Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

BRIDGE PLATE BRGP

Facility

$3,720.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,083.20
Max. Negotiated Rate	$3,608.40
Rate for Payer: Cash Price	$2,232.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,604.00
Rate for Payer: Health Management Network Commercial	$3,162.00
Rate for Payer: MDX Hawaii PPO	$3,608.40
Rate for Payer: University Health Alliance Commercial	$2,083.20

BRITE TIP INTRODUCER 10X11

Facility

$540.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$275.40
Max. Negotiated Rate	$523.80
Rate for Payer: Cash Price	$324.00
Rate for Payer: Hawaii Western Management Group Commercial	$513.00
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: Kaiser Permanente Commercial	$340.20
Rate for Payer: Kaiser Permanente Medicaid	$275.40
Rate for Payer: MDX Hawaii PPO	$523.80
Rate for Payer: University Health Alliance Commercial	$393.61

BRITE TIP INTRODUCER 10X11

Facility

$540.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$459.00
Max. Negotiated Rate	$523.80
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: MDX Hawaii PPO	$523.80

BRITE TIP INTRODUCER 10X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: MDX Hawaii PPO	$585.88

BRITE TIP INTRODUCER 10X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$308.04
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Hawaii Western Management Group Commercial	$573.80
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$380.52
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: University Health Alliance Commercial	$440.26

BRITE TIP INTRODUCER 4X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$308.04
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Hawaii Western Management Group Commercial	$573.80
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$380.52
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: University Health Alliance Commercial	$440.26

BRITE TIP INTRODUCER 4X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: MDX Hawaii PPO	$585.88

BRITE TIP INTRODUCER 5X11

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: University Health Alliance Commercial	$102.05

BRITE TIP INTRODUCER 5X11

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: MDX Hawaii PPO	$135.80

BRITE TIP INTRODUCER 5X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$308.04
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Hawaii Western Management Group Commercial	$573.80
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$380.52
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: University Health Alliance Commercial	$440.26

BRITE TIP INTRODUCER 5X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: MDX Hawaii PPO	$585.88

BRITE TIP INTRODUCER 6X11

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$308.04
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Hawaii Western Management Group Commercial	$573.80
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$380.52
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: University Health Alliance Commercial	$440.26

BRITE TIP INTRODUCER 6X11

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: MDX Hawaii PPO	$585.88

BRITE TIP INTRODUCER 6X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$308.04
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Hawaii Western Management Group Commercial	$573.80
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$380.52
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: University Health Alliance Commercial	$440.26

BRITE TIP INTRODUCER 6X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: MDX Hawaii PPO	$585.88

BRITE TIP INTRODUCER 6X5.5

Facility

$439.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$373.15
Max. Negotiated Rate	$425.83
Rate for Payer: Cash Price	$263.40
Rate for Payer: Health Management Network Commercial	$373.15
Rate for Payer: MDX Hawaii PPO	$425.83

BRITE TIP INTRODUCER 6X5.5

Facility

$439.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$223.89
Max. Negotiated Rate	$425.83
Rate for Payer: Cash Price	$263.40
Rate for Payer: Hawaii Western Management Group Commercial	$417.05
Rate for Payer: Health Management Network Commercial	$373.15
Rate for Payer: Kaiser Permanente Commercial	$276.57
Rate for Payer: Kaiser Permanente Medicaid	$223.89
Rate for Payer: MDX Hawaii PPO	$425.83
Rate for Payer: University Health Alliance Commercial	$319.99

BRITE TIP INTRODUCER 7FX11

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: MDX Hawaii PPO	$135.80

BRITE TIP INTRODUCER 7FX11

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: University Health Alliance Commercial	$102.05

BRITE TIP INTRODUCER 7X23

Facility

$528.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$269.28
Max. Negotiated Rate	$512.16
Rate for Payer: Cash Price	$316.80
Rate for Payer: Hawaii Western Management Group Commercial	$501.60
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Kaiser Permanente Commercial	$332.64
Rate for Payer: Kaiser Permanente Medicaid	$269.28
Rate for Payer: MDX Hawaii PPO	$512.16
Rate for Payer: University Health Alliance Commercial	$384.86

BRITE TIP INTRODUCER 7X23

Facility

$528.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$448.80
Max. Negotiated Rate	$512.16
Rate for Payer: Cash Price	$316.80
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: MDX Hawaii PPO	$512.16

BRITE TIP INTRODUCER 8X11

Facility

$554.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$282.54
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$332.40
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$349.02
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: University Health Alliance Commercial	$403.81

BRITE TIP INTRODUCER 8X11

Facility

$554.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$332.40
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: MDX Hawaii PPO	$537.38

BRITE TIP INTRODUCER 8X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: MDX Hawaii PPO	$585.88

BRITE TIP INTRODUCER 8X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$308.04
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Hawaii Western Management Group Commercial	$573.80
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$380.52
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: University Health Alliance Commercial	$440.26

Know your out-of-pocket cost for care.

All Charges