Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME

Professional

Both

$155.85

Service Code	HCPCS 99315
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$132.47
Rate for Payer: AlohaCare Medicaid	$83.54
Rate for Payer: AlohaCare Medicare	$74.63
Rate for Payer: Cash Price	$93.51
Rate for Payer: Cash Price	$93.51
Rate for Payer: Devoted Health Medicare	$82.09
Rate for Payer: Hawaii Medical Service Association Medicare	$74.63
Rate for Payer: Hawaii Western Management Group Commercial	$45.97
Rate for Payer: Health Management Network Commercial	$132.47
Rate for Payer: Kaiser Permanente Commercial	$89.56
Rate for Payer: Kaiser Permanente Medicaid	$89.56
Rate for Payer: Kaiser Permanente Medicare	$89.56
Rate for Payer: Ohana Health Plan Medicaid	$83.54
Rate for Payer: Ohana Health Plan Medicare	$74.63
Rate for Payer: UnitedHealthcare Medicaid	$83.54
Rate for Payer: UnitedHealthcare Medicare	$74.63

PR NUSHIELD 1 SQUARE CM

Professional

Both

$253.21

Service Code	HCPCS Q4160
Min. Negotiated Rate	$144.69
Max. Negotiated Rate	$215.23
Rate for Payer: AlohaCare Medicare	$144.69
Rate for Payer: Cash Price	$151.93
Rate for Payer: Cash Price	$151.93
Rate for Payer: Devoted Health Medicare	$159.16
Rate for Payer: Hawaii Medical Service Association Medicare	$144.69
Rate for Payer: Health Management Network Commercial	$215.23
Rate for Payer: Kaiser Permanente Commercial	$173.63
Rate for Payer: Kaiser Permanente Medicaid	$173.63
Rate for Payer: Kaiser Permanente Medicare	$173.63
Rate for Payer: Ohana Health Plan Medicare	$144.69
Rate for Payer: UnitedHealthcare Medicare	$144.69

PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM

Professional

Both

$4,506.00

Service Code	HCPCS 59510
Min. Negotiated Rate	$1,448.98
Max. Negotiated Rate	$3,830.10
Rate for Payer: AlohaCare Medicaid	$2,656.47
Rate for Payer: AlohaCare Medicare	$2,382.05
Rate for Payer: Cash Price	$2,703.60
Rate for Payer: Cash Price	$2,703.60
Rate for Payer: Devoted Health Medicare	$2,620.26
Rate for Payer: Hawaii Medical Service Association Medicare	$2,382.05
Rate for Payer: Hawaii Western Management Group Commercial	$1,448.98
Rate for Payer: Health Management Network Commercial	$3,830.10
Rate for Payer: Kaiser Permanente Commercial	$2,858.46
Rate for Payer: Kaiser Permanente Medicaid	$2,858.46
Rate for Payer: Kaiser Permanente Medicare	$2,858.46
Rate for Payer: Ohana Health Plan Medicaid	$2,656.47
Rate for Payer: Ohana Health Plan Medicare	$2,382.05
Rate for Payer: UnitedHealthcare Medicaid	$2,656.47
Rate for Payer: UnitedHealthcare Medicare	$2,382.05

PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM

Professional

Both

$4,089.00

Service Code	HCPCS 59400
Min. Negotiated Rate	$1,053.78
Max. Negotiated Rate	$3,475.65
Rate for Payer: AlohaCare Medicaid	$2,408.90
Rate for Payer: AlohaCare Medicare	$2,152.11
Rate for Payer: Cash Price	$2,453.40
Rate for Payer: Cash Price	$2,453.40
Rate for Payer: Devoted Health Medicare	$2,367.32
Rate for Payer: Hawaii Medical Service Association Medicare	$2,152.11
Rate for Payer: Hawaii Western Management Group Commercial	$1,053.78
Rate for Payer: Health Management Network Commercial	$3,475.65
Rate for Payer: Kaiser Permanente Commercial	$2,582.53
Rate for Payer: Kaiser Permanente Medicaid	$2,582.53
Rate for Payer: Kaiser Permanente Medicare	$2,582.53
Rate for Payer: Ohana Health Plan Medicaid	$2,408.90
Rate for Payer: Ohana Health Plan Medicare	$2,152.11
Rate for Payer: UnitedHealthcare Medicaid	$2,408.90
Rate for Payer: UnitedHealthcare Medicare	$2,152.11

