▸ Hospital · HI · CCN 120014

Wilcox Memorial Hospital

3-3420 KUHIO HIGHWAY, LIHUE, HI, 96766-

72 bedsAcute Care Hospitals2

Compliance grade

100/100

Rates published

2,130

last crawl 2026-05-23

Procedures tracked

130

of 209 target codes

Payers

with negotiated rates

Procedures tracked

...

Payers

...

▸ Compare with other hospitals All HI hospitals JSON

Source MRF: https://hph.pt.panaceainc.com/MRFDownload/hph/wilcox/990074365_Wilcox-Medical-Center_standardcharges.csv · CSV

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
behavioral
Psychoses	MS-DRG	885	12	—	—	$1,230	$15,804	$49,300
emergency
ED visit level 1	CPT	99281	12	$370	$148	$11.52	$80	$848
ED visit level 2	CPT	99282	12	$778	$311.2	$23.95	$80	$848
ED visit level 3	CPT	99283	12	$1,642	$656.8	$47	$80	$1,342
ED visit level 4	CPT	99284	12	$2,558	$1,023.2	$47	$80	$1,834
ED visit level 5	CPT	99285	12	$4,596	$1,838.4	$47	$80	$2,778
Critical care, first hour	CPT	99291	11	$7,640	$3,056	$47	$80	$1,342
imaging
CT head without contrast	CPT	70450	13	$1,506	$602.4	$73.85	$139.1	$462.59
CT head with contrast	CPT	70460	13	$1,825	$730	$80	$186.48	$601.17
CT head with and without contrast	CPT	70470	13	$2,090	$836	$80	$232.9	$631.97
CT neck with contrast	CPT	70491	13	$2,023	$809.2	$80	$186.48	$735.34
MRI brain without contrast	CPT	70551	13	$2,250	$900	$80	$396.85	$1,092.79
MRI brain with contrast	CPT	70552	13	$2,504	$1,001.6	$80	$442.34	$1,408.43
MRI brain with and without contrast	CPT	70553	13	$2,726	$1,090.4	$80	$760.83	$1,725.19
Chest X-ray single view	CPT	71045	10	$321	$128.4	$15.78	$31.02	$85
Chest X-ray 2 views	CPT	71046	10	$384	$153.6	$20.4	$41.09	$85
Chest X-ray 3 views	CPT	71047	10	$468	$187.2	$24.39	$49.29	$85
CT chest without contrast	CPT	71250	13	$1,801	$720.4	$80	$194.84	$600.06
CT chest with contrast	CPT	71260	13	$2,115	$846	$80	$232.9	$749.64
CT chest with and without contrast	CPT	71270	13	$2,545	$1,018	$80	$291.1	$939.91
MRI chest without contrast	CPT	71550	13	$2,397	$958.8	$80	$372.23	$1,092.79
MRI chest with contrast	CPT	71551	13	$2,810	$1,124	$80	$414.97	$1,408.43
MRI chest with and without contrast	CPT	71552	13	$2,877	$1,150.8	$80	$704.71	$1,725.19
Lumbosacral spine X-ray	CPT	72100	13	$484	$193.6	$21.96	$54.02	$85
CT cervical spine without contrast	CPT	72125	13	$1,464	$585.6	$80	$194.84	$605.56
CT thoracic spine without contrast	CPT	72128	13	$1,945	$778	$80	$194.84	$603.38
CT lumbar spine without contrast	CPT	72131	13	$1,032	$412.8	$80	$177.96	$601.17
MRI cervical spine without contrast	CPT	72141	13	$1,767	$706.8	$80	$381.36	$1,092.79
MRI thoracic spine without contrast	CPT	72146	13	$1,475	$590	$80	$388.54	$1,092.79
MRI lumbar spine without contrast	CPT	72148	13	$2,067	$826.8	$80	$401.86	$1,092.79
