Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CEMENTED STEMLESS 5200-00-036

Facility

$15,097.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,699.47
Max. Negotiated Rate	$14,644.09
Rate for Payer: Cash Price	$9,058.20
Rate for Payer: Hawaii Western Management Group Commercial	$10,567.90
Rate for Payer: Health Management Network Commercial	$12,832.45
Rate for Payer: Kaiser Permanente Commercial	$9,511.11
Rate for Payer: Kaiser Permanente Medicaid	$7,699.47
Rate for Payer: MDX Hawaii PPO	$14,644.09
Rate for Payer: University Health Alliance Commercial	$8,454.32

CEMENT FEMUR LFTS6 02.12.0006L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,040.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

CEMENT FEMUR LFTS6 02.12.0006L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

CEMENT GLENOID AS 01.04214.370

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,464.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,080.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: MDX Hawaii PPO	$4,268.00
Rate for Payer: University Health Alliance Commercial	$2,464.00

CEMENT GLENOID AS 01.04214.370

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,244.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,080.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: Kaiser Permanente Commercial	$2,772.00
Rate for Payer: Kaiser Permanente Medicaid	$2,244.00
Rate for Payer: MDX Hawaii PPO	$4,268.00
Rate for Payer: University Health Alliance Commercial	$2,464.00

CEMENT GLENOID AS 01.04214.400

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,244.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,080.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: Kaiser Permanente Commercial	$2,772.00
Rate for Payer: Kaiser Permanente Medicaid	$2,244.00
Rate for Payer: MDX Hawaii PPO	$4,268.00
Rate for Payer: University Health Alliance Commercial	$2,464.00

CEMENT GLENOID AS 01.04214.400

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,464.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,080.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: MDX Hawaii PPO	$4,268.00
Rate for Payer: University Health Alliance Commercial	$2,464.00

CEMENT RESTRICT MED B000-0240

Facility

$542.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$303.52
Max. Negotiated Rate	$525.74
Rate for Payer: Cash Price	$325.20
Rate for Payer: Hawaii Western Management Group Commercial	$379.40
Rate for Payer: Health Management Network Commercial	$460.70
Rate for Payer: MDX Hawaii PPO	$525.74
Rate for Payer: University Health Alliance Commercial	$303.52

CEMENT RESTRICT MED B000-0240

Facility

$542.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$276.42
Max. Negotiated Rate	$525.74
Rate for Payer: Cash Price	$325.20
Rate for Payer: Hawaii Western Management Group Commercial	$379.40
Rate for Payer: Health Management Network Commercial	$460.70
Rate for Payer: Kaiser Permanente Commercial	$341.46
Rate for Payer: Kaiser Permanente Medicaid	$276.42
Rate for Payer: MDX Hawaii PPO	$525.74
Rate for Payer: University Health Alliance Commercial	$303.52

CEMENT RESTRICTOR

Facility

$1,068.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$544.68
Max. Negotiated Rate	$1,035.96
Rate for Payer: Cash Price	$640.80
Rate for Payer: Hawaii Western Management Group Commercial	$747.60
Rate for Payer: Health Management Network Commercial	$907.80
Rate for Payer: Kaiser Permanente Commercial	$672.84
Rate for Payer: Kaiser Permanente Medicaid	$544.68
Rate for Payer: MDX Hawaii PPO	$1,035.96
Rate for Payer: University Health Alliance Commercial	$598.08

CEMENT RESTRICTOR

Facility

$1,068.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$598.08
Max. Negotiated Rate	$1,035.96
Rate for Payer: Cash Price	$640.80
Rate for Payer: Hawaii Western Management Group Commercial	$747.60
Rate for Payer: Health Management Network Commercial	$907.80
Rate for Payer: MDX Hawaii PPO	$1,035.96
Rate for Payer: University Health Alliance Commercial	$598.08

CEMENT TIBIAL TRAY 02.07.1205L

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,836.00
Max. Negotiated Rate	$3,492.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,520.00
Rate for Payer: Health Management Network Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: Kaiser Permanente Medicaid	$1,836.00
Rate for Payer: MDX Hawaii PPO	$3,492.00
Rate for Payer: University Health Alliance Commercial	$2,016.00

