Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

INSTR DUODENOSCOPE

Facility

$7,650.00

Service Code	HCPCS C1748
Hospital Revenue Code	272
Min. Negotiated Rate	$6,502.50
Max. Negotiated Rate	$7,420.50
Rate for Payer: Cash Price	$4,590.00
Rate for Payer: Health Management Network Commercial	$6,502.50
Rate for Payer: MDX Hawaii PPO	$7,420.50

INSTR ENDO BABCOCK

Facility

$293.00

Hospital Revenue Code	272
Min. Negotiated Rate	$149.43
Max. Negotiated Rate	$284.21
Rate for Payer: Cash Price	$175.80
Rate for Payer: Hawaii Western Management Group Commercial	$278.35
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Kaiser Permanente Commercial	$184.59
Rate for Payer: Kaiser Permanente Medicaid	$149.43
Rate for Payer: MDX Hawaii PPO	$284.21
Rate for Payer: University Health Alliance Commercial	$213.57

INSTR ENDO BABCOCK

Facility

$293.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.05
Max. Negotiated Rate	$284.21
Rate for Payer: Cash Price	$175.80
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: MDX Hawaii PPO	$284.21

INSTR FORCEP ALLIGA RESCUE

Facility

$309.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$157.59
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$185.40
Rate for Payer: Hawaii Western Management Group Commercial	$293.55
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Kaiser Permanente Commercial	$194.67
Rate for Payer: Kaiser Permanente Medicaid	$157.59
Rate for Payer: MDX Hawaii PPO	$299.73
Rate for Payer: University Health Alliance Commercial	$225.23

INSTR FORCEP ALLIGA RESCUE

Facility

$309.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$185.40
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: MDX Hawaii PPO	$299.73

INSTR FORCEP BIOP ENDOJAW

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

INSTR FORCEP BIOP ENDOJAW

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$91.35
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: University Health Alliance Commercial	$105.69

INSTR FORCEP BIOPSY PULM

Facility

$201.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: MDX Hawaii PPO	$194.97

INSTR FORCEP BIOPSY PULM

Facility

$201.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
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	$190.95
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	$146.51

INSTR FORCEP GRASPING

Facility

$288.00

Hospital Revenue Code	272
Min. Negotiated Rate	$146.88
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Hawaii Western Management Group Commercial	$273.60
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$181.44
Rate for Payer: Kaiser Permanente Medicaid	$146.88
Rate for Payer: MDX Hawaii PPO	$279.36
Rate for Payer: University Health Alliance Commercial	$209.92

INSTR FORCEP GRASPING

Facility

$288.00

Hospital Revenue Code	272
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: MDX Hawaii PPO	$279.36

INSTR FORCEP RAPTOR GRASPING

Facility

$396.00

Hospital Revenue Code	272
Min. Negotiated Rate	$201.96
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$237.60
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$249.48
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: University Health Alliance Commercial	$288.64

INSTR FORCEP RAPTOR GRASPING

Facility

$396.00

Hospital Revenue Code	272
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$237.60
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: MDX Hawaii PPO	$384.12

INSTR FORCEP RESCUE GRASP

Facility

$309.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$185.40
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: MDX Hawaii PPO	$299.73

INSTR FORCEP RESCUE GRASP

Facility

$309.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$157.59
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$185.40
Rate for Payer: Hawaii Western Management Group Commercial	$293.55
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Kaiser Permanente Commercial	$194.67
Rate for Payer: Kaiser Permanente Medicaid	$157.59
Rate for Payer: MDX Hawaii PPO	$299.73
Rate for Payer: University Health Alliance Commercial	$225.23

INSTR FORCEPS BIOPSY

Facility

$1,364.00

Hospital Revenue Code	272
Min. Negotiated Rate	$695.64
Max. Negotiated Rate	$1,323.08
Rate for Payer: Cash Price	$818.40
Rate for Payer: Cash Price	$940.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,295.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,489.60
Rate for Payer: Health Management Network Commercial	$1,159.40
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: Kaiser Permanente Commercial	$987.84
Rate for Payer: Kaiser Permanente Commercial	$859.32
Rate for Payer: Kaiser Permanente Medicaid	$695.64
Rate for Payer: Kaiser Permanente Medicaid	$799.68
Rate for Payer: MDX Hawaii PPO	$1,323.08
Rate for Payer: MDX Hawaii PPO	$1,520.96
Rate for Payer: University Health Alliance Commercial	$994.22
Rate for Payer: University Health Alliance Commercial	$1,142.92

INSTR FORCEPS BIOPSY

Facility

$1,364.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,159.40
Max. Negotiated Rate	$1,323.08
Rate for Payer: Cash Price	$818.40
Rate for Payer: Cash Price	$940.80
Rate for Payer: Health Management Network Commercial	$1,159.40
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: MDX Hawaii PPO	$1,520.96
Rate for Payer: MDX Hawaii PPO	$1,323.08

INSTR GRASPING DEVICE MINI

Facility

$396.00

Hospital Revenue Code	272
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$237.60
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: MDX Hawaii PPO	$384.12

INSTR GRASPING DEVICE MINI

Facility

$396.00

Hospital Revenue Code	272
Min. Negotiated Rate	$201.96
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$237.60
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$249.48
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: University Health Alliance Commercial	$288.64

INSTR LITHOTRIPTOR MECH

Facility

$1,830.00

Hospital Revenue Code	272
Min. Negotiated Rate	$933.30
Max. Negotiated Rate	$1,775.10
Rate for Payer: Cash Price	$1,098.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.50
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: Kaiser Permanente Commercial	$1,152.90
Rate for Payer: Kaiser Permanente Medicaid	$933.30
Rate for Payer: MDX Hawaii PPO	$1,775.10
Rate for Payer: University Health Alliance Commercial	$1,333.89

INSTR LITHOTRIPTOR MECH

Facility

$1,830.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,555.50
Max. Negotiated Rate	$1,775.10
Rate for Payer: Cash Price	$1,098.00
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: MDX Hawaii PPO	$1,775.10

INSTR RADIAL JAW FORCEP LG

Facility

$93.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$58.59
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: University Health Alliance Commercial	$67.79

INSTR RADIAL JAW FORCEP LG

Facility

$93.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: MDX Hawaii PPO	$90.21

INSTR RADIAL JAW JUMBO 3.2MM

Facility

$164.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$83.64
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$98.40
Rate for Payer: Hawaii Western Management Group Commercial	$155.80
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Kaiser Permanente Commercial	$103.32
Rate for Payer: Kaiser Permanente Medicaid	$83.64
Rate for Payer: MDX Hawaii PPO	$159.08
Rate for Payer: University Health Alliance Commercial	$119.54

INSTR RADIAL JAW JUMBO 3.2MM

Facility

$164.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$98.40
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: MDX Hawaii PPO	$159.08

Know your out-of-pocket cost for care.

All Charges