Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC INSERT MIDLINE WO PORT >=5YRS

Facility

$7,728.00

Service Code	HCPCS 36573
Hospital Charge Code	3203657302
Hospital Revenue Code	320
Min. Negotiated Rate	$6,568.80
Max. Negotiated Rate	$7,496.16
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Health Management Network Commercial	$6,568.80
Rate for Payer: MDX Hawaii PPO	$7,496.16

HC INSERT MIDLINE WO PORT >=5YRS

Facility

$7,728.00

Service Code	HCPCS 36573
Hospital Charge Code	3203657302
Hospital Revenue Code	320
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$7,496.16
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Devoted Health Medicare	$2,045.58
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 Medicare	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$7,341.60
Rate for Payer: Health Management Network Commercial	$6,568.80
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$4,868.64
Rate for Payer: Kaiser Permanente Medicaid	$3,941.28
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$7,496.16
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$5,632.94

HC INSERT NEEDLE,INTRAOSSEOUS INFUSN

Facility

$1,588.00

Service Code	HCPCS 36680
Hospital Charge Code	7613668001
Hospital Revenue Code	761
Min. Negotiated Rate	$61.78
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Devoted Health Medicare	$580.51
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 Medicare	$527.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,508.60
Rate for Payer: Health Management Network Commercial	$1,349.80
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$1,000.44
Rate for Payer: Kaiser Permanente Medicaid	$809.88
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$1,540.36
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicaid	$61.78
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$1,157.49

HC INSERT NEEDLE,INTRAOSSEOUS INFUSN

Facility

$1,588.00

Service Code	HCPCS 36680
Hospital Charge Code	7613668001
Hospital Revenue Code	761
Min. Negotiated Rate	$1,349.80
Max. Negotiated Rate	$1,540.36
Rate for Payer: Cash Price	$952.80
Rate for Payer: Health Management Network Commercial	$1,349.80
Rate for Payer: MDX Hawaii PPO	$1,540.36

HC INSERT,NON-INDWELLING BLADDER CATHETER

Facility

$513.00

Service Code	HCPCS 51701
Hospital Charge Code	7615170101
Hospital Revenue Code	761
Min. Negotiated Rate	$19.82
Max. Negotiated Rate	$497.61
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$261.63
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$19.82
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC INSERT,NON-INDWELLING BLADDER CATHETER

Facility

$513.00

Service Code	HCPCS 51701
Hospital Charge Code	7615170101
Hospital Revenue Code	761
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC INSERT NON-TUNNEL CV CATH

Facility

$12,526.00

Service Code	HCPCS 36556
Hospital Charge Code	3613655601
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$12,150.22
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$4,103.08
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 Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,891.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$12,150.22
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$9,130.20

HC INSERT NON-TUNNEL CV CATH

Facility

$12,526.00

Service Code	HCPCS 36556
Hospital Charge Code	3613655601
Hospital Revenue Code	361
Min. Negotiated Rate	$10,647.10
Max. Negotiated Rate	$12,150.22
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: MDX Hawaii PPO	$12,150.22

HC INSERT NON-TUNNEL CV CATH < 5 Y/O

Facility

$12,526.00

Service Code	HCPCS 36555
Hospital Charge Code	7613655501
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$12,150.22
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$11,899.70
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,891.38
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$12,150.22
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$9,130.20

HC INSERT NON-TUNNEL CV CATH < 5 Y/O

Facility

$12,526.00

Service Code	HCPCS 36555
Hospital Charge Code	7613655501
Hospital Revenue Code	450
Min. Negotiated Rate	$10,647.10
Max. Negotiated Rate	$12,150.22
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: MDX Hawaii PPO	$12,150.22

HC INSERT PICC WO PORT >=5YRS

Facility

$6,182.00

Service Code	HCPCS 36573
Hospital Charge Code	4503657301
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$5,996.54
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Devoted Health Medicare	$2,045.58
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 Medicare	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$5,872.90
Rate for Payer: Health Management Network Commercial	$5,254.70
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$3,894.66
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$5,996.54
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$4,506.06

HC INSERT PICC WO PORT >=5YRS

Facility

$6,182.00

Service Code	HCPCS 36573
Hospital Charge Code	4503657301
Hospital Revenue Code	450
Min. Negotiated Rate	$5,254.70
Max. Negotiated Rate	$5,996.54
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Health Management Network Commercial	$5,254.70
Rate for Payer: MDX Hawaii PPO	$5,996.54

HC INSERT PICC WO PORT >=5YRS

Facility

$7,728.00

Service Code	HCPCS 36573
Hospital Charge Code	3203657301
Hospital Revenue Code	320
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$7,496.16
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Devoted Health Medicare	$2,045.58
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 Medicare	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$7,341.60
Rate for Payer: Health Management Network Commercial	$6,568.80
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$4,868.64
Rate for Payer: Kaiser Permanente Medicaid	$3,941.28
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$7,496.16
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$5,632.94

HC INSERT PICC WO PORT >=5YRS

Facility

$7,728.00

Service Code	HCPCS 36573
Hospital Charge Code	3203657301
Hospital Revenue Code	320
Min. Negotiated Rate	$6,568.80
Max. Negotiated Rate	$7,496.16
Rate for Payer: Cash Price	$4,636.80
Rate for Payer: Health Management Network Commercial	$6,568.80
Rate for Payer: MDX Hawaii PPO	$7,496.16

