Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CATH 24F URETHRAL DCB

Facility

$6,510.00

Hospital Revenue Code	272
Min. Negotiated Rate	$5,533.50
Max. Negotiated Rate	$6,314.70
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: MDX Hawaii PPO	$6,314.70

CATH 24F URETHRAL DCB

Facility

$6,510.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,320.10
Max. Negotiated Rate	$6,314.70
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,184.50
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: Kaiser Permanente Commercial	$4,101.30
Rate for Payer: Kaiser Permanente Medicaid	$3,320.10
Rate for Payer: MDX Hawaii PPO	$6,314.70
Rate for Payer: University Health Alliance Commercial	$4,745.14

CATH 24FX12 NEPH BALLOON

Facility

$895.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$760.75
Max. Negotiated Rate	$868.15
Rate for Payer: Cash Price	$537.00
Rate for Payer: Cash Price	$547.80
Rate for Payer: Health Management Network Commercial	$760.75
Rate for Payer: Health Management Network Commercial	$776.05
Rate for Payer: MDX Hawaii PPO	$885.61
Rate for Payer: MDX Hawaii PPO	$868.15

CATH 24FX12 NEPH BALLOON

Facility

$895.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$456.45
Max. Negotiated Rate	$868.15
Rate for Payer: Cash Price	$537.00
Rate for Payer: Cash Price	$547.80
Rate for Payer: Hawaii Western Management Group Commercial	$850.25
Rate for Payer: Hawaii Western Management Group Commercial	$867.35
Rate for Payer: Health Management Network Commercial	$760.75
Rate for Payer: Health Management Network Commercial	$776.05
Rate for Payer: Kaiser Permanente Commercial	$575.19
Rate for Payer: Kaiser Permanente Commercial	$563.85
Rate for Payer: Kaiser Permanente Medicaid	$456.45
Rate for Payer: Kaiser Permanente Medicaid	$465.63
Rate for Payer: MDX Hawaii PPO	$868.15
Rate for Payer: MDX Hawaii PPO	$885.61
Rate for Payer: University Health Alliance Commercial	$652.37
Rate for Payer: University Health Alliance Commercial	$665.49

CATH 24FX4 NEPH 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 24FX4 NEPH 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 28FR 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 28FR 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 30CC 16F FOLEY 3WAY

Facility

$83.00

Hospital Revenue Code	272
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$49.80
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: MDX Hawaii PPO	$80.51

CATH 30CC 16F FOLEY 3WAY

Facility

$83.00

Hospital Revenue Code	272
Min. Negotiated Rate	$42.33
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$49.80
Rate for Payer: Hawaii Western Management Group Commercial	$78.85
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Kaiser Permanente Commercial	$52.29
Rate for Payer: Kaiser Permanente Medicaid	$42.33
Rate for Payer: MDX Hawaii PPO	$80.51
Rate for Payer: University Health Alliance Commercial	$60.50

CATH 30CC 18F FOLEY 3WAY

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 30CC 18F FOLEY 3WAY

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 30CC 20F FOLEY 3WAY

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 30CC 20F FOLEY 3WAY

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 30CC 22F FOLEY 3WAY

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 30CC 22F FOLEY 3WAY

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 30F URETHRAL DCB

Facility

$6,510.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,320.10
Max. Negotiated Rate	$6,314.70
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,184.50
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: Kaiser Permanente Commercial	$4,101.30
Rate for Payer: Kaiser Permanente Medicaid	$3,320.10
Rate for Payer: MDX Hawaii PPO	$6,314.70
Rate for Payer: University Health Alliance Commercial	$4,745.14

CATH 30F URETHRAL DCB

Facility

$6,510.00

Hospital Revenue Code	272
Min. Negotiated Rate	$5,533.50
Max. Negotiated Rate	$6,314.70
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: MDX Hawaii PPO	$6,314.70

CATH 30FX12 NEPH BALLOON

Facility

$904.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$768.40
Max. Negotiated Rate	$876.88
Rate for Payer: Cash Price	$542.40
Rate for Payer: Cash Price	$557.40
Rate for Payer: Health Management Network Commercial	$789.65
Rate for Payer: Health Management Network Commercial	$768.40
Rate for Payer: MDX Hawaii PPO	$876.88
Rate for Payer: MDX Hawaii PPO	$901.13

CATH 30FX12 NEPH BALLOON

Facility

$904.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$461.04
Max. Negotiated Rate	$876.88
Rate for Payer: Cash Price	$542.40
Rate for Payer: Cash Price	$557.40
Rate for Payer: Hawaii Western Management Group Commercial	$882.55
Rate for Payer: Hawaii Western Management Group Commercial	$858.80
Rate for Payer: Health Management Network Commercial	$768.40
Rate for Payer: Health Management Network Commercial	$789.65
Rate for Payer: Kaiser Permanente Commercial	$585.27
Rate for Payer: Kaiser Permanente Commercial	$569.52
Rate for Payer: Kaiser Permanente Medicaid	$461.04
Rate for Payer: Kaiser Permanente Medicaid	$473.79
Rate for Payer: MDX Hawaii PPO	$901.13
Rate for Payer: MDX Hawaii PPO	$876.88
Rate for Payer: University Health Alliance Commercial	$658.93
Rate for Payer: University Health Alliance Commercial	$677.15

CATH 3.5 UMBILICAL VEIN/ARTERY

Facility

$153.00

Service Code	HCPCS C1751
Hospital Revenue Code	278
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$91.80
Rate for Payer: Hawaii Western Management Group Commercial	$107.10
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: University Health Alliance Commercial	$85.68

CATH 3.5 UMBILICAL VEIN/ARTERY

Facility

$153.00

Service Code	HCPCS C1751
Hospital Revenue Code	278
Min. Negotiated Rate	$78.03
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$91.80
Rate for Payer: Hawaii Western Management Group Commercial	$107.10
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Kaiser Permanente Commercial	$96.39
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: University Health Alliance Commercial	$85.68

CATH 3F 40CM FOGARTY

Facility

$744.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$632.40
Max. Negotiated Rate	$721.68
Rate for Payer: Cash Price	$446.40
Rate for Payer: Health Management Network Commercial	$632.40
Rate for Payer: MDX Hawaii PPO	$721.68

CATH 3F 40CM FOGARTY

Facility

$744.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$379.44
Max. Negotiated Rate	$721.68
Rate for Payer: Cash Price	$446.40
Rate for Payer: Hawaii Western Management Group Commercial	$706.80
Rate for Payer: Health Management Network Commercial	$632.40
Rate for Payer: Kaiser Permanente Commercial	$468.72
Rate for Payer: Kaiser Permanente Medicaid	$379.44
Rate for Payer: MDX Hawaii PPO	$721.68
Rate for Payer: University Health Alliance Commercial	$542.30

CATH 3W 22FR SIMPLASTIC

Facility

$136.00

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

Know your out-of-pocket cost for care.

All Charges