Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CATHETER UROLOGY 5X65

Facility

$105.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$99.75
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$66.15
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: University Health Alliance Commercial	$76.53

CATH FOLEY 2WAY LF 14F

Facility

$72.00

Hospital Revenue Code	272
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$69.84

CATH FOLEY 2WAY LF 14F

Facility

$72.00

Hospital Revenue Code	272
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Hawaii Western Management Group Commercial	$68.40
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$45.36
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: University Health Alliance Commercial	$52.48

CATH FOLEY 2WAY LF 16F

Facility

$70.00

Hospital Revenue Code	272
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Hawaii Western Management Group Commercial	$66.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: University Health Alliance Commercial	$51.02

CATH FOLEY 2WAY LF 16F

Facility

$70.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: MDX Hawaii PPO	$67.90

CATH FOLEY 2WAY LF 18F

Facility

$72.00

Hospital Revenue Code	272
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$69.84

CATH FOLEY 2WAY LF 18F

Facility

$72.00

Hospital Revenue Code	272
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Hawaii Western Management Group Commercial	$68.40
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$45.36
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: University Health Alliance Commercial	$52.48

CATH FOLEY COUDE 14F

Facility

$99.00

Hospital Revenue Code	272
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: MDX Hawaii PPO	$96.03

CATH FOLEY COUDE 14F

Facility

$99.00

Hospital Revenue Code	272
Min. Negotiated Rate	$50.49
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$62.37
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: University Health Alliance Commercial	$72.16

CATH FOLEY COUDE 16F

Facility

$99.00

Hospital Revenue Code	272
Min. Negotiated Rate	$50.49
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$62.37
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: University Health Alliance Commercial	$72.16

CATH FOLEY COUDE 16F

Facility

$99.00

Hospital Revenue Code	272
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: MDX Hawaii PPO	$96.03

CATH FOLEY COUDE 2WAY 18F

Facility

$66.00

Hospital Revenue Code	272
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: MDX Hawaii PPO	$64.02

CATH FOLEY COUDE 2WAY 18F

Facility

$66.00

Hospital Revenue Code	272
Min. Negotiated Rate	$33.66
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$41.58
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: University Health Alliance Commercial	$48.11

CATH FOLEY COUDE 2WAY 20F

Facility

$98.00

Hospital Revenue Code	272
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$58.80
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: MDX Hawaii PPO	$95.06

CATH FOLEY COUDE 2WAY 20F

Facility

$98.00

Hospital Revenue Code	272
Min. Negotiated Rate	$49.98
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$58.80
Rate for Payer: Hawaii Western Management Group Commercial	$93.10
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Kaiser Permanente Commercial	$61.74
Rate for Payer: Kaiser Permanente Medicaid	$49.98
Rate for Payer: MDX Hawaii PPO	$95.06
Rate for Payer: University Health Alliance Commercial	$71.43

CATH FOLEY COUNCIL

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: MDX Hawaii PPO	$110.58

CATH FOLEY COUNCIL

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$58.14
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$71.82
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: University Health Alliance Commercial	$83.09

CATH LATEX 2W 25FR 30CC

Facility

$82.00

Hospital Revenue Code	272
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$49.20
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: MDX Hawaii PPO	$79.54

CATH LATEX 2W 25FR 30CC

Facility

$82.00

Hospital Revenue Code	272
Min. Negotiated Rate	$41.82
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$49.20
Rate for Payer: Hawaii Western Management Group Commercial	$77.90
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$51.66
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: University Health Alliance Commercial	$59.77

CATH MAHURKAR HP 3LUMEN

Facility

$509.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$432.65
Max. Negotiated Rate	$493.73
Rate for Payer: Cash Price	$305.40
Rate for Payer: Health Management Network Commercial	$432.65
Rate for Payer: MDX Hawaii PPO	$493.73

CATH MAHURKAR HP 3LUMEN

Facility

$509.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$259.59
Max. Negotiated Rate	$493.73
Rate for Payer: Cash Price	$305.40
Rate for Payer: Hawaii Western Management Group Commercial	$483.55
Rate for Payer: Health Management Network Commercial	$432.65
Rate for Payer: Kaiser Permanente Commercial	$320.67
Rate for Payer: Kaiser Permanente Medicaid	$259.59
Rate for Payer: MDX Hawaii PPO	$493.73
Rate for Payer: University Health Alliance Commercial	$371.01

CATH NASAL CATH EPISTAT

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$555.05
Max. Negotiated Rate	$633.41
Rate for Payer: Cash Price	$391.80
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: MDX Hawaii PPO	$633.41

CATH NASAL CATH EPISTAT

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$333.03
Max. Negotiated Rate	$633.41
Rate for Payer: Cash Price	$391.80
Rate for Payer: Hawaii Western Management Group Commercial	$620.35
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Kaiser Permanente Commercial	$411.39
Rate for Payer: Kaiser Permanente Medicaid	$333.03
Rate for Payer: MDX Hawaii PPO	$633.41
Rate for Payer: University Health Alliance Commercial	$475.97

CATH PALIN RIGHT #8888145063P

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$749.70
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: Kaiser Permanente Medicaid	$749.70
Rate for Payer: MDX Hawaii PPO	$1,425.90
Rate for Payer: University Health Alliance Commercial	$1,071.48

CATH PALIN RIGHT #8888145063P

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: MDX Hawaii PPO	$1,425.90

Know your out-of-pocket cost for care.

All Charges