Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility

$17,325.92

Service Code	MSDRG 788
Min. Negotiated Rate	$10,905.64
Max. Negotiated Rate	$17,325.92
Rate for Payer: AlohaCare Medicare	$10,905.64
Rate for Payer: Devoted Health Medicare	$11,996.20
Rate for Payer: Hawaii Medical Service Association Commercial	$17,325.92
Rate for Payer: Hawaii Medical Service Association Medicare	$10,905.64
Rate for Payer: Humana Medicare	$10,905.64
Rate for Payer: Kaiser Permanente Commercial	$16,539.30
Rate for Payer: Kaiser Permanente Medicare	$10,905.64
Rate for Payer: Ohana Health Plan Medicare	$10,905.64
Rate for Payer: UnitedHealthcare Medicare	$10,905.64

CESAREAN SECTION WITH STERILIZATION WITH CC

Facility

$19,558.40

Service Code	MSDRG 784
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,558.40
Rate for Payer: AlohaCare Medicare	$12,057.84
Rate for Payer: Devoted Health Medicare	$13,263.62
Rate for Payer: Hawaii Medical Service Association Commercial	$19,558.40
Rate for Payer: Hawaii Medical Service Association Medicare	$12,057.84
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: Humana Medicare	$12,057.84
Rate for Payer: Kaiser Permanente Commercial	$16,235.00
Rate for Payer: Kaiser Permanente Medicare	$12,057.84
Rate for Payer: Ohana Health Plan Medicare	$12,057.84
Rate for Payer: UnitedHealthcare Medicare	$12,057.84
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility

$30,717.42

Service Code	MSDRG 783
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$30,717.42
Rate for Payer: AlohaCare Medicare	$27,924.93
Rate for Payer: Devoted Health Medicare	$30,717.42
Rate for Payer: Hawaii Medical Service Association Commercial	$19,558.40
Rate for Payer: Hawaii Medical Service Association Medicare	$27,924.93
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: Humana Medicare	$27,924.93
Rate for Payer: Kaiser Permanente Commercial	$16,235.00
Rate for Payer: Kaiser Permanente Medicare	$27,924.93
Rate for Payer: Ohana Health Plan Medicare	$27,924.93
Rate for Payer: UnitedHealthcare Medicare	$27,924.93
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility

$17,325.92

Service Code	MSDRG 785
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$17,325.92
Rate for Payer: AlohaCare Medicare	$10,894.25
Rate for Payer: Devoted Health Medicare	$11,983.67
Rate for Payer: Hawaii Medical Service Association Commercial	$17,325.92
Rate for Payer: Hawaii Medical Service Association Medicare	$10,894.25
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: Humana Medicare	$10,894.25
Rate for Payer: Kaiser Permanente Commercial	$16,235.00
Rate for Payer: Kaiser Permanente Medicare	$10,894.25
Rate for Payer: Ohana Health Plan Medicare	$10,894.25
Rate for Payer: UnitedHealthcare Medicare	$10,894.25
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION W/O STERILIZATION

Facility

$4,249.42

Service Code	APR-DRG 5401
Min. Negotiated Rate	$4,249.42
Max. Negotiated Rate	$4,249.42
Rate for Payer: AlohaCare Medicaid	$4,249.42
Rate for Payer: Hawaii Medical Service Association ABD	$4,249.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,249.42
Rate for Payer: Kaiser Permanente Medicaid	$4,249.42
Rate for Payer: Ohana Health Plan Medicaid	$4,249.42
Rate for Payer: UnitedHealthcare Medicaid	$4,249.42

CESAREAN SECTION W/O STERILIZATION

Facility

$10,308.88

Service Code	APR-DRG 5404
Min. Negotiated Rate	$10,308.88
Max. Negotiated Rate	$10,308.88
Rate for Payer: AlohaCare Medicaid	$10,308.88
Rate for Payer: Hawaii Medical Service Association ABD	$10,308.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,308.88
Rate for Payer: Kaiser Permanente Medicaid	$10,308.88
Rate for Payer: Ohana Health Plan Medicaid	$10,308.88
Rate for Payer: UnitedHealthcare Medicaid	$10,308.88

CESAREAN SECTION W/O STERILIZATION

Facility

$5,073.80

Service Code	APR-DRG 5402
Min. Negotiated Rate	$5,073.80
Max. Negotiated Rate	$5,073.80
Rate for Payer: AlohaCare Medicaid	$5,073.80
Rate for Payer: Hawaii Medical Service Association ABD	$5,073.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,073.80
Rate for Payer: Kaiser Permanente Medicaid	$5,073.80
Rate for Payer: Ohana Health Plan Medicaid	$5,073.80
Rate for Payer: UnitedHealthcare Medicaid	$5,073.80

