Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

STABILIZER FEMORAL 5512-F-201

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,264.33
Max. Negotiated Rate	$11,914.51
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Kaiser Permanente Commercial	$7,738.29
Rate for Payer: Kaiser Permanente Medicaid	$6,264.33
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: University Health Alliance Commercial	$6,878.48

STABILIZER FEMORAL 5512-F-502

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,264.33
Max. Negotiated Rate	$11,914.51
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Kaiser Permanente Commercial	$7,738.29
Rate for Payer: Kaiser Permanente Medicaid	$6,264.33
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: University Health Alliance Commercial	$6,878.48

STABILIZER FEMORAL 5512-F-502

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,878.48
Max. Negotiated Rate	$11,914.51
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: University Health Alliance Commercial	$6,878.48

STABILIZER FEMORAL 5515-F-302

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER FEMORAL 5515-F-302

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,183.82
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$2,697.66
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER INSERT 5537-G-113

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.53
Max. Negotiated Rate	$4,755.91
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Kaiser Permanente Commercial	$3,088.89
Rate for Payer: Kaiser Permanente Medicaid	$2,500.53
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: University Health Alliance Commercial	$2,745.68

STABILIZER INSERT 5537-G-113

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,745.68
Max. Negotiated Rate	$4,755.91
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: University Health Alliance Commercial	$2,745.68

STABILIZER POST SZ8 5515-F-802

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER POST SZ8 5515-F-802

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,183.82
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$2,697.66
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER SZ.6 5515-F-602

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER SZ.6 5515-F-602

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,183.82
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$2,697.66
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER TIBIAL 5537-G-513-E

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,745.68
Max. Negotiated Rate	$4,755.91
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: University Health Alliance Commercial	$2,745.68

STABILIZER TIBIAL 5537-G-513-E

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.53
Max. Negotiated Rate	$4,755.91
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Kaiser Permanente Commercial	$3,088.89
Rate for Payer: Kaiser Permanente Medicaid	$2,500.53
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: University Health Alliance Commercial	$2,745.68

STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20 STAB INCISIONS

Facility

$8,270.00

Service Code	CPT 37765
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,743.44

STANDARD INTENSITY HEPARIN CALCULATOR PRN BOLUS [4080208]

Facility

$31.00

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: MDX Hawaii PPO	$30.07

STANDARD INTENSITY HEPARIN CALCULATOR PRN BOLUS [4080208]

Facility

$31.00

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$18.60
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$19.53
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: UnitedHealthcare Medicaid	$18.60
Rate for Payer: University Health Alliance Commercial	$22.60

STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT USE OF FOREIGN MATERIAL;

Facility

$11,157.19

Service Code	CPT 69660
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$11,157.19
Rate for Payer: AlohaCare Medicaid	$6,993.36
Rate for Payer: AlohaCare Medicare	$6,993.36
Rate for Payer: Devoted Health Medicare	$7,692.70
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,993.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$6,993.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,993.36
Rate for Payer: Ohana Health Plan Medicaid	$7,692.70
Rate for Payer: Ohana Health Plan Medicare	$6,993.36
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,993.36
Rate for Payer: University Health Alliance Commercial	$11,157.19

STAPLE CEEA PREM PLUS 21MM

Facility

$944.00

Hospital Revenue Code	272
Min. Negotiated Rate	$802.40
Max. Negotiated Rate	$915.68
Rate for Payer: Cash Price	$566.40
Rate for Payer: Health Management Network Commercial	$802.40
Rate for Payer: MDX Hawaii PPO	$915.68

STAPLE CEEA PREM PLUS 21MM

Facility

$944.00

Hospital Revenue Code	272
Min. Negotiated Rate	$481.44
Max. Negotiated Rate	$915.68
Rate for Payer: Cash Price	$566.40
Rate for Payer: Hawaii Western Management Group Commercial	$896.80
Rate for Payer: Health Management Network Commercial	$802.40
Rate for Payer: Kaiser Permanente Commercial	$594.72
Rate for Payer: Kaiser Permanente Medicaid	$481.44
Rate for Payer: MDX Hawaii PPO	$915.68
Rate for Payer: University Health Alliance Commercial	$688.08

STAPLE CEEA PREM PLUS 25MM

Facility

$999.00

Hospital Revenue Code	272
Min. Negotiated Rate	$849.15
Max. Negotiated Rate	$969.03
Rate for Payer: Cash Price	$599.40
Rate for Payer: Health Management Network Commercial	$849.15
Rate for Payer: MDX Hawaii PPO	$969.03

STAPLE CEEA PREM PLUS 25MM

Facility

$999.00

Hospital Revenue Code	272
Min. Negotiated Rate	$509.49
Max. Negotiated Rate	$969.03
Rate for Payer: Cash Price	$599.40
Rate for Payer: Hawaii Western Management Group Commercial	$949.05
Rate for Payer: Health Management Network Commercial	$849.15
Rate for Payer: Kaiser Permanente Commercial	$629.37
Rate for Payer: Kaiser Permanente Medicaid	$509.49
Rate for Payer: MDX Hawaii PPO	$969.03
Rate for Payer: University Health Alliance Commercial	$728.17

STAPLE CEEA PREM PLUS 28MM

Facility

$1,019.00

Hospital Revenue Code	272
Min. Negotiated Rate	$519.69
Max. Negotiated Rate	$988.43
Rate for Payer: Cash Price	$611.40
Rate for Payer: Hawaii Western Management Group Commercial	$968.05
Rate for Payer: Health Management Network Commercial	$866.15
Rate for Payer: Kaiser Permanente Commercial	$641.97
Rate for Payer: Kaiser Permanente Medicaid	$519.69
Rate for Payer: MDX Hawaii PPO	$988.43
Rate for Payer: University Health Alliance Commercial	$742.75

STAPLE CEEA PREM PLUS 28MM

Facility

$1,019.00

Hospital Revenue Code	272
Min. Negotiated Rate	$866.15
Max. Negotiated Rate	$988.43
Rate for Payer: Cash Price	$611.40
Rate for Payer: Health Management Network Commercial	$866.15
Rate for Payer: MDX Hawaii PPO	$988.43

STAPLE CEEA PREM PLUS 31MM

Facility

$1,183.00

Hospital Revenue Code	272
Min. Negotiated Rate	$603.33
Max. Negotiated Rate	$1,147.51
Rate for Payer: Cash Price	$709.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,123.85
Rate for Payer: Health Management Network Commercial	$1,005.55
Rate for Payer: Kaiser Permanente Commercial	$745.29
Rate for Payer: Kaiser Permanente Medicaid	$603.33
Rate for Payer: MDX Hawaii PPO	$1,147.51
Rate for Payer: University Health Alliance Commercial	$862.29

STAPLE CEEA PREM PLUS 31MM

Facility

$1,183.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,005.55
Max. Negotiated Rate	$1,147.51
Rate for Payer: Cash Price	$709.80
Rate for Payer: Health Management Network Commercial	$1,005.55
Rate for Payer: MDX Hawaii PPO	$1,147.51

Know your out-of-pocket cost for care.

All Charges