Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NEX GEN PATELLA 00-5972-065-38

Facility

$2,323.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.88
Max. Negotiated Rate	$2,253.31
Rate for Payer: Cash Price	$1,393.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,626.10
Rate for Payer: Health Management Network Commercial	$1,974.55
Rate for Payer: MDX Hawaii PPO	$2,253.31
Rate for Payer: University Health Alliance Commercial	$1,300.88

NEX GEN PATELLA 00-5972-065-38

Facility

$2,323.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,184.73
Max. Negotiated Rate	$2,253.31
Rate for Payer: Cash Price	$1,393.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,626.10
Rate for Payer: Health Management Network Commercial	$1,974.55
Rate for Payer: Kaiser Permanente Commercial	$1,463.49
Rate for Payer: Kaiser Permanente Medicaid	$1,184.73
Rate for Payer: MDX Hawaii PPO	$2,253.31
Rate for Payer: University Health Alliance Commercial	$1,300.88

NEXGEN TAPER PLUG

Facility

$2,861.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,459.11
Max. Negotiated Rate	$2,775.17
Rate for Payer: Cash Price	$1,716.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,002.70
Rate for Payer: Health Management Network Commercial	$2,431.85
Rate for Payer: Kaiser Permanente Commercial	$1,802.43
Rate for Payer: Kaiser Permanente Medicaid	$1,459.11
Rate for Payer: MDX Hawaii PPO	$2,775.17
Rate for Payer: University Health Alliance Commercial	$1,602.16

NEXGEN TAPER PLUG

Facility

$2,861.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,602.16
Max. Negotiated Rate	$2,775.17
Rate for Payer: Cash Price	$1,716.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,002.70
Rate for Payer: Health Management Network Commercial	$2,431.85
Rate for Payer: MDX Hawaii PPO	$2,775.17
Rate for Payer: University Health Alliance Commercial	$1,602.16

NEXGEN TIB AUGMENT BLCK 5M, 6

Facility

$2,240.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,142.40
Max. Negotiated Rate	$2,172.80
Rate for Payer: Cash Price	$1,344.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,568.00
Rate for Payer: Health Management Network Commercial	$1,904.00
Rate for Payer: Kaiser Permanente Commercial	$1,411.20
Rate for Payer: Kaiser Permanente Medicaid	$1,142.40
Rate for Payer: MDX Hawaii PPO	$2,172.80
Rate for Payer: University Health Alliance Commercial	$1,254.40

NEXGEN TIB AUGMENT BLCK 5M, 6

Facility

$2,240.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,254.40
Max. Negotiated Rate	$2,172.80
Rate for Payer: Cash Price	$1,344.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,568.00
Rate for Payer: Health Management Network Commercial	$1,904.00
Rate for Payer: MDX Hawaii PPO	$2,172.80
Rate for Payer: University Health Alliance Commercial	$1,254.40

NEXGEN TIBIAL SZ 2 5980-27-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
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	$1,820.00
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	$1,456.00

NEXGEN TIBIAL SZ 2 5980-27-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

NEX KNE 3-4 12M 90-5970-030-12

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEX KNE 3-4 12M 90-5970-030-12

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,266.33
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$1,564.29
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEX TIB PL SZ:3 00-5980-037-01

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,365.44
Max. Negotiated Rate	$4,097.28
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: University Health Alliance Commercial	$2,365.44

NEX TIB PL SZ:3 00-5980-037-01

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,154.24
Max. Negotiated Rate	$4,097.28
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: Kaiser Permanente Commercial	$2,661.12
Rate for Payer: Kaiser Permanente Medicaid	$2,154.24
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: University Health Alliance Commercial	$2,365.44

NEX TIB PL SZ:4 00-5980-037-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
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	$1,820.00
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	$1,456.00

NEX TIB PL SZ:4 00-5980-037-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

NEX TIB PL SZ:5 00-5980-047-01

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
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	$1,820.00
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	$1,456.00

NEX TIB PL SZ:5 00-5980-047-01

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

NEX TIB PL SZ:6 00-5980-047-02

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,154.24
Max. Negotiated Rate	$4,097.28
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: Kaiser Permanente Commercial	$2,661.12
Rate for Payer: Kaiser Permanente Medicaid	$2,154.24
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: University Health Alliance Commercial	$2,365.44

NEX TIB PL SZ:6 00-5980-047-02

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,365.44
Max. Negotiated Rate	$4,097.28
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: University Health Alliance Commercial	$2,365.44

NEX TIB PL SZ:8 00-5980-057-02

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,154.24
Max. Negotiated Rate	$4,097.28
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: Kaiser Permanente Commercial	$2,661.12
Rate for Payer: Kaiser Permanente Medicaid	$2,154.24
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: University Health Alliance Commercial	$2,365.44

NEX TIB PL SZ:8 00-5980-057-02

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,365.44
Max. Negotiated Rate	$4,097.28
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: University Health Alliance Commercial	$2,365.44

NICARDIPINE 20 MG CAPSULE [10712]

Facility

$39.00

Service Code	NDC 42806050109
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: MDX Hawaii PPO	$37.83

NICARDIPINE 20 MG CAPSULE [10712]

Facility

$39.00

Service Code	NDC 68462012090
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: MDX Hawaii PPO	$37.83

NICARDIPINE 20 MG CAPSULE [10712]

Facility

$39.00

Service Code	NDC 42806050109
Hospital Revenue Code	637
Min. Negotiated Rate	$19.89
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$24.57
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: University Health Alliance Commercial	$28.43

NICARDIPINE 20 MG CAPSULE [10712]

Facility

$39.00

Service Code	NDC 68462012090
Hospital Revenue Code	637
Min. Negotiated Rate	$19.89
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$24.57
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: University Health Alliance Commercial	$28.43

NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION [12370]

Facility

$90.00

Service Code	HCPCS J2404
Hospital Revenue Code	250
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: MDX Hawaii PPO	$87.30

Know your out-of-pocket cost for care.

All Charges