Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$43.00

Service Code	NDC 00781730458
Hospital Revenue Code	637
Min. Negotiated Rate	$21.93
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$27.09
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: University Health Alliance Commercial	$31.34

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$43.00

Service Code	NDC 00781730458
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: MDX Hawaii PPO	$41.71

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730931
Hospital Revenue Code	637
Min. Negotiated Rate	$21.93
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$27.09
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: University Health Alliance Commercial	$31.34

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730958
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: MDX Hawaii PPO	$41.71

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730958
Hospital Revenue Code	637
Min. Negotiated Rate	$21.93
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$27.09
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: University Health Alliance Commercial	$31.34

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730931
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: MDX Hawaii PPO	$41.71

R MEDIUM 3D MAX LIGHT MESH

Facility

$1,233.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$690.48
Max. Negotiated Rate	$1,196.01
Rate for Payer: Cash Price	$739.80
Rate for Payer: Hawaii Western Management Group Commercial	$863.10
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: University Health Alliance Commercial	$690.48

R MEDIUM 3D MAX LIGHT MESH

Facility

$1,233.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$628.83
Max. Negotiated Rate	$1,196.01
Rate for Payer: Cash Price	$739.80
Rate for Payer: Hawaii Western Management Group Commercial	$863.10
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Kaiser Permanente Commercial	$776.79
Rate for Payer: Kaiser Permanente Medicaid	$628.83
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: University Health Alliance Commercial	$690.48

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95811]

Facility

$16.00

Service Code	NDC 00409318910
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: MDX Hawaii PPO	$15.52

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95811]

Facility

$16.00

Service Code	NDC 00409318905
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: MDX Hawaii PPO	$15.52

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95811]

Facility

$34.00

Service Code	NDC 71288071811
Hospital Revenue Code	250
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: MDX Hawaii PPO	$32.98

ROD 11MM X 500MM

Facility

$1,713.00

Hospital Revenue Code	278
Min. Negotiated Rate	$873.63
Max. Negotiated Rate	$1,661.61
Rate for Payer: Cash Price	$1,027.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,199.10
Rate for Payer: Health Management Network Commercial	$1,456.05
Rate for Payer: Kaiser Permanente Commercial	$1,079.19
Rate for Payer: Kaiser Permanente Medicaid	$873.63
Rate for Payer: MDX Hawaii PPO	$1,661.61
Rate for Payer: University Health Alliance Commercial	$959.28

ROD 11MM X 500MM

Facility

$1,713.00

Hospital Revenue Code	278
Min. Negotiated Rate	$959.28
Max. Negotiated Rate	$1,661.61
Rate for Payer: Cash Price	$1,027.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,199.10
Rate for Payer: Health Management Network Commercial	$1,456.05
Rate for Payer: MDX Hawaii PPO	$1,661.61
Rate for Payer: University Health Alliance Commercial	$959.28

ROD 11X450MM 4922-8-450

Facility

$1,502.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,276.70
Max. Negotiated Rate	$1,456.94
Rate for Payer: Cash Price	$901.20
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: MDX Hawaii PPO	$1,456.94

ROD 11X450MM 4922-8-450

Facility

$1,502.00

Hospital Revenue Code	272
Min. Negotiated Rate	$766.02
Max. Negotiated Rate	$1,456.94
Rate for Payer: Cash Price	$901.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,426.90
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Kaiser Permanente Commercial	$946.26
Rate for Payer: Kaiser Permanente Medicaid	$766.02
Rate for Payer: MDX Hawaii PPO	$1,456.94
Rate for Payer: University Health Alliance Commercial	$1,094.81

ROD ATTCHMT MULTI PIN 390.003

Facility

$1,617.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$824.67
Max. Negotiated Rate	$1,568.49
Rate for Payer: Cash Price	$970.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.90
Rate for Payer: Health Management Network Commercial	$1,374.45
Rate for Payer: Kaiser Permanente Commercial	$1,018.71
Rate for Payer: Kaiser Permanente Medicaid	$824.67
Rate for Payer: MDX Hawaii PPO	$1,568.49
Rate for Payer: University Health Alliance Commercial	$905.52

ROD ATTCHMT MULTI PIN 390.003

Facility

$1,617.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$905.52
Max. Negotiated Rate	$1,568.49
Rate for Payer: Cash Price	$970.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.90
Rate for Payer: Health Management Network Commercial	$1,374.45
Rate for Payer: MDX Hawaii PPO	$1,568.49
Rate for Payer: University Health Alliance Commercial	$905.52

ROD CARBON FIBER 8.0M #395.792

Facility

$735.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$712.95
Rate for Payer: Cash Price	$441.00
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: MDX Hawaii PPO	$712.95

ROD CARBON FIBER 8.0M #395.792

Facility

$735.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$374.85
Max. Negotiated Rate	$712.95
Rate for Payer: Cash Price	$441.00
Rate for Payer: Hawaii Western Management Group Commercial	$698.25
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Kaiser Permanente Commercial	$463.05
Rate for Payer: Kaiser Permanente Medicaid	$374.85
Rate for Payer: MDX Hawaii PPO	$712.95
Rate for Payer: University Health Alliance Commercial	$535.74

ROD CONNECTING 4922-8-350

Facility

$1,312.00

Hospital Revenue Code	272
Min. Negotiated Rate	$669.12
Max. Negotiated Rate	$1,272.64
Rate for Payer: Cash Price	$787.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,246.40
Rate for Payer: Health Management Network Commercial	$1,115.20
Rate for Payer: Kaiser Permanente Commercial	$826.56
Rate for Payer: Kaiser Permanente Medicaid	$669.12
Rate for Payer: MDX Hawaii PPO	$1,272.64
Rate for Payer: University Health Alliance Commercial	$956.32

ROD CONNECTING 4922-8-350

Facility

$1,312.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,115.20
Max. Negotiated Rate	$1,272.64
Rate for Payer: Cash Price	$787.20
Rate for Payer: Health Management Network Commercial	$1,115.20
Rate for Payer: MDX Hawaii PPO	$1,272.64

ROD EX-FIX 11X150MM 394.82

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$860.20
Max. Negotiated Rate	$981.64
Rate for Payer: Cash Price	$607.20
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: MDX Hawaii PPO	$981.64

ROD EX-FIX 11X150MM 394.82

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$516.12
Max. Negotiated Rate	$981.64
Rate for Payer: Cash Price	$607.20
Rate for Payer: Hawaii Western Management Group Commercial	$961.40
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: Kaiser Permanente Commercial	$637.56
Rate for Payer: Kaiser Permanente Medicaid	$516.12
Rate for Payer: MDX Hawaii PPO	$981.64
Rate for Payer: University Health Alliance Commercial	$737.65

ROD EX-FIX 11X200MM 394.83

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$516.12
Max. Negotiated Rate	$981.64
Rate for Payer: Cash Price	$607.20
Rate for Payer: Hawaii Western Management Group Commercial	$961.40
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: Kaiser Permanente Commercial	$637.56
Rate for Payer: Kaiser Permanente Medicaid	$516.12
Rate for Payer: MDX Hawaii PPO	$981.64
Rate for Payer: University Health Alliance Commercial	$737.65

ROD EX-FIX 11X200MM 394.83

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$860.20
Max. Negotiated Rate	$981.64
Rate for Payer: Cash Price	$607.20
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: MDX Hawaii PPO	$981.64

Know your out-of-pocket cost for care.

All Charges