Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC EO W/O JOINTS CF

Facility

$1,041.00

Service Code	HCPCS L3702
Hospital Charge Code	274L370201
Hospital Revenue Code	274
Min. Negotiated Rate	$123.89
Max. Negotiated Rate	$1,009.77
Rate for Payer: Cash Price	$624.60
Rate for Payer: Cash Price	$624.60
Rate for Payer: Hawaii Western Management Group Commercial	$728.70
Rate for Payer: Health Management Network Commercial	$884.85
Rate for Payer: Kaiser Permanente Commercial	$655.83
Rate for Payer: Kaiser Permanente Medicaid	$530.91
Rate for Payer: MDX Hawaii PPO	$1,009.77
Rate for Payer: UnitedHealthcare Medicaid	$123.89
Rate for Payer: University Health Alliance Commercial	$582.96

HC EO W/O JOINTS CF

Facility

$1,041.00

Service Code	HCPCS L3702
Hospital Charge Code	274L370201
Hospital Revenue Code	274
Min. Negotiated Rate	$582.96
Max. Negotiated Rate	$1,009.77
Rate for Payer: Cash Price	$624.60
Rate for Payer: Hawaii Western Management Group Commercial	$728.70
Rate for Payer: Health Management Network Commercial	$884.85
Rate for Payer: MDX Hawaii PPO	$1,009.77
Rate for Payer: University Health Alliance Commercial	$582.96

HC EP EVAL CARDIOVERT LEADS/PULS GEN

Facility

$2,731.00

Service Code	HCPCS 93641
Hospital Charge Code	4809364101
Hospital Revenue Code	480
Min. Negotiated Rate	$2,321.35
Max. Negotiated Rate	$2,649.07
Rate for Payer: Cash Price	$1,638.60
Rate for Payer: Health Management Network Commercial	$2,321.35
Rate for Payer: MDX Hawaii PPO	$2,649.07

HC EP EVAL CARDIOVERT LEADS/PULS GEN

Facility

$2,731.00

Service Code	HCPCS 93641
Hospital Charge Code	4809364101
Hospital Revenue Code	480
Min. Negotiated Rate	$237.33
Max. Negotiated Rate	$8,270.00
Rate for Payer: Cash Price	$1,638.60
Rate for Payer: Cash Price	$1,638.60
Rate for Payer: Cash Price	$1,638.60
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 Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$2,594.45
Rate for Payer: Health Management Network Commercial	$2,321.35
Rate for Payer: Kaiser Permanente Commercial	$1,720.53
Rate for Payer: Kaiser Permanente Medicaid	$1,392.81
Rate for Payer: MDX Hawaii PPO	$2,649.07
Rate for Payer: UnitedHealthcare Medicaid	$237.33
Rate for Payer: University Health Alliance Commercial	$1,990.63

HC EPIDURAL ANESTHESIA TIME - EACH INCREMENTAL 1 MINUTE

Facility

$30.00

Hospital Charge Code	3700000008
Hospital Revenue Code	370
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: MDX Hawaii PPO	$29.10

HC EPIDURAL ANESTHESIA TIME - EACH INCREMENTAL 1 MINUTE

Facility

$30.00

Hospital Charge Code	3700000008
Hospital Revenue Code	370
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: University Health Alliance Commercial	$21.87

HC EPIDURAL ANESTHESIA TIME - INITIAL BASE CHARGE

Facility

$559.00

Hospital Charge Code	3700000007
Hospital Revenue Code	370
Min. Negotiated Rate	$285.09
Max. Negotiated Rate	$542.23
Rate for Payer: Cash Price	$335.40
Rate for Payer: Hawaii Western Management Group Commercial	$531.05
Rate for Payer: Health Management Network Commercial	$475.15
Rate for Payer: Kaiser Permanente Commercial	$352.17
Rate for Payer: Kaiser Permanente Medicaid	$285.09
Rate for Payer: MDX Hawaii PPO	$542.23
Rate for Payer: University Health Alliance Commercial	$407.46

