Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

ABSORBATACK FIX HERNIA REP 5MM

Facility

$1,724.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$965.44
Max. Negotiated Rate	$1,672.28
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,206.80
Rate for Payer: Health Management Network Commercial	$1,465.40
Rate for Payer: MDX Hawaii PPO	$1,672.28
Rate for Payer: University Health Alliance Commercial	$965.44

ABSORBATACK FIX HERNIA REP 5MM

Facility

$1,724.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$879.24
Max. Negotiated Rate	$1,672.28
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,206.80
Rate for Payer: Health Management Network Commercial	$1,465.40
Rate for Payer: Kaiser Permanente Commercial	$1,086.12
Rate for Payer: Kaiser Permanente Medicaid	$879.24
Rate for Payer: MDX Hawaii PPO	$1,672.28
Rate for Payer: University Health Alliance Commercial	$965.44

ABS TIGHTROPE II AR-1588TN-20

Facility

$998.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$558.88
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$598.80
Rate for Payer: Hawaii Western Management Group Commercial	$698.60
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: MDX Hawaii PPO	$968.06
Rate for Payer: University Health Alliance Commercial	$558.88

ABS TIGHTROPE II AR-1588TN-20

Facility

$998.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$508.98
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$598.80
Rate for Payer: Hawaii Western Management Group Commercial	$698.60
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: Kaiser Permanente Commercial	$628.74
Rate for Payer: Kaiser Permanente Medicaid	$508.98
Rate for Payer: MDX Hawaii PPO	$968.06
Rate for Payer: University Health Alliance Commercial	$558.88

AB THERA DRESSING KIT

Facility

$383.00

Hospital Revenue Code	272
Min. Negotiated Rate	$195.33
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$229.80
Rate for Payer: Hawaii Western Management Group Commercial	$363.85
Rate for Payer: Health Management Network Commercial	$325.55
Rate for Payer: Kaiser Permanente Commercial	$241.29
Rate for Payer: Kaiser Permanente Medicaid	$195.33
Rate for Payer: MDX Hawaii PPO	$371.51
Rate for Payer: University Health Alliance Commercial	$279.17

AB THERA DRESSING KIT

Facility

$383.00

Hospital Revenue Code	272
Min. Negotiated Rate	$325.55
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$229.80
Rate for Payer: Health Management Network Commercial	$325.55
Rate for Payer: MDX Hawaii PPO	$371.51

ACARBOSE 25 MG TABLET [22148]

Facility

$4.00

Service Code	NDC 23155014701
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

ACARBOSE 25 MG TABLET [22148]

Facility

$4.00

Service Code	NDC 23155014701
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

ACARBOSE 25 MG TABLET [22148]

Facility

$4.00

Service Code	NDC 64380075806
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

ACARBOSE 25 MG TABLET [22148]

Facility

$4.00

Service Code	NDC 64380075806
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

ACCESSORY KIT 3550-80

Facility

$220.00

Hospital Revenue Code	272
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$132.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: MDX Hawaii PPO	$213.40

ACCESSORY KIT 3550-80

Facility

$220.00

Hospital Revenue Code	272
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$132.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: University Health Alliance Commercial	$160.36

ACCOLADE C 127 DEG 6057-0637D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,578.96
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$1,950.48
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

ACCOLADE C 127 DEG 6057-0637D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

ACCOLADE C HIP STEM 6057-0435D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,578.96
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$1,950.48
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

ACCOLADE C HIP STEM 6057-0435D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

ACCOLADE DR EL MRI/2 LEAD 9H52

Facility

$10,336.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$5,271.36
Max. Negotiated Rate	$10,025.92
Rate for Payer: Cash Price	$6,201.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,235.20
Rate for Payer: Health Management Network Commercial	$8,785.60
Rate for Payer: Kaiser Permanente Commercial	$6,511.68
Rate for Payer: Kaiser Permanente Medicaid	$5,271.36
Rate for Payer: MDX Hawaii PPO	$10,025.92
Rate for Payer: University Health Alliance Commercial	$5,788.16

