Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

REAMER 20MM METATARSL 323-1420

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 PHALANX 323-1520

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 PHALANX 323-1520

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 22MM METATARSL 323-1422

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 22MM METATARSL 323-1422

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 22MM PHALANX 323-1522

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 22MM PHALANX 323-1522

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 CANNULATED 2.7MM 117066

Facility

$3,240.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,754.00
Max. Negotiated Rate	$3,142.80
Rate for Payer: Cash Price	$1,944.00
Rate for Payer: Health Management Network Commercial	$2,754.00
Rate for Payer: MDX Hawaii PPO	$3,142.80

REAMER CANNULATED 2.7MM 117066

Facility

$3,240.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,652.40
Max. Negotiated Rate	$3,142.80
Rate for Payer: Cash Price	$1,944.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,078.00
Rate for Payer: Health Management Network Commercial	$2,754.00
Rate for Payer: Kaiser Permanente Commercial	$2,041.20
Rate for Payer: Kaiser Permanente Medicaid	$1,652.40
Rate for Payer: MDX Hawaii PPO	$3,142.80
Rate for Payer: University Health Alliance Commercial	$2,361.64

REAMER FUSION CUP 18 RMRUFC-18

Facility

$1,211.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,029.35
Max. Negotiated Rate	$1,174.67
Rate for Payer: Cash Price	$726.60
Rate for Payer: Health Management Network Commercial	$1,029.35
Rate for Payer: MDX Hawaii PPO	$1,174.67

REAMER FUSION CUP 18 RMRUFC-18

Facility

$1,211.00

Hospital Revenue Code	272
Min. Negotiated Rate	$617.61
Max. Negotiated Rate	$1,174.67
Rate for Payer: Cash Price	$726.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,150.45
Rate for Payer: Health Management Network Commercial	$1,029.35
Rate for Payer: Kaiser Permanente Commercial	$762.93
Rate for Payer: Kaiser Permanente Medicaid	$617.61
Rate for Payer: MDX Hawaii PPO	$1,174.67
Rate for Payer: University Health Alliance Commercial	$882.70

REAMER HEAD 12MM 352.250S

Facility

$1,536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$783.36
Max. Negotiated Rate	$1,489.92
Rate for Payer: Cash Price	$921.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.20
Rate for Payer: Health Management Network Commercial	$1,305.60
Rate for Payer: Kaiser Permanente Commercial	$967.68
Rate for Payer: Kaiser Permanente Medicaid	$783.36
Rate for Payer: MDX Hawaii PPO	$1,489.92
Rate for Payer: University Health Alliance Commercial	$1,119.59

REAMER HEAD 12MM 352.250S

Facility

$1,536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,305.60
Max. Negotiated Rate	$1,489.92
Rate for Payer: Cash Price	$921.60
Rate for Payer: Health Management Network Commercial	$1,305.60
Rate for Payer: MDX Hawaii PPO	$1,489.92

REAMER HEAD 14MM 352.254S

Facility

$1,536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,305.60
Max. Negotiated Rate	$1,489.92
Rate for Payer: Cash Price	$921.60
Rate for Payer: Health Management Network Commercial	$1,305.60
Rate for Payer: MDX Hawaii PPO	$1,489.92

REAMER HEAD 14MM 352.254S

Facility

$1,536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$783.36
Max. Negotiated Rate	$1,489.92
Rate for Payer: Cash Price	$921.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.20
Rate for Payer: Health Management Network Commercial	$1,305.60
Rate for Payer: Kaiser Permanente Commercial	$967.68
Rate for Payer: Kaiser Permanente Medicaid	$783.36
Rate for Payer: MDX Hawaii PPO	$1,489.92
Rate for Payer: University Health Alliance Commercial	$1,119.59

