Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES

Facility

$98,444.02

Service Code	MSDRG 213
Min. Negotiated Rate	$64,911.73
Max. Negotiated Rate	$98,444.02
Rate for Payer: AlohaCare Medicare	$64,911.73
Rate for Payer: Devoted Health Medicare	$71,402.90
Rate for Payer: Hawaii Medical Service Association Commercial	$98,325.83
Rate for Payer: Hawaii Medical Service Association Medicare	$64,911.73
Rate for Payer: Humana Medicare	$64,911.73
Rate for Payer: Kaiser Permanente Commercial	$98,444.02
Rate for Payer: Kaiser Permanente Medicare	$64,911.73
Rate for Payer: Ohana Health Plan Medicare	$64,911.73
Rate for Payer: UnitedHealthcare Medicare	$64,911.73

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$105,714.90

Service Code	MSDRG 266
Min. Negotiated Rate	$69,705.99
Max. Negotiated Rate	$105,714.90
Rate for Payer: AlohaCare Medicare	$69,705.99
Rate for Payer: Devoted Health Medicare	$76,676.59
Rate for Payer: Hawaii Medical Service Association Commercial	$94,564.60
Rate for Payer: Hawaii Medical Service Association Medicare	$69,705.99
Rate for Payer: Humana Medicare	$69,705.99
Rate for Payer: Kaiser Permanente Commercial	$105,714.90
Rate for Payer: Kaiser Permanente Medicare	$69,705.99
Rate for Payer: Ohana Health Plan Medicare	$69,705.99
Rate for Payer: UnitedHealthcare Medicare	$69,705.99

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$82,358.80

Service Code	MSDRG 267
Min. Negotiated Rate	$54,150.56
Max. Negotiated Rate	$82,358.80
Rate for Payer: AlohaCare Medicare	$54,150.56
Rate for Payer: Devoted Health Medicare	$59,565.62
Rate for Payer: Hawaii Medical Service Association Commercial	$82,358.80
Rate for Payer: Hawaii Medical Service Association Medicare	$54,150.56
Rate for Payer: Humana Medicare	$54,150.56
Rate for Payer: Kaiser Permanente Commercial	$82,123.80
Rate for Payer: Kaiser Permanente Medicare	$54,150.56
Rate for Payer: Ohana Health Plan Medicare	$54,150.56
Rate for Payer: UnitedHealthcare Medicare	$54,150.56

ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED

Facility

$24,500.00

Service Code	CPT 36475
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$24,500.00

ENDURANT BIFOR #ESBF2514C103E

Facility

$19,950.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$11,172.00
Max. Negotiated Rate	$19,351.50
Rate for Payer: Cash Price	$11,970.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,965.00
Rate for Payer: Health Management Network Commercial	$16,957.50
Rate for Payer: MDX Hawaii PPO	$19,351.50
Rate for Payer: University Health Alliance Commercial	$11,172.00

ENDURANT BIFOR #ESBF2514C103E

Facility

$19,950.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$10,174.50
Max. Negotiated Rate	$19,351.50
Rate for Payer: Cash Price	$11,970.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,965.00
Rate for Payer: Health Management Network Commercial	$16,957.50
Rate for Payer: Kaiser Permanente Commercial	$12,568.50
Rate for Payer: Kaiser Permanente Medicaid	$10,174.50
Rate for Payer: MDX Hawaii PPO	$19,351.50
Rate for Payer: University Health Alliance Commercial	$11,172.00

ENDURANT GRAFT #ETLW1616C124E

Facility

$9,300.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$4,743.00
Max. Negotiated Rate	$9,021.00
Rate for Payer: Cash Price	$5,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,510.00
Rate for Payer: Health Management Network Commercial	$7,905.00
Rate for Payer: Kaiser Permanente Commercial	$5,859.00
Rate for Payer: Kaiser Permanente Medicaid	$4,743.00
Rate for Payer: MDX Hawaii PPO	$9,021.00
Rate for Payer: University Health Alliance Commercial	$5,208.00

ENDURANT GRAFT #ETLW1616C124E

Facility

$9,300.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,208.00
Max. Negotiated Rate	$9,021.00
Rate for Payer: Cash Price	$5,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,510.00
Rate for Payer: Health Management Network Commercial	$7,905.00
Rate for Payer: MDX Hawaii PPO	$9,021.00
Rate for Payer: University Health Alliance Commercial	$5,208.00

ENDURANT GRAFT #ETLW1616C93E

Facility

$9,300.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,208.00
Max. Negotiated Rate	$9,021.00
Rate for Payer: Cash Price	$5,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,510.00
Rate for Payer: Health Management Network Commercial	$7,905.00
Rate for Payer: MDX Hawaii PPO	$9,021.00
Rate for Payer: University Health Alliance Commercial	$5,208.00

ENDURANT GRAFT #ETLW1616C93E

Facility

$9,300.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$4,743.00
Max. Negotiated Rate	$9,021.00
Rate for Payer: Cash Price	$5,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,510.00
Rate for Payer: Health Management Network Commercial	$7,905.00
Rate for Payer: Kaiser Permanente Commercial	$5,859.00
Rate for Payer: Kaiser Permanente Medicaid	$4,743.00
Rate for Payer: MDX Hawaii PPO	$9,021.00
Rate for Payer: University Health Alliance Commercial	$5,208.00

