Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

ADOLESCENT TAN 13MM DIA. RIGHT

Facility

$6,776.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,455.76
Max. Negotiated Rate	$6,572.72
Rate for Payer: Cash Price	$4,065.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,743.20
Rate for Payer: Health Management Network Commercial	$5,759.60
Rate for Payer: Kaiser Permanente Commercial	$4,268.88
Rate for Payer: Kaiser Permanente Medicaid	$3,455.76
Rate for Payer: MDX Hawaii PPO	$6,572.72
Rate for Payer: University Health Alliance Commercial	$3,794.56

ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [120086]

Facility

$5,288.00

Service Code	HCPCS J9354
Hospital Revenue Code	636
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$5,129.36
Rate for Payer: AlohaCare Medicaid	$42.20
Rate for Payer: AlohaCare Medicare	$42.20
Rate for Payer: Cash Price	$3,172.80
Rate for Payer: Cash Price	$3,172.80
Rate for Payer: Devoted Health Medicare	$46.42
Rate for Payer: Hawaii Medical Service Association ABD	$41.85
Rate for Payer: Hawaii Medical Service Association Commercial	$52.75
Rate for Payer: Hawaii Medical Service Association Medicare	$42.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.85
Rate for Payer: Hawaii Western Management Group Commercial	$5,023.60
Rate for Payer: Health Management Network Commercial	$4,494.80
Rate for Payer: Humana Medicare	$42.20
Rate for Payer: Kaiser Permanente Commercial	$3,331.44
Rate for Payer: Kaiser Permanente Medicaid	$2,696.88
Rate for Payer: Kaiser Permanente Medicare	$42.20
Rate for Payer: MDX Hawaii PPO	$5,129.36
Rate for Payer: Ohana Health Plan Medicaid	$46.42
Rate for Payer: Ohana Health Plan Medicare	$42.20
Rate for Payer: UnitedHealthcare Medicaid	$3,172.80
Rate for Payer: UnitedHealthcare Medicare	$42.20
Rate for Payer: University Health Alliance Commercial	$3,854.42

ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [120086]

Facility

$5,288.00

Service Code	HCPCS J9354
Hospital Revenue Code	250
Min. Negotiated Rate	$4,494.80
Max. Negotiated Rate	$5,129.36
Rate for Payer: Cash Price	$3,172.80
Rate for Payer: Health Management Network Commercial	$4,494.80
Rate for Payer: MDX Hawaii PPO	$5,129.36

ADO-TRASTUZUMAB EMTANSINE 160 MG/8ML IV (WET SOLR VIAL) [430120087]

Facility

$8,161.00

Service Code	HCPCS J9354
Hospital Revenue Code	250
Min. Negotiated Rate	$6,936.85
Max. Negotiated Rate	$7,916.17
Rate for Payer: Cash Price	$4,896.60
Rate for Payer: Health Management Network Commercial	$6,936.85
Rate for Payer: MDX Hawaii PPO	$7,916.17

ADO-TRASTUZUMAB EMTANSINE 160 MG/8ML IV (WET SOLR VIAL) [430120087]

Facility

$8,161.00

Service Code	HCPCS J9354
Hospital Revenue Code	636
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$7,916.17
Rate for Payer: AlohaCare Medicaid	$42.20
Rate for Payer: AlohaCare Medicare	$42.20
Rate for Payer: Cash Price	$4,896.60
Rate for Payer: Cash Price	$4,896.60
Rate for Payer: Devoted Health Medicare	$46.42
Rate for Payer: Hawaii Medical Service Association ABD	$41.85
Rate for Payer: Hawaii Medical Service Association Commercial	$52.75
Rate for Payer: Hawaii Medical Service Association Medicare	$42.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.85
Rate for Payer: Hawaii Western Management Group Commercial	$7,752.95
Rate for Payer: Health Management Network Commercial	$6,936.85
Rate for Payer: Humana Medicare	$42.20
Rate for Payer: Kaiser Permanente Commercial	$5,141.43
Rate for Payer: Kaiser Permanente Medicaid	$4,162.11
Rate for Payer: Kaiser Permanente Medicare	$42.20
Rate for Payer: MDX Hawaii PPO	$7,916.17
Rate for Payer: Ohana Health Plan Medicaid	$46.42
Rate for Payer: Ohana Health Plan Medicare	$42.20
Rate for Payer: UnitedHealthcare Medicaid	$4,896.60
Rate for Payer: UnitedHealthcare Medicare	$42.20
Rate for Payer: University Health Alliance Commercial	$5,948.55

ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [120087]

Facility

$7,912.00

Service Code	HCPCS J9354
Hospital Revenue Code	250
Min. Negotiated Rate	$6,725.20
Max. Negotiated Rate	$7,674.64
Rate for Payer: Cash Price	$4,747.20
Rate for Payer: Cash Price	$4,896.60
Rate for Payer: Health Management Network Commercial	$6,936.85
Rate for Payer: Health Management Network Commercial	$6,725.20
Rate for Payer: MDX Hawaii PPO	$7,916.17
Rate for Payer: MDX Hawaii PPO	$7,674.64

ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [120087]

Facility

$7,912.00

Service Code	HCPCS J9354
Hospital Revenue Code	636
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$7,674.64
Rate for Payer: AlohaCare Medicaid	$42.20
Rate for Payer: AlohaCare Medicaid	$42.20
Rate for Payer: AlohaCare Medicare	$42.20
Rate for Payer: AlohaCare Medicare	$42.20
Rate for Payer: Cash Price	$4,747.20
Rate for Payer: Cash Price	$4,747.20
Rate for Payer: Cash Price	$4,896.60
Rate for Payer: Cash Price	$4,896.60
Rate for Payer: Devoted Health Medicare	$46.42
Rate for Payer: Devoted Health Medicare	$46.42
Rate for Payer: Hawaii Medical Service Association ABD	$41.85
Rate for Payer: Hawaii Medical Service Association ABD	$41.85
Rate for Payer: Hawaii Medical Service Association Commercial	$52.75
Rate for Payer: Hawaii Medical Service Association Commercial	$52.75
Rate for Payer: Hawaii Medical Service Association Medicare	$42.20
Rate for Payer: Hawaii Medical Service Association Medicare	$42.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.85
Rate for Payer: Hawaii Western Management Group Commercial	$7,752.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,516.40
Rate for Payer: Health Management Network Commercial	$6,725.20
Rate for Payer: Health Management Network Commercial	$6,936.85
Rate for Payer: Humana Medicare	$42.20
Rate for Payer: Humana Medicare	$42.20
Rate for Payer: Kaiser Permanente Commercial	$4,984.56
Rate for Payer: Kaiser Permanente Commercial	$5,141.43
Rate for Payer: Kaiser Permanente Medicaid	$4,035.12
Rate for Payer: Kaiser Permanente Medicaid	$4,162.11
Rate for Payer: Kaiser Permanente Medicare	$42.20
Rate for Payer: Kaiser Permanente Medicare	$42.20
Rate for Payer: MDX Hawaii PPO	$7,674.64
Rate for Payer: MDX Hawaii PPO	$7,916.17
Rate for Payer: Ohana Health Plan Medicaid	$46.42
Rate for Payer: Ohana Health Plan Medicaid	$46.42
Rate for Payer: Ohana Health Plan Medicare	$42.20
Rate for Payer: Ohana Health Plan Medicare	$42.20
Rate for Payer: UnitedHealthcare Medicaid	$4,747.20
Rate for Payer: UnitedHealthcare Medicaid	$4,896.60
Rate for Payer: UnitedHealthcare Medicare	$42.20
Rate for Payer: UnitedHealthcare Medicare	$42.20
Rate for Payer: University Health Alliance Commercial	$5,767.06
Rate for Payer: University Health Alliance Commercial	$5,948.55

ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

Facility

$58,408.26

Service Code	MSDRG 614
Min. Negotiated Rate	$24,930.10
Max. Negotiated Rate	$58,408.26
Rate for Payer: AlohaCare Medicare	$24,930.10
Rate for Payer: Devoted Health Medicare	$27,423.11
Rate for Payer: Hawaii Medical Service Association Commercial	$58,408.26
Rate for Payer: Hawaii Medical Service Association Medicare	$24,930.10
Rate for Payer: Humana Medicare	$24,930.10
Rate for Payer: Kaiser Permanente Commercial	$37,808.55
Rate for Payer: Kaiser Permanente Medicare	$24,930.10
Rate for Payer: Ohana Health Plan Medicare	$24,930.10
Rate for Payer: UnitedHealthcare Medicare	$24,930.10

ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

Facility

$58,408.26

Service Code	MSDRG 615
Min. Negotiated Rate	$15,916.00
Max. Negotiated Rate	$58,408.26
Rate for Payer: AlohaCare Medicare	$15,916.00
Rate for Payer: Devoted Health Medicare	$17,507.60
Rate for Payer: Hawaii Medical Service Association Commercial	$58,408.26
Rate for Payer: Hawaii Medical Service Association Medicare	$15,916.00
Rate for Payer: Humana Medicare	$15,916.00
Rate for Payer: Kaiser Permanente Commercial	$24,137.92
Rate for Payer: Kaiser Permanente Medicare	$15,916.00
Rate for Payer: Ohana Health Plan Medicare	$15,916.00
Rate for Payer: UnitedHealthcare Medicare	$15,916.00

ADRENAL PROCEDURES

Facility

$15,126.96

Service Code	APR-DRG 4013
Min. Negotiated Rate	$15,126.96
Max. Negotiated Rate	$15,126.96
Rate for Payer: AlohaCare Medicaid	$15,126.96
Rate for Payer: Hawaii Medical Service Association ABD	$15,126.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,126.96
Rate for Payer: Kaiser Permanente Medicaid	$15,126.96
Rate for Payer: Ohana Health Plan Medicaid	$15,126.96
Rate for Payer: UnitedHealthcare Medicaid	$15,126.96

ADRENAL PROCEDURES

Facility

$22,328.75

Service Code	APR-DRG 4014
Min. Negotiated Rate	$22,328.75
Max. Negotiated Rate	$22,328.75
Rate for Payer: AlohaCare Medicaid	$22,328.75
Rate for Payer: Hawaii Medical Service Association ABD	$22,328.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,328.75
Rate for Payer: Kaiser Permanente Medicaid	$22,328.75
Rate for Payer: Ohana Health Plan Medicaid	$22,328.75
Rate for Payer: UnitedHealthcare Medicaid	$22,328.75

ADRENAL PROCEDURES

Facility

$7,390.95

Service Code	APR-DRG 4011
Min. Negotiated Rate	$7,390.95
Max. Negotiated Rate	$7,390.95
Rate for Payer: AlohaCare Medicaid	$7,390.95
Rate for Payer: Hawaii Medical Service Association ABD	$7,390.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,390.95
Rate for Payer: Kaiser Permanente Medicaid	$7,390.95
Rate for Payer: Ohana Health Plan Medicaid	$7,390.95
Rate for Payer: UnitedHealthcare Medicaid	$7,390.95

ADRENAL PROCEDURES

Facility

$12,781.37

Service Code	APR-DRG 4012
Min. Negotiated Rate	$12,781.37
Max. Negotiated Rate	$12,781.37
Rate for Payer: AlohaCare Medicaid	$12,781.37
Rate for Payer: Hawaii Medical Service Association ABD	$12,781.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,781.37
Rate for Payer: Kaiser Permanente Medicaid	$12,781.37
Rate for Payer: Ohana Health Plan Medicaid	$12,781.37
Rate for Payer: UnitedHealthcare Medicaid	$12,781.37

ADVANCE MIXING BOWL 306-563

Facility

$349.00

Hospital Revenue Code	272
Min. Negotiated Rate	$177.99
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$209.40
Rate for Payer: Hawaii Western Management Group Commercial	$331.55
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: Kaiser Permanente Commercial	$219.87
Rate for Payer: Kaiser Permanente Medicaid	$177.99
Rate for Payer: MDX Hawaii PPO	$338.53
Rate for Payer: University Health Alliance Commercial	$254.39

ADVANCE MIXING BOWL 306-563

Facility

$349.00

Hospital Revenue Code	272
Min. Negotiated Rate	$296.65
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$209.40
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: MDX Hawaii PPO	$338.53

ADVINCULA DELT AD750SC-KE30

Facility

$1,058.00

Hospital Revenue Code	272
Min. Negotiated Rate	$539.58
Max. Negotiated Rate	$1,026.26
Rate for Payer: Cash Price	$634.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,005.10
Rate for Payer: Health Management Network Commercial	$899.30
Rate for Payer: Kaiser Permanente Commercial	$666.54
Rate for Payer: Kaiser Permanente Medicaid	$539.58
Rate for Payer: MDX Hawaii PPO	$1,026.26
Rate for Payer: University Health Alliance Commercial	$771.18

