Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

FIXATION TOOL 6616

Facility

$150.00

Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: University Health Alliance Commercial	$109.33

FIXATOR CALCANEAL M145

Facility

$5,778.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,911.30
Max. Negotiated Rate	$5,604.66
Rate for Payer: Cash Price	$3,466.80
Rate for Payer: Health Management Network Commercial	$4,911.30
Rate for Payer: MDX Hawaii PPO	$5,604.66

FIXATOR CALCANEAL M145

Facility

$5,778.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,946.78
Max. Negotiated Rate	$5,604.66
Rate for Payer: Cash Price	$3,466.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,489.10
Rate for Payer: Health Management Network Commercial	$4,911.30
Rate for Payer: Kaiser Permanente Commercial	$3,640.14
Rate for Payer: Kaiser Permanente Medicaid	$2,946.78
Rate for Payer: MDX Hawaii PPO	$5,604.66
Rate for Payer: University Health Alliance Commercial	$4,211.58

FIXATOR ENDOSCOPIC MARKER

Facility

$152.00

Hospital Revenue Code	272
Min. Negotiated Rate	$77.52
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Hawaii Western Management Group Commercial	$144.40
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$95.76
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: University Health Alliance Commercial	$110.79

FIXATOR ENDOSCOPIC MARKER

Facility

$152.00

Hospital Revenue Code	272
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: MDX Hawaii PPO	$147.44

FIXATOR ENDOSCOPIC TATTOO 5ML

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$161.50
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: MDX Hawaii PPO	$184.30

FIXATOR ENDOSCOPIC TATTOO 5ML

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: University Health Alliance Commercial	$138.49

FIXATOR MINIRAIL M2 M511

Facility

$5,328.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,528.80
Max. Negotiated Rate	$5,168.16
Rate for Payer: Cash Price	$3,196.80
Rate for Payer: Health Management Network Commercial	$4,528.80
Rate for Payer: MDX Hawaii PPO	$5,168.16

FIXATOR MINIRAIL M2 M511

Facility

$5,328.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,717.28
Max. Negotiated Rate	$5,168.16
Rate for Payer: Cash Price	$3,196.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,061.60
Rate for Payer: Health Management Network Commercial	$4,528.80
Rate for Payer: Kaiser Permanente Commercial	$3,356.64
Rate for Payer: Kaiser Permanente Medicaid	$2,717.28
Rate for Payer: MDX Hawaii PPO	$5,168.16
Rate for Payer: University Health Alliance Commercial	$3,883.58

FIXATR ARTIC MINIRAIL DBL M514

Facility

$5,328.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,528.80
Max. Negotiated Rate	$5,168.16
Rate for Payer: Cash Price	$3,196.80
Rate for Payer: Health Management Network Commercial	$4,528.80
Rate for Payer: MDX Hawaii PPO	$5,168.16

FIXATR ARTIC MINIRAIL DBL M514

Facility

$5,328.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,717.28
Max. Negotiated Rate	$5,168.16
Rate for Payer: Cash Price	$3,196.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,061.60
Rate for Payer: Health Management Network Commercial	$4,528.80
Rate for Payer: Kaiser Permanente Commercial	$3,356.64
Rate for Payer: Kaiser Permanente Medicaid	$2,717.28
Rate for Payer: MDX Hawaii PPO	$5,168.16
Rate for Payer: University Health Alliance Commercial	$3,883.58

FIXATR CAP/WIRE LOCK MODEL D

Facility

$102.00

Hospital Revenue Code	272
Min. Negotiated Rate	$52.02
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Hawaii Western Management Group Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Kaiser Permanente Commercial	$64.26
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: University Health Alliance Commercial	$74.35

FIXATR CAP/WIRE LOCK MODEL D

Facility

$102.00

Hospital Revenue Code	272
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: MDX Hawaii PPO	$98.94

FIXATR CAP/WIRE LOCK OLYMPUS

Facility

$102.00

Hospital Revenue Code	272
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: MDX Hawaii PPO	$98.94

FIXATR CAP/WIRE LOCK OLYMPUS

Facility

$102.00

Hospital Revenue Code	272
Min. Negotiated Rate	$52.02
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Hawaii Western Management Group Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Kaiser Permanente Commercial	$64.26
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: University Health Alliance Commercial	$74.35

FLAME FINISHING M58-8812

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$48.51
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: University Health Alliance Commercial	$56.13

