Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

3/8" IM DRILL

Facility

$1,620.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,377.00
Max. Negotiated Rate	$1,571.40
Rate for Payer: Cash Price	$972.00
Rate for Payer: Health Management Network Commercial	$1,377.00
Rate for Payer: MDX Hawaii PPO	$1,571.40

3FR URETER BIOPSY FOREPS

Facility

$1,111.00

Hospital Revenue Code	272
Min. Negotiated Rate	$944.35
Max. Negotiated Rate	$1,077.67
Rate for Payer: Cash Price	$666.60
Rate for Payer: Health Management Network Commercial	$944.35
Rate for Payer: MDX Hawaii PPO	$1,077.67

3FR URETER BIOPSY FOREPS

Facility

$1,111.00

Hospital Revenue Code	272
Min. Negotiated Rate	$566.61
Max. Negotiated Rate	$1,077.67
Rate for Payer: Cash Price	$666.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,055.45
Rate for Payer: Health Management Network Commercial	$944.35
Rate for Payer: Kaiser Permanente Commercial	$699.93
Rate for Payer: Kaiser Permanente Medicaid	$566.61
Rate for Payer: MDX Hawaii PPO	$1,077.67
Rate for Payer: University Health Alliance Commercial	$809.81

3LOOP SNARE RETRIEVAL KIT

Facility

$1,770.00

Service Code	HCPCS C1773
Hospital Revenue Code	272
Min. Negotiated Rate	$902.70
Max. Negotiated Rate	$1,716.90
Rate for Payer: Cash Price	$1,062.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,681.50
Rate for Payer: Health Management Network Commercial	$1,504.50
Rate for Payer: Kaiser Permanente Commercial	$1,115.10
Rate for Payer: Kaiser Permanente Medicaid	$902.70
Rate for Payer: MDX Hawaii PPO	$1,716.90
Rate for Payer: University Health Alliance Commercial	$1,290.15

3LOOP SNARE RETRIEVAL KIT

Facility

$1,770.00

Service Code	HCPCS C1773
Hospital Revenue Code	272
Min. Negotiated Rate	$1,504.50
Max. Negotiated Rate	$1,716.90
Rate for Payer: Cash Price	$1,062.00
Rate for Payer: Health Management Network Commercial	$1,504.50
Rate for Payer: MDX Hawaii PPO	$1,716.90

4.5M LCP CONDYLAR PLATE

Facility

$4,310.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,198.10
Max. Negotiated Rate	$4,180.70
Rate for Payer: Cash Price	$2,586.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,017.00
Rate for Payer: Health Management Network Commercial	$3,663.50
Rate for Payer: Kaiser Permanente Commercial	$2,715.30
Rate for Payer: Kaiser Permanente Medicaid	$2,198.10
Rate for Payer: MDX Hawaii PPO	$4,180.70
Rate for Payer: University Health Alliance Commercial	$2,413.60

4.5M LCP CONDYLAR PLATE

Facility

$4,310.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,413.60
Max. Negotiated Rate	$4,180.70
Rate for Payer: Cash Price	$2,586.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,017.00
Rate for Payer: Health Management Network Commercial	$3,663.50
Rate for Payer: MDX Hawaii PPO	$4,180.70
Rate for Payer: University Health Alliance Commercial	$2,413.60

4.5MM LCP CONDYLAR PLATE

Facility

$3,542.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,806.42
Max. Negotiated Rate	$3,435.74
Rate for Payer: Cash Price	$2,125.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,479.40
Rate for Payer: Health Management Network Commercial	$3,010.70
Rate for Payer: Kaiser Permanente Commercial	$2,231.46
Rate for Payer: Kaiser Permanente Medicaid	$1,806.42
Rate for Payer: MDX Hawaii PPO	$3,435.74
Rate for Payer: University Health Alliance Commercial	$1,983.52

4.5MM LCP CONDYLAR PLATE

Facility

$3,542.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,983.52
Max. Negotiated Rate	$3,435.74
Rate for Payer: Cash Price	$2,125.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,479.40
Rate for Payer: Health Management Network Commercial	$3,010.70
Rate for Payer: MDX Hawaii PPO	$3,435.74
Rate for Payer: University Health Alliance Commercial	$1,983.52

4806-110-25 DRILLBIT QC 2.5MM

Facility

$750.00

Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: MDX Hawaii PPO	$727.50

4806-110-25 DRILLBIT QC 2.5MM

Facility

$750.00

Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$712.50
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: University Health Alliance Commercial	$546.67

4806-110-35 DRILLBIT QC 3.5MM

Facility

$638.00

Hospital Revenue Code	272
Min. Negotiated Rate	$542.30
Max. Negotiated Rate	$618.86
Rate for Payer: Cash Price	$382.80
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: MDX Hawaii PPO	$618.86

4806-110-35 DRILLBIT QC 3.5MM

Facility

$638.00

Hospital Revenue Code	272
Min. Negotiated Rate	$325.38
Max. Negotiated Rate	$618.86
Rate for Payer: Cash Price	$382.80
Rate for Payer: Hawaii Western Management Group Commercial	$606.10
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: Kaiser Permanente Commercial	$401.94
Rate for Payer: Kaiser Permanente Medicaid	$325.38
Rate for Payer: MDX Hawaii PPO	$618.86
Rate for Payer: University Health Alliance Commercial	$465.04

