Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML INTRAMUSCULAR SYRINGE [180688]

Facility

$160.00

Service Code	HCPCS 90371
Hospital Revenue Code	636
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$175.26
Rate for Payer: AlohaCare Medicaid	$140.21
Rate for Payer: AlohaCare Medicare	$140.21
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Devoted Health Medicare	$154.23
Rate for Payer: Hawaii Medical Service Association Commercial	$175.26
Rate for Payer: Hawaii Medical Service Association Medicare	$140.21
Rate for Payer: Hawaii Western Management Group Commercial	$152.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$140.21
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$140.21
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$154.23
Rate for Payer: Ohana Health Plan Medicare	$140.21
Rate for Payer: UnitedHealthcare Medicaid	$96.00
Rate for Payer: UnitedHealthcare Medicare	$140.21
Rate for Payer: University Health Alliance Commercial	$116.62

HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML INTRAMUSCULAR SYRINGE [180688]

Facility

$160.00

Service Code	HCPCS 90371
Hospital Revenue Code	250
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: MDX Hawaii PPO	$155.20

HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]

Facility

$1,423.00

Service Code	HCPCS 90371
Hospital Revenue Code	250
Min. Negotiated Rate	$1,209.55
Max. Negotiated Rate	$1,380.31
Rate for Payer: Cash Price	$853.80
Rate for Payer: Health Management Network Commercial	$1,209.55
Rate for Payer: MDX Hawaii PPO	$1,380.31

HEPATITIS B VIRUS VACCINE RECMB(PF) 5 MCG/0.5 ML INTRAMUSCULAR SYRINGE [187816]

Facility

$70.00

Service Code	NDC 00006409301
Hospital Revenue Code	250
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: MDX Hawaii PPO	$67.90

HEPATITIS B VIRUS VACCINE RECMB(PF) 5 MCG/0.5 ML INTRAMUSCULAR SYRINGE [187816]

Facility

$70.00

Service Code	NDC 00006409302
Hospital Revenue Code	250
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: MDX Hawaii PPO	$67.90

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [203219]

Facility

$88.00

Service Code	HCPCS 90744
Hospital Revenue Code	636
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Hawaii Medical Service Association ABD	$30.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.77
Rate for Payer: Hawaii Western Management Group Commercial	$83.60
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$55.44
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: UnitedHealthcare Medicaid	$52.80
Rate for Payer: University Health Alliance Commercial	$64.14

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [203219]

Facility

$88.00

Service Code	HCPCS 90744
Hospital Revenue Code	250
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: MDX Hawaii PPO	$85.36

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90740
Hospital Revenue Code	250
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: MDX Hawaii PPO	$168.78

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90747
Hospital Revenue Code	250
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: MDX Hawaii PPO	$168.78

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90747
Hospital Revenue Code	636
Min. Negotiated Rate	$88.74
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Hawaii Medical Service Association ABD	$140.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$140.75
Rate for Payer: Hawaii Western Management Group Commercial	$165.30
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$109.62
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: UnitedHealthcare Medicaid	$104.40
Rate for Payer: University Health Alliance Commercial	$126.83

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90740
Hospital Revenue Code	636
Min. Negotiated Rate	$88.74
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Hawaii Medical Service Association ABD	$158.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$158.15
Rate for Payer: Hawaii Western Management Group Commercial	$165.30
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$109.62
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: UnitedHealthcare Medicaid	$104.40
Rate for Payer: University Health Alliance Commercial	$126.83

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$67,022.69

Service Code	MSDRG 421
Min. Negotiated Rate	$19,762.76
Max. Negotiated Rate	$67,022.69
Rate for Payer: AlohaCare Medicare	$19,762.76
Rate for Payer: Devoted Health Medicare	$21,739.04
Rate for Payer: Hawaii Medical Service Association Commercial	$67,022.69
Rate for Payer: Hawaii Medical Service Association Medicare	$19,762.76
Rate for Payer: Humana Medicare	$19,762.76
Rate for Payer: Kaiser Permanente Commercial	$29,971.88
Rate for Payer: Kaiser Permanente Medicare	$19,762.76
Rate for Payer: Ohana Health Plan Medicare	$19,762.76
Rate for Payer: UnitedHealthcare Medicare	$19,762.76

