Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CRCLG STR PASSER SM AR-7825

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$574.77
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,070.65
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$710.01
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: University Health Alliance Commercial	$821.47

CRCLG STR PASSER SM AR-7825

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$957.95
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: MDX Hawaii PPO	$1,093.19

CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT)

Facility

$10,679.55

Service Code	CPT 36830
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Devoted Health Medicare	$7,230.94
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$10,679.55

CRESCENT PLATE 2X2 04.503.711

Facility

$2,344.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.64
Max. Negotiated Rate	$2,273.68
Rate for Payer: Cash Price	$1,406.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,640.80
Rate for Payer: Health Management Network Commercial	$1,992.40
Rate for Payer: MDX Hawaii PPO	$2,273.68
Rate for Payer: University Health Alliance Commercial	$1,312.64

CRESCENT PLATE 2X2 04.503.711

Facility

$2,344.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,195.44
Max. Negotiated Rate	$2,273.68
Rate for Payer: Cash Price	$1,406.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,640.80
Rate for Payer: Health Management Network Commercial	$1,992.40
Rate for Payer: Kaiser Permanente Commercial	$1,476.72
Rate for Payer: Kaiser Permanente Medicaid	$1,195.44
Rate for Payer: MDX Hawaii PPO	$2,273.68
Rate for Payer: University Health Alliance Commercial	$1,312.64

CRESCENT PLATE 3X3 04.503.727

Facility

$2,852.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,454.52
Max. Negotiated Rate	$2,766.44
Rate for Payer: Cash Price	$1,711.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,996.40
Rate for Payer: Health Management Network Commercial	$2,424.20
Rate for Payer: Kaiser Permanente Commercial	$1,796.76
Rate for Payer: Kaiser Permanente Medicaid	$1,454.52
Rate for Payer: MDX Hawaii PPO	$2,766.44
Rate for Payer: University Health Alliance Commercial	$1,597.12

CRESCENT PLATE 3X3 04.503.727

Facility

$2,852.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,597.12
Max. Negotiated Rate	$2,766.44
Rate for Payer: Cash Price	$1,711.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,996.40
Rate for Payer: Health Management Network Commercial	$2,424.20
Rate for Payer: MDX Hawaii PPO	$2,766.44
Rate for Payer: University Health Alliance Commercial	$1,597.12

CR FEMORAL SZ 7 5510-F-702

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

CR FEMORAL SZ 7 5510-F-702

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,183.82
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$2,697.66
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

CR FLEX FEM G-RT 5956-017-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

CR FLEX FEM G-RT 5956-017-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

CR FLX FEM COMPNT #5750-017-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

CR FLX FEM COMPNT #5750-017-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

CRTD COBALT XT HF MRI IS1 HF

Facility

$52,098.00

Service Code	HCPCS C1882
Hospital Revenue Code	275
Min. Negotiated Rate	$29,174.88
Max. Negotiated Rate	$50,535.06
Rate for Payer: Cash Price	$31,258.80
Rate for Payer: Hawaii Western Management Group Commercial	$36,468.60
Rate for Payer: Health Management Network Commercial	$44,283.30
Rate for Payer: MDX Hawaii PPO	$50,535.06
Rate for Payer: University Health Alliance Commercial	$29,174.88

CRTD COBALT XT HF MRI IS1 HF

Facility

$52,098.00

Service Code	HCPCS C1882
Hospital Revenue Code	275
Min. Negotiated Rate	$26,569.98
Max. Negotiated Rate	$50,535.06
Rate for Payer: Cash Price	$31,258.80
Rate for Payer: Hawaii Western Management Group Commercial	$36,468.60
Rate for Payer: Health Management Network Commercial	$44,283.30
Rate for Payer: Kaiser Permanente Commercial	$32,821.74
Rate for Payer: Kaiser Permanente Medicaid	$26,569.98
Rate for Payer: MDX Hawaii PPO	$50,535.06
Rate for Payer: University Health Alliance Commercial	$29,174.88

CRUCIATE RETAINING 5510-F-202

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

CRUCIATE RETAINING 5510-F-202

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,183.82
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$2,697.66
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

CRUCIATE RETAINING 5517-F-502

Facility

$5,947.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,032.97
Max. Negotiated Rate	$5,768.59
Rate for Payer: Cash Price	$3,568.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,162.90
Rate for Payer: Health Management Network Commercial	$5,054.95
Rate for Payer: Kaiser Permanente Commercial	$3,746.61
Rate for Payer: Kaiser Permanente Medicaid	$3,032.97
Rate for Payer: MDX Hawaii PPO	$5,768.59
Rate for Payer: University Health Alliance Commercial	$3,330.32

CRUCIATE RETAINING 5517-F-502

Facility

$5,947.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,330.32
Max. Negotiated Rate	$5,768.59
Rate for Payer: Cash Price	$3,568.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,162.90
Rate for Payer: Health Management Network Commercial	$5,054.95
Rate for Payer: MDX Hawaii PPO	$5,768.59
Rate for Payer: University Health Alliance Commercial	$3,330.32

CRYSTAL CANNULA 5.75 AR-6564

Facility

$131.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.81
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$78.60
Rate for Payer: Hawaii Western Management Group Commercial	$124.45
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$82.53
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: University Health Alliance Commercial	$95.49

CRYSTAL CANNULA 5.75 AR-6564

Facility

$131.00

Hospital Revenue Code	272
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$78.60
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: MDX Hawaii PPO	$127.07

C-TAPER +0 HEAD 06-2600

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.40
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER +0 HEAD 06-2600

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,014.90
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$1,253.70
Rate for Payer: Kaiser Permanente Medicaid	$1,014.90
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER BIOLOX HEAD 18-3600

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,364.76
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: Kaiser Permanente Commercial	$1,685.88
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

C-TAPER BIOLOX HEAD 18-3600

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

Know your out-of-pocket cost for care.

All Charges