Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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

CATH 3W 24FR SIMPLASTIC

Facility

$136.00

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 3W 24FR 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

CATH 44-20MM ECRP SPHINCT

Facility

$1,452.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$740.52
Max. Negotiated Rate	$1,408.44
Rate for Payer: Cash Price	$871.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.40
Rate for Payer: Health Management Network Commercial	$1,234.20
Rate for Payer: Kaiser Permanente Commercial	$914.76
Rate for Payer: Kaiser Permanente Medicaid	$740.52
Rate for Payer: MDX Hawaii PPO	$1,408.44
Rate for Payer: University Health Alliance Commercial	$1,058.36

CATH 44-20MM ECRP SPHINCT

Facility

$1,452.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,234.20
Max. Negotiated Rate	$1,408.44
Rate for Payer: Cash Price	$871.20
Rate for Payer: Health Management Network Commercial	$1,234.20
Rate for Payer: MDX Hawaii PPO	$1,408.44

CATH 4X4 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 4X4 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 5F IV UMBIL LUMEN

Facility

$146.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$87.60
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: MDX Hawaii PPO	$141.62

CATH 5F IV UMBIL LUMEN

Facility

$146.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$74.46
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$87.60
Rate for Payer: Hawaii Western Management Group Commercial	$138.70
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$91.98
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: University Health Alliance Commercial	$106.42

CATH 5FRX40 KMP BEACON TIP

Facility

$110.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$66.00
Rate for Payer: Hawaii Western Management Group Commercial	$104.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: University Health Alliance Commercial	$80.18

CATH 5FRX40 KMP BEACON TIP

Facility

$110.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$66.00
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: MDX Hawaii PPO	$106.70

CATH 5FRX65CM SOFT-VU FLUSH

Facility

$207.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$105.57
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$124.20
Rate for Payer: Hawaii Western Management Group Commercial	$196.65
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Kaiser Permanente Commercial	$130.41
Rate for Payer: Kaiser Permanente Medicaid	$105.57
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: University Health Alliance Commercial	$150.88

CATH 5FRX65CM SOFT-VU FLUSH

Facility

$207.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$175.95
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$124.20
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: MDX Hawaii PPO	$200.79

CATH 5FRX65 SIM1 BEACON TIP

Facility

$130.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: MDX Hawaii PPO	$126.10

CATH 5FRX65 SIM1 BEACON TIP

Facility

$130.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$78.00
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: University Health Alliance Commercial	$94.76

CATH 5FRX65 SOFT-VU RIM

Facility

$130.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$78.00
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: University Health Alliance Commercial	$94.76

CATH 5FRX65 SOFT-VU RIM

Facility

$130.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: MDX Hawaii PPO	$126.10

CATH 6F FOLEY LUBRISIL

Facility

$138.00

Hospital Revenue Code	272
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: MDX Hawaii PPO	$133.86

CATH 6F FOLEY LUBRISIL

Facility

$138.00

Hospital Revenue Code	272
Min. Negotiated Rate	$70.38
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Hawaii Western Management Group Commercial	$131.10
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$86.94
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: University Health Alliance Commercial	$100.59

CATH 6FR OPEN END URETERAL

Facility

$71.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: MDX Hawaii PPO	$68.87

CATH 6FR OPEN END URETERAL

Facility

$71.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$36.21
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Hawaii Western Management Group Commercial	$67.45
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: University Health Alliance Commercial	$51.75

CATH 6X4 ECRPO BDC HURRICANE

Facility

$925.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$471.75
Max. Negotiated Rate	$897.25
Rate for Payer: Cash Price	$555.00
Rate for Payer: Hawaii Western Management Group Commercial	$878.75
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: Kaiser Permanente Commercial	$582.75
Rate for Payer: Kaiser Permanente Medicaid	$471.75
Rate for Payer: MDX Hawaii PPO	$897.25
Rate for Payer: University Health Alliance Commercial	$674.23

CATH 6X4 ECRPO BDC HURRICANE

Facility

$925.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$786.25
Max. Negotiated Rate	$897.25
Rate for Payer: Cash Price	$555.00
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: MDX Hawaii PPO	$897.25

CATH 7.5F SWAN GANZ

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$342.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: University Health Alliance Commercial	$262.40

CATH 7.5F SWAN GANZ

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$349.20

Know your out-of-pocket cost for care.

All Charges