Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

LIGASURE MARYLA LF1937/ LF1737

Facility

$1,650.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,402.50
Max. Negotiated Rate	$1,600.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: MDX Hawaii PPO	$1,600.50

LIGASURE MARYLA LF1937/ LF1737

Facility

$1,650.00

Hospital Revenue Code	272
Min. Negotiated Rate	$841.50
Max. Negotiated Rate	$1,600.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,567.50
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Kaiser Permanente Commercial	$1,039.50
Rate for Payer: Kaiser Permanente Medicaid	$841.50
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: University Health Alliance Commercial	$1,202.68

LIGASURE MARYLAND XP LXMJ37L

Facility

$1,626.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,382.10
Max. Negotiated Rate	$1,577.22
Rate for Payer: Cash Price	$975.60
Rate for Payer: Health Management Network Commercial	$1,382.10
Rate for Payer: MDX Hawaii PPO	$1,577.22

LIGASURE MARYLAND XP LXMJ37L

Facility

$1,626.00

Hospital Revenue Code	272
Min. Negotiated Rate	$829.26
Max. Negotiated Rate	$1,577.22
Rate for Payer: Cash Price	$975.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,544.70
Rate for Payer: Health Management Network Commercial	$1,382.10
Rate for Payer: Kaiser Permanente Commercial	$1,024.38
Rate for Payer: Kaiser Permanente Medicaid	$829.26
Rate for Payer: MDX Hawaii PPO	$1,577.22
Rate for Payer: University Health Alliance Commercial	$1,185.19

LIGATION, DIVISION, AND/OR EXCISION OF VARICOSE VEIN CLUSTER(S), 1 LEG

Facility

$8,270.00

Service Code	CPT 37785
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,743.44

LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUS VEIN

Facility

$13,778.00

Service Code	CPT 37718
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,778.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,743.44

LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA

Facility

$6,743.44

Service Code	CPT 37607
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,743.44

LIGATION OR BIOPSY, TEMPORAL ARTERY

Facility

$5,509.00

Service Code	CPT 37609
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
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 ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
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

LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$219,340.37

Service Code	MSDRG 956
Min. Negotiated Rate	$42,801.33
Max. Negotiated Rate	$219,340.37
Rate for Payer: AlohaCare Medicare	$42,801.33
Rate for Payer: Devoted Health Medicare	$47,081.46
Rate for Payer: Hawaii Medical Service Association Commercial	$219,340.37
Rate for Payer: Hawaii Medical Service Association Medicare	$42,801.33
Rate for Payer: Humana Medicare	$42,801.33
Rate for Payer: Kaiser Permanente Commercial	$64,911.75
Rate for Payer: Kaiser Permanente Medicare	$42,801.33
Rate for Payer: Ohana Health Plan Medicare	$42,801.33
Rate for Payer: UnitedHealthcare Medicare	$42,801.33

LINER 42MM CMNTLESS 626-00-42E

Facility

$3,331.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,698.81
Max. Negotiated Rate	$3,231.07
Rate for Payer: Cash Price	$1,998.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,331.70
Rate for Payer: Health Management Network Commercial	$2,831.35
Rate for Payer: Kaiser Permanente Commercial	$2,098.53
Rate for Payer: Kaiser Permanente Medicaid	$1,698.81
Rate for Payer: MDX Hawaii PPO	$3,231.07
Rate for Payer: University Health Alliance Commercial	$1,865.36

LINER 42MM CMNTLESS 626-00-42E

Facility

$3,331.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,865.36
Max. Negotiated Rate	$3,231.07
Rate for Payer: Cash Price	$1,998.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,331.70
Rate for Payer: Health Management Network Commercial	$2,831.35
Rate for Payer: MDX Hawaii PPO	$3,231.07
Rate for Payer: University Health Alliance Commercial	$1,865.36

LINER MDM 38MM 626-00-38D

Facility

$3,344.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,705.44
Max. Negotiated Rate	$3,243.68
Rate for Payer: Cash Price	$2,006.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,340.80
Rate for Payer: Health Management Network Commercial	$2,842.40
Rate for Payer: Kaiser Permanente Commercial	$2,106.72
Rate for Payer: Kaiser Permanente Medicaid	$1,705.44
Rate for Payer: MDX Hawaii PPO	$3,243.68
Rate for Payer: University Health Alliance Commercial	$1,872.64

