Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC REVSC EVASC IVT ST PLMT UNI SF LES EA ADDL VSL

Facility

$15,143.00

Service Code	HCPCS 37259
Hospital Charge Code	4813725901
Hospital Revenue Code	481
Min. Negotiated Rate	$7,722.93
Max. Negotiated Rate	$14,688.71
Rate for Payer: Cash Price	$9,085.80
Rate for Payer: Hawaii Western Management Group Commercial	$14,385.85
Rate for Payer: Health Management Network Commercial	$12,871.55
Rate for Payer: Kaiser Permanente Commercial	$9,540.09
Rate for Payer: Kaiser Permanente Medicaid	$7,722.93
Rate for Payer: MDX Hawaii PPO	$14,688.71
Rate for Payer: University Health Alliance Commercial	$11,037.73

HC REVSC EVASC IVT ST PLMT UNI SF LES EA ADDL VSL

Facility

$15,143.00

Service Code	HCPCS 37259
Hospital Charge Code	4813725901
Hospital Revenue Code	481
Min. Negotiated Rate	$12,871.55
Max. Negotiated Rate	$14,688.71
Rate for Payer: Cash Price	$9,085.80
Rate for Payer: Health Management Network Commercial	$12,871.55
Rate for Payer: MDX Hawaii PPO	$14,688.71

HC REVSC EVASC TPVT ANGIOP UNI CPLX LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37282
Hospital Charge Code	4813728201
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$38,554.59
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
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	$37,759.65
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$25,040.61
Rate for Payer: Kaiser Permanente Medicaid	$20,270.97
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$38,554.59
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	$28,971.59

HC REVSC EVASC TPVT ANGIOP UNI CPLX LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37282
Hospital Charge Code	4813728201
Hospital Revenue Code	481
Min. Negotiated Rate	$33,784.95
Max. Negotiated Rate	$38,554.59
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: MDX Hawaii PPO	$38,554.59

HC REVSC EVASC TPVT ANGIOP UNI CPLX LES EA ADDL VSL

Facility

$15,143.00

Service Code	HCPCS 37283
Hospital Charge Code	4813728301
Hospital Revenue Code	481
Min. Negotiated Rate	$7,722.93
Max. Negotiated Rate	$14,688.71
Rate for Payer: Cash Price	$9,085.80
Rate for Payer: Hawaii Western Management Group Commercial	$14,385.85
Rate for Payer: Health Management Network Commercial	$12,871.55
Rate for Payer: Kaiser Permanente Commercial	$9,540.09
Rate for Payer: Kaiser Permanente Medicaid	$7,722.93
Rate for Payer: MDX Hawaii PPO	$14,688.71
Rate for Payer: University Health Alliance Commercial	$11,037.73

HC REVSC EVASC TPVT ANGIOP UNI CPLX LES EA ADDL VSL

Facility

$15,143.00

Service Code	HCPCS 37283
Hospital Charge Code	4813728301
Hospital Revenue Code	481
Min. Negotiated Rate	$12,871.55
Max. Negotiated Rate	$14,688.71
Rate for Payer: Cash Price	$9,085.80
Rate for Payer: Health Management Network Commercial	$12,871.55
Rate for Payer: MDX Hawaii PPO	$14,688.71

HC REVSC EVASC TPVT ANGIOP UNI SF LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37280
Hospital Charge Code	4813728001
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$38,554.59
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
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	$37,759.65
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$25,040.61
Rate for Payer: Kaiser Permanente Medicaid	$20,270.97
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$38,554.59
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	$28,971.59

HC REVSC EVASC TPVT ANGIOP UNI SF LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37280
Hospital Charge Code	4813728001
Hospital Revenue Code	481
Min. Negotiated Rate	$33,784.95
Max. Negotiated Rate	$38,554.59
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: MDX Hawaii PPO	$38,554.59

HC REVSC EVASC TPVT ANGIOP UNI SF LES EA ADDL VSL

Facility

$15,143.00

Service Code	HCPCS 37281
Hospital Charge Code	4813728101
Hospital Revenue Code	481
Min. Negotiated Rate	$12,871.55
Max. Negotiated Rate	$14,688.71
Rate for Payer: Cash Price	$9,085.80
Rate for Payer: Health Management Network Commercial	$12,871.55
Rate for Payer: MDX Hawaii PPO	$14,688.71

