Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

KII FIOS OBTURATOR 5X100 CTF03

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$342.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: University Health Alliance Commercial	$262.40

KII SLEEVE 5X100 CFS02

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: University Health Alliance Commercial	$164.00

KII SLEEVE 5X100 CFS02

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25

KIRSCHNER WIRE 47-186-78

Facility

$126.00

Service Code	HCPCS C1713
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

KIRSCHNER WIRE 47-186-78

Facility

$126.00

Service Code	HCPCS C1713
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

KIT 3.0 SUTURE TAK AR-1938DS

Facility

$1,084.00

Hospital Revenue Code	272
Min. Negotiated Rate	$552.84
Max. Negotiated Rate	$1,051.48
Rate for Payer: Cash Price	$650.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,029.80
Rate for Payer: Health Management Network Commercial	$921.40
Rate for Payer: Kaiser Permanente Commercial	$682.92
Rate for Payer: Kaiser Permanente Medicaid	$552.84
Rate for Payer: MDX Hawaii PPO	$1,051.48
Rate for Payer: University Health Alliance Commercial	$790.13

KIT 3.0 SUTURE TAK AR-1938DS

Facility

$1,084.00

Hospital Revenue Code	272
Min. Negotiated Rate	$921.40
Max. Negotiated Rate	$1,051.48
Rate for Payer: Cash Price	$650.40
Rate for Payer: Health Management Network Commercial	$921.40
Rate for Payer: MDX Hawaii PPO	$1,051.48

KIT 3MM SUTURETAK #AR-1934DS-2

Facility

$859.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$438.09
Max. Negotiated Rate	$833.23
Rate for Payer: Cash Price	$515.40
Rate for Payer: Hawaii Western Management Group Commercial	$816.05
Rate for Payer: Health Management Network Commercial	$730.15
Rate for Payer: Kaiser Permanente Commercial	$541.17
Rate for Payer: Kaiser Permanente Medicaid	$438.09
Rate for Payer: MDX Hawaii PPO	$833.23
Rate for Payer: University Health Alliance Commercial	$626.13

KIT 3MM SUTURETAK #AR-1934DS-2

Facility

$859.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$730.15
Max. Negotiated Rate	$833.23
Rate for Payer: Cash Price	$515.40
Rate for Payer: Health Management Network Commercial	$730.15
Rate for Payer: MDX Hawaii PPO	$833.23

KIT ANKLE SPRAIN CARE UNIVERS

Facility

$111.00

Service Code	HCPCS L4350
Hospital Revenue Code	274
Min. Negotiated Rate	$56.61
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Cash Price	$66.60
Rate for Payer: Hawaii Western Management Group Commercial	$77.70
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$69.93
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: UnitedHealthcare Medicaid	$81.51
Rate for Payer: University Health Alliance Commercial	$62.16

KIT ANKLE SPRAIN CARE UNIVERS

Facility

$111.00

Service Code	HCPCS L4350
Hospital Revenue Code	274
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Hawaii Western Management Group Commercial	$77.70
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: University Health Alliance Commercial	$62.16

KIT BIOCUE MINI 30ML 800-0610A

Facility

$5,104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,338.40
Max. Negotiated Rate	$4,950.88
Rate for Payer: Cash Price	$3,062.40
Rate for Payer: Health Management Network Commercial	$4,338.40
Rate for Payer: MDX Hawaii PPO	$4,950.88

KIT BIOCUE MINI 30ML 800-0610A

Facility

$5,104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,603.04
Max. Negotiated Rate	$4,950.88
Rate for Payer: Cash Price	$3,062.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,848.80
Rate for Payer: Health Management Network Commercial	$4,338.40
Rate for Payer: Kaiser Permanente Commercial	$3,215.52
Rate for Payer: Kaiser Permanente Medicaid	$2,603.04
Rate for Payer: MDX Hawaii PPO	$4,950.88
Rate for Payer: University Health Alliance Commercial	$3,720.31

