Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

IMPLAN PUMP PENILE PRO INFRA

Facility

$24,970.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$12,734.70
Max. Negotiated Rate	$24,220.90
Rate for Payer: Cash Price	$14,982.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,479.00
Rate for Payer: Health Management Network Commercial	$21,224.50
Rate for Payer: Kaiser Permanente Commercial	$15,731.10
Rate for Payer: Kaiser Permanente Medicaid	$12,734.70
Rate for Payer: MDX Hawaii PPO	$24,220.90
Rate for Payer: University Health Alliance Commercial	$13,983.20

IMPLAN PUMP PENILE PRO INFRA

Facility

$24,970.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$13,983.20
Max. Negotiated Rate	$24,220.90
Rate for Payer: Cash Price	$14,982.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,479.00
Rate for Payer: Health Management Network Commercial	$21,224.50
Rate for Payer: MDX Hawaii PPO	$24,220.90
Rate for Payer: University Health Alliance Commercial	$13,983.20

IMPLAN PUMP PENILE PROTHESIS

Facility

$25,510.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$13,010.10
Max. Negotiated Rate	$24,744.70
Rate for Payer: Cash Price	$15,306.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,857.00
Rate for Payer: Health Management Network Commercial	$21,683.50
Rate for Payer: Kaiser Permanente Commercial	$16,071.30
Rate for Payer: Kaiser Permanente Medicaid	$13,010.10
Rate for Payer: MDX Hawaii PPO	$24,744.70
Rate for Payer: University Health Alliance Commercial	$14,285.60

IMPLAN PUMP PENILE PROTHESIS

Facility

$25,510.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$14,285.60
Max. Negotiated Rate	$24,744.70
Rate for Payer: Cash Price	$15,306.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,857.00
Rate for Payer: Health Management Network Commercial	$21,683.50
Rate for Payer: MDX Hawaii PPO	$24,744.70
Rate for Payer: University Health Alliance Commercial	$14,285.60

IMPLAN SILICONE SHEETING

Facility

$225.00

Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Hawaii Western Management Group Commercial	$157.50
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: University Health Alliance Commercial	$126.00

IMPLAN SILICONE SHEETING

Facility

$225.00

Hospital Revenue Code	278
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Hawaii Western Management Group Commercial	$157.50
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: University Health Alliance Commercial	$126.00

IMPLAN SLEEP REMOTE

Facility

$2,800.00

Service Code	HCPCS C1787
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

IMPLAN SLEEP REMOTE

Facility

$2,800.00

Service Code	HCPCS C1787
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

IMPLAN SPHINCTER URINE CUFF

Facility

$15,040.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$7,670.40
Max. Negotiated Rate	$14,588.80
Rate for Payer: Cash Price	$9,024.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,528.00
Rate for Payer: Health Management Network Commercial	$12,784.00
Rate for Payer: Kaiser Permanente Commercial	$9,475.20
Rate for Payer: Kaiser Permanente Medicaid	$7,670.40
Rate for Payer: MDX Hawaii PPO	$14,588.80
Rate for Payer: University Health Alliance Commercial	$8,422.40

IMPLAN SPHINCTER URINE CUFF

Facility

$15,040.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$8,422.40
Max. Negotiated Rate	$14,588.80
Rate for Payer: Cash Price	$9,024.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,528.00
Rate for Payer: Health Management Network Commercial	$12,784.00
Rate for Payer: MDX Hawaii PPO	$14,588.80
Rate for Payer: University Health Alliance Commercial	$8,422.40

IMPLAN SPHINCTER URINE KIT

Facility

$3,030.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,545.30
Max. Negotiated Rate	$2,939.10
Rate for Payer: Cash Price	$1,818.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,878.50
Rate for Payer: Health Management Network Commercial	$2,575.50
Rate for Payer: Kaiser Permanente Commercial	$1,908.90
Rate for Payer: Kaiser Permanente Medicaid	$1,545.30
Rate for Payer: MDX Hawaii PPO	$2,939.10
Rate for Payer: University Health Alliance Commercial	$2,208.57

IMPLAN SPHINCTER URINE KIT

Facility

$3,030.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,575.50
Max. Negotiated Rate	$2,939.10
Rate for Payer: Cash Price	$1,818.00
Rate for Payer: Health Management Network Commercial	$2,575.50
Rate for Payer: MDX Hawaii PPO	$2,939.10

IMPLAN SPHINCTER URINE PUMP

Facility

$14,490.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$7,389.90
Max. Negotiated Rate	$14,055.30
Rate for Payer: Cash Price	$8,694.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,143.00
Rate for Payer: Health Management Network Commercial	$12,316.50
Rate for Payer: Kaiser Permanente Commercial	$9,128.70
Rate for Payer: Kaiser Permanente Medicaid	$7,389.90
Rate for Payer: MDX Hawaii PPO	$14,055.30
Rate for Payer: University Health Alliance Commercial	$8,114.40

