Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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	$254.15
Max. Negotiated Rate	$290.03
Rate for Payer: Cash Price	$179.40
Rate for Payer: Health Management Network Commercial	$254.15
Rate for Payer: MDX Hawaii PPO	$290.03

HC CATH HEART FLOW RESERV MEASURE,ADDN VESSL

Facility

$1,779.00

Service Code	HCPCS 93572
Hospital Charge Code	4819357201
Hospital Revenue Code	481
Min. Negotiated Rate	$92.02
Max. Negotiated Rate	$1,725.63
Rate for Payer: Cash Price	$1,067.40
Rate for Payer: Cash Price	$1,067.40
Rate for Payer: Hawaii Medical Service Association ABD	$92.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$117.10
Rate for Payer: Hawaii Western Management Group Commercial	$1,690.05
Rate for Payer: Health Management Network Commercial	$1,512.15
Rate for Payer: Kaiser Permanente Commercial	$1,120.77
Rate for Payer: Kaiser Permanente Medicaid	$907.29
Rate for Payer: MDX Hawaii PPO	$1,725.63
Rate for Payer: UnitedHealthcare Medicaid	$92.02
Rate for Payer: University Health Alliance Commercial	$1,296.71

HC CATH HEART FLOW RESERV MEASURE,ADDN VESSL

Facility

$1,779.00

Service Code	HCPCS 93572
Hospital Charge Code	4819357201
Hospital Revenue Code	481
Min. Negotiated Rate	$1,512.15
Max. Negotiated Rate	$1,725.63
Rate for Payer: Cash Price	$1,067.40
Rate for Payer: Health Management Network Commercial	$1,512.15
Rate for Payer: MDX Hawaii PPO	$1,725.63

HC CATH HEART FLOW RESERV MEASURE,INIT VESSL

Facility

$3,351.00

Service Code	HCPCS 93571
Hospital Charge Code	4819357101
Hospital Revenue Code	481
Min. Negotiated Rate	$148.43
Max. Negotiated Rate	$3,250.47
Rate for Payer: Cash Price	$2,010.60
Rate for Payer: Cash Price	$2,010.60
Rate for Payer: Hawaii Medical Service Association ABD	$148.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$155.85
Rate for Payer: Hawaii Western Management Group Commercial	$3,183.45
Rate for Payer: Health Management Network Commercial	$2,848.35
Rate for Payer: Kaiser Permanente Commercial	$2,111.13
Rate for Payer: Kaiser Permanente Medicaid	$1,709.01
Rate for Payer: MDX Hawaii PPO	$3,250.47
Rate for Payer: UnitedHealthcare Medicaid	$148.43
Rate for Payer: University Health Alliance Commercial	$2,442.54

HC CATH HEART FLOW RESERV MEASURE,INIT VESSL

Facility

$3,351.00

Service Code	HCPCS 93571
Hospital Charge Code	4819357101
Hospital Revenue Code	481
Min. Negotiated Rate	$2,848.35
Max. Negotiated Rate	$3,250.47
Rate for Payer: Cash Price	$2,010.60
Rate for Payer: Health Management Network Commercial	$2,848.35
Rate for Payer: MDX Hawaii PPO	$3,250.47

HC CATH/INJECT HYSTEROSALPINGOGRAM

Facility

$403.00

Service Code	HCPCS 58340
Hospital Charge Code	3615834001
Hospital Revenue Code	361
Min. Negotiated Rate	$342.55
Max. Negotiated Rate	$390.91
Rate for Payer: Cash Price	$241.80
Rate for Payer: Health Management Network Commercial	$342.55
Rate for Payer: MDX Hawaii PPO	$390.91

HC CATH/INJECT HYSTEROSALPINGOGRAM

Facility

$403.00

Service Code	HCPCS 58340
Hospital Charge Code	3615834001
Hospital Revenue Code	361
Min. Negotiated Rate	$38.69
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$241.80
Rate for Payer: Cash Price	$241.80
Rate for Payer: Cash Price	$241.80
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$342.55
Rate for Payer: Kaiser Permanente Commercial	$253.89
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$390.91
Rate for Payer: UnitedHealthcare Medicaid	$38.69
Rate for Payer: University Health Alliance Commercial	$293.75

HC CATH INSERT INTRA-AORTIC BALLOON ASST DEVICE

Facility

$1,384.00

Service Code	HCPCS 33967
Hospital Charge Code	3613396701
Hospital Revenue Code	361
Min. Negotiated Rate	$190.78
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$830.40
Rate for Payer: Cash Price	$830.40
Rate for Payer: Cash Price	$830.40
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Kaiser Permanente Commercial	$871.92
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: UnitedHealthcare Medicaid	$190.78
Rate for Payer: University Health Alliance Commercial	$1,008.80

