Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CARD MRI VELOC FLOW MAPPING - MRI CARDIAC VELOCITY FLOW MAPPING

Facility

$795.00

Service Code	HCPCS 75565
Hospital Charge Code	6107556501
Hospital Revenue Code	610
Min. Negotiated Rate	$43.22
Max. Negotiated Rate	$771.15
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Hawaii Medical Service Association ABD	$43.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.01
Rate for Payer: Hawaii Western Management Group Commercial	$755.25
Rate for Payer: Health Management Network Commercial	$675.75
Rate for Payer: Kaiser Permanente Commercial	$500.85
Rate for Payer: Kaiser Permanente Medicaid	$405.45
Rate for Payer: MDX Hawaii PPO	$771.15
Rate for Payer: UnitedHealthcare Medicaid	$43.22
Rate for Payer: University Health Alliance Commercial	$196.95

HC CARD MRI VELOC FLOW MAPPING - MRI CARDIAC VELOCITY FLOW MAPPING

Facility

$795.00

Service Code	HCPCS 75565
Hospital Charge Code	6107556501
Hospital Revenue Code	610
Min. Negotiated Rate	$675.75
Max. Negotiated Rate	$771.15
Rate for Payer: Cash Price	$477.00
Rate for Payer: Health Management Network Commercial	$675.75
Rate for Payer: MDX Hawaii PPO	$771.15

HC CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM

Facility

$119.00

Service Code	HCPCS 96161
Hospital Charge Code	9189616101
Hospital Revenue Code	918
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$44.26
Rate for Payer: AlohaCare Medicare	$44.26
Rate for Payer: Cash Price	$71.40
Rate for Payer: Cash Price	$71.40
Rate for Payer: Devoted Health Medicare	$48.69
Rate for Payer: Hawaii Medical Service Association Commercial	$55.33
Rate for Payer: Hawaii Medical Service Association Medicare	$44.26
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$44.26
Rate for Payer: Kaiser Permanente Commercial	$74.97
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$44.26
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$48.69
Rate for Payer: Ohana Health Plan Medicare	$44.26
Rate for Payer: UnitedHealthcare Medicaid	$3.44
Rate for Payer: UnitedHealthcare Medicare	$44.26
Rate for Payer: University Health Alliance Commercial	$86.74

HC CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM

Facility

$119.00

Service Code	HCPCS 96161
Hospital Charge Code	9189616101
Hospital Revenue Code	918
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: MDX Hawaii PPO	$115.43

HC CAREGIVER TRAING 1ST 30 MIN

Facility

$238.00

Service Code	HCPCS 97550
Hospital Charge Code	9429755001
Hospital Revenue Code	942
Min. Negotiated Rate	$46.47
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$142.80
Rate for Payer: Cash Price	$142.80
Rate for Payer: Hawaii Western Management Group Commercial	$226.10
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Kaiser Permanente Commercial	$149.94
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: UnitedHealthcare Medicaid	$46.47
Rate for Payer: University Health Alliance Commercial	$173.48

HC CAREGIVER TRAING 1ST 30 MIN

Facility

$238.00

Service Code	HCPCS 97550
Hospital Charge Code	9429755001
Hospital Revenue Code	942
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$142.80
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: MDX Hawaii PPO	$230.86

HC CAR SEAT/BED TEST INFT THRU 12 MO 60 MIN

Facility

$153.00

Service Code	HCPCS 94780
Hospital Charge Code	4609478001
Hospital Revenue Code	460
Min. Negotiated Rate	$14.47
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$44.12
Rate for Payer: AlohaCare Medicare	$44.12
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Devoted Health Medicare	$48.53
Rate for Payer: Hawaii Medical Service Association Commercial	$55.15
Rate for Payer: Hawaii Medical Service Association Medicare	$44.12
Rate for Payer: Hawaii Western Management Group Commercial	$145.35
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$44.12
Rate for Payer: Kaiser Permanente Commercial	$96.39
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$44.12
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$48.53
Rate for Payer: Ohana Health Plan Medicare	$44.12
Rate for Payer: UnitedHealthcare Medicaid	$14.47
Rate for Payer: UnitedHealthcare Medicare	$44.12
Rate for Payer: University Health Alliance Commercial	$111.52

HC CAR SEAT/BED TEST INFT THRU 12 MO 60 MIN

Facility

$153.00

Service Code	HCPCS 94780
Hospital Charge Code	4609478001
Hospital Revenue Code	460
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$91.80
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: MDX Hawaii PPO	$148.41

HC CAR SEAT/BED TEST INFT THRU 12 MO EA ADDL 30 MIN

Facility

$37.00

Service Code	HCPCS 94781
Hospital Charge Code	4609478101
Hospital Revenue Code	460
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Cash Price	$22.20
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$23.31
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: UnitedHealthcare Medicaid	$5.03
Rate for Payer: University Health Alliance Commercial	$26.97

HC CAR SEAT/BED TEST INFT THRU 12 MO EA ADDL 30 MIN

Facility

$37.00

Service Code	HCPCS 94781
Hospital Charge Code	4609478101
Hospital Revenue Code	460
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: MDX Hawaii PPO	$35.89

