Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

BIOLOX DELTA V40 FH 6570-0-232

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,364.76
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$1,685.88
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

BIOLOX FEM HEAD 00-8775-036-03

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$1,638.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

BIOLOX FEM HEAD 00-8775-036-03

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

BIOLOX FEM HEAD 1365-36-220

Facility

$4,880.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,488.80
Max. Negotiated Rate	$4,733.60
Rate for Payer: Cash Price	$2,928.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,416.00
Rate for Payer: Health Management Network Commercial	$4,148.00
Rate for Payer: Kaiser Permanente Commercial	$3,074.40
Rate for Payer: Kaiser Permanente Medicaid	$2,488.80
Rate for Payer: MDX Hawaii PPO	$4,733.60
Rate for Payer: University Health Alliance Commercial	$2,732.80

BIOLOX FEM HEAD 1365-36-220

Facility

$4,880.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,732.80
Max. Negotiated Rate	$4,733.60
Rate for Payer: Cash Price	$2,928.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,416.00
Rate for Payer: Health Management Network Commercial	$4,148.00
Rate for Payer: MDX Hawaii PPO	$4,733.60
Rate for Payer: University Health Alliance Commercial	$2,732.80

BIOLOX FEMORAL HEAD 6570-0-032

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BIOLOX FEMORAL HEAD 6570-0-032

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,378.53
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$1,702.89
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BIOLOX V40 FEM HEAD 6570-0-132

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BIOLOX V40 FEM HEAD 6570-0-132

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,378.53
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$1,702.89
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BIOLX DLTA FEM #00-8775-036-04

Facility

$4,270.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,177.70
Max. Negotiated Rate	$4,141.90
Rate for Payer: Cash Price	$2,562.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,989.00
Rate for Payer: Health Management Network Commercial	$3,629.50
Rate for Payer: Kaiser Permanente Commercial	$2,690.10
Rate for Payer: Kaiser Permanente Medicaid	$2,177.70
Rate for Payer: MDX Hawaii PPO	$4,141.90
Rate for Payer: University Health Alliance Commercial	$2,391.20

BIOLX DLTA FEM #00-8775-036-04

Facility

$4,270.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,391.20
Max. Negotiated Rate	$4,141.90
Rate for Payer: Cash Price	$2,562.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,989.00
Rate for Payer: Health Management Network Commercial	$3,629.50
Rate for Payer: MDX Hawaii PPO	$4,141.90
Rate for Payer: University Health Alliance Commercial	$2,391.20

BIOMONITOR III 436066

Facility

$11,700.00

Service Code	HCPCS C1764
Hospital Revenue Code	278
Min. Negotiated Rate	$5,967.00
Max. Negotiated Rate	$11,349.00
Rate for Payer: Cash Price	$7,020.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,190.00
Rate for Payer: Health Management Network Commercial	$9,945.00
Rate for Payer: Kaiser Permanente Commercial	$7,371.00
Rate for Payer: Kaiser Permanente Medicaid	$5,967.00
Rate for Payer: MDX Hawaii PPO	$11,349.00
Rate for Payer: University Health Alliance Commercial	$6,552.00

BIOMONITOR III 436066

Facility

$11,700.00

Service Code	HCPCS C1764
Hospital Revenue Code	278
Min. Negotiated Rate	$6,552.00
Max. Negotiated Rate	$11,349.00
Rate for Payer: Cash Price	$7,020.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,190.00
Rate for Payer: Health Management Network Commercial	$9,945.00
Rate for Payer: MDX Hawaii PPO	$11,349.00
Rate for Payer: University Health Alliance Commercial	$6,552.00

BIOPREP PREP KIT 0206-710-000

Facility

$408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$208.08
Max. Negotiated Rate	$395.76
Rate for Payer: Cash Price	$244.80
Rate for Payer: Hawaii Western Management Group Commercial	$285.60
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Kaiser Permanente Commercial	$257.04
Rate for Payer: Kaiser Permanente Medicaid	$208.08
Rate for Payer: MDX Hawaii PPO	$395.76
Rate for Payer: University Health Alliance Commercial	$228.48

BIOPREP PREP KIT 0206-710-000

Facility

$408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$228.48
Max. Negotiated Rate	$395.76
Rate for Payer: Cash Price	$244.80
Rate for Payer: Hawaii Western Management Group Commercial	$285.60
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: MDX Hawaii PPO	$395.76
Rate for Payer: University Health Alliance Commercial	$228.48

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$48,968.79

Service Code	MSDRG 478
Min. Negotiated Rate	$27,971.56
Max. Negotiated Rate	$48,968.79
Rate for Payer: AlohaCare Medicare	$27,971.56
Rate for Payer: Devoted Health Medicare	$30,768.72
Rate for Payer: Hawaii Medical Service Association Commercial	$48,968.79
Rate for Payer: Hawaii Medical Service Association Medicare	$27,971.56
Rate for Payer: Humana Medicare	$27,971.56
Rate for Payer: Kaiser Permanente Commercial	$42,421.20
Rate for Payer: Kaiser Permanente Medicare	$27,971.56
Rate for Payer: Ohana Health Plan Medicare	$27,971.56
Rate for Payer: UnitedHealthcare Medicare	$27,971.56