PROBE ARTHROSCOPIC AR-4070-01

Facility

$1,001.00

Hospital Revenue Code	272
Min. Negotiated Rate	$510.51
Max. Negotiated Rate	$970.97
Rate for Payer: Cash Price	$600.60
Rate for Payer: Hawaii Western Management Group Commercial	$950.95
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: Kaiser Permanente Commercial	$630.63
Rate for Payer: Kaiser Permanente Medicaid	$510.51
Rate for Payer: MDX Hawaii PPO	$970.97
Rate for Payer: University Health Alliance Commercial	$729.63

PROBE ARTHROSCOPIC AR-4070-01

Facility

$1,001.00

Hospital Revenue Code	272
Min. Negotiated Rate	$850.85
Max. Negotiated Rate	$970.97
Rate for Payer: Cash Price	$600.60
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: MDX Hawaii PPO	$970.97

PROBE BIOPLAR STIMULATOR

Facility

$704.00

Hospital Revenue Code	270
Min. Negotiated Rate	$598.40
Max. Negotiated Rate	$682.88
Rate for Payer: Cash Price	$422.40
Rate for Payer: Health Management Network Commercial	$598.40
Rate for Payer: MDX Hawaii PPO	$682.88

PROBE BIOPLAR STIMULATOR

Facility

$704.00

Hospital Revenue Code	270
Min. Negotiated Rate	$359.04
Max. Negotiated Rate	$682.88
Rate for Payer: Cash Price	$422.40
Rate for Payer: Hawaii Western Management Group Commercial	$668.80
Rate for Payer: Health Management Network Commercial	$598.40
Rate for Payer: Kaiser Permanente Commercial	$443.52
Rate for Payer: Kaiser Permanente Medicaid	$359.04
Rate for Payer: MDX Hawaii PPO	$682.88
Rate for Payer: University Health Alliance Commercial	$513.15

PROBE BIPOLAR GOLD 7FR

Facility

$640.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$544.00
Max. Negotiated Rate	$620.80
Rate for Payer: Cash Price	$384.00
Rate for Payer: Health Management Network Commercial	$544.00
Rate for Payer: MDX Hawaii PPO	$620.80

PROBE BIPOLAR GOLD 7FR

Facility

$640.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$326.40
Max. Negotiated Rate	$620.80
Rate for Payer: Cash Price	$384.00
Rate for Payer: Hawaii Western Management Group Commercial	$608.00
Rate for Payer: Health Management Network Commercial	$544.00
Rate for Payer: Kaiser Permanente Commercial	$403.20
Rate for Payer: Kaiser Permanente Medicaid	$326.40
Rate for Payer: MDX Hawaii PPO	$620.80
Rate for Payer: University Health Alliance Commercial	$466.50

PROBE GOLD ELECTRO 10FR

Facility

$585.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$497.25
Max. Negotiated Rate	$567.45
Rate for Payer: Cash Price	$351.00
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: MDX Hawaii PPO	$567.45

PROBE GOLD ELECTRO 10FR

Facility

$585.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$567.45
Rate for Payer: Cash Price	$351.00
Rate for Payer: Hawaii Western Management Group Commercial	$555.75
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Kaiser Permanente Commercial	$368.55
Rate for Payer: Kaiser Permanente Medicaid	$298.35
Rate for Payer: MDX Hawaii PPO	$567.45
Rate for Payer: University Health Alliance Commercial	$426.41

PROBE GOLD INJ 10FR

Facility

$788.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$669.80
Max. Negotiated Rate	$764.36
Rate for Payer: Cash Price	$472.80
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: MDX Hawaii PPO	$764.36

PROBE GOLD INJ 10FR

Facility

$788.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$401.88
Max. Negotiated Rate	$764.36
Rate for Payer: Cash Price	$472.80
Rate for Payer: Hawaii Western Management Group Commercial	$748.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Kaiser Permanente Commercial	$496.44
Rate for Payer: Kaiser Permanente Medicaid	$401.88
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: University Health Alliance Commercial	$574.37

