Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

STENT GRAFT AAA26X20 TGM262610

Facility

$44,598.00

Hospital Revenue Code	278
Min. Negotiated Rate	$24,974.88
Max. Negotiated Rate	$43,260.06
Rate for Payer: Cash Price	$26,758.80
Rate for Payer: Hawaii Western Management Group Commercial	$31,218.60
Rate for Payer: Health Management Network Commercial	$37,908.30
Rate for Payer: MDX Hawaii PPO	$43,260.06
Rate for Payer: University Health Alliance Commercial	$24,974.88

STENT GRAFT AAA26X20 TGM262610

Facility

$44,598.00

Hospital Revenue Code	278
Min. Negotiated Rate	$22,744.98
Max. Negotiated Rate	$43,260.06
Rate for Payer: Cash Price	$26,758.80
Rate for Payer: Hawaii Western Management Group Commercial	$31,218.60
Rate for Payer: Health Management Network Commercial	$37,908.30
Rate for Payer: Kaiser Permanente Commercial	$28,096.74
Rate for Payer: Kaiser Permanente Medicaid	$22,744.98
Rate for Payer: MDX Hawaii PPO	$43,260.06
Rate for Payer: University Health Alliance Commercial	$24,974.88

STENT PANCREATIC 5FX3CM

Facility

$316.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$161.16
Max. Negotiated Rate	$306.52
Rate for Payer: Cash Price	$189.60
Rate for Payer: Hawaii Western Management Group Commercial	$221.20
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Kaiser Permanente Commercial	$199.08
Rate for Payer: Kaiser Permanente Medicaid	$161.16
Rate for Payer: MDX Hawaii PPO	$306.52
Rate for Payer: University Health Alliance Commercial	$176.96

STENT PANCREATIC 5FX3CM

Facility

$316.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$176.96
Max. Negotiated Rate	$306.52
Rate for Payer: Cash Price	$189.60
Rate for Payer: Hawaii Western Management Group Commercial	$221.20
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: MDX Hawaii PPO	$306.52
Rate for Payer: University Health Alliance Commercial	$176.96

STENT POLARIS LOOP M0061552300

Facility

$558.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$312.48
Max. Negotiated Rate	$541.26
Rate for Payer: Cash Price	$334.80
Rate for Payer: Hawaii Western Management Group Commercial	$390.60
Rate for Payer: Health Management Network Commercial	$474.30
Rate for Payer: MDX Hawaii PPO	$541.26
Rate for Payer: University Health Alliance Commercial	$312.48

STENT POLARIS LOOP M0061552300

Facility

$558.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$284.58
Max. Negotiated Rate	$541.26
Rate for Payer: Cash Price	$334.80
Rate for Payer: Hawaii Western Management Group Commercial	$390.60
Rate for Payer: Health Management Network Commercial	$474.30
Rate for Payer: Kaiser Permanente Commercial	$351.54
Rate for Payer: Kaiser Permanente Medicaid	$284.58
Rate for Payer: MDX Hawaii PPO	$541.26
Rate for Payer: University Health Alliance Commercial	$312.48

STENT POLARIS LOOP URETERAL

Facility

$552.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$309.12
Max. Negotiated Rate	$535.44
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$341.40
Rate for Payer: Hawaii Western Management Group Commercial	$398.30
Rate for Payer: Hawaii Western Management Group Commercial	$386.40
Rate for Payer: Health Management Network Commercial	$469.20
Rate for Payer: Health Management Network Commercial	$483.65
Rate for Payer: MDX Hawaii PPO	$535.44
Rate for Payer: MDX Hawaii PPO	$551.93
Rate for Payer: University Health Alliance Commercial	$318.64
Rate for Payer: University Health Alliance Commercial	$309.12

STENT POLARIS LOOP URETERAL

Facility

$569.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$290.19
Max. Negotiated Rate	$551.93
Rate for Payer: Cash Price	$341.40
Rate for Payer: Cash Price	$331.20
Rate for Payer: Hawaii Western Management Group Commercial	$386.40
Rate for Payer: Hawaii Western Management Group Commercial	$398.30
Rate for Payer: Health Management Network Commercial	$483.65
Rate for Payer: Health Management Network Commercial	$469.20
Rate for Payer: Kaiser Permanente Commercial	$347.76
Rate for Payer: Kaiser Permanente Commercial	$358.47
Rate for Payer: Kaiser Permanente Medicaid	$281.52
Rate for Payer: Kaiser Permanente Medicaid	$290.19
Rate for Payer: MDX Hawaii PPO	$535.44
Rate for Payer: MDX Hawaii PPO	$551.93
Rate for Payer: University Health Alliance Commercial	$318.64
Rate for Payer: University Health Alliance Commercial	$309.12

STENT PUSHER 4/5FR

Facility

$201.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$102.51
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Hawaii Western Management Group Commercial	$140.70
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$126.63
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: University Health Alliance Commercial	$112.56

STENT PUSHER 4/5FR

Facility

$201.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$112.56
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Hawaii Western Management Group Commercial	$140.70
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: University Health Alliance Commercial	$112.56

