Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CHEMICAL PLEURODESIS FOR PERSISTENT PNEUMOTHORAX

Facility

$2,460.00

Service Code	HCPCS 32560
Hospital Charge Code	3613256001
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$741.06
Rate for Payer: AlohaCare Medicare	$741.06
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Devoted Health Medicare	$815.17
Rate for Payer: Hawaii Medical Service Association Commercial	$926.33
Rate for Payer: Hawaii Medical Service Association Medicare	$741.06
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: Humana Medicare	$741.06
Rate for Payer: Kaiser Permanente Commercial	$1,549.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$741.06
Rate for Payer: MDX Hawaii PPO	$2,386.20
Rate for Payer: Ohana Health Plan Medicaid	$815.17
Rate for Payer: Ohana Health Plan Medicare	$741.06
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$741.06
Rate for Payer: University Health Alliance Commercial	$1,793.09

HC CHEMO EXTEND IV INFUS W/PUMP

Facility

$1,320.00

Service Code	HCPCS G0498
Hospital Charge Code	335G049801
Hospital Revenue Code	335
Min. Negotiated Rate	$1,122.00
Max. Negotiated Rate	$1,280.40
Rate for Payer: Cash Price	$792.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: MDX Hawaii PPO	$1,280.40

HC CHEMO EXTEND IV INFUS W/PUMP

Facility

$1,320.00

Service Code	HCPCS G0498
Hospital Charge Code	335G049801
Hospital Revenue Code	335
Min. Negotiated Rate	$248.77
Max. Negotiated Rate	$1,280.40
Rate for Payer: AlohaCare Medicaid	$390.20
Rate for Payer: AlohaCare Medicare	$390.20
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Devoted Health Medicare	$429.22
Rate for Payer: Hawaii Medical Service Association Commercial	$487.75
Rate for Payer: Hawaii Medical Service Association Medicare	$390.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,254.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: Humana Medicare	$390.20
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$673.20
Rate for Payer: Kaiser Permanente Medicare	$390.20
Rate for Payer: MDX Hawaii PPO	$1,280.40
Rate for Payer: Ohana Health Plan Medicaid	$429.22
Rate for Payer: Ohana Health Plan Medicare	$390.20
Rate for Payer: UnitedHealthcare Medicaid	$248.77
Rate for Payer: UnitedHealthcare Medicare	$390.20
Rate for Payer: University Health Alliance Commercial	$962.15

HC CHEMOTHER,CNS,W/LUMBAR PUNCTURE

Facility

$1,320.00

Service Code	HCPCS 96450
Hospital Charge Code	3319645001
Hospital Revenue Code	331
Min. Negotiated Rate	$118.87
Max. Negotiated Rate	$1,280.40
Rate for Payer: AlohaCare Medicaid	$390.20
Rate for Payer: AlohaCare Medicare	$390.20
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Devoted Health Medicare	$429.22
Rate for Payer: Hawaii Medical Service Association Commercial	$487.75
Rate for Payer: Hawaii Medical Service Association Medicare	$390.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,254.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: Humana Medicare	$390.20
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$673.20
Rate for Payer: Kaiser Permanente Medicare	$390.20
Rate for Payer: MDX Hawaii PPO	$1,280.40
Rate for Payer: Ohana Health Plan Medicaid	$429.22
Rate for Payer: Ohana Health Plan Medicare	$390.20
Rate for Payer: UnitedHealthcare Medicaid	$118.87
Rate for Payer: UnitedHealthcare Medicare	$390.20
Rate for Payer: University Health Alliance Commercial	$962.15

HC CHEMOTHER,CNS,W/LUMBAR PUNCTURE

Facility

$1,320.00

Service Code	HCPCS 96450
Hospital Charge Code	3319645001
Hospital Revenue Code	331
Min. Negotiated Rate	$1,122.00
Max. Negotiated Rate	$1,280.40
Rate for Payer: Cash Price	$792.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: MDX Hawaii PPO	$1,280.40

