Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CLAMP MED PIN 4-POS 390.026

Facility

$2,193.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,118.43
Max. Negotiated Rate	$2,127.21
Rate for Payer: Cash Price	$1,315.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,083.35
Rate for Payer: Health Management Network Commercial	$1,864.05
Rate for Payer: Kaiser Permanente Commercial	$1,381.59
Rate for Payer: Kaiser Permanente Medicaid	$1,118.43
Rate for Payer: MDX Hawaii PPO	$2,127.21
Rate for Payer: University Health Alliance Commercial	$1,598.48

CLAMP MULTI-PIN 4-POS 390.004

Facility

$2,700.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,377.00
Max. Negotiated Rate	$2,619.00
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,565.00
Rate for Payer: Health Management Network Commercial	$2,295.00
Rate for Payer: Kaiser Permanente Commercial	$1,701.00
Rate for Payer: Kaiser Permanente Medicaid	$1,377.00
Rate for Payer: MDX Hawaii PPO	$2,619.00
Rate for Payer: University Health Alliance Commercial	$1,968.03

CLAMP MULTI-PIN 4-POS 390.004

Facility

$2,700.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,295.00
Max. Negotiated Rate	$2,619.00
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Health Management Network Commercial	$2,295.00
Rate for Payer: MDX Hawaii PPO	$2,619.00

CLAMP MULTI-PIN 6 POS 390.002

Facility

$2,885.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,471.35
Max. Negotiated Rate	$2,798.45
Rate for Payer: Cash Price	$1,731.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,019.50
Rate for Payer: Health Management Network Commercial	$2,452.25
Rate for Payer: Kaiser Permanente Commercial	$1,817.55
Rate for Payer: Kaiser Permanente Medicaid	$1,471.35
Rate for Payer: MDX Hawaii PPO	$2,798.45
Rate for Payer: University Health Alliance Commercial	$1,615.60

CLAMP MULTI-PIN 6 POS 390.002

Facility

$2,885.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.60
Max. Negotiated Rate	$2,798.45
Rate for Payer: Cash Price	$1,731.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,019.50
Rate for Payer: Health Management Network Commercial	$2,452.25
Rate for Payer: MDX Hawaii PPO	$2,798.45
Rate for Payer: University Health Alliance Commercial	$1,615.60

CLAMP OPEN ADJ 390.008

Facility

$2,090.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.40
Max. Negotiated Rate	$2,027.30
Rate for Payer: Cash Price	$1,254.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.00
Rate for Payer: Health Management Network Commercial	$1,776.50
Rate for Payer: MDX Hawaii PPO	$2,027.30
Rate for Payer: University Health Alliance Commercial	$1,170.40

CLAMP OPEN ADJ 390.008

Facility

$2,090.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.90
Max. Negotiated Rate	$2,027.30
Rate for Payer: Cash Price	$1,254.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.00
Rate for Payer: Health Management Network Commercial	$1,776.50
Rate for Payer: Kaiser Permanente Commercial	$1,316.70
Rate for Payer: Kaiser Permanente Medicaid	$1,065.90
Rate for Payer: MDX Hawaii PPO	$2,027.30
Rate for Payer: University Health Alliance Commercial	$1,170.40

CLAMP PIN 4 POSITION #390.033

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,266.84
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$1,564.92
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: University Health Alliance Commercial	$1,810.59

CLAMP PIN 4 POSITION #390.033

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: MDX Hawaii PPO	$2,409.48

CLAMP PIN 5 HOLE 4922-2-020

Facility

$2,221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,132.71
Max. Negotiated Rate	$2,154.37
Rate for Payer: Cash Price	$1,332.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,109.95
Rate for Payer: Health Management Network Commercial	$1,887.85
Rate for Payer: Kaiser Permanente Commercial	$1,399.23
Rate for Payer: Kaiser Permanente Medicaid	$1,132.71
Rate for Payer: MDX Hawaii PPO	$2,154.37
Rate for Payer: University Health Alliance Commercial	$1,618.89

CLAMP PIN 5 HOLE 4922-2-020

Facility

$2,221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,887.85
Max. Negotiated Rate	$2,154.37
Rate for Payer: Cash Price	$1,332.60
Rate for Payer: Health Management Network Commercial	$1,887.85
Rate for Payer: MDX Hawaii PPO	$2,154.37

CLAMP PIN 6 POSITION #390.036

Facility

$2,576.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,189.60
Max. Negotiated Rate	$2,498.72
Rate for Payer: Cash Price	$1,545.60
Rate for Payer: Health Management Network Commercial	$2,189.60
Rate for Payer: MDX Hawaii PPO	$2,498.72

