Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

ANCHOR SUTURE #AR-2324SLM

Facility

$1,603.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$897.68
Max. Negotiated Rate	$1,554.91
Rate for Payer: Cash Price	$961.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.10
Rate for Payer: Health Management Network Commercial	$1,362.55
Rate for Payer: MDX Hawaii PPO	$1,554.91
Rate for Payer: University Health Alliance Commercial	$897.68

ANCHOR SUTURE #AR-2324SLM

Facility

$1,603.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$817.53
Max. Negotiated Rate	$1,554.91
Rate for Payer: Cash Price	$961.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.10
Rate for Payer: Health Management Network Commercial	$1,362.55
Rate for Payer: Kaiser Permanente Commercial	$1,009.89
Rate for Payer: Kaiser Permanente Medicaid	$817.53
Rate for Payer: MDX Hawaii PPO	$1,554.91
Rate for Payer: University Health Alliance Commercial	$897.68

ANCHOR SUTURE AR-8990ST

Facility

$1,995.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.20
Max. Negotiated Rate	$1,935.15
Rate for Payer: Cash Price	$1,197.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,695.75
Rate for Payer: MDX Hawaii PPO	$1,935.15
Rate for Payer: University Health Alliance Commercial	$1,117.20

ANCHOR SUTURE AR-8990ST

Facility

$1,995.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,017.45
Max. Negotiated Rate	$1,935.15
Rate for Payer: Cash Price	$1,197.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,695.75
Rate for Payer: Kaiser Permanente Commercial	$1,256.85
Rate for Payer: Kaiser Permanente Medicaid	$1,017.45
Rate for Payer: MDX Hawaii PPO	$1,935.15
Rate for Payer: University Health Alliance Commercial	$1,117.20

ANCHOR SUTURE PUSHLOCK

Facility

$2,001.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,020.51
Max. Negotiated Rate	$1,940.97
Rate for Payer: Cash Price	$1,200.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.70
Rate for Payer: Health Management Network Commercial	$1,700.85
Rate for Payer: Kaiser Permanente Commercial	$1,260.63
Rate for Payer: Kaiser Permanente Medicaid	$1,020.51
Rate for Payer: MDX Hawaii PPO	$1,940.97
Rate for Payer: University Health Alliance Commercial	$1,120.56

ANCHOR SUTURE PUSHLOCK

Facility

$2,001.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.56
Max. Negotiated Rate	$1,940.97
Rate for Payer: Cash Price	$1,200.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.70
Rate for Payer: Health Management Network Commercial	$1,700.85
Rate for Payer: MDX Hawaii PPO	$1,940.97
Rate for Payer: University Health Alliance Commercial	$1,120.56

ANCHOR SWIVELOCK AR-1593-BC

Facility

$2,284.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,279.04
Max. Negotiated Rate	$2,215.48
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,598.80
Rate for Payer: Health Management Network Commercial	$1,941.40
Rate for Payer: MDX Hawaii PPO	$2,215.48
Rate for Payer: University Health Alliance Commercial	$1,279.04

ANCHOR SWIVELOCK AR-1593-BC

Facility

$2,284.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.84
Max. Negotiated Rate	$2,215.48
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,598.80
Rate for Payer: Health Management Network Commercial	$1,941.40
Rate for Payer: Kaiser Permanente Commercial	$1,438.92
Rate for Payer: Kaiser Permanente Medicaid	$1,164.84
Rate for Payer: MDX Hawaii PPO	$2,215.48
Rate for Payer: University Health Alliance Commercial	$1,279.04

ANCHOR TISS. RET SYS TRS100SB2

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Hawaii Western Management Group Commercial	$427.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$283.50
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: University Health Alliance Commercial	$328.00

ANCHOR TISS. RET SYS TRS100SB2

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: MDX Hawaii PPO	$436.50

ANCHOR W/SUTURE #AR-1927BCF

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$853.44
Max. Negotiated Rate	$1,478.28
Rate for Payer: Cash Price	$914.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,066.80
Rate for Payer: Health Management Network Commercial	$1,295.40
Rate for Payer: MDX Hawaii PPO	$1,478.28
Rate for Payer: University Health Alliance Commercial	$853.44

ANCHOR W/SUTURE #AR-1927BCF

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$777.24
Max. Negotiated Rate	$1,478.28
Rate for Payer: Cash Price	$914.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,066.80
Rate for Payer: Health Management Network Commercial	$1,295.40
Rate for Payer: Kaiser Permanente Commercial	$960.12
Rate for Payer: Kaiser Permanente Medicaid	$777.24
Rate for Payer: MDX Hawaii PPO	$1,478.28
Rate for Payer: University Health Alliance Commercial	$853.44

ANCHR FOOTPRINT 4.5MM 72202901

Facility

$1,384.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$775.04
Max. Negotiated Rate	$1,342.48
Rate for Payer: Cash Price	$830.40
Rate for Payer: Hawaii Western Management Group Commercial	$968.80
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: University Health Alliance Commercial	$775.04