MRI lumbar spine with and without contrast	CPT	72149	13	$2,283	$913.2	$80	$442.34	$1,407.34
MRI cervical spine with and without contrast	CPT	72156	13	$2,578	$1,031.2	$80	$733.84	$1,718.58
MRI lumbar spine with contrast	CPT	72158	13	$2,413	$965.2	$80	$731.66	$1,715.28
CT pelvis without contrast	CPT	72192	13	$1,108	$443.2	$80	$194.84	$564.87
CT pelvis with contrast	CPT	72193	13	$1,374	$549.6	$80	$235.33	$711.14
Shoulder X-ray	CPT	73030	13	$598	$239.2	$18.84	$42.46	$85
Humerus X-ray	CPT	73060	13	$524	$209.6	$18.84	$42.22	$85
Hand X-ray 3 views	CPT	73130	13	$734	$293.6	$19.08	$45.68	$85
MRI upper extremity joint without contrast	CPT	73221	13	$2,100	$840	$80	$414	$1,092.79
MRI upper extremity joint with and without contrast	CPT	73223	13	$2,706	$1,082.4	$80	$918.98	$1,707.58
Knee X-ray 1-2 views	CPT	73560	13	$644	$257.6	$17.04	$41.36	$85
Ankle X-ray 3 views	CPT	73610	13	$625	$250	$17.34	$44.93	$85
MRI lower extremity joint without contrast	CPT	73721	13	$2,068	$827.2	$80	$396.1	$1,092.79
MRI lower extremity joint with and without contrast	CPT	73723	13	$3,126	$1,250.4	$80	$707.76	$1,710.89
CT abdomen without contrast	CPT	74150	13	$1,839	$735.6	$80	$186.48	$562.69
CT abdomen with contrast	CPT	74160	13	$2,147	$858.8	$80	$235.33	$822.25
CT abdomen with and without contrast	CPT	74170	13	$2,272	$908.8	$80	$279.37	$1,079.59
CT abdomen and pelvis without contrast	CPT	74176	11	$2,830	$1,132	$80	$128.25	$760.47
CT abdomen and pelvis with contrast	CPT	74177	11	$3,484	$1,393.6	$80	$216.98	$900.93
CT abdomen and pelvis with and without contrast	CPT	74178	11	$3,722	$1,488.8	$80	$243.48	$1,155.48
MRI abdomen without contrast	CPT	74181	13	$2,167	$866.8	$80	$369.03	$1,092.79
MRI abdomen with and without contrast	CPT	74183	13	$2,674	$1,069.6	$80	$709.06	$1,725.19
Abdominal ultrasound complete	CPT	76700	13	$836	$334.4	$64.94	$85	$323.48
Abdominal ultrasound limited	CPT	76705	13	$593	$237.2	$46.98	$85	$262.41
Retroperitoneal ultrasound complete	CPT	76770	13	$714	$285.6	$64.94	$85	$310.83
Obstetric ultrasound first trimester	CPT	76801	13	$742	$296.8	$55.49	$85	$269.03
Obstetric ultrasound after first trimester	CPT	76805	13	$919	$367.6	$61.23	$93.79	$310.94
Obstetric ultrasound with fetal anatomy	CPT	76811	13	$938	$375.2	$80	$127.03	$320.71
Transvaginal ultrasound	CPT	76830	13	$700	$280	$50.35	$85	$307.53
Pelvic ultrasound complete	CPT	76856	13	$745	$298	$50.35	$85	$304.22
Scrotal ultrasound	CPT	76870	13	$582	$232.8	$50.35	$85	$308.62
Diagnostic mammography unilateral	CPT	77065	10	$499	$199.6	$64.13	$85.82	$301.28
Diagnostic mammography bilateral	CPT	77066	10	$695	$278	$77.83	$108.6	$385.7
Screening mammography bilateral	CPT	77067	10	$416	$166.4	$80	$90.39	$318.64
EKG tracing only	CPT	93005	8	$415	$166	$7.28	$80	$274.5
