Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CONTAINE CHEST TUBE ATRIUM RVR

Facility

$213.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$127.80
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: MDX Hawaii PPO	$206.61

CONTIN LONGEVITY NEUTRAL LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTIN LONGEVITY NEUTRAL LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTINUUM 36X56 00-8752-012-36

Facility

$5,696.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,904.96
Max. Negotiated Rate	$5,525.12
Rate for Payer: Cash Price	$3,417.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,987.20
Rate for Payer: Health Management Network Commercial	$4,841.60
Rate for Payer: Kaiser Permanente Commercial	$3,588.48
Rate for Payer: Kaiser Permanente Medicaid	$2,904.96
Rate for Payer: MDX Hawaii PPO	$5,525.12
Rate for Payer: University Health Alliance Commercial	$3,189.76

CONTINUUM 36X56 00-8752-012-36

Facility

$5,696.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,189.76
Max. Negotiated Rate	$5,525.12
Rate for Payer: Cash Price	$3,417.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,987.20
Rate for Payer: Health Management Network Commercial	$4,841.60
Rate for Payer: MDX Hawaii PPO	$5,525.12
Rate for Payer: University Health Alliance Commercial	$3,189.76

CONTINUUM 36X58 00-8752-013-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTINUUM 36X58 00-8752-013-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTINUUM LINER 00-8752-015-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTINUUM LINER 00-8752-015-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTINUUM LONGEVITY LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	272
Min. Negotiated Rate	$2,380.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00

CONTINUUM LONGEVITY LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	272
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$2,040.92

CONT LONGEVITY ELEVATED LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONT LONGEVITY ELEVATED LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONT LONGEVITY NEUT LINE HH

Facility

$2,642.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.52
Max. Negotiated Rate	$2,562.74
Rate for Payer: Cash Price	$1,585.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,849.40
Rate for Payer: Health Management Network Commercial	$2,245.70
Rate for Payer: MDX Hawaii PPO	$2,562.74
Rate for Payer: University Health Alliance Commercial	$1,479.52

CONT LONGEVITY NEUT LINE HH

Facility

$2,642.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,347.42
Max. Negotiated Rate	$2,562.74
Rate for Payer: Cash Price	$1,585.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,849.40
Rate for Payer: Health Management Network Commercial	$2,245.70
Rate for Payer: Kaiser Permanente Commercial	$1,664.46
Rate for Payer: Kaiser Permanente Medicaid	$1,347.42
Rate for Payer: MDX Hawaii PPO	$2,562.74
Rate for Payer: University Health Alliance Commercial	$1,479.52

CONT LONGEVITY NEUT LINER 00

Facility

$3,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,544.28
Max. Negotiated Rate	$2,937.16
Rate for Payer: Cash Price	$1,816.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,119.60
Rate for Payer: Health Management Network Commercial	$2,573.80
Rate for Payer: Kaiser Permanente Commercial	$1,907.64
Rate for Payer: Kaiser Permanente Medicaid	$1,544.28
Rate for Payer: MDX Hawaii PPO	$2,937.16
Rate for Payer: University Health Alliance Commercial	$1,695.68

CONT LONGEVITY NEUT LINER 00

Facility

$3,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.68
Max. Negotiated Rate	$2,937.16
Rate for Payer: Cash Price	$1,816.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,119.60
Rate for Payer: Health Management Network Commercial	$2,573.80
Rate for Payer: MDX Hawaii PPO	$2,937.16
Rate for Payer: University Health Alliance Commercial	$1,695.68

CONT LONGEVITY NEUT LINER LL

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONT LONGEVITY NEUT LINER LL

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTOUR 40MM LINEAR STAPLER

Facility

$2,964.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,519.40
Max. Negotiated Rate	$2,875.08
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Health Management Network Commercial	$2,519.40
Rate for Payer: MDX Hawaii PPO	$2,875.08

CONTOUR 40MM LINEAR STAPLER

Facility

$2,964.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,511.64
Max. Negotiated Rate	$2,875.08
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,815.80
Rate for Payer: Health Management Network Commercial	$2,519.40
Rate for Payer: Kaiser Permanente Commercial	$1,867.32
Rate for Payer: Kaiser Permanente Medicaid	$1,511.64
Rate for Payer: MDX Hawaii PPO	$2,875.08
Rate for Payer: University Health Alliance Commercial	$2,160.46

CONTRALATERAL LEF ENDOPROSTHES

Facility

$8,800.00

Hospital Revenue Code	278
Min. Negotiated Rate	$4,928.00
Max. Negotiated Rate	$8,536.00
Rate for Payer: Cash Price	$5,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,160.00
Rate for Payer: Health Management Network Commercial	$7,480.00
Rate for Payer: MDX Hawaii PPO	$8,536.00
Rate for Payer: University Health Alliance Commercial	$4,928.00

CONTRALATERAL LEF ENDOPROSTHES

Facility

$8,800.00

Hospital Revenue Code	278
Min. Negotiated Rate	$4,488.00
Max. Negotiated Rate	$8,536.00
Rate for Payer: Cash Price	$5,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,160.00
Rate for Payer: Health Management Network Commercial	$7,480.00
Rate for Payer: Kaiser Permanente Commercial	$5,544.00
Rate for Payer: Kaiser Permanente Medicaid	$4,488.00
Rate for Payer: MDX Hawaii PPO	$8,536.00
Rate for Payer: University Health Alliance Commercial	$4,928.00

CONTROLLER 97745

Facility

$4,400.00

Service Code	HCPCS C1787
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

CONTROLLER 97745

Facility

$4,400.00

Service Code	HCPCS C1787
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

Know your out-of-pocket cost for care.

All Charges