LINER MDM 38MM 626-00-38D

Facility

$3,344.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,872.64
Max. Negotiated Rate	$3,243.68
Rate for Payer: Cash Price	$2,006.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,340.80
Rate for Payer: Health Management Network Commercial	$2,842.40
Rate for Payer: MDX Hawaii PPO	$3,243.68
Rate for Payer: University Health Alliance Commercial	$1,872.64

LINER NEUTRAL #00-8751-013-36

Facility

$2,800.00

Service Code	HCPCS C1776
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

LINER NEUTRAL #00-8751-013-36

Facility

$2,800.00

Service Code	HCPCS C1776
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

LINER RIM JJ/36 00-8752-011-36

Facility

$2,800.00

Service Code	HCPCS C1776
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

LINER RIM JJ/36 00-8752-011-36

Facility

$2,800.00

Service Code	HCPCS C1776
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

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$1,436.00

Service Code	NDC 00054031950
Hospital Revenue Code	250
Min. Negotiated Rate	$1,220.60
Max. Negotiated Rate	$1,392.92
Rate for Payer: Cash Price	$861.60
Rate for Payer: Health Management Network Commercial	$1,220.60
Rate for Payer: MDX Hawaii PPO	$1,392.92

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$607.00

Service Code	NDC 60687075405
Hospital Revenue Code	637
Min. Negotiated Rate	$309.57
Max. Negotiated Rate	$588.79
Rate for Payer: Cash Price	$364.20
Rate for Payer: Hawaii Western Management Group Commercial	$576.65
Rate for Payer: Health Management Network Commercial	$515.95
Rate for Payer: Kaiser Permanente Commercial	$382.41
Rate for Payer: Kaiser Permanente Medicaid	$309.57
Rate for Payer: MDX Hawaii PPO	$588.79
Rate for Payer: University Health Alliance Commercial	$442.44

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$1,436.00

Service Code	NDC 00054031950
Hospital Revenue Code	637
Min. Negotiated Rate	$732.36
Max. Negotiated Rate	$1,392.92
Rate for Payer: Cash Price	$861.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,364.20
Rate for Payer: Health Management Network Commercial	$1,220.60
Rate for Payer: Kaiser Permanente Commercial	$904.68
Rate for Payer: Kaiser Permanente Medicaid	$732.36
Rate for Payer: MDX Hawaii PPO	$1,392.92
Rate for Payer: University Health Alliance Commercial	$1,046.70

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$607.00

Service Code	NDC 60687075405
Hospital Revenue Code	250
Min. Negotiated Rate	$515.95
Max. Negotiated Rate	$588.79
Rate for Payer: Cash Price	$364.20
Rate for Payer: Health Management Network Commercial	$515.95
Rate for Payer: MDX Hawaii PPO	$588.79

LINEZOLID 600 MG TABLET [28224]

Facility

$276.00

Service Code	NDC 67877041933
Hospital Revenue Code	637
Min. Negotiated Rate	$140.76
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Hawaii Western Management Group Commercial	$262.20
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$173.88
Rate for Payer: Kaiser Permanente Medicaid	$140.76
Rate for Payer: MDX Hawaii PPO	$267.72
Rate for Payer: University Health Alliance Commercial	$201.18

LINEZOLID 600 MG TABLET [28224]

Facility

$276.00

Service Code	NDC 67877041984
Hospital Revenue Code	250
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: MDX Hawaii PPO	$267.72

LINEZOLID 600 MG TABLET [28224]

Facility

$276.00

Service Code	NDC 67877041933
Hospital Revenue Code	250
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: MDX Hawaii PPO	$267.72

LINEZOLID 600 MG TABLET [28224]

Facility

$190.00

Service Code	NDC 60687030921
Hospital Revenue Code	637
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: University Health Alliance Commercial	$138.49

Know your out-of-pocket cost for care.

All Charges