Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

BLADE SAW CUT D 6720-127-105

Facility

$1,276.00

Hospital Revenue Code	272
Min. Negotiated Rate	$650.76
Max. Negotiated Rate	$1,237.72
Rate for Payer: Cash Price	$765.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,212.20
Rate for Payer: Health Management Network Commercial	$1,084.60
Rate for Payer: Kaiser Permanente Commercial	$803.88
Rate for Payer: Kaiser Permanente Medicaid	$650.76
Rate for Payer: MDX Hawaii PPO	$1,237.72
Rate for Payer: University Health Alliance Commercial	$930.08

BLADE SAW SAGITTAL 100MM 1.14M

Facility

$128.00

Hospital Revenue Code	272
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$76.80
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: MDX Hawaii PPO	$124.16

BLADE SAW SAGITTAL 100MM 1.14M

Facility

$128.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.28
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$76.80
Rate for Payer: Hawaii Western Management Group Commercial	$121.60
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Kaiser Permanente Commercial	$80.64
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: University Health Alliance Commercial	$93.30

BLADE SHAVER 2MM

Facility

$1,958.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,664.30
Max. Negotiated Rate	$1,899.26
Rate for Payer: Cash Price	$1,174.80
Rate for Payer: Health Management Network Commercial	$1,664.30
Rate for Payer: MDX Hawaii PPO	$1,899.26

BLADE SHAVER 2MM

Facility

$1,958.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$998.58
Max. Negotiated Rate	$1,899.26
Rate for Payer: Cash Price	$1,174.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,860.10
Rate for Payer: Health Management Network Commercial	$1,664.30
Rate for Payer: Kaiser Permanente Commercial	$1,233.54
Rate for Payer: Kaiser Permanente Medicaid	$998.58
Rate for Payer: MDX Hawaii PPO	$1,899.26
Rate for Payer: University Health Alliance Commercial	$1,427.19

BLADE SHAVER 3MM STR

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: MDX Hawaii PPO	$891.43

BLADE SHAVER 3MM STR

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$468.69
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$578.97
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: University Health Alliance Commercial	$669.86

BLADE SHAVER 4MM 12 DEG

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$468.69
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$578.97
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: University Health Alliance Commercial	$669.86

BLADE SHAVER 4MM 12 DEG

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: MDX Hawaii PPO	$891.43

BLADE SHAVER 4MM 40DEG

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: MDX Hawaii PPO	$891.43

BLADE SHAVER 4MM 40DEG

Facility

$845.00

Hospital Revenue Code	270
Min. Negotiated Rate	$718.25
Max. Negotiated Rate	$819.65
Rate for Payer: Cash Price	$507.00
Rate for Payer: Health Management Network Commercial	$718.25
Rate for Payer: MDX Hawaii PPO	$819.65

BLADE SHAVER 4MM 40DEG

Facility

$845.00

Hospital Revenue Code	270
Min. Negotiated Rate	$430.95
Max. Negotiated Rate	$819.65
Rate for Payer: Cash Price	$507.00
Rate for Payer: Hawaii Western Management Group Commercial	$802.75
Rate for Payer: Health Management Network Commercial	$718.25
Rate for Payer: Kaiser Permanente Commercial	$532.35
Rate for Payer: Kaiser Permanente Medicaid	$430.95
Rate for Payer: MDX Hawaii PPO	$819.65
Rate for Payer: University Health Alliance Commercial	$615.92

BLADE SHAVER 4MM 40DEG

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$468.69
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$578.97
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: University Health Alliance Commercial	$669.86

BLADE SHAVER 4MM 60DEG

Facility

$845.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$718.25
Max. Negotiated Rate	$819.65
Rate for Payer: Cash Price	$507.00
Rate for Payer: Health Management Network Commercial	$718.25
Rate for Payer: MDX Hawaii PPO	$819.65

BLADE SHAVER 4MM 60DEG

Facility

$845.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$430.95
Max. Negotiated Rate	$819.65
Rate for Payer: Cash Price	$507.00
Rate for Payer: Hawaii Western Management Group Commercial	$802.75
Rate for Payer: Health Management Network Commercial	$718.25
Rate for Payer: Kaiser Permanente Commercial	$532.35
Rate for Payer: Kaiser Permanente Medicaid	$430.95
Rate for Payer: MDX Hawaii PPO	$819.65
Rate for Payer: University Health Alliance Commercial	$615.92

BLADE SHAVER 4MM STR

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$468.69
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$578.97
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: University Health Alliance Commercial	$669.86

BLADE SHAVER 4MM STR

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: MDX Hawaii PPO	$891.43

BLADE SHAVER STD A 4MM 0DEG

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.39
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.55
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Kaiser Permanente Commercial	$308.07
Rate for Payer: Kaiser Permanente Medicaid	$249.39
Rate for Payer: MDX Hawaii PPO	$474.33
Rate for Payer: University Health Alliance Commercial	$356.43

BLADE SHAVER STD A 4MM 0DEG

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: MDX Hawaii PPO	$474.33

BLADE SMR BIPOLAR SHAVER A

Facility

$641.00

Hospital Revenue Code	272
Min. Negotiated Rate	$326.91
Max. Negotiated Rate	$621.77
Rate for Payer: Cash Price	$384.60
Rate for Payer: Hawaii Western Management Group Commercial	$608.95
Rate for Payer: Health Management Network Commercial	$544.85
Rate for Payer: Kaiser Permanente Commercial	$403.83
Rate for Payer: Kaiser Permanente Medicaid	$326.91
Rate for Payer: MDX Hawaii PPO	$621.77
Rate for Payer: University Health Alliance Commercial	$467.22

BLADE SMR BIPOLAR SHAVER A

Facility

$641.00

Hospital Revenue Code	272
Min. Negotiated Rate	$544.85
Max. Negotiated Rate	$621.77
Rate for Payer: Cash Price	$384.60
Rate for Payer: Health Management Network Commercial	$544.85
Rate for Payer: MDX Hawaii PPO	$621.77

BLADE SPIRAL 10MM TI END CAP

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$571.20
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Hawaii Western Management Group Commercial	$784.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Kaiser Permanente Commercial	$705.60
Rate for Payer: Kaiser Permanente Medicaid	$571.20
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: University Health Alliance Commercial	$627.20

BLADE SPIRAL 10MM TI END CAP

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$627.20
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Hawaii Western Management Group Commercial	$784.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: University Health Alliance Commercial	$627.20

BLADE SPIRAL ARM #03.010.055

Facility

$3,034.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,578.90
Max. Negotiated Rate	$2,942.98
Rate for Payer: Cash Price	$1,820.40
Rate for Payer: Health Management Network Commercial	$2,578.90
Rate for Payer: MDX Hawaii PPO	$2,942.98

BLADE SPIRAL ARM #03.010.055

Facility

$3,034.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,547.34
Max. Negotiated Rate	$2,942.98
Rate for Payer: Cash Price	$1,820.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,882.30
Rate for Payer: Health Management Network Commercial	$2,578.90
Rate for Payer: Kaiser Permanente Commercial	$1,911.42
Rate for Payer: Kaiser Permanente Medicaid	$1,547.34
Rate for Payer: MDX Hawaii PPO	$2,942.98
Rate for Payer: University Health Alliance Commercial	$2,211.48

Know your out-of-pocket cost for care.

All Charges