Breast lump removal cost in HI
What a breast lump removal costs at HI hospitals — and the fair price to aim for.
Typical commercial prices here are +9% above the fair benchmark (1.09×) even after accounting for local nurse/doctor wages and patient complexity.
Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.
Loss-Leader / Captive Ancillary Cross-Subsidizer
Hilo Benioff Medical Center prices routine shoppable procedures near 0.7× Medicare (p50 0.80×) while skewing captive emergency, lab, and upper-quartile codes to 1.1× Medicare (p75 0.96×, +20% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.
Where They're Good (Patient & Payer Edge)
- Elective shoppable care is priced 20% below peer Fair BaseRate (0.80×)
- Self-pay cash beats commercial insurance on 49% of shoppable procedures (99/100 Cash Honesty)
- CMS clinical safety score (69/100 safety score) with 64% patient recommendation
- Binding Good Faith Estimate rights under 45 CFR § 149.610 protect self-pay patients before scheduling
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (1.09× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Captive ER (0.5×) & laboratory (0.6×) services average 1.57× higher multiples than routine shoppable care (0.7×)
- Upper-quartile procedures (Q75 0.96×) jump +20% above the median procedure ratio (Q50 0.80×)
- Consolidated metro market (HHI 4,475) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
In general, HI hospitals charge about the fair price for this. how we calculate the BaseRate →
Compared with the rest of the country, HI’s fair BaseRate ($4,183) is about the same as the national fair price of $3,733.
Cheapest HI hospitals for a breast lump removal
- Hilo Benioff Medical Center · Hilo $492
- Kohala Hospital · Kapaau $3,850
- Kaiser Foundation Hospital · Honolulu $4,119
- Pali Momi Medical Center · Aiea $4,219
- Kapiolani Medical Center for Women & Children · Honolulu $4,219
- Kuakini Medical Center · Honolulu $4,237
- Wilcox Memorial Hospital · Lihue $4,456
- The Queens Medical Center · Honolulu $4,536
- Kona Community Hospital · Kealakekua $4,625
- North Hawaii Community Hospital, Inc · Kamuela $4,930
Audit a Bill or Quote at HI Hospital Benchmark (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $3,683
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $3,683).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Ask HI Hospital Benchmark's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.
Negotiate Toward $4,183 Fair BaseRate ($2,426 Medicare)
Your bill ($10,147) is $5,964 above the denoised Fair BaseRate ($4,183) and 4.2× the $2,426 Medicare rate.