Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC PHLEBOTOMY

Facility

$667.00

Service Code	HCPCS 99195
Hospital Charge Code	9409919501
Hospital Revenue Code	940
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$646.99
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$400.20
Rate for Payer: Cash Price	$400.20
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	$633.65
Rate for Payer: Health Management Network Commercial	$566.95
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$420.21
Rate for Payer: Kaiser Permanente Medicaid	$340.17
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$646.99
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$14.85
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$486.18

HC PHLEBOTOMY

Facility

$667.00

Service Code	HCPCS 99195
Hospital Charge Code	9409919501
Hospital Revenue Code	940
Min. Negotiated Rate	$566.95
Max. Negotiated Rate	$646.99
Rate for Payer: Cash Price	$400.20
Rate for Payer: Health Management Network Commercial	$566.95
Rate for Payer: MDX Hawaii PPO	$646.99

HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES

Facility

$135.00

Service Code	HCPCS 86148
Hospital Charge Code	3028614801
Hospital Revenue Code	302
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$130.95
Rate for Payer: AlohaCare Medicaid	$16.07
Rate for Payer: AlohaCare Medicare	$16.07
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Devoted Health Medicare	$17.68
Rate for Payer: Hawaii Medical Service Association ABD	$22.20
Rate for Payer: Hawaii Medical Service Association Commercial	$20.09
Rate for Payer: Hawaii Medical Service Association Medicare	$16.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.31
Rate for Payer: Hawaii Western Management Group Commercial	$16.07
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$16.07
Rate for Payer: Kaiser Permanente Commercial	$85.05
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$16.07
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$17.68
Rate for Payer: Ohana Health Plan Medicare	$16.07
Rate for Payer: UnitedHealthcare Medicaid	$22.20
Rate for Payer: UnitedHealthcare Medicare	$16.07
Rate for Payer: University Health Alliance Commercial	$41.51

HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES

Facility

$135.00

Service Code	HCPCS 86148
Hospital Charge Code	3028614801
Hospital Revenue Code	302
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: MDX Hawaii PPO	$130.95

HC P-INC DRAIN ABSC HEMATOMA

Facility

$12,912.00

Service Code	HCPCS 26990
Hospital Charge Code	3612699001
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$12,524.64
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	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$12,266.40
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	$937.50
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	$4,035.20

HC P-INC DRAIN ABSC HEMATOMA

Facility

$12,912.00

Service Code	HCPCS 26990
Hospital Charge Code	3612699001
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$12,524.64
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	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
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	$4,035.20

HC P-INC DRAIN ABSC HEMATOMA

Facility

$12,912.00

Service Code	HCPCS 26990
Hospital Charge Code	3612699001
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 P-INC DRAIN ABSC HEMATOMA

Facility

$12,912.00

Service Code	HCPCS 26990
Hospital Charge Code	3612699001
Hospital Revenue Code	450
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 PLACE CATH ADDN SUBSEL ART,ABD/PEL

Facility

$851.00

Service Code	HCPCS 36248
Hospital Charge Code	3613624801
Hospital Revenue Code	361
Min. Negotiated Rate	$723.35
Max. Negotiated Rate	$825.47
Rate for Payer: Cash Price	$510.60
Rate for Payer: Health Management Network Commercial	$723.35
Rate for Payer: MDX Hawaii PPO	$825.47

HC PLACE CATH ADDN SUBSEL ART,ABD/PEL

Facility

$851.00

Service Code	HCPCS 36248
Hospital Charge Code	3613624801
Hospital Revenue Code	361
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$510.60
Rate for Payer: Cash Price	$510.60
Rate for Payer: Cash Price	$510.60
Rate for Payer: Health Management Network Commercial	$723.35
Rate for Payer: Kaiser Permanente Commercial	$536.13
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$825.47
Rate for Payer: UnitedHealthcare Medicaid	$44.55
Rate for Payer: University Health Alliance Commercial	$620.29

