Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NEEDLE GUIDE W/COVER

Facility

$102.00

Hospital Revenue Code	272
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: MDX Hawaii PPO	$98.94

NEEDLE INJECTION THERAPY CATH

Facility

$156.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$79.56
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$93.60
Rate for Payer: Hawaii Western Management Group Commercial	$148.20
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Kaiser Permanente Commercial	$98.28
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: University Health Alliance Commercial	$113.71

NEEDLE INJECTION THERAPY CATH

Facility

$156.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: MDX Hawaii PPO	$151.32

NEEDLE INSUFF 14G

Facility

$92.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.92
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$57.96
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: University Health Alliance Commercial	$67.06

NEEDLE INSUFF 14G

Facility

$92.00

Hospital Revenue Code	272
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: MDX Hawaii PPO	$89.24

NEEDLE INSUFF 14G LONG

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$60.48
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: University Health Alliance Commercial	$69.97

NEEDLE INSUFF 14G LONG

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: MDX Hawaii PPO	$93.12

NEEDLE INTRODUCER 15G

Facility

$108.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Hawaii Western Management Group Commercial	$102.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$68.04
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: University Health Alliance Commercial	$78.72

NEEDLE INTRODUCER 15G

Facility

$108.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$104.76

NEEDLE MARROW/ASP 11GX4

Facility

$127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: MDX Hawaii PPO	$123.19

NEEDLE MARROW/ASP 11GX4

Facility

$127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.77
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$80.01
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: University Health Alliance Commercial	$92.57

NEEDLE MARROW/ASP 13GX2

Facility

$123.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.73
Max. Negotiated Rate	$119.31
Rate for Payer: Cash Price	$73.80
Rate for Payer: Hawaii Western Management Group Commercial	$116.85
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: Kaiser Permanente Commercial	$77.49
Rate for Payer: Kaiser Permanente Medicaid	$62.73
Rate for Payer: MDX Hawaii PPO	$119.31
Rate for Payer: University Health Alliance Commercial	$89.65

NEEDLE MARROW/ASP 13GX2

Facility

$123.00

Hospital Revenue Code	272
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$119.31
Rate for Payer: Cash Price	$73.80
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: MDX Hawaii PPO	$119.31

NEEDLE MARROW/ASP 13GX3.5

Facility

$92.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.92
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$57.96
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: University Health Alliance Commercial	$67.06

NEEDLE MARROW/ASP 13GX3.5

Facility

$92.00

Hospital Revenue Code	272
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: MDX Hawaii PPO	$89.24

NEEDLE SCORPION

Facility

$669.00

Hospital Revenue Code	272
Min. Negotiated Rate	$341.19
Max. Negotiated Rate	$648.93
Rate for Payer: Cash Price	$401.40
Rate for Payer: Hawaii Western Management Group Commercial	$635.55
Rate for Payer: Health Management Network Commercial	$568.65
Rate for Payer: Kaiser Permanente Commercial	$421.47
Rate for Payer: Kaiser Permanente Medicaid	$341.19
Rate for Payer: MDX Hawaii PPO	$648.93
Rate for Payer: University Health Alliance Commercial	$487.63

NEEDLE SCORPION

Facility

$669.00

Hospital Revenue Code	272
Min. Negotiated Rate	$568.65
Max. Negotiated Rate	$648.93
Rate for Payer: Cash Price	$401.40
Rate for Payer: Health Management Network Commercial	$568.65
Rate for Payer: MDX Hawaii PPO	$648.93

NEEDLE SCORPION KNEE AR-12990N

Facility

$2,048.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,740.80
Max. Negotiated Rate	$1,986.56
Rate for Payer: Cash Price	$1,228.80
Rate for Payer: Health Management Network Commercial	$1,740.80
Rate for Payer: MDX Hawaii PPO	$1,986.56

NEEDLE SCORPION KNEE AR-12990N

Facility

$2,048.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,044.48
Max. Negotiated Rate	$1,986.56
Rate for Payer: Cash Price	$1,228.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,945.60
Rate for Payer: Health Management Network Commercial	$1,740.80
Rate for Payer: Kaiser Permanente Commercial	$1,290.24
Rate for Payer: Kaiser Permanente Medicaid	$1,044.48
Rate for Payer: MDX Hawaii PPO	$1,986.56
Rate for Payer: University Health Alliance Commercial	$1,492.79

NEEDLE SPINAL 22GX3.5

Facility

$66.00

Hospital Revenue Code	272
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: MDX Hawaii PPO	$64.02

NEEDLE SPINAL 22GX3.5

Facility

$66.00

Hospital Revenue Code	272
Min. Negotiated Rate	$33.66
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$41.58
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: University Health Alliance Commercial	$48.11

NEEDLE SPINAL 25GX3.5 WHITACRE

Facility

$68.00

Hospital Revenue Code	272
Min. Negotiated Rate	$34.68
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Hawaii Western Management Group Commercial	$64.60
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: University Health Alliance Commercial	$49.57

NEEDLE SPINAL 25GX3.5 WHITACRE

Facility

$68.00

Hospital Revenue Code	272
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

NEEDLE SPINAL 27GX3.5 WHITACRE

Facility

$76.00

Hospital Revenue Code	272
Min. Negotiated Rate	$38.76
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$45.60
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$47.88
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: University Health Alliance Commercial	$55.40

NEEDLE SPINAL 27GX3.5 WHITACRE

Facility

$76.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: MDX Hawaii PPO	$73.72

Know your out-of-pocket cost for care.

All Charges