Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

10 FR SOEHENDRA STENT RETRIEVE

Facility

$480.00

Hospital Revenue Code	272
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$288.00
Rate for Payer: Hawaii Western Management Group Commercial	$456.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$244.80
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: University Health Alliance Commercial	$349.87

10 FR SOEHENDRA STENT RETRIEVE

Facility

$480.00

Hospital Revenue Code	272
Min. Negotiated Rate	$408.00
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$288.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: MDX Hawaii PPO	$465.60

1.8MM Q-FIX IMPLANT 25-1800

Facility

$1,274.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$649.74
Max. Negotiated Rate	$1,235.78
Rate for Payer: Cash Price	$764.40
Rate for Payer: Hawaii Western Management Group Commercial	$891.80
Rate for Payer: Health Management Network Commercial	$1,082.90
Rate for Payer: Kaiser Permanente Commercial	$802.62
Rate for Payer: Kaiser Permanente Medicaid	$649.74
Rate for Payer: MDX Hawaii PPO	$1,235.78
Rate for Payer: University Health Alliance Commercial	$713.44

1.8MM Q-FIX IMPLANT 25-1800

Facility

$1,274.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$713.44
Max. Negotiated Rate	$1,235.78
Rate for Payer: Cash Price	$764.40
Rate for Payer: Hawaii Western Management Group Commercial	$891.80
Rate for Payer: Health Management Network Commercial	$1,082.90
Rate for Payer: MDX Hawaii PPO	$1,235.78
Rate for Payer: University Health Alliance Commercial	$713.44

1/8" PEG DRILL

Facility

$1,729.00

Hospital Revenue Code	272
Min. Negotiated Rate	$881.79
Max. Negotiated Rate	$1,677.13
Rate for Payer: Cash Price	$1,037.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,642.55
Rate for Payer: Health Management Network Commercial	$1,469.65
Rate for Payer: Kaiser Permanente Commercial	$1,089.27
Rate for Payer: Kaiser Permanente Medicaid	$881.79
Rate for Payer: MDX Hawaii PPO	$1,677.13
Rate for Payer: University Health Alliance Commercial	$1,260.27

1/8" PEG DRILL

Facility

$1,729.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,469.65
Max. Negotiated Rate	$1,677.13
Rate for Payer: Cash Price	$1,037.40
Rate for Payer: Health Management Network Commercial	$1,469.65
Rate for Payer: MDX Hawaii PPO	$1,677.13

2.0MM STANDARD DRILL, QC, 175M

Facility

$1,190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,011.50
Max. Negotiated Rate	$1,154.30
Rate for Payer: Cash Price	$714.00
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: MDX Hawaii PPO	$1,154.30

2.0MM STANDARD DRILL, QC, 175M

Facility

$1,190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$606.90
Max. Negotiated Rate	$1,154.30
Rate for Payer: Cash Price	$714.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,130.50
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: Kaiser Permanente Commercial	$749.70
Rate for Payer: Kaiser Permanente Medicaid	$606.90
Rate for Payer: MDX Hawaii PPO	$1,154.30
Rate for Payer: University Health Alliance Commercial	$867.39

2.0M NON THREADED GUIDE WIRE

Facility

$231.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$117.81
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$138.60
Rate for Payer: Hawaii Western Management Group Commercial	$219.45
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$145.53
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: University Health Alliance Commercial	$168.38

2.0M NON THREADED GUIDE WIRE

Facility

$231.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$138.60
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: MDX Hawaii PPO	$224.07

2.4MM LCP RADIAL HEAD 241.681

Facility

$2,289.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.84
Max. Negotiated Rate	$2,220.33
Rate for Payer: Cash Price	$1,373.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,602.30
Rate for Payer: Health Management Network Commercial	$1,945.65
Rate for Payer: MDX Hawaii PPO	$2,220.33
Rate for Payer: University Health Alliance Commercial	$1,281.84

2.4MM LCP RADIAL HEAD 241.681

Facility

$2,289.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.39
Max. Negotiated Rate	$2,220.33
Rate for Payer: Cash Price	$1,373.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,602.30
Rate for Payer: Health Management Network Commercial	$1,945.65
Rate for Payer: Kaiser Permanente Commercial	$1,442.07
Rate for Payer: Kaiser Permanente Medicaid	$1,167.39
Rate for Payer: MDX Hawaii PPO	$2,220.33
Rate for Payer: University Health Alliance Commercial	$1,281.84

2.5MM COUNTERBORE

Facility

$863.00

Hospital Revenue Code	272
Min. Negotiated Rate	$733.55
Max. Negotiated Rate	$837.11
Rate for Payer: Cash Price	$517.80
Rate for Payer: Health Management Network Commercial	$733.55
Rate for Payer: MDX Hawaii PPO	$837.11