HC CHEMOTHER HORMON ANTINEOPL SUB-Q/IM

Facility

$283.00

Service Code	HCPCS 96402
Hospital Charge Code	3319640201
Hospital Revenue Code	331
Min. Negotiated Rate	$30.04
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$85.06
Rate for Payer: AlohaCare Medicare	$85.06
Rate for Payer: Cash Price	$169.80
Rate for Payer: Cash Price	$169.80
Rate for Payer: Devoted Health Medicare	$93.57
Rate for Payer: Hawaii Medical Service Association Commercial	$106.33
Rate for Payer: Hawaii Medical Service Association Medicare	$85.06
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$85.06
Rate for Payer: Kaiser Permanente Commercial	$178.29
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$85.06
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$93.57
Rate for Payer: Ohana Health Plan Medicare	$85.06
Rate for Payer: UnitedHealthcare Medicaid	$30.04
Rate for Payer: UnitedHealthcare Medicare	$85.06
Rate for Payer: University Health Alliance Commercial	$206.28

HC CHEMOTHER HORMON ANTINEOPL SUB-Q/IM

Facility

$283.00

Service Code	HCPCS 96402
Hospital Charge Code	3319640201
Hospital Revenue Code	331
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: MDX Hawaii PPO	$274.51

HC CHEMOTHER, IV INFUSE, EACH SEQU INFUS

Facility

$283.00

Service Code	HCPCS 96417
Hospital Charge Code	3359641701
Hospital Revenue Code	335
Min. Negotiated Rate	$55.33
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$85.06
Rate for Payer: AlohaCare Medicare	$85.06
Rate for Payer: Cash Price	$169.80
Rate for Payer: Cash Price	$169.80
Rate for Payer: Devoted Health Medicare	$93.57
Rate for Payer: Hawaii Medical Service Association Commercial	$106.33
Rate for Payer: Hawaii Medical Service Association Medicare	$85.06
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$85.06
Rate for Payer: Kaiser Permanente Commercial	$178.29
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$85.06
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$93.57
Rate for Payer: Ohana Health Plan Medicare	$85.06
Rate for Payer: UnitedHealthcare Medicaid	$55.33
Rate for Payer: UnitedHealthcare Medicare	$85.06
Rate for Payer: University Health Alliance Commercial	$206.28

HC CHEMOTHER, IV INFUSE, EACH SEQU INFUS

Facility

$283.00

Service Code	HCPCS 96417
Hospital Charge Code	3359641701
Hospital Revenue Code	335
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: MDX Hawaii PPO	$274.51

HC CHEMOTHER, IV INFUSION, 1 HR

Facility

$1,320.00

Service Code	HCPCS 96413
Hospital Charge Code	3359641301
Hospital Revenue Code	335
Min. Negotiated Rate	$113.96
Max. Negotiated Rate	$1,280.40
Rate for Payer: AlohaCare Medicaid	$390.20
Rate for Payer: AlohaCare Medicare	$390.20
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Devoted Health Medicare	$429.22
Rate for Payer: Hawaii Medical Service Association Commercial	$487.75
Rate for Payer: Hawaii Medical Service Association Medicare	$390.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,254.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: Humana Medicare	$390.20
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$673.20
Rate for Payer: Kaiser Permanente Medicare	$390.20
Rate for Payer: MDX Hawaii PPO	$1,280.40
Rate for Payer: Ohana Health Plan Medicaid	$429.22
Rate for Payer: Ohana Health Plan Medicare	$390.20
Rate for Payer: UnitedHealthcare Medicaid	$113.96
Rate for Payer: UnitedHealthcare Medicare	$390.20
Rate for Payer: University Health Alliance Commercial	$962.15

HC CHEMOTHER, IV INFUSION, 1 HR

Facility

$1,320.00

Service Code	HCPCS 96413
Hospital Charge Code	3359641301
Hospital Revenue Code	335
Min. Negotiated Rate	$1,122.00
Max. Negotiated Rate	$1,280.40
Rate for Payer: Cash Price	$792.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: MDX Hawaii PPO	$1,280.40

HC CHEMOTHER, IV INFUSION, EA ADD HR

Facility

$283.00

Service Code	HCPCS 96415
Hospital Charge Code	3359641501
Hospital Revenue Code	335
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: MDX Hawaii PPO	$274.51