HC CASTING/STRAPPING PROCEDURE

Facility

$628.00

Service Code	HCPCS 29799
Hospital Charge Code	4502979901
Hospital Revenue Code	450
Min. Negotiated Rate	$191.97
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$191.97
Rate for Payer: AlohaCare Medicare	$191.97
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Devoted Health Medicare	$211.17
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$191.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$596.60
Rate for Payer: Health Management Network Commercial	$533.80
Rate for Payer: Humana Medicare	$191.97
Rate for Payer: Kaiser Permanente Commercial	$395.64
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$191.97
Rate for Payer: MDX Hawaii PPO	$609.16
Rate for Payer: Ohana Health Plan Medicaid	$211.17
Rate for Payer: Ohana Health Plan Medicare	$191.97
Rate for Payer: UnitedHealthcare Medicare	$191.97
Rate for Payer: University Health Alliance Commercial	$457.75

HC CASTING/STRAPPING PROCEDURE

Facility

$628.00

Service Code	HCPCS 29799
Hospital Charge Code	4502979901
Hospital Revenue Code	450
Min. Negotiated Rate	$533.80
Max. Negotiated Rate	$609.16
Rate for Payer: Cash Price	$376.80
Rate for Payer: Health Management Network Commercial	$533.80
Rate for Payer: MDX Hawaii PPO	$609.16

HC CATH CARDIAC SURG PROCEDURE UNLIST

Facility

$2,460.00

Service Code	HCPCS 33999
Hospital Charge Code	3613399901
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$741.06
Rate for Payer: AlohaCare Medicare	$741.06
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Devoted Health Medicare	$815.17
Rate for Payer: Hawaii Medical Service Association Commercial	$926.33
Rate for Payer: Hawaii Medical Service Association Medicare	$741.06
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: Humana Medicare	$741.06
Rate for Payer: Kaiser Permanente Commercial	$1,549.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$741.06
Rate for Payer: MDX Hawaii PPO	$2,386.20
Rate for Payer: Ohana Health Plan Medicaid	$815.17
Rate for Payer: Ohana Health Plan Medicare	$741.06
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$741.06
Rate for Payer: University Health Alliance Commercial	$1,793.09

HC CATH CARDIAC SURG PROCEDURE UNLIST

Facility

$2,460.00

Service Code	HCPCS 33999
Hospital Charge Code	3613399901
Hospital Revenue Code	361
Min. Negotiated Rate	$2,091.00
Max. Negotiated Rate	$2,386.20
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: MDX Hawaii PPO	$2,386.20

HC CATH CARDIOVASCULAR PROCEDURE UNLISTED

Facility

$779.00

Service Code	HCPCS 93799
Hospital Charge Code	4819379901
Hospital Revenue Code	481
Min. Negotiated Rate	$117.35
Max. Negotiated Rate	$755.63
Rate for Payer: AlohaCare Medicaid	$152.01
Rate for Payer: AlohaCare Medicare	$152.01
Rate for Payer: Cash Price	$467.40
Rate for Payer: Cash Price	$467.40
Rate for Payer: Devoted Health Medicare	$167.21
Rate for Payer: Hawaii Medical Service Association Commercial	$190.01
Rate for Payer: Hawaii Medical Service Association Medicare	$152.01
Rate for Payer: Hawaii Western Management Group Commercial	$740.05
Rate for Payer: Health Management Network Commercial	$662.15
Rate for Payer: Humana Medicare	$152.01
Rate for Payer: Kaiser Permanente Commercial	$490.77
Rate for Payer: Kaiser Permanente Medicaid	$397.29
Rate for Payer: Kaiser Permanente Medicare	$152.01
Rate for Payer: MDX Hawaii PPO	$755.63
Rate for Payer: Ohana Health Plan Medicaid	$167.21
Rate for Payer: Ohana Health Plan Medicare	$152.01
Rate for Payer: UnitedHealthcare Medicaid	$117.35
Rate for Payer: UnitedHealthcare Medicare	$152.01
Rate for Payer: University Health Alliance Commercial	$567.81

HC CATH CARDIOVASCULAR PROCEDURE UNLISTED

Facility

$779.00

Service Code	HCPCS 93799
Hospital Charge Code	4819379901
Hospital Revenue Code	481
Min. Negotiated Rate	$662.15
Max. Negotiated Rate	$755.63
Rate for Payer: Cash Price	$467.40
Rate for Payer: Health Management Network Commercial	$662.15
Rate for Payer: MDX Hawaii PPO	$755.63

HC CATH CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,R&L HRT CATH, L HRT VENTRIC

Facility

$16,000.00

Service Code	HCPCS 93460
Hospital Charge Code	4819346001
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$3,829.84
Rate for Payer: AlohaCare Medicare	$3,829.84
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Devoted Health Medicare	$4,212.82
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	$3,829.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Hawaii Western Management Group Commercial	$15,200.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: Humana Medicare	$3,829.84
Rate for Payer: Kaiser Permanente Commercial	$10,080.00
Rate for Payer: Kaiser Permanente Medicaid	$8,160.00
Rate for Payer: Kaiser Permanente Medicare	$3,829.84
Rate for Payer: MDX Hawaii PPO	$15,520.00
Rate for Payer: Ohana Health Plan Medicaid	$4,212.82
Rate for Payer: Ohana Health Plan Medicare	$3,829.84
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$3,829.84
Rate for Payer: University Health Alliance Commercial	$24,500.00