HC EPIDURAL ANESTHESIA TIME - INITIAL BASE CHARGE

Facility

$559.00

Hospital Charge Code	3700000007
Hospital Revenue Code	370
Min. Negotiated Rate	$475.15
Max. Negotiated Rate	$542.23
Rate for Payer: Cash Price	$335.40
Rate for Payer: Health Management Network Commercial	$475.15
Rate for Payer: MDX Hawaii PPO	$542.23

HC EP INSER HART PACER XVENOUS ATRIAL

Facility

$41,648.00

Service Code	HCPCS 33206
Hospital Charge Code	3613320601
Hospital Revenue Code	361
Min. Negotiated Rate	$35,400.80
Max. Negotiated Rate	$40,398.56
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Health Management Network Commercial	$35,400.80
Rate for Payer: MDX Hawaii PPO	$40,398.56

HC EP INSER HART PACER XVENOUS ATRIAL

Facility

$41,648.00

Service Code	HCPCS 33206
Hospital Charge Code	3613320601
Hospital Revenue Code	361
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$40,398.56
Rate for Payer: AlohaCare Medicaid	$12,347.41
Rate for Payer: AlohaCare Medicare	$12,347.41
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Devoted Health Medicare	$13,582.15
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	$12,347.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$35,400.80
Rate for Payer: Humana Medicare	$12,347.41
Rate for Payer: Kaiser Permanente Commercial	$26,238.24
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$12,347.41
Rate for Payer: MDX Hawaii PPO	$40,398.56
Rate for Payer: Ohana Health Plan Medicaid	$13,582.15
Rate for Payer: Ohana Health Plan Medicare	$12,347.41
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$12,347.41
Rate for Payer: University Health Alliance Commercial	$30,357.23

HC EP INSER HART PACER XVENOUS VENTR

Facility

$41,648.00

Service Code	HCPCS 33207
Hospital Charge Code	3613320701
Hospital Revenue Code	361
Min. Negotiated Rate	$35,400.80
Max. Negotiated Rate	$40,398.56
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Health Management Network Commercial	$35,400.80
Rate for Payer: MDX Hawaii PPO	$40,398.56

HC EP INSER HART PACER XVENOUS VENTR

Facility

$41,648.00

Service Code	HCPCS 33207
Hospital Charge Code	3613320701
Hospital Revenue Code	361
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$40,398.56
Rate for Payer: AlohaCare Medicaid	$12,347.41
Rate for Payer: AlohaCare Medicare	$12,347.41
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Cash Price	$24,988.80
Rate for Payer: Devoted Health Medicare	$13,582.15
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	$12,347.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$35,400.80
Rate for Payer: Humana Medicare	$12,347.41
Rate for Payer: Kaiser Permanente Commercial	$26,238.24
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$12,347.41
Rate for Payer: MDX Hawaii PPO	$40,398.56
Rate for Payer: Ohana Health Plan Medicaid	$13,582.15
Rate for Payer: Ohana Health Plan Medicare	$12,347.41
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$12,347.41
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC EP INSER HEART TEMP PACER ONE CHMBR

Facility

$32,935.00

Service Code	HCPCS 33210
Hospital Charge Code	3613321001
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$31,946.95
Rate for Payer: AlohaCare Medicaid	$9,776.09
Rate for Payer: AlohaCare Medicare	$9,776.09
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Devoted Health Medicare	$10,753.70
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$9,776.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$27,994.75
Rate for Payer: Humana Medicare	$9,776.09
Rate for Payer: Kaiser Permanente Commercial	$20,749.05
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$9,776.09
Rate for Payer: MDX Hawaii PPO	$31,946.95
Rate for Payer: Ohana Health Plan Medicaid	$10,753.70
Rate for Payer: Ohana Health Plan Medicare	$9,776.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$9,776.09
Rate for Payer: University Health Alliance Commercial	$24,006.32

HC EP INSER HEART TEMP PACER ONE CHMBR

Facility

$32,935.00

Service Code	HCPCS 33210
Hospital Charge Code	3613321001
Hospital Revenue Code	361
Min. Negotiated Rate	$27,994.75
Max. Negotiated Rate	$31,946.95
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Health Management Network Commercial	$27,994.75
Rate for Payer: MDX Hawaii PPO	$31,946.95

