Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CAUTERY L HOOK

Facility

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$118.83
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$139.80
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$146.79
Rate for Payer: Kaiser Permanente Medicaid	$118.83
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: University Health Alliance Commercial	$169.83

CAUTERY PENVAC MEGADYNE

Facility

$218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$185.30
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: MDX Hawaii PPO	$211.46

CAUTERY PENVAC MEGADYNE

Facility

$218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$111.18
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Hawaii Western Management Group Commercial	$207.10
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$137.34
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: University Health Alliance Commercial	$158.90

CAUT HOOK HAND CONTROL

Facility

$191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$114.60
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: MDX Hawaii PPO	$185.27

CAUT HOOK HAND CONTROL

Facility

$191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$97.41
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$114.60
Rate for Payer: Hawaii Western Management Group Commercial	$181.45
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Kaiser Permanente Commercial	$120.33
Rate for Payer: Kaiser Permanente Medicaid	$97.41
Rate for Payer: MDX Hawaii PPO	$185.27
Rate for Payer: University Health Alliance Commercial	$139.22

CAUT HOOK LAP ELECTRODE

Facility

$325.00

Hospital Revenue Code	272
Min. Negotiated Rate	$276.25
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: MDX Hawaii PPO	$315.25

CAUT HOOK LAP ELECTRODE

Facility

$325.00

Hospital Revenue Code	272
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$195.00
Rate for Payer: Hawaii Western Management Group Commercial	$308.75
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Kaiser Permanente Commercial	$204.75
Rate for Payer: Kaiser Permanente Medicaid	$165.75
Rate for Payer: MDX Hawaii PPO	$315.25
Rate for Payer: University Health Alliance Commercial	$236.89

CAUT LIGASURE 5MM BLUNT

Facility

$1,507.00

Hospital Revenue Code	272
Min. Negotiated Rate	$768.57
Max. Negotiated Rate	$1,461.79
Rate for Payer: Cash Price	$904.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,431.65
Rate for Payer: Health Management Network Commercial	$1,280.95
Rate for Payer: Kaiser Permanente Commercial	$949.41
Rate for Payer: Kaiser Permanente Medicaid	$768.57
Rate for Payer: MDX Hawaii PPO	$1,461.79
Rate for Payer: University Health Alliance Commercial	$1,098.45

CAUT LIGASURE 5MM BLUNT

Facility

$1,507.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,280.95
Max. Negotiated Rate	$1,461.79
Rate for Payer: Cash Price	$904.20
Rate for Payer: Health Management Network Commercial	$1,280.95
Rate for Payer: MDX Hawaii PPO	$1,461.79

CAUT LIGASURE ATLAS HANDHELD

Facility

$1,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,356.60
Max. Negotiated Rate	$1,548.12
Rate for Payer: Cash Price	$957.60
Rate for Payer: Health Management Network Commercial	$1,356.60
Rate for Payer: MDX Hawaii PPO	$1,548.12

CAUT LIGASURE ATLAS HANDHELD

Facility

$1,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$813.96
Max. Negotiated Rate	$1,548.12
Rate for Payer: Cash Price	$957.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,516.20
Rate for Payer: Health Management Network Commercial	$1,356.60
Rate for Payer: Kaiser Permanente Commercial	$1,005.48
Rate for Payer: Kaiser Permanente Medicaid	$813.96
Rate for Payer: MDX Hawaii PPO	$1,548.12
Rate for Payer: University Health Alliance Commercial	$1,163.32

CAUT SURGIWAND II 5M

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: MDX Hawaii PPO	$329.80

CAUT SURGIWAND II 5M

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Hawaii Western Management Group Commercial	$323.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: University Health Alliance Commercial	$247.83

CEFAZOLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [160202]

Facility

$42.00

Service Code	HCPCS J0689
Hospital Revenue Code	250
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$25.20
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: MDX Hawaii PPO	$40.74

CEFAZOLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [160202]

Facility

$42.00

Service Code	HCPCS J0689
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Hawaii Medical Service Association ABD	$1.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.33
Rate for Payer: Hawaii Western Management Group Commercial	$39.90
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Kaiser Permanente Commercial	$26.46
Rate for Payer: Kaiser Permanente Medicaid	$21.42
Rate for Payer: MDX Hawaii PPO	$40.74
Rate for Payer: UnitedHealthcare Medicaid	$25.20
Rate for Payer: University Health Alliance Commercial	$30.61

CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]

Facility

$5.00

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: MDX Hawaii PPO	$4.85

CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]

Facility

$6.00

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Commercial	$3.15
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: UnitedHealthcare Medicaid	$3.00
Rate for Payer: UnitedHealthcare Medicaid	$3.60
Rate for Payer: University Health Alliance Commercial	$3.64
Rate for Payer: University Health Alliance Commercial	$4.37

CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [163119]

Facility

$47.00

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Cash Price	$28.20
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$44.65
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Kaiser Permanente Commercial	$29.61
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: UnitedHealthcare Medicaid	$28.20
Rate for Payer: University Health Alliance Commercial	$34.26

CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [163119]

Facility

$47.00

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$45.59

CEFAZOLIN 2 GRAM SOLUTION FOR INJECTION [183731]

Facility

$22.00

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$13.20
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$13.86
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: University Health Alliance Commercial	$16.04

CEFAZOLIN 2 GRAM SOLUTION FOR INJECTION [183731]

Facility

$22.00

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: MDX Hawaii PPO	$21.34

CEFAZOLIN 3 G IN 100 ML NS - ADD-A-VIAL (SIMPLE) [4080010]

Facility

$38.00

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Cash Price	$22.80
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$36.10
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$23.94
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: UnitedHealthcare Medicaid	$22.80
Rate for Payer: University Health Alliance Commercial	$27.70

CEFAZOLIN 3 G IN 100 ML NS - ADD-A-VIAL (SIMPLE) [4080010]

Facility

$38.00

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$36.86

CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION [191108]

Facility

$32.00

Service Code	HCPCS J0688
Hospital Revenue Code	250
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: MDX Hawaii PPO	$31.04

CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION [191108]

Facility

$22.00

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: MDX Hawaii PPO	$21.34

Know your out-of-pocket cost for care.

All Charges