Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CERAMIC HEAD 36MM 6570-0-436

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

CERC CBL 1.8X635MM 2232-04-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$987.84
Max. Negotiated Rate	$1,711.08
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL 1.8X635MM 2232-04-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$899.64
Max. Negotiated Rate	$1,711.08
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Commercial	$1,111.32
Rate for Payer: Kaiser Permanente Medicaid	$899.64
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL W/CRMP 22" 2232-01-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$987.84
Max. Negotiated Rate	$1,711.08
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL W/CRMP 22" 2232-01-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$899.64
Max. Negotiated Rate	$1,711.08
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Commercial	$1,111.32
Rate for Payer: Kaiser Permanente Medicaid	$899.64
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL W/CRMP 36" 2232-01-28

Facility

$2,730.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,392.30
Max. Negotiated Rate	$2,648.10
Rate for Payer: Cash Price	$1,638.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,911.00
Rate for Payer: Health Management Network Commercial	$2,320.50
Rate for Payer: Kaiser Permanente Commercial	$1,719.90
Rate for Payer: Kaiser Permanente Medicaid	$1,392.30
Rate for Payer: MDX Hawaii PPO	$2,648.10
Rate for Payer: University Health Alliance Commercial	$1,528.80

CERC CBL W/CRMP 36" 2232-01-28

Facility

$2,730.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,528.80
Max. Negotiated Rate	$2,648.10
Rate for Payer: Cash Price	$1,638.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,911.00
Rate for Payer: Health Management Network Commercial	$2,320.50
Rate for Payer: MDX Hawaii PPO	$2,648.10
Rate for Payer: University Health Alliance Commercial	$1,528.80

CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL

Facility

$5,509.00

Service Code	CPT 59320
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$4,035.20

CERCLAGE PC 0.5X175 291.230.98

Facility

$121.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$61.71
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Hawaii Western Management Group Commercial	$114.95
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$76.23
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: University Health Alliance Commercial	$88.20

CERCLAGE PC 0.5X175 291.230.98

Facility

$121.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: MDX Hawaii PPO	$117.37

CERCLAGE TENSIONER AR-7820

Facility

$1,011.00

Hospital Revenue Code	272
Min. Negotiated Rate	$859.35
Max. Negotiated Rate	$980.67
Rate for Payer: Cash Price	$606.60
Rate for Payer: Health Management Network Commercial	$859.35
Rate for Payer: MDX Hawaii PPO	$980.67

CERCLAGE TENSIONER AR-7820

Facility

$1,011.00

Hospital Revenue Code	272
Min. Negotiated Rate	$515.61
Max. Negotiated Rate	$980.67
Rate for Payer: Cash Price	$606.60
Rate for Payer: Hawaii Western Management Group Commercial	$960.45
Rate for Payer: Health Management Network Commercial	$859.35
Rate for Payer: Kaiser Permanente Commercial	$636.93
Rate for Payer: Kaiser Permanente Medicaid	$515.61
Rate for Payer: MDX Hawaii PPO	$980.67
Rate for Payer: University Health Alliance Commercial	$736.92

CERMENT BONE VOID A0210-08

Facility

$5,390.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,018.40
Max. Negotiated Rate	$5,228.30
Rate for Payer: Cash Price	$3,234.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,773.00
Rate for Payer: Health Management Network Commercial	$4,581.50
Rate for Payer: MDX Hawaii PPO	$5,228.30
Rate for Payer: University Health Alliance Commercial	$3,018.40

CERMENT BONE VOID A0210-08

Facility

$5,390.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,748.90
Max. Negotiated Rate	$5,228.30
Rate for Payer: Cash Price	$3,234.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,773.00
Rate for Payer: Health Management Network Commercial	$4,581.50
Rate for Payer: Kaiser Permanente Commercial	$3,395.70
Rate for Payer: Kaiser Permanente Medicaid	$2,748.90
Rate for Payer: MDX Hawaii PPO	$5,228.30
Rate for Payer: University Health Alliance Commercial	$3,018.40

CERVICAL RIPENING BALLOON 18FR

Facility

$288.00

Service Code	HCPCS C1726
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

CERVICAL RIPENING BALLOON 18FR

Facility

$288.00

Service Code	HCPCS C1726
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

CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$8,951.85

Service Code	APR-DRG 3211
Min. Negotiated Rate	$8,951.85
Max. Negotiated Rate	$8,951.85
Rate for Payer: AlohaCare Medicaid	$8,951.85
Rate for Payer: Hawaii Medical Service Association ABD	$8,951.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,951.85
Rate for Payer: Kaiser Permanente Medicaid	$8,951.85
Rate for Payer: Ohana Health Plan Medicaid	$8,951.85
Rate for Payer: UnitedHealthcare Medicaid	$8,951.85

CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$10,773.01

Service Code	APR-DRG 3212
Min. Negotiated Rate	$10,773.01
Max. Negotiated Rate	$10,773.01
Rate for Payer: AlohaCare Medicaid	$10,773.01
Rate for Payer: Hawaii Medical Service Association ABD	$10,773.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,773.01
Rate for Payer: Kaiser Permanente Medicaid	$10,773.01
Rate for Payer: Ohana Health Plan Medicaid	$10,773.01
Rate for Payer: UnitedHealthcare Medicaid	$10,773.01

CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$15,276.33

Service Code	APR-DRG 3213
Min. Negotiated Rate	$15,276.33
Max. Negotiated Rate	$15,276.33
Rate for Payer: AlohaCare Medicaid	$15,276.33
Rate for Payer: Hawaii Medical Service Association ABD	$15,276.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,276.33
Rate for Payer: Kaiser Permanente Medicaid	$15,276.33
Rate for Payer: Ohana Health Plan Medicaid	$15,276.33
Rate for Payer: UnitedHealthcare Medicaid	$15,276.33

CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$24,947.64

Service Code	APR-DRG 3214
Min. Negotiated Rate	$24,947.64
Max. Negotiated Rate	$24,947.64
Rate for Payer: AlohaCare Medicaid	$24,947.64
Rate for Payer: Hawaii Medical Service Association ABD	$24,947.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24,947.64
Rate for Payer: Kaiser Permanente Medicaid	$24,947.64
Rate for Payer: Ohana Health Plan Medicaid	$24,947.64
Rate for Payer: UnitedHealthcare Medicaid	$24,947.64

CERVICAL SPINAL FUSION WITH CC

Facility

$51,322.59

Service Code	MSDRG 472
Min. Negotiated Rate	$33,509.69
Max. Negotiated Rate	$51,322.59
Rate for Payer: AlohaCare Medicare	$33,509.69
Rate for Payer: Devoted Health Medicare	$36,860.66
Rate for Payer: Hawaii Medical Service Association Commercial	$51,322.59
Rate for Payer: Hawaii Medical Service Association Medicare	$33,509.69
Rate for Payer: Humana Medicare	$33,509.69
Rate for Payer: Kaiser Permanente Commercial	$50,820.22
Rate for Payer: Kaiser Permanente Medicare	$33,509.69
Rate for Payer: Ohana Health Plan Medicare	$33,509.69
Rate for Payer: UnitedHealthcare Medicare	$33,509.69

CERVICAL SPINAL FUSION WITH MCC

Facility

$83,295.07

Service Code	MSDRG 471
Min. Negotiated Rate	$54,922.88
Max. Negotiated Rate	$83,295.07
Rate for Payer: AlohaCare Medicare	$54,922.88
Rate for Payer: Devoted Health Medicare	$60,415.17
Rate for Payer: Hawaii Medical Service Association Commercial	$63,382.79
Rate for Payer: Hawaii Medical Service Association Medicare	$54,922.88
Rate for Payer: Humana Medicare	$54,922.88
Rate for Payer: Kaiser Permanente Commercial	$83,295.07
Rate for Payer: Kaiser Permanente Medicare	$54,922.88
Rate for Payer: Ohana Health Plan Medicare	$54,922.88
Rate for Payer: UnitedHealthcare Medicare	$54,922.88

CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$47,100.31

Service Code	MSDRG 473
Min. Negotiated Rate	$27,767.98
Max. Negotiated Rate	$47,100.31
Rate for Payer: AlohaCare Medicare	$27,767.98
Rate for Payer: Devoted Health Medicare	$30,544.78
Rate for Payer: Hawaii Medical Service Association Commercial	$47,100.31
Rate for Payer: Hawaii Medical Service Association Medicare	$27,767.98
Rate for Payer: Humana Medicare	$27,767.98
Rate for Payer: Kaiser Permanente Commercial	$42,112.43
Rate for Payer: Kaiser Permanente Medicare	$27,767.98
Rate for Payer: Ohana Health Plan Medicare	$27,767.98
Rate for Payer: UnitedHealthcare Medicare	$27,767.98

CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility

$19,558.40

Service Code	MSDRG 787
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,558.40
Rate for Payer: AlohaCare Medicare	$12,702.77
Rate for Payer: Devoted Health Medicare	$13,973.05
Rate for Payer: Hawaii Medical Service Association Commercial	$19,558.40
Rate for Payer: Hawaii Medical Service Association Medicare	$12,702.77
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: Humana Medicare	$12,702.77
Rate for Payer: Kaiser Permanente Commercial	$16,235.00
Rate for Payer: Kaiser Permanente Medicare	$12,702.77
Rate for Payer: Ohana Health Plan Medicare	$12,702.77
Rate for Payer: UnitedHealthcare Medicare	$12,702.77
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility

$20,638.01

Service Code	MSDRG 786
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$20,638.01
Rate for Payer: AlohaCare Medicare	$18,761.83
Rate for Payer: Devoted Health Medicare	$20,638.01
Rate for Payer: Hawaii Medical Service Association Commercial	$19,558.40
Rate for Payer: Hawaii Medical Service Association Medicare	$18,761.83
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: Humana Medicare	$18,761.83
Rate for Payer: Kaiser Permanente Commercial	$16,235.00
Rate for Payer: Kaiser Permanente Medicare	$18,761.83
Rate for Payer: Ohana Health Plan Medicare	$18,761.83
Rate for Payer: UnitedHealthcare Medicare	$18,761.83
Rate for Payer: University Health Alliance Commercial	$9,950.00

Know your out-of-pocket cost for care.

All Charges