HC EP INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB

Facility

$32,935.00

Service Code	HCPCS 33216
Hospital Charge Code	3613321601
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$31,946.95
Rate for Payer: AlohaCare Medicaid	$9,776.09
Rate for Payer: AlohaCare Medicare	$9,776.09
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Devoted Health Medicare	$10,753.70
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	$9,776.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$27,994.75
Rate for Payer: Humana Medicare	$9,776.09
Rate for Payer: Kaiser Permanente Commercial	$20,749.05
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$9,776.09
Rate for Payer: MDX Hawaii PPO	$31,946.95
Rate for Payer: Ohana Health Plan Medicaid	$10,753.70
Rate for Payer: Ohana Health Plan Medicare	$9,776.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$9,776.09
Rate for Payer: University Health Alliance Commercial	$24,006.32

HC EP INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB

Facility

$32,935.00

Service Code	HCPCS 33216
Hospital Charge Code	3613321601
Hospital Revenue Code	361
Min. Negotiated Rate	$27,994.75
Max. Negotiated Rate	$31,946.95
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Health Management Network Commercial	$27,994.75
Rate for Payer: MDX Hawaii PPO	$31,946.95

HC EP INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR

Facility

$127,593.00

Service Code	HCPCS 33249
Hospital Charge Code	3613324901
Hospital Revenue Code	361
Min. Negotiated Rate	$820.76
Max. Negotiated Rate	$123,765.21
Rate for Payer: AlohaCare Medicaid	$37,081.07
Rate for Payer: AlohaCare Medicare	$37,081.07
Rate for Payer: Cash Price	$76,555.80
Rate for Payer: Cash Price	$76,555.80
Rate for Payer: Cash Price	$76,555.80
Rate for Payer: Devoted Health Medicare	$40,789.18
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 Medicare	$37,081.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$108,454.05
Rate for Payer: Humana Medicare	$37,081.07
Rate for Payer: Kaiser Permanente Commercial	$80,383.59
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$37,081.07
Rate for Payer: MDX Hawaii PPO	$123,765.21
Rate for Payer: Ohana Health Plan Medicaid	$40,789.18
Rate for Payer: Ohana Health Plan Medicare	$37,081.07
Rate for Payer: UnitedHealthcare Medicaid	$820.76
Rate for Payer: UnitedHealthcare Medicare	$37,081.07
Rate for Payer: University Health Alliance Commercial	$24,500.00

HC EP INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR

Facility

$127,593.00

Service Code	HCPCS 33249
Hospital Charge Code	3613324901
Hospital Revenue Code	361
Min. Negotiated Rate	$108,454.05
Max. Negotiated Rate	$123,765.21
Rate for Payer: Cash Price	$76,555.80
Rate for Payer: Health Management Network Commercial	$108,454.05
Rate for Payer: MDX Hawaii PPO	$123,765.21

HC EP PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB

Facility

$185.00

Service Code	HCPCS 93284
Hospital Charge Code	4809328403
Hospital Revenue Code	480
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$111.00
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: MDX Hawaii PPO	$179.45

HC EP PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB

Facility

$185.00

Service Code	HCPCS 93284
Hospital Charge Code	4809328403
Hospital Revenue Code	480
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$44.09
Rate for Payer: AlohaCare Medicare	$44.09
Rate for Payer: Cash Price	$111.00
Rate for Payer: Cash Price	$111.00
Rate for Payer: Devoted Health Medicare	$48.50
Rate for Payer: Hawaii Medical Service Association ABD	$21.18
Rate for Payer: Hawaii Medical Service Association Commercial	$55.11
Rate for Payer: Hawaii Medical Service Association Medicare	$44.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.45
Rate for Payer: Hawaii Western Management Group Commercial	$175.75
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$44.09
Rate for Payer: Kaiser Permanente Commercial	$116.55
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$44.09
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$48.50
Rate for Payer: Ohana Health Plan Medicare	$44.09
Rate for Payer: UnitedHealthcare Medicaid	$21.18
Rate for Payer: UnitedHealthcare Medicare	$44.09
Rate for Payer: University Health Alliance Commercial	$134.85

