Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

SWVLLCK 3.5X8.5MM AR-8978P

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$833.28
Max. Negotiated Rate	$1,443.36
Rate for Payer: Cash Price	$892.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: University Health Alliance Commercial	$833.28

SWVLLCK 3.5X8.5MM AR-8978P

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$758.88
Max. Negotiated Rate	$1,443.36
Rate for Payer: Cash Price	$892.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Kaiser Permanente Commercial	$937.44
Rate for Payer: Kaiser Permanente Medicaid	$758.88
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: University Health Alliance Commercial	$833.28

SYNCHFIX GRAVITY SUT 86SYN005

Facility

$2,455.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.05
Max. Negotiated Rate	$2,381.35
Rate for Payer: Cash Price	$1,473.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,718.50
Rate for Payer: Health Management Network Commercial	$2,086.75
Rate for Payer: Kaiser Permanente Commercial	$1,546.65
Rate for Payer: Kaiser Permanente Medicaid	$1,252.05
Rate for Payer: MDX Hawaii PPO	$2,381.35
Rate for Payer: University Health Alliance Commercial	$1,374.80

SYNCHFIX GRAVITY SUT 86SYN005

Facility

$2,455.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,374.80
Max. Negotiated Rate	$2,381.35
Rate for Payer: Cash Price	$1,473.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,718.50
Rate for Payer: Health Management Network Commercial	$2,086.75
Rate for Payer: MDX Hawaii PPO	$2,381.35
Rate for Payer: University Health Alliance Commercial	$1,374.80

SYNCHROSEAL 480440

Facility

$2,070.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,055.70
Max. Negotiated Rate	$2,007.90
Rate for Payer: Cash Price	$1,242.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,966.50
Rate for Payer: Health Management Network Commercial	$1,759.50
Rate for Payer: Kaiser Permanente Commercial	$1,304.10
Rate for Payer: Kaiser Permanente Medicaid	$1,055.70
Rate for Payer: MDX Hawaii PPO	$2,007.90
Rate for Payer: University Health Alliance Commercial	$1,508.82

SYNCHROSEAL 480440

Facility

$2,070.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,759.50
Max. Negotiated Rate	$2,007.90
Rate for Payer: Cash Price	$1,242.00
Rate for Payer: Health Management Network Commercial	$1,759.50
Rate for Payer: MDX Hawaii PPO	$2,007.90

SYNCOPE AND COLLAPSE

Facility

$15,035.10

Service Code	MSDRG 312
Min. Negotiated Rate	$9,913.80
Max. Negotiated Rate	$15,035.10
Rate for Payer: AlohaCare Medicare	$9,913.80
Rate for Payer: Devoted Health Medicare	$10,905.18
Rate for Payer: Hawaii Medical Service Association Commercial	$14,341.21
Rate for Payer: Hawaii Medical Service Association Medicare	$9,913.80
Rate for Payer: Humana Medicare	$9,913.80
Rate for Payer: Kaiser Permanente Commercial	$15,035.10
Rate for Payer: Kaiser Permanente Medicare	$9,913.80
Rate for Payer: Ohana Health Plan Medicare	$9,913.80
Rate for Payer: UnitedHealthcare Medicare	$9,913.80

SYNCOPE & COLLAPSE

Facility

$2,926.77

Service Code	APR-DRG 2041
Min. Negotiated Rate	$2,926.77
Max. Negotiated Rate	$2,926.77
Rate for Payer: AlohaCare Medicaid	$2,926.77
Rate for Payer: Hawaii Medical Service Association ABD	$2,926.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,926.77
Rate for Payer: Kaiser Permanente Medicaid	$2,926.77
Rate for Payer: Ohana Health Plan Medicaid	$2,926.77
Rate for Payer: UnitedHealthcare Medicaid	$2,926.77

SYNCOPE & COLLAPSE

Facility

$6,745.20

Service Code	APR-DRG 2044
Min. Negotiated Rate	$6,745.20
Max. Negotiated Rate	$6,745.20
Rate for Payer: AlohaCare Medicaid	$6,745.20
Rate for Payer: Hawaii Medical Service Association ABD	$6,745.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,745.20
Rate for Payer: Kaiser Permanente Medicaid	$6,745.20
Rate for Payer: Ohana Health Plan Medicaid	$6,745.20
Rate for Payer: UnitedHealthcare Medicaid	$6,745.20