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility

$67,022.69

Service Code	MSDRG 420
Min. Negotiated Rate	$38,753.23
Max. Negotiated Rate	$67,022.69
Rate for Payer: AlohaCare Medicare	$38,753.23
Rate for Payer: Devoted Health Medicare	$42,628.55
Rate for Payer: Hawaii Medical Service Association Commercial	$67,022.69
Rate for Payer: Hawaii Medical Service Association Medicare	$38,753.23
Rate for Payer: Humana Medicare	$38,753.23
Rate for Payer: Kaiser Permanente Commercial	$58,772.47
Rate for Payer: Kaiser Permanente Medicare	$38,753.23
Rate for Payer: Ohana Health Plan Medicare	$38,753.23
Rate for Payer: UnitedHealthcare Medicare	$38,753.23

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC

Facility

$59,475.97

Service Code	MSDRG 422
Min. Negotiated Rate	$15,918.26
Max. Negotiated Rate	$59,475.97
Rate for Payer: AlohaCare Medicare	$15,918.26
Rate for Payer: Devoted Health Medicare	$17,510.09
Rate for Payer: Hawaii Medical Service Association Commercial	$59,475.97
Rate for Payer: Hawaii Medical Service Association Medicare	$15,918.26
Rate for Payer: Humana Medicare	$15,918.26
Rate for Payer: Kaiser Permanente Commercial	$24,141.38
Rate for Payer: Kaiser Permanente Medicare	$15,918.26
Rate for Payer: Ohana Health Plan Medicare	$15,918.26
Rate for Payer: UnitedHealthcare Medicare	$15,918.26

HERNIA PATCH VENTRIO 5950040

Facility

$2,435.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,363.60
Max. Negotiated Rate	$2,361.95
Rate for Payer: Cash Price	$1,461.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,704.50
Rate for Payer: Health Management Network Commercial	$2,069.75
Rate for Payer: MDX Hawaii PPO	$2,361.95
Rate for Payer: University Health Alliance Commercial	$1,363.60

HERNIA PATCH VENTRIO 5950040

Facility

$2,435.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.85
Max. Negotiated Rate	$2,361.95
Rate for Payer: Cash Price	$1,461.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,704.50
Rate for Payer: Health Management Network Commercial	$2,069.75
Rate for Payer: Kaiser Permanente Commercial	$1,534.05
Rate for Payer: Kaiser Permanente Medicaid	$1,241.85
Rate for Payer: MDX Hawaii PPO	$2,361.95
Rate for Payer: University Health Alliance Commercial	$1,363.60

HERNIA PATCH VENTRIOST 5950030

Facility

$2,423.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.88
Max. Negotiated Rate	$2,350.31
Rate for Payer: Cash Price	$1,453.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,696.10
Rate for Payer: Health Management Network Commercial	$2,059.55
Rate for Payer: MDX Hawaii PPO	$2,350.31
Rate for Payer: University Health Alliance Commercial	$1,356.88

HERNIA PATCH VENTRIOST 5950030

Facility

$2,423.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,235.73
Max. Negotiated Rate	$2,350.31
Rate for Payer: Cash Price	$1,453.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,696.10
Rate for Payer: Health Management Network Commercial	$2,059.55
Rate for Payer: Kaiser Permanente Commercial	$1,526.49
Rate for Payer: Kaiser Permanente Medicaid	$1,235.73
Rate for Payer: MDX Hawaii PPO	$2,350.31
Rate for Payer: University Health Alliance Commercial	$1,356.88

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC

Facility

$32,710.57

Service Code	MSDRG 354
Min. Negotiated Rate	$19,136.06
Max. Negotiated Rate	$32,710.57
Rate for Payer: AlohaCare Medicare	$19,136.06
Rate for Payer: Devoted Health Medicare	$21,049.67
Rate for Payer: Hawaii Medical Service Association Commercial	$32,710.57
Rate for Payer: Hawaii Medical Service Association Medicare	$19,136.06
Rate for Payer: Humana Medicare	$19,136.06
Rate for Payer: Kaiser Permanente Commercial	$29,021.40
Rate for Payer: Kaiser Permanente Medicare	$19,136.06
Rate for Payer: Ohana Health Plan Medicare	$19,136.06
Rate for Payer: UnitedHealthcare Medicare	$19,136.06