ADVINCULA DELT AD750SC-KE30

Facility

$1,058.00

Hospital Revenue Code	272
Min. Negotiated Rate	$899.30
Max. Negotiated Rate	$1,026.26
Rate for Payer: Cash Price	$634.80
Rate for Payer: Health Management Network Commercial	$899.30
Rate for Payer: MDX Hawaii PPO	$1,026.26

ADVINCULA DELT AD750SC-KE35

Facility

$1,137.00

Hospital Revenue Code	272
Min. Negotiated Rate	$966.45
Max. Negotiated Rate	$1,102.89
Rate for Payer: Cash Price	$682.20
Rate for Payer: Health Management Network Commercial	$966.45
Rate for Payer: MDX Hawaii PPO	$1,102.89

ADVINCULA DELT AD750SC-KE35

Facility

$1,137.00

Hospital Revenue Code	272
Min. Negotiated Rate	$579.87
Max. Negotiated Rate	$1,102.89
Rate for Payer: Cash Price	$682.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.15
Rate for Payer: Health Management Network Commercial	$966.45
Rate for Payer: Kaiser Permanente Commercial	$716.31
Rate for Payer: Kaiser Permanente Medicaid	$579.87
Rate for Payer: MDX Hawaii PPO	$1,102.89
Rate for Payer: University Health Alliance Commercial	$828.76

ADVINCULA DELT AD750SC-KE40

Facility

$895.00

Hospital Revenue Code	272
Min. Negotiated Rate	$760.75
Max. Negotiated Rate	$868.15
Rate for Payer: Cash Price	$537.00
Rate for Payer: Health Management Network Commercial	$760.75
Rate for Payer: MDX Hawaii PPO	$868.15

ADVINCULA DELT AD750SC-KE40

Facility

$895.00

Hospital Revenue Code	272
Min. Negotiated Rate	$456.45
Max. Negotiated Rate	$868.15
Rate for Payer: Cash Price	$537.00
Rate for Payer: Hawaii Western Management Group Commercial	$850.25
Rate for Payer: Health Management Network Commercial	$760.75
Rate for Payer: Kaiser Permanente Commercial	$563.85
Rate for Payer: Kaiser Permanente Medicaid	$456.45
Rate for Payer: MDX Hawaii PPO	$868.15
Rate for Payer: University Health Alliance Commercial	$652.37

ADVINCULA DELT AD750SC-KES25

Facility

$895.00

Hospital Revenue Code	272
Min. Negotiated Rate	$456.45
Max. Negotiated Rate	$868.15
Rate for Payer: Cash Price	$537.00
Rate for Payer: Hawaii Western Management Group Commercial	$850.25
Rate for Payer: Health Management Network Commercial	$760.75
Rate for Payer: Kaiser Permanente Commercial	$563.85
Rate for Payer: Kaiser Permanente Medicaid	$456.45
Rate for Payer: MDX Hawaii PPO	$868.15
Rate for Payer: University Health Alliance Commercial	$652.37

ADVINCULA DELT AD750SC-KES25

Facility

$895.00

Hospital Revenue Code	272
Min. Negotiated Rate	$760.75
Max. Negotiated Rate	$868.15
Rate for Payer: Cash Price	$537.00
Rate for Payer: Health Management Network Commercial	$760.75
Rate for Payer: MDX Hawaii PPO	$868.15

AEQUALIS ASCEND DWF606B

Facility

$8,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,906.72
Max. Negotiated Rate	$8,499.14
Rate for Payer: Cash Price	$5,257.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,133.40
Rate for Payer: Health Management Network Commercial	$7,447.70
Rate for Payer: MDX Hawaii PPO	$8,499.14
Rate for Payer: University Health Alliance Commercial	$4,906.72

AEQUALIS ASCEND DWF606B

Facility

$8,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,468.62
Max. Negotiated Rate	$8,499.14
Rate for Payer: Cash Price	$5,257.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,133.40
Rate for Payer: Health Management Network Commercial	$7,447.70
Rate for Payer: Kaiser Permanente Commercial	$5,520.06
Rate for Payer: Kaiser Permanente Medicaid	$4,468.62
Rate for Payer: MDX Hawaii PPO	$8,499.14
Rate for Payer: University Health Alliance Commercial	$4,906.72

Know your out-of-pocket cost for care.

All Charges