CLAMP PIN 6 POSITION #390.036

Facility

$2,576.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,313.76
Max. Negotiated Rate	$2,498.72
Rate for Payer: Cash Price	$1,545.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,447.20
Rate for Payer: Health Management Network Commercial	$2,189.60
Rate for Payer: Kaiser Permanente Commercial	$1,622.88
Rate for Payer: Kaiser Permanente Medicaid	$1,313.76
Rate for Payer: MDX Hawaii PPO	$2,498.72
Rate for Payer: University Health Alliance Commercial	$1,877.65

CLAMP SCREW M4X8 MINIFIX M132

Facility

$158.00

Hospital Revenue Code	272
Min. Negotiated Rate	$134.30
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$94.80
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: MDX Hawaii PPO	$153.26

CLAMP SCREW M4X8 MINIFIX M132

Facility

$158.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.58
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$94.80
Rate for Payer: Hawaii Western Management Group Commercial	$150.10
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$99.54
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: University Health Alliance Commercial	$115.17

CLAMPS MEDIUM ADJUST #390.035

Facility

$1,695.00

Hospital Revenue Code	272
Min. Negotiated Rate	$864.45
Max. Negotiated Rate	$1,644.15
Rate for Payer: Cash Price	$1,017.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,610.25
Rate for Payer: Health Management Network Commercial	$1,440.75
Rate for Payer: Kaiser Permanente Commercial	$1,067.85
Rate for Payer: Kaiser Permanente Medicaid	$864.45
Rate for Payer: MDX Hawaii PPO	$1,644.15
Rate for Payer: University Health Alliance Commercial	$1,235.49

CLAMPS MEDIUM ADJUST #390.035

Facility

$1,695.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,440.75
Max. Negotiated Rate	$1,644.15
Rate for Payer: Cash Price	$1,017.00
Rate for Payer: Health Management Network Commercial	$1,440.75
Rate for Payer: MDX Hawaii PPO	$1,644.15

CLAMPS MINI LNGTHER SSM501

Facility

$2,790.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,371.50
Max. Negotiated Rate	$2,706.30
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Health Management Network Commercial	$2,371.50
Rate for Payer: MDX Hawaii PPO	$2,706.30

CLAMPS MINI LNGTHER SSM501

Facility

$2,790.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,422.90
Max. Negotiated Rate	$2,706.30
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,650.50
Rate for Payer: Health Management Network Commercial	$2,371.50
Rate for Payer: Kaiser Permanente Commercial	$1,757.70
Rate for Payer: Kaiser Permanente Medicaid	$1,422.90
Rate for Payer: MDX Hawaii PPO	$2,706.30
Rate for Payer: University Health Alliance Commercial	$2,033.63

CLAMPS MR CONDITIONAL #390.034

Facility

$1,666.00

Hospital Revenue Code	272
Min. Negotiated Rate	$849.66
Max. Negotiated Rate	$1,616.02
Rate for Payer: Cash Price	$999.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,582.70
Rate for Payer: Health Management Network Commercial	$1,416.10
Rate for Payer: Kaiser Permanente Commercial	$1,049.58
Rate for Payer: Kaiser Permanente Medicaid	$849.66
Rate for Payer: MDX Hawaii PPO	$1,616.02
Rate for Payer: University Health Alliance Commercial	$1,214.35

CLAMPS MR CONDITIONAL #390.034

Facility

$1,666.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,416.10
Max. Negotiated Rate	$1,616.02
Rate for Payer: Cash Price	$999.60
Rate for Payer: Health Management Network Commercial	$1,416.10
Rate for Payer: MDX Hawaii PPO	$1,616.02

CLAMP TRANSVERSE 393.66

Facility

$2,482.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,265.82
Max. Negotiated Rate	$2,407.54
Rate for Payer: Cash Price	$1,489.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,357.90
Rate for Payer: Health Management Network Commercial	$2,109.70
Rate for Payer: Kaiser Permanente Commercial	$1,563.66
Rate for Payer: Kaiser Permanente Medicaid	$1,265.82
Rate for Payer: MDX Hawaii PPO	$2,407.54
Rate for Payer: University Health Alliance Commercial	$1,809.13

CLAMP TRANSVERSE 393.66

Facility

$2,482.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,109.70
Max. Negotiated Rate	$2,407.54
Rate for Payer: Cash Price	$1,489.20
Rate for Payer: Health Management Network Commercial	$2,109.70
Rate for Payer: MDX Hawaii PPO	$2,407.54

CLAMP TUBE-TUBE LRG 390.007

Facility

$2,606.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,215.10
Max. Negotiated Rate	$2,527.82
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: MDX Hawaii PPO	$2,527.82

CLAMP TUBE-TUBE LRG 390.007

Facility

$2,606.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,329.06
Max. Negotiated Rate	$2,527.82
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,475.70
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: Kaiser Permanente Commercial	$1,641.78
Rate for Payer: Kaiser Permanente Medicaid	$1,329.06
Rate for Payer: MDX Hawaii PPO	$2,527.82
Rate for Payer: University Health Alliance Commercial	$1,899.51

Know your out-of-pocket cost for care.

All Charges