Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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

HC PLACE CATH SUBSUBSELECT ART,ABD/PEL

Facility

$1,269.00

Service Code	HCPCS 36247
Hospital Charge Code	3613624701
Hospital Revenue Code	361
Min. Negotiated Rate	$270.60
Max. Negotiated Rate	$16,700.00
Rate for Payer: Cash Price	$761.40
Rate for Payer: Cash Price	$761.40
Rate for Payer: Cash Price	$761.40
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	$1,078.65
Rate for Payer: Kaiser Permanente Commercial	$799.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$1,230.93
Rate for Payer: UnitedHealthcare Medicaid	$270.60
Rate for Payer: University Health Alliance Commercial	$16,700.00

HC PLACE CATH SUBSUBSELECT ART,ABD/PEL

Facility

$1,269.00

Service Code	HCPCS 36247
Hospital Charge Code	3613624701
Hospital Revenue Code	361
Min. Negotiated Rate	$1,078.65
Max. Negotiated Rate	$1,230.93
Rate for Payer: Cash Price	$761.40
Rate for Payer: Health Management Network Commercial	$1,078.65
Rate for Payer: MDX Hawaii PPO	$1,230.93

HC PLACE INTERST RAD THER GUIDE, INTRAABD/INTRAPELV/RETROPER,1+,PERC

Facility

$5,332.00

Service Code	HCPCS 49411
Hospital Charge Code	3614941101
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$1,635.14
Rate for Payer: AlohaCare Medicare	$1,635.14
Rate for Payer: Cash Price	$3,199.20
Rate for Payer: Cash Price	$3,199.20
Rate for Payer: Cash Price	$3,199.20
Rate for Payer: Devoted Health Medicare	$1,798.65
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	$1,635.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$4,532.20
Rate for Payer: Humana Medicare	$1,635.14
Rate for Payer: Kaiser Permanente Commercial	$3,359.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,635.14
Rate for Payer: MDX Hawaii PPO	$5,172.04
Rate for Payer: Ohana Health Plan Medicaid	$1,798.65
Rate for Payer: Ohana Health Plan Medicare	$1,635.14
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,635.14
Rate for Payer: University Health Alliance Commercial	$3,886.49

HC PLACE INTERST RAD THER GUIDE, INTRAABD/INTRAPELV/RETROPER,1+,PERC

Facility

$5,332.00

Service Code	HCPCS 49411
Hospital Charge Code	3614941101
Hospital Revenue Code	361
Min. Negotiated Rate	$4,532.20
Max. Negotiated Rate	$5,172.04
Rate for Payer: Cash Price	$3,199.20
Rate for Payer: Health Management Network Commercial	$4,532.20
Rate for Payer: MDX Hawaii PPO	$5,172.04

HC PLACEMENT NG/OG TUBE BY PHYSICIAN

Facility

$1,588.00

Service Code	HCPCS 43752
Hospital Charge Code	3614375201
Hospital Revenue Code	361
Min. Negotiated Rate	$36.91
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Devoted Health Medicare	$580.51
Rate for Payer: Hawaii Medical Service Association Commercial	$659.67
Rate for Payer: Hawaii Medical Service Association Medicare	$527.74
Rate for Payer: Health Management Network Commercial	$1,349.80
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$1,000.44
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$1,540.36
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicaid	$36.91
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$1,157.49

HC PLACEMENT NG/OG TUBE BY PHYSICIAN

Facility

$1,588.00

Service Code	HCPCS 43752
Hospital Charge Code	3614375201
Hospital Revenue Code	361
Min. Negotiated Rate	$1,349.80
Max. Negotiated Rate	$1,540.36
Rate for Payer: Cash Price	$952.80
Rate for Payer: Health Management Network Commercial	$1,349.80
Rate for Payer: MDX Hawaii PPO	$1,540.36

HC PLACE NEEDLE IN VEIN

Facility

$1,009.00

Service Code	HCPCS 36000
Hospital Charge Code	3613600001
Hospital Revenue Code	361
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$605.40
Rate for Payer: Cash Price	$605.40
Rate for Payer: Cash Price	$605.40
Rate for Payer: Health Management Network Commercial	$857.65
Rate for Payer: Kaiser Permanente Commercial	$635.67
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$978.73
Rate for Payer: UnitedHealthcare Medicaid	$7.48
Rate for Payer: University Health Alliance Commercial	$735.46