HC REVSC EVASC TPVT ANGIOP UNI SF LES EA ADDL VSL

Facility

$15,143.00

Service Code	HCPCS 37281
Hospital Charge Code	4813728101
Hospital Revenue Code	481
Min. Negotiated Rate	$7,722.93
Max. Negotiated Rate	$14,688.71
Rate for Payer: Cash Price	$9,085.80
Rate for Payer: Hawaii Western Management Group Commercial	$14,385.85
Rate for Payer: Health Management Network Commercial	$12,871.55
Rate for Payer: Kaiser Permanente Commercial	$9,540.09
Rate for Payer: Kaiser Permanente Medicaid	$7,722.93
Rate for Payer: MDX Hawaii PPO	$14,688.71
Rate for Payer: University Health Alliance Commercial	$11,037.73

HC REVSC EVASC TPVT ATHRC UNI CPLX LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37290
Hospital Charge Code	4813729001
Hospital Revenue Code	481
Min. Negotiated Rate	$53,648.60
Max. Negotiated Rate	$61,222.52
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: MDX Hawaii PPO	$61,222.52

HC REVSC EVASC TPVT ATHRC UNI CPLX LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37290
Hospital Charge Code	4813729001
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$61,222.52
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
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	$59,960.20
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Commercial	$39,763.08
Rate for Payer: Kaiser Permanente Medicaid	$32,189.16
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: MDX Hawaii PPO	$61,222.52
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	$46,005.25

HC REVSC EVASC TPVT ATHRC UNI SF LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37288
Hospital Charge Code	4813728801
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$61,222.52
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
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	$59,960.20
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Commercial	$39,763.08
Rate for Payer: Kaiser Permanente Medicaid	$32,189.16
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: MDX Hawaii PPO	$61,222.52
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	$46,005.25

HC REVSC EVASC TPVT ATHRC UNI SF LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37288
Hospital Charge Code	4813728801
Hospital Revenue Code	481
Min. Negotiated Rate	$53,648.60
Max. Negotiated Rate	$61,222.52
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: MDX Hawaii PPO	$61,222.52

HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR - RA QUANT

Facility

$48.00

Service Code	HCPCS 86431
Hospital Charge Code	3028643101
Hospital Revenue Code	302
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$5.67
Rate for Payer: AlohaCare Medicare	$5.67
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Devoted Health Medicare	$6.24
Rate for Payer: Hawaii Medical Service Association ABD	$7.85
Rate for Payer: Hawaii Medical Service Association Commercial	$7.09
Rate for Payer: Hawaii Medical Service Association Medicare	$5.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.24
Rate for Payer: Hawaii Western Management Group Commercial	$5.67
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$5.67
Rate for Payer: Kaiser Permanente Commercial	$30.24
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$5.67
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$6.24
Rate for Payer: Ohana Health Plan Medicare	$5.67
Rate for Payer: UnitedHealthcare Medicaid	$7.85
Rate for Payer: UnitedHealthcare Medicare	$5.67
Rate for Payer: University Health Alliance Commercial	$14.67

HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR - RA QUANT

Facility

$48.00

Service Code	HCPCS 86431
Hospital Charge Code	3028643101
Hospital Revenue Code	302
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: MDX Hawaii PPO	$46.56

HC RH PHENOTYPING COMPL SO

Facility

$389.00

Service Code	HCPCS 86906
Hospital Charge Code	3008690601
Hospital Revenue Code	300
Min. Negotiated Rate	$330.65
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$233.40
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: MDX Hawaii PPO	$377.33