Transthoracic echocardiogram complete	CPT	93306	8	$2,600	$1,040	$80	$132.88	$977.26
Stress echocardiogram	CPT	93350	7	$2,042	$816.8	$58.9	$82.5	$339.09
inpatient
Intracranial hemorrhage/CVA w MCC	MS-DRG	064	8	—	—	$1,230	$5,521	$47,773
Intracranial hemorrhage/CVA w CC	MS-DRG	065	8	—	—	$1,230	$5,521	$24,000
Intracranial hemorrhage/CVA w/o CC/MCC	MS-DRG	066	8	—	—	$1,230	$5,521	$16,258
Respiratory infections & inflammations w MCC	MS-DRG	177	12	—	—	$1,230	$17,921	$41,953
COPD w MCC	MS-DRG	190	12	—	—	$1,230	$12,564	$31,224
COPD w CC	MS-DRG	191	12	—	—	$1,230	$9,589.11	$19,145
COPD w/o CC/MCC	MS-DRG	192	12	—	—	$1,230	$7,259.77	$14,930
Simple pneumonia & pleurisy w CC	MS-DRG	194	12	—	—	$1,230	$9,159.24	$22,547
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	12	—	—	$1,230	$7,040.83	$17,014
AMI discharged alive w MCC	MS-DRG	280	12	—	—	$1,230	$18,287	$21,892
AMI discharged alive w CC	MS-DRG	281	12	—	—	$1,230	$10,364	$17,178
AMI discharged alive w/o CC/MCC	MS-DRG	282	12	—	—	$1,230	$8,153.38	$47,055
Heart failure & shock w MCC	MS-DRG	291	12	—	—	$1,230	$14,582	$20,169
Heart failure & shock w CC	MS-DRG	292	12	—	—	$1,230	$9,632.93	$13,446
Heart failure & shock w/o CC/MCC	MS-DRG	293	12	—	—	$1,230	$6,481.51	$37,104
Cardiac arrhythmia w MCC	MS-DRG	308	12	—	—	$1,230	$13,567	$16,674
Cardiac arrhythmia w CC	MS-DRG	309	12	—	—	$1,230	$8,304.98	$20,705
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	12	—	—	$1,230	$6,547.23	$17,104
GI hemorrhage w CC	MS-DRG	378	12	—	—	$1,230	$11,073	$23,297
GI hemorrhage w/o CC/MCC	MS-DRG	379	12	—	—	$1,230	$7,135.86	$14,976
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	12	—	—	$1,230	$8,781.59	$18,520
Fractures of femur w/o MCC	MS-DRG	533	12	—	—	$1,230	$17,390	$20,338
Kidney/UTI w MCC	MS-DRG	689	12	—	—	$1,230	$13,124	$19,230
Kidney/UTI w/o MCC	MS-DRG	690	12	—	—	$1,230	$9,071.98	$31,940
Septicemia or severe sepsis w MV 96+ hrs	MS-DRG	871	12	—	—	$1,230	$21,989	$26,169
Septicemia or severe sepsis w/o MV 96+ hrs	MS-DRG	872	12	—	—	$1,230	$11,568	$91,813
lab
Basic metabolic panel (BMP)	CPT	80048	14	$94	$37.6	$8.29	$12.05	$85
General health panel	CPT	80050	7	$347	$138.8	$41.19	$77.7	$85
Electrolyte panel	CPT	80051	14	$78	$31.2	$6.87	$9.98	$85
Comprehensive metabolic panel	CPT	80053	14	$114	$45.6	$10.35	$15.05	$85
Lipid panel	CPT	80061	14	$159	$63.6	$13.12	$19.07	$85
Renal function panel	CPT	80069	14	$94	$37.6	$8.51	$12.36	$85
Hepatic function panel	CPT	80076	14	$90	$36	$8.01	$11.63	$85
Urinalysis non-automated	CPT	81002	14	$73	$29.2	$3.41	$4.18	$85
Urinalysis automated	CPT	81003	14	$30	$12	$2.21	$3.19	$85
Glucose quantitative	CPT	82947	14	$45	$18	$3.85	$5.58	$85
Hemoglobin A1c	CPT	83036	14	$85	$34	$9.52	$13.82	$85
Thyroid stimulating hormone (TSH)	CPT	84443	14	$138	$55.2	$16.46	$23.91	$85
