Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC MR ANGIO ABDOMEN (MRA) - MR ABDOMEN ANGIO W IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 74185
Hospital Charge Code	6187418502
Hospital Revenue Code	618
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,687.20
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$987.38

HC MR ANGIO ABDOMEN (MRA) - MR ABDOMEN ANGIO W IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 74185
Hospital Charge Code	6187418502
Hospital Revenue Code	618
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC MR ANGIO CHEST (MRA) - MR CHEST ANGIO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 71555
Hospital Charge Code	6187155502
Hospital Revenue Code	618
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,687.20
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.97

HC MR ANGIO CHEST (MRA) - MR CHEST ANGIO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 71555
Hospital Charge Code	6187155502
Hospital Revenue Code	618
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC MR ANGIO CHEST (MRA) - MR CHEST ANGIO W IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 71555
Hospital Charge Code	6187155501
Hospital Revenue Code	618
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,687.20
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.97

HC MR ANGIO CHEST (MRA) - MR CHEST ANGIO W IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 71555
Hospital Charge Code	6187155501
Hospital Revenue Code	618
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC MR ANGIO CHEST (MRA) - MR CHEST ANGIO WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 71555
Hospital Charge Code	6187155503
Hospital Revenue Code	618
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,687.20
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.97

HC MR ANGIO CHEST (MRA) - MR CHEST ANGIO WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 71555
Hospital Charge Code	6187155503
Hospital Revenue Code	618
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC MR ANGIO, HEAD, COMBO - MR HEAD ANGIO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 70546
Hospital Charge Code	6157054601
Hospital Revenue Code	615
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$634.35
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$789.35
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$634.35
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,259.74

HC MR ANGIO, HEAD, COMBO - MR HEAD ANGIO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 70546
Hospital Charge Code	6157054601
Hospital Revenue Code	615
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC MR ANGIO, HEAD - MR HEAD ANGIO WO IV CONTRAST

Facility

$1,203.00

Service Code	HCPCS 70544
Hospital Charge Code	6157054401
Hospital Revenue Code	615
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$1,166.91
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$721.80
Rate for Payer: Cash Price	$721.80
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$322.35
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$757.89
Rate for Payer: Kaiser Permanente Medicaid	$613.53
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,166.91
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$322.35
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$821.79

HC MR ANGIO, HEAD - MR HEAD ANGIO WO IV CONTRAST

Facility

$1,203.00

Service Code	HCPCS 70544
Hospital Charge Code	6157054401
Hospital Revenue Code	615
Min. Negotiated Rate	$1,022.55
Max. Negotiated Rate	$1,166.91
Rate for Payer: Cash Price	$721.80
Rate for Payer: Health Management Network Commercial	$1,022.55
Rate for Payer: MDX Hawaii PPO	$1,166.91

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO BI WO IV CONT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372503
Hospital Revenue Code	616
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.80
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: Kaiser Permanente Commercial	$758.52
Rate for Payer: Kaiser Permanente Medicaid	$614.04
Rate for Payer: MDX Hawaii PPO	$1,167.88
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO BI WO IV CONT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372503
Hospital Revenue Code	616
Min. Negotiated Rate	$1,023.40
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: MDX Hawaii PPO	$1,167.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO LT WO IV CONT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372502
Hospital Revenue Code	616
Min. Negotiated Rate	$1,023.40
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: MDX Hawaii PPO	$1,167.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO LT WO IV CONT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372502
Hospital Revenue Code	616
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.80
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: Kaiser Permanente Commercial	$758.52
Rate for Payer: Kaiser Permanente Medicaid	$614.04
Rate for Payer: MDX Hawaii PPO	$1,167.88
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO RT WO IV CONT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372501
Hospital Revenue Code	616
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.80
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: Kaiser Permanente Commercial	$758.52
Rate for Payer: Kaiser Permanente Medicaid	$614.04
Rate for Payer: MDX Hawaii PPO	$1,167.88
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO RT WO IV CONT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372501
Hospital Revenue Code	616
Min. Negotiated Rate	$1,023.40
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: MDX Hawaii PPO	$1,167.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W AND WO IV CONT BI

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372509
Hospital Revenue Code	616
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.80
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: Kaiser Permanente Commercial	$758.52
Rate for Payer: Kaiser Permanente Medicaid	$614.04
Rate for Payer: MDX Hawaii PPO	$1,167.88
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W AND WO IV CONT BI

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372509
Hospital Revenue Code	616
Min. Negotiated Rate	$1,023.40
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: MDX Hawaii PPO	$1,167.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W AND WO IV CONT LT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372508
Hospital Revenue Code	616
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.80
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: Kaiser Permanente Commercial	$758.52
Rate for Payer: Kaiser Permanente Medicaid	$614.04
Rate for Payer: MDX Hawaii PPO	$1,167.88
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W AND WO IV CONT LT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372508
Hospital Revenue Code	616
Min. Negotiated Rate	$1,023.40
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: MDX Hawaii PPO	$1,167.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W AND WO IV CONT RT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372506
Hospital Revenue Code	616
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.80
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: Kaiser Permanente Commercial	$758.52
Rate for Payer: Kaiser Permanente Medicaid	$614.04
Rate for Payer: MDX Hawaii PPO	$1,167.88
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W AND WO IV CONT RT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372506
Hospital Revenue Code	616
Min. Negotiated Rate	$1,023.40
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: MDX Hawaii PPO	$1,167.88

HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W IV CONT BI

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372504
Hospital Revenue Code	616
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,167.88
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.80
Rate for Payer: Health Management Network Commercial	$1,023.40
Rate for Payer: Kaiser Permanente Commercial	$758.52
Rate for Payer: Kaiser Permanente Medicaid	$614.04
Rate for Payer: MDX Hawaii PPO	$1,167.88
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.88

Know your out-of-pocket cost for care.

All Charges