IMPLAN SPHINCTER URINE PUMP

Facility

$14,490.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$8,114.40
Max. Negotiated Rate	$14,055.30
Rate for Payer: Cash Price	$8,694.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,143.00
Rate for Payer: Health Management Network Commercial	$12,316.50
Rate for Payer: MDX Hawaii PPO	$14,055.30
Rate for Payer: University Health Alliance Commercial	$8,114.40

IMPLAN SPHINCTER URINE SYS

Facility

$6,890.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$3,858.40
Max. Negotiated Rate	$6,683.30
Rate for Payer: Cash Price	$4,134.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,823.00
Rate for Payer: Health Management Network Commercial	$5,856.50
Rate for Payer: MDX Hawaii PPO	$6,683.30
Rate for Payer: University Health Alliance Commercial	$3,858.40

IMPLAN SPHINCTER URINE SYS

Facility

$6,890.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$3,513.90
Max. Negotiated Rate	$6,683.30
Rate for Payer: Cash Price	$4,134.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,823.00
Rate for Payer: Health Management Network Commercial	$5,856.50
Rate for Payer: Kaiser Permanente Commercial	$4,340.70
Rate for Payer: Kaiser Permanente Medicaid	$3,513.90
Rate for Payer: MDX Hawaii PPO	$6,683.30
Rate for Payer: University Health Alliance Commercial	$3,858.40

IMPLAN STENT COLONIC 25X60

Facility

$4,928.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,759.68
Max. Negotiated Rate	$4,780.16
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,449.60
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: MDX Hawaii PPO	$4,780.16
Rate for Payer: University Health Alliance Commercial	$2,759.68

IMPLAN STENT COLONIC 25X60

Facility

$4,928.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,513.28
Max. Negotiated Rate	$4,780.16
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,449.60
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Kaiser Permanente Commercial	$3,104.64
Rate for Payer: Kaiser Permanente Medicaid	$2,513.28
Rate for Payer: MDX Hawaii PPO	$4,780.16
Rate for Payer: University Health Alliance Commercial	$2,759.68

IMPLAN STENT DRUG ELUTING

Facility

$2,606.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,459.36
Max. Negotiated Rate	$2,527.82
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,824.20
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: MDX Hawaii PPO	$2,527.82
Rate for Payer: University Health Alliance Commercial	$1,459.36

IMPLAN STENT DRUG ELUTING

Facility

$2,606.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,329.06
Max. Negotiated Rate	$2,527.82
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,824.20
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: Kaiser Permanente Commercial	$1,641.78
Rate for Payer: Kaiser Permanente Medicaid	$1,329.06
Rate for Payer: MDX Hawaii PPO	$2,527.82
Rate for Payer: University Health Alliance Commercial	$1,459.36

IMPLAN STENT DRUG ELUTING MINI

Facility

$2,606.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,459.36
Max. Negotiated Rate	$2,527.82
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,824.20
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: MDX Hawaii PPO	$2,527.82
Rate for Payer: University Health Alliance Commercial	$1,459.36

IMPLAN STENT DRUG ELUTING MINI

Facility

$2,606.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,329.06
Max. Negotiated Rate	$2,527.82
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,824.20
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: Kaiser Permanente Commercial	$1,641.78
Rate for Payer: Kaiser Permanente Medicaid	$1,329.06
Rate for Payer: MDX Hawaii PPO	$2,527.82
Rate for Payer: University Health Alliance Commercial	$1,459.36

IMPLAN STENT/INTROD 6FRX20

Facility

$2,198.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.98
Max. Negotiated Rate	$2,132.06
Rate for Payer: Cash Price	$1,318.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,538.60
Rate for Payer: Health Management Network Commercial	$1,868.30
Rate for Payer: Kaiser Permanente Commercial	$1,384.74
Rate for Payer: Kaiser Permanente Medicaid	$1,120.98
Rate for Payer: MDX Hawaii PPO	$2,132.06
Rate for Payer: University Health Alliance Commercial	$1,230.88

IMPLAN STENT/INTROD 6FRX20

Facility

$2,198.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.88
Max. Negotiated Rate	$2,132.06
Rate for Payer: Cash Price	$1,318.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,538.60
Rate for Payer: Health Management Network Commercial	$1,868.30
Rate for Payer: MDX Hawaii PPO	$2,132.06
Rate for Payer: University Health Alliance Commercial	$1,230.88

IMPLAN STENT/INTROD 6FRX22

Facility

$2,198.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.88
Max. Negotiated Rate	$2,132.06
Rate for Payer: Cash Price	$1,318.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,538.60
Rate for Payer: Health Management Network Commercial	$1,868.30
Rate for Payer: MDX Hawaii PPO	$2,132.06
Rate for Payer: University Health Alliance Commercial	$1,230.88

Know your out-of-pocket cost for care.

All Charges