Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PACEMAKER PM1272SYSCELL

Facility

$10,850.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,533.50
Max. Negotiated Rate	$10,524.50
Rate for Payer: Cash Price	$6,510.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,595.00
Rate for Payer: Health Management Network Commercial	$9,222.50
Rate for Payer: Kaiser Permanente Commercial	$6,835.50
Rate for Payer: Kaiser Permanente Medicaid	$5,533.50
Rate for Payer: MDX Hawaii PPO	$10,524.50
Rate for Payer: University Health Alliance Commercial	$6,076.00

PACEMAKER PM1272SYSCELL

Facility

$10,850.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$6,076.00
Max. Negotiated Rate	$10,524.50
Rate for Payer: Cash Price	$6,510.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,595.00
Rate for Payer: Health Management Network Commercial	$9,222.50
Rate for Payer: MDX Hawaii PPO	$10,524.50
Rate for Payer: University Health Alliance Commercial	$6,076.00

PACEMAKER SINGLE CHAMBER

Facility

$12,004.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$6,122.04
Max. Negotiated Rate	$11,643.88
Rate for Payer: Cash Price	$7,202.40
Rate for Payer: Hawaii Western Management Group Commercial	$8,402.80
Rate for Payer: Health Management Network Commercial	$10,203.40
Rate for Payer: Kaiser Permanente Commercial	$7,562.52
Rate for Payer: Kaiser Permanente Medicaid	$6,122.04
Rate for Payer: MDX Hawaii PPO	$11,643.88
Rate for Payer: University Health Alliance Commercial	$6,722.24

PACEMAKER SINGLE CHAMBER

Facility

$12,004.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$6,722.24
Max. Negotiated Rate	$11,643.88
Rate for Payer: Cash Price	$7,202.40
Rate for Payer: Hawaii Western Management Group Commercial	$8,402.80
Rate for Payer: Health Management Network Commercial	$10,203.40
Rate for Payer: MDX Hawaii PPO	$11,643.88
Rate for Payer: University Health Alliance Commercial	$6,722.24

PACEMAKER SNGL CD135-740C

Facility

$27,900.00

Service Code	HCPCS C1722
Hospital Revenue Code	275
Min. Negotiated Rate	$14,229.00
Max. Negotiated Rate	$27,063.00
Rate for Payer: Cash Price	$16,740.00
Rate for Payer: Hawaii Western Management Group Commercial	$19,530.00
Rate for Payer: Health Management Network Commercial	$23,715.00
Rate for Payer: Kaiser Permanente Commercial	$17,577.00
Rate for Payer: Kaiser Permanente Medicaid	$14,229.00
Rate for Payer: MDX Hawaii PPO	$27,063.00
Rate for Payer: University Health Alliance Commercial	$15,624.00

PACEMAKER SNGL CD135-740C

Facility

$27,900.00

Service Code	HCPCS C1722
Hospital Revenue Code	275
Min. Negotiated Rate	$15,624.00
Max. Negotiated Rate	$27,063.00
Rate for Payer: Cash Price	$16,740.00
Rate for Payer: Hawaii Western Management Group Commercial	$19,530.00
Rate for Payer: Health Management Network Commercial	$23,715.00
Rate for Payer: MDX Hawaii PPO	$27,063.00
Rate for Payer: University Health Alliance Commercial	$15,624.00

PACK ARTHRO SHOULDER/KNEE

Facility

$496.00

Hospital Revenue Code	272
Min. Negotiated Rate	$421.60
Max. Negotiated Rate	$481.12
Rate for Payer: Cash Price	$297.60
Rate for Payer: Health Management Network Commercial	$421.60
Rate for Payer: MDX Hawaii PPO	$481.12

PACK ARTHRO SHOULDER/KNEE

Facility

$496.00

Hospital Revenue Code	272
Min. Negotiated Rate	$252.96
Max. Negotiated Rate	$481.12
Rate for Payer: Cash Price	$297.60
Rate for Payer: Hawaii Western Management Group Commercial	$471.20
Rate for Payer: Health Management Network Commercial	$421.60
Rate for Payer: Kaiser Permanente Commercial	$312.48
Rate for Payer: Kaiser Permanente Medicaid	$252.96
Rate for Payer: MDX Hawaii PPO	$481.12
Rate for Payer: University Health Alliance Commercial	$361.53