HC PLACE NEEDLE IN VEIN

Facility

$1,009.00

Service Code	HCPCS 36000
Hospital Charge Code	3613600001
Hospital Revenue Code	361
Min. Negotiated Rate	$857.65
Max. Negotiated Rate	$978.73
Rate for Payer: Cash Price	$605.40
Rate for Payer: Health Management Network Commercial	$857.65
Rate for Payer: MDX Hawaii PPO	$978.73

HC PLATELET ANTIBODIES - PLATELET ANTIBODIES

Facility

$154.00

Service Code	HCPCS 86022
Hospital Charge Code	3028602202
Hospital Revenue Code	302
Min. Negotiated Rate	$18.37
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$18.37
Rate for Payer: AlohaCare Medicare	$18.37
Rate for Payer: Cash Price	$92.40
Rate for Payer: Cash Price	$92.40
Rate for Payer: Devoted Health Medicare	$20.21
Rate for Payer: Hawaii Medical Service Association ABD	$25.38
Rate for Payer: Hawaii Medical Service Association Commercial	$22.96
Rate for Payer: Hawaii Medical Service Association Medicare	$18.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.65
Rate for Payer: Hawaii Western Management Group Commercial	$18.37
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$18.37
Rate for Payer: Kaiser Permanente Commercial	$97.02
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$18.37
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$20.21
Rate for Payer: Ohana Health Plan Medicare	$18.37
Rate for Payer: UnitedHealthcare Medicaid	$25.38
Rate for Payer: UnitedHealthcare Medicare	$18.37
Rate for Payer: University Health Alliance Commercial	$47.47

HC PLATELET ANTIBODIES - PLATELET ANTIBODIES

Facility

$154.00

Service Code	HCPCS 86022
Hospital Charge Code	3028602202
Hospital Revenue Code	302
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$92.40
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: MDX Hawaii PPO	$149.38

HC PLATELET COUNT - PLATELET COUNT

Facility

$38.00

Service Code	HCPCS 85049
Hospital Charge Code	3058504902
Hospital Revenue Code	305
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$36.86

HC PLATELET COUNT - PLATELET COUNT

Facility

$38.00

Service Code	HCPCS 85049
Hospital Charge Code	3058504902
Hospital Revenue Code	305
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$36.86
Rate for Payer: AlohaCare Medicaid	$4.48
Rate for Payer: AlohaCare Medicare	$4.48
Rate for Payer: Cash Price	$22.80
Rate for Payer: Cash Price	$22.80
Rate for Payer: Devoted Health Medicare	$4.93
Rate for Payer: Hawaii Medical Service Association ABD	$6.25
Rate for Payer: Hawaii Medical Service Association Commercial	$5.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.56
Rate for Payer: Hawaii Western Management Group Commercial	$4.48
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Humana Medicare	$4.48
Rate for Payer: Kaiser Permanente Commercial	$23.94
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: Kaiser Permanente Medicare	$4.48
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: Ohana Health Plan Medicaid	$4.93
Rate for Payer: Ohana Health Plan Medicare	$4.48
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: UnitedHealthcare Medicare	$4.48
Rate for Payer: University Health Alliance Commercial	$11.56

HC PLATELET PHER LEUKORD IRR

Facility

$9,372.00

Service Code	HCPCS P9037
Hospital Charge Code	390P903701
Hospital Revenue Code	390
Min. Negotiated Rate	$506.75
Max. Negotiated Rate	$9,090.84
Rate for Payer: AlohaCare Medicaid	$786.99
Rate for Payer: AlohaCare Medicare	$786.99
Rate for Payer: Cash Price	$5,623.20
Rate for Payer: Cash Price	$5,623.20
Rate for Payer: Devoted Health Medicare	$865.69
Rate for Payer: Hawaii Medical Service Association Commercial	$983.74
Rate for Payer: Hawaii Medical Service Association Medicare	$786.99
Rate for Payer: Hawaii Western Management Group Commercial	$8,903.40
Rate for Payer: Health Management Network Commercial	$7,966.20
Rate for Payer: Humana Medicare	$786.99
Rate for Payer: Kaiser Permanente Commercial	$5,904.36
Rate for Payer: Kaiser Permanente Medicaid	$4,779.72
Rate for Payer: Kaiser Permanente Medicare	$786.99
Rate for Payer: MDX Hawaii PPO	$9,090.84
Rate for Payer: Ohana Health Plan Medicaid	$865.69
Rate for Payer: Ohana Health Plan Medicare	$786.99
Rate for Payer: UnitedHealthcare Medicaid	$506.75
Rate for Payer: UnitedHealthcare Medicare	$786.99
Rate for Payer: University Health Alliance Commercial	$6,831.25

