Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

VENOVO VENOUS STENT 20X60

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,920.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,900.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

VENOVO VENOUS STENT 20X60

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,570.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,900.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Kaiser Permanente Commercial	$4,410.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHESIA

Facility

$4,308.37

Service Code	CPT 69424
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,308.37
Rate for Payer: AlohaCare Medicaid	$3,916.70
Rate for Payer: AlohaCare Medicare	$3,916.70
Rate for Payer: Devoted Health Medicare	$4,308.37
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,916.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Humana Medicare	$3,916.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,916.70
Rate for Payer: Ohana Health Plan Medicaid	$4,308.37
Rate for Payer: Ohana Health Plan Medicare	$3,916.70
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,916.70
Rate for Payer: University Health Alliance Commercial	$4,035.20

VENTRALIGHT MESH 4.5" 5990011

Facility

$2,580.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,315.80
Max. Negotiated Rate	$2,502.60
Rate for Payer: Cash Price	$1,548.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,806.00
Rate for Payer: Health Management Network Commercial	$2,193.00
Rate for Payer: Kaiser Permanente Commercial	$1,625.40
Rate for Payer: Kaiser Permanente Medicaid	$1,315.80
Rate for Payer: MDX Hawaii PPO	$2,502.60
Rate for Payer: University Health Alliance Commercial	$1,444.80

VENTRALIGHT MESH 4.5" 5990011

Facility

$2,580.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,444.80
Max. Negotiated Rate	$2,502.60
Rate for Payer: Cash Price	$1,548.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,806.00
Rate for Payer: Health Management Network Commercial	$2,193.00
Rate for Payer: MDX Hawaii PPO	$2,502.60
Rate for Payer: University Health Alliance Commercial	$1,444.80

VENTRALIGHT MESH 4X6 5991015

Facility

$2,086.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,168.16
Max. Negotiated Rate	$2,023.42
Rate for Payer: Cash Price	$1,251.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,460.20
Rate for Payer: Health Management Network Commercial	$1,773.10
Rate for Payer: MDX Hawaii PPO	$2,023.42
Rate for Payer: University Health Alliance Commercial	$1,168.16

VENTRALIGHT MESH 4X6 5991015

Facility

$2,086.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,063.86
Max. Negotiated Rate	$2,023.42
Rate for Payer: Cash Price	$1,251.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,460.20
Rate for Payer: Health Management Network Commercial	$1,773.10
Rate for Payer: Kaiser Permanente Commercial	$1,314.18
Rate for Payer: Kaiser Permanente Medicaid	$1,063.86
Rate for Payer: MDX Hawaii PPO	$2,023.42
Rate for Payer: University Health Alliance Commercial	$1,168.16

VENTRALIGHT MESH 6" 5990020

Facility

$5,268.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,686.68
Max. Negotiated Rate	$5,109.96
Rate for Payer: Cash Price	$3,160.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,687.60
Rate for Payer: Health Management Network Commercial	$4,477.80
Rate for Payer: Kaiser Permanente Commercial	$3,318.84
Rate for Payer: Kaiser Permanente Medicaid	$2,686.68
Rate for Payer: MDX Hawaii PPO	$5,109.96
Rate for Payer: University Health Alliance Commercial	$2,950.08

VENTRALIGHT MESH 6" 5990020

Facility

$5,268.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,950.08
Max. Negotiated Rate	$5,109.96
Rate for Payer: Cash Price	$3,160.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,687.60
Rate for Payer: Health Management Network Commercial	$4,477.80
Rate for Payer: MDX Hawaii PPO	$5,109.96
Rate for Payer: University Health Alliance Commercial	$2,950.08

VENTRALIGHT MESH 7X9 5991525

Facility

$4,580.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.80
Max. Negotiated Rate	$4,442.60
Rate for Payer: Cash Price	$2,748.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,206.00
Rate for Payer: Health Management Network Commercial	$3,893.00
Rate for Payer: MDX Hawaii PPO	$4,442.60
Rate for Payer: University Health Alliance Commercial	$2,564.80

VENTRALIGHT MESH 7X9 5991525

Facility

$4,580.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,335.80
Max. Negotiated Rate	$4,442.60
Rate for Payer: Cash Price	$2,748.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,206.00
Rate for Payer: Health Management Network Commercial	$3,893.00
Rate for Payer: Kaiser Permanente Commercial	$2,885.40
Rate for Payer: Kaiser Permanente Medicaid	$2,335.80
Rate for Payer: MDX Hawaii PPO	$4,442.60
Rate for Payer: University Health Alliance Commercial	$2,564.80

VENTRICULAR SHUNT PROCEDURES

Facility

$6,751.72

Service Code	APR-DRG 0221
Min. Negotiated Rate	$6,751.72
Max. Negotiated Rate	$6,751.72
Rate for Payer: AlohaCare Medicaid	$6,751.72
Rate for Payer: Hawaii Medical Service Association ABD	$6,751.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,751.72
Rate for Payer: Kaiser Permanente Medicaid	$6,751.72
Rate for Payer: Ohana Health Plan Medicaid	$6,751.72
Rate for Payer: UnitedHealthcare Medicaid	$6,751.72

