Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

FEVER & INFLAMMATORY CONDITIONS

Facility

$6,320.56

Service Code	APR-DRG 7224
Min. Negotiated Rate	$6,320.56
Max. Negotiated Rate	$6,320.56
Rate for Payer: AlohaCare Medicaid	$6,320.56
Rate for Payer: Hawaii Medical Service Association ABD	$6,320.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,320.56
Rate for Payer: Kaiser Permanente Medicaid	$6,320.56
Rate for Payer: Ohana Health Plan Medicaid	$6,320.56
Rate for Payer: UnitedHealthcare Medicaid	$6,320.56

FIBER 200 MOSES LASER

Facility

$1,732.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$883.32
Max. Negotiated Rate	$1,680.04
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,645.40
Rate for Payer: Health Management Network Commercial	$1,472.20
Rate for Payer: Kaiser Permanente Commercial	$1,091.16
Rate for Payer: Kaiser Permanente Medicaid	$883.32
Rate for Payer: MDX Hawaii PPO	$1,680.04
Rate for Payer: University Health Alliance Commercial	$1,262.45

FIBER 200 MOSES LASER

Facility

$1,732.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,472.20
Max. Negotiated Rate	$1,680.04
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Health Management Network Commercial	$1,472.20
Rate for Payer: MDX Hawaii PPO	$1,680.04

FIBER 365 MOSES LASER

Facility

$1,382.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,174.70
Max. Negotiated Rate	$1,340.54
Rate for Payer: Cash Price	$829.20
Rate for Payer: Health Management Network Commercial	$1,174.70
Rate for Payer: MDX Hawaii PPO	$1,340.54

FIBER 365 MOSES LASER

Facility

$1,382.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$704.82
Max. Negotiated Rate	$1,340.54
Rate for Payer: Cash Price	$829.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,312.90
Rate for Payer: Health Management Network Commercial	$1,174.70
Rate for Payer: Kaiser Permanente Commercial	$870.66
Rate for Payer: Kaiser Permanente Medicaid	$704.82
Rate for Payer: MDX Hawaii PPO	$1,340.54
Rate for Payer: University Health Alliance Commercial	$1,007.34

FIBER 550 MOSES LASER

Facility

$1,589.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,350.65
Max. Negotiated Rate	$1,541.33
Rate for Payer: Cash Price	$953.40
Rate for Payer: Health Management Network Commercial	$1,350.65
Rate for Payer: MDX Hawaii PPO	$1,541.33

FIBER 550 MOSES LASER

Facility

$1,589.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$810.39
Max. Negotiated Rate	$1,541.33
Rate for Payer: Cash Price	$953.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.55
Rate for Payer: Health Management Network Commercial	$1,350.65
Rate for Payer: Kaiser Permanente Commercial	$1,001.07
Rate for Payer: Kaiser Permanente Medicaid	$810.39
Rate for Payer: MDX Hawaii PPO	$1,541.33
Rate for Payer: University Health Alliance Commercial	$1,158.22

FIBER CO2 LASER 320

Facility

$2,970.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,514.70
Max. Negotiated Rate	$2,880.90
Rate for Payer: Cash Price	$1,782.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,821.50
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: Kaiser Permanente Commercial	$1,871.10
Rate for Payer: Kaiser Permanente Medicaid	$1,514.70
Rate for Payer: MDX Hawaii PPO	$2,880.90
Rate for Payer: University Health Alliance Commercial	$2,164.83

FIBER CO2 LASER 320

Facility

$2,970.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,524.50
Max. Negotiated Rate	$2,880.90
Rate for Payer: Cash Price	$1,782.00
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: MDX Hawaii PPO	$2,880.90

FIBER PROBE SIDEFIRE W/FILTER

Facility

$911.00

Hospital Revenue Code	272
Min. Negotiated Rate	$464.61
Max. Negotiated Rate	$883.67
Rate for Payer: Cash Price	$546.60
Rate for Payer: Hawaii Western Management Group Commercial	$865.45
Rate for Payer: Health Management Network Commercial	$774.35
Rate for Payer: Kaiser Permanente Commercial	$573.93
Rate for Payer: Kaiser Permanente Medicaid	$464.61
Rate for Payer: MDX Hawaii PPO	$883.67
Rate for Payer: University Health Alliance Commercial	$664.03

FIBER PROBE SIDEFIRE W/FILTER

Facility

$911.00

Hospital Revenue Code	272
Min. Negotiated Rate	$774.35
Max. Negotiated Rate	$883.67
Rate for Payer: Cash Price	$546.60
Rate for Payer: Health Management Network Commercial	$774.35
Rate for Payer: MDX Hawaii PPO	$883.67

