Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC PBB REPAIR EXTEN TENDON,DORSUM FINGR,EA

Facility

$6,369.00

Service Code	HCPCS 26418
Hospital Charge Code	76126418PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,089.55
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	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$6,050.55
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$4,012.47
Rate for Payer: Kaiser Permanente Medicaid	$3,248.19
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC PBB REPAIR EXTEN TENDON,DORSUM FINGR,EA

Facility

$6,369.00

Service Code	HCPCS 26418
Hospital Charge Code	76126418PB
Hospital Revenue Code	761
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC PBB REPAIR PALATE LACER <2 CM

Facility

$1,984.00

Service Code	HCPCS 42180
Hospital Charge Code	76142180PB
Hospital Revenue Code	761
Min. Negotiated Rate	$137.66
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$637.13
Rate for Payer: AlohaCare Medicare	$637.13
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Devoted Health Medicare	$700.84
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	$637.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,884.80
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: Humana Medicare	$637.13
Rate for Payer: Kaiser Permanente Commercial	$1,249.92
Rate for Payer: Kaiser Permanente Medicaid	$1,011.84
Rate for Payer: Kaiser Permanente Medicare	$637.13
Rate for Payer: MDX Hawaii PPO	$1,924.48
Rate for Payer: Ohana Health Plan Medicaid	$700.84
Rate for Payer: Ohana Health Plan Medicare	$637.13
Rate for Payer: UnitedHealthcare Medicaid	$137.66
Rate for Payer: UnitedHealthcare Medicare	$637.13
Rate for Payer: University Health Alliance Commercial	$1,446.14

HC PBB REPAIR PALATE LACER <2 CM

Facility

$1,984.00

Service Code	HCPCS 42180
Hospital Charge Code	76142180PB
Hospital Revenue Code	761
Min. Negotiated Rate	$1,686.40
Max. Negotiated Rate	$1,924.48
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: MDX Hawaii PPO	$1,924.48

HC PCI ACUTEMI+STENT DE SNGL VSL

Facility

$37,745.00

Service Code	HCPCS C9606
Hospital Charge Code	481C960601
Hospital Revenue Code	481
Min. Negotiated Rate	$19,249.95
Max. Negotiated Rate	$36,612.65
Rate for Payer: Cash Price	$22,647.00
Rate for Payer: Hawaii Western Management Group Commercial	$35,857.75
Rate for Payer: Health Management Network Commercial	$32,083.25
Rate for Payer: Kaiser Permanente Commercial	$23,779.35
Rate for Payer: Kaiser Permanente Medicaid	$19,249.95
Rate for Payer: MDX Hawaii PPO	$36,612.65
Rate for Payer: University Health Alliance Commercial	$27,512.33

HC PCI ACUTEMI+STENT DE SNGL VSL

Facility

$37,745.00

Service Code	HCPCS C9606
Hospital Charge Code	481C960601
Hospital Revenue Code	481
Min. Negotiated Rate	$32,083.25
Max. Negotiated Rate	$36,612.65
Rate for Payer: Cash Price	$22,647.00
Rate for Payer: Health Management Network Commercial	$32,083.25
Rate for Payer: MDX Hawaii PPO	$36,612.65

HC PCI BYPASS + STENT DE

Facility

$56,414.00

Service Code	HCPCS C9604
Hospital Charge Code	481C960401
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 PCI BYPASS + STENT DE

Facility

$56,414.00

Service Code	HCPCS C9604
Hospital Charge Code	481C960401
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

HC PCI BYPASS + STENT DE ADDL

Facility

$37,745.00

Service Code	HCPCS C9605
Hospital Charge Code	481C960501
Hospital Revenue Code	481
Min. Negotiated Rate	$19,249.95
Max. Negotiated Rate	$36,612.65
Rate for Payer: Cash Price	$22,647.00
Rate for Payer: Hawaii Western Management Group Commercial	$35,857.75
Rate for Payer: Health Management Network Commercial	$32,083.25
Rate for Payer: Kaiser Permanente Commercial	$23,779.35
Rate for Payer: Kaiser Permanente Medicaid	$19,249.95
Rate for Payer: MDX Hawaii PPO	$36,612.65
Rate for Payer: University Health Alliance Commercial	$27,512.33

HC PCI BYPASS + STENT DE ADDL

Facility

$37,745.00

Service Code	HCPCS C9605
Hospital Charge Code	481C960501
Hospital Revenue Code	481
Min. Negotiated Rate	$32,083.25
Max. Negotiated Rate	$36,612.65
Rate for Payer: Cash Price	$22,647.00
Rate for Payer: Health Management Network Commercial	$32,083.25
Rate for Payer: MDX Hawaii PPO	$36,612.65

HC PCI OF CTO + STENT DE

Facility

$89,326.00

Service Code	HCPCS C9607
Hospital Charge Code	481C960701
Hospital Revenue Code	481
Min. Negotiated Rate	$75,927.10
Max. Negotiated Rate	$86,646.22
Rate for Payer: Cash Price	$53,595.60
Rate for Payer: Health Management Network Commercial	$75,927.10
Rate for Payer: MDX Hawaii PPO	$86,646.22

HC PCI OF CTO + STENT DE

Facility

$89,326.00

Service Code	HCPCS C9607
Hospital Charge Code	481C960701
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$86,646.22
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Cash Price	$53,595.60
Rate for Payer: Cash Price	$53,595.60
Rate for Payer: Cash Price	$53,595.60
Rate for Payer: Devoted Health Medicare	$23,821.58
Rate for Payer: Hawaii Medical Service Association Commercial	$27,069.97
Rate for Payer: Hawaii Medical Service Association Medicare	$21,655.98
Rate for Payer: Hawaii Western Management Group Commercial	$84,859.70
Rate for Payer: Health Management Network Commercial	$75,927.10
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Commercial	$56,275.38
Rate for Payer: Kaiser Permanente Medicaid	$45,556.26
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: MDX Hawaii PPO	$86,646.22
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	$24,500.00

