Supplies, drugs & other prices at Straub Benioff Medical Center
Honolulu, HI · every code in this section with a posted price and a Medicare benchmark.
98 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2d tee w or w/o fol w/con,in (C8925) | $1,333.80 | $2,223 | 1.4× |
| 2d tte w or w/o fol w/con,fu (C8924) | $711 | $1,185 | 1.7× |
| Adm of soc dtr assess 5-15 m (G0136) | $19.80 | $33 | 0.4× |
| Admin hepatitis b vaccine (G0010) | $24.30 | $40.50 | 0.4× |
| Admin influenza virus vac (G0008) | $28.80 | $48 | 0.5× |
| Admin pneumococcal vaccine (G0009) | $28.80 | $48 | 0.5× |
| Adv prim care mgmt lvl 1 (G0556) | $10.80 | $18 | 0.2× |
| Adv prim care mgmt lvl 2 (G0557) | $36 | $60 | 0.8× |
| Adv prim care mgmt lvl 3 (G0558) | $77.40 | $129 | 0.6× |
| Alcohol/sub misuse assess (G2011) | $36 | $60 | 1.1× |
| Alcohol/subs interv 15-30mn (G0396) | $42.60 | $71 | 1.0× |
| Alcohol/subs interv >30 min (G0397) | $208.80 | $348 | 1.0× |
| Annual alcohol screen 15 min (G0442) | $20.40 | $34 | 0.5× |
| Behavior counsel obesity 15m (G0447) | $25.20 | $42 | 0.2× |
| Brief alcohol misuse counsel (G0443) | $16.20 | $27 | 0.1× |
| Ca screen;flexi sigmoidscope (G0104) | $189.60 | $316 | 0.2× |
| Ca screen;pelvic/breast exam (G0101) | $49.80 | $83 | 0.4× |
| Catheterize for urine spec (P9612) | $179.40 | $299 | 19.2× |
| Chemo extend iv infus w/pump (G0498) | $679.20 | $1,132 | 1.7× |
| Colon ca scrn not hi rsk ind (G0121) | $310.80 | $518 | 0.3× |
| Covid-19 lab test non-cdc (U0002) | $85.80 | $143 | 1.7× |
| Depression screen annual (G0444) | $20.40 | $34 | 0.5× |
| Diab manage trn per indiv (G0108) | $103.80 | $173 | 1.9× |
| Diab manage trn ind/group (G0109) | $29.40 | $49 | 1.8× |
| Direct refer hospital observ (G0379) | $78 | $130 | 0.1× |
| Drug test def 1-7 classes (G0480) | $142.50 | $237.50 | 1.2× |
| Drug test def 8-14 classes (G0481) | $168.90 | $281.50 | 1.1× |
| Ekg tracing for initial prev (G0404) | $31.80 | $53 | 0.9× |
| Elec stim other than wound (G0283) | $66.60 | $111 | 5.2× |
| Fecal blood scrn immunoassay (G0328) | $33 | $55 | 1.8× |
| Followup eval of foot pt lop (G0246) | $40.80 | $68 | 0.3× |
| High inten beh couns std 30m (G0445) | $18 | $30 | 0.1× |
| Home sleep test/type 3 porta (G0399) | $308.40 | $514 | 1.2× |
| Home sleep test/type 4 porta (G0400) | $387.60 | $646 | 1.5× |
| Hospital outpt clinic visit (G0463) | $252 | $420 | 1.6× |
| Hpv combo assay ca screen (G0476) | $74.10 | $123.50 | 2.1× |
| Initial care training 30 m (G0539) | $10.20 | $17 | 0.2× |
| Initial foot exam pt lops (G0245) | $48 | $80 | 0.3× |
| Initial preventive exam (G0402) | $160.20 | $267 | 1.0× |
| Inj for sacroiliac jt anesth (G0260) | $607.20 | $1,012 | 0.7× |
| Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) unusually low: confirm this is the full procedure |
$11,401.80 | $19,003 | 0.3× |
| Intens behave ther cardio dx (G0446) | $16.20 | $27 | 0.4× |
| Intens cardiac rehab no exer (G0423) | $202.20 | $337 | 1.3× |
| Intens cardiac rehab w/exerc (G0422) | $202.20 | $337 | 1.3× |
| Mra w/cont, abd (C8900) | $1,591.20 | $2,652 | 3.9× |
| Mra w/cont, chest (C8909) | $1,566 | $2,610 | 3.8× |
| Mra w/cont, lwr ext (C8912) | $1,545.60 | $2,576 | 3.8× |
| Mra w/cont, pelvis (C8918) | $1,566 | $2,610 | 3.8× |
| Mra w/o cont, abd (C8901) | $1,456.20 | $2,427 | 5.2× |
