Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

IMPLANT PENILE PROSTHSEIS

Facility

$25,110.00

Service Code	HCPCS C2622
Hospital Revenue Code	278
Min. Negotiated Rate	$14,061.60
Max. Negotiated Rate	$24,356.70
Rate for Payer: Cash Price	$15,066.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,577.00
Rate for Payer: Health Management Network Commercial	$21,343.50
Rate for Payer: MDX Hawaii PPO	$24,356.70
Rate for Payer: University Health Alliance Commercial	$14,061.60

IMPLANT SYS LNT AR-1665KBCSL

Facility

$2,458.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.48
Max. Negotiated Rate	$2,384.26
Rate for Payer: Cash Price	$1,474.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,720.60
Rate for Payer: Health Management Network Commercial	$2,089.30
Rate for Payer: MDX Hawaii PPO	$2,384.26
Rate for Payer: University Health Alliance Commercial	$1,376.48

IMPLANT SYS LNT AR-1665KBCSL

Facility

$2,458.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,253.58
Max. Negotiated Rate	$2,384.26
Rate for Payer: Cash Price	$1,474.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,720.60
Rate for Payer: Health Management Network Commercial	$2,089.30
Rate for Payer: Kaiser Permanente Commercial	$1,548.54
Rate for Payer: Kaiser Permanente Medicaid	$1,253.58
Rate for Payer: MDX Hawaii PPO	$2,384.26
Rate for Payer: University Health Alliance Commercial	$1,376.48

IMPLANT SYS MPFL AR-1360CST-CP

Facility

$3,543.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,806.93
Max. Negotiated Rate	$3,436.71
Rate for Payer: Cash Price	$2,125.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,480.10
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: Kaiser Permanente Commercial	$2,232.09
Rate for Payer: Kaiser Permanente Medicaid	$1,806.93
Rate for Payer: MDX Hawaii PPO	$3,436.71
Rate for Payer: University Health Alliance Commercial	$1,984.08

IMPLANT SYS MPFL AR-1360CST-CP

Facility

$3,543.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.08
Max. Negotiated Rate	$3,436.71
Rate for Payer: Cash Price	$2,125.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,480.10
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: MDX Hawaii PPO	$3,436.71
Rate for Payer: University Health Alliance Commercial	$1,984.08

IMPLANT SYSTEM AR-8978-CP

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.40
Max. Negotiated Rate	$3,045.80
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: University Health Alliance Commercial	$1,758.40

IMPLANT SYSTEM AR-8978-CP

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.40
Max. Negotiated Rate	$3,045.80
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: Kaiser Permanente Commercial	$1,978.20
Rate for Payer: Kaiser Permanente Medicaid	$1,601.40
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: University Health Alliance Commercial	$1,758.40

IMPLAN TYMPANOST 1.14MM

Facility

$194.00

Hospital Revenue Code	278
Min. Negotiated Rate	$108.64
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$116.40
Rate for Payer: Hawaii Western Management Group Commercial	$135.80
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: University Health Alliance Commercial	$108.64

IMPLAN TYMPANOST 1.14MM

Facility

$194.00

Hospital Revenue Code	278
Min. Negotiated Rate	$98.94
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$116.40
Rate for Payer: Hawaii Western Management Group Commercial	$135.80
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Kaiser Permanente Commercial	$122.22
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: University Health Alliance Commercial	$108.64

IMPLAN TYMPANOST W/TAB 1.14

Facility

$126.00

Hospital Revenue Code	278
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$88.20
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$79.38
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$70.56

IMPLAN TYMPANOST W/TAB 1.14

Facility

$126.00

Hospital Revenue Code	278
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$88.20
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$70.56

IMPLAN WEIGHT EYELID 1.4G

Facility

$1,218.00

Service Code	HCPCS L8610
Hospital Revenue Code	278
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$1,181.46
Rate for Payer: Cash Price	$730.80
Rate for Payer: Cash Price	$730.80
Rate for Payer: Hawaii Western Management Group Commercial	$852.60
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: Kaiser Permanente Commercial	$767.34
Rate for Payer: Kaiser Permanente Medicaid	$621.18
Rate for Payer: MDX Hawaii PPO	$1,181.46
Rate for Payer: UnitedHealthcare Medicaid	$44.09
Rate for Payer: University Health Alliance Commercial	$682.08

IMPLAN WEIGHT EYELID 1.4G

Facility

$1,218.00

Service Code	HCPCS L8610
Hospital Revenue Code	278
Min. Negotiated Rate	$682.08
Max. Negotiated Rate	$1,181.46
Rate for Payer: Cash Price	$730.80
Rate for Payer: Hawaii Western Management Group Commercial	$852.60
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: MDX Hawaii PPO	$1,181.46
Rate for Payer: University Health Alliance Commercial	$682.08

IMPRESS BERENSTEIN 5FX125

Facility

$195.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: MDX Hawaii PPO	$189.15