HC EP RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR

Facility

$7,280.00

Service Code	HCPCS 33223
Hospital Charge Code	3613322301
Hospital Revenue Code	361
Min. Negotiated Rate	$6,188.00
Max. Negotiated Rate	$7,061.60
Rate for Payer: Cash Price	$4,368.00
Rate for Payer: Health Management Network Commercial	$6,188.00
Rate for Payer: MDX Hawaii PPO	$7,061.60

HC EP RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR

Facility

$7,280.00

Service Code	HCPCS 33223
Hospital Charge Code	3613322301
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,061.60
Rate for Payer: AlohaCare Medicaid	$2,437.45
Rate for Payer: AlohaCare Medicare	$2,437.45
Rate for Payer: Cash Price	$4,368.00
Rate for Payer: Cash Price	$4,368.00
Rate for Payer: Cash Price	$4,368.00
Rate for Payer: Devoted Health Medicare	$2,681.20
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,437.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$6,188.00
Rate for Payer: Humana Medicare	$2,437.45
Rate for Payer: Kaiser Permanente Commercial	$4,586.40
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,437.45
Rate for Payer: MDX Hawaii PPO	$7,061.60
Rate for Payer: Ohana Health Plan Medicaid	$2,681.20
Rate for Payer: Ohana Health Plan Medicare	$2,437.45
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,437.45
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC EP RELOCATION OF SKIN POCKET FOR PACEMAKER

Facility

$7,280.00

Service Code	HCPCS 33222
Hospital Charge Code	3613322201
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,061.60
Rate for Payer: AlohaCare Medicaid	$2,437.45
Rate for Payer: AlohaCare Medicare	$2,437.45
Rate for Payer: Cash Price	$4,368.00
Rate for Payer: Cash Price	$4,368.00
Rate for Payer: Cash Price	$4,368.00
Rate for Payer: Devoted Health Medicare	$2,681.20
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,437.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$6,188.00
Rate for Payer: Humana Medicare	$2,437.45
Rate for Payer: Kaiser Permanente Commercial	$4,586.40
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,437.45
Rate for Payer: MDX Hawaii PPO	$7,061.60
Rate for Payer: Ohana Health Plan Medicaid	$2,681.20
Rate for Payer: Ohana Health Plan Medicare	$2,437.45
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,437.45
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC EP RELOCATION OF SKIN POCKET FOR PACEMAKER

Facility

$7,280.00

Service Code	HCPCS 33222
Hospital Charge Code	3613322201
Hospital Revenue Code	361
Min. Negotiated Rate	$6,188.00
Max. Negotiated Rate	$7,061.60
Rate for Payer: Cash Price	$4,368.00
Rate for Payer: Health Management Network Commercial	$6,188.00
Rate for Payer: MDX Hawaii PPO	$7,061.60

HC EP REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD

Facility

$32,935.00

Service Code	HCPCS 33227
Hospital Charge Code	3613322701
Hospital Revenue Code	361
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$31,946.95
Rate for Payer: AlohaCare Medicaid	$9,776.09
Rate for Payer: AlohaCare Medicare	$9,776.09
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Cash Price	$19,761.00
Rate for Payer: Devoted Health Medicare	$10,753.70
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$9,776.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$27,994.75
Rate for Payer: Humana Medicare	$9,776.09
Rate for Payer: Kaiser Permanente Commercial	$20,749.05
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$9,776.09
Rate for Payer: MDX Hawaii PPO	$31,946.95
Rate for Payer: Ohana Health Plan Medicaid	$10,753.70
Rate for Payer: Ohana Health Plan Medicare	$9,776.09
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$9,776.09
Rate for Payer: University Health Alliance Commercial	$24,006.32

Know your out-of-pocket cost for care.

All Charges