HC CHEMOTHER, IV INFUSION, EA ADD HR

Facility

$283.00

Service Code	HCPCS 96415
Hospital Charge Code	3359641501
Hospital Revenue Code	335
Min. Negotiated Rate	$38.31
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$85.06
Rate for Payer: AlohaCare Medicare	$85.06
Rate for Payer: Cash Price	$169.80
Rate for Payer: Cash Price	$169.80
Rate for Payer: Devoted Health Medicare	$93.57
Rate for Payer: Hawaii Medical Service Association Commercial	$106.33
Rate for Payer: Hawaii Medical Service Association Medicare	$85.06
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$85.06
Rate for Payer: Kaiser Permanente Commercial	$178.29
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$85.06
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$93.57
Rate for Payer: Ohana Health Plan Medicare	$85.06
Rate for Payer: UnitedHealthcare Medicaid	$38.31
Rate for Payer: UnitedHealthcare Medicare	$85.06
Rate for Payer: University Health Alliance Commercial	$206.28

HC CHEMOTHER, IV PUSH,EA ADD DRUG

Facility

$283.00

Service Code	HCPCS 96411
Hospital Charge Code	3319641101
Hospital Revenue Code	331
Min. Negotiated Rate	$46.33
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$85.06
Rate for Payer: AlohaCare Medicare	$85.06
Rate for Payer: Cash Price	$169.80
Rate for Payer: Cash Price	$169.80
Rate for Payer: Devoted Health Medicare	$93.57
Rate for Payer: Hawaii Medical Service Association Commercial	$106.33
Rate for Payer: Hawaii Medical Service Association Medicare	$85.06
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$85.06
Rate for Payer: Kaiser Permanente Commercial	$178.29
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$85.06
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$93.57
Rate for Payer: Ohana Health Plan Medicare	$85.06
Rate for Payer: UnitedHealthcare Medicaid	$46.33
Rate for Payer: UnitedHealthcare Medicare	$85.06
Rate for Payer: University Health Alliance Commercial	$206.28

HC CHEMOTHER, IV PUSH,EA ADD DRUG

Facility

$283.00

Service Code	HCPCS 96411
Hospital Charge Code	3319641101
Hospital Revenue Code	331
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: MDX Hawaii PPO	$274.51

HC CHEMOTHER, IV PUSH, SNGL DRUG

Facility

$1,320.00

Service Code	HCPCS 96409
Hospital Charge Code	3319640901
Hospital Revenue Code	331
Min. Negotiated Rate	$80.60
Max. Negotiated Rate	$1,280.40
Rate for Payer: Humana Medicare	$390.20
Rate for Payer: AlohaCare Medicaid	$390.20
Rate for Payer: AlohaCare Medicare	$390.20
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Devoted Health Medicare	$429.22
Rate for Payer: Hawaii Medical Service Association Commercial	$487.75
Rate for Payer: Hawaii Medical Service Association Medicare	$390.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,254.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$673.20
Rate for Payer: Kaiser Permanente Medicare	$390.20
Rate for Payer: MDX Hawaii PPO	$1,280.40
Rate for Payer: Ohana Health Plan Medicaid	$429.22
Rate for Payer: Ohana Health Plan Medicare	$390.20
Rate for Payer: UnitedHealthcare Medicaid	$80.60
Rate for Payer: UnitedHealthcare Medicare	$390.20
Rate for Payer: University Health Alliance Commercial	$962.15

HC CHEMOTHER, IV PUSH, SNGL DRUG

Facility

$1,320.00

Service Code	HCPCS 96409
Hospital Charge Code	3319640901
Hospital Revenue Code	331
Min. Negotiated Rate	$1,122.00
Max. Negotiated Rate	$1,280.40
Rate for Payer: Cash Price	$792.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: MDX Hawaii PPO	$1,280.40