HC PLATELET PHER LEUKORD IRR

Facility

$9,372.00

Service Code	HCPCS P9037
Hospital Charge Code	390P903701
Hospital Revenue Code	390
Min. Negotiated Rate	$7,966.20
Max. Negotiated Rate	$9,090.84
Rate for Payer: Cash Price	$5,623.20
Rate for Payer: Health Management Network Commercial	$7,966.20
Rate for Payer: MDX Hawaii PPO	$9,090.84

HC PLATELET PHER LEUKORD IRR

Facility

$6,694.00

Service Code	HCPCS P9037
Hospital Charge Code	384P903701
Hospital Revenue Code	384
Min. Negotiated Rate	$5,689.90
Max. Negotiated Rate	$6,493.18
Rate for Payer: Cash Price	$4,016.40
Rate for Payer: Health Management Network Commercial	$5,689.90
Rate for Payer: MDX Hawaii PPO	$6,493.18

HC PLATELET PHER LEUKORD IRR

Facility

$6,694.00

Service Code	HCPCS P9037
Hospital Charge Code	384P903701
Hospital Revenue Code	384
Min. Negotiated Rate	$506.75
Max. Negotiated Rate	$6,493.18
Rate for Payer: AlohaCare Medicaid	$786.99
Rate for Payer: AlohaCare Medicare	$786.99
Rate for Payer: Cash Price	$4,016.40
Rate for Payer: Cash Price	$4,016.40
Rate for Payer: Devoted Health Medicare	$865.69
Rate for Payer: Hawaii Medical Service Association Commercial	$983.74
Rate for Payer: Hawaii Medical Service Association Medicare	$786.99
Rate for Payer: Hawaii Western Management Group Commercial	$6,359.30
Rate for Payer: Health Management Network Commercial	$5,689.90
Rate for Payer: Humana Medicare	$786.99
Rate for Payer: Kaiser Permanente Commercial	$4,217.22
Rate for Payer: Kaiser Permanente Medicaid	$3,413.94
Rate for Payer: Kaiser Permanente Medicare	$786.99
Rate for Payer: MDX Hawaii PPO	$6,493.18
Rate for Payer: Ohana Health Plan Medicaid	$865.69
Rate for Payer: Ohana Health Plan Medicare	$786.99
Rate for Payer: UnitedHealthcare Medicaid	$506.75
Rate for Payer: UnitedHealthcare Medicare	$786.99
Rate for Payer: University Health Alliance Commercial	$4,879.26

HC PLATELETPHERSIS LEUKOREDU

Facility

$6,756.00

Service Code	HCPCS P9035
Hospital Charge Code	390P903501
Hospital Revenue Code	390
Min. Negotiated Rate	$580.00
Max. Negotiated Rate	$6,553.32
Rate for Payer: AlohaCare Medicaid	$591.55
Rate for Payer: AlohaCare Medicare	$591.55
Rate for Payer: Cash Price	$4,053.60
Rate for Payer: Cash Price	$4,053.60
Rate for Payer: Devoted Health Medicare	$650.71
Rate for Payer: Hawaii Medical Service Association Commercial	$739.44
Rate for Payer: Hawaii Medical Service Association Medicare	$591.55
Rate for Payer: Hawaii Western Management Group Commercial	$6,418.20
Rate for Payer: Health Management Network Commercial	$5,742.60
Rate for Payer: Humana Medicare	$591.55
Rate for Payer: Kaiser Permanente Commercial	$4,256.28
Rate for Payer: Kaiser Permanente Medicaid	$3,445.56
Rate for Payer: Kaiser Permanente Medicare	$591.55
Rate for Payer: MDX Hawaii PPO	$6,553.32
Rate for Payer: Ohana Health Plan Medicaid	$650.71
Rate for Payer: Ohana Health Plan Medicare	$591.55
Rate for Payer: UnitedHealthcare Medicaid	$580.00
Rate for Payer: UnitedHealthcare Medicare	$591.55
Rate for Payer: University Health Alliance Commercial	$4,924.45