CESAREAN SECTION W/O STERILIZATION

Facility

$6,411.26

Service Code	APR-DRG 5403
Min. Negotiated Rate	$6,411.26
Max. Negotiated Rate	$6,411.26
Rate for Payer: AlohaCare Medicaid	$6,411.26
Rate for Payer: Hawaii Medical Service Association ABD	$6,411.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,411.26
Rate for Payer: Kaiser Permanente Medicaid	$6,411.26
Rate for Payer: Ohana Health Plan Medicaid	$6,411.26
Rate for Payer: UnitedHealthcare Medicaid	$6,411.26

CESAREAN SECTION W STERILIZATION

Facility

$13,056.56

Service Code	APR-DRG 5394
Min. Negotiated Rate	$13,056.56
Max. Negotiated Rate	$13,056.56
Rate for Payer: AlohaCare Medicaid	$13,056.56
Rate for Payer: Hawaii Medical Service Association ABD	$13,056.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,056.56
Rate for Payer: Kaiser Permanente Medicaid	$13,056.56
Rate for Payer: Ohana Health Plan Medicaid	$13,056.56
Rate for Payer: UnitedHealthcare Medicaid	$13,056.56

CESAREAN SECTION W STERILIZATION

Facility

$4,338.69

Service Code	APR-DRG 5391
Min. Negotiated Rate	$4,338.69
Max. Negotiated Rate	$4,338.69
Rate for Payer: AlohaCare Medicaid	$4,338.69
Rate for Payer: Hawaii Medical Service Association ABD	$4,338.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,338.69
Rate for Payer: Kaiser Permanente Medicaid	$4,338.69
Rate for Payer: Ohana Health Plan Medicaid	$4,338.69
Rate for Payer: UnitedHealthcare Medicaid	$4,338.69

CESAREAN SECTION W STERILIZATION

Facility

$6,815.58

Service Code	APR-DRG 5393
Min. Negotiated Rate	$6,815.58
Max. Negotiated Rate	$6,815.58
Rate for Payer: AlohaCare Medicaid	$6,815.58
Rate for Payer: Hawaii Medical Service Association ABD	$6,815.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,815.58
Rate for Payer: Kaiser Permanente Medicaid	$6,815.58
Rate for Payer: Ohana Health Plan Medicaid	$6,815.58
Rate for Payer: UnitedHealthcare Medicaid	$6,815.58

CESAREAN SECTION W STERILIZATION

Facility

$4,857.77

Service Code	APR-DRG 5392
Min. Negotiated Rate	$4,857.77
Max. Negotiated Rate	$4,857.77
Rate for Payer: AlohaCare Medicaid	$4,857.77
Rate for Payer: Hawaii Medical Service Association ABD	$4,857.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,857.77
Rate for Payer: Kaiser Permanente Medicaid	$4,857.77
Rate for Payer: Ohana Health Plan Medicaid	$4,857.77
Rate for Payer: UnitedHealthcare Medicaid	$4,857.77

CETIRIZINE 10 MG TABLET [9506]

Facility

$9.00

Service Code	NDC 51079059720
Hospital Revenue Code	637
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$5.67
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: University Health Alliance Commercial	$6.56

CETIRIZINE 10 MG TABLET [9506]

Facility

$1.00

Service Code	NDC 00904671761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85

CETIRIZINE 10 MG TABLET [9506]

Facility

$9.00

Service Code	NDC 51079059720
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: MDX Hawaii PPO	$8.73

CETIRIZINE 10 MG TABLET [9506]

Facility

$1.00

Service Code	NDC 00904671761
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

CETIRIZINE 1 MG/ML ORAL SOLUTION [124409]

Facility

$92.00

Service Code	NDC 51672407008
Hospital Revenue Code	637
Min. Negotiated Rate	$46.92
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$57.96
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: University Health Alliance Commercial	$67.06

CETIRIZINE 1 MG/ML ORAL SOLUTION [124409]

Facility

$20.00

Service Code	NDC 00904676520
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: MDX Hawaii PPO	$19.40

CETIRIZINE 1 MG/ML ORAL SOLUTION [124409]

Facility

$92.00

Service Code	NDC 51672407008
Hospital Revenue Code	250
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: MDX Hawaii PPO	$89.24

CETIRIZINE 1 MG/ML ORAL SOLUTION [124409]

Facility

$20.00

Service Code	NDC 00904676520
Hospital Revenue Code	637
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: University Health Alliance Commercial	$14.58

CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]