SYNCOPE & COLLAPSE

Facility

$4,285.46

Service Code	APR-DRG 2043
Min. Negotiated Rate	$4,285.46
Max. Negotiated Rate	$4,285.46
Rate for Payer: AlohaCare Medicaid	$4,285.46
Rate for Payer: Hawaii Medical Service Association ABD	$4,285.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,285.46
Rate for Payer: Kaiser Permanente Medicaid	$4,285.46
Rate for Payer: Ohana Health Plan Medicaid	$4,285.46
Rate for Payer: UnitedHealthcare Medicaid	$4,285.46

SYNCOPE & COLLAPSE

Facility

$3,372.92

Service Code	APR-DRG 2042
Min. Negotiated Rate	$3,372.92
Max. Negotiated Rate	$3,372.92
Rate for Payer: AlohaCare Medicaid	$3,372.92
Rate for Payer: Hawaii Medical Service Association ABD	$3,372.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,372.92
Rate for Payer: Kaiser Permanente Medicaid	$3,372.92
Rate for Payer: Ohana Health Plan Medicaid	$3,372.92
Rate for Payer: UnitedHealthcare Medicaid	$3,372.92

SYNTEL ART EMBOLECTOMY CATH 80

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$265.71
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$328.23
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: University Health Alliance Commercial	$379.76

SYNTEL ART EMBOLECTOMY CATH 80

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: MDX Hawaii PPO	$505.37

SYNTEL ARTERIAL EMBOLECTOMY

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$265.71
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$328.23
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: University Health Alliance Commercial	$379.76

SYNTEL ARTERIAL EMBOLECTOMY

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: MDX Hawaii PPO	$505.37

SYRINGE CONTINUOUS INJECTION

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$79.38
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$91.84

SYRINGE CONTINUOUS INJECTION

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$122.22

SYRINGE INFLATION DEVICE

Facility

$167.00

Hospital Revenue Code	272
Min. Negotiated Rate	$85.17
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$100.20
Rate for Payer: Hawaii Western Management Group Commercial	$158.65
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Kaiser Permanente Commercial	$105.21
Rate for Payer: Kaiser Permanente Medicaid	$85.17
Rate for Payer: MDX Hawaii PPO	$161.99
Rate for Payer: University Health Alliance Commercial	$121.73

SYRINGE INFLATION DEVICE

Facility

$167.00

Hospital Revenue Code	272
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$100.20
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: MDX Hawaii PPO	$161.99

SYRINGE INFLATOR ALLIANCE

Facility

$152.00

Hospital Revenue Code	272
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: MDX Hawaii PPO	$147.44

SYRINGE INFLATOR ALLIANCE

Facility

$152.00

Hospital Revenue Code	272
Min. Negotiated Rate	$77.52
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Hawaii Western Management Group Commercial	$144.40
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$95.76
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: University Health Alliance Commercial	$110.79

SYRINGE THERACAL PT H-34110P

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: MDX Hawaii PPO	$291.00

SYRINGE THERACAL PT H-34110P

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$189.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: University Health Alliance Commercial	$218.67

SYSTEM IMPLANT AR-1360FT-BC

Facility

$6,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,391.50
Max. Negotiated Rate	$6,450.50
Rate for Payer: Cash Price	$3,990.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,655.00
Rate for Payer: Health Management Network Commercial	$5,652.50
Rate for Payer: Kaiser Permanente Commercial	$4,189.50
Rate for Payer: Kaiser Permanente Medicaid	$3,391.50
Rate for Payer: MDX Hawaii PPO	$6,450.50
Rate for Payer: University Health Alliance Commercial	$3,724.00

SYSTEM IMPLANT AR-1360FT-BC

Facility

$6,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,724.00
Max. Negotiated Rate	$6,450.50
Rate for Payer: Cash Price	$3,990.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,655.00
Rate for Payer: Health Management Network Commercial	$5,652.50
Rate for Payer: MDX Hawaii PPO	$6,450.50
Rate for Payer: University Health Alliance Commercial	$3,724.00

Know your out-of-pocket cost for care.

All Charges