HC CATH INSERT INTRA-AORTIC BALLOON ASST DEVICE

Facility

$1,384.00

Service Code	HCPCS 33967
Hospital Charge Code	3613396701
Hospital Revenue Code	361
Min. Negotiated Rate	$1,176.40
Max. Negotiated Rate	$1,342.48
Rate for Payer: Cash Price	$830.40
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: MDX Hawaii PPO	$1,342.48

HC CATH INTRAVASC CORONARY SONO,ADDN VESSEL

Facility

$2,224.00

Service Code	HCPCS 92979
Hospital Charge Code	4819297901
Hospital Revenue Code	481
Min. Negotiated Rate	$75.74
Max. Negotiated Rate	$2,157.28
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Hawaii Medical Service Association ABD	$75.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$79.53
Rate for Payer: Hawaii Western Management Group Commercial	$2,112.80
Rate for Payer: Health Management Network Commercial	$1,890.40
Rate for Payer: Kaiser Permanente Commercial	$1,401.12
Rate for Payer: Kaiser Permanente Medicaid	$1,134.24
Rate for Payer: MDX Hawaii PPO	$2,157.28
Rate for Payer: UnitedHealthcare Medicaid	$75.74
Rate for Payer: University Health Alliance Commercial	$1,621.07

HC CATH INTRAVASC CORONARY SONO,ADDN VESSEL

Facility

$2,224.00

Service Code	HCPCS 92979
Hospital Charge Code	4819297901
Hospital Revenue Code	481
Min. Negotiated Rate	$1,890.40
Max. Negotiated Rate	$2,157.28
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Health Management Network Commercial	$1,890.40
Rate for Payer: MDX Hawaii PPO	$2,157.28

HC CATH INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL

Facility

$3,279.00

Service Code	HCPCS 37253
Hospital Charge Code	4813725301
Hospital Revenue Code	481
Min. Negotiated Rate	$66.36
Max. Negotiated Rate	$3,180.63
Rate for Payer: Cash Price	$1,967.40
Rate for Payer: Cash Price	$1,967.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,115.05
Rate for Payer: Health Management Network Commercial	$2,787.15
Rate for Payer: Kaiser Permanente Commercial	$2,065.77
Rate for Payer: Kaiser Permanente Medicaid	$1,672.29
Rate for Payer: MDX Hawaii PPO	$3,180.63
Rate for Payer: UnitedHealthcare Medicaid	$66.36
Rate for Payer: University Health Alliance Commercial	$2,390.06

HC CATH INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL

Facility

$3,279.00

Service Code	HCPCS 37253
Hospital Charge Code	4813725301
Hospital Revenue Code	481
Min. Negotiated Rate	$2,787.15
Max. Negotiated Rate	$3,180.63
Rate for Payer: Cash Price	$1,967.40
Rate for Payer: Health Management Network Commercial	$2,787.15
Rate for Payer: MDX Hawaii PPO	$3,180.63

HC CATH INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL

Facility

$6,563.00

Service Code	HCPCS 37252
Hospital Charge Code	4813725201
Hospital Revenue Code	481
Min. Negotiated Rate	$83.28
Max. Negotiated Rate	$6,366.11
Rate for Payer: Cash Price	$3,937.80
Rate for Payer: Cash Price	$3,937.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,234.85
Rate for Payer: Health Management Network Commercial	$5,578.55
Rate for Payer: Kaiser Permanente Commercial	$4,134.69
Rate for Payer: Kaiser Permanente Medicaid	$3,347.13
Rate for Payer: MDX Hawaii PPO	$6,366.11
Rate for Payer: UnitedHealthcare Medicaid	$83.28
Rate for Payer: University Health Alliance Commercial	$4,783.77

HC CATH INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL

Facility

$6,563.00

Service Code	HCPCS 37252
Hospital Charge Code	4813725201
Hospital Revenue Code	481
Min. Negotiated Rate	$5,578.55
Max. Negotiated Rate	$6,366.11
Rate for Payer: Cash Price	$3,937.80
Rate for Payer: Health Management Network Commercial	$5,578.55
Rate for Payer: MDX Hawaii PPO	$6,366.11