STENT SET FILIFORM DBL PIG

Facility

$532.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$271.32
Max. Negotiated Rate	$516.04
Rate for Payer: Cash Price	$319.20
Rate for Payer: Cash Price	$283.80
Rate for Payer: Hawaii Western Management Group Commercial	$331.10
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: Health Management Network Commercial	$402.05
Rate for Payer: Kaiser Permanente Commercial	$297.99
Rate for Payer: Kaiser Permanente Commercial	$335.16
Rate for Payer: Kaiser Permanente Medicaid	$241.23
Rate for Payer: Kaiser Permanente Medicaid	$271.32
Rate for Payer: MDX Hawaii PPO	$458.81
Rate for Payer: MDX Hawaii PPO	$516.04
Rate for Payer: University Health Alliance Commercial	$297.92
Rate for Payer: University Health Alliance Commercial	$264.88

STENT SET FILIFORM DBL PIG

Facility

$473.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$264.88
Max. Negotiated Rate	$458.81
Rate for Payer: Cash Price	$283.80
Rate for Payer: Cash Price	$319.20
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Hawaii Western Management Group Commercial	$331.10
Rate for Payer: Health Management Network Commercial	$402.05
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: MDX Hawaii PPO	$458.81
Rate for Payer: MDX Hawaii PPO	$516.04
Rate for Payer: University Health Alliance Commercial	$297.92
Rate for Payer: University Health Alliance Commercial	$264.88

STENT SYSTEM 7X40 SR-0740-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

STENT SYSTEM 7X40 SR-0740-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,754.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$3,402.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

STENT URETERAL 6FRX22-30CM

Facility

$415.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$232.40
Max. Negotiated Rate	$402.55
Rate for Payer: Cash Price	$249.00
Rate for Payer: Hawaii Western Management Group Commercial	$290.50
Rate for Payer: Health Management Network Commercial	$352.75
Rate for Payer: MDX Hawaii PPO	$402.55
Rate for Payer: University Health Alliance Commercial	$232.40

STENT URETERAL 6FRX22-30CM

Facility

$415.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$211.65
Max. Negotiated Rate	$402.55
Rate for Payer: Cash Price	$249.00
Rate for Payer: Hawaii Western Management Group Commercial	$290.50
Rate for Payer: Health Management Network Commercial	$352.75
Rate for Payer: Kaiser Permanente Commercial	$261.45
Rate for Payer: Kaiser Permanente Medicaid	$211.65
Rate for Payer: MDX Hawaii PPO	$402.55
Rate for Payer: University Health Alliance Commercial	$232.40

STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL, EXTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$2,837.00

Service Code	CPT 61782
Hospital Revenue Code	360
Min. Negotiated Rate	$125.42
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$125.42

STERLING MONORAIL 4.5X20X135

Facility

$875.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: MDX Hawaii PPO	$848.75

STERLING MONORAIL 4.5X20X135

Facility

$875.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$551.25
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$637.79

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$91,774.01

Service Code	MSDRG 327
Min. Negotiated Rate	$27,800.95
Max. Negotiated Rate	$91,774.01
Rate for Payer: AlohaCare Medicare	$27,800.95
Rate for Payer: Devoted Health Medicare	$30,581.04
Rate for Payer: Hawaii Medical Service Association Commercial	$91,774.01
Rate for Payer: Hawaii Medical Service Association Medicare	$27,800.95
Rate for Payer: Humana Medicare	$27,800.95
Rate for Payer: Kaiser Permanente Commercial	$42,162.45
Rate for Payer: Kaiser Permanente Medicare	$27,800.95
Rate for Payer: Ohana Health Plan Medicare	$27,800.95
Rate for Payer: UnitedHealthcare Medicare	$27,800.95

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$129,653.24

Service Code	MSDRG 326
Min. Negotiated Rate	$56,727.97
Max. Negotiated Rate	$129,653.24
Rate for Payer: AlohaCare Medicare	$56,727.97
Rate for Payer: Devoted Health Medicare	$62,400.77
Rate for Payer: Hawaii Medical Service Association Commercial	$129,653.24
Rate for Payer: Hawaii Medical Service Association Medicare	$56,727.97
Rate for Payer: Humana Medicare	$56,727.97
Rate for Payer: Kaiser Permanente Commercial	$86,032.65
Rate for Payer: Kaiser Permanente Medicare	$56,727.97
Rate for Payer: Ohana Health Plan Medicare	$56,727.97
Rate for Payer: UnitedHealthcare Medicare	$56,727.97

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$39,286.65

Service Code	MSDRG 328
Min. Negotiated Rate	$18,224.97
Max. Negotiated Rate	$39,286.65
Rate for Payer: AlohaCare Medicare	$18,224.97
Rate for Payer: Devoted Health Medicare	$20,047.47
Rate for Payer: Hawaii Medical Service Association Commercial	$39,286.65
Rate for Payer: Hawaii Medical Service Association Medicare	$18,224.97
Rate for Payer: Humana Medicare	$18,224.97
Rate for Payer: Kaiser Permanente Commercial	$27,639.67
Rate for Payer: Kaiser Permanente Medicare	$18,224.97
Rate for Payer: Ohana Health Plan Medicare	$18,224.97
Rate for Payer: UnitedHealthcare Medicare	$18,224.97

STRATAFIX 2-0 CT-2 9 SXPP1B432

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: MDX Hawaii PPO	$120.28

STRATAFIX 2-0 CT-2 9 SXPP1B432

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$78.12
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: University Health Alliance Commercial	$90.38

STRATAFIX SPIRAL SXPP1B450

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$78.12
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: University Health Alliance Commercial	$90.38

Know your out-of-pocket cost for care.

All Charges