Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HIP STEM 14/225MM 01-00102-214

Facility

$13,867.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,765.52
Max. Negotiated Rate	$13,450.99
Rate for Payer: Cash Price	$8,320.20
Rate for Payer: Hawaii Western Management Group Commercial	$9,706.90
Rate for Payer: Health Management Network Commercial	$11,786.95
Rate for Payer: MDX Hawaii PPO	$13,450.99
Rate for Payer: University Health Alliance Commercial	$7,765.52

HIP STEM 15 STD 00-7711-015-00

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 15 STD 00-7711-015-00

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,652.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Kaiser Permanente Commercial	$3,276.00
Rate for Payer: Kaiser Permanente Medicaid	$2,652.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 17.5 00-7711-017-00

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,178.54
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Kaiser Permanente Commercial	$6,397.02
Rate for Payer: Kaiser Permanente Medicaid	$5,178.54
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 17.5 00-7711-017-00

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,686.24
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 18/225MM 01-00102-218

Facility

$13,867.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,072.17
Max. Negotiated Rate	$13,450.99
Rate for Payer: Cash Price	$8,320.20
Rate for Payer: Hawaii Western Management Group Commercial	$9,706.90
Rate for Payer: Health Management Network Commercial	$11,786.95
Rate for Payer: Kaiser Permanente Commercial	$8,736.21
Rate for Payer: Kaiser Permanente Medicaid	$7,072.17
Rate for Payer: MDX Hawaii PPO	$13,450.99
Rate for Payer: University Health Alliance Commercial	$7,765.52

HIP STEM 18/225MM 01-00102-218

Facility

$13,867.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,765.52
Max. Negotiated Rate	$13,450.99
Rate for Payer: Cash Price	$8,320.20
Rate for Payer: Hawaii Western Management Group Commercial	$9,706.90
Rate for Payer: Health Management Network Commercial	$11,786.95
Rate for Payer: MDX Hawaii PPO	$13,450.99
Rate for Payer: University Health Alliance Commercial	$7,765.52

HIP STEM #3 30X102MM 6721-0330

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM #3 30X102MM 6721-0330

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,947.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$3,641.40
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM 6051-0730S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,947.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$3,641.40
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM 6051-0730S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM 6 EXT 00-7711-006-40

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,686.24
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 6 EXT 00-7711-006-40

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,178.54
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Kaiser Permanente Commercial	$6,397.02
Rate for Payer: Kaiser Permanente Medicaid	$5,178.54
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 7.5 00-7711-007-00

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,178.54
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Kaiser Permanente Commercial	$6,397.02
Rate for Payer: Kaiser Permanente Medicaid	$5,178.54
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 7.5 00-7711-007-00

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,686.24
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 7.5 00-7711-007-10

Facility

$7,220.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,682.20
Max. Negotiated Rate	$7,003.40
Rate for Payer: Cash Price	$4,332.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,054.00
Rate for Payer: Health Management Network Commercial	$6,137.00
Rate for Payer: Kaiser Permanente Commercial	$4,548.60
Rate for Payer: Kaiser Permanente Medicaid	$3,682.20
Rate for Payer: MDX Hawaii PPO	$7,003.40
Rate for Payer: University Health Alliance Commercial	$4,043.20

HIP STEM 7.5 00-7711-007-10

Facility

$7,220.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,043.20
Max. Negotiated Rate	$7,003.40
Rate for Payer: Cash Price	$4,332.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,054.00
Rate for Payer: Health Management Network Commercial	$6,137.00
Rate for Payer: MDX Hawaii PPO	$7,003.40
Rate for Payer: University Health Alliance Commercial	$4,043.20

HIP STEM 7.5 00-7711-007-40

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,652.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Kaiser Permanente Commercial	$3,276.00
Rate for Payer: Kaiser Permanente Medicaid	$2,652.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 7.5 00-7711-007-40

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM ACCOLADE II 6720-0937

Facility

$5,839.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,977.89
Max. Negotiated Rate	$5,663.83
Rate for Payer: Cash Price	$3,503.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,087.30
Rate for Payer: Health Management Network Commercial	$4,963.15
Rate for Payer: Kaiser Permanente Commercial	$3,678.57
Rate for Payer: Kaiser Permanente Medicaid	$2,977.89
Rate for Payer: MDX Hawaii PPO	$5,663.83
Rate for Payer: University Health Alliance Commercial	$3,269.84

HIP STEM ACCOLADE II 6720-0937

Facility

$5,839.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,269.84
Max. Negotiated Rate	$5,663.83
Rate for Payer: Cash Price	$3,503.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,087.30
Rate for Payer: Health Management Network Commercial	$4,963.15
Rate for Payer: MDX Hawaii PPO	$5,663.83
Rate for Payer: University Health Alliance Commercial	$3,269.84

HIP STEM SZ#8 37X117 6721-0837

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM SZ#8 37X117 6721-0837

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,947.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$3,641.40
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP SYS RESTORATION 6276-1-021

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,972.24
Max. Negotiated Rate	$8,612.63
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: University Health Alliance Commercial	$4,972.24

HIP SYS RESTORATION 6276-1-021

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,528.29
Max. Negotiated Rate	$8,612.63
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Kaiser Permanente Commercial	$5,593.77
Rate for Payer: Kaiser Permanente Medicaid	$4,528.29
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: University Health Alliance Commercial	$4,972.24

Know your out-of-pocket cost for care.

All Charges