Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC ALPHA-FETOPROTEIN, SERUM

Facility

$141.00

Service Code	HCPCS 82105
Hospital Charge Code	3018210501
Hospital Revenue Code	301
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: MDX Hawaii PPO	$136.77

HC AMIDARONE SO

Facility

$156.00

Service Code	HCPCS 80151
Hospital Charge Code	3018015101
Hospital Revenue Code	301
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$151.32
Rate for Payer: AlohaCare Medicaid	$18.64
Rate for Payer: AlohaCare Medicare	$18.64
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Devoted Health Medicare	$20.50
Rate for Payer: Hawaii Medical Service Association ABD	$18.92
Rate for Payer: Hawaii Medical Service Association Commercial	$23.30
Rate for Payer: Hawaii Medical Service Association Medicare	$18.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.87
Rate for Payer: Hawaii Western Management Group Commercial	$18.64
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$18.64
Rate for Payer: Kaiser Permanente Commercial	$98.28
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$18.64
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$20.50
Rate for Payer: Ohana Health Plan Medicare	$18.64
Rate for Payer: UnitedHealthcare Medicaid	$11.18
Rate for Payer: UnitedHealthcare Medicare	$18.64
Rate for Payer: University Health Alliance Commercial	$113.71

HC AMIDARONE SO

Facility

$156.00

Service Code	HCPCS 80151
Hospital Charge Code	3018015101
Hospital Revenue Code	301
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: MDX Hawaii PPO	$151.32

HC AMPHETAMINES CONFIRMATION

Facility

$960.00

Service Code	HCPCS G0480
Hospital Charge Code	301G048001
Hospital Revenue Code	301
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: MDX Hawaii PPO	$931.20

HC AMPHETAMINES CONFIRMATION

Facility

$960.00

Service Code	HCPCS G0480
Hospital Charge Code	301G048001
Hospital Revenue Code	301
Min. Negotiated Rate	$47.96
Max. Negotiated Rate	$931.20
Rate for Payer: AlohaCare Medicaid	$114.43
Rate for Payer: AlohaCare Medicare	$114.43
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Devoted Health Medicare	$125.87
Rate for Payer: Hawaii Medical Service Association Commercial	$143.04
Rate for Payer: Hawaii Medical Service Association Medicare	$114.43
Rate for Payer: Hawaii Western Management Group Commercial	$912.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: Humana Medicare	$114.43
Rate for Payer: Kaiser Permanente Commercial	$604.80
Rate for Payer: Kaiser Permanente Medicaid	$489.60
Rate for Payer: Kaiser Permanente Medicare	$114.43
Rate for Payer: MDX Hawaii PPO	$931.20
Rate for Payer: Ohana Health Plan Medicaid	$125.87
Rate for Payer: Ohana Health Plan Medicare	$114.43
Rate for Payer: UnitedHealthcare Medicaid	$47.96
Rate for Payer: UnitedHealthcare Medicare	$114.43
Rate for Payer: University Health Alliance Commercial	$699.74

HC ANCA AB SCREEN EA AB SO

Facility

$101.00

Service Code	HCPCS 86036
Hospital Charge Code	3028603601
Hospital Revenue Code	302
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: MDX Hawaii PPO	$97.97

HC ANCA AB SCREEN EA AB SO

Facility

$101.00

Service Code	HCPCS 86036
Hospital Charge Code	3028603601
Hospital Revenue Code	302
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$12.05
Rate for Payer: AlohaCare Medicare	$12.05
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$13.26
Rate for Payer: Hawaii Medical Service Association ABD	$16.66
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$12.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.49
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$12.05
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$12.05
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$13.26
Rate for Payer: Ohana Health Plan Medicare	$12.05
Rate for Payer: UnitedHealthcare Medicaid	$7.23
Rate for Payer: UnitedHealthcare Medicare	$12.05
Rate for Payer: University Health Alliance Commercial	$73.62

HC ANESTHESIA EA ADDL MINUTE

Facility

$42.00

Hospital Charge Code	3700000002
Hospital Revenue Code	370
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$25.20
Rate for Payer: Hawaii Western Management Group Commercial	$39.90
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Kaiser Permanente Commercial	$26.46
Rate for Payer: Kaiser Permanente Medicaid	$21.42
Rate for Payer: MDX Hawaii PPO	$40.74
Rate for Payer: University Health Alliance Commercial	$30.61

HC ANESTHESIA EA ADDL MINUTE

Facility

$42.00

Hospital Charge Code	3700000002
Hospital Revenue Code	370
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$25.20
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: MDX Hawaii PPO	$40.74

HC ANESTHESIA INITIAL 15 MIN

Facility

$783.00

Hospital Charge Code	3700000001
Hospital Revenue Code	370
Min. Negotiated Rate	$399.33
Max. Negotiated Rate	$759.51
Rate for Payer: Cash Price	$469.80
Rate for Payer: Hawaii Western Management Group Commercial	$743.85
Rate for Payer: Health Management Network Commercial	$665.55
Rate for Payer: Kaiser Permanente Commercial	$493.29
Rate for Payer: Kaiser Permanente Medicaid	$399.33
Rate for Payer: MDX Hawaii PPO	$759.51
Rate for Payer: University Health Alliance Commercial	$570.73