HC PCI OF CTO + STENT DE ADDL BR

Facility

$59,939.00

Service Code	HCPCS C9608
Hospital Charge Code	481C960801
Hospital Revenue Code	481
Min. Negotiated Rate	$50,948.15
Max. Negotiated Rate	$58,140.83
Rate for Payer: Cash Price	$35,963.40
Rate for Payer: Health Management Network Commercial	$50,948.15
Rate for Payer: MDX Hawaii PPO	$58,140.83

HC PCI OF CTO + STENT DE ADDL BR

Facility

$59,939.00

Service Code	HCPCS C9608
Hospital Charge Code	481C960801
Hospital Revenue Code	481
Min. Negotiated Rate	$30,568.89
Max. Negotiated Rate	$58,140.83
Rate for Payer: Cash Price	$35,963.40
Rate for Payer: Hawaii Western Management Group Commercial	$56,942.05
Rate for Payer: Health Management Network Commercial	$50,948.15
Rate for Payer: Kaiser Permanente Commercial	$37,761.57
Rate for Payer: Kaiser Permanente Medicaid	$30,568.89
Rate for Payer: MDX Hawaii PPO	$58,140.83
Rate for Payer: University Health Alliance Commercial	$43,689.54

HC PED ROOM DAILY

Facility

$3,125.00

Hospital Charge Code	1230000001
Hospital Revenue Code	123
Min. Negotiated Rate	$2,656.25
Max. Negotiated Rate	$7,250.00
Rate for Payer: Cash Price	$1,875.00
Rate for Payer: Cash Price	$1,875.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$2,656.25
Rate for Payer: MDX Hawaii PPO	$3,031.25
Rate for Payer: University Health Alliance Commercial	$5,923.00

HC PERC RADIOFREQ ABLATE RENAL TUMOR

Facility

$23,219.00

Service Code	HCPCS 50592
Hospital Charge Code	3615059201
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$22,522.43
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Cash Price	$13,931.40
Rate for Payer: Cash Price	$13,931.40
Rate for Payer: Cash Price	$13,931.40
Rate for Payer: Devoted Health Medicare	$7,856.03
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	$7,141.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$19,736.15
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Commercial	$14,627.97
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: MDX Hawaii PPO	$22,522.43
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85
Rate for Payer: University Health Alliance Commercial	$16,924.33

HC PERC RADIOFREQ ABLATE RENAL TUMOR

Facility

$23,219.00

Service Code	HCPCS 50592
Hospital Charge Code	3615059201
Hospital Revenue Code	361
Min. Negotiated Rate	$19,736.15
Max. Negotiated Rate	$22,522.43
Rate for Payer: Cash Price	$13,931.40
Rate for Payer: Health Management Network Commercial	$19,736.15
Rate for Payer: MDX Hawaii PPO	$22,522.43

HC PERCUT ASPIRATION VERTEBRAL DISC

Facility

$2,800.00

Service Code	HCPCS 62267
Hospital Charge Code	3616226701
Hospital Revenue Code	361
Min. Negotiated Rate	$2,380.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00

HC PERCUT ASPIRATION VERTEBRAL DISC

Facility

$2,800.00

Service Code	HCPCS 62267
Hospital Charge Code	3616226701
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$920.21
Rate for Payer: Hawaii Medical Service Association Commercial	$1,045.69
Rate for Payer: Hawaii Medical Service Association Medicare	$836.55
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55
Rate for Payer: University Health Alliance Commercial	$2,040.92

HC PERCUT BIOPSY, ABDOMINAL MASS

Facility

$6,448.00

Service Code	HCPCS 49180
Hospital Charge Code	3614918001
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,699.95

HC PERCUT BIOPSY, ABDOMINAL MASS

Facility

$6,448.00

Service Code	HCPCS 49180
Hospital Charge Code	3614918001
Hospital Revenue Code	361
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC PERCUT DRAIN/INJECT RENAL CYST

Facility

$2,800.00

Service Code	HCPCS 50390
Hospital Charge Code	3615039001
Hospital Revenue Code	361
Min. Negotiated Rate	$2,380.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00

HC PERCUT DRAIN/INJECT RENAL CYST

Facility

$2,800.00

Service Code	HCPCS 50390
Hospital Charge Code	3615039001
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$920.21
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	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55
Rate for Payer: University Health Alliance Commercial	$2,040.92

HC PERCUT MECH THROMBECTOMY, VENOUS

Facility

$45,131.00

Service Code	HCPCS 37187
Hospital Charge Code	3613718701
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$43,777.07
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$27,078.60
Rate for Payer: Cash Price	$27,078.60
Rate for Payer: Cash Price	$27,078.60
Rate for Payer: Devoted Health Medicare	$15,001.44
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	$13,637.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$38,361.35
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$28,432.53
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$43,777.07
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	$521.33
Rate for Payer: UnitedHealthcare Medicare	$13,637.67
Rate for Payer: University Health Alliance Commercial	$32,895.99

HC PERCUT MECH THROMBECTOMY, VENOUS

Facility

$45,131.00

Service Code	HCPCS 37187
Hospital Charge Code	3613718701
Hospital Revenue Code	361
Min. Negotiated Rate	$38,361.35
Max. Negotiated Rate	$43,777.07
Rate for Payer: Cash Price	$27,078.60
Rate for Payer: Health Management Network Commercial	$38,361.35
Rate for Payer: MDX Hawaii PPO	$43,777.07

Know your out-of-pocket cost for care.

All Charges