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC

Facility

$50,059.50

Service Code	MSDRG 353
Min. Negotiated Rate	$33,008.08
Max. Negotiated Rate	$50,059.50
Rate for Payer: AlohaCare Medicare	$33,008.08
Rate for Payer: Devoted Health Medicare	$36,308.89
Rate for Payer: Hawaii Medical Service Association Commercial	$42,392.70
Rate for Payer: Hawaii Medical Service Association Medicare	$33,008.08
Rate for Payer: Humana Medicare	$33,008.08
Rate for Payer: Kaiser Permanente Commercial	$50,059.50
Rate for Payer: Kaiser Permanente Medicare	$33,008.08
Rate for Payer: Ohana Health Plan Medicare	$33,008.08
Rate for Payer: UnitedHealthcare Medicare	$33,008.08

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$24,168.94

Service Code	MSDRG 355
Min. Negotiated Rate	$15,298.38
Max. Negotiated Rate	$24,168.94
Rate for Payer: AlohaCare Medicare	$15,298.38
Rate for Payer: Devoted Health Medicare	$16,828.22
Rate for Payer: Hawaii Medical Service Association Commercial	$24,168.94
Rate for Payer: Hawaii Medical Service Association Medicare	$15,298.38
Rate for Payer: Humana Medicare	$15,298.38
Rate for Payer: Kaiser Permanente Commercial	$23,201.25
Rate for Payer: Kaiser Permanente Medicare	$15,298.38
Rate for Payer: Ohana Health Plan Medicare	$15,298.38
Rate for Payer: UnitedHealthcare Medicare	$15,298.38

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL

Facility

$7,868.42

Service Code	APR-DRG 2272
Min. Negotiated Rate	$7,868.42
Max. Negotiated Rate	$7,868.42
Rate for Payer: AlohaCare Medicaid	$7,868.42
Rate for Payer: Hawaii Medical Service Association ABD	$7,868.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,868.42
Rate for Payer: Kaiser Permanente Medicaid	$7,868.42
Rate for Payer: Ohana Health Plan Medicaid	$7,868.42
Rate for Payer: UnitedHealthcare Medicaid	$7,868.42

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL

Facility

$6,264.47

Service Code	APR-DRG 2271
Min. Negotiated Rate	$6,264.47
Max. Negotiated Rate	$6,264.47
Rate for Payer: AlohaCare Medicaid	$6,264.47
Rate for Payer: Hawaii Medical Service Association ABD	$6,264.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,264.47
Rate for Payer: Kaiser Permanente Medicaid	$6,264.47
Rate for Payer: Ohana Health Plan Medicaid	$6,264.47
Rate for Payer: UnitedHealthcare Medicaid	$6,264.47

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL

Facility

$20,417.57

Service Code	APR-DRG 2274
Min. Negotiated Rate	$20,417.57
Max. Negotiated Rate	$20,417.57
Rate for Payer: AlohaCare Medicaid	$20,417.57
Rate for Payer: Hawaii Medical Service Association ABD	$20,417.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,417.57
Rate for Payer: Kaiser Permanente Medicaid	$20,417.57
Rate for Payer: Ohana Health Plan Medicaid	$20,417.57
Rate for Payer: UnitedHealthcare Medicaid	$20,417.57

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL

Facility

$11,393.32

Service Code	APR-DRG 2273
Min. Negotiated Rate	$11,393.32
Max. Negotiated Rate	$11,393.32
Rate for Payer: AlohaCare Medicaid	$11,393.32
Rate for Payer: Hawaii Medical Service Association ABD	$11,393.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,393.32
Rate for Payer: Kaiser Permanente Medicaid	$11,393.32
Rate for Payer: Ohana Health Plan Medicaid	$11,393.32
Rate for Payer: UnitedHealthcare Medicaid	$11,393.32

Know your out-of-pocket cost for care.

All Charges