ACCOLADE DR EL MRI/2 LEAD 9H52

Facility

$10,336.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$5,788.16
Max. Negotiated Rate	$10,025.92
Rate for Payer: Cash Price	$6,201.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,235.20
Rate for Payer: Health Management Network Commercial	$8,785.60
Rate for Payer: MDX Hawaii PPO	$10,025.92
Rate for Payer: University Health Alliance Commercial	$5,788.16

ACCOLADE GNRTR DR L301

Facility

$8,100.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$4,131.00
Max. Negotiated Rate	$7,857.00
Rate for Payer: Cash Price	$4,860.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,670.00
Rate for Payer: Health Management Network Commercial	$6,885.00
Rate for Payer: Kaiser Permanente Commercial	$5,103.00
Rate for Payer: Kaiser Permanente Medicaid	$4,131.00
Rate for Payer: MDX Hawaii PPO	$7,857.00
Rate for Payer: University Health Alliance Commercial	$4,536.00

ACCOLADE GNRTR DR L301

Facility

$8,100.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$4,536.00
Max. Negotiated Rate	$7,857.00
Rate for Payer: Cash Price	$4,860.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,670.00
Rate for Payer: Health Management Network Commercial	$6,885.00
Rate for Payer: MDX Hawaii PPO	$7,857.00
Rate for Payer: University Health Alliance Commercial	$4,536.00

ACCOLADE GNRTR EL DR L321

Facility

$8,100.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$4,536.00
Max. Negotiated Rate	$7,857.00
Rate for Payer: Cash Price	$4,860.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,670.00
Rate for Payer: Health Management Network Commercial	$6,885.00
Rate for Payer: MDX Hawaii PPO	$7,857.00
Rate for Payer: University Health Alliance Commercial	$4,536.00

ACCOLADE GNRTR EL DR L321

Facility

$8,100.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$4,131.00
Max. Negotiated Rate	$7,857.00
Rate for Payer: Cash Price	$4,860.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,670.00
Rate for Payer: Health Management Network Commercial	$6,885.00
Rate for Payer: Kaiser Permanente Commercial	$5,103.00
Rate for Payer: Kaiser Permanente Medicaid	$4,131.00
Rate for Payer: MDX Hawaii PPO	$7,857.00
Rate for Payer: University Health Alliance Commercial	$4,536.00

ACCOLADE GNRTR MRI EL DR L331

Facility

$13,810.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$7,733.60
Max. Negotiated Rate	$13,395.70
Rate for Payer: Cash Price	$8,286.00
Rate for Payer: Hawaii Western Management Group Commercial	$9,667.00
Rate for Payer: Health Management Network Commercial	$11,738.50
Rate for Payer: MDX Hawaii PPO	$13,395.70
Rate for Payer: University Health Alliance Commercial	$7,733.60

ACCOLADE GNRTR MRI EL DR L331

Facility

$13,810.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$7,043.10
Max. Negotiated Rate	$13,395.70
Rate for Payer: Cash Price	$8,286.00
Rate for Payer: Hawaii Western Management Group Commercial	$9,667.00
Rate for Payer: Health Management Network Commercial	$11,738.50
Rate for Payer: Kaiser Permanente Commercial	$8,700.30
Rate for Payer: Kaiser Permanente Medicaid	$7,043.10
Rate for Payer: MDX Hawaii PPO	$13,395.70
Rate for Payer: University Health Alliance Commercial	$7,733.60

ACCOLADE GNRTR SR L300

Facility

$10,886.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,551.86
Max. Negotiated Rate	$10,559.42
Rate for Payer: Cash Price	$6,531.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,620.20
Rate for Payer: Health Management Network Commercial	$9,253.10
Rate for Payer: Kaiser Permanente Commercial	$6,858.18
Rate for Payer: Kaiser Permanente Medicaid	$5,551.86
Rate for Payer: MDX Hawaii PPO	$10,559.42
Rate for Payer: University Health Alliance Commercial	$6,096.16

Know your out-of-pocket cost for care.

All Charges