Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

FEMORAL SZ5 LEFT PS 5515-F-501

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

FEMORAL SZ5 LEFT PS 5515-F-501

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

FEMORAL SZ5 RIGHT 5516-F-502

Facility

$16,152.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,237.52
Max. Negotiated Rate	$15,667.44
Rate for Payer: Cash Price	$9,691.20
Rate for Payer: Hawaii Western Management Group Commercial	$11,306.40
Rate for Payer: Health Management Network Commercial	$13,729.20
Rate for Payer: Kaiser Permanente Commercial	$10,175.76
Rate for Payer: Kaiser Permanente Medicaid	$8,237.52
Rate for Payer: MDX Hawaii PPO	$15,667.44
Rate for Payer: University Health Alliance Commercial	$9,045.12

FEMORAL SZ5 RIGHT 5516-F-502

Facility

$16,152.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,045.12
Max. Negotiated Rate	$15,667.44
Rate for Payer: Cash Price	$9,691.20
Rate for Payer: Hawaii Western Management Group Commercial	$11,306.40
Rate for Payer: Health Management Network Commercial	$13,729.20
Rate for Payer: MDX Hawaii PPO	$15,667.44
Rate for Payer: University Health Alliance Commercial	$9,045.12

FEMORAL SZ#6 RETAIN 5517-F-601

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

FEMORAL SZ#6 RETAIN 5517-F-601

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

FEMORAL SZ#7 RETAIN 5517-F-702

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

FEMORAL SZ#7 RETAIN 5517-F-702

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

FEMORAL SZ7 TRIATH 5515-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

FEMORAL SZ7 TRIATH 5515-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

FEMORAL SZ8 LEFT PS 5515-F-801

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

FEMORAL SZ8 LEFT PS 5515-F-801

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

FEMORAL TRIATHLON #5510-F-401

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

FEMORAL TRIATHLON #5510-F-401

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

FEMORAL TRIATH SZ#7 5515-F-701

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

FEMORAL TRIATH SZ#7 5515-F-701

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

FEMORAL TT CR FSZ4 5517-F-401

Facility

$5,887.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,296.72
Max. Negotiated Rate	$5,710.39
Rate for Payer: Cash Price	$3,532.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,120.90
Rate for Payer: Health Management Network Commercial	$5,003.95
Rate for Payer: MDX Hawaii PPO	$5,710.39
Rate for Payer: University Health Alliance Commercial	$3,296.72

FEMORAL TT CR FSZ4 5517-F-401

Facility

$5,887.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,002.37
Max. Negotiated Rate	$5,710.39
Rate for Payer: Cash Price	$3,532.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,120.90
Rate for Payer: Health Management Network Commercial	$5,003.95
Rate for Payer: Kaiser Permanente Commercial	$3,708.81
Rate for Payer: Kaiser Permanente Medicaid	$3,002.37
Rate for Payer: MDX Hawaii PPO	$5,710.39
Rate for Payer: University Health Alliance Commercial	$3,296.72

FEMORL CMNT LT SZ7 1506-70-007

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,904.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,380.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: University Health Alliance Commercial	$1,904.00

FEMORL CMNT LT SZ7 1506-70-007

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,734.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,380.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$2,142.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: University Health Alliance Commercial	$1,904.00

FEMORL HEAD #00-8018-028-03

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,224.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

FEMORL HEAD #00-8018-028-03

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

FEMORL HEAD 36/-5MM 6570-0-036

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

FEMORL HEAD 36/-5MM 6570-0-036

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,378.53
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$1,702.89
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

FEMUR SPHERE R6+ 02.12.0026R

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

Know your out-of-pocket cost for care.

All Charges