Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

C-TAPER HEAD 32/-5 #06-3299

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 HEAD 36/-5 #06-3699

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 HEAD 36/-5 #06-3699

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 HEAD LOW FRICT 06-2200

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.21
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,241.73
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD LOW FRICT 06-2200

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD S-1400-HH82

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD S-1400-HH82

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.21
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,241.73
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TPR FEM HEAD 36/+0 06-3600

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-TPR FEM HEAD 36/+0 06-3600

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-TPR FEM HEAD 36/+10 06-3610

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,721.60
Max. Negotiated Rate	$4,714.20
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: University Health Alliance Commercial	$2,721.60

C-TPR FEM HEAD 36/+10 06-3610

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,478.60
Max. Negotiated Rate	$4,714.20
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: Kaiser Permanente Commercial	$3,061.80
Rate for Payer: Kaiser Permanente Medicaid	$2,478.60
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: University Health Alliance Commercial	$2,721.60

C-TPR FEM HEAD 36/+2.5 06-3625

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,721.60
Max. Negotiated Rate	$4,714.20
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: University Health Alliance Commercial	$2,721.60

C-TPR FEM HEAD 36/+2.5 06-3625

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,478.60
Max. Negotiated Rate	$4,714.20
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: Kaiser Permanente Commercial	$3,061.80
Rate for Payer: Kaiser Permanente Medicaid	$2,478.60
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: University Health Alliance Commercial	$2,721.60

C-TPR FEM HEAD 36/-2.5 06-3697

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-TPR FEM HEAD 36/-2.5 06-3697

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-TPR FEM HEAD 36/+5 06-3605

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-TPR FEM HEAD 36/+5 06-3605

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-TPR FEM HEAD 36/+5 18-3605

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

C-TPR FEM HEAD 36/+5 18-3605

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-TPR FEM HEAD 36/+7.5 06-3675

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,721.60
Max. Negotiated Rate	$4,714.20
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: University Health Alliance Commercial	$2,721.60

C-TPR FEM HEAD 36/+7.5 06-3675

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,478.60
Max. Negotiated Rate	$4,714.20
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: Kaiser Permanente Commercial	$3,061.80
Rate for Payer: Kaiser Permanente Medicaid	$2,478.60
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: University Health Alliance Commercial	$2,721.60

CUFF CONTR 18X4.5 60797510300

Facility

$111.00

Hospital Revenue Code	272
Min. Negotiated Rate	$56.61
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Hawaii Western Management Group Commercial	$105.45
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$69.93
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: University Health Alliance Commercial	$80.91

CUFF CONTR 18X4.5 60797510300

Facility

$111.00

Hospital Revenue Code	272
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: MDX Hawaii PPO	$107.67

CUFF FGS 3.5CM INHIIZONE

Facility

$14,652.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$8,205.12
Max. Negotiated Rate	$14,212.44
Rate for Payer: Cash Price	$8,791.20
Rate for Payer: Hawaii Western Management Group Commercial	$10,256.40
Rate for Payer: Health Management Network Commercial	$12,454.20
Rate for Payer: MDX Hawaii PPO	$14,212.44
Rate for Payer: University Health Alliance Commercial	$8,205.12

CUFF FGS 3.5CM INHIIZONE

Facility

$14,652.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$7,472.52
Max. Negotiated Rate	$14,212.44
Rate for Payer: Cash Price	$8,791.20
Rate for Payer: Hawaii Western Management Group Commercial	$10,256.40
Rate for Payer: Health Management Network Commercial	$12,454.20
Rate for Payer: Kaiser Permanente Commercial	$9,230.76
Rate for Payer: Kaiser Permanente Medicaid	$7,472.52
Rate for Payer: MDX Hawaii PPO	$14,212.44
Rate for Payer: University Health Alliance Commercial	$8,205.12

Know your out-of-pocket cost for care.

All Charges