Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC PERQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY

Facility

$13,214.00

Service Code	HCPCS 92973
Hospital Charge Code	4819297301
Hospital Revenue Code	481
Min. Negotiated Rate	$11,231.90
Max. Negotiated Rate	$12,817.58
Rate for Payer: Cash Price	$7,928.40
Rate for Payer: Health Management Network Commercial	$11,231.90
Rate for Payer: MDX Hawaii PPO	$12,817.58

HC PERQ TRLUML CORONRY LITHOTRP

Facility

$2,205.00

Service Code	HCPCS 92972
Hospital Charge Code	4819297201
Hospital Revenue Code	481
Min. Negotiated Rate	$144.07
Max. Negotiated Rate	$2,138.85
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,094.75
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Kaiser Permanente Commercial	$1,389.15
Rate for Payer: Kaiser Permanente Medicaid	$1,124.55
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: UnitedHealthcare Medicaid	$144.07
Rate for Payer: University Health Alliance Commercial	$1,607.22

HC PERQ TRLUML CORONRY LITHOTRP

Facility

$2,205.00

Service Code	HCPCS 92972
Hospital Charge Code	4819297201
Hospital Revenue Code	481
Min. Negotiated Rate	$1,874.25
Max. Negotiated Rate	$2,138.85
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: MDX Hawaii PPO	$2,138.85

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION

Facility

$28,429.00

Service Code	HCPCS 22513
Hospital Charge Code	3612251301
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$27,576.13
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Cash Price	$17,057.40
Rate for Payer: Cash Price	$17,057.40
Rate for Payer: Cash Price	$17,057.40
Rate for Payer: Devoted Health Medicare	$9,429.30
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	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$24,164.65
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Commercial	$17,910.27
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: MDX Hawaii PPO	$27,576.13
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$20,721.90

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION

Facility

$28,429.00

Service Code	HCPCS 22513
Hospital Charge Code	3612251301
Hospital Revenue Code	361
Min. Negotiated Rate	$24,164.65
Max. Negotiated Rate	$27,576.13
Rate for Payer: Cash Price	$17,057.40
Rate for Payer: Health Management Network Commercial	$24,164.65
Rate for Payer: MDX Hawaii PPO	$27,576.13

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH

Facility

$23,670.00

Service Code	HCPCS 22515
Hospital Charge Code	3612251501
Hospital Revenue Code	361
Min. Negotiated Rate	$211.20
Max. Negotiated Rate	$22,959.90
Rate for Payer: Cash Price	$14,202.00
Rate for Payer: Cash Price	$14,202.00
Rate for Payer: Cash Price	$14,202.00
Rate for Payer: Health Management Network Commercial	$20,119.50
Rate for Payer: Kaiser Permanente Commercial	$14,912.10
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$22,959.90
Rate for Payer: UnitedHealthcare Medicaid	$211.20
Rate for Payer: University Health Alliance Commercial	$17,253.06

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH

Facility

$23,670.00

Service Code	HCPCS 22515
Hospital Charge Code	3612251501
Hospital Revenue Code	361
Min. Negotiated Rate	$20,119.50
Max. Negotiated Rate	$22,959.90
Rate for Payer: Cash Price	$14,202.00
Rate for Payer: Health Management Network Commercial	$20,119.50
Rate for Payer: MDX Hawaii PPO	$22,959.90

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR

Facility

$28,429.00

Service Code	HCPCS 22514
Hospital Charge Code	3612251401
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$27,576.13
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Cash Price	$17,057.40
Rate for Payer: Cash Price	$17,057.40
Rate for Payer: Cash Price	$17,057.40
Rate for Payer: Devoted Health Medicare	$9,429.30
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	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$24,164.65
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Commercial	$17,910.27
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: MDX Hawaii PPO	$27,576.13
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$13,923.44