HC ANESTHESIA INITIAL 15 MIN

Facility

$783.00

Hospital Charge Code	3700000001
Hospital Revenue Code	370
Min. Negotiated Rate	$665.55
Max. Negotiated Rate	$759.51
Rate for Payer: Cash Price	$469.80
Rate for Payer: Health Management Network Commercial	$665.55
Rate for Payer: MDX Hawaii PPO	$759.51

HC ANGIO EA ADDNL SELECTV VESSEL - IR ANGIO SELECTIVE EA ADDL VESSEL

Facility

$3,006.00

Service Code	HCPCS 75774
Hospital Charge Code	3237577401
Hospital Revenue Code	323
Min. Negotiated Rate	$414.83
Max. Negotiated Rate	$2,915.82
Rate for Payer: Cash Price	$1,803.60
Rate for Payer: Cash Price	$1,803.60
Rate for Payer: Hawaii Medical Service Association ABD	$414.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$435.57
Rate for Payer: Hawaii Western Management Group Commercial	$2,855.70
Rate for Payer: Health Management Network Commercial	$2,555.10
Rate for Payer: Kaiser Permanente Commercial	$1,893.78
Rate for Payer: Kaiser Permanente Medicaid	$1,533.06
Rate for Payer: MDX Hawaii PPO	$2,915.82
Rate for Payer: UnitedHealthcare Medicaid	$414.83
Rate for Payer: University Health Alliance Commercial	$667.31

HC ANGIO EA ADDNL SELECTV VESSEL - IR ANGIO SELECTIVE EA ADDL VESSEL

Facility

$3,006.00

Service Code	HCPCS 75774
Hospital Charge Code	3237577401
Hospital Revenue Code	323
Min. Negotiated Rate	$2,555.10
Max. Negotiated Rate	$2,915.82
Rate for Payer: Cash Price	$1,803.60
Rate for Payer: Health Management Network Commercial	$2,555.10
Rate for Payer: MDX Hawaii PPO	$2,915.82

HC ANGIO EXTERMITY BILAT - IR ANGIOGRAM EXTREMITY BILATERAL

Facility

$15,658.00

Service Code	HCPCS 75716
Hospital Charge Code	3237571601
Hospital Revenue Code	323
Min. Negotiated Rate	$414.83
Max. Negotiated Rate	$15,188.26
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$414.83
Rate for Payer: Hawaii Medical Service Association Commercial	$4,662.59
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$435.57
Rate for Payer: Hawaii Western Management Group Commercial	$3,730.07
Rate for Payer: Health Management Network Commercial	$13,309.30
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$9,864.54
Rate for Payer: Kaiser Permanente Medicaid	$7,985.58
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$15,188.26
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$414.83
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$837.37

HC ANGIO EXTERMITY BILAT - IR ANGIOGRAM EXTREMITY BILATERAL

Facility

$15,658.00

Service Code	HCPCS 75716
Hospital Charge Code	3237571601
Hospital Revenue Code	323
Min. Negotiated Rate	$13,309.30
Max. Negotiated Rate	$15,188.26
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Health Management Network Commercial	$13,309.30
Rate for Payer: MDX Hawaii PPO	$15,188.26

HC ANGIO EXTREMITY UNILAT - IR ANGIOGRAM EXTREMITY

Facility

$15,658.00

Service Code	HCPCS 75710
Hospital Charge Code	3237571001
Hospital Revenue Code	323
Min. Negotiated Rate	$414.83
Max. Negotiated Rate	$15,188.26
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,395.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Hawaii Western Management Group Commercial	$3,730.07
Rate for Payer: Health Management Network Commercial	$13,309.30
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$9,864.54
Rate for Payer: Kaiser Permanente Medicaid	$7,985.58
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$15,188.26
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$414.83
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$786.73

HC ANGIO EXTREMITY UNILAT - IR ANGIOGRAM EXTREMITY

Facility

$15,658.00

Service Code	HCPCS 75710
Hospital Charge Code	3237571001
Hospital Revenue Code	323
Min. Negotiated Rate	$13,309.30
Max. Negotiated Rate	$15,188.26
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Health Management Network Commercial	$13,309.30
Rate for Payer: MDX Hawaii PPO	$15,188.26

HC ANGIO INTERN MAMMARY - IR ANGIOGRAM INTERNAL MAMMARY

Facility

$15,658.00

Service Code	HCPCS 75756
Hospital Charge Code	3237575601
Hospital Revenue Code	323
Min. Negotiated Rate	$414.83
Max. Negotiated Rate	$15,188.26
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$414.83
Rate for Payer: Hawaii Medical Service Association Commercial	$4,662.59
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$435.57
Rate for Payer: Hawaii Western Management Group Commercial	$3,730.07
Rate for Payer: Health Management Network Commercial	$13,309.30
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$9,864.54
Rate for Payer: Kaiser Permanente Medicaid	$7,985.58
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$15,188.26
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$414.83
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$802.83

