Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

SLEEVE NAIL INSERT 1806-1406S

Facility

$538.00

Hospital Revenue Code	272
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$521.86
Rate for Payer: Cash Price	$322.80
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: MDX Hawaii PPO	$521.86

SLEEVE NAIL INSERT 1806-1406S

Facility

$538.00

Hospital Revenue Code	272
Min. Negotiated Rate	$274.38
Max. Negotiated Rate	$521.86
Rate for Payer: Cash Price	$322.80
Rate for Payer: Hawaii Western Management Group Commercial	$511.10
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: Kaiser Permanente Commercial	$338.94
Rate for Payer: Kaiser Permanente Medicaid	$274.38
Rate for Payer: MDX Hawaii PPO	$521.86
Rate for Payer: University Health Alliance Commercial	$392.15

SLEEVE PROTCTN 10MM 03.010.038

Facility

$1,674.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$853.74
Max. Negotiated Rate	$1,623.78
Rate for Payer: Cash Price	$1,004.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,590.30
Rate for Payer: Health Management Network Commercial	$1,422.90
Rate for Payer: Kaiser Permanente Commercial	$1,054.62
Rate for Payer: Kaiser Permanente Medicaid	$853.74
Rate for Payer: MDX Hawaii PPO	$1,623.78
Rate for Payer: University Health Alliance Commercial	$1,220.18

SLEEVE PROTCTN 10MM 03.010.038

Facility

$1,674.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$1,422.90
Max. Negotiated Rate	$1,623.78
Rate for Payer: Cash Price	$1,004.40
Rate for Payer: Health Management Network Commercial	$1,422.90
Rate for Payer: MDX Hawaii PPO	$1,623.78

SLEEVE SCD KNEE XLG EXPRESS

Facility

$249.00

Hospital Revenue Code	271
Min. Negotiated Rate	$211.65
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$149.40
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: MDX Hawaii PPO	$241.53

SLEEVE SCD KNEE XLG EXPRESS

Facility

$249.00

Hospital Revenue Code	271
Min. Negotiated Rate	$126.99
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$149.40
Rate for Payer: Hawaii Western Management Group Commercial	$236.55
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Kaiser Permanente Commercial	$156.87
Rate for Payer: Kaiser Permanente Medicaid	$126.99
Rate for Payer: MDX Hawaii PPO	$241.53
Rate for Payer: University Health Alliance Commercial	$181.50

SLING ABBREVO URETHRAL

Facility

$3,439.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$1,925.84
Max. Negotiated Rate	$3,335.83
Rate for Payer: Cash Price	$2,063.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,407.30
Rate for Payer: Health Management Network Commercial	$2,923.15
Rate for Payer: MDX Hawaii PPO	$3,335.83
Rate for Payer: University Health Alliance Commercial	$1,925.84

SLING ABBREVO URETHRAL

Facility

$3,439.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$1,753.89
Max. Negotiated Rate	$3,335.83
Rate for Payer: Cash Price	$2,063.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,407.30
Rate for Payer: Health Management Network Commercial	$2,923.15
Rate for Payer: Kaiser Permanente Commercial	$2,166.57
Rate for Payer: Kaiser Permanente Medicaid	$1,753.89
Rate for Payer: MDX Hawaii PPO	$3,335.83
Rate for Payer: University Health Alliance Commercial	$1,925.84

SLING LATERAL TRACT S3 AR-1652

Facility

$344.00

Hospital Revenue Code	271
Min. Negotiated Rate	$175.44
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$206.40
Rate for Payer: Hawaii Western Management Group Commercial	$326.80
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: Kaiser Permanente Commercial	$216.72
Rate for Payer: Kaiser Permanente Medicaid	$175.44
Rate for Payer: MDX Hawaii PPO	$333.68
Rate for Payer: University Health Alliance Commercial	$250.74

SLING LATERAL TRACT S3 AR-1652

Facility

$344.00

Hospital Revenue Code	271
Min. Negotiated Rate	$292.40
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$206.40
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: MDX Hawaii PPO	$333.68

SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)

Facility

$13,778.00

Service Code	CPT 57288
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$13,778.00
Rate for Payer: AlohaCare Medicaid	$5,909.62
Rate for Payer: AlohaCare Medicare	$5,909.62
Rate for Payer: Devoted Health Medicare	$6,500.58
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,909.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Humana Medicare	$5,909.62
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$5,909.62
Rate for Payer: Ohana Health Plan Medicaid	$6,500.58
Rate for Payer: Ohana Health Plan Medicare	$5,909.62
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$5,909.62
Rate for Payer: University Health Alliance Commercial	$11,157.19

SLING SUPER PLUS LG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$43.27
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Cash Price	$130.80
Rate for Payer: Hawaii Western Management Group Commercial	$152.60
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$137.34
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: UnitedHealthcare Medicaid	$43.27
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SUPER PLUS LG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$122.08
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Hawaii Western Management Group Commercial	$152.60
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SUPER PLUS XLG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$122.08
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Hawaii Western Management Group Commercial	$152.60
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SUPER PLUS XLG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$43.27
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Cash Price	$130.80
Rate for Payer: Hawaii Western Management Group Commercial	$152.60
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$137.34
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: UnitedHealthcare Medicaid	$43.27
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SWATHE LG

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: University Health Alliance Commercial	$26.88

SLING SWATHE LG

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$30.24
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: University Health Alliance Commercial	$26.88

SLING SWATHE SM

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$30.24
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: University Health Alliance Commercial	$26.88

SLING SWATHE SM

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: University Health Alliance Commercial	$26.88

SLOTTED WHISKER 3.8M AR-8380SW

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: MDX Hawaii PPO	$329.80

SLOTTED WHISKER 3.8M AR-8380SW

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Hawaii Western Management Group Commercial	$323.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: University Health Alliance Commercial	$247.83

SMART PROGRAMMER TH90Q01

Facility

$4,095.00

Service Code	HCPCS C1787
Hospital Revenue Code	272
Min. Negotiated Rate	$2,088.45
Max. Negotiated Rate	$3,972.15
Rate for Payer: Cash Price	$2,457.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,890.25
Rate for Payer: Health Management Network Commercial	$3,480.75
Rate for Payer: Kaiser Permanente Commercial	$2,579.85
Rate for Payer: Kaiser Permanente Medicaid	$2,088.45
Rate for Payer: MDX Hawaii PPO	$3,972.15
Rate for Payer: University Health Alliance Commercial	$2,984.85

SMART PROGRAMMER TH90Q01

Facility

$4,095.00

Service Code	HCPCS C1787
Hospital Revenue Code	272
Min. Negotiated Rate	$3,480.75
Max. Negotiated Rate	$3,972.15
Rate for Payer: Cash Price	$2,457.00
Rate for Payer: Health Management Network Commercial	$3,480.75
Rate for Payer: MDX Hawaii PPO	$3,972.15

SMETRIC PTLA 33x9MM 5550-G-339

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,031.68
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: University Health Alliance Commercial	$2,031.68

SMETRIC PTLA 33x9MM 5550-G-339

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,850.28
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Kaiser Permanente Commercial	$2,285.64
Rate for Payer: Kaiser Permanente Medicaid	$1,850.28
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: University Health Alliance Commercial	$2,031.68

Know your out-of-pocket cost for care.

All Charges