Facility

$2,510.00

Service Code	HCPCS J9055
Hospital Revenue Code	636
Min. Negotiated Rate	$78.47
Max. Negotiated Rate	$2,434.70
Rate for Payer: AlohaCare Medicaid	$80.46
Rate for Payer: AlohaCare Medicare	$80.46
Rate for Payer: Cash Price	$1,506.00
Rate for Payer: Cash Price	$1,506.00
Rate for Payer: Devoted Health Medicare	$88.51
Rate for Payer: Hawaii Medical Service Association ABD	$78.47
Rate for Payer: Hawaii Medical Service Association Commercial	$100.58
Rate for Payer: Hawaii Medical Service Association Medicare	$80.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$78.47
Rate for Payer: Hawaii Western Management Group Commercial	$2,384.50
Rate for Payer: Health Management Network Commercial	$2,133.50
Rate for Payer: Humana Medicare	$80.46
Rate for Payer: Kaiser Permanente Commercial	$1,581.30
Rate for Payer: Kaiser Permanente Medicaid	$1,280.10
Rate for Payer: Kaiser Permanente Medicare	$80.46
Rate for Payer: MDX Hawaii PPO	$2,434.70
Rate for Payer: Ohana Health Plan Medicaid	$88.51
Rate for Payer: Ohana Health Plan Medicare	$80.46
Rate for Payer: UnitedHealthcare Medicaid	$1,506.00
Rate for Payer: UnitedHealthcare Medicare	$80.46
Rate for Payer: University Health Alliance Commercial	$1,829.54

CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]

Facility

$2,510.00

Service Code	HCPCS J9055
Hospital Revenue Code	250
Min. Negotiated Rate	$2,133.50
Max. Negotiated Rate	$2,434.70
Rate for Payer: Cash Price	$1,506.00
Rate for Payer: Health Management Network Commercial	$2,133.50
Rate for Payer: MDX Hawaii PPO	$2,434.70

CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]

Facility

$5,019.00

Service Code	HCPCS J9055
Hospital Revenue Code	250
Min. Negotiated Rate	$4,266.15
Max. Negotiated Rate	$4,868.43
Rate for Payer: Cash Price	$3,011.40
Rate for Payer: Health Management Network Commercial	$4,266.15
Rate for Payer: MDX Hawaii PPO	$4,868.43

CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]

Facility

$5,019.00

Service Code	HCPCS J9055
Hospital Revenue Code	636
Min. Negotiated Rate	$78.47
Max. Negotiated Rate	$4,868.43
Rate for Payer: AlohaCare Medicaid	$80.46
Rate for Payer: AlohaCare Medicare	$80.46
Rate for Payer: Cash Price	$3,011.40
Rate for Payer: Cash Price	$3,011.40
Rate for Payer: Devoted Health Medicare	$88.51
Rate for Payer: Hawaii Medical Service Association ABD	$78.47
Rate for Payer: Hawaii Medical Service Association Commercial	$100.58
Rate for Payer: Hawaii Medical Service Association Medicare	$80.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$78.47
Rate for Payer: Hawaii Western Management Group Commercial	$4,768.05
Rate for Payer: Health Management Network Commercial	$4,266.15
Rate for Payer: Humana Medicare	$80.46
Rate for Payer: Kaiser Permanente Commercial	$3,161.97
Rate for Payer: Kaiser Permanente Medicaid	$2,559.69
Rate for Payer: Kaiser Permanente Medicare	$80.46
Rate for Payer: MDX Hawaii PPO	$4,868.43
Rate for Payer: Ohana Health Plan Medicaid	$88.51
Rate for Payer: Ohana Health Plan Medicare	$80.46
Rate for Payer: UnitedHealthcare Medicaid	$3,011.40
Rate for Payer: UnitedHealthcare Medicare	$80.46
Rate for Payer: University Health Alliance Commercial	$3,658.35

CHAMBER ILIVIA NEO DUAL 429529

Facility

$38,500.00

Service Code	HCPCS C1721
Hospital Revenue Code	275
Min. Negotiated Rate	$19,635.00
Max. Negotiated Rate	$37,345.00
Rate for Payer: Cash Price	$23,100.00
Rate for Payer: Hawaii Western Management Group Commercial	$26,950.00
Rate for Payer: Health Management Network Commercial	$32,725.00
Rate for Payer: Kaiser Permanente Commercial	$24,255.00
Rate for Payer: Kaiser Permanente Medicaid	$19,635.00
Rate for Payer: MDX Hawaii PPO	$37,345.00
Rate for Payer: University Health Alliance Commercial	$21,560.00

Know your out-of-pocket cost for care.

All Charges