Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PERSONA FEM PS POR STD SZ3 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ3 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$10,186.74
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ4 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ4 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$10,186.74
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ4 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$10,186.74
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ4 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ5 L

Facility

$9,310.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,748.10
Max. Negotiated Rate	$9,030.70
Rate for Payer: Cash Price	$5,586.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,517.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$7,913.50
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$5,865.30
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Medicaid	$4,748.10
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$9,030.70
Rate for Payer: University Health Alliance Commercial	$5,213.60
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ5 L

Facility

$9,310.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,213.60
Max. Negotiated Rate	$9,030.70
Rate for Payer: Cash Price	$5,586.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,517.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$7,913.50
Rate for Payer: MDX Hawaii PPO	$9,030.70
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44
Rate for Payer: University Health Alliance Commercial	$5,213.60

PERSONA FEM PS POR STD SZ5 R

Facility

$7,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,774.00
Max. Negotiated Rate	$7,178.00
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Commercial	$4,662.00
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicaid	$3,774.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: University Health Alliance Commercial	$4,144.00
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ5 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44
Rate for Payer: University Health Alliance Commercial	$4,144.00

PERSONA FEM PS POR STD SZ6 L

Facility

$7,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,774.00
Max. Negotiated Rate	$7,178.00
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Commercial	$4,662.00
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicaid	$3,774.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: University Health Alliance Commercial	$4,144.00
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ6 L

Facility

$7,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,144.00
Max. Negotiated Rate	$7,178.00
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: University Health Alliance Commercial	$4,144.00
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ6 R

Facility

$9,310.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,213.60
Max. Negotiated Rate	$9,030.70
Rate for Payer: Cash Price	$5,586.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,517.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$7,913.50
Rate for Payer: MDX Hawaii PPO	$9,030.70
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44
Rate for Payer: University Health Alliance Commercial	$5,213.60

PERSONA FEM PS POR STD SZ6 R

Facility

$9,310.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,748.10
Max. Negotiated Rate	$9,030.70
Rate for Payer: Cash Price	$5,586.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,517.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$7,913.50
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$5,865.30
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Medicaid	$4,748.10
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$9,030.70
Rate for Payer: University Health Alliance Commercial	$5,213.60
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ7 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44
Rate for Payer: University Health Alliance Commercial	$4,144.00

PERSONA FEM PS POR STD SZ7 L

Facility

$7,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,774.00
Max. Negotiated Rate	$7,178.00
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Commercial	$4,662.00
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicaid	$3,774.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: University Health Alliance Commercial	$4,144.00
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ7 R

Facility

$7,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,144.00
Max. Negotiated Rate	$7,178.00
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: University Health Alliance Commercial	$4,144.00
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ7 R

Facility

$7,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,774.00
Max. Negotiated Rate	$7,178.00
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Commercial	$4,662.00
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicaid	$3,774.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: University Health Alliance Commercial	$4,144.00
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ8 L

Facility

$7,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,144.00
Max. Negotiated Rate	$7,178.00
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44
Rate for Payer: University Health Alliance Commercial	$4,144.00

PERSONA FEM PS POR STD SZ8 L

Facility

$7,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,774.00
Max. Negotiated Rate	$7,178.00
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$4,662.00
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Medicaid	$3,774.00
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: University Health Alliance Commercial	$4,144.00
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ8 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44
Rate for Payer: University Health Alliance Commercial	$4,144.00

PERSONA FEM PS POR STD SZ8 R

Facility

$7,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,774.00
Max. Negotiated Rate	$7,178.00
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Commercial	$4,662.00
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicaid	$3,774.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: University Health Alliance Commercial	$4,144.00
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ9 L

Facility

$9,310.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,748.10
Max. Negotiated Rate	$9,030.70
Rate for Payer: Cash Price	$5,586.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,517.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$7,913.50
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Commercial	$5,865.30
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicaid	$4,748.10
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$9,030.70
Rate for Payer: University Health Alliance Commercial	$5,213.60
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ9 L

Facility

$9,310.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,213.60
Max. Negotiated Rate	$9,030.70
Rate for Payer: Cash Price	$5,586.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,517.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$7,913.50
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$9,030.70
Rate for Payer: University Health Alliance Commercial	$5,213.60
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR STD SZ9 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$10,186.74
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: Kaiser Permanente Commercial	$4,662.00
Rate for Payer: Kaiser Permanente Commercial	$12,583.62
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicaid	$3,774.00
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: University Health Alliance Commercial	$4,144.00
Rate for Payer: University Health Alliance Commercial	$11,185.44

Know your out-of-pocket cost for care.

All Charges