ENDURANT SHEATH 12F SENSH1228W

Facility

$563.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$287.13
Max. Negotiated Rate	$546.11
Rate for Payer: Cash Price	$337.80
Rate for Payer: Hawaii Western Management Group Commercial	$534.85
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Kaiser Permanente Commercial	$354.69
Rate for Payer: Kaiser Permanente Medicaid	$287.13
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: University Health Alliance Commercial	$410.37

ENDURANT SHEATH 12F SENSH1228W

Facility

$563.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$478.55
Max. Negotiated Rate	$546.11
Rate for Payer: Cash Price	$337.80
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: MDX Hawaii PPO	$546.11

ENDURANT SHEATH 14F SENSH1428W

Facility

$750.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$712.50
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: University Health Alliance Commercial	$546.67

ENDURANT SHEATH 14F SENSH1428W

Facility

$750.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: MDX Hawaii PPO	$727.50

ENDURANT SHEATH 16F SENSH1628W

Facility

$750.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: MDX Hawaii PPO	$727.50

ENDURANT SHEATH 16F SENSH1628W

Facility

$750.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$712.50
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: University Health Alliance Commercial	$546.67

ENDURTY PULS GNRTR DDDR PM1260

Facility

$11,200.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,712.00
Max. Negotiated Rate	$10,864.00
Rate for Payer: Cash Price	$6,720.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,840.00
Rate for Payer: Health Management Network Commercial	$9,520.00
Rate for Payer: Kaiser Permanente Commercial	$7,056.00
Rate for Payer: Kaiser Permanente Medicaid	$5,712.00
Rate for Payer: MDX Hawaii PPO	$10,864.00
Rate for Payer: University Health Alliance Commercial	$6,272.00

ENDURTY PULS GNRTR DDDR PM1260

Facility

$11,200.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$6,272.00
Max. Negotiated Rate	$10,864.00
Rate for Payer: Cash Price	$6,720.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,840.00
Rate for Payer: Health Management Network Commercial	$9,520.00
Rate for Payer: MDX Hawaii PPO	$10,864.00
Rate for Payer: University Health Alliance Commercial	$6,272.00

ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [170496]

Facility

$3,871.00

Service Code	HCPCS J9177
Hospital Revenue Code	250
Min. Negotiated Rate	$3,290.35
Max. Negotiated Rate	$3,754.87
Rate for Payer: Cash Price	$2,322.60
Rate for Payer: Health Management Network Commercial	$3,290.35
Rate for Payer: MDX Hawaii PPO	$3,754.87

ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [170496]

Facility

$3,871.00

Service Code	HCPCS J9177
Hospital Revenue Code	636
Min. Negotiated Rate	$36.66
Max. Negotiated Rate	$3,754.87
Rate for Payer: AlohaCare Medicaid	$36.71
Rate for Payer: AlohaCare Medicare	$36.71
Rate for Payer: Cash Price	$2,322.60
Rate for Payer: Cash Price	$2,322.60
Rate for Payer: Devoted Health Medicare	$40.38
Rate for Payer: Hawaii Medical Service Association ABD	$36.66
Rate for Payer: Hawaii Medical Service Association Commercial	$45.89
Rate for Payer: Hawaii Medical Service Association Medicare	$36.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.66
Rate for Payer: Hawaii Western Management Group Commercial	$3,677.45
Rate for Payer: Health Management Network Commercial	$3,290.35
Rate for Payer: Humana Medicare	$36.71
Rate for Payer: Kaiser Permanente Commercial	$2,438.73
Rate for Payer: Kaiser Permanente Medicaid	$1,974.21
Rate for Payer: Kaiser Permanente Medicare	$36.71
Rate for Payer: MDX Hawaii PPO	$3,754.87
Rate for Payer: Ohana Health Plan Medicaid	$40.38
Rate for Payer: Ohana Health Plan Medicare	$36.71
Rate for Payer: UnitedHealthcare Medicaid	$2,322.60
Rate for Payer: UnitedHealthcare Medicare	$36.71
Rate for Payer: University Health Alliance Commercial	$2,821.57

ENFORTUMAB VEDOTIN-EJFV 30 MG/3ML IV (WET SOLR VIAL) [430170497]

Facility

$5,557.00

Service Code	HCPCS J9177
Hospital Revenue Code	250
Min. Negotiated Rate	$4,723.45
Max. Negotiated Rate	$5,390.29
Rate for Payer: Cash Price	$3,334.20
Rate for Payer: Health Management Network Commercial	$4,723.45
Rate for Payer: MDX Hawaii PPO	$5,390.29

ENFORTUMAB VEDOTIN-EJFV 30 MG/3ML IV (WET SOLR VIAL) [430170497]