PROBE GOLD INJ 7FR

Facility

$811.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$413.61
Max. Negotiated Rate	$786.67
Rate for Payer: Cash Price	$486.60
Rate for Payer: Hawaii Western Management Group Commercial	$770.45
Rate for Payer: Health Management Network Commercial	$689.35
Rate for Payer: Kaiser Permanente Commercial	$510.93
Rate for Payer: Kaiser Permanente Medicaid	$413.61
Rate for Payer: MDX Hawaii PPO	$786.67
Rate for Payer: University Health Alliance Commercial	$591.14

PROBE GOLD INJ 7FR

Facility

$811.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$689.35
Max. Negotiated Rate	$786.67
Rate for Payer: Cash Price	$486.60
Rate for Payer: Health Management Network Commercial	$689.35
Rate for Payer: MDX Hawaii PPO	$786.67

PROBE LITHOTRISPY 11.3FR

Facility

$1,935.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,644.75
Max. Negotiated Rate	$1,876.95
Rate for Payer: Cash Price	$1,161.00
Rate for Payer: Health Management Network Commercial	$1,644.75
Rate for Payer: MDX Hawaii PPO	$1,876.95

PROBE LITHOTRISPY 11.3FR

Facility

$1,935.00

Hospital Revenue Code	272
Min. Negotiated Rate	$986.85
Max. Negotiated Rate	$1,876.95
Rate for Payer: Cash Price	$1,161.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,838.25
Rate for Payer: Health Management Network Commercial	$1,644.75
Rate for Payer: Kaiser Permanente Commercial	$1,219.05
Rate for Payer: Kaiser Permanente Medicaid	$986.85
Rate for Payer: MDX Hawaii PPO	$1,876.95
Rate for Payer: University Health Alliance Commercial	$1,410.42

PROBE LITHROTRIPSY 1.9FR

Facility

$1,502.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$766.02
Max. Negotiated Rate	$1,456.94
Rate for Payer: Cash Price	$901.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,426.90
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Kaiser Permanente Commercial	$946.26
Rate for Payer: Kaiser Permanente Medicaid	$766.02
Rate for Payer: MDX Hawaii PPO	$1,456.94
Rate for Payer: University Health Alliance Commercial	$1,094.81

PROBE LITHROTRIPSY 1.9FR

Facility

$1,502.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,276.70
Max. Negotiated Rate	$1,456.94
Rate for Payer: Cash Price	$901.20
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: MDX Hawaii PPO	$1,456.94

PROBENECID 500 MG TABLET [6561]

Facility

$4.00

Service Code	NDC 00591534701
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

PROBENECID 500 MG TABLET [6561]

Facility

$4.00

Service Code	NDC 00591534701
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

PROBE PRASS MONOPOLAR

Facility

$593.00

Hospital Revenue Code	270
Min. Negotiated Rate	$504.05
Max. Negotiated Rate	$575.21
Rate for Payer: Cash Price	$355.80
Rate for Payer: Health Management Network Commercial	$504.05
Rate for Payer: MDX Hawaii PPO	$575.21

PROBE PRASS MONOPOLAR

Facility

$593.00

Hospital Revenue Code	270
Min. Negotiated Rate	$302.43
Max. Negotiated Rate	$575.21
Rate for Payer: Cash Price	$355.80
Rate for Payer: Hawaii Western Management Group Commercial	$563.35
Rate for Payer: Health Management Network Commercial	$504.05
Rate for Payer: Kaiser Permanente Commercial	$373.59
Rate for Payer: Kaiser Permanente Medicaid	$302.43
Rate for Payer: MDX Hawaii PPO	$575.21
Rate for Payer: University Health Alliance Commercial	$432.24

PROBE PRASS NERVE LOCATE

Facility

$953.00

Hospital Revenue Code	270
Min. Negotiated Rate	$486.03
Max. Negotiated Rate	$924.41
Rate for Payer: Cash Price	$571.80
Rate for Payer: Hawaii Western Management Group Commercial	$905.35
Rate for Payer: Health Management Network Commercial	$810.05
Rate for Payer: Kaiser Permanente Commercial	$600.39
Rate for Payer: Kaiser Permanente Medicaid	$486.03
Rate for Payer: MDX Hawaii PPO	$924.41
Rate for Payer: University Health Alliance Commercial	$694.64

Know your out-of-pocket cost for care.

All Charges