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$59,591.85

Service Code	MSDRG 477
Min. Negotiated Rate	$39,293.51
Max. Negotiated Rate	$59,591.85
Rate for Payer: AlohaCare Medicare	$39,293.51
Rate for Payer: Devoted Health Medicare	$43,222.86
Rate for Payer: Hawaii Medical Service Association Commercial	$48,968.79
Rate for Payer: Hawaii Medical Service Association Medicare	$39,293.51
Rate for Payer: Humana Medicare	$39,293.51
Rate for Payer: Kaiser Permanente Commercial	$59,591.85
Rate for Payer: Kaiser Permanente Medicare	$39,293.51
Rate for Payer: Ohana Health Plan Medicare	$39,293.51
Rate for Payer: UnitedHealthcare Medicare	$39,293.51

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$48,968.79

Service Code	MSDRG 479
Min. Negotiated Rate	$21,143.61
Max. Negotiated Rate	$48,968.79
Rate for Payer: AlohaCare Medicare	$21,143.61
Rate for Payer: Devoted Health Medicare	$23,257.97
Rate for Payer: Hawaii Medical Service Association Commercial	$48,968.79
Rate for Payer: Hawaii Medical Service Association Medicare	$21,143.61
Rate for Payer: Humana Medicare	$21,143.61
Rate for Payer: Kaiser Permanente Commercial	$32,066.03
Rate for Payer: Kaiser Permanente Medicare	$21,143.61
Rate for Payer: Ohana Health Plan Medicare	$21,143.61
Rate for Payer: UnitedHealthcare Medicare	$21,143.61

BIOPSY, BONE, OPEN; SUPERFICIAL (EG, STERNUM, SPINOUS PROCESS, RIB, PATELLA, OLECRANON PROCESS, CALCANEUS, TARSAL, METATARSAL, CARPAL, METACARPAL, PHALANX)

Facility

$5,160.40

Service Code	CPT 20240
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$5,160.40

BIOPSY MAX-CORE 18X25 MC1825

Facility

$191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$114.60
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: MDX Hawaii PPO	$185.27

BIOPSY MAX-CORE 18X25 MC1825

Facility

$191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$97.41
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$114.60
Rate for Payer: Hawaii Western Management Group Commercial	$181.45
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Kaiser Permanente Commercial	$120.33
Rate for Payer: Kaiser Permanente Medicaid	$97.41
Rate for Payer: MDX Hawaii PPO	$185.27
Rate for Payer: University Health Alliance Commercial	$139.22

BIOPSY; NASOPHARYNX, SURVEY FOR UNKNOWN PRIMARY LESION

Facility

$5,509.00

Service Code	CPT 42806
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$3,916.70
Rate for Payer: AlohaCare Medicare	$3,916.70
Rate for Payer: Devoted Health Medicare	$4,308.37
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,916.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$3,916.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,916.70
Rate for Payer: Ohana Health Plan Medicaid	$4,308.37
Rate for Payer: Ohana Health Plan Medicare	$3,916.70
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,916.70
Rate for Payer: University Health Alliance Commercial	$5,160.40

BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)

Facility

$5,509.00

Service Code	CPT 45100
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Devoted Health Medicare	$3,606.91
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01

BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (SEPARATE PROCEDURE)

Facility

$11,157.19

Service Code	CPT 57500
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$11,157.19
Rate for Payer: AlohaCare Medicaid	$1,088.08
Rate for Payer: AlohaCare Medicare	$1,088.08
Rate for Payer: Devoted Health Medicare	$1,196.89
Rate for Payer: Hawaii Medical Service Association Commercial	$1,360.10
Rate for Payer: Hawaii Medical Service Association Medicare	$1,088.08
Rate for Payer: Humana Medicare	$1,088.08
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,088.08
Rate for Payer: Ohana Health Plan Medicaid	$1,196.89
Rate for Payer: Ohana Health Plan Medicare	$1,088.08
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,088.08
Rate for Payer: University Health Alliance Commercial	$11,157.19

BIOPSY OF NERVE

Facility

$5,509.00

Service Code	CPT 64795
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$2,306.84
Rate for Payer: AlohaCare Medicare	$2,306.84
Rate for Payer: Devoted Health Medicare	$2,537.52
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,306.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$2,306.84
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,306.84
Rate for Payer: Ohana Health Plan Medicaid	$2,537.52
Rate for Payer: Ohana Health Plan Medicare	$2,306.84
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,306.84
Rate for Payer: University Health Alliance Commercial	$5,160.40

Know your out-of-pocket cost for care.

All Charges