Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

ROD EX-FIX 11X250MM 394.84

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$553.35
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,030.75
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$683.55
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: University Health Alliance Commercial	$790.86

ROD EX-FIX 11X250MM 394.84

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$922.25
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: MDX Hawaii PPO	$1,052.45

ROD EX-FIX 11X300MM 394.85

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$553.35
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,030.75
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$683.55
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: University Health Alliance Commercial	$790.86

ROD EX-FIX 11X300MM 394.85

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$922.25
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: MDX Hawaii PPO	$1,052.45

ROD EX-FIX 11X350MM 394.86

Facility

$1,085.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$607.60
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Hawaii Western Management Group Commercial	$759.50
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: University Health Alliance Commercial	$607.60

ROD EX-FIX 11X350MM 394.86

Facility

$1,085.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$553.35
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Hawaii Western Management Group Commercial	$759.50
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$683.55
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: University Health Alliance Commercial	$607.60

ROD EX-FIX 11X400MM 394.87

Facility

$1,191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,012.35
Max. Negotiated Rate	$1,155.27
Rate for Payer: Cash Price	$714.60
Rate for Payer: Health Management Network Commercial	$1,012.35
Rate for Payer: MDX Hawaii PPO	$1,155.27

ROD EX-FIX 11X400MM 394.87

Facility

$1,191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$607.41
Max. Negotiated Rate	$1,155.27
Rate for Payer: Cash Price	$714.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.45
Rate for Payer: Health Management Network Commercial	$1,012.35
Rate for Payer: Kaiser Permanente Commercial	$750.33
Rate for Payer: Kaiser Permanente Medicaid	$607.41
Rate for Payer: MDX Hawaii PPO	$1,155.27
Rate for Payer: University Health Alliance Commercial	$868.12

ROD EXTERN FIX CONNECT 200MM

Facility

$1,279.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$716.24
Max. Negotiated Rate	$1,240.63
Rate for Payer: Cash Price	$767.40
Rate for Payer: Hawaii Western Management Group Commercial	$895.30
Rate for Payer: Health Management Network Commercial	$1,087.15
Rate for Payer: MDX Hawaii PPO	$1,240.63
Rate for Payer: University Health Alliance Commercial	$716.24

ROD EXTERN FIX CONNECT 200MM

Facility

$1,279.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$652.29
Max. Negotiated Rate	$1,240.63
Rate for Payer: Cash Price	$767.40
Rate for Payer: Hawaii Western Management Group Commercial	$895.30
Rate for Payer: Health Management Network Commercial	$1,087.15
Rate for Payer: Kaiser Permanente Commercial	$805.77
Rate for Payer: Kaiser Permanente Medicaid	$652.29
Rate for Payer: MDX Hawaii PPO	$1,240.63
Rate for Payer: University Health Alliance Commercial	$716.24

ROD FIBER 8.0X120 395.780

Facility

$735.00

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 FIBER 8.0X120 395.780

Facility

$735.00

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 REAMING 3.0, 950MM

Facility

$709.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$361.59
Max. Negotiated Rate	$687.73
Rate for Payer: Cash Price	$425.40
Rate for Payer: Hawaii Western Management Group Commercial	$673.55
Rate for Payer: Health Management Network Commercial	$602.65
Rate for Payer: Kaiser Permanente Commercial	$446.67
Rate for Payer: Kaiser Permanente Medicaid	$361.59
Rate for Payer: MDX Hawaii PPO	$687.73
Rate for Payer: University Health Alliance Commercial	$516.79

ROD REAMING 3.0, 950MM

Facility

$709.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$602.65
Max. Negotiated Rate	$687.73
Rate for Payer: Cash Price	$425.40
Rate for Payer: Health Management Network Commercial	$602.65
Rate for Payer: MDX Hawaii PPO	$687.73

RODS 8MM 500MM 5028-8-500

Facility

$1,399.00

Hospital Revenue Code	278
Min. Negotiated Rate	$783.44
Max. Negotiated Rate	$1,357.03
Rate for Payer: Cash Price	$839.40
Rate for Payer: Hawaii Western Management Group Commercial	$979.30
Rate for Payer: Health Management Network Commercial	$1,189.15
Rate for Payer: MDX Hawaii PPO	$1,357.03
Rate for Payer: University Health Alliance Commercial	$783.44

