Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CATHETER 4FRX55 POWERPICC

Facility

$2,270.00

Service Code	HCPCS C1751
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.20
Max. Negotiated Rate	$2,201.90
Rate for Payer: Cash Price	$1,362.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,589.00
Rate for Payer: Health Management Network Commercial	$1,929.50
Rate for Payer: MDX Hawaii PPO	$2,201.90
Rate for Payer: University Health Alliance Commercial	$1,271.20

CATHETER 4FRX55 POWERPICC

Facility

$2,270.00

Service Code	HCPCS C1751
Hospital Revenue Code	278
Min. Negotiated Rate	$1,157.70
Max. Negotiated Rate	$2,201.90
Rate for Payer: Cash Price	$1,362.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,589.00
Rate for Payer: Health Management Network Commercial	$1,929.50
Rate for Payer: Kaiser Permanente Commercial	$1,430.10
Rate for Payer: Kaiser Permanente Medicaid	$1,157.70
Rate for Payer: MDX Hawaii PPO	$2,201.90
Rate for Payer: University Health Alliance Commercial	$1,271.20

CATHETER 5FR POWERPICC TRIPLE

Facility

$2,774.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$2,357.90
Max. Negotiated Rate	$2,690.78
Rate for Payer: Cash Price	$1,664.40
Rate for Payer: Health Management Network Commercial	$2,357.90
Rate for Payer: MDX Hawaii PPO	$2,690.78

CATHETER 5FR POWERPICC TRIPLE

Facility

$2,774.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$1,414.74
Max. Negotiated Rate	$2,690.78
Rate for Payer: Cash Price	$1,664.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,635.30
Rate for Payer: Health Management Network Commercial	$2,357.90
Rate for Payer: Kaiser Permanente Commercial	$1,747.62
Rate for Payer: Kaiser Permanente Medicaid	$1,414.74
Rate for Payer: MDX Hawaii PPO	$2,690.78
Rate for Payer: University Health Alliance Commercial	$2,021.97

CATHETER BALLOON #Q50-65P

Facility

$1,740.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$1,479.00
Max. Negotiated Rate	$1,687.80
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Health Management Network Commercial	$1,479.00
Rate for Payer: MDX Hawaii PPO	$1,687.80

CATHETER BALLOON #Q50-65P

Facility

$1,740.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$887.40
Max. Negotiated Rate	$1,687.80
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,653.00
Rate for Payer: Health Management Network Commercial	$1,479.00
Rate for Payer: Kaiser Permanente Commercial	$1,096.20
Rate for Payer: Kaiser Permanente Medicaid	$887.40
Rate for Payer: MDX Hawaii PPO	$1,687.80
Rate for Payer: University Health Alliance Commercial	$1,268.29

CATHETER BLN DILAT SR-4525-BC

Facility

$1,397.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$1,187.45
Max. Negotiated Rate	$1,355.09
Rate for Payer: Cash Price	$838.20
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: MDX Hawaii PPO	$1,355.09

CATHETER BLN DILAT SR-4525-BC

Facility

$1,397.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$712.47
Max. Negotiated Rate	$1,355.09
Rate for Payer: Cash Price	$838.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,327.15
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Kaiser Permanente Commercial	$880.11
Rate for Payer: Kaiser Permanente Medicaid	$712.47
Rate for Payer: MDX Hawaii PPO	$1,355.09
Rate for Payer: University Health Alliance Commercial	$1,018.27

CATHETER C1 TIP 65CM

Facility

$396.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$237.60
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: MDX Hawaii PPO	$384.12

CATHETER C1 TIP 65CM

Facility

$396.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$201.96
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$237.60
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$249.48
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: University Health Alliance Commercial	$288.64

CATHETER CENTESIS DRAINER 5X19

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: MDX Hawaii PPO	$142.59

CATHETER CENTESIS DRAINER 5X19

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$107.15

CATHETER COUDE SILICONE 3W 22F

Facility

$109.00

Hospital Revenue Code	272
Min. Negotiated Rate	$55.59
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$65.40
Rate for Payer: Hawaii Western Management Group Commercial	$103.55
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Kaiser Permanente Commercial	$68.67
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: University Health Alliance Commercial	$79.45

CATHETER COUDE SILICONE 3W 22F

Facility

$109.00

Hospital Revenue Code	272
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$65.40
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: MDX Hawaii PPO	$105.73

CATHETER COUDE SILICONE 3W 24F

Facility

$92.00

Hospital Revenue Code	272
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: MDX Hawaii PPO	$89.24

CATHETER COUDE SILICONE 3W 24F

Facility

$92.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.92
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$57.96
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: University Health Alliance Commercial	$67.06

CATHETER DIGITAL VIDEO

Facility

$5,665.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$2,889.15
Max. Negotiated Rate	$5,495.05
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,381.75
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Kaiser Permanente Commercial	$3,568.95
Rate for Payer: Kaiser Permanente Medicaid	$2,889.15
Rate for Payer: MDX Hawaii PPO	$5,495.05
Rate for Payer: University Health Alliance Commercial	$4,129.22

CATHETER DIGITAL VIDEO

Facility

$5,665.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$4,815.25
Max. Negotiated Rate	$5,495.05
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: MDX Hawaii PPO	$5,495.05

CATHETER OPEN 5FRX70CM

Facility

$78.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: MDX Hawaii PPO	$75.66

CATHETER OPEN 5FRX70CM

Facility

$78.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$49.14
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: University Health Alliance Commercial	$56.85

CATHETER PUSHER

Facility

$198.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$100.98
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$118.80
Rate for Payer: Hawaii Western Management Group Commercial	$188.10
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Kaiser Permanente Commercial	$124.74
Rate for Payer: Kaiser Permanente Medicaid	$100.98
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: University Health Alliance Commercial	$144.32

CATHETER PUSHER

Facility

$198.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$118.80
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: MDX Hawaii PPO	$192.06

CATHETER SWAN NECK PD

Facility

$891.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$757.35
Max. Negotiated Rate	$864.27
Rate for Payer: Cash Price	$534.60
Rate for Payer: Health Management Network Commercial	$757.35
Rate for Payer: MDX Hawaii PPO	$864.27

CATHETER SWAN NECK PD

Facility

$891.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$454.41
Max. Negotiated Rate	$864.27
Rate for Payer: Cash Price	$534.60
Rate for Payer: Hawaii Western Management Group Commercial	$846.45
Rate for Payer: Health Management Network Commercial	$757.35
Rate for Payer: Kaiser Permanente Commercial	$561.33
Rate for Payer: Kaiser Permanente Medicaid	$454.41
Rate for Payer: MDX Hawaii PPO	$864.27
Rate for Payer: University Health Alliance Commercial	$649.45

CATHETER UROLOGY 5X65

Facility

$105.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: MDX Hawaii PPO	$101.85

Know your out-of-pocket cost for care.

All Charges