Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

VIABAHN VBX EX BAL BXA073901A

Facility

$6,510.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,320.10
Max. Negotiated Rate	$6,314.70
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,557.00
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: Kaiser Permanente Commercial	$4,101.30
Rate for Payer: Kaiser Permanente Medicaid	$3,320.10
Rate for Payer: MDX Hawaii PPO	$6,314.70
Rate for Payer: University Health Alliance Commercial	$3,645.60

VIABAHN VBX EX BAL BXA075902A

Facility

$6,510.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,645.60
Max. Negotiated Rate	$6,314.70
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,557.00
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: MDX Hawaii PPO	$6,314.70
Rate for Payer: University Health Alliance Commercial	$3,645.60

VIABAHN VBX EX BAL BXA075902A

Facility

$6,510.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,320.10
Max. Negotiated Rate	$6,314.70
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,557.00
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: Kaiser Permanente Commercial	$4,101.30
Rate for Payer: Kaiser Permanente Medicaid	$3,320.10
Rate for Payer: MDX Hawaii PPO	$6,314.70
Rate for Payer: University Health Alliance Commercial	$3,645.60

VIABAHN VBX EX BAL BXA077901A

Facility

$7,140.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,641.40
Max. Negotiated Rate	$6,925.80
Rate for Payer: Cash Price	$4,284.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,998.00
Rate for Payer: Health Management Network Commercial	$6,069.00
Rate for Payer: Kaiser Permanente Commercial	$4,498.20
Rate for Payer: Kaiser Permanente Medicaid	$3,641.40
Rate for Payer: MDX Hawaii PPO	$6,925.80
Rate for Payer: University Health Alliance Commercial	$3,998.40

VIABAHN VBX EX BAL BXA077901A

Facility

$7,140.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,998.40
Max. Negotiated Rate	$6,925.80
Rate for Payer: Cash Price	$4,284.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,998.00
Rate for Payer: Health Management Network Commercial	$6,069.00
Rate for Payer: MDX Hawaii PPO	$6,925.80
Rate for Payer: University Health Alliance Commercial	$3,998.40

VIABAHN VBX EX BAL BXA097902A

Facility

$7,688.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,305.28
Max. Negotiated Rate	$7,457.36
Rate for Payer: Cash Price	$4,612.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,381.60
Rate for Payer: Health Management Network Commercial	$6,534.80
Rate for Payer: MDX Hawaii PPO	$7,457.36
Rate for Payer: University Health Alliance Commercial	$4,305.28

VIABAHN VBX EX BAL BXA097902A

Facility

$7,688.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,920.88
Max. Negotiated Rate	$7,457.36
Rate for Payer: Cash Price	$4,612.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,381.60
Rate for Payer: Health Management Network Commercial	$6,534.80
Rate for Payer: Kaiser Permanente Commercial	$4,843.44
Rate for Payer: Kaiser Permanente Medicaid	$3,920.88
Rate for Payer: MDX Hawaii PPO	$7,457.36
Rate for Payer: University Health Alliance Commercial	$4,305.28

VIABAHN VBX EX BAL BXA115901A

Facility

$7,148.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,002.88
Max. Negotiated Rate	$6,933.56
Rate for Payer: Cash Price	$4,288.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,003.60
Rate for Payer: Health Management Network Commercial	$6,075.80
Rate for Payer: MDX Hawaii PPO	$6,933.56
Rate for Payer: University Health Alliance Commercial	$4,002.88

VIABAHN VBX EX BAL BXA115901A

Facility

$7,148.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,645.48
Max. Negotiated Rate	$6,933.56
Rate for Payer: Cash Price	$4,288.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,003.60
Rate for Payer: Health Management Network Commercial	$6,075.80
Rate for Payer: Kaiser Permanente Commercial	$4,503.24
Rate for Payer: Kaiser Permanente Medicaid	$3,645.48
Rate for Payer: MDX Hawaii PPO	$6,933.56
Rate for Payer: University Health Alliance Commercial	$4,002.88

VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]

Facility

$194.00

Service Code	HCPCS J9360
Hospital Revenue Code	250
Min. Negotiated Rate	$164.90
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$116.40
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: MDX Hawaii PPO	$56.26

VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]

Facility

$58.00

Service Code	HCPCS J9360
Hospital Revenue Code	636
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Cash Price	$116.40
Rate for Payer: Cash Price	$116.40
Rate for Payer: Cash Price	$34.80
Rate for Payer: Hawaii Medical Service Association ABD	$5.29
Rate for Payer: Hawaii Medical Service Association ABD	$5.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.29
Rate for Payer: Hawaii Western Management Group Commercial	$184.30
Rate for Payer: Hawaii Western Management Group Commercial	$55.10
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Kaiser Permanente Commercial	$36.54
Rate for Payer: Kaiser Permanente Commercial	$122.22
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: UnitedHealthcare Medicaid	$34.80
Rate for Payer: UnitedHealthcare Medicaid	$116.40
Rate for Payer: University Health Alliance Commercial	$42.28
Rate for Payer: University Health Alliance Commercial	$141.41

VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]

Facility

$54.00

Service Code	HCPCS J9370
Hospital Revenue Code	250
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$32.40
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$52.38

VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]

Facility

$54.00

Service Code	HCPCS J9370
Hospital Revenue Code	636
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Hawaii Medical Service Association ABD	$7.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.86
Rate for Payer: Hawaii Western Management Group Commercial	$51.30
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: Kaiser Permanente Commercial	$34.02
Rate for Payer: Kaiser Permanente Medicaid	$27.54
Rate for Payer: MDX Hawaii PPO	$52.38
Rate for Payer: UnitedHealthcare Medicaid	$32.40
Rate for Payer: University Health Alliance Commercial	$39.36

VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [199441]

Facility

$47.00

Service Code	HCPCS J9370
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

VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [199441]

Facility

$47.00

Service Code	HCPCS J9370
Hospital Revenue Code	636
Min. Negotiated Rate	$7.86
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	$7.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.86
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

VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]

Facility

$160.00

Service Code	HCPCS J9390
Hospital Revenue Code	636
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: Hawaii Medical Service Association ABD	$1.96
Rate for Payer: Hawaii Medical Service Association ABD	$1.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.96
Rate for Payer: Hawaii Western Management Group Commercial	$152.00
Rate for Payer: Hawaii Western Management Group Commercial	$256.50
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Health Management Network Commercial	$229.50
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Commercial	$170.10
Rate for Payer: Kaiser Permanente Medicaid	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: MDX Hawaii PPO	$261.90
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: UnitedHealthcare Medicaid	$96.00
Rate for Payer: UnitedHealthcare Medicaid	$162.00
Rate for Payer: University Health Alliance Commercial	$116.62
Rate for Payer: University Health Alliance Commercial	$196.80

VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]

Facility

$270.00

Service Code	HCPCS J9390
Hospital Revenue Code	250
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$261.90
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Health Management Network Commercial	$229.50
Rate for Payer: MDX Hawaii PPO	$261.90
Rate for Payer: MDX Hawaii PPO	$155.20

VIRAL ILLNESS

Facility

$2,011.62

Service Code	APR-DRG 7231
Min. Negotiated Rate	$2,011.62
Max. Negotiated Rate	$2,011.62
Rate for Payer: AlohaCare Medicaid	$2,011.62
Rate for Payer: Hawaii Medical Service Association ABD	$2,011.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,011.62
Rate for Payer: Kaiser Permanente Medicaid	$2,011.62
Rate for Payer: Ohana Health Plan Medicaid	$2,011.62
Rate for Payer: UnitedHealthcare Medicaid	$2,011.62

VIRAL ILLNESS

Facility

$4,230.02

Service Code	APR-DRG 7233
Min. Negotiated Rate	$4,230.02
Max. Negotiated Rate	$4,230.02
Rate for Payer: AlohaCare Medicaid	$4,230.02
Rate for Payer: Hawaii Medical Service Association ABD	$4,230.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,230.02
Rate for Payer: Kaiser Permanente Medicaid	$4,230.02
Rate for Payer: Ohana Health Plan Medicaid	$4,230.02
Rate for Payer: UnitedHealthcare Medicaid	$4,230.02

