Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

RAPID STRUT TL LONG 50-10190CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,342.83
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$1,658.79
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL MED 50-10180

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,342.83
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$1,658.79
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL MED 50-10180

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL SHORT 50-10170

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL SHORT 50-10170

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,342.83
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$1,658.79
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL SHRT 50-10170CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL SHRT 50-10170CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,342.83
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$1,658.79
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: University Health Alliance Commercial	$1,919.19

RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]

Facility

$1,829.00

Service Code	HCPCS J2783
Hospital Revenue Code	636
Min. Negotiated Rate	$376.48
Max. Negotiated Rate	$1,774.13
Rate for Payer: AlohaCare Medicaid	$382.19
Rate for Payer: AlohaCare Medicare	$382.19
Rate for Payer: Cash Price	$1,097.40
Rate for Payer: Cash Price	$1,097.40
Rate for Payer: Devoted Health Medicare	$420.41
Rate for Payer: Hawaii Medical Service Association ABD	$376.48
Rate for Payer: Hawaii Medical Service Association Commercial	$477.74
Rate for Payer: Hawaii Medical Service Association Medicare	$382.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$376.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,737.55
Rate for Payer: Health Management Network Commercial	$1,554.65
Rate for Payer: Humana Medicare	$382.19
Rate for Payer: Kaiser Permanente Commercial	$1,152.27
Rate for Payer: Kaiser Permanente Medicaid	$932.79
Rate for Payer: Kaiser Permanente Medicare	$382.19
Rate for Payer: MDX Hawaii PPO	$1,774.13
Rate for Payer: Ohana Health Plan Medicaid	$420.41
Rate for Payer: Ohana Health Plan Medicare	$382.19
Rate for Payer: UnitedHealthcare Medicaid	$1,097.40
Rate for Payer: UnitedHealthcare Medicare	$382.19
Rate for Payer: University Health Alliance Commercial	$1,333.16

RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]

Facility

$1,829.00

Service Code	HCPCS J2783
Hospital Revenue Code	250
Min. Negotiated Rate	$1,554.65
Max. Negotiated Rate	$1,774.13
Rate for Payer: Cash Price	$1,097.40
Rate for Payer: Health Management Network Commercial	$1,554.65
Rate for Payer: MDX Hawaii PPO	$1,774.13

RASBURICASE 7.5 MG/5ML IV (WET SOLR VIAL) [43076868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	250
Min. Negotiated Rate	$6,070.70
Max. Negotiated Rate	$6,927.74
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: MDX Hawaii PPO	$6,927.74

RASBURICASE 7.5 MG/5ML IV (WET SOLR VIAL) [43076868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	636
Min. Negotiated Rate	$376.48
Max. Negotiated Rate	$6,927.74
Rate for Payer: AlohaCare Medicaid	$382.19
Rate for Payer: AlohaCare Medicare	$382.19
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Devoted Health Medicare	$420.41
Rate for Payer: Hawaii Medical Service Association ABD	$376.48
Rate for Payer: Hawaii Medical Service Association Commercial	$477.74
Rate for Payer: Hawaii Medical Service Association Medicare	$382.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$376.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,784.90
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: Humana Medicare	$382.19
Rate for Payer: Kaiser Permanente Commercial	$4,499.46
Rate for Payer: Kaiser Permanente Medicaid	$3,642.42
Rate for Payer: Kaiser Permanente Medicare	$382.19
Rate for Payer: MDX Hawaii PPO	$6,927.74
Rate for Payer: Ohana Health Plan Medicaid	$420.41
Rate for Payer: Ohana Health Plan Medicare	$382.19
Rate for Payer: UnitedHealthcare Medicaid	$4,285.20
Rate for Payer: UnitedHealthcare Medicare	$382.19
Rate for Payer: University Health Alliance Commercial	$5,205.80

RASBURICASE 7.5 MG INTRAVENOUS SOLUTION [76868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	250
Min. Negotiated Rate	$6,070.70
Max. Negotiated Rate	$6,927.74
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: MDX Hawaii PPO	$6,927.74

RASBURICASE 7.5 MG INTRAVENOUS SOLUTION [76868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	636
Min. Negotiated Rate	$376.48
Max. Negotiated Rate	$6,927.74
Rate for Payer: AlohaCare Medicaid	$382.19
Rate for Payer: AlohaCare Medicare	$382.19
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Devoted Health Medicare	$420.41
Rate for Payer: Hawaii Medical Service Association ABD	$376.48
Rate for Payer: Hawaii Medical Service Association Commercial	$477.74
Rate for Payer: Hawaii Medical Service Association Medicare	$382.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$376.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,784.90
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: Humana Medicare	$382.19
Rate for Payer: Kaiser Permanente Commercial	$4,499.46
Rate for Payer: Kaiser Permanente Medicaid	$3,642.42
Rate for Payer: Kaiser Permanente Medicare	$382.19
Rate for Payer: MDX Hawaii PPO	$6,927.74
Rate for Payer: Ohana Health Plan Medicaid	$420.41
Rate for Payer: Ohana Health Plan Medicare	$382.19
Rate for Payer: UnitedHealthcare Medicaid	$4,285.20
Rate for Payer: UnitedHealthcare Medicare	$382.19
Rate for Payer: University Health Alliance Commercial	$5,205.80

RASP PROXIMAL OSFT-1P

Facility

$1,147.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$584.97
Max. Negotiated Rate	$1,112.59
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$802.90
Rate for Payer: Health Management Network Commercial	$974.95
Rate for Payer: Kaiser Permanente Commercial	$722.61
Rate for Payer: Kaiser Permanente Medicaid	$584.97
Rate for Payer: MDX Hawaii PPO	$1,112.59
Rate for Payer: University Health Alliance Commercial	$642.32

RASP PROXIMAL OSFT-1P

Facility

$1,147.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$642.32
Max. Negotiated Rate	$1,112.59
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$802.90
Rate for Payer: Health Management Network Commercial	$974.95
Rate for Payer: MDX Hawaii PPO	$1,112.59
Rate for Payer: University Health Alliance Commercial	$642.32

REALIGNMENT OF EXTENSOR TENDON, HAND, EACH TENDON

Facility

$6,743.44

Service Code	CPT 26437
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Devoted Health Medicare	$4,251.90
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	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$6,743.44

REAMER 16MM METATARSL 323-1416

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 16MM METATARSL 323-1416

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,323.96
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$1,635.48
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 16MM PHALANX 323-1516

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,323.96
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$1,635.48
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 16MM PHALANX 323-1516

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 18MM METATARSL 323-1418

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 18MM METATARSL 323-1418

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,323.96
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$1,635.48
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 18MM PHALANX 323-1518

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,323.96
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$1,635.48
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 18MM PHALANX 323-1518

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 20MM METATARSL 323-1420

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,323.96
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$1,635.48
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: University Health Alliance Commercial	$1,892.22

Know your out-of-pocket cost for care.

All Charges