Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

COUNTERSINK 2.0/2.4MM 316-0101

Facility

$906.50

Hospital Revenue Code	272
Min. Negotiated Rate	$770.52
Max. Negotiated Rate	$879.30
Rate for Payer: Cash Price	$543.90
Rate for Payer: Health Management Network Commercial	$770.52
Rate for Payer: MDX Hawaii PPO	$879.30

COUNTERSINK 2.0/2.4MM 316-0101

Facility

$906.50

Hospital Revenue Code	272
Min. Negotiated Rate	$462.31
Max. Negotiated Rate	$879.30
Rate for Payer: Cash Price	$543.90
Rate for Payer: Hawaii Western Management Group Commercial	$861.17
Rate for Payer: Health Management Network Commercial	$770.52
Rate for Payer: Kaiser Permanente Commercial	$571.10
Rate for Payer: Kaiser Permanente Medicaid	$462.31
Rate for Payer: MDX Hawaii PPO	$879.30
Rate for Payer: University Health Alliance Commercial	$660.75

COUNTERSINK 2.3MM HSINK-2.3

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: University Health Alliance Commercial	$459.21

COUNTERSINK 2.3MM HSINK-2.3

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: MDX Hawaii PPO	$611.10

COUNTERSINK 2.7MM QR 320-2727

Facility

$840.00

Hospital Revenue Code	272
Min. Negotiated Rate	$714.00
Max. Negotiated Rate	$814.80
Rate for Payer: Cash Price	$504.00
Rate for Payer: Health Management Network Commercial	$714.00
Rate for Payer: MDX Hawaii PPO	$814.80

COUNTERSINK 2.7MM QR 320-2727

Facility

$840.00

Hospital Revenue Code	272
Min. Negotiated Rate	$428.40
Max. Negotiated Rate	$814.80
Rate for Payer: Cash Price	$504.00
Rate for Payer: Hawaii Western Management Group Commercial	$798.00
Rate for Payer: Health Management Network Commercial	$714.00
Rate for Payer: Kaiser Permanente Commercial	$529.20
Rate for Payer: Kaiser Permanente Medicaid	$428.40
Rate for Payer: MDX Hawaii PPO	$814.80
Rate for Payer: University Health Alliance Commercial	$612.28

COUNTERSINK 3.0MM HSINK-3.0

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: MDX Hawaii PPO	$611.10

COUNTERSINK 3.0MM HSINK-3.0

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: University Health Alliance Commercial	$459.21

COUNTERSINK 3.5MM HSINK-3.5

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: MDX Hawaii PPO	$611.10

COUNTERSINK 3.5MM HSINK-3.5

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: University Health Alliance Commercial	$459.21

COUNTERSINK 4.5/5.5MM

Facility

$1,846.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,569.10
Max. Negotiated Rate	$1,790.62
Rate for Payer: Cash Price	$1,107.60
Rate for Payer: Health Management Network Commercial	$1,569.10
Rate for Payer: MDX Hawaii PPO	$1,790.62

COUNTERSINK 4.5/5.5MM

Facility

$1,846.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$941.46
Max. Negotiated Rate	$1,790.62
Rate for Payer: Cash Price	$1,107.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.70
Rate for Payer: Health Management Network Commercial	$1,569.10
Rate for Payer: Kaiser Permanente Commercial	$1,162.98
Rate for Payer: Kaiser Permanente Medicaid	$941.46
Rate for Payer: MDX Hawaii PPO	$1,790.62
Rate for Payer: University Health Alliance Commercial	$1,345.55

COUNTER SINK 45-80040

Facility

$535.00

Hospital Revenue Code	272
Min. Negotiated Rate	$454.75
Max. Negotiated Rate	$518.95
Rate for Payer: Cash Price	$321.00
Rate for Payer: Health Management Network Commercial	$454.75
Rate for Payer: MDX Hawaii PPO	$518.95