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR

Facility

$28,429.00

Service Code	HCPCS 22514
Hospital Charge Code	3612251401
Hospital Revenue Code	361
Min. Negotiated Rate	$24,164.65
Max. Negotiated Rate	$27,576.13
Rate for Payer: Cash Price	$17,057.40
Rate for Payer: Health Management Network Commercial	$24,164.65
Rate for Payer: MDX Hawaii PPO	$27,576.13

HC PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL

Facility

$12,912.00

Service Code	HCPCS 22511
Hospital Charge Code	3612251101
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,778.00
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Devoted Health Medicare	$4,251.90
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	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$10,975.20
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Commercial	$8,134.56
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: MDX Hawaii PPO	$12,524.64
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$9,411.56

HC PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL

Facility

$12,912.00

Service Code	HCPCS 22511
Hospital Charge Code	3612251101
Hospital Revenue Code	361
Min. Negotiated Rate	$10,975.20
Max. Negotiated Rate	$12,524.64
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Health Management Network Commercial	$10,975.20
Rate for Payer: MDX Hawaii PPO	$12,524.64

HC PET MYOCARDIAL METABOLIC EVAL

Facility

$5,087.00

Service Code	HCPCS 78459
Hospital Charge Code	3417845901
Hospital Revenue Code	341
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$4,934.39
Rate for Payer: AlohaCare Medicaid	$1,529.43
Rate for Payer: AlohaCare Medicare	$1,529.43
Rate for Payer: Cash Price	$3,052.20
Rate for Payer: Cash Price	$3,052.20
Rate for Payer: Devoted Health Medicare	$1,682.37
Rate for Payer: Hawaii Medical Service Association ABD	$1,495.20
Rate for Payer: Hawaii Medical Service Association Commercial	$1,911.79
Rate for Payer: Hawaii Medical Service Association Medicare	$1,529.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,779.65
Rate for Payer: Hawaii Western Management Group Commercial	$1,529.43
Rate for Payer: Health Management Network Commercial	$4,323.95
Rate for Payer: Humana Medicare	$1,529.43
Rate for Payer: Kaiser Permanente Commercial	$3,204.81
Rate for Payer: Kaiser Permanente Medicaid	$2,594.37
Rate for Payer: Kaiser Permanente Medicare	$1,529.43
Rate for Payer: MDX Hawaii PPO	$4,934.39
Rate for Payer: Ohana Health Plan Medicaid	$1,682.37
Rate for Payer: Ohana Health Plan Medicare	$1,529.43
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: UnitedHealthcare Medicare	$1,529.43
Rate for Payer: University Health Alliance Commercial	$3,707.91

HC PET MYOCARDIAL METABOLIC EVAL

Facility

$5,087.00

Service Code	HCPCS 78459
Hospital Charge Code	3417845901
Hospital Revenue Code	341
Min. Negotiated Rate	$4,323.95
Max. Negotiated Rate	$4,934.39
Rate for Payer: Cash Price	$3,052.20
Rate for Payer: Health Management Network Commercial	$4,323.95
Rate for Payer: MDX Hawaii PPO	$4,934.39

HC P-FNA W/CT GUIDANCE

Facility

$3,500.00

Service Code	HCPCS 10009
Hospital Charge Code	3501000901
Hospital Revenue Code	350
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Devoted Health Medicare	$920.21
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	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,325.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$2,205.00
Rate for Payer: Kaiser Permanente Medicaid	$1,785.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$3,395.00
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	$4,035.20

HC P-FNA W/CT GUIDANCE

Facility

$3,500.00

Service Code	HCPCS 10009
Hospital Charge Code	3501000901
Hospital Revenue Code	350
Min. Negotiated Rate	$2,975.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: MDX Hawaii PPO	$3,395.00