2.5MM COUNTERBORE

Facility

$863.00

Hospital Revenue Code	272
Min. Negotiated Rate	$440.13
Max. Negotiated Rate	$837.11
Rate for Payer: Cash Price	$517.80
Rate for Payer: Hawaii Western Management Group Commercial	$819.85
Rate for Payer: Health Management Network Commercial	$733.55
Rate for Payer: Kaiser Permanente Commercial	$543.69
Rate for Payer: Kaiser Permanente Medicaid	$440.13
Rate for Payer: MDX Hawaii PPO	$837.11
Rate for Payer: University Health Alliance Commercial	$629.04

2.5X2.5 MED CIRCLE W/STRAP

Facility

$1,966.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,002.66
Max. Negotiated Rate	$1,907.02
Rate for Payer: Cash Price	$1,179.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,376.20
Rate for Payer: Health Management Network Commercial	$1,671.10
Rate for Payer: Kaiser Permanente Commercial	$1,238.58
Rate for Payer: Kaiser Permanente Medicaid	$1,002.66
Rate for Payer: MDX Hawaii PPO	$1,907.02
Rate for Payer: University Health Alliance Commercial	$1,100.96

2.5X2.5 MED CIRCLE W/STRAP

Facility

$1,966.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.96
Max. Negotiated Rate	$1,907.02
Rate for Payer: Cash Price	$1,179.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,376.20
Rate for Payer: Health Management Network Commercial	$1,671.10
Rate for Payer: MDX Hawaii PPO	$1,907.02
Rate for Payer: University Health Alliance Commercial	$1,100.96

2.7MM 5 HOLE STRAIGHT PLATE

Facility

$2,163.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,211.28
Max. Negotiated Rate	$2,098.11
Rate for Payer: Cash Price	$1,297.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,514.10
Rate for Payer: Health Management Network Commercial	$1,838.55
Rate for Payer: MDX Hawaii PPO	$2,098.11
Rate for Payer: University Health Alliance Commercial	$1,211.28

2.7MM 5 HOLE STRAIGHT PLATE

Facility

$2,163.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.13
Max. Negotiated Rate	$2,098.11
Rate for Payer: Cash Price	$1,297.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,514.10
Rate for Payer: Health Management Network Commercial	$1,838.55
Rate for Payer: Kaiser Permanente Commercial	$1,362.69
Rate for Payer: Kaiser Permanente Medicaid	$1,103.13
Rate for Payer: MDX Hawaii PPO	$2,098.11
Rate for Payer: University Health Alliance Commercial	$1,211.28

2.7MM/7H COMPRESSION T PLATE

Facility

$2,163.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,211.28
Max. Negotiated Rate	$2,098.11
Rate for Payer: Cash Price	$1,297.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,514.10
Rate for Payer: Health Management Network Commercial	$1,838.55
Rate for Payer: MDX Hawaii PPO	$2,098.11
Rate for Payer: University Health Alliance Commercial	$1,211.28

2.7MM/7H COMPRESSION T PLATE

Facility

$2,163.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.13
Max. Negotiated Rate	$2,098.11
Rate for Payer: Cash Price	$1,297.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,514.10
Rate for Payer: Health Management Network Commercial	$1,838.55
Rate for Payer: Kaiser Permanente Commercial	$1,362.69
Rate for Payer: Kaiser Permanente Medicaid	$1,103.13
Rate for Payer: MDX Hawaii PPO	$2,098.11
Rate for Payer: University Health Alliance Commercial	$1,211.28

2-STAGED GUIDE ACCUCUT 19509

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$398.65
Max. Negotiated Rate	$454.93
Rate for Payer: Cash Price	$281.40
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: MDX Hawaii PPO	$454.93

2-STAGED GUIDE ACCUCUT 19509

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$239.19
Max. Negotiated Rate	$454.93
Rate for Payer: Cash Price	$281.40
Rate for Payer: Hawaii Western Management Group Commercial	$445.55
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Kaiser Permanente Commercial	$295.47
Rate for Payer: Kaiser Permanente Medicaid	$239.19
Rate for Payer: MDX Hawaii PPO	$454.93
Rate for Payer: University Health Alliance Commercial	$341.85

2X4 POCKET ADAPTOR 74002

Facility

$2,400.00

Service Code	HCPCS C1883
Hospital Revenue Code	275
Min. Negotiated Rate	$1,224.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

2X4 POCKET ADAPTOR 74002

Facility

$2,400.00

Service Code	HCPCS C1883
Hospital Revenue Code	275
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

3/8" IM DRILL

Facility

$1,620.00

Hospital Revenue Code	272
Min. Negotiated Rate	$826.20
Max. Negotiated Rate	$1,571.40
Rate for Payer: Cash Price	$972.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,539.00
Rate for Payer: Health Management Network Commercial	$1,377.00
Rate for Payer: Kaiser Permanente Commercial	$1,020.60
Rate for Payer: Kaiser Permanente Medicaid	$826.20
Rate for Payer: MDX Hawaii PPO	$1,571.40
Rate for Payer: University Health Alliance Commercial	$1,180.82

Know your out-of-pocket cost for care.

All Charges