Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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	$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 LT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372507
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 IV CONT LT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372507
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 RT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372505
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 IV CONT RT

Facility

$1,204.00

Service Code	HCPCS 73725
Hospital Charge Code	6167372505
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, NECK, COMBO - MR NECK ANGIO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 70549
Hospital Charge Code	6157054901
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, NECK, COMBO - MR NECK ANGIO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 70549
Hospital Charge Code	6157054901
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, NECK - MR NECK ANGIO WO IV CONTRAST

Facility

$1,203.00

Service Code	HCPCS 70547
Hospital Charge Code	6157054701
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	$820.99

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

Facility

$1,203.00

Service Code	HCPCS 70547
Hospital Charge Code	6157054701
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 PELVIS(MRA) - MR PELVIS ANGIO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 72198
Hospital Charge Code	6147219802
Hospital Revenue Code	614
Min. Negotiated Rate	$326.65
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	$326.65
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	$326.65
Rate for Payer: University Health Alliance Commercial	$987.38

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

Facility

$1,776.00

Service Code	HCPCS 72198
Hospital Charge Code	6147219802
Hospital Revenue Code	614
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 PELVIS(MRA) - MR PELVIS ANGIO W IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 72198
Hospital Charge Code	6147219801
Hospital Revenue Code	614
Min. Negotiated Rate	$326.65
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	$326.65
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	$326.65
Rate for Payer: University Health Alliance Commercial	$987.38

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

Facility

$1,776.00

Service Code	HCPCS 72198
Hospital Charge Code	6147219801
Hospital Revenue Code	614
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 SPINE (MRA) - MR SPINE ANGIO W AND WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 72159
Hospital Charge Code	6187215901
Hospital Revenue Code	618
Min. Negotiated Rate	$190.44
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 Non-ABD	$445.02
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	$190.44
Rate for Payer: University Health Alliance Commercial	$819.53

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

Facility

$1,776.00

Service Code	HCPCS 72159
Hospital Charge Code	6187215901
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 SPINE (MRA) - MR SPINE ANGIO W IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 72159
Hospital Charge Code	6187215902
Hospital Revenue Code	618
Min. Negotiated Rate	$190.44
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 Non-ABD	$445.02
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	$190.44
Rate for Payer: University Health Alliance Commercial	$819.53

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

Facility

$1,776.00

Service Code	HCPCS 72159
Hospital Charge Code	6187215902
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 UPPER EXTREM - MR UPPER EXTREMITY ANGIO W IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 73225
Hospital Charge Code	6187322504
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 UPPER EXTREM - MR UPPER EXTREMITY ANGIO W IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 73225
Hospital Charge Code	6187322504
Hospital Revenue Code	618
Min. Negotiated Rate	$182.68
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 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	$182.68
Rate for Payer: University Health Alliance Commercial	$1,317.77

HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 73225
Hospital Charge Code	6187322508
Hospital Revenue Code	618
Min. Negotiated Rate	$182.68
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 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	$182.68
Rate for Payer: University Health Alliance Commercial	$1,317.77

HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 73225
Hospital Charge Code	6187322508
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 UPPER EXTREM - MR UPPER EXTREMITY ANGIO W/WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 73225
Hospital Charge Code	6187322501
Hospital Revenue Code	618
Min. Negotiated Rate	$182.68
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 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	$182.68
Rate for Payer: University Health Alliance Commercial	$1,317.77

HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO W/WO IV CONTRAST

Facility

$1,776.00

Service Code	HCPCS 73225
Hospital Charge Code	6187322501
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 MRI, ABDOMEN, COMBO - MRI ABDOMEN W WO CONTRAST

Facility

$1,776.00

Service Code	HCPCS 74183
Hospital Charge Code	6107418303
Hospital Revenue Code	610
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 MRI, ABDOMEN, COMBO - MRI ABDOMEN W WO CONTRAST

Facility

$1,776.00

Service Code	HCPCS 74183
Hospital Charge Code	6107418303
Hospital Revenue Code	610
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	$709.06
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	$882.31
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	$709.06
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,294.91

Know your out-of-pocket cost for care.

All Charges