COUNTER SINK 45-80040

Facility

$535.00

Hospital Revenue Code	272
Min. Negotiated Rate	$272.85
Max. Negotiated Rate	$518.95
Rate for Payer: Cash Price	$321.00
Rate for Payer: Hawaii Western Management Group Commercial	$508.25
Rate for Payer: Health Management Network Commercial	$454.75
Rate for Payer: Kaiser Permanente Commercial	$337.05
Rate for Payer: Kaiser Permanente Medicaid	$272.85
Rate for Payer: MDX Hawaii PPO	$518.95
Rate for Payer: University Health Alliance Commercial	$389.96

COUNTERSNK CANN 3/4MM 316-0201

Facility

$1,054.00

Hospital Revenue Code	272
Min. Negotiated Rate	$537.54
Max. Negotiated Rate	$1,022.38
Rate for Payer: Cash Price	$632.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,001.30
Rate for Payer: Health Management Network Commercial	$895.90
Rate for Payer: Kaiser Permanente Commercial	$664.02
Rate for Payer: Kaiser Permanente Medicaid	$537.54
Rate for Payer: MDX Hawaii PPO	$1,022.38
Rate for Payer: University Health Alliance Commercial	$768.26

COUNTERSNK CANN 3/4MM 316-0201

Facility

$1,054.00

Hospital Revenue Code	272
Min. Negotiated Rate	$895.90
Max. Negotiated Rate	$1,022.38
Rate for Payer: Cash Price	$632.40
Rate for Payer: Health Management Network Commercial	$895.90
Rate for Payer: MDX Hawaii PPO	$1,022.38

COUPLING BAR TO BAR 4922-1-010

Facility

$2,156.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.36
Max. Negotiated Rate	$2,091.32
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.20
Rate for Payer: Health Management Network Commercial	$1,832.60
Rate for Payer: MDX Hawaii PPO	$2,091.32
Rate for Payer: University Health Alliance Commercial	$1,207.36

COUPLING BAR TO BAR 4922-1-010

Facility

$2,156.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,099.56
Max. Negotiated Rate	$2,091.32
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.20
Rate for Payer: Health Management Network Commercial	$1,832.60
Rate for Payer: Kaiser Permanente Commercial	$1,358.28
Rate for Payer: Kaiser Permanente Medicaid	$1,099.56
Rate for Payer: MDX Hawaii PPO	$2,091.32
Rate for Payer: University Health Alliance Commercial	$1,207.36

COUPLING PIN TO ROD 4922-1-020

Facility

$2,739.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,396.89
Max. Negotiated Rate	$2,656.83
Rate for Payer: Cash Price	$1,643.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,917.30
Rate for Payer: Health Management Network Commercial	$2,328.15
Rate for Payer: Kaiser Permanente Commercial	$1,725.57
Rate for Payer: Kaiser Permanente Medicaid	$1,396.89
Rate for Payer: MDX Hawaii PPO	$2,656.83
Rate for Payer: University Health Alliance Commercial	$1,533.84

COUPLING PIN TO ROD 4922-1-020

Facility

$2,739.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.84
Max. Negotiated Rate	$2,656.83
Rate for Payer: Cash Price	$1,643.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,917.30
Rate for Payer: Health Management Network Commercial	$2,328.15
Rate for Payer: MDX Hawaii PPO	$2,656.83
Rate for Payer: University Health Alliance Commercial	$1,533.84

COVER ALEXIS LAP MEDIUM C8502

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: MDX Hawaii PPO	$848.75

COVER ALEXIS LAP MEDIUM C8502

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$551.25
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$637.79

COVER ALEXIS LAP SMALL C8501

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: MDX Hawaii PPO	$848.75

COVER ALEXIS LAP SMALL C8501

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$551.25
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$637.79

COVER TIP ACCESSORY 400180

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$122.22

Know your out-of-pocket cost for care.

All Charges