HC CATH INTRAVASC US,HEART,1ST VESSEL

Facility

$4,023.00

Service Code	HCPCS 92978
Hospital Charge Code	4819297801
Hospital Revenue Code	481
Min. Negotiated Rate	$150.61
Max. Negotiated Rate	$13,778.00
Rate for Payer: Cash Price	$2,413.80
Rate for Payer: Cash Price	$2,413.80
Rate for Payer: Cash Price	$2,413.80
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Hawaii Western Management Group Commercial	$3,821.85
Rate for Payer: Health Management Network Commercial	$3,419.55
Rate for Payer: Kaiser Permanente Commercial	$2,534.49
Rate for Payer: Kaiser Permanente Medicaid	$2,051.73
Rate for Payer: MDX Hawaii PPO	$3,902.31
Rate for Payer: UnitedHealthcare Medicaid	$150.61
Rate for Payer: University Health Alliance Commercial	$2,932.36

HC CATH INTRAVASC US,HEART,1ST VESSEL

Facility

$4,023.00

Service Code	HCPCS 92978
Hospital Charge Code	4819297801
Hospital Revenue Code	481
Min. Negotiated Rate	$3,419.55
Max. Negotiated Rate	$3,902.31
Rate for Payer: Cash Price	$2,413.80
Rate for Payer: Health Management Network Commercial	$3,419.55
Rate for Payer: MDX Hawaii PPO	$3,902.31

HC CATH MEDICATION ADMIN & HEMODYNAMIC MEASURMENT

Facility

$599.00

Service Code	HCPCS 93463
Hospital Charge Code	4819346301
Hospital Revenue Code	481
Min. Negotiated Rate	$65.51
Max. Negotiated Rate	$581.03
Rate for Payer: Cash Price	$359.40
Rate for Payer: Cash Price	$359.40
Rate for Payer: Hawaii Western Management Group Commercial	$569.05
Rate for Payer: Health Management Network Commercial	$509.15
Rate for Payer: Kaiser Permanente Commercial	$377.37
Rate for Payer: Kaiser Permanente Medicaid	$305.49
Rate for Payer: MDX Hawaii PPO	$581.03
Rate for Payer: UnitedHealthcare Medicaid	$65.51
Rate for Payer: University Health Alliance Commercial	$436.61

HC CATH MEDICATION ADMIN & HEMODYNAMIC MEASURMENT

Facility

$599.00

Service Code	HCPCS 93463
Hospital Charge Code	4819346301
Hospital Revenue Code	481
Min. Negotiated Rate	$509.15
Max. Negotiated Rate	$581.03
Rate for Payer: Cash Price	$359.40
Rate for Payer: Health Management Network Commercial	$509.15
Rate for Payer: MDX Hawaii PPO	$581.03

HC CATH PLACE/CORON ANGIO, IMG SUPER/INTERP, BYPASS ANGIO,W L HRT VENTRIC

Facility

$16,000.00

Service Code	HCPCS 93459
Hospital Charge Code	4819345901
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 PLACE/CORON ANGIO, IMG SUPER/INTERP, BYPASS ANGIO,W L HRT VENTRIC

Facility

$16,000.00

Service Code	HCPCS 93459
Hospital Charge Code	4819345901
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 PLACE/CORON ANGIO, IMG SUPER/INTERP,W LEFT HEART VENTRICULOGRAPHY

Facility

$16,000.00

Service Code	HCPCS 93458
Hospital Charge Code	4819345801
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 PLACE/CORON ANGIO, IMG SUPER/INTERP,W LEFT HEART VENTRICULOGRAPHY

Facility

$16,000.00

Service Code	HCPCS 93458
Hospital Charge Code	4819345801
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 PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH

Facility

$56,414.00

Service Code	HCPCS 92924
Hospital Charge Code	4819292401
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$54,721.58
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Devoted Health Medicare	$15,001.44
Rate for Payer: Hawaii Medical Service Association Commercial	$17,047.09
Rate for Payer: Hawaii Medical Service Association Medicare	$13,637.67
Rate for Payer: Hawaii Western Management Group Commercial	$53,593.30
Rate for Payer: Health Management Network Commercial	$47,951.90
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$35,540.82
Rate for Payer: Kaiser Permanente Medicaid	$28,771.14
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$54,721.58
Rate for Payer: Ohana Health Plan Medicaid	$15,001.44
Rate for Payer: Ohana Health Plan Medicare	$13,637.67
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$13,637.67
Rate for Payer: University Health Alliance Commercial	$41,120.16

HC CATH PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH

Facility

$56,414.00

Service Code	HCPCS 92924
Hospital Charge Code	4819292401
Hospital Revenue Code	481
Min. Negotiated Rate	$47,951.90
Max. Negotiated Rate	$54,721.58
Rate for Payer: Cash Price	$33,848.40
Rate for Payer: Health Management Network Commercial	$47,951.90
Rate for Payer: MDX Hawaii PPO	$54,721.58

Know your out-of-pocket cost for care.

All Charges