Facility

$5,557.00

Service Code	HCPCS J9177
Hospital Revenue Code	636
Min. Negotiated Rate	$36.66
Max. Negotiated Rate	$5,390.29
Rate for Payer: AlohaCare Medicaid	$36.71
Rate for Payer: AlohaCare Medicare	$36.71
Rate for Payer: Cash Price	$3,334.20
Rate for Payer: Cash Price	$3,334.20
Rate for Payer: Devoted Health Medicare	$40.38
Rate for Payer: Hawaii Medical Service Association ABD	$36.66
Rate for Payer: Hawaii Medical Service Association Commercial	$45.89
Rate for Payer: Hawaii Medical Service Association Medicare	$36.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.66
Rate for Payer: Hawaii Western Management Group Commercial	$5,279.15
Rate for Payer: Health Management Network Commercial	$4,723.45
Rate for Payer: Humana Medicare	$36.71
Rate for Payer: Kaiser Permanente Commercial	$3,500.91
Rate for Payer: Kaiser Permanente Medicaid	$2,834.07
Rate for Payer: Kaiser Permanente Medicare	$36.71
Rate for Payer: MDX Hawaii PPO	$5,390.29
Rate for Payer: Ohana Health Plan Medicaid	$40.38
Rate for Payer: Ohana Health Plan Medicare	$36.71
Rate for Payer: UnitedHealthcare Medicaid	$3,334.20
Rate for Payer: UnitedHealthcare Medicare	$36.71
Rate for Payer: University Health Alliance Commercial	$4,050.50

ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [170497]

Facility

$4,124.00

Service Code	HCPCS J9177
Hospital Revenue Code	250
Min. Negotiated Rate	$3,505.40
Max. Negotiated Rate	$4,000.28
Rate for Payer: Cash Price	$2,474.40
Rate for Payer: Cash Price	$3,334.20
Rate for Payer: Health Management Network Commercial	$3,505.40
Rate for Payer: Health Management Network Commercial	$4,723.45
Rate for Payer: MDX Hawaii PPO	$4,000.28
Rate for Payer: MDX Hawaii PPO	$5,390.29

ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [170497]

Facility

$5,557.00

Service Code	HCPCS J9177
Hospital Revenue Code	636
Min. Negotiated Rate	$36.66
Max. Negotiated Rate	$5,390.29
Rate for Payer: AlohaCare Medicaid	$36.71
Rate for Payer: AlohaCare Medicaid	$36.71
Rate for Payer: AlohaCare Medicare	$36.71
Rate for Payer: AlohaCare Medicare	$36.71
Rate for Payer: Cash Price	$3,334.20
Rate for Payer: Cash Price	$3,334.20
Rate for Payer: Cash Price	$2,474.40
Rate for Payer: Cash Price	$2,474.40
Rate for Payer: Devoted Health Medicare	$40.38
Rate for Payer: Devoted Health Medicare	$40.38
Rate for Payer: Hawaii Medical Service Association ABD	$36.66
Rate for Payer: Hawaii Medical Service Association ABD	$36.66
Rate for Payer: Hawaii Medical Service Association Commercial	$45.89
Rate for Payer: Hawaii Medical Service Association Commercial	$45.89
Rate for Payer: Hawaii Medical Service Association Medicare	$36.71
Rate for Payer: Hawaii Medical Service Association Medicare	$36.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.66
Rate for Payer: Hawaii Western Management Group Commercial	$3,917.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,279.15
Rate for Payer: Health Management Network Commercial	$3,505.40
Rate for Payer: Health Management Network Commercial	$4,723.45
Rate for Payer: Humana Medicare	$36.71
Rate for Payer: Humana Medicare	$36.71
Rate for Payer: Kaiser Permanente Commercial	$2,598.12
Rate for Payer: Kaiser Permanente Commercial	$3,500.91
Rate for Payer: Kaiser Permanente Medicaid	$2,834.07
Rate for Payer: Kaiser Permanente Medicaid	$2,103.24
Rate for Payer: Kaiser Permanente Medicare	$36.71
Rate for Payer: Kaiser Permanente Medicare	$36.71
Rate for Payer: MDX Hawaii PPO	$5,390.29
Rate for Payer: MDX Hawaii PPO	$4,000.28
Rate for Payer: Ohana Health Plan Medicaid	$40.38
Rate for Payer: Ohana Health Plan Medicaid	$40.38
Rate for Payer: Ohana Health Plan Medicare	$36.71
Rate for Payer: Ohana Health Plan Medicare	$36.71
Rate for Payer: UnitedHealthcare Medicaid	$3,334.20
Rate for Payer: UnitedHealthcare Medicaid	$2,474.40
Rate for Payer: UnitedHealthcare Medicare	$36.71
Rate for Payer: UnitedHealthcare Medicare	$36.71
Rate for Payer: University Health Alliance Commercial	$4,050.50
Rate for Payer: University Health Alliance Commercial	$3,005.98

ENOVIS SR MCP IMPLANT SIZE LG

Facility

$7,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,284.00
Max. Negotiated Rate	$7,420.50
Rate for Payer: Cash Price	$4,590.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,355.00
Rate for Payer: Health Management Network Commercial	$6,502.50
Rate for Payer: MDX Hawaii PPO	$7,420.50
Rate for Payer: University Health Alliance Commercial	$4,284.00

Know your out-of-pocket cost for care.

All Charges