CEMENT TIBIAL TRAY 02.07.1205L

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,016.00
Max. Negotiated Rate	$3,492.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,520.00
Rate for Payer: Health Management Network Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,492.00
Rate for Payer: University Health Alliance Commercial	$2,016.00

CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [164576]

Facility

$14,102.00

Service Code	HCPCS J9119
Hospital Revenue Code	250
Min. Negotiated Rate	$11,986.70
Max. Negotiated Rate	$13,678.94
Rate for Payer: Cash Price	$8,461.20
Rate for Payer: Health Management Network Commercial	$11,986.70
Rate for Payer: MDX Hawaii PPO	$13,678.94

CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [164576]

Facility

$14,102.00

Service Code	HCPCS J9119
Hospital Revenue Code	636
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$13,678.94
Rate for Payer: AlohaCare Medicaid	$29.76
Rate for Payer: AlohaCare Medicare	$29.76
Rate for Payer: Cash Price	$8,461.20
Rate for Payer: Cash Price	$8,461.20
Rate for Payer: Devoted Health Medicare	$32.74
Rate for Payer: Hawaii Medical Service Association ABD	$28.70
Rate for Payer: Hawaii Medical Service Association Commercial	$37.20
Rate for Payer: Hawaii Medical Service Association Medicare	$29.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.70
Rate for Payer: Hawaii Western Management Group Commercial	$13,396.90
Rate for Payer: Health Management Network Commercial	$11,986.70
Rate for Payer: Humana Medicare	$29.76
Rate for Payer: Kaiser Permanente Commercial	$8,884.26
Rate for Payer: Kaiser Permanente Medicaid	$7,192.02
Rate for Payer: Kaiser Permanente Medicare	$29.76
Rate for Payer: MDX Hawaii PPO	$13,678.94
Rate for Payer: Ohana Health Plan Medicaid	$32.74
Rate for Payer: Ohana Health Plan Medicare	$29.76
Rate for Payer: UnitedHealthcare Medicaid	$8,461.20
Rate for Payer: UnitedHealthcare Medicare	$29.76
Rate for Payer: University Health Alliance Commercial	$10,278.95

CENTERPOINT DELIVERY CATH 6.5F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: MDX Hawaii PPO	$1,681.01

CENTERPOINT DELIVERY CATH 6.5F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$883.83
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,646.35
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,091.79
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: University Health Alliance Commercial	$1,263.18

CENTERPOINT SSPC3 8F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$883.83
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,646.35
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,091.79
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: University Health Alliance Commercial	$1,263.18

CENTERPOINT SSPC3 8F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: MDX Hawaii PPO	$1,681.01

CENTERPOINT SSPC3 9F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: MDX Hawaii PPO	$1,681.01

CENTERPOINT SSPC3 9F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$883.83
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,646.35
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,091.79
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: University Health Alliance Commercial	$1,263.18

CENTRALIZER #00-7859-013-00

Facility

$750.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$525.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: University Health Alliance Commercial	$420.00

CENTRALIZER #00-7859-013-00

Facility

$750.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$525.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: University Health Alliance Commercial	$420.00

CENTRALIZER #00-7859-015-00

Facility

$470.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$263.20
Max. Negotiated Rate	$455.90
Rate for Payer: Cash Price	$282.00
Rate for Payer: Hawaii Western Management Group Commercial	$329.00
Rate for Payer: Health Management Network Commercial	$399.50
Rate for Payer: MDX Hawaii PPO	$455.90
Rate for Payer: University Health Alliance Commercial	$263.20

CENTRALIZER #00-7859-015-00

Facility

$470.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$455.90
Rate for Payer: Cash Price	$282.00
Rate for Payer: Hawaii Western Management Group Commercial	$329.00
Rate for Payer: Health Management Network Commercial	$399.50
Rate for Payer: Kaiser Permanente Commercial	$296.10
Rate for Payer: Kaiser Permanente Medicaid	$239.70
Rate for Payer: MDX Hawaii PPO	$455.90
Rate for Payer: University Health Alliance Commercial	$263.20

Know your out-of-pocket cost for care.

All Charges