HC ANGIO INTERN MAMMARY - IR ANGIOGRAM INTERNAL MAMMARY

Facility

$15,658.00

Service Code	HCPCS 75756
Hospital Charge Code	3237575601
Hospital Revenue Code	323
Min. Negotiated Rate	$13,309.30
Max. Negotiated Rate	$15,188.26
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Health Management Network Commercial	$13,309.30
Rate for Payer: MDX Hawaii PPO	$15,188.26

HC ANGIO PELVIS - IR ANGIO PELVIC SELECTIVE OR SUPRASELECTIVE

Facility

$26,891.00

Service Code	HCPCS 75736
Hospital Charge Code	3237573601
Hospital Revenue Code	323
Min. Negotiated Rate	$414.83
Max. Negotiated Rate	$26,084.27
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Cash Price	$16,134.60
Rate for Payer: Cash Price	$16,134.60
Rate for Payer: Devoted Health Medicare	$7,230.94
Rate for Payer: Hawaii Medical Service Association ABD	$414.83
Rate for Payer: Hawaii Medical Service Association Commercial	$8,216.98
Rate for Payer: Hawaii Medical Service Association Medicare	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$435.57
Rate for Payer: Hawaii Western Management Group Commercial	$6,573.58
Rate for Payer: Health Management Network Commercial	$22,857.35
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Commercial	$16,941.33
Rate for Payer: Kaiser Permanente Medicaid	$13,714.41
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: MDX Hawaii PPO	$26,084.27
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$414.83
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$783.01

HC ANGIO PELVIS - IR ANGIO PELVIC SELECTIVE OR SUPRASELECTIVE

Facility

$26,891.00

Service Code	HCPCS 75736
Hospital Charge Code	3237573601
Hospital Revenue Code	323
Min. Negotiated Rate	$22,857.35
Max. Negotiated Rate	$26,084.27
Rate for Payer: Cash Price	$16,134.60
Rate for Payer: Health Management Network Commercial	$22,857.35
Rate for Payer: MDX Hawaii PPO	$26,084.27

HC ANGIO PULMON BILAT SELECT - IR ANGIOGRAM PULMONARY SELECTIVE BILAT

Facility

$15,658.00

Service Code	HCPCS 75743
Hospital Charge Code	3237574302
Hospital Revenue Code	323
Min. Negotiated Rate	$414.83
Max. Negotiated Rate	$15,188.26
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$414.83
Rate for Payer: Hawaii Medical Service Association Commercial	$4,662.59
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$435.57
Rate for Payer: Hawaii Western Management Group Commercial	$3,730.07
Rate for Payer: Health Management Network Commercial	$13,309.30
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$9,864.54
Rate for Payer: Kaiser Permanente Medicaid	$7,985.58
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$15,188.26
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$414.83
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$809.56

HC ANGIO PULMON BILAT SELECT - IR ANGIOGRAM PULMONARY SELECTIVE BILAT

Facility

$15,658.00

Service Code	HCPCS 75743
Hospital Charge Code	3237574302
Hospital Revenue Code	323
Min. Negotiated Rate	$13,309.30
Max. Negotiated Rate	$15,188.26
Rate for Payer: Cash Price	$9,394.80
Rate for Payer: Health Management Network Commercial	$13,309.30
Rate for Payer: MDX Hawaii PPO	$15,188.26

HC ANGIO SPINAL SELECTV - IR ANGIOGRAM SPINAL SELECTIVE

Facility

$26,891.00

Service Code	HCPCS 75705
Hospital Charge Code	3237570501
Hospital Revenue Code	323
Min. Negotiated Rate	$414.83
Max. Negotiated Rate	$26,084.27
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Cash Price	$16,134.60
Rate for Payer: Cash Price	$16,134.60
Rate for Payer: Devoted Health Medicare	$7,230.94
Rate for Payer: Hawaii Medical Service Association ABD	$414.83
Rate for Payer: Hawaii Medical Service Association Commercial	$8,216.98
Rate for Payer: Hawaii Medical Service Association Medicare	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$435.57
Rate for Payer: Hawaii Western Management Group Commercial	$6,573.58
Rate for Payer: Health Management Network Commercial	$22,857.35
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Commercial	$16,941.33
Rate for Payer: Kaiser Permanente Medicaid	$13,714.41
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: MDX Hawaii PPO	$26,084.27
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$414.83
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$876.33

HC ANGIO SPINAL SELECTV - IR ANGIOGRAM SPINAL SELECTIVE

Facility

$26,891.00

Service Code	HCPCS 75705
Hospital Charge Code	3237570501
Hospital Revenue Code	323
Min. Negotiated Rate	$22,857.35
Max. Negotiated Rate	$26,084.27
Rate for Payer: Cash Price	$16,134.60
Rate for Payer: Health Management Network Commercial	$22,857.35
Rate for Payer: MDX Hawaii PPO	$26,084.27

Know your out-of-pocket cost for care.

All Charges