Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CATH 10FR DRAINAGE APD

Facility

$400.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: MDX Hawaii PPO	$388.00

CATH 10FR DRAINAGE APD

Facility

$400.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Hawaii Western Management Group Commercial	$380.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$252.00
Rate for Payer: Kaiser Permanente Medicaid	$204.00
Rate for Payer: MDX Hawaii PPO	$388.00
Rate for Payer: University Health Alliance Commercial	$291.56

CATH 10FR MALECOT

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$107.15

CATH 10FR MALECOT

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: MDX Hawaii PPO	$142.59

CATH 10X4 ERCP BDC HURRICANE

Facility

$898.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$763.30
Max. Negotiated Rate	$871.06
Rate for Payer: Cash Price	$538.80
Rate for Payer: Health Management Network Commercial	$763.30
Rate for Payer: MDX Hawaii PPO	$871.06

CATH 10X4 ERCP BDC HURRICANE

Facility

$898.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$457.98
Max. Negotiated Rate	$871.06
Rate for Payer: Cash Price	$538.80
Rate for Payer: Hawaii Western Management Group Commercial	$853.10
Rate for Payer: Health Management Network Commercial	$763.30
Rate for Payer: Kaiser Permanente Commercial	$565.74
Rate for Payer: Kaiser Permanente Medicaid	$457.98
Rate for Payer: MDX Hawaii PPO	$871.06
Rate for Payer: University Health Alliance Commercial	$654.55

CATH 12FR DRAINAGE APD

Facility

$400.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Hawaii Western Management Group Commercial	$380.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$252.00
Rate for Payer: Kaiser Permanente Medicaid	$204.00
Rate for Payer: MDX Hawaii PPO	$388.00
Rate for Payer: University Health Alliance Commercial	$291.56

CATH 12FR DRAINAGE APD

Facility

$400.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: MDX Hawaii PPO	$388.00

CATH 12FR MALECOT

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: MDX Hawaii PPO	$142.59

CATH 12FR MALECOT

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$107.15

CATH 12X16 HEMODIALYSIS DL

Facility

$434.00

Service Code	HCPCS C1752
Hospital Revenue Code	272
Min. Negotiated Rate	$368.90
Max. Negotiated Rate	$420.98
Rate for Payer: Cash Price	$260.40
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: MDX Hawaii PPO	$420.98

CATH 12X16 HEMODIALYSIS DL

Facility

$434.00

Service Code	HCPCS C1752
Hospital Revenue Code	272
Min. Negotiated Rate	$221.34
Max. Negotiated Rate	$420.98
Rate for Payer: Cash Price	$260.40
Rate for Payer: Hawaii Western Management Group Commercial	$412.30
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Kaiser Permanente Commercial	$273.42
Rate for Payer: Kaiser Permanente Medicaid	$221.34
Rate for Payer: MDX Hawaii PPO	$420.98
Rate for Payer: University Health Alliance Commercial	$316.34

CATH 12X20 HEMODIALYSIS

Facility

$434.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$368.90
Max. Negotiated Rate	$420.98
Rate for Payer: Cash Price	$260.40
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: MDX Hawaii PPO	$420.98

CATH 12X20 HEMODIALYSIS

Facility

$434.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$221.34
Max. Negotiated Rate	$420.98
Rate for Payer: Cash Price	$260.40
Rate for Payer: Hawaii Western Management Group Commercial	$412.30
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Kaiser Permanente Commercial	$273.42
Rate for Payer: Kaiser Permanente Medicaid	$221.34
Rate for Payer: MDX Hawaii PPO	$420.98
Rate for Payer: University Health Alliance Commercial	$316.34

CATH 14F FOLEY IC COMPLETE

Facility

$87.00

Hospital Revenue Code	272
Min. Negotiated Rate	$44.37
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$54.81
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: University Health Alliance Commercial	$63.41

CATH 14F FOLEY IC COMPLETE

Facility

$87.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: MDX Hawaii PPO	$84.39

CATH 14FR MALECOT

Facility

$89.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$45.39
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$53.40
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$56.07
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: University Health Alliance Commercial	$64.87

CATH 14FR MALECOT

Facility

$89.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$53.40
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: MDX Hawaii PPO	$86.33

CATH 16F FOLEY IC COMPLETE

Facility

$87.00

Hospital Revenue Code	272
Min. Negotiated Rate	$44.37
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$54.81
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: University Health Alliance Commercial	$63.41

CATH 16F FOLEY IC COMPLETE

Facility

$87.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: MDX Hawaii PPO	$84.39

CATH 16FR FOLEY 3WAY

Facility

$85.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: MDX Hawaii PPO	$82.45

CATH 16FR FOLEY 3WAY

Facility

$85.00

Hospital Revenue Code	272
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Hawaii Western Management Group Commercial	$80.75
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Kaiser Permanente Commercial	$53.55
Rate for Payer: Kaiser Permanente Medicaid	$43.35
Rate for Payer: MDX Hawaii PPO	$82.45
Rate for Payer: University Health Alliance Commercial	$61.96

CATH 16FR MALECOT

Facility

$127.00

Service Code	HCPCS C1729
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

CATH 16FR MALECOT

Facility

$127.00

Service Code	HCPCS C1729
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

CATH 18F LATEX 3-WAY 30ML

Facility

$81.00

Hospital Revenue Code	272
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: MDX Hawaii PPO	$78.57

Know your out-of-pocket cost for care.

All Charges