Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

STAPLER SUREFORM 8MM 488530

Facility

$1,638.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,392.30
Max. Negotiated Rate	$1,588.86
Rate for Payer: Cash Price	$982.80
Rate for Payer: Health Management Network Commercial	$1,392.30
Rate for Payer: MDX Hawaii PPO	$1,588.86

STAPLER TA90-4.8 TA9048S

Facility

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: MDX Hawaii PPO	$363.75

STAPLER TA90-4.8 TA9048S

Facility

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$225.00
Rate for Payer: Hawaii Western Management Group Commercial	$356.25
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Kaiser Permanente Commercial	$236.25
Rate for Payer: Kaiser Permanente Medicaid	$191.25
Rate for Payer: MDX Hawaii PPO	$363.75
Rate for Payer: University Health Alliance Commercial	$273.34

STAPLE TA 60-3.5MM TA6035S

Facility

$341.00

Hospital Revenue Code	272
Min. Negotiated Rate	$173.91
Max. Negotiated Rate	$330.77
Rate for Payer: Cash Price	$204.60
Rate for Payer: Hawaii Western Management Group Commercial	$323.95
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Kaiser Permanente Commercial	$214.83
Rate for Payer: Kaiser Permanente Medicaid	$173.91
Rate for Payer: MDX Hawaii PPO	$330.77
Rate for Payer: University Health Alliance Commercial	$248.55

STAPLE TA 60-3.5MM TA6035S

Facility

$341.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.85
Max. Negotiated Rate	$330.77
Rate for Payer: Cash Price	$204.60
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: MDX Hawaii PPO	$330.77

STAPLE TA 60-4.8 LOAD TA6048L

Facility

$211.00

Hospital Revenue Code	272
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$126.60
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: MDX Hawaii PPO	$204.67

STAPLE TA 60-4.8 LOAD TA6048L

Facility

$211.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.61
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$126.60
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$132.93
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: University Health Alliance Commercial	$153.80

STAPLE TA 90-3.5 LOAD TA9035L

Facility

$218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$111.18
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Hawaii Western Management Group Commercial	$207.10
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: University Health Alliance Commercial	$158.90

STAPLE TA 90-3.5 LOAD TA9035L

Facility

$218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$185.30
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: MDX Hawaii PPO	$211.46

STAPLE TA 90-3.5MM TA9035S

Facility

$315.00

Hospital Revenue Code	272
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$305.55
Rate for Payer: Cash Price	$189.00
Rate for Payer: Hawaii Western Management Group Commercial	$299.25
Rate for Payer: Health Management Network Commercial	$267.75
Rate for Payer: Kaiser Permanente Commercial	$198.45
Rate for Payer: Kaiser Permanente Medicaid	$160.65
Rate for Payer: MDX Hawaii PPO	$305.55
Rate for Payer: University Health Alliance Commercial	$229.60

STAPLE TA 90-3.5MM TA9035S

Facility

$315.00

Hospital Revenue Code	272
Min. Negotiated Rate	$267.75
Max. Negotiated Rate	$305.55
Rate for Payer: Cash Price	$189.00
Rate for Payer: Health Management Network Commercial	$267.75
Rate for Payer: MDX Hawaii PPO	$305.55

STAPLE TA 90-4.8 LOAD TA9048L

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: MDX Hawaii PPO	$207.58

STAPLE TA 90-4.8 LOAD TA9048L

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.14
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$134.82
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: University Health Alliance Commercial	$155.98

STEINMANN 2.0X229MM 262-07-04

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$459.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: Kaiser Permanente Medicaid	$459.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$504.00

STEINMANN 2.0X229MM 262-07-04

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$504.00

STEINMANN 2.4X229MM 262-06-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$399.28
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$499.10
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: University Health Alliance Commercial	$399.28

STEINMANN 2.4X229MM 262-06-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$363.63
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$499.10
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Kaiser Permanente Commercial	$449.19
Rate for Payer: Kaiser Permanente Medicaid	$363.63
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: University Health Alliance Commercial	$399.28

STEINMANN 2.8X229MM 262-05-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$363.63
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$499.10
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Kaiser Permanente Commercial	$449.19
Rate for Payer: Kaiser Permanente Medicaid	$363.63
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: University Health Alliance Commercial	$399.28

STEINMANN 2.8X229MM 262-05-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$399.28
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$499.10
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: University Health Alliance Commercial	$399.28

STEINMANN 3.2X229MM 262-04-04

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$459.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: Kaiser Permanente Medicaid	$459.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$504.00

STEINMANN 3.2X229MM 262-04-04

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$504.00

STEINMANN 3.6X229MM 262-03-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$363.63
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$499.10
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Kaiser Permanente Commercial	$449.19
Rate for Payer: Kaiser Permanente Medicaid	$363.63
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: University Health Alliance Commercial	$399.28

STEINMANN 3.6X229MM 262-03-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$399.28
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$499.10
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: University Health Alliance Commercial	$399.28

STEINMANN 4.0X229MM 262-02-04

Facility

$160.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Hawaii Western Management Group Commercial	$112.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: University Health Alliance Commercial	$89.60

STEINMANN 4.0X229MM 262-02-04

Facility

$160.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Hawaii Western Management Group Commercial	$112.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: University Health Alliance Commercial	$89.60

Know your out-of-pocket cost for care.

All Charges