5.5 ABRADER BURR 180MM

Facility

$417.00

Hospital Revenue Code	272
Min. Negotiated Rate	$212.67
Max. Negotiated Rate	$404.49
Rate for Payer: Cash Price	$250.20
Rate for Payer: Hawaii Western Management Group Commercial	$396.15
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Kaiser Permanente Commercial	$262.71
Rate for Payer: Kaiser Permanente Medicaid	$212.67
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: University Health Alliance Commercial	$303.95

5.5 ABRADER BURR 180MM

Facility

$417.00

Hospital Revenue Code	272
Min. Negotiated Rate	$354.45
Max. Negotiated Rate	$404.49
Rate for Payer: Cash Price	$250.20
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: MDX Hawaii PPO	$404.49

7.0 MM MALYUGIN RING

Facility

$531.00

Hospital Revenue Code	272
Min. Negotiated Rate	$451.35
Max. Negotiated Rate	$515.07
Rate for Payer: Cash Price	$318.60
Rate for Payer: Health Management Network Commercial	$451.35
Rate for Payer: MDX Hawaii PPO	$515.07

7.0 MM MALYUGIN RING

Facility

$531.00

Hospital Revenue Code	272
Min. Negotiated Rate	$270.81
Max. Negotiated Rate	$515.07
Rate for Payer: Cash Price	$318.60
Rate for Payer: Hawaii Western Management Group Commercial	$504.45
Rate for Payer: Health Management Network Commercial	$451.35
Rate for Payer: Kaiser Permanente Commercial	$334.53
Rate for Payer: Kaiser Permanente Medicaid	$270.81
Rate for Payer: MDX Hawaii PPO	$515.07
Rate for Payer: University Health Alliance Commercial	$387.05

AAA ENDOPROSTHESIS #PLC161000

Facility

$9,714.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$4,954.14
Max. Negotiated Rate	$9,422.58
Rate for Payer: Cash Price	$5,828.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,799.80
Rate for Payer: Health Management Network Commercial	$8,256.90
Rate for Payer: Kaiser Permanente Commercial	$6,119.82
Rate for Payer: Kaiser Permanente Medicaid	$4,954.14
Rate for Payer: MDX Hawaii PPO	$9,422.58
Rate for Payer: University Health Alliance Commercial	$5,439.84

AAA ENDOPROSTHESIS #PLC161000

Facility

$9,714.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,439.84
Max. Negotiated Rate	$9,422.58
Rate for Payer: Cash Price	$5,828.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,799.80
Rate for Payer: Health Management Network Commercial	$8,256.90
Rate for Payer: MDX Hawaii PPO	$9,422.58
Rate for Payer: University Health Alliance Commercial	$5,439.84

AAA ENDOPROSTHESIS #PLC271000

Facility

$11,540.00

Hospital Revenue Code	278
Min. Negotiated Rate	$6,462.40
Max. Negotiated Rate	$11,193.80
Rate for Payer: Cash Price	$6,924.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,078.00
Rate for Payer: Health Management Network Commercial	$9,809.00
Rate for Payer: MDX Hawaii PPO	$11,193.80
Rate for Payer: University Health Alliance Commercial	$6,462.40

AAA ENDOPROSTHESIS #PLC271000

Facility

$11,540.00

Hospital Revenue Code	278
Min. Negotiated Rate	$5,885.40
Max. Negotiated Rate	$11,193.80
Rate for Payer: Cash Price	$6,924.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,078.00
Rate for Payer: Health Management Network Commercial	$9,809.00
Rate for Payer: Kaiser Permanente Commercial	$7,270.20
Rate for Payer: Kaiser Permanente Medicaid	$5,885.40
Rate for Payer: MDX Hawaii PPO	$11,193.80
Rate for Payer: University Health Alliance Commercial	$6,462.40

AAA ILIAC 10MMX10CM CEB231010A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$10,965.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Kaiser Permanente Commercial	$13,545.00
Rate for Payer: Kaiser Permanente Medicaid	$10,965.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 10MMX10CM CEB231010A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$12,040.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 10MMX7CM HGB161007A

Facility

$6,924.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,531.24
Max. Negotiated Rate	$6,716.28
Rate for Payer: Cash Price	$4,154.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,846.80
Rate for Payer: Health Management Network Commercial	$5,885.40
Rate for Payer: Kaiser Permanente Commercial	$4,362.12
Rate for Payer: Kaiser Permanente Medicaid	$3,531.24
Rate for Payer: MDX Hawaii PPO	$6,716.28
Rate for Payer: University Health Alliance Commercial	$3,877.44

AAA ILIAC 10MMX7CM HGB161007A

Facility

$6,924.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,877.44
Max. Negotiated Rate	$6,716.28
Rate for Payer: Cash Price	$4,154.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,846.80
Rate for Payer: Health Management Network Commercial	$5,885.40
Rate for Payer: MDX Hawaii PPO	$6,716.28
Rate for Payer: University Health Alliance Commercial	$3,877.44

Know your out-of-pocket cost for care.

All Charges