IMPRESS BERENSTEIN 5FX125

Facility

$195.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$117.00
Rate for Payer: Hawaii Western Management Group Commercial	$185.25
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$122.85
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: University Health Alliance Commercial	$142.14

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$87,357.60

Service Code	MSDRG 642
Min. Negotiated Rate	$16,175.34
Max. Negotiated Rate	$87,357.60
Rate for Payer: AlohaCare Medicare	$16,175.34
Rate for Payer: Devoted Health Medicare	$17,792.87
Rate for Payer: Hawaii Medical Service Association Commercial	$87,357.60
Rate for Payer: Hawaii Medical Service Association Medicare	$16,175.34
Rate for Payer: Humana Medicare	$16,175.34
Rate for Payer: Kaiser Permanente Commercial	$24,531.22
Rate for Payer: Kaiser Permanente Medicare	$16,175.34
Rate for Payer: Ohana Health Plan Medicare	$16,175.34
Rate for Payer: UnitedHealthcare Medicare	$16,175.34

INBORN ERRORS OF METABOLISM

Facility

$4,098.91

Service Code	APR-DRG 4232
Min. Negotiated Rate	$4,098.91
Max. Negotiated Rate	$4,098.91
Rate for Payer: AlohaCare Medicaid	$4,098.91
Rate for Payer: Hawaii Medical Service Association ABD	$4,098.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,098.91
Rate for Payer: Kaiser Permanente Medicaid	$4,098.91
Rate for Payer: Ohana Health Plan Medicaid	$4,098.91
Rate for Payer: UnitedHealthcare Medicaid	$4,098.91

INBORN ERRORS OF METABOLISM

Facility

$3,251.60

Service Code	APR-DRG 4231
Min. Negotiated Rate	$3,251.60
Max. Negotiated Rate	$3,251.60
Rate for Payer: AlohaCare Medicaid	$3,251.60
Rate for Payer: Hawaii Medical Service Association ABD	$3,251.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,251.60
Rate for Payer: Kaiser Permanente Medicaid	$3,251.60
Rate for Payer: Ohana Health Plan Medicaid	$3,251.60
Rate for Payer: UnitedHealthcare Medicaid	$3,251.60

INBORN ERRORS OF METABOLISM

Facility

$19,060.84

Service Code	APR-DRG 4234
Min. Negotiated Rate	$19,060.84
Max. Negotiated Rate	$19,060.84
Rate for Payer: AlohaCare Medicaid	$19,060.84
Rate for Payer: Hawaii Medical Service Association ABD	$19,060.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,060.84
Rate for Payer: Kaiser Permanente Medicaid	$19,060.84
Rate for Payer: Ohana Health Plan Medicaid	$19,060.84
Rate for Payer: UnitedHealthcare Medicaid	$19,060.84

INBORN ERRORS OF METABOLISM

Facility

$6,131.40

Service Code	APR-DRG 4233
Min. Negotiated Rate	$6,131.40
Max. Negotiated Rate	$6,131.40
Rate for Payer: AlohaCare Medicaid	$6,131.40
Rate for Payer: Hawaii Medical Service Association ABD	$6,131.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,131.40
Rate for Payer: Kaiser Permanente Medicaid	$6,131.40
Rate for Payer: Ohana Health Plan Medicaid	$6,131.40
Rate for Payer: UnitedHealthcare Medicaid	$6,131.40

INCISIONAL BIOPSY OF SKIN (EG, WEDGE) (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION

Facility

$2,837.00

Service Code	CPT 11106
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$873.10
Rate for Payer: AlohaCare Medicare	$873.10
Rate for Payer: Devoted Health Medicare	$960.41
Rate for Payer: Hawaii Medical Service Association Commercial	$1,091.38
Rate for Payer: Hawaii Medical Service Association Medicare	$873.10
Rate for Payer: Humana Medicare	$873.10
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$873.10
Rate for Payer: Ohana Health Plan Medicaid	$960.41
Rate for Payer: Ohana Health Plan Medicare	$873.10
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$873.10

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); COMPLICATED OR MULTIPLE

Facility

$4,035.20

Service Code	CPT 10061
Hospital Revenue Code	360
Min. Negotiated Rate	$97.47
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$97.47
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$4,035.20

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE

Facility

$4,035.20

Service Code	CPT 10060
Hospital Revenue Code	361
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Devoted Health Medicare	$260.72
Rate for Payer: Hawaii Medical Service Association Commercial	$296.27
Rate for Payer: Hawaii Medical Service Association Medicare	$237.02
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicaid	$52.42
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$4,035.20

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE

Facility

$4,035.20

Service Code	CPT 10060
Hospital Revenue Code	360
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Devoted Health Medicare	$260.72
Rate for Payer: Hawaii Medical Service Association Commercial	$296.27
Rate for Payer: Hawaii Medical Service Association Medicare	$237.02
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicaid	$52.42
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$4,035.20

INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION

Facility

$5,160.40

Service Code	CPT 10140
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,160.40

Know your out-of-pocket cost for care.

All Charges