Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

BIOPSY OF OVARY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)

Facility

$8,270.00

Service Code	CPT 58900
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
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	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$6,743.44

BIOPSY OF PENIS; (SEPARATE PROCEDURE)

Facility

$4,035.20

Service Code	CPT 54100
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
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	$4,035.20

BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION

Facility

$2,837.00

Service Code	CPT 56605
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,088.08
Rate for Payer: AlohaCare Medicare	$1,088.08
Rate for Payer: Devoted Health Medicare	$1,196.89
Rate for Payer: Hawaii Medical Service Association Commercial	$1,360.10
Rate for Payer: Hawaii Medical Service Association Medicare	$1,088.08
Rate for Payer: Humana Medicare	$1,088.08
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,088.08
Rate for Payer: Ohana Health Plan Medicaid	$1,196.89
Rate for Payer: Ohana Health Plan Medicare	$1,088.08
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,088.08

BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$2,837.00

Service Code	CPT 56606
Hospital Revenue Code	360
Min. Negotiated Rate	$21.72
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$21.72

BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S)

Facility

$8,270.00

Service Code	CPT 38525
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$4,625.48
Rate for Payer: AlohaCare Medicare	$4,625.48
Rate for Payer: Devoted Health Medicare	$5,088.03
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	$4,625.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$4,625.48
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,625.48
Rate for Payer: Ohana Health Plan Medicaid	$5,088.03
Rate for Payer: Ohana Health Plan Medicare	$4,625.48
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,625.48
Rate for Payer: University Health Alliance Commercial	$5,160.40

BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)

Facility

$8,270.00

Service Code	CPT 38510
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$4,625.48
Rate for Payer: AlohaCare Medicare	$4,625.48
Rate for Payer: Devoted Health Medicare	$5,088.03
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	$4,625.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$4,625.48
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,625.48
Rate for Payer: Ohana Health Plan Medicaid	$5,088.03
Rate for Payer: Ohana Health Plan Medicare	$4,625.48
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,625.48
Rate for Payer: University Health Alliance Commercial	$5,160.40

BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, INGUINOFEMORAL NODE(S)

Facility

$8,270.00

Service Code	CPT 38531
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$4,625.48
Rate for Payer: AlohaCare Medicare	$4,625.48
Rate for Payer: Devoted Health Medicare	$5,088.03
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	$4,625.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$4,625.48
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,625.48
Rate for Payer: Ohana Health Plan Medicaid	$5,088.03
Rate for Payer: Ohana Health Plan Medicare	$4,625.48
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,625.48
Rate for Payer: University Health Alliance Commercial	$5,160.40

BIOPSY; OROPHARYNX

Facility

$2,837.00

Service Code	CPT 42800
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,832.96
Rate for Payer: AlohaCare Medicare	$1,832.96
Rate for Payer: Devoted Health Medicare	$2,016.26
Rate for Payer: Hawaii Medical Service Association Commercial	$2,291.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,832.96
Rate for Payer: Humana Medicare	$1,832.96
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,832.96
Rate for Payer: Ohana Health Plan Medicaid	$2,016.26
Rate for Payer: Ohana Health Plan Medicare	$1,832.96
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,832.96

BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH

Facility

$5,509.00

Service Code	CPT 55700
Hospital Revenue Code	360
Min. Negotiated Rate	$64.46
Max. Negotiated Rate	$5,509.00
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 Non-ABD	$1,028.67
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$64.46
Rate for Payer: University Health Alliance Commercial	$4,035.20

BIOPSY, SOFT TISSUE OF BACK OR FLANK; SUPERFICIAL

Facility

$4,035.20

Service Code	CPT 21920
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
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	$4,035.20

BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL

Facility

$4,035.20

Service Code	CPT 27323
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
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	$4,035.20

BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL

Facility

$4,035.20

Service Code	CPT 27323
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
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	$4,035.20

BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)

Facility

$5,160.40

Service Code	CPT 24066
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$5,160.40

BIOPSY, VESTIBULE OF MOUTH

Facility

$2,837.00

Service Code	CPT 40808
Hospital Revenue Code	360
Min. Negotiated Rate	$61.15
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$637.13
Rate for Payer: AlohaCare Medicare	$637.13
Rate for Payer: Devoted Health Medicare	$700.84
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	$637.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Humana Medicare	$637.13
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$637.13
Rate for Payer: Ohana Health Plan Medicaid	$700.84
Rate for Payer: Ohana Health Plan Medicare	$637.13
Rate for Payer: UnitedHealthcare Medicaid	$61.15
Rate for Payer: UnitedHealthcare Medicare	$637.13

BIO-SUTURE KIT #AR-1934-24DS

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: MDX Hawaii PPO	$848.75

BIO-SUTURE KIT #AR-1934-24DS

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$551.25
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$637.79

BIPOLAR 39X22 00-5001-039-22

Facility

$875.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$551.25
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

BIPOLAR 39X22 00-5001-039-22

Facility

$875.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

BIPOLAR 42MM 00-5001-042-00

Facility

$1,050.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

BIPOLAR 42MM 00-5001-042-00

Facility

$1,050.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

BIPOLAR DISORDERS

Facility

$2,845.95

Service Code	APR-DRG 7531
Min. Negotiated Rate	$2,845.95
Max. Negotiated Rate	$2,845.95
Rate for Payer: AlohaCare Medicaid	$2,845.95
Rate for Payer: Hawaii Medical Service Association ABD	$2,845.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,845.95
Rate for Payer: Kaiser Permanente Medicaid	$2,845.95
Rate for Payer: Ohana Health Plan Medicaid	$2,845.95
Rate for Payer: UnitedHealthcare Medicaid	$2,845.95

BIPOLAR DISORDERS

Facility

$3,458.05

Service Code	APR-DRG 7532
Min. Negotiated Rate	$3,458.05
Max. Negotiated Rate	$3,458.05
Rate for Payer: AlohaCare Medicaid	$3,458.05
Rate for Payer: Hawaii Medical Service Association ABD	$3,458.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,458.05
Rate for Payer: Kaiser Permanente Medicaid	$3,458.05
Rate for Payer: Ohana Health Plan Medicaid	$3,458.05
Rate for Payer: UnitedHealthcare Medicaid	$3,458.05

BIPOLAR DISORDERS

Facility

$13,402.37

Service Code	APR-DRG 7534
Min. Negotiated Rate	$13,402.37
Max. Negotiated Rate	$13,402.37
Rate for Payer: AlohaCare Medicaid	$13,402.37
Rate for Payer: Hawaii Medical Service Association ABD	$13,402.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,402.37
Rate for Payer: Kaiser Permanente Medicaid	$13,402.37
Rate for Payer: Ohana Health Plan Medicaid	$13,402.37
Rate for Payer: UnitedHealthcare Medicaid	$13,402.37

BIPOLAR DISORDERS

Facility

$5,182.57

Service Code	APR-DRG 7533
Min. Negotiated Rate	$5,182.57
Max. Negotiated Rate	$5,182.57
Rate for Payer: AlohaCare Medicaid	$5,182.57
Rate for Payer: Hawaii Medical Service Association ABD	$5,182.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,182.57
Rate for Payer: Kaiser Permanente Medicaid	$5,182.57
Rate for Payer: Ohana Health Plan Medicaid	$5,182.57
Rate for Payer: UnitedHealthcare Medicaid	$5,182.57

BIPOLAR HIP #98-0001-006-00

Facility

$7,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,920.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,900.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

Know your out-of-pocket cost for care.

All Charges