Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

BLADE MINI SAW 2296-003-511

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$174.60

BLADE MINI SAW 2296-003-511

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Hawaii Western Management Group Commercial	$171.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: University Health Alliance Commercial	$131.20

BLADE OSTEOTOME 00-9986-21-21

Facility

$454.00

Hospital Revenue Code	272
Min. Negotiated Rate	$231.54
Max. Negotiated Rate	$440.38
Rate for Payer: Cash Price	$272.40
Rate for Payer: Hawaii Western Management Group Commercial	$431.30
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Kaiser Permanente Commercial	$286.02
Rate for Payer: Kaiser Permanente Medicaid	$231.54
Rate for Payer: MDX Hawaii PPO	$440.38
Rate for Payer: University Health Alliance Commercial	$330.92

BLADE OSTEOTOME 00-9986-21-21

Facility

$454.00

Hospital Revenue Code	272
Min. Negotiated Rate	$385.90
Max. Negotiated Rate	$440.38
Rate for Payer: Cash Price	$272.40
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: MDX Hawaii PPO	$440.38

BLADE SAG DUAL 4125-127-100

Facility

$234.00

Hospital Revenue Code	272
Min. Negotiated Rate	$119.34
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$140.40
Rate for Payer: Hawaii Western Management Group Commercial	$222.30
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Kaiser Permanente Commercial	$147.42
Rate for Payer: Kaiser Permanente Medicaid	$119.34
Rate for Payer: MDX Hawaii PPO	$226.98
Rate for Payer: University Health Alliance Commercial	$170.56

BLADE SAG DUAL 4125-127-100

Facility

$234.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$226.98

BLADE SAGITTAL 2296-003-109S2

Facility

$316.00

Hospital Revenue Code	272
Min. Negotiated Rate	$161.16
Max. Negotiated Rate	$306.52
Rate for Payer: Cash Price	$189.60
Rate for Payer: Hawaii Western Management Group Commercial	$300.20
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Kaiser Permanente Commercial	$199.08
Rate for Payer: Kaiser Permanente Medicaid	$161.16
Rate for Payer: MDX Hawaii PPO	$306.52
Rate for Payer: University Health Alliance Commercial	$230.33

BLADE SAGITTAL 2296-003-109S2

Facility

$316.00

Hospital Revenue Code	272
Min. Negotiated Rate	$268.60
Max. Negotiated Rate	$306.52
Rate for Payer: Cash Price	$189.60
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: MDX Hawaii PPO	$306.52

BLADE SAGITTAL 2296-003-114

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$174.60

BLADE SAGITTAL 2296-003-114

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Hawaii Western Management Group Commercial	$171.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: University Health Alliance Commercial	$131.20

BLADE SAGITTAL 2296-003-225

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

BLADE SAGITTAL 2296-003-225

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

BLADE SAGITTAL 4118-127-100

Facility

$78.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: MDX Hawaii PPO	$75.66

BLADE SAGITTAL 4118-127-100

Facility

$78.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$49.14
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: University Health Alliance Commercial	$56.85

BLADE SAGITTAL 6118-089-075

Facility

$240.00

Hospital Revenue Code	272
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Hawaii Western Management Group Commercial	$228.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$151.20
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: University Health Alliance Commercial	$174.94

BLADE SAGITTAL 6118-089-075

Facility

$240.00

Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: MDX Hawaii PPO	$232.80

BLADE SAG WIDE

Facility

$155.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$97.65
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: University Health Alliance Commercial	$112.98

BLADE SAG WIDE

Facility

$155.00

Hospital Revenue Code	272
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: MDX Hawaii PPO	$150.35

BLADE SAW 0.98IN X 2.76IN

Facility

$104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: MDX Hawaii PPO	$100.88

BLADE SAW 0.98IN X 2.76IN

Facility

$104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$53.04
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$62.40
Rate for Payer: Hawaii Western Management Group Commercial	$98.80
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Kaiser Permanente Commercial	$65.52
Rate for Payer: Kaiser Permanente Medicaid	$53.04
Rate for Payer: MDX Hawaii PPO	$100.88
Rate for Payer: University Health Alliance Commercial	$75.81

BLADE SAW 105X25 6425-127-105

Facility

$1,120.00

Hospital Revenue Code	272
Min. Negotiated Rate	$952.00
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: MDX Hawaii PPO	$1,086.40

BLADE SAW 105X25 6425-127-105

Facility

$1,120.00

Hospital Revenue Code	272
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	$1,064.00
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	$816.37

BLADE SAW BR4125-127-100

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 SAW BR4125-127-100

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 CUT D 6720-127-105

Facility

$1,276.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,084.60
Max. Negotiated Rate	$1,237.72
Rate for Payer: Cash Price	$765.60
Rate for Payer: Health Management Network Commercial	$1,084.60
Rate for Payer: MDX Hawaii PPO	$1,237.72

Know your out-of-pocket cost for care.

All Charges