Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$67,896.27

Service Code	MSDRG 462
Min. Negotiated Rate	$30,255.52
Max. Negotiated Rate	$67,896.27
Rate for Payer: AlohaCare Medicare	$30,255.52
Rate for Payer: Devoted Health Medicare	$33,281.07
Rate for Payer: Hawaii Medical Service Association Commercial	$67,896.27
Rate for Payer: Hawaii Medical Service Association Medicare	$30,255.52
Rate for Payer: Humana Medicare	$30,255.52
Rate for Payer: Kaiser Permanente Commercial	$45,885.00
Rate for Payer: Kaiser Permanente Medicare	$30,255.52
Rate for Payer: Ohana Health Plan Medicare	$30,255.52
Rate for Payer: UnitedHealthcare Medicare	$30,255.52

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility

$47,342.97

Service Code	MSDRG 409
Min. Negotiated Rate	$24,765.17
Max. Negotiated Rate	$47,342.97
Rate for Payer: AlohaCare Medicare	$24,765.17
Rate for Payer: Devoted Health Medicare	$27,241.69
Rate for Payer: Hawaii Medical Service Association Commercial	$47,342.97
Rate for Payer: Hawaii Medical Service Association Medicare	$24,765.17
Rate for Payer: Humana Medicare	$24,765.17
Rate for Payer: Kaiser Permanente Commercial	$37,558.43
Rate for Payer: Kaiser Permanente Medicare	$24,765.17
Rate for Payer: Ohana Health Plan Medicare	$24,765.17
Rate for Payer: UnitedHealthcare Medicare	$24,765.17

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility

$61,506.60

Service Code	MSDRG 408
Min. Negotiated Rate	$40,556.04
Max. Negotiated Rate	$61,506.60
Rate for Payer: AlohaCare Medicare	$40,556.04
Rate for Payer: Devoted Health Medicare	$44,611.64
Rate for Payer: Hawaii Medical Service Association Commercial	$47,342.97
Rate for Payer: Hawaii Medical Service Association Medicare	$40,556.04
Rate for Payer: Humana Medicare	$40,556.04
Rate for Payer: Kaiser Permanente Commercial	$61,506.60
Rate for Payer: Kaiser Permanente Medicare	$40,556.04
Rate for Payer: Ohana Health Plan Medicare	$40,556.04
Rate for Payer: UnitedHealthcare Medicare	$40,556.04

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$46,323.79

Service Code	MSDRG 410
Min. Negotiated Rate	$18,058.91
Max. Negotiated Rate	$46,323.79
Rate for Payer: AlohaCare Medicare	$18,058.91
Rate for Payer: Devoted Health Medicare	$19,864.80
Rate for Payer: Hawaii Medical Service Association Commercial	$46,323.79
Rate for Payer: Hawaii Medical Service Association Medicare	$18,058.91
Rate for Payer: Humana Medicare	$18,058.91
Rate for Payer: Kaiser Permanente Commercial	$27,387.83
Rate for Payer: Kaiser Permanente Medicare	$18,058.91
Rate for Payer: Ohana Health Plan Medicare	$18,058.91
Rate for Payer: UnitedHealthcare Medicare	$18,058.91

BILOX DELTA CERMAIC 6570-0-228

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

BILOX DELTA CERMAIC 6570-0-228

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,364.76
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$1,685.88
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

BINDER BREAST, FLORAL LAV 2X

Facility

$147.00

Hospital Revenue Code	271
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: MDX Hawaii PPO	$142.59

BINDER BREAST, FLORAL LAV 2X

Facility

$147.00

Hospital Revenue Code	271
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$107.15

BINDER BREAST, FLORAL LAV LG

Facility

$177.00

Hospital Revenue Code	271
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: MDX Hawaii PPO	$171.69

BINDER BREAST, FLORAL LAV LG

Facility

$177.00

Hospital Revenue Code	271
Min. Negotiated Rate	$90.27
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Hawaii Western Management Group Commercial	$168.15
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$111.51
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: University Health Alliance Commercial	$129.02

BINDER BREAST, FLORAL LAV MED

Facility

$177.00

Hospital Revenue Code	271
Min. Negotiated Rate	$90.27
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Hawaii Western Management Group Commercial	$168.15
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$111.51
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: University Health Alliance Commercial	$129.02

BINDER BREAST, FLORAL LAV MED

Facility

$177.00

Hospital Revenue Code	271
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: MDX Hawaii PPO	$171.69

BINDER BREAST, FLORAL LAV SM

Facility

$177.00

Hospital Revenue Code	271
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: MDX Hawaii PPO	$171.69

BINDER BREAST, FLORAL LAV SM

Facility

$177.00

Hospital Revenue Code	271
Min. Negotiated Rate	$90.27
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Hawaii Western Management Group Commercial	$168.15
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$111.51
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: University Health Alliance Commercial	$129.02

BINDER BREAST, FLORAL LAV XL

Facility

$177.00

Hospital Revenue Code	271
Min. Negotiated Rate	$90.27
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Hawaii Western Management Group Commercial	$168.15
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$111.51
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: University Health Alliance Commercial	$129.02

BINDER BREAST, FLORAL LAV XL

Facility

$177.00

Hospital Revenue Code	271
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: MDX Hawaii PPO	$171.69

BIOCOMP SWVLK AR-1662BCS-710S

Facility

$2,265.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,268.40
Max. Negotiated Rate	$2,197.05
Rate for Payer: Cash Price	$1,359.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,585.50
Rate for Payer: Health Management Network Commercial	$1,925.25
Rate for Payer: MDX Hawaii PPO	$2,197.05
Rate for Payer: University Health Alliance Commercial	$1,268.40

BIOCOMP SWVLK AR-1662BCS-710S

Facility

$2,265.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.15
Max. Negotiated Rate	$2,197.05
Rate for Payer: Cash Price	$1,359.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,585.50
Rate for Payer: Health Management Network Commercial	$1,925.25
Rate for Payer: Kaiser Permanente Commercial	$1,426.95
Rate for Payer: Kaiser Permanente Medicaid	$1,155.15
Rate for Payer: MDX Hawaii PPO	$2,197.05
Rate for Payer: University Health Alliance Commercial	$1,268.40

BIO-COMP SWVLK SP AR-2323BCM

Facility

$1,800.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,746.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,260.00
Rate for Payer: Health Management Network Commercial	$1,530.00
Rate for Payer: MDX Hawaii PPO	$1,746.00
Rate for Payer: University Health Alliance Commercial	$1,008.00

BIO-COMP SWVLK SP AR-2323BCM

Facility

$1,800.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$918.00
Max. Negotiated Rate	$1,746.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,260.00
Rate for Payer: Health Management Network Commercial	$1,530.00
Rate for Payer: Kaiser Permanente Commercial	$1,134.00
Rate for Payer: Kaiser Permanente Medicaid	$918.00
Rate for Payer: MDX Hawaii PPO	$1,746.00
Rate for Payer: University Health Alliance Commercial	$1,008.00

BIOINDUCTIVE IMPLANT SYS 4565

Facility

$4,000.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

BIOINDUCTIVE IMPLANT SYS 4565

Facility

$4,000.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,040.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

BIOLOX DELTA FEM HEAD 32X3.5MM

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	272
Min. Negotiated Rate	$2,210.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: MDX Hawaii PPO	$2,522.00

BIOLOX DELTA FEM HEAD 32X3.5MM

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	272
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,470.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$1,638.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,895.14

BIOLOX DELTA V40 FH 6570-0-232

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

Know your out-of-pocket cost for care.

All Charges