REAMER LOW PROFILE AR-1408LP

Facility

$768.00

Hospital Revenue Code	272
Min. Negotiated Rate	$391.68
Max. Negotiated Rate	$744.96
Rate for Payer: Cash Price	$460.80
Rate for Payer: Hawaii Western Management Group Commercial	$729.60
Rate for Payer: Health Management Network Commercial	$652.80
Rate for Payer: Kaiser Permanente Commercial	$483.84
Rate for Payer: Kaiser Permanente Medicaid	$391.68
Rate for Payer: MDX Hawaii PPO	$744.96
Rate for Payer: University Health Alliance Commercial	$559.80

REAMER LOW PROFILE AR-1408LP

Facility

$768.00

Hospital Revenue Code	272
Min. Negotiated Rate	$652.80
Max. Negotiated Rate	$744.96
Rate for Payer: Cash Price	$460.80
Rate for Payer: Health Management Network Commercial	$652.80
Rate for Payer: MDX Hawaii PPO	$744.96

REAMING ROD 2.5X850MM 359.083S

Facility

$843.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$429.93
Max. Negotiated Rate	$817.71
Rate for Payer: Cash Price	$505.80
Rate for Payer: Hawaii Western Management Group Commercial	$800.85
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Kaiser Permanente Commercial	$531.09
Rate for Payer: Kaiser Permanente Medicaid	$429.93
Rate for Payer: MDX Hawaii PPO	$817.71
Rate for Payer: University Health Alliance Commercial	$614.46

REAMING ROD 2.5X850MM 359.083S

Facility

$843.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$716.55
Max. Negotiated Rate	$817.71
Rate for Payer: Cash Price	$505.80
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: MDX Hawaii PPO	$817.71

REAMING ROD 2.5X950MM 351.706S

Facility

$518.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$440.30
Max. Negotiated Rate	$502.46
Rate for Payer: Cash Price	$310.80
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: MDX Hawaii PPO	$502.46

REAMING ROD 2.5X950MM 351.706S

Facility

$518.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$264.18
Max. Negotiated Rate	$502.46
Rate for Payer: Cash Price	$310.80
Rate for Payer: Hawaii Western Management Group Commercial	$492.10
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Kaiser Permanente Commercial	$326.34
Rate for Payer: Kaiser Permanente Medicaid	$264.18
Rate for Payer: MDX Hawaii PPO	$502.46
Rate for Payer: University Health Alliance Commercial	$377.57

REAMING ROD 3.0X950MM 351.71S

Facility

$784.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$399.84
Max. Negotiated Rate	$760.48
Rate for Payer: Cash Price	$470.40
Rate for Payer: Hawaii Western Management Group Commercial	$744.80
Rate for Payer: Health Management Network Commercial	$666.40
Rate for Payer: Kaiser Permanente Commercial	$493.92
Rate for Payer: Kaiser Permanente Medicaid	$399.84
Rate for Payer: MDX Hawaii PPO	$760.48
Rate for Payer: University Health Alliance Commercial	$571.46

REAMING ROD 3.0X950MM 351.71S

Facility

$784.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$666.40
Max. Negotiated Rate	$760.48
Rate for Payer: Cash Price	$470.40
Rate for Payer: Health Management Network Commercial	$666.40
Rate for Payer: MDX Hawaii PPO	$760.48

REAMING ROD 3.0X950MM 351.76S

Facility

$1,023.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$521.73
Max. Negotiated Rate	$992.31
Rate for Payer: Cash Price	$613.80
Rate for Payer: Hawaii Western Management Group Commercial	$971.85
Rate for Payer: Health Management Network Commercial	$869.55
Rate for Payer: Kaiser Permanente Commercial	$644.49
Rate for Payer: Kaiser Permanente Medicaid	$521.73
Rate for Payer: MDX Hawaii PPO	$992.31
Rate for Payer: University Health Alliance Commercial	$745.66

REAMING ROD 3.0X950MM 351.76S

Facility

$1,023.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$869.55
Max. Negotiated Rate	$992.31
Rate for Payer: Cash Price	$613.80
Rate for Payer: Health Management Network Commercial	$869.55
Rate for Payer: MDX Hawaii PPO	$992.31

Know your out-of-pocket cost for care.

All Charges