HC RH PHENOTYPING COMPL SO

Facility

$389.00

Service Code	HCPCS 86906
Hospital Charge Code	3008690601
Hospital Revenue Code	300
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$377.33
Rate for Payer: AlohaCare Medicaid	$7.75
Rate for Payer: AlohaCare Medicare	$7.75
Rate for Payer: Cash Price	$233.40
Rate for Payer: Cash Price	$233.40
Rate for Payer: Devoted Health Medicare	$8.53
Rate for Payer: Hawaii Medical Service Association ABD	$10.71
Rate for Payer: Hawaii Medical Service Association Commercial	$9.69
Rate for Payer: Hawaii Medical Service Association Medicare	$7.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.25
Rate for Payer: Hawaii Western Management Group Commercial	$7.75
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: Humana Medicare	$7.75
Rate for Payer: Kaiser Permanente Commercial	$245.07
Rate for Payer: Kaiser Permanente Medicaid	$198.39
Rate for Payer: Kaiser Permanente Medicare	$7.75
Rate for Payer: MDX Hawaii PPO	$377.33
Rate for Payer: Ohana Health Plan Medicaid	$8.53
Rate for Payer: Ohana Health Plan Medicare	$7.75
Rate for Payer: UnitedHealthcare Medicaid	$10.71
Rate for Payer: UnitedHealthcare Medicare	$7.75
Rate for Payer: University Health Alliance Commercial	$20.04

HC RIA NONANTIBODY

Facility

$154.00

Service Code	HCPCS 83519
Hospital Charge Code	3018351904
Hospital Revenue Code	301
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 RIA NONANTIBODY

Facility

$154.00

Service Code	HCPCS 83519
Hospital Charge Code	3018351904
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$18.40
Rate for Payer: AlohaCare Medicare	$18.40
Rate for Payer: Cash Price	$92.40
Rate for Payer: Cash Price	$92.40
Rate for Payer: Devoted Health Medicare	$20.24
Rate for Payer: Hawaii Medical Service Association ABD	$18.67
Rate for Payer: Hawaii Medical Service Association Commercial	$23.00
Rate for Payer: Hawaii Medical Service Association Medicare	$18.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.60
Rate for Payer: Hawaii Western Management Group Commercial	$18.40
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$18.40
Rate for Payer: Kaiser Permanente Commercial	$97.02
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$18.40
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$20.24
Rate for Payer: Ohana Health Plan Medicare	$18.40
Rate for Payer: UnitedHealthcare Medicaid	$18.67
Rate for Payer: UnitedHealthcare Medicare	$18.40
Rate for Payer: University Health Alliance Commercial	$34.93

HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I

Facility

$16,000.00

Service Code	HCPCS 93461
Hospital Charge Code	4819346101
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$15,520.00
Rate for Payer: AlohaCare Medicaid	$3,829.84
Rate for Payer: AlohaCare Medicare	$3,829.84
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Devoted Health Medicare	$4,212.82
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,395.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,829.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Hawaii Western Management Group Commercial	$15,200.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: Humana Medicare	$3,829.84
Rate for Payer: Kaiser Permanente Commercial	$10,080.00
Rate for Payer: Kaiser Permanente Medicaid	$8,160.00
Rate for Payer: Kaiser Permanente Medicare	$3,829.84
Rate for Payer: MDX Hawaii PPO	$15,520.00
Rate for Payer: Ohana Health Plan Medicaid	$4,212.82
Rate for Payer: Ohana Health Plan Medicare	$3,829.84
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$3,829.84
Rate for Payer: University Health Alliance Commercial	$11,662.40

HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I

Facility

$16,000.00

Service Code	HCPCS 93461
Hospital Charge Code	4819346101
Hospital Revenue Code	481
Min. Negotiated Rate	$13,600.00
Max. Negotiated Rate	$15,520.00
Rate for Payer: Cash Price	$9,600.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: MDX Hawaii PPO	$15,520.00

HC RMVAL SUBQ CARDIACRHYT MONITOR

Facility

$2,800.00

Service Code	HCPCS 33286
Hospital Charge Code	3613328601
Hospital Revenue Code	361
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	$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	$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: 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	$4,035.20

HC RMVAL SUBQ CARDIACRHYT MONITOR

Facility

$2,800.00

Service Code	HCPCS 33286
Hospital Charge Code	3613328601
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 RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH

Facility

$7,982.00

Service Code	HCPCS 50387
Hospital Charge Code	3615038701
Hospital Revenue Code	361
Min. Negotiated Rate	$6,784.70
Max. Negotiated Rate	$7,742.54
Rate for Payer: Cash Price	$4,789.20
Rate for Payer: Health Management Network Commercial	$6,784.70
Rate for Payer: MDX Hawaii PPO	$7,742.54

Know your out-of-pocket cost for care.

All Charges