIM HYPERKERATOTIC SKIN LESION, ONE

Facility

$791.00

Service Code	HCPCS 11055
Hospital Charge Code	4501105501
Hospital Revenue Code	450
Min. Negotiated Rate	$672.35
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: MDX Hawaii PPO	$767.27

HC TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER

Facility

$236.00

Service Code	HCPCS 11719
Hospital Charge Code	4501171901
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 TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER

Facility

$236.00

Service Code	HCPCS 11719
Hospital Charge Code	4501171901
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 TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART

Facility

$22,690.00

Service Code	HCPCS 37246
Hospital Charge Code	3603724601
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$22,009.30
Rate for Payer: AlohaCare Medicaid	$6,723.70
Rate for Payer: AlohaCare Medicare	$6,723.70
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Devoted Health Medicare	$7,396.07
Rate for Payer: Hawaii Medical Service Association Commercial	$8,404.62
Rate for Payer: Hawaii Medical Service Association Medicare	$6,723.70
Rate for Payer: Health Management Network Commercial	$19,286.50
Rate for Payer: Humana Medicare	$6,723.70
Rate for Payer: Kaiser Permanente Commercial	$14,294.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,723.70
Rate for Payer: MDX Hawaii PPO	$22,009.30
Rate for Payer: Ohana Health Plan Medicaid	$7,396.07
Rate for Payer: Ohana Health Plan Medicare	$6,723.70
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,723.70
Rate for Payer: University Health Alliance Commercial	$16,538.74

HC TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART

Facility

$22,690.00

Service Code	HCPCS 37246
Hospital Charge Code	3603724601
Hospital Revenue Code	360
Min. Negotiated Rate	$19,286.50
Max. Negotiated Rate	$22,009.30
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Health Management Network Commercial	$19,286.50
Rate for Payer: MDX Hawaii PPO	$22,009.30

HC TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN

Facility

$22,690.00

Service Code	HCPCS 37248
Hospital Charge Code	3603724801
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$22,009.30
Rate for Payer: AlohaCare Medicaid	$6,723.70
Rate for Payer: AlohaCare Medicare	$6,723.70
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Devoted Health Medicare	$7,396.07
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	$6,723.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$19,286.50
Rate for Payer: Humana Medicare	$6,723.70
Rate for Payer: Kaiser Permanente Commercial	$14,294.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,723.70
Rate for Payer: MDX Hawaii PPO	$22,009.30
Rate for Payer: Ohana Health Plan Medicaid	$7,396.07
Rate for Payer: Ohana Health Plan Medicare	$6,723.70
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,723.70
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN

Facility

$22,690.00

Service Code	HCPCS 37248
Hospital Charge Code	3603724801
Hospital Revenue Code	360
Min. Negotiated Rate	$19,286.50
Max. Negotiated Rate	$22,009.30
Rate for Payer: Cash Price	$13,614.00
Rate for Payer: Health Management Network Commercial	$19,286.50
Rate for Payer: MDX Hawaii PPO	$22,009.30

HC TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I

Facility

$23,423.00

Service Code	HCPCS 36907
Hospital Charge Code	3613690701
Hospital Revenue Code	361
Min. Negotiated Rate	$138.86
Max. Negotiated Rate	$22,720.31
Rate for Payer: Cash Price	$14,053.80
Rate for Payer: Cash Price	$14,053.80
Rate for Payer: Cash Price	$14,053.80
Rate for Payer: Health Management Network Commercial	$19,909.55
Rate for Payer: Kaiser Permanente Commercial	$14,756.49
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$22,720.31
Rate for Payer: UnitedHealthcare Medicaid	$138.86
Rate for Payer: University Health Alliance Commercial	$17,073.02

HC TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I

Facility

$23,423.00

Service Code	HCPCS 36907
Hospital Charge Code	3613690701
Hospital Revenue Code	361
Min. Negotiated Rate	$19,909.55
Max. Negotiated Rate	$22,720.31
Rate for Payer: Cash Price	$14,053.80
Rate for Payer: Health Management Network Commercial	$19,909.55
Rate for Payer: MDX Hawaii PPO	$22,720.31