ANCHR FOOTPRINT 4.5MM 72202901

Facility

$1,384.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$705.84
Max. Negotiated Rate	$1,342.48
Rate for Payer: Cash Price	$830.40
Rate for Payer: Hawaii Western Management Group Commercial	$968.80
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Kaiser Permanente Commercial	$871.92
Rate for Payer: Kaiser Permanente Medicaid	$705.84
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: University Health Alliance Commercial	$775.04

ANGINA PECTORIS

Facility

$13,006.58

Service Code	MSDRG 311
Min. Negotiated Rate	$7,983.59
Max. Negotiated Rate	$13,006.58
Rate for Payer: AlohaCare Medicare	$7,983.59
Rate for Payer: Devoted Health Medicare	$8,781.95
Rate for Payer: Hawaii Medical Service Association Commercial	$13,006.58
Rate for Payer: Hawaii Medical Service Association Medicare	$7,983.59
Rate for Payer: Humana Medicare	$7,983.59
Rate for Payer: Kaiser Permanente Commercial	$12,107.77
Rate for Payer: Kaiser Permanente Medicare	$7,983.59
Rate for Payer: Ohana Health Plan Medicare	$7,983.59
Rate for Payer: UnitedHealthcare Medicare	$7,983.59

ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS

Facility

$6,269.03

Service Code	APR-DRG 1984
Min. Negotiated Rate	$6,269.03
Max. Negotiated Rate	$6,269.03
Rate for Payer: AlohaCare Medicaid	$6,269.03
Rate for Payer: Hawaii Medical Service Association ABD	$6,269.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,269.03
Rate for Payer: Kaiser Permanente Medicaid	$6,269.03
Rate for Payer: Ohana Health Plan Medicaid	$6,269.03
Rate for Payer: UnitedHealthcare Medicaid	$6,269.03

ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS

Facility

$2,497.57

Service Code	APR-DRG 1981
Min. Negotiated Rate	$2,497.57
Max. Negotiated Rate	$2,497.57
Rate for Payer: AlohaCare Medicaid	$2,497.57
Rate for Payer: Hawaii Medical Service Association ABD	$2,497.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,497.57
Rate for Payer: Kaiser Permanente Medicaid	$2,497.57
Rate for Payer: Ohana Health Plan Medicaid	$2,497.57
Rate for Payer: UnitedHealthcare Medicaid	$2,497.57

ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS

Facility

$2,963.29

Service Code	APR-DRG 1982
Min. Negotiated Rate	$2,963.29
Max. Negotiated Rate	$2,963.29
Rate for Payer: AlohaCare Medicaid	$2,963.29
Rate for Payer: Hawaii Medical Service Association ABD	$2,963.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,963.29
Rate for Payer: Kaiser Permanente Medicaid	$2,963.29
Rate for Payer: Ohana Health Plan Medicaid	$2,963.29
Rate for Payer: UnitedHealthcare Medicaid	$2,963.29

ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS

Facility

$3,862.13

Service Code	APR-DRG 1983
Min. Negotiated Rate	$3,862.13
Max. Negotiated Rate	$3,862.13
Rate for Payer: AlohaCare Medicaid	$3,862.13
Rate for Payer: Hawaii Medical Service Association ABD	$3,862.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,862.13
Rate for Payer: Kaiser Permanente Medicaid	$3,862.13
Rate for Payer: Ohana Health Plan Medicaid	$3,862.13
Rate for Payer: UnitedHealthcare Medicaid	$3,862.13

ANGIOSEAL 6FR

Facility

$1,575.00

Service Code	HCPCS C1760
Hospital Revenue Code	278
Min. Negotiated Rate	$803.25
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Kaiser Permanente Commercial	$992.25
Rate for Payer: Kaiser Permanente Medicaid	$803.25
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: University Health Alliance Commercial	$882.00

ANGIOSEAL 6FR

Facility

$1,575.00

Service Code	HCPCS C1760
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: University Health Alliance Commercial	$882.00

ANGULAR TL ASSM 100MM 51-10460

Facility

$2,565.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,308.15
Max. Negotiated Rate	$2,488.05
Rate for Payer: Cash Price	$1,539.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,436.75
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Kaiser Permanente Commercial	$1,615.95
Rate for Payer: Kaiser Permanente Medicaid	$1,308.15
Rate for Payer: MDX Hawaii PPO	$2,488.05
Rate for Payer: University Health Alliance Commercial	$1,869.63

ANGULAR TL ASSM 100MM 51-10460

Facility

$2,565.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,180.25
Max. Negotiated Rate	$2,488.05
Rate for Payer: Cash Price	$1,539.00
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: MDX Hawaii PPO	$2,488.05

ANKLE CRYO CUFF 10A01

Facility

$181.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.85
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$108.60
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: MDX Hawaii PPO	$175.57

ANKLE CRYO CUFF 10A01

Facility

$181.00

Hospital Revenue Code	272
Min. Negotiated Rate	$92.31
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$108.60
Rate for Payer: Hawaii Western Management Group Commercial	$171.95
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Kaiser Permanente Commercial	$114.03
Rate for Payer: Kaiser Permanente Medicaid	$92.31
Rate for Payer: MDX Hawaii PPO	$175.57
Rate for Payer: University Health Alliance Commercial	$131.93

Know your out-of-pocket cost for care.

All Charges