Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CATH 18F LATEX 3-WAY 30ML

Facility

$81.00

Hospital Revenue Code	272
Min. Negotiated Rate	$41.31
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Hawaii Western Management Group Commercial	$76.95
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Kaiser Permanente Commercial	$51.03
Rate for Payer: Kaiser Permanente Medicaid	$41.31
Rate for Payer: MDX Hawaii PPO	$78.57
Rate for Payer: University Health Alliance Commercial	$59.04

CATH 18FR 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 18FR 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 18G FEMORAL ART

Facility

$136.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: MDX Hawaii PPO	$131.92

CATH 18G FEMORAL ART

Facility

$136.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$69.36
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$85.68
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: University Health Alliance Commercial	$99.13

CATH 18X4 URETHRAL BALLOON

Facility

$910.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$464.10
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Hawaii Western Management Group Commercial	$864.50
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Kaiser Permanente Commercial	$573.30
Rate for Payer: Kaiser Permanente Medicaid	$464.10
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: University Health Alliance Commercial	$663.30

CATH 18X4 URETHRAL BALLOON

Facility

$910.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$773.50
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: MDX Hawaii PPO	$882.70

CATH 18X6 URETHRAL BALLOON

Facility

$850.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$722.50
Max. Negotiated Rate	$824.50
Rate for Payer: Cash Price	$510.00
Rate for Payer: Health Management Network Commercial	$722.50
Rate for Payer: MDX Hawaii PPO	$824.50

CATH 18X6 URETHRAL BALLOON

Facility

$850.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$433.50
Max. Negotiated Rate	$824.50
Rate for Payer: Cash Price	$510.00
Rate for Payer: Hawaii Western Management Group Commercial	$807.50
Rate for Payer: Health Management Network Commercial	$722.50
Rate for Payer: Kaiser Permanente Commercial	$535.50
Rate for Payer: Kaiser Permanente Medicaid	$433.50
Rate for Payer: MDX Hawaii PPO	$824.50
Rate for Payer: University Health Alliance Commercial	$619.57

CATH 20F LATEX 3-WAY 30ML

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$91.35
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: University Health Alliance Commercial	$105.69

CATH 20F LATEX 3-WAY 30ML

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

CATH 20FR 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 20FR 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 20GX1.50 RADIAL ART

Facility

$79.00

Hospital Revenue Code	272
Min. Negotiated Rate	$40.29
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Hawaii Western Management Group Commercial	$75.05
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Kaiser Permanente Commercial	$49.77
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: University Health Alliance Commercial	$57.58

CATH 20GX1.50 RADIAL ART

Facility

$79.00

Hospital Revenue Code	272
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: MDX Hawaii PPO	$76.63

CATH 22F LATEX 3-WAY 30ML

Facility

$93.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: MDX Hawaii PPO	$90.21

CATH 22F LATEX 3-WAY 30ML

Facility

$93.00

Hospital Revenue Code	272
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$58.59
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: University Health Alliance Commercial	$67.79

CATH 22FR LATEX RED COUNCIL

Facility

$78.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$49.14
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: University Health Alliance Commercial	$56.85

CATH 22FR LATEX RED COUNCIL

Facility

$78.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: MDX Hawaii PPO	$75.66

CATH 24F FOLEY LUBRIL

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$48.51
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: University Health Alliance Commercial	$56.13

CATH 24F FOLEY LUBRIL

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: MDX Hawaii PPO	$74.69

CATH 24FR HEMO FOLEY

Facility

$125.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$78.75
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: University Health Alliance Commercial	$91.11

CATH 24FR HEMO FOLEY

Facility

$125.00

Hospital Revenue Code	272
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: MDX Hawaii PPO	$121.25

CATH 24FR 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 24FR 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

Know your out-of-pocket cost for care.

All Charges