FIBER PROBE W/FILTER 6.9F

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: MDX Hawaii PPO	$208.55

FIBER PROBE W/FILTER 6.9F

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$135.45
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: University Health Alliance Commercial	$156.71

FIBERSTITCH 1.5 24" AR-4580-24

Facility

$1,733.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$883.83
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,213.10
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,091.79
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: University Health Alliance Commercial	$970.48

FIBERSTITCH 1.5 24" AR-4580-24

Facility

$1,733.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$970.48
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,213.10
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: University Health Alliance Commercial	$970.48

FIBERSTITCH 1.5 CURVED AR-4580

Facility

$1,733.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$883.83
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,213.10
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,091.79
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: University Health Alliance Commercial	$970.48

FIBERSTITCH 1.5 CURVED AR-4580

Facility

$1,733.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$970.48
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,213.10
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: University Health Alliance Commercial	$970.48

FIBERSTITCH IMPLANT AR-4570

Facility

$1,559.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$873.04
Max. Negotiated Rate	$1,512.23
Rate for Payer: Cash Price	$935.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,091.30
Rate for Payer: Health Management Network Commercial	$1,325.15
Rate for Payer: MDX Hawaii PPO	$1,512.23
Rate for Payer: University Health Alliance Commercial	$873.04

FIBERSTITCH IMPLANT AR-4570

Facility

$1,559.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$795.09
Max. Negotiated Rate	$1,512.23
Rate for Payer: Cash Price	$935.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,091.30
Rate for Payer: Health Management Network Commercial	$1,325.15
Rate for Payer: Kaiser Permanente Commercial	$982.17
Rate for Payer: Kaiser Permanente Medicaid	$795.09
Rate for Payer: MDX Hawaii PPO	$1,512.23
Rate for Payer: University Health Alliance Commercial	$873.04

FIBERSTITCH STRAIGHT AR-4580S

Facility

$1,559.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$873.04
Max. Negotiated Rate	$1,512.23
Rate for Payer: Cash Price	$935.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,091.30
Rate for Payer: Health Management Network Commercial	$1,325.15
Rate for Payer: MDX Hawaii PPO	$1,512.23
Rate for Payer: University Health Alliance Commercial	$873.04

FIBERSTITCH STRAIGHT AR-4580S

Facility

$1,559.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$795.09
Max. Negotiated Rate	$1,512.23
Rate for Payer: Cash Price	$935.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,091.30
Rate for Payer: Health Management Network Commercial	$1,325.15
Rate for Payer: Kaiser Permanente Commercial	$982.17
Rate for Payer: Kaiser Permanente Medicaid	$795.09
Rate for Payer: MDX Hawaii PPO	$1,512.23
Rate for Payer: University Health Alliance Commercial	$873.04

FIBERTAG TIGHTROPE II ABS

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,032.75
Max. Negotiated Rate	$1,964.25
Rate for Payer: Cash Price	$1,215.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,417.50
Rate for Payer: Health Management Network Commercial	$1,721.25
Rate for Payer: Kaiser Permanente Commercial	$1,275.75
Rate for Payer: Kaiser Permanente Medicaid	$1,032.75
Rate for Payer: MDX Hawaii PPO	$1,964.25
Rate for Payer: University Health Alliance Commercial	$1,134.00

FIBERTAG TIGHTROPE II ABS

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.00
Max. Negotiated Rate	$1,964.25
Rate for Payer: Cash Price	$1,215.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,417.50
Rate for Payer: Health Management Network Commercial	$1,721.25
Rate for Payer: MDX Hawaii PPO	$1,964.25
Rate for Payer: University Health Alliance Commercial	$1,134.00

FIBERTAG TR II AR-1588RTT2-IB

Facility

$2,285.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.35
Max. Negotiated Rate	$2,216.45
Rate for Payer: Cash Price	$1,371.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,599.50
Rate for Payer: Health Management Network Commercial	$1,942.25
Rate for Payer: Kaiser Permanente Commercial	$1,439.55
Rate for Payer: Kaiser Permanente Medicaid	$1,165.35
Rate for Payer: MDX Hawaii PPO	$2,216.45
Rate for Payer: University Health Alliance Commercial	$1,279.60

FIBERTAG TR II AR-1588RTT2-IB

Facility

$2,285.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,279.60
Max. Negotiated Rate	$2,216.45
Rate for Payer: Cash Price	$1,371.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,599.50
Rate for Payer: Health Management Network Commercial	$1,942.25
Rate for Payer: MDX Hawaii PPO	$2,216.45
Rate for Payer: University Health Alliance Commercial	$1,279.60

Know your out-of-pocket cost for care.

All Charges