HC P-FNA W/US GDN ADDL LESION

Facility

$1,420.00

Service Code	HCPCS 10006
Hospital Charge Code	4021000601
Hospital Revenue Code	402
Min. Negotiated Rate	$49.69
Max. Negotiated Rate	$1,377.40
Rate for Payer: Cash Price	$852.00
Rate for Payer: Cash Price	$852.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,349.00
Rate for Payer: Health Management Network Commercial	$1,207.00
Rate for Payer: Kaiser Permanente Commercial	$894.60
Rate for Payer: Kaiser Permanente Medicaid	$724.20
Rate for Payer: MDX Hawaii PPO	$1,377.40
Rate for Payer: UnitedHealthcare Medicaid	$49.69
Rate for Payer: University Health Alliance Commercial	$1,035.04

HC P-FNA W/US GDN ADDL LESION

Facility

$1,420.00

Service Code	HCPCS 10006
Hospital Charge Code	4021000601
Hospital Revenue Code	402
Min. Negotiated Rate	$1,207.00
Max. Negotiated Rate	$1,377.40
Rate for Payer: Cash Price	$852.00
Rate for Payer: Health Management Network Commercial	$1,207.00
Rate for Payer: MDX Hawaii PPO	$1,377.40

HC P-FNA W/US GUIDANCE

Facility

$3,500.00

Service Code	HCPCS 10005
Hospital Charge Code	4021000501
Hospital Revenue Code	402
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,395.00
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Devoted Health Medicare	$920.21
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	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,325.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$2,205.00
Rate for Payer: Kaiser Permanente Medicaid	$1,785.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$3,395.00
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	$2,551.15

HC P-FNA W/US GUIDANCE

Facility

$3,500.00

Service Code	HCPCS 10005
Hospital Charge Code	4021000501
Hospital Revenue Code	402
Min. Negotiated Rate	$2,975.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: MDX Hawaii PPO	$3,395.00

HC PHASE TWO TIME - EACH INCREMENTAL 1 MINUTE

Facility

$17.00

Hospital Charge Code	7100000010
Hospital Revenue Code	710
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: University Health Alliance Commercial	$12.39

HC PHASE TWO TIME - EACH INCREMENTAL 1 MINUTE

Facility

$17.00

Hospital Charge Code	7100000010
Hospital Revenue Code	710
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: MDX Hawaii PPO	$16.49

HC PHASE TWO TIME - INITIAL BASE CHARGE

Facility

$230.00

Hospital Charge Code	7100000009
Hospital Revenue Code	710
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$138.00
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: MDX Hawaii PPO	$223.10

HC PHASE TWO TIME - INITIAL BASE CHARGE

Facility

$230.00

Hospital Charge Code	7100000009
Hospital Revenue Code	710
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$138.00
Rate for Payer: Hawaii Western Management Group Commercial	$218.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: University Health Alliance Commercial	$167.65

HC PH BODY FLUID NOS - PH BODY FLUID

Facility

$30.00

Service Code	HCPCS 83986
Hospital Charge Code	3018398601
Hospital Revenue Code	301
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$3.58
Rate for Payer: AlohaCare Medicare	$3.58
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Devoted Health Medicare	$3.94
Rate for Payer: Hawaii Medical Service Association ABD	$4.95
Rate for Payer: Hawaii Medical Service Association Commercial	$4.47
Rate for Payer: Hawaii Medical Service Association Medicare	$3.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.20
Rate for Payer: Hawaii Western Management Group Commercial	$3.58
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$3.58
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$3.58
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$3.94
Rate for Payer: Ohana Health Plan Medicare	$3.58
Rate for Payer: UnitedHealthcare Medicaid	$4.95
Rate for Payer: UnitedHealthcare Medicare	$3.58
Rate for Payer: University Health Alliance Commercial	$9.25

HC PH BODY FLUID NOS - PH BODY FLUID

Facility

$30.00

Service Code	HCPCS 83986
Hospital Charge Code	3018398601
Hospital Revenue Code	301
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

Know your out-of-pocket cost for care.

All Charges