| Mra w/o cont, chest (C8910) | $1,498.80 | $2,498 | 5.3× |
| Mra w/o cont, lwr ext (C8913) | $1,475.40 | $2,459 | 5.2× |
| Mra w/o cont, pelvis (C8919) | $1,475.40 | $2,459 | 5.2× |
| Mra w/o fol w/cont, abd (C8902) | $1,788 | $2,980 | 4.3× |
| Mra w/o fol w/cont, chest (C8911) | $1,702.80 | $2,838 | 4.1× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,675.20 | $2,792 | 4.1× |
| Mra w/o fol w/cont, pelvis (C8920) | $1,788 | $2,980 | 4.3× |
| Mra, w/dye, spinal canal (C8931) | $1,566 | $2,610 | 3.8× |
| Mra, w/dye, upper extremity (C8934) | $1,566 | $2,610 | 3.8× |
| Mra, w/o dye, spinal canal (C8932) | $1,351.20 | $2,252 | 4.8× |
| Mra, w/o dye, upper extr (C8935) | $1,475.40 | $2,459 | 5.2× |
| Mra, w/o&w/dye, spinal canal (C8933) | $1,675.20 | $2,792 | 4.1× |
| Mra, w/o&w/dye, upper extr (C8936) | $1,675.20 | $2,792 | 4.1× |
| Mri w/o fol w/cont, breast, (C8908) | $2,461.20 | $4,102 | 6.0× |
| Mri w/o fol w/cont, brst, un (C8905) | $1,757.40 | $2,929 | 4.3× |
| Nav srv peer sup 60 min pr m (G0140) | $69.60 | $116 | 0.6× |
| Neuro csf prion prtn qual (0035U) | $789 | $1,315 | 1.5× |
| Njx pltlt plasma w/img harvest/preparation (0232T) | $376.20 | $627 | 0.7× |
| Obtaining screen pap smear (Q0091) | $52.20 | $87 | 1.5× |
| Pattern erg w/i&r (0509T) | $274.80 | $458 | 1.1× |
| Perc d-e cor revasc chro sin (C9607) | $25,179.60 | $41,966 | 1.2× |
| Perc d-e cor revasc t cabg s (C9604) | $25,179.60 | $41,966 | 1.8× |
| Perc d-e cor stent ather s (C9602) | $25,179.60 | $41,966 | 1.2× |
| Perc drug-el cor stent sing (C9600) | $16,340.40 | $27,234 | 1.2× |
| Perq Sacral Augmt Bilat Inj (0201T) unusually low: confirm this is the full procedure |
$2,610.60 | $4,351 | 0.3× |
| Perq Sacral Augmt Unilat Inj (0200T) unusually low: confirm this is the full procedure |
$2,610.60 | $4,351 | 0.3× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) | $7,908.60 | $13,181 | 0.6× |
| Pin service 60m per month (G0023) | $69.60 | $116 | 0.6× |
| Potassium hydroxide preps (Q0112) | $9 | $15 | 1.5× |
| Prgrmg dev eval ldls pm single car chamber ip (0826T) | $55.80 | $93 | 1.3× |
| Prostate biopsy, any mthd (G0416) | $301.80 | $503 | 0.7× |
| Psa screening (G0103) | $66.60 | $111 | 3.4× |
| Scr c/v cyto,thinlayer,rescr (G0145) | $134.40 | $224 | 5.1× |
| Screen cerv/vag thin layer (G0123) | $66.60 | $111 | 3.3× |
| Screen pap by tech w md supv (P3000) | $24.60 | $41 | 1.3× |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) | $12,447.60 | $20,746 | 0.5× |
| Tcat rmvl perm 1chmbr ldls pacemaker r atrial (0824T) | $3,726 | $6,210 | 1.0× |
| Tcat rmvl&rplcmt perm 1chmbr ldls pm r atrial (0825T) | $12,447.60 | $20,746 | 0.5× |
| Therapeutic ultrafiltration (0692T) | $728.40 | $1,214 | 0.4× |
| Tomosynthesis, mammo (G0279) | $39 | $65 | 3.1× |
| Train for caregiver add 15 (G0540) | $12 | $20 | 0.5× |
| Tte w or w/o contr, cont ecg (C8930) | $1,365.30 | $2,275.50 | 1.5× |
| Tte w or w/o fol w/con,stres (C8928) | $1,325.10 | $2,208.50 | 1.4× |
| Tte w or w/o fol w/cont, com (C8921) | $1,354.80 | $2,258 | 1.5× |
| Tte w or w/o fol w/cont, f/u (C8922) | $1,119 | $1,865 | 1.2× |
| Tte w or wo fol wcon,doppler (C8929) | $1,293 | $2,155 | 1.4× |
| Unsched dialysis esrd pt hos (G0257) | $930 | $1,550 | 1.1× |
| Visit to determ ldct elig (G0296) | $16.20 | $27 | 0.1× |
| Wet mounts/ w preparations (Q0111) | $9 | $15 | 0.5× |