HC PLATELETPHERSIS LEUKOREDU

Facility

$6,756.00

Service Code	HCPCS P9035
Hospital Charge Code	390P903501
Hospital Revenue Code	390
Min. Negotiated Rate	$5,742.60
Max. Negotiated Rate	$6,553.32
Rate for Payer: Cash Price	$4,053.60
Rate for Payer: Health Management Network Commercial	$5,742.60
Rate for Payer: MDX Hawaii PPO	$6,553.32

HC PLATELETPHERSIS LEUKOREDU

Facility

$4,826.00

Service Code	HCPCS P9035
Hospital Charge Code	384P903501
Hospital Revenue Code	384
Min. Negotiated Rate	$580.00
Max. Negotiated Rate	$4,681.22
Rate for Payer: AlohaCare Medicaid	$591.55
Rate for Payer: AlohaCare Medicare	$591.55
Rate for Payer: Cash Price	$2,895.60
Rate for Payer: Cash Price	$2,895.60
Rate for Payer: Devoted Health Medicare	$650.71
Rate for Payer: Hawaii Medical Service Association Commercial	$739.44
Rate for Payer: Hawaii Medical Service Association Medicare	$591.55
Rate for Payer: Hawaii Western Management Group Commercial	$4,584.70
Rate for Payer: Health Management Network Commercial	$4,102.10
Rate for Payer: Humana Medicare	$591.55
Rate for Payer: Kaiser Permanente Commercial	$3,040.38
Rate for Payer: Kaiser Permanente Medicaid	$2,461.26
Rate for Payer: Kaiser Permanente Medicare	$591.55
Rate for Payer: MDX Hawaii PPO	$4,681.22
Rate for Payer: Ohana Health Plan Medicaid	$650.71
Rate for Payer: Ohana Health Plan Medicare	$591.55
Rate for Payer: UnitedHealthcare Medicaid	$580.00
Rate for Payer: UnitedHealthcare Medicare	$591.55
Rate for Payer: University Health Alliance Commercial	$3,517.67

HC PLATELETPHERSIS LEUKOREDU

Facility

$4,826.00

Service Code	HCPCS P9035
Hospital Charge Code	384P903501
Hospital Revenue Code	384
Min. Negotiated Rate	$4,102.10
Max. Negotiated Rate	$4,681.22
Rate for Payer: Cash Price	$2,895.60
Rate for Payer: Health Management Network Commercial	$4,102.10
Rate for Payer: MDX Hawaii PPO	$4,681.22

HC PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I

Facility

$10,190.00

Service Code	HCPCS 50432
Hospital Charge Code	3205043201
Hospital Revenue Code	320
Min. Negotiated Rate	$8,661.50
Max. Negotiated Rate	$9,884.30
Rate for Payer: Cash Price	$6,114.00
Rate for Payer: Health Management Network Commercial	$8,661.50
Rate for Payer: MDX Hawaii PPO	$9,884.30

HC PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I

Facility

$10,190.00

Service Code	HCPCS 50432
Hospital Charge Code	3205043201
Hospital Revenue Code	320
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,884.30
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Cash Price	$6,114.00
Rate for Payer: Cash Price	$6,114.00
Rate for Payer: Cash Price	$6,114.00
Rate for Payer: Devoted Health Medicare	$2,716.41
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 Medicare	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$9,680.50
Rate for Payer: Health Management Network Commercial	$8,661.50
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Commercial	$6,419.70
Rate for Payer: Kaiser Permanente Medicaid	$5,196.90
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: MDX Hawaii PPO	$9,884.30
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I

Facility

$17,158.00

Service Code	HCPCS 50433
Hospital Charge Code	3205043301
Hospital Revenue Code	320
Min. Negotiated Rate	$14,584.30
Max. Negotiated Rate	$16,643.26
Rate for Payer: Cash Price	$10,294.80
Rate for Payer: Health Management Network Commercial	$14,584.30
Rate for Payer: MDX Hawaii PPO	$16,643.26

HC PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I

Facility

$17,158.00

Service Code	HCPCS 50433
Hospital Charge Code	3205043301
Hospital Revenue Code	320
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$16,643.26
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Cash Price	$10,294.80
Rate for Payer: Cash Price	$10,294.80
Rate for Payer: Cash Price	$10,294.80
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$16,300.10
Rate for Payer: Health Management Network Commercial	$14,584.30
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Commercial	$10,809.54
Rate for Payer: Kaiser Permanente Medicaid	$8,750.58
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: MDX Hawaii PPO	$16,643.26
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$6,743.44

Know your out-of-pocket cost for care.

All Charges