HC PLACE CATH AORTA

Facility

$3,565.00

Service Code	HCPCS 36200
Hospital Charge Code	3203620001
Hospital Revenue Code	320
Min. Negotiated Rate	$143.67
Max. Negotiated Rate	$8,270.00
Rate for Payer: Cash Price	$2,139.00
Rate for Payer: Cash Price	$2,139.00
Rate for Payer: Cash Price	$2,139.00
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 Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,386.75
Rate for Payer: Health Management Network Commercial	$3,030.25
Rate for Payer: Kaiser Permanente Commercial	$2,245.95
Rate for Payer: Kaiser Permanente Medicaid	$1,818.15
Rate for Payer: MDX Hawaii PPO	$3,458.05
Rate for Payer: UnitedHealthcare Medicaid	$143.67
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC PLACE CATH AORTA

Facility

$3,565.00

Service Code	HCPCS 36200
Hospital Charge Code	3203620001
Hospital Revenue Code	320
Min. Negotiated Rate	$3,030.25
Max. Negotiated Rate	$3,458.05
Rate for Payer: Cash Price	$2,139.00
Rate for Payer: Health Management Network Commercial	$3,030.25
Rate for Payer: MDX Hawaii PPO	$3,458.05

HC PLACE CATH EXTREM ARTERY

Facility

$2,871.00

Service Code	HCPCS 36140
Hospital Charge Code	3213614001
Hospital Revenue Code	321
Min. Negotiated Rate	$89.83
Max. Negotiated Rate	$2,784.87
Rate for Payer: Cash Price	$1,722.60
Rate for Payer: Cash Price	$1,722.60
Rate for Payer: Cash Price	$1,722.60
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 Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,727.45
Rate for Payer: Health Management Network Commercial	$2,440.35
Rate for Payer: Kaiser Permanente Commercial	$1,808.73
Rate for Payer: Kaiser Permanente Medicaid	$1,464.21
Rate for Payer: MDX Hawaii PPO	$2,784.87
Rate for Payer: UnitedHealthcare Medicaid	$89.83
Rate for Payer: University Health Alliance Commercial	$2,092.67

HC PLACE CATH EXTREM ARTERY

Facility

$2,871.00

Service Code	HCPCS 36140
Hospital Charge Code	3213614001
Hospital Revenue Code	321
Min. Negotiated Rate	$2,440.35
Max. Negotiated Rate	$2,784.87
Rate for Payer: Cash Price	$1,722.60
Rate for Payer: Health Management Network Commercial	$2,440.35
Rate for Payer: MDX Hawaii PPO	$2,784.87

HC PLACE CATH IN VEIN,SELECT

Facility

$3,163.00

Service Code	HCPCS 36011
Hospital Charge Code	3613601101
Hospital Revenue Code	361
Min. Negotiated Rate	$135.35
Max. Negotiated Rate	$13,778.00
Rate for Payer: Cash Price	$1,897.80
Rate for Payer: Cash Price	$1,897.80
Rate for Payer: Cash Price	$1,897.80
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 Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$2,688.55
Rate for Payer: Kaiser Permanente Commercial	$1,992.69
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$3,068.11
Rate for Payer: UnitedHealthcare Medicaid	$135.35
Rate for Payer: University Health Alliance Commercial	$2,305.51

HC PLACE CATH IN VEIN,SELECT

Facility

$3,163.00

Service Code	HCPCS 36011
Hospital Charge Code	3613601101
Hospital Revenue Code	361
Min. Negotiated Rate	$2,688.55
Max. Negotiated Rate	$3,068.11
Rate for Payer: Cash Price	$1,897.80
Rate for Payer: Health Management Network Commercial	$2,688.55
Rate for Payer: MDX Hawaii PPO	$3,068.11

HC PLACE CATH IN VEIN,SUBSELECT

Facility

$4,907.00

Service Code	HCPCS 36012
Hospital Charge Code	3613601201
Hospital Revenue Code	361
Min. Negotiated Rate	$157.51
Max. Negotiated Rate	$13,778.00
Rate for Payer: Cash Price	$2,944.20
Rate for Payer: Cash Price	$2,944.20
Rate for Payer: Cash Price	$2,944.20
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 Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$4,170.95
Rate for Payer: Kaiser Permanente Commercial	$3,091.41
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$4,759.79
Rate for Payer: UnitedHealthcare Medicaid	$157.51
Rate for Payer: University Health Alliance Commercial	$3,576.71