HC CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM

Facility

$283.00

Service Code	HCPCS 96401
Hospital Charge Code	3319640101
Hospital Revenue Code	331
Min. Negotiated Rate	$34.54
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$85.06
Rate for Payer: AlohaCare Medicare	$85.06
Rate for Payer: Cash Price	$169.80
Rate for Payer: Cash Price	$169.80
Rate for Payer: Devoted Health Medicare	$93.57
Rate for Payer: Hawaii Medical Service Association Commercial	$106.33
Rate for Payer: Hawaii Medical Service Association Medicare	$85.06
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$85.06
Rate for Payer: Kaiser Permanente Commercial	$178.29
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$85.06
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$93.57
Rate for Payer: Ohana Health Plan Medicare	$85.06
Rate for Payer: UnitedHealthcare Medicaid	$34.54
Rate for Payer: UnitedHealthcare Medicare	$85.06
Rate for Payer: University Health Alliance Commercial	$206.28

HC CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM

Facility

$283.00

Service Code	HCPCS 96401
Hospital Charge Code	3319640101
Hospital Revenue Code	331
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: MDX Hawaii PPO	$274.51

HC CHEMOTHER PROLONG INFUSE W/PUMP

Facility

$1,320.00

Service Code	HCPCS 96416
Hospital Charge Code	3359641601
Hospital Revenue Code	335
Min. Negotiated Rate	$122.71
Max. Negotiated Rate	$1,280.40
Rate for Payer: AlohaCare Medicaid	$390.20
Rate for Payer: AlohaCare Medicare	$390.20
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Devoted Health Medicare	$429.22
Rate for Payer: Hawaii Medical Service Association Commercial	$487.75
Rate for Payer: Hawaii Medical Service Association Medicare	$390.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,254.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: Humana Medicare	$390.20
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$673.20
Rate for Payer: Kaiser Permanente Medicare	$390.20
Rate for Payer: MDX Hawaii PPO	$1,280.40
Rate for Payer: Ohana Health Plan Medicaid	$429.22
Rate for Payer: Ohana Health Plan Medicare	$390.20
Rate for Payer: UnitedHealthcare Medicaid	$122.71
Rate for Payer: UnitedHealthcare Medicare	$390.20
Rate for Payer: University Health Alliance Commercial	$962.15

HC CHEMOTHER PROLONG INFUSE W/PUMP

Facility

$1,320.00

Service Code	HCPCS 96416
Hospital Charge Code	3359641601
Hospital Revenue Code	335
Min. Negotiated Rate	$1,122.00
Max. Negotiated Rate	$1,280.40
Rate for Payer: Cash Price	$792.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: MDX Hawaii PPO	$1,280.40

HC CHG COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE - DRAW CHARGE

Facility

$513.00

Service Code	HCPCS 36591
Hospital Charge Code	3613659101
Hospital Revenue Code	361
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$12.68
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC CHG COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE - DRAW CHARGE

Facility

$513.00

Service Code	HCPCS 36591
Hospital Charge Code	3613659101
Hospital Revenue Code	361
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC CHG COLLECTION VENOUS BLOOD, VENIPUNCTURE - DRAW CHARGE

Facility

$76.00

Service Code	HCPCS 36415
Hospital Charge Code	3003641501
Hospital Revenue Code	300
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$9.34
Rate for Payer: AlohaCare Medicare	$9.34
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Devoted Health Medicare	$10.27
Rate for Payer: Hawaii Medical Service Association Commercial	$11.68
Rate for Payer: Hawaii Medical Service Association Medicare	$9.34
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$9.34
Rate for Payer: Kaiser Permanente Commercial	$47.88
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$9.34
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$10.27
Rate for Payer: Ohana Health Plan Medicare	$9.34
Rate for Payer: UnitedHealthcare Medicaid	$3.00
Rate for Payer: UnitedHealthcare Medicare	$9.34
Rate for Payer: University Health Alliance Commercial	$55.40

HC CHG COLLECTION VENOUS BLOOD, VENIPUNCTURE - DRAW CHARGE

Facility

$76.00

Service Code	HCPCS 36415
Hospital Charge Code	3003641501
Hospital Revenue Code	300
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: MDX Hawaii PPO	$73.72

Know your out-of-pocket cost for care.

All Charges