Complete blood count with automated differential	CPT	85025	14	$74	$29.6	$7.61	$11.06	$85
Complete blood count without differential	CPT	85027	14	$64	$25.6	$6.34	$9.22	$85
Urine culture bacterial	CPT	87086	14	$84	$33.6	$7.91	$11.49	$85
Urine culture identification	CPT	87088	14	$80	$32	$7.93	$10.87	$85
Tissue exam by pathologist level IV	CPT	88305	7	$317	$126.8	$40.64	$64.84	$92.17
maternity
Fetal non-stress test	CPT	59025	8	$715	$286	$8.21	$54.31	$437.16
office
Office visit, established patient, 5 min	CPT	99211	6	$260	$104	$9.13	$80	$85
Office visit, established patient, 10-19 min	CPT	99212	6	$350	$140	$24.13	$80	$85
Office visit, established patient, 20-29 minutes	CPT	99213	6	$450	$180	$36.31	$80	$85
surgery
Major small/large bowel procedures w MCC	MS-DRG	329	12	—	—	$1,641	$43,769	$61,244
Major small/large bowel procedures w CC	MS-DRG	330	12	—	—	$1,641	$26,786	$86,012
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	12	—	—	$1,641	$18,753	$55,641
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	12	—	—	$1,641	$18,843	$40,185
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	12	—	—	$1,641	$15,084	$32,446
Laparoscopic cholecystectomy w/o CDE w/o CC/MCC	MS-DRG	420	12	—	—	$1,641	$39,105	$80,938
Major joint replacement w MCC	MS-DRG	469	12	—	—	$1,641	$35,583	$72,056
Major joint replacement w/o MCC	MS-DRG	470	12	—	—	$1,641	$21,453	$45,822
Hip & femur procedures except major joint w MCC	MS-DRG	480	12	—	—	$1,641	$32,964	$69,184
Hip & femur procedures except major joint w CC	MS-DRG	481	12	—	—	$1,641	$23,462	$49,756
Hip & femur procedures except major joint w/o CC/MCC	MS-DRG	482	12	—	—	$1,641	$18,092	$38,746
OR procedure for obesity w MCC	MS-DRG	619	12	—	—	$1,641	$31,529	$38,016
OR procedure for obesity w CC	MS-DRG	620	12	—	—	$1,641	$17,997	$35,833
OR procedure for obesity w/o CC/MCC	MS-DRG	621	12	—	—	$1,641	$16,699	$84,551
Uterine & adnexa procedures w CC/MCC	MS-DRG	743	12	—	—	$1,641	$13,882	$48,678
Uterine & adnexa procedures w/o CC/MCC	MS-DRG	744	12	—	—	$1,641	$22,492	$27,022

Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.

Payer mix (top 20)

Payer	Codes covered	Median rate
Kaiser Permanente	130	$80
UnitedHealthcare	130	$285.24
alohacare	127	$79.28
verdegard	121	$1,092.79
hcha	121	$594.99
medical cost containment professionals	87	$85
ohana health plan	87	$70.55
Multiplan	87	$82.5
hawaii medical service association (hmsa)	78	$180.62
mdx hawaii	78	$34.87
hawaii medical assurance association (hmaa)	72	$217.9
university health alliance	71	$407.25
pacific administrators inc	69	$175.97
ohana	55	$11,943
uha	43	$5,479
pac admin	43	$5,525
hwmg/hmaa	43	$6,285
mdx	43	$11,362
devoted	40	$17,488
hmsa	40	$16,305

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