VENTRICULAR SHUNT PROCEDURES

Facility

$10,965.43

Service Code	APR-DRG 0223
Min. Negotiated Rate	$10,965.43
Max. Negotiated Rate	$10,965.43
Rate for Payer: AlohaCare Medicaid	$10,965.43
Rate for Payer: Hawaii Medical Service Association ABD	$10,965.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,965.43
Rate for Payer: Kaiser Permanente Medicaid	$10,965.43
Rate for Payer: Ohana Health Plan Medicaid	$10,965.43
Rate for Payer: UnitedHealthcare Medicaid	$10,965.43

VENTRICULAR SHUNT PROCEDURES

Facility

$7,807.76

Service Code	APR-DRG 0222
Min. Negotiated Rate	$7,807.76
Max. Negotiated Rate	$7,807.76
Rate for Payer: AlohaCare Medicaid	$7,807.76
Rate for Payer: Hawaii Medical Service Association ABD	$7,807.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,807.76
Rate for Payer: Kaiser Permanente Medicaid	$7,807.76
Rate for Payer: Ohana Health Plan Medicaid	$7,807.76
Rate for Payer: UnitedHealthcare Medicaid	$7,807.76

VENTRICULAR SHUNT PROCEDURES

Facility

$23,944.44

Service Code	APR-DRG 0224
Min. Negotiated Rate	$23,944.44
Max. Negotiated Rate	$23,944.44
Rate for Payer: AlohaCare Medicaid	$23,944.44
Rate for Payer: Hawaii Medical Service Association ABD	$23,944.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23,944.44
Rate for Payer: Kaiser Permanente Medicaid	$23,944.44
Rate for Payer: Ohana Health Plan Medicaid	$23,944.44
Rate for Payer: UnitedHealthcare Medicaid	$23,944.44

VENTRICULAR SHUNT PROCEDURES WITH CC

Facility

$55,108.09

Service Code	MSDRG 032
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$55,108.09
Rate for Payer: AlohaCare Medicare	$24,238.54
Rate for Payer: Devoted Health Medicare	$26,662.39
Rate for Payer: Hawaii Medical Service Association Commercial	$55,108.09
Rate for Payer: Hawaii Medical Service Association Medicare	$24,238.54
Rate for Payer: Humana Medicare	$24,238.54
Rate for Payer: Kaiser Permanente Commercial	$36,759.75
Rate for Payer: Kaiser Permanente Medicare	$24,238.54
Rate for Payer: Ohana Health Plan Medicare	$24,238.54
Rate for Payer: UnitedHealthcare Medicare	$24,238.54
Rate for Payer: University Health Alliance Commercial	$10,400.00

VENTRICULAR SHUNT PROCEDURES WITH MCC

Facility

$77,288.62

Service Code	MSDRG 031
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$77,288.62
Rate for Payer: AlohaCare Medicare	$50,962.35
Rate for Payer: Devoted Health Medicare	$56,058.58
Rate for Payer: Hawaii Medical Service Association Commercial	$55,108.09
Rate for Payer: Hawaii Medical Service Association Medicare	$50,962.35
Rate for Payer: Humana Medicare	$50,962.35
Rate for Payer: Kaiser Permanente Commercial	$77,288.62
Rate for Payer: Kaiser Permanente Medicare	$50,962.35
Rate for Payer: Ohana Health Plan Medicare	$50,962.35
Rate for Payer: UnitedHealthcare Medicare	$50,962.35
Rate for Payer: University Health Alliance Commercial	$10,400.00

VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$38,291.75

Service Code	MSDRG 033
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$38,291.75
Rate for Payer: AlohaCare Medicare	$18,914.26
Rate for Payer: Devoted Health Medicare	$20,805.69
Rate for Payer: Hawaii Medical Service Association Commercial	$38,291.75
Rate for Payer: Hawaii Medical Service Association Medicare	$18,914.26
Rate for Payer: Humana Medicare	$18,914.26
Rate for Payer: Kaiser Permanente Commercial	$28,685.03
Rate for Payer: Kaiser Permanente Medicare	$18,914.26
Rate for Payer: Ohana Health Plan Medicare	$18,914.26
Rate for Payer: UnitedHealthcare Medicare	$18,914.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

VENTRIO ST HERNIA PATCH OVAL

Facility

$3,260.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,825.60
Max. Negotiated Rate	$3,162.20
Rate for Payer: Cash Price	$1,956.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,282.00
Rate for Payer: Health Management Network Commercial	$2,771.00
Rate for Payer: MDX Hawaii PPO	$3,162.20
Rate for Payer: University Health Alliance Commercial	$1,825.60

VENTRIO ST HERNIA PATCH OVAL

Facility

$3,260.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,662.60
Max. Negotiated Rate	$3,162.20
Rate for Payer: Cash Price	$1,956.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,282.00
Rate for Payer: Health Management Network Commercial	$2,771.00
Rate for Payer: Kaiser Permanente Commercial	$2,053.80
Rate for Payer: Kaiser Permanente Medicaid	$1,662.60
Rate for Payer: MDX Hawaii PPO	$3,162.20
Rate for Payer: University Health Alliance Commercial	$1,825.60

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$38.00

Service Code	NDC 70710164301
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$36.86

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$38.00

Service Code	NDC 70710164307
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$36.86

VERAPAMIL 40 MG TABLET [8529]

Facility

$1.00

Service Code	NDC 00591040401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97

VERAPAMIL 40 MG TABLET [8529]

Facility

$1.00

Service Code	NDC 00591040401
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]

Facility

$6.00

Service Code	NDC 75834015801
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

Know your out-of-pocket cost for care.

All Charges