Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

INSTR RADIAL JAW PEDS 2MM

Facility

$171.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$145.35
Max. Negotiated Rate	$165.87
Rate for Payer: Cash Price	$102.60
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: MDX Hawaii PPO	$165.87

INSTR RADIAL JAW PEDS 2MM

Facility

$171.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$87.21
Max. Negotiated Rate	$165.87
Rate for Payer: Cash Price	$102.60
Rate for Payer: Hawaii Western Management Group Commercial	$162.45
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Kaiser Permanente Commercial	$107.73
Rate for Payer: Kaiser Permanente Medicaid	$87.21
Rate for Payer: MDX Hawaii PPO	$165.87
Rate for Payer: University Health Alliance Commercial	$124.64

INSTR ROUTER 2.3MM TAPERED

Facility

$566.00

Hospital Revenue Code	272
Min. Negotiated Rate	$288.66
Max. Negotiated Rate	$549.02
Rate for Payer: Cash Price	$339.60
Rate for Payer: Hawaii Western Management Group Commercial	$537.70
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Kaiser Permanente Commercial	$356.58
Rate for Payer: Kaiser Permanente Medicaid	$288.66
Rate for Payer: MDX Hawaii PPO	$549.02
Rate for Payer: University Health Alliance Commercial	$412.56

INSTR ROUTER 2.3MM TAPERED

Facility

$566.00

Hospital Revenue Code	272
Min. Negotiated Rate	$481.10
Max. Negotiated Rate	$549.02
Rate for Payer: Cash Price	$339.60
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: MDX Hawaii PPO	$549.02

INSTR SCISSOR METZ TIP

Facility

$221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: MDX Hawaii PPO	$214.37

INSTR SCISSOR METZ TIP

Facility

$221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$112.71
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Hawaii Western Management Group Commercial	$209.95
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$139.23
Rate for Payer: Kaiser Permanente Medicaid	$112.71
Rate for Payer: MDX Hawaii PPO	$214.37
Rate for Payer: University Health Alliance Commercial	$161.09

INSULIN ASPAR PROT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS PEN [124856]

Facility

$84.00

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$52.92
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: UnitedHealthcare Medicaid	$50.40
Rate for Payer: University Health Alliance Commercial	$61.23

INSULIN ASPAR PROT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS PEN [124856]

Facility

$84.00

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: MDX Hawaii PPO	$81.48

INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [33666]

Facility

$174.00

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
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	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
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

INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [33666]

Facility

$174.00

Service Code	HCPCS J1815
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

INSULIN ASPART 100 UNIT/ML SQ GLUCOSE CORRECTION SCALE [400930]

Facility

$174.00

Service Code	HCPCS J1815
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

INSULIN ASPART 100 UNIT/ML SQ GLUCOSE CORRECTION SCALE [400930]

Facility

$174.00

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
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	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
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

INSULIN ASPART 100 UNIT/ML SQ PEN GLUCOSE CORRECTION SCALE [4080155]

Facility

$84.00

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$52.92
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: UnitedHealthcare Medicaid	$50.40
Rate for Payer: University Health Alliance Commercial	$61.23

INSULIN ASPART 100 UNIT/ML SQ PEN GLUCOSE CORRECTION SCALE [4080155]

Facility

$84.00

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: MDX Hawaii PPO	$81.48

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124838]

Facility

$84.00

Service Code	HCPCS J1817
Hospital Revenue Code	636
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Hawaii Medical Service Association ABD	$3.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.24
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$52.92
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: UnitedHealthcare Medicaid	$50.40
Rate for Payer: University Health Alliance Commercial	$61.23

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124838]

Facility

$84.00

Service Code	HCPCS J1817
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: MDX Hawaii PPO	$81.48

INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION [183769]

Facility

$174.00

Service Code	HCPCS J1817
Hospital Revenue Code	636
Min. Negotiated Rate	$3.24
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	$3.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.24
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

INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION [183769]

Facility

$174.00

Service Code	HCPCS J1817
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

INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [186530]

Facility

$58.00

Service Code	NDC 00088221905
Hospital Revenue Code	250
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: MDX Hawaii PPO	$56.26

INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [186530]

Facility

$58.00

Service Code	NDC 00088221901
Hospital Revenue Code	250
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: MDX Hawaii PPO	$56.26

INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [28282]

Facility

$155.00

Service Code	NDC 00088222033
Hospital Revenue Code	250
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: MDX Hawaii PPO	$150.35

INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [28282]

Facility

$205.00

Service Code	NDC 00955172901
Hospital Revenue Code	250
Min. Negotiated Rate	$174.25
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$123.00
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: MDX Hawaii PPO	$198.85

INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP [10286]

Facility

$116.00

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$69.60
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$102.60
Rate for Payer: Hawaii Western Management Group Commercial	$110.20
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$73.08
Rate for Payer: Kaiser Permanente Commercial	$68.04
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: Kaiser Permanente Medicaid	$59.16
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: UnitedHealthcare Medicaid	$64.80
Rate for Payer: UnitedHealthcare Medicaid	$69.60
Rate for Payer: University Health Alliance Commercial	$78.72
Rate for Payer: University Health Alliance Commercial	$84.55

INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP [10286]

Facility

$108.00

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$69.60
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: MDX Hawaii PPO	$104.76

INSULIN LISPRO 100 UNIT/ML IJ SOLN (ADMELOG) [440184255]

Facility

$118.00

Service Code	HCPCS J1817
Hospital Revenue Code	250
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: MDX Hawaii PPO	$114.46

Know your out-of-pocket cost for care.

All Charges