HC INSERT SUBQ CARDIAC RHYT MONIT

Facility

$41,169.00

Service Code	HCPCS 33285
Hospital Charge Code	4813328501
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$39,933.93
Rate for Payer: AlohaCare Medicaid	$9,776.09
Rate for Payer: AlohaCare Medicare	$9,776.09
Rate for Payer: Cash Price	$24,701.40
Rate for Payer: Cash Price	$24,701.40
Rate for Payer: Cash Price	$24,701.40
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: Hawaii Western Management Group Commercial	$39,110.55
Rate for Payer: Health Management Network Commercial	$34,993.65
Rate for Payer: Humana Medicare	$9,776.09
Rate for Payer: Kaiser Permanente Commercial	$25,936.47
Rate for Payer: Kaiser Permanente Medicaid	$20,996.19
Rate for Payer: Kaiser Permanente Medicare	$9,776.09
Rate for Payer: MDX Hawaii PPO	$39,933.93
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	$30,008.08

HC INSERT SUBQ CARDIAC RHYT MONIT

Facility

$41,169.00

Service Code	HCPCS 33285
Hospital Charge Code	4813328501
Hospital Revenue Code	481
Min. Negotiated Rate	$34,993.65
Max. Negotiated Rate	$39,933.93
Rate for Payer: Cash Price	$24,701.40
Rate for Payer: Health Management Network Commercial	$34,993.65
Rate for Payer: MDX Hawaii PPO	$39,933.93

HC INSERT,TEMP INDWELLING BLAD CATH,COMP

Facility

$623.00

Service Code	HCPCS 51703
Hospital Charge Code	7615170301
Hospital Revenue Code	450
Min. Negotiated Rate	$152.01
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$152.01
Rate for Payer: AlohaCare Medicare	$152.01
Rate for Payer: Cash Price	$373.80
Rate for Payer: Cash Price	$373.80
Rate for Payer: Cash Price	$373.80
Rate for Payer: Devoted Health Medicare	$167.21
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 Medicare	$152.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$591.85
Rate for Payer: Health Management Network Commercial	$529.55
Rate for Payer: Humana Medicare	$152.01
Rate for Payer: Kaiser Permanente Commercial	$392.49
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$152.01
Rate for Payer: MDX Hawaii PPO	$604.31
Rate for Payer: Ohana Health Plan Medicaid	$167.21
Rate for Payer: Ohana Health Plan Medicare	$152.01
Rate for Payer: UnitedHealthcare Medicare	$152.01
Rate for Payer: University Health Alliance Commercial	$454.10

HC INSERT,TEMP INDWELLING BLAD CATH,COMP

Facility

$623.00

Service Code	HCPCS 51703
Hospital Charge Code	7615170301
Hospital Revenue Code	450
Min. Negotiated Rate	$529.55
Max. Negotiated Rate	$604.31
Rate for Payer: Cash Price	$373.80
Rate for Payer: Health Management Network Commercial	$529.55
Rate for Payer: MDX Hawaii PPO	$604.31

HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE

Facility

$513.00

Service Code	HCPCS 51702
Hospital Charge Code	76151702PB
Hospital Revenue Code	761
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$497.61
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$261.63
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$21.90
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE

Facility

$513.00

Service Code	HCPCS 51702
Hospital Charge Code	76151702PB
Hospital Revenue Code	761
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE

Facility

$513.00

Service Code	HCPCS 51702
Hospital Charge Code	3615170201
Hospital Revenue Code	361
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$21.90
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE

Facility

$513.00

Service Code	HCPCS 51702
Hospital Charge Code	3615170201
Hospital Revenue Code	361
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT

Facility

$16,076.00

Service Code	HCPCS 37182
Hospital Charge Code	3613718201
Hospital Revenue Code	361
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$23,821.58
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Cash Price	$9,645.60
Rate for Payer: Cash Price	$9,645.60
Rate for Payer: Cash Price	$9,645.60
Rate for Payer: Devoted Health Medicare	$23,821.58
Rate for Payer: Hawaii Medical Service Association ABD	$2,102.00
Rate for Payer: Hawaii Medical Service Association Commercial	$19,192.00
Rate for Payer: Hawaii Medical Service Association Medicare	$21,655.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,561.00
Rate for Payer: Health Management Network Commercial	$13,664.60
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Commercial	$10,127.88
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: MDX Hawaii PPO	$15,593.72
Rate for Payer: Ohana Health Plan Medicaid	$23,821.58
Rate for Payer: Ohana Health Plan Medicare	$21,655.98
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$21,655.98
Rate for Payer: University Health Alliance Commercial	$11,717.80

HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT

Facility

$16,076.00

Service Code	HCPCS 37182
Hospital Charge Code	3613718201
Hospital Revenue Code	361
Min. Negotiated Rate	$13,664.60
Max. Negotiated Rate	$15,593.72
Rate for Payer: Cash Price	$9,645.60
Rate for Payer: Health Management Network Commercial	$13,664.60
Rate for Payer: MDX Hawaii PPO	$15,593.72

HC INSERT TUNNELED CV CATH WITH PORT

Facility

$12,526.00

Service Code	HCPCS 36561
Hospital Charge Code	3613656101
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,150.22
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,891.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$12,150.22
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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,743.44

Know your out-of-pocket cost for care.

All Charges