HC PLACE CATH IN VEIN,SUBSELECT

Facility

$4,907.00

Service Code	HCPCS 36012
Hospital Charge Code	3613601201
Hospital Revenue Code	361
Min. Negotiated Rate	$4,170.95
Max. Negotiated Rate	$4,759.79
Rate for Payer: Cash Price	$2,944.20
Rate for Payer: Health Management Network Commercial	$4,170.95
Rate for Payer: MDX Hawaii PPO	$4,759.79

HC PLACE CATH IN VEIN,SVC,IVC

Facility

$3,266.00

Service Code	HCPCS 36010
Hospital Charge Code	3613601001
Hospital Revenue Code	361
Min. Negotiated Rate	$115.98
Max. Negotiated Rate	$8,270.00
Rate for Payer: Cash Price	$1,959.60
Rate for Payer: Cash Price	$1,959.60
Rate for Payer: Cash Price	$1,959.60
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 Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$2,776.10
Rate for Payer: Kaiser Permanente Commercial	$2,057.58
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$3,168.02
Rate for Payer: UnitedHealthcare Medicaid	$115.98
Rate for Payer: University Health Alliance Commercial	$2,380.59

HC PLACE CATH IN VEIN,SVC,IVC

Facility

$3,266.00

Service Code	HCPCS 36010
Hospital Charge Code	3613601001
Hospital Revenue Code	361
Min. Negotiated Rate	$2,776.10
Max. Negotiated Rate	$3,168.02
Rate for Payer: Cash Price	$1,959.60
Rate for Payer: Health Management Network Commercial	$2,776.10
Rate for Payer: MDX Hawaii PPO	$3,168.02

HC PLACE CATH SELECT ART,ABD/PEL

Facility

$1,016.00

Service Code	HCPCS 36245
Hospital Charge Code	3613624501
Hospital Revenue Code	361
Min. Negotiated Rate	$863.60
Max. Negotiated Rate	$985.52
Rate for Payer: Cash Price	$609.60
Rate for Payer: Health Management Network Commercial	$863.60
Rate for Payer: MDX Hawaii PPO	$985.52

HC PLACE CATH SELECT ART,ABD/PEL

Facility

$1,016.00

Service Code	HCPCS 36245
Hospital Charge Code	3613624501
Hospital Revenue Code	361
Min. Negotiated Rate	$210.20
Max. Negotiated Rate	$8,270.00
Rate for Payer: Cash Price	$609.60
Rate for Payer: Cash Price	$609.60
Rate for Payer: Cash Price	$609.60
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 Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$863.60
Rate for Payer: Kaiser Permanente Commercial	$640.08
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$985.52
Rate for Payer: UnitedHealthcare Medicaid	$210.20
Rate for Payer: University Health Alliance Commercial	$740.56

HC PLACE CATH SELECTIVE ART,NECK

Facility

$3,405.00

Service Code	HCPCS 36215
Hospital Charge Code	3613621501
Hospital Revenue Code	361
Min. Negotiated Rate	$199.40
Max. Negotiated Rate	$8,270.00
Rate for Payer: Cash Price	$2,043.00
Rate for Payer: Cash Price	$2,043.00
Rate for Payer: Cash Price	$2,043.00
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 Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$2,894.25
Rate for Payer: Kaiser Permanente Commercial	$2,145.15
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$3,302.85
Rate for Payer: UnitedHealthcare Medicaid	$199.40
Rate for Payer: University Health Alliance Commercial	$2,481.90

HC PLACE CATH SELECTIVE ART,NECK

Facility

$3,405.00

Service Code	HCPCS 36215
Hospital Charge Code	3613621501
Hospital Revenue Code	361
Min. Negotiated Rate	$2,894.25
Max. Negotiated Rate	$3,302.85
Rate for Payer: Cash Price	$2,043.00
Rate for Payer: Health Management Network Commercial	$2,894.25
Rate for Payer: MDX Hawaii PPO	$3,302.85

HC PLACE CATH SUBSELECT ART,ABD/PEL

Facility

$1,143.00

Service Code	HCPCS 36246
Hospital Charge Code	3613624601
Hospital Revenue Code	361
Min. Negotiated Rate	$971.55
Max. Negotiated Rate	$1,108.71
Rate for Payer: Cash Price	$685.80
Rate for Payer: Health Management Network Commercial	$971.55
Rate for Payer: MDX Hawaii PPO	$1,108.71

Know your out-of-pocket cost for care.

All Charges