PACK AV FISTULA

Facility

$641.00

Hospital Revenue Code	272
Min. Negotiated Rate	$326.91
Max. Negotiated Rate	$621.77
Rate for Payer: Cash Price	$384.60
Rate for Payer: Hawaii Western Management Group Commercial	$608.95
Rate for Payer: Health Management Network Commercial	$544.85
Rate for Payer: Kaiser Permanente Commercial	$403.83
Rate for Payer: Kaiser Permanente Medicaid	$326.91
Rate for Payer: MDX Hawaii PPO	$621.77
Rate for Payer: University Health Alliance Commercial	$467.22

PACK AV FISTULA

Facility

$641.00

Hospital Revenue Code	272
Min. Negotiated Rate	$544.85
Max. Negotiated Rate	$621.77
Rate for Payer: Cash Price	$384.60
Rate for Payer: Health Management Network Commercial	$544.85
Rate for Payer: MDX Hawaii PPO	$621.77

PACK BASIC CATARACT

Facility

$80.00

Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: MDX Hawaii PPO	$77.60

PACK BASIC CATARACT

Facility

$80.00

Hospital Revenue Code	272
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Hawaii Western Management Group Commercial	$76.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: University Health Alliance Commercial	$58.31

PACK CESAREAN

Facility

$291.00

Hospital Revenue Code	272
Min. Negotiated Rate	$247.35
Max. Negotiated Rate	$282.27
Rate for Payer: Cash Price	$174.60
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: MDX Hawaii PPO	$282.27

PACK CESAREAN

Facility

$291.00

Hospital Revenue Code	272
Min. Negotiated Rate	$148.41
Max. Negotiated Rate	$282.27
Rate for Payer: Cash Price	$174.60
Rate for Payer: Hawaii Western Management Group Commercial	$276.45
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Kaiser Permanente Commercial	$183.33
Rate for Payer: Kaiser Permanente Medicaid	$148.41
Rate for Payer: MDX Hawaii PPO	$282.27
Rate for Payer: University Health Alliance Commercial	$212.11

PACK CYSTO

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: University Health Alliance Commercial	$164.00

PACK CYSTO

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25

PACK ENDO TYMPANOPLASTY

Facility

$745.00

Hospital Revenue Code	272
Min. Negotiated Rate	$633.25
Max. Negotiated Rate	$722.65
Rate for Payer: Cash Price	$447.00
Rate for Payer: Health Management Network Commercial	$633.25
Rate for Payer: MDX Hawaii PPO	$722.65

PACK ENDO TYMPANOPLASTY

Facility

$745.00

Hospital Revenue Code	272
Min. Negotiated Rate	$379.95
Max. Negotiated Rate	$722.65
Rate for Payer: Cash Price	$447.00
Rate for Payer: Hawaii Western Management Group Commercial	$707.75
Rate for Payer: Health Management Network Commercial	$633.25
Rate for Payer: Kaiser Permanente Commercial	$469.35
Rate for Payer: Kaiser Permanente Medicaid	$379.95
Rate for Payer: MDX Hawaii PPO	$722.65
Rate for Payer: University Health Alliance Commercial	$543.03

PACK GENERAL

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$290.70
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$205.20
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: MDX Hawaii PPO	$331.74

PACK GENERAL

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$174.42
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$205.20
Rate for Payer: Hawaii Western Management Group Commercial	$324.90
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Kaiser Permanente Commercial	$215.46
Rate for Payer: Kaiser Permanente Medicaid	$174.42
Rate for Payer: MDX Hawaii PPO	$331.74
Rate for Payer: University Health Alliance Commercial	$249.28

PACK HEAD

Facility

$71.00

Hospital Revenue Code	272
Min. Negotiated Rate	$36.21
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Hawaii Western Management Group Commercial	$67.45
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: University Health Alliance Commercial	$51.75

PACK HEAD

Facility

$71.00

Hospital Revenue Code	272
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: MDX Hawaii PPO	$68.87

PACKING 4.5CM NASAL

Facility

$99.00

Hospital Revenue Code	272
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: MDX Hawaii PPO	$96.03

PACKING 4.5CM NASAL

Facility

$99.00

Hospital Revenue Code	272
Min. Negotiated Rate	$50.49
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$62.37
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: University Health Alliance Commercial	$72.16

PACKING 8CM NASAL

Facility

$146.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.46
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$87.60
Rate for Payer: Hawaii Western Management Group Commercial	$138.70
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$91.98
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: University Health Alliance Commercial	$106.42

Know your out-of-pocket cost for care.

All Charges