FLAME FINISHING M58-8812

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: MDX Hawaii PPO	$74.69

FLECAINIDE 100 MG TABLET [10041]

Facility

$13.00

Service Code	NDC 00054001120
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: MDX Hawaii PPO	$12.61

FLECAINIDE 100 MG TABLET [10041]

Facility

$13.00

Service Code	NDC 00054001120
Hospital Revenue Code	637
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$8.19
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: University Health Alliance Commercial	$9.48

FLEXIGRAFT FGL

Facility

$4,820.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$2,699.20
Max. Negotiated Rate	$4,675.40
Rate for Payer: Cash Price	$2,892.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,374.00
Rate for Payer: Health Management Network Commercial	$4,097.00
Rate for Payer: MDX Hawaii PPO	$4,675.40
Rate for Payer: University Health Alliance Commercial	$2,699.20

FLEXIGRAFT FGL

Facility

$4,820.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$2,458.20
Max. Negotiated Rate	$4,675.40
Rate for Payer: Cash Price	$2,892.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,374.00
Rate for Payer: Health Management Network Commercial	$4,097.00
Rate for Payer: Kaiser Permanente Commercial	$3,036.60
Rate for Payer: Kaiser Permanente Medicaid	$2,458.20
Rate for Payer: MDX Hawaii PPO	$4,675.40
Rate for Payer: University Health Alliance Commercial	$2,699.20

FLEXIGRAFT TENDSON HAM FST

Facility

$3,026.00

Service Code	HCPCS C1716
Hospital Revenue Code	278
Min. Negotiated Rate	$593.84
Max. Negotiated Rate	$2,935.22
Rate for Payer: AlohaCare Medicaid	$593.84
Rate for Payer: AlohaCare Medicare	$593.84
Rate for Payer: Cash Price	$1,815.60
Rate for Payer: Cash Price	$1,815.60
Rate for Payer: Devoted Health Medicare	$653.22
Rate for Payer: Hawaii Medical Service Association Commercial	$742.30
Rate for Payer: Hawaii Medical Service Association Medicare	$593.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,118.20
Rate for Payer: Health Management Network Commercial	$2,572.10
Rate for Payer: Humana Medicare	$593.84
Rate for Payer: Kaiser Permanente Commercial	$1,906.38
Rate for Payer: Kaiser Permanente Medicaid	$1,543.26
Rate for Payer: Kaiser Permanente Medicare	$593.84
Rate for Payer: MDX Hawaii PPO	$2,935.22
Rate for Payer: Ohana Health Plan Medicaid	$653.22
Rate for Payer: Ohana Health Plan Medicare	$593.84
Rate for Payer: UnitedHealthcare Medicaid	$651.25
Rate for Payer: UnitedHealthcare Medicare	$593.84
Rate for Payer: University Health Alliance Commercial	$1,694.56

FLEXIGRAFT TENDSON HAM FST

Facility

$3,026.00

Service Code	HCPCS C1716
Hospital Revenue Code	278
Min. Negotiated Rate	$1,694.56
Max. Negotiated Rate	$2,935.22
Rate for Payer: Cash Price	$1,815.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,118.20
Rate for Payer: Health Management Network Commercial	$2,572.10
Rate for Payer: MDX Hawaii PPO	$2,935.22
Rate for Payer: University Health Alliance Commercial	$1,694.56

FLEX SHOULDER SYS DWF361B

Facility

$3,530.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,976.80
Max. Negotiated Rate	$3,424.10
Rate for Payer: Cash Price	$2,118.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,471.00
Rate for Payer: Health Management Network Commercial	$3,000.50
Rate for Payer: MDX Hawaii PPO	$3,424.10
Rate for Payer: University Health Alliance Commercial	$1,976.80

FLEX SHOULDER SYS DWF361B

Facility

$3,530.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.30
Max. Negotiated Rate	$3,424.10
Rate for Payer: Cash Price	$2,118.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,471.00
Rate for Payer: Health Management Network Commercial	$3,000.50
Rate for Payer: Kaiser Permanente Commercial	$2,223.90
Rate for Payer: Kaiser Permanente Medicaid	$1,800.30
Rate for Payer: MDX Hawaii PPO	$3,424.10
Rate for Payer: University Health Alliance Commercial	$1,976.80

Know your out-of-pocket cost for care.

All Charges