Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CATH PD TITANI EXT 8888415612

Facility

$391.00

Hospital Revenue Code	272
Min. Negotiated Rate	$332.35
Max. Negotiated Rate	$379.27
Rate for Payer: Cash Price	$234.60
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: MDX Hawaii PPO	$379.27

CATH PD TITANI EXT 8888415612

Facility

$391.00

Hospital Revenue Code	272
Min. Negotiated Rate	$199.41
Max. Negotiated Rate	$379.27
Rate for Payer: Cash Price	$234.60
Rate for Payer: Hawaii Western Management Group Commercial	$371.45
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: Kaiser Permanente Commercial	$246.33
Rate for Payer: Kaiser Permanente Medicaid	$199.41
Rate for Payer: MDX Hawaii PPO	$379.27
Rate for Payer: University Health Alliance Commercial	$285.00

CATH PERITONEAL 8888414011

Facility

$1,680.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$1,629.60
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: MDX Hawaii PPO	$1,629.60

CATH PERITONEAL 8888414011

Facility

$1,680.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$856.80
Max. Negotiated Rate	$1,629.60
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Kaiser Permanente Commercial	$1,058.40
Rate for Payer: Kaiser Permanente Medicaid	$856.80
Rate for Payer: MDX Hawaii PPO	$1,629.60
Rate for Payer: University Health Alliance Commercial	$1,224.55

CATH PNEUMOTHORAX PIGTAIL

Facility

$933.00

Hospital Revenue Code	272
Min. Negotiated Rate	$475.83
Max. Negotiated Rate	$905.01
Rate for Payer: Cash Price	$559.80
Rate for Payer: Hawaii Western Management Group Commercial	$886.35
Rate for Payer: Health Management Network Commercial	$793.05
Rate for Payer: Kaiser Permanente Commercial	$587.79
Rate for Payer: Kaiser Permanente Medicaid	$475.83
Rate for Payer: MDX Hawaii PPO	$905.01
Rate for Payer: University Health Alliance Commercial	$680.06

CATH PNEUMOTHORAX PIGTAIL

Facility

$933.00

Hospital Revenue Code	272
Min. Negotiated Rate	$793.05
Max. Negotiated Rate	$905.01
Rate for Payer: Cash Price	$559.80
Rate for Payer: Health Management Network Commercial	$793.05
Rate for Payer: MDX Hawaii PPO	$905.01

CATH RED 18FRX5CC FOLEY

Facility

$118.00

Hospital Revenue Code	272
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: MDX Hawaii PPO	$114.46

CATH RED 18FRX5CC FOLEY

Facility

$118.00

Hospital Revenue Code	272
Min. Negotiated Rate	$60.18
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$74.34
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: University Health Alliance Commercial	$86.01

CATH SUPRAPUBC 14FR SET G26648

Facility

$304.00

Service Code	HCPCS C2627
Hospital Revenue Code	272
Min. Negotiated Rate	$155.04
Max. Negotiated Rate	$294.88
Rate for Payer: Cash Price	$182.40
Rate for Payer: Hawaii Western Management Group Commercial	$288.80
Rate for Payer: Health Management Network Commercial	$258.40
Rate for Payer: Kaiser Permanente Commercial	$191.52
Rate for Payer: Kaiser Permanente Medicaid	$155.04
Rate for Payer: MDX Hawaii PPO	$294.88
Rate for Payer: University Health Alliance Commercial	$221.59

CATH SUPRAPUBC 14FR SET G26648

Facility

$304.00

Service Code	HCPCS C2627
Hospital Revenue Code	272
Min. Negotiated Rate	$258.40
Max. Negotiated Rate	$294.88
Rate for Payer: Cash Price	$182.40
Rate for Payer: Health Management Network Commercial	$258.40
Rate for Payer: MDX Hawaii PPO	$294.88

CATH SUPRAPUBC 16FR SET

Facility

$349.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$296.65
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$209.40
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: MDX Hawaii PPO	$338.53

CATH SUPRAPUBC 16FR SET

Facility

$349.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$177.99
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$209.40
Rate for Payer: Hawaii Western Management Group Commercial	$331.55
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: Kaiser Permanente Commercial	$219.87
Rate for Payer: Kaiser Permanente Medicaid	$177.99
Rate for Payer: MDX Hawaii PPO	$338.53
Rate for Payer: University Health Alliance Commercial	$254.39

CATH UMBIL 5FR

Facility

$74.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$44.40
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: MDX Hawaii PPO	$71.78

CATH UMBIL 5FR

Facility

$74.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$37.74
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$44.40
Rate for Payer: Hawaii Western Management Group Commercial	$70.30
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: Kaiser Permanente Commercial	$46.62
Rate for Payer: Kaiser Permanente Medicaid	$37.74
Rate for Payer: MDX Hawaii PPO	$71.78
Rate for Payer: University Health Alliance Commercial	$53.94

CATH UMBILICAL 3.5FR

Facility

$77.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: MDX Hawaii PPO	$74.69

CATH UMBILICAL 3.5FR

Facility

$77.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$48.51
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: University Health Alliance Commercial	$56.13

CATH UROMAX ULTRA BALLOON

Facility

$919.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: MDX Hawaii PPO	$891.43

CATH UROMAX ULTRA BALLOON

Facility

$919.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$468.69
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$578.97
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: University Health Alliance Commercial	$669.86

CATH VIDEO CHOLEDOCHOSCOPE

Facility

$5,500.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$4,675.00
Max. Negotiated Rate	$5,335.00
Rate for Payer: Cash Price	$3,300.00
Rate for Payer: Health Management Network Commercial	$4,675.00
Rate for Payer: MDX Hawaii PPO	$5,335.00

CATH VIDEO CHOLEDOCHOSCOPE

Facility

$5,500.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$2,805.00
Max. Negotiated Rate	$5,335.00
Rate for Payer: Cash Price	$3,300.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,225.00
Rate for Payer: Health Management Network Commercial	$4,675.00
Rate for Payer: Kaiser Permanente Commercial	$3,465.00
Rate for Payer: Kaiser Permanente Medicaid	$2,805.00
Rate for Payer: MDX Hawaii PPO	$5,335.00
Rate for Payer: University Health Alliance Commercial	$4,008.95

CAUT ELECTROD 5X58 FULGURATING

Facility

$286.00

Hospital Revenue Code	272
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$277.42
Rate for Payer: Cash Price	$171.60
Rate for Payer: Health Management Network Commercial	$243.10
Rate for Payer: MDX Hawaii PPO	$277.42

CAUT ELECTROD 5X58 FULGURATING

Facility

$286.00

Hospital Revenue Code	272
Min. Negotiated Rate	$145.86
Max. Negotiated Rate	$277.42
Rate for Payer: Cash Price	$171.60
Rate for Payer: Hawaii Western Management Group Commercial	$271.70
Rate for Payer: Health Management Network Commercial	$243.10
Rate for Payer: Kaiser Permanente Commercial	$180.18
Rate for Payer: Kaiser Permanente Medicaid	$145.86
Rate for Payer: MDX Hawaii PPO	$277.42
Rate for Payer: University Health Alliance Commercial	$208.47

CAUTERY BLADE

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Hawaii Western Management Group Commercial	$102.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$68.04
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: University Health Alliance Commercial	$78.72

CAUTERY BLADE

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$104.76

CAUTERY L HOOK

Facility

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$139.80
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: MDX Hawaii PPO	$226.01

Know your out-of-pocket cost for care.

All Charges