HC TTE 2D FU/LTD W/CONT

Facility

$1,776.00

Service Code	HCPCS C8924
Hospital Charge Code	483C892401
Hospital Revenue Code	483
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC TTE 2D FU/LTD W/CONT

Facility

$1,776.00

Service Code	HCPCS C8924
Hospital Charge Code	483C892401
Hospital Revenue Code	483
Min. Negotiated Rate	$267.85
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Western Management Group Commercial	$1,687.20
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$267.85
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,294.53

HC TTE F-UP OR LMTD - TTE LIMITED

Facility

$1,203.00

Service Code	HCPCS 93308
Hospital Charge Code	4839330807
Hospital Revenue Code	483
Min. Negotiated Rate	$1,022.55
Max. Negotiated Rate	$1,166.91
Rate for Payer: Cash Price	$721.80
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: MDX Hawaii PPO	$1,166.91

HC TTE F-UP OR LMTD - TTE LIMITED

Facility

$1,203.00

Service Code	HCPCS 93308
Hospital Charge Code	4839330807
Hospital Revenue Code	483
Min. Negotiated Rate	$64.51
Max. Negotiated Rate	$1,166.91
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$721.80
Rate for Payer: Cash Price	$721.80
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$64.51
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$67.74
Rate for Payer: Hawaii Western Management Group Commercial	$1,142.85
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$757.89
Rate for Payer: Kaiser Permanente Medicaid	$613.53
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,166.91
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$64.51
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$876.87

HC TTE W/DOPPLER COMPLETE - TTE COMPLETE

Facility

$3,930.00

Service Code	HCPCS 93306
Hospital Charge Code	4839330602
Hospital Revenue Code	483
Min. Negotiated Rate	$3,340.50
Max. Negotiated Rate	$3,812.10
Rate for Payer: Cash Price	$2,358.00
Rate for Payer: Health Management Network Commercial	$3,340.50
Rate for Payer: MDX Hawaii PPO	$3,812.10

HC TTE W/DOPPLER COMPLETE - TTE COMPLETE

Facility

$3,930.00

Service Code	HCPCS 93306
Hospital Charge Code	4839330602
Hospital Revenue Code	483
Min. Negotiated Rate	$132.88
Max. Negotiated Rate	$3,812.10
Rate for Payer: AlohaCare Medicaid	$645.50
Rate for Payer: AlohaCare Medicare	$645.50
Rate for Payer: Cash Price	$2,358.00
Rate for Payer: Cash Price	$2,358.00
Rate for Payer: Cash Price	$2,358.00
Rate for Payer: Devoted Health Medicare	$710.05
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	$645.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,733.50
Rate for Payer: Health Management Network Commercial	$3,340.50
Rate for Payer: Humana Medicare	$645.50
Rate for Payer: Kaiser Permanente Commercial	$2,475.90
Rate for Payer: Kaiser Permanente Medicaid	$2,004.30
Rate for Payer: Kaiser Permanente Medicare	$645.50
Rate for Payer: MDX Hawaii PPO	$3,812.10
Rate for Payer: Ohana Health Plan Medicaid	$710.05
Rate for Payer: Ohana Health Plan Medicare	$645.50
Rate for Payer: UnitedHealthcare Medicaid	$132.88
Rate for Payer: UnitedHealthcare Medicare	$645.50
Rate for Payer: University Health Alliance Commercial	$2,864.58

HC TTE W/O DOPPLER COMPLETE - TRANSTHORACIC ECHO (TTE) COMPLETE

Facility

$421.00

Service Code	HCPCS 93307
Hospital Charge Code	4839330701
Hospital Revenue Code	483
Min. Negotiated Rate	$357.85
Max. Negotiated Rate	$408.37
Rate for Payer: Cash Price	$252.60
Rate for Payer: Health Management Network Commercial	$357.85
Rate for Payer: MDX Hawaii PPO	$408.37

Know your out-of-pocket cost for care.

All Charges