RODS 8MM 500MM 5028-8-500

Facility

$1,399.00

Hospital Revenue Code	278
Min. Negotiated Rate	$713.49
Max. Negotiated Rate	$1,357.03
Rate for Payer: Cash Price	$839.40
Rate for Payer: Hawaii Western Management Group Commercial	$979.30
Rate for Payer: Health Management Network Commercial	$1,189.15
Rate for Payer: Kaiser Permanente Commercial	$881.37
Rate for Payer: Kaiser Permanente Medicaid	$713.49
Rate for Payer: MDX Hawaii PPO	$1,357.03
Rate for Payer: University Health Alliance Commercial	$783.44

ROD THREADED 115MM 55-10060

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25

ROD THREADED 115MM 55-10060

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: University Health Alliance Commercial	$164.00

ROD TL THREADED 100MM 51-10310

Facility

$376.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.76
Max. Negotiated Rate	$364.72
Rate for Payer: Cash Price	$225.60
Rate for Payer: Hawaii Western Management Group Commercial	$357.20
Rate for Payer: Health Management Network Commercial	$319.60
Rate for Payer: Kaiser Permanente Commercial	$236.88
Rate for Payer: Kaiser Permanente Medicaid	$191.76
Rate for Payer: MDX Hawaii PPO	$364.72
Rate for Payer: University Health Alliance Commercial	$274.07

ROD TL THREADED 100MM 51-10310

Facility

$376.00

Hospital Revenue Code	272
Min. Negotiated Rate	$319.60
Max. Negotiated Rate	$364.72
Rate for Payer: Cash Price	$225.60
Rate for Payer: Health Management Network Commercial	$319.60
Rate for Payer: MDX Hawaii PPO	$364.72

ROD TL THREADED 150MM 51-10550

Facility

$252.00

Hospital Revenue Code	272
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$244.44
Rate for Payer: Cash Price	$151.20
Rate for Payer: Health Management Network Commercial	$214.20
Rate for Payer: MDX Hawaii PPO	$244.44

ROD TL THREADED 150MM 51-10550

Facility

$252.00

Hospital Revenue Code	272
Min. Negotiated Rate	$128.52
Max. Negotiated Rate	$244.44
Rate for Payer: Cash Price	$151.20
Rate for Payer: Hawaii Western Management Group Commercial	$239.40
Rate for Payer: Health Management Network Commercial	$214.20
Rate for Payer: Kaiser Permanente Commercial	$158.76
Rate for Payer: Kaiser Permanente Medicaid	$128.52
Rate for Payer: MDX Hawaii PPO	$244.44
Rate for Payer: University Health Alliance Commercial	$183.68

ROLLER BALL ELECTRODE 24F #RE

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

ROLLER BALL ELECTRODE 24F #RE

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

ROMIPLOSTIM 250 MCG/0.5ML SC (WET SOLR VIAL) [43093566]

Facility

$1,069.00

Service Code	HCPCS J2796
Hospital Revenue Code	636
Min. Negotiated Rate	$101.05
Max. Negotiated Rate	$1,036.93
Rate for Payer: Cash Price	$641.40
Rate for Payer: Cash Price	$641.40
Rate for Payer: Cash Price	$2,282.40
Rate for Payer: Cash Price	$2,282.40
Rate for Payer: Hawaii Medical Service Association ABD	$101.05
Rate for Payer: Hawaii Medical Service Association ABD	$101.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$101.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$101.05
Rate for Payer: Hawaii Western Management Group Commercial	$3,613.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,015.55
Rate for Payer: Health Management Network Commercial	$908.65
Rate for Payer: Health Management Network Commercial	$3,233.40
Rate for Payer: Kaiser Permanente Commercial	$2,396.52
Rate for Payer: Kaiser Permanente Commercial	$673.47
Rate for Payer: Kaiser Permanente Medicaid	$545.19
Rate for Payer: Kaiser Permanente Medicaid	$1,940.04
Rate for Payer: MDX Hawaii PPO	$1,036.93
Rate for Payer: MDX Hawaii PPO	$3,689.88
Rate for Payer: UnitedHealthcare Medicaid	$2,282.40
Rate for Payer: UnitedHealthcare Medicaid	$641.40
Rate for Payer: University Health Alliance Commercial	$779.19
Rate for Payer: University Health Alliance Commercial	$2,772.74

Know your out-of-pocket cost for care.

All Charges