HC CATH CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,R&L HRT CATH, L HRT VENTRIC

Facility

$16,000.00

Service Code	HCPCS 93460
Hospital Charge Code	4819346001
Hospital Revenue Code	481
Min. Negotiated Rate	$13,600.00
Max. Negotiated Rate	$15,520.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: MDX Hawaii PPO	$15,520.00

HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP

Facility

$16,000.00

Service Code	HCPCS 93454
Hospital Charge Code	4819345401
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$3,829.84
Rate for Payer: AlohaCare Medicare	$3,829.84
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Devoted Health Medicare	$4,212.82
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,829.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$15,200.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: Humana Medicare	$3,829.84
Rate for Payer: Kaiser Permanente Commercial	$10,080.00
Rate for Payer: Kaiser Permanente Medicaid	$8,160.00
Rate for Payer: Kaiser Permanente Medicare	$3,829.84
Rate for Payer: MDX Hawaii PPO	$15,520.00
Rate for Payer: Ohana Health Plan Medicaid	$4,212.82
Rate for Payer: Ohana Health Plan Medicare	$3,829.84
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$3,829.84
Rate for Payer: University Health Alliance Commercial	$24,500.00

HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP

Facility

$16,000.00

Service Code	HCPCS 93454
Hospital Charge Code	4819345401
Hospital Revenue Code	481
Min. Negotiated Rate	$13,600.00
Max. Negotiated Rate	$15,520.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: MDX Hawaii PPO	$15,520.00

HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP, BYPASS ANGIO

Facility

$16,000.00

Service Code	HCPCS 93455
Hospital Charge Code	4819345501
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$15,520.00
Rate for Payer: AlohaCare Medicaid	$3,829.84
Rate for Payer: AlohaCare Medicare	$3,829.84
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Devoted Health Medicare	$4,212.82
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	$3,829.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Hawaii Western Management Group Commercial	$15,200.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: Humana Medicare	$3,829.84
Rate for Payer: Kaiser Permanente Commercial	$10,080.00
Rate for Payer: Kaiser Permanente Medicaid	$8,160.00
Rate for Payer: Kaiser Permanente Medicare	$3,829.84
Rate for Payer: MDX Hawaii PPO	$15,520.00
Rate for Payer: Ohana Health Plan Medicaid	$4,212.82
Rate for Payer: Ohana Health Plan Medicare	$3,829.84
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$3,829.84
Rate for Payer: University Health Alliance Commercial	$11,662.40

HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP, BYPASS ANGIO

Facility

$16,000.00

Service Code	HCPCS 93455
Hospital Charge Code	4819345501
Hospital Revenue Code	481
Min. Negotiated Rate	$13,600.00
Max. Negotiated Rate	$15,520.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: MDX Hawaii PPO	$15,520.00

HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP,W RIGHT HEART CATH

Facility

$16,000.00

Service Code	HCPCS 93456
Hospital Charge Code	4819345601
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$3,829.84
Rate for Payer: AlohaCare Medicare	$3,829.84
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Devoted Health Medicare	$4,212.82
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	$3,829.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Hawaii Western Management Group Commercial	$15,200.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: Humana Medicare	$3,829.84
Rate for Payer: Kaiser Permanente Commercial	$10,080.00
Rate for Payer: Kaiser Permanente Medicaid	$8,160.00
Rate for Payer: Kaiser Permanente Medicare	$3,829.84
Rate for Payer: MDX Hawaii PPO	$15,520.00
Rate for Payer: Ohana Health Plan Medicaid	$4,212.82
Rate for Payer: Ohana Health Plan Medicare	$3,829.84
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$3,829.84
Rate for Payer: University Health Alliance Commercial	$24,500.00

HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP,W RIGHT HEART CATH

Facility

$16,000.00

Service Code	HCPCS 93456
Hospital Charge Code	4819345601
Hospital Revenue Code	481
Min. Negotiated Rate	$13,600.00
Max. Negotiated Rate	$15,520.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: MDX Hawaii PPO	$15,520.00

HC CATHETERIZATION OF UMBILICAL VEIN FOR DIAGNOSIS OR THERAPY, NEWBORN

Facility

$299.00

Service Code	HCPCS 36510
Hospital Charge Code	4503651001
Hospital Revenue Code	450
Min. Negotiated Rate	$188.37
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$179.40
Rate for Payer: Cash Price	$179.40
Rate for Payer: Cash Price	$179.40
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$284.05
Rate for Payer: Health Management Network Commercial	$254.15
Rate for Payer: Kaiser Permanente Commercial	$188.37
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$290.03
Rate for Payer: University Health Alliance Commercial	$217.94

Know your out-of-pocket cost for care.

All Charges