Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CATH CHOLANGIOGRAM

Facility

$175.00

Hospital Revenue Code	272
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$105.00
Rate for Payer: Hawaii Western Management Group Commercial	$166.25
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: University Health Alliance Commercial	$127.56

CATH CHOLANGIOGRAM INTRO

Facility

$223.00

Hospital Revenue Code	272
Min. Negotiated Rate	$113.73
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$133.80
Rate for Payer: Hawaii Western Management Group Commercial	$211.85
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Kaiser Permanente Commercial	$140.49
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: University Health Alliance Commercial	$162.54

CATH CHOLANGIOGRAM INTRO

Facility

$223.00

Hospital Revenue Code	272
Min. Negotiated Rate	$189.55
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$133.80
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: MDX Hawaii PPO	$216.31

CATH COUNCIL 20F FOLEY

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: MDX Hawaii PPO	$110.58

CATH COUNCIL 20F FOLEY

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$58.14
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$71.82
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: University Health Alliance Commercial	$83.09

CATH DRAIN 5FX15 CENTESIS

Facility

$107.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$54.57
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Hawaii Western Management Group Commercial	$101.65
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$67.41
Rate for Payer: Kaiser Permanente Medicaid	$54.57
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: University Health Alliance Commercial	$77.99

CATH DRAIN 5FX15 CENTESIS

Facility

$107.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: MDX Hawaii PPO	$103.79

CATH DRAIN 5FX9 CENTESIS

Facility

$107.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: MDX Hawaii PPO	$103.79

CATH DRAIN 5FX9 CENTESIS

Facility

$107.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$54.57
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Hawaii Western Management Group Commercial	$101.65
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$67.41
Rate for Payer: Kaiser Permanente Medicaid	$54.57
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: University Health Alliance Commercial	$77.99

CATH DUAL LUMEN URETERAL

Facility

$273.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$139.23
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$163.80
Rate for Payer: Hawaii Western Management Group Commercial	$259.35
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: Kaiser Permanente Commercial	$171.99
Rate for Payer: Kaiser Permanente Medicaid	$139.23
Rate for Payer: MDX Hawaii PPO	$264.81
Rate for Payer: University Health Alliance Commercial	$198.99

CATH DUAL LUMEN URETERAL

Facility

$273.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$232.05
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$163.80
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: MDX Hawaii PPO	$264.81

CATH ENT DILATION 7X20

Facility

$3,300.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$2,805.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: MDX Hawaii PPO	$3,201.00

CATH ENT DILATION 7X20

Facility

$3,300.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$1,683.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,135.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,079.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$2,405.37

CATH ERCP 5X20 SPHINCTEROTOME

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 ERCP 5X20 SPHINCTEROTOME

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 ERCP ELECTRO .64X260

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 ERCP ELECTRO .64X260

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 ET DILATION TUBE

Facility

$4,600.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$3,910.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: MDX Hawaii PPO	$4,462.00

CATH ET DILATION TUBE

Facility

$4,600.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$2,346.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,370.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Kaiser Permanente Commercial	$2,898.00
Rate for Payer: Kaiser Permanente Medicaid	$2,346.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: University Health Alliance Commercial	$3,352.94

CATHETER 12FR 4CM BDC

Facility

$829.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$704.65
Max. Negotiated Rate	$804.13
Rate for Payer: Cash Price	$497.40
Rate for Payer: Health Management Network Commercial	$704.65
Rate for Payer: MDX Hawaii PPO	$804.13

CATHETER 12FR 4CM BDC

Facility

$829.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$422.79
Max. Negotiated Rate	$804.13
Rate for Payer: Cash Price	$497.40
Rate for Payer: Hawaii Western Management Group Commercial	$787.55
Rate for Payer: Health Management Network Commercial	$704.65
Rate for Payer: Kaiser Permanente Commercial	$522.27
Rate for Payer: Kaiser Permanente Medicaid	$422.79
Rate for Payer: MDX Hawaii PPO	$804.13
Rate for Payer: University Health Alliance Commercial	$604.26

CATHETER 20G ARTERIAL LINE SET

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

CATHETER 20G ARTERIAL LINE SET

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

CATHETER 4FR GLO-TIP ERCP

Facility

$288.00

Hospital Revenue Code	272
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: MDX Hawaii PPO	$279.36

CATHETER 4FR GLO-TIP ERCP

Facility

$288.00

Hospital Revenue Code	272
Min. Negotiated Rate	$146.88
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Hawaii Western Management Group Commercial	$273.60
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$181.44
Rate for Payer: Kaiser Permanente Medicaid	$146.88
Rate for Payer: MDX Hawaii PPO	$279.36
Rate for Payer: University Health Alliance Commercial	$209.92

Know your out-of-pocket cost for care.

All Charges