VIRAL ILLNESS

Facility

$9,083.61

Service Code	APR-DRG 7234
Min. Negotiated Rate	$9,083.61
Max. Negotiated Rate	$9,083.61
Rate for Payer: AlohaCare Medicaid	$9,083.61
Rate for Payer: Hawaii Medical Service Association ABD	$9,083.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,083.61
Rate for Payer: Kaiser Permanente Medicaid	$9,083.61
Rate for Payer: Ohana Health Plan Medicaid	$9,083.61
Rate for Payer: UnitedHealthcare Medicaid	$9,083.61

VIRAL ILLNESS

Facility

$2,819.79

Service Code	APR-DRG 7232
Min. Negotiated Rate	$2,819.79
Max. Negotiated Rate	$2,819.79
Rate for Payer: AlohaCare Medicaid	$2,819.79
Rate for Payer: Hawaii Medical Service Association ABD	$2,819.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,819.79
Rate for Payer: Kaiser Permanente Medicaid	$2,819.79
Rate for Payer: Ohana Health Plan Medicaid	$2,819.79
Rate for Payer: UnitedHealthcare Medicaid	$2,819.79

VIRAL ILLNESS WITH MCC

Facility

$25,845.67

Service Code	MSDRG 865
Min. Negotiated Rate	$17,042.04
Max. Negotiated Rate	$25,845.67
Rate for Payer: AlohaCare Medicare	$17,042.04
Rate for Payer: Devoted Health Medicare	$18,746.24
Rate for Payer: Hawaii Medical Service Association Commercial	$24,921.18
Rate for Payer: Hawaii Medical Service Association Medicare	$17,042.04
Rate for Payer: Humana Medicare	$17,042.04
Rate for Payer: Kaiser Permanente Commercial	$25,845.67
Rate for Payer: Kaiser Permanente Medicare	$17,042.04
Rate for Payer: Ohana Health Plan Medicare	$17,042.04
Rate for Payer: UnitedHealthcare Medicare	$17,042.04

VIRAL ILLNESS WITHOUT MCC

Facility

$23,368.16

Service Code	MSDRG 866
Min. Negotiated Rate	$9,891.06
Max. Negotiated Rate	$23,368.16
Rate for Payer: AlohaCare Medicare	$9,891.06
Rate for Payer: Devoted Health Medicare	$10,880.17
Rate for Payer: Hawaii Medical Service Association Commercial	$23,368.16
Rate for Payer: Hawaii Medical Service Association Medicare	$9,891.06
Rate for Payer: Humana Medicare	$9,891.06
Rate for Payer: Kaiser Permanente Commercial	$15,000.60
Rate for Payer: Kaiser Permanente Medicare	$9,891.06
Rate for Payer: Ohana Health Plan Medicare	$9,891.06
Rate for Payer: UnitedHealthcare Medicare	$9,891.06

VIRAL MENINGITIS

Facility

$3,798.86

Service Code	APR-DRG 0512
Min. Negotiated Rate	$3,798.86
Max. Negotiated Rate	$3,798.86
Rate for Payer: AlohaCare Medicaid	$3,798.86
Rate for Payer: Hawaii Medical Service Association ABD	$3,798.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,798.86
Rate for Payer: Kaiser Permanente Medicaid	$3,798.86
Rate for Payer: Ohana Health Plan Medicaid	$3,798.86
Rate for Payer: UnitedHealthcare Medicaid	$3,798.86

VIRAL MENINGITIS

Facility

$6,824.77

Service Code	APR-DRG 0513
Min. Negotiated Rate	$6,824.77
Max. Negotiated Rate	$6,824.77
Rate for Payer: AlohaCare Medicaid	$6,824.77
Rate for Payer: Hawaii Medical Service Association ABD	$6,824.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,824.77
Rate for Payer: Kaiser Permanente Medicaid	$6,824.77
Rate for Payer: Ohana Health Plan Medicaid	$6,824.77
Rate for Payer: UnitedHealthcare Medicaid	$6,824.77

Know your out-of-pocket cost for care.

All Charges