KIT BIOCUE STD 60ML 800-0611A

Facility

$5,104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,603.04
Max. Negotiated Rate	$4,950.88
Rate for Payer: Cash Price	$3,062.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,848.80
Rate for Payer: Health Management Network Commercial	$4,338.40
Rate for Payer: Kaiser Permanente Commercial	$3,215.52
Rate for Payer: Kaiser Permanente Medicaid	$2,603.04
Rate for Payer: MDX Hawaii PPO	$4,950.88
Rate for Payer: University Health Alliance Commercial	$3,720.31

KIT BIOCUE STD 60ML 800-0611A

Facility

$5,104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,338.40
Max. Negotiated Rate	$4,950.88
Rate for Payer: Cash Price	$3,062.40
Rate for Payer: Health Management Network Commercial	$4,338.40
Rate for Payer: MDX Hawaii PPO	$4,950.88

KIT BIO DISTAL BICEP AR-2260BC

Facility

$2,310.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,178.10
Max. Negotiated Rate	$2,240.70
Rate for Payer: Cash Price	$1,386.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,617.00
Rate for Payer: Health Management Network Commercial	$1,963.50
Rate for Payer: Kaiser Permanente Commercial	$1,455.30
Rate for Payer: Kaiser Permanente Medicaid	$1,178.10
Rate for Payer: MDX Hawaii PPO	$2,240.70
Rate for Payer: University Health Alliance Commercial	$1,293.60

KIT BIO DISTAL BICEP AR-2260BC

Facility

$2,310.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,293.60
Max. Negotiated Rate	$2,240.70
Rate for Payer: Cash Price	$1,386.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,617.00
Rate for Payer: Health Management Network Commercial	$1,963.50
Rate for Payer: MDX Hawaii PPO	$2,240.70
Rate for Payer: University Health Alliance Commercial	$1,293.60

KIT CATH TRAY SILICONE 16FR

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: MDX Hawaii PPO	$91.18

KIT CATH TRAY SILICONE 16FR

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$47.94
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$59.22
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: University Health Alliance Commercial	$68.52

KIT CENTESIS 5FR CATHETER

Facility

$394.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$200.94
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Hawaii Western Management Group Commercial	$374.30
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$248.22
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: University Health Alliance Commercial	$287.19

KIT CENTESIS 5FR CATHETER

Facility

$394.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: MDX Hawaii PPO	$382.18

KIT CRICOTHYROTOMY 2MM

Facility

$655.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$556.75
Max. Negotiated Rate	$635.35
Rate for Payer: Cash Price	$393.00
Rate for Payer: Health Management Network Commercial	$556.75
Rate for Payer: MDX Hawaii PPO	$635.35

KIT CRICOTHYROTOMY 2MM

Facility

$655.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$334.05
Max. Negotiated Rate	$635.35
Rate for Payer: Cash Price	$393.00
Rate for Payer: Hawaii Western Management Group Commercial	$622.25
Rate for Payer: Health Management Network Commercial	$556.75
Rate for Payer: Kaiser Permanente Commercial	$412.65
Rate for Payer: Kaiser Permanente Medicaid	$334.05
Rate for Payer: MDX Hawaii PPO	$635.35
Rate for Payer: University Health Alliance Commercial	$477.43

KIT CRICOTHYROTOMY 4.0MM

Facility

$569.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$290.19
Max. Negotiated Rate	$551.93
Rate for Payer: Cash Price	$341.40
Rate for Payer: Hawaii Western Management Group Commercial	$540.55
Rate for Payer: Health Management Network Commercial	$483.65
Rate for Payer: Kaiser Permanente Commercial	$358.47
Rate for Payer: Kaiser Permanente Medicaid	$290.19
Rate for Payer: MDX Hawaii PPO	$551.93
Rate for Payer: University Health Alliance Commercial	$414.74

KIT CRICOTHYROTOMY 4.0MM

Facility

$569.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$483.65
Max. Negotiated Rate	$551.93
Rate for Payer: Cash Price	$341.40
Rate for Payer: Health Management Network Commercial	$483.65
Rate for Payer: MDX Hawaii PPO	$551.93

Know your out-of-pocket cost for care.

All Charges