Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OMNIFIT HIPCSTEM#11 6098-1140

Facility

$10,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,116.32
Max. Negotiated Rate	$9,731.04
Rate for Payer: Cash Price	$6,019.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,022.40
Rate for Payer: Health Management Network Commercial	$8,527.20
Rate for Payer: Kaiser Permanente Commercial	$6,320.16
Rate for Payer: Kaiser Permanente Medicaid	$5,116.32
Rate for Payer: MDX Hawaii PPO	$9,731.04
Rate for Payer: University Health Alliance Commercial	$5,617.92

OMNIFIT HIPCSTEM#4 6098-0425

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIPCSTEM#4 6098-0425

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,578.96
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$1,950.48
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIPCSTEM#5 6098-0530

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIPCSTEM#5 6098-0530

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,578.96
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$1,950.48
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIPCSTEM#7 #6098-0735

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIPCSTEM#7 #6098-0735

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,578.96
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$1,950.48
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIPCSTEM#8 #6098-0835

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,578.96
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$1,950.48
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIPCSTEM#8 #6098-0835

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIPCSTEM#9 #6098-0940

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,578.96
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$1,950.48
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIPCSTEM#9 #6098-0940

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIP STEM#10 #6097-1040

Facility

$10,332.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,785.92
Max. Negotiated Rate	$10,022.04
Rate for Payer: Cash Price	$6,199.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,232.40
Rate for Payer: Health Management Network Commercial	$8,782.20
Rate for Payer: MDX Hawaii PPO	$10,022.04
Rate for Payer: University Health Alliance Commercial	$5,785.92

OMNIFIT HIP STEM#10 #6097-1040

Facility

$10,332.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,269.32
Max. Negotiated Rate	$10,022.04
Rate for Payer: Cash Price	$6,199.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,232.40
Rate for Payer: Health Management Network Commercial	$8,782.20
Rate for Payer: Kaiser Permanente Commercial	$6,509.16
Rate for Payer: Kaiser Permanente Medicaid	$5,269.32
Rate for Payer: MDX Hawaii PPO	$10,022.04
Rate for Payer: University Health Alliance Commercial	$5,785.92

OMNIFIT HIP STEM#11 #6097-1140

Facility

$10,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,116.32
Max. Negotiated Rate	$9,731.04
Rate for Payer: Cash Price	$6,019.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,022.40
Rate for Payer: Health Management Network Commercial	$8,527.20
Rate for Payer: Kaiser Permanente Commercial	$6,320.16
Rate for Payer: Kaiser Permanente Medicaid	$5,116.32
Rate for Payer: MDX Hawaii PPO	$9,731.04
Rate for Payer: University Health Alliance Commercial	$5,617.92

OMNIFIT HIP STEM#11 #6097-1140

Facility

$10,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,617.92
Max. Negotiated Rate	$9,731.04
Rate for Payer: Cash Price	$6,019.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,022.40
Rate for Payer: Health Management Network Commercial	$8,527.20
Rate for Payer: MDX Hawaii PPO	$9,731.04
Rate for Payer: University Health Alliance Commercial	$5,617.92

OMNIFIT HIP STEM#4 #6097-0425

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,578.96
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$1,950.48
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIP STEM#4 #6097-0425

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIP STEM#5 #6097-0530

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIP STEM#5 #6097-0530

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,578.96
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$1,950.48
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIP STEM#6 #6097-0630

Facility

$3,127.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,751.12
Max. Negotiated Rate	$3,033.19
Rate for Payer: Cash Price	$1,876.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,188.90
Rate for Payer: Health Management Network Commercial	$2,657.95
Rate for Payer: MDX Hawaii PPO	$3,033.19
Rate for Payer: University Health Alliance Commercial	$1,751.12

OMNIFIT HIP STEM#6 #6097-0630

Facility

$3,127.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,594.77
Max. Negotiated Rate	$3,033.19
Rate for Payer: Cash Price	$1,876.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,188.90
Rate for Payer: Health Management Network Commercial	$2,657.95
Rate for Payer: Kaiser Permanente Commercial	$1,970.01
Rate for Payer: Kaiser Permanente Medicaid	$1,594.77
Rate for Payer: MDX Hawaii PPO	$3,033.19
Rate for Payer: University Health Alliance Commercial	$1,751.12

OMNIFIT HIP STEM #7 6097-0735

Facility

$3,127.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,751.12
Max. Negotiated Rate	$3,033.19
Rate for Payer: Cash Price	$1,876.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,188.90
Rate for Payer: Health Management Network Commercial	$2,657.95
Rate for Payer: MDX Hawaii PPO	$3,033.19
Rate for Payer: University Health Alliance Commercial	$1,751.12

OMNIFIT HIP STEM #7 6097-0735

Facility

$3,127.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,594.77
Max. Negotiated Rate	$3,033.19
Rate for Payer: Cash Price	$1,876.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,188.90
Rate for Payer: Health Management Network Commercial	$2,657.95
Rate for Payer: Kaiser Permanente Commercial	$1,970.01
Rate for Payer: Kaiser Permanente Medicaid	$1,594.77
Rate for Payer: MDX Hawaii PPO	$3,033.19
Rate for Payer: University Health Alliance Commercial	$1,751.12

OMNIFIT HIP STEM #8 #6097-0835

Facility

$10,332.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,269.32
Max. Negotiated Rate	$10,022.04
Rate for Payer: Cash Price	$6,199.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,232.40
Rate for Payer: Health Management Network Commercial	$8,782.20
Rate for Payer: Kaiser Permanente Commercial	$6,509.16
Rate for Payer: Kaiser Permanente Medicaid	$5,269.32
Rate for Payer: MDX Hawaii PPO	$10,022.04
Rate for Payer: University Health Alliance Commercial	$5,785.92

OMNIFIT HIP STEM #8 #6097-0835

Facility

$10,332.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,785.92
Max. Negotiated Rate	$10,022.04
Rate for Payer: Cash Price	$6,199.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,232.40
Rate for Payer: Health Management Network Commercial	$8,782.20
Rate for Payer: MDX Hawaii PPO	$10,022.04
Rate for Payer: University Health Alliance Commercial	$5,785.92

Know your out-of-pocket cost for care.

All Charges