Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

BEARING TIBIAL 5X13 5532-G-513

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,378.53
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$1,702.89
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BEARING TIBIAL 8X13 5532-G-813

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BEARING TIBIAL 8X13 5532-G-813

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,378.53
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$1,702.89
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BEARING TIBIAL X3 5531-G-611-E

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,364.76
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$1,685.88
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

BEARING TIBIAL X3 5531-G-611-E

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

BEARING TIB SZ#3 X3 5532-G-311

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BEARING TIB SZ#3 X3 5532-G-311

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,378.53
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$1,702.89
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BEAUTI BOND S23-2149

Facility

$540.00

Hospital Revenue Code	272
Min. Negotiated Rate	$459.00
Max. Negotiated Rate	$523.80
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: MDX Hawaii PPO	$523.80

BEAUTI BOND S23-2149

Facility

$540.00

Hospital Revenue Code	272
Min. Negotiated Rate	$275.40
Max. Negotiated Rate	$523.80
Rate for Payer: Cash Price	$324.00
Rate for Payer: Hawaii Western Management Group Commercial	$513.00
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: Kaiser Permanente Commercial	$340.20
Rate for Payer: Kaiser Permanente Medicaid	$275.40
Rate for Payer: MDX Hawaii PPO	$523.80
Rate for Payer: University Health Alliance Commercial	$393.61

BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$35,798.93

Service Code	MSDRG 886
Min. Negotiated Rate	$14,462.54
Max. Negotiated Rate	$35,798.93
Rate for Payer: AlohaCare Medicare	$23,604.99
Rate for Payer: Devoted Health Medicare	$25,965.49
Rate for Payer: Hawaii Medical Service Association Commercial	$14,462.54
Rate for Payer: Hawaii Medical Service Association Medicare	$23,604.99
Rate for Payer: Humana Medicare	$23,604.99
Rate for Payer: Kaiser Permanente Commercial	$35,798.93
Rate for Payer: Kaiser Permanente Medicare	$23,604.99
Rate for Payer: Ohana Health Plan Medicare	$23,604.99
Rate for Payer: UnitedHealthcare Medicare	$23,604.99

BEHAVIORAL DISORDERS

Facility

$4,541.22

Service Code	APR-DRG 7583
Min. Negotiated Rate	$4,541.22
Max. Negotiated Rate	$4,541.22
Rate for Payer: AlohaCare Medicaid	$4,541.22
Rate for Payer: Hawaii Medical Service Association ABD	$4,541.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,541.22
Rate for Payer: Kaiser Permanente Medicaid	$4,541.22
Rate for Payer: Ohana Health Plan Medicaid	$4,541.22
Rate for Payer: UnitedHealthcare Medicaid	$4,541.22

BEHAVIORAL DISORDERS

Facility

$2,833.95

Service Code	APR-DRG 7581
Min. Negotiated Rate	$2,833.95
Max. Negotiated Rate	$2,833.95
Rate for Payer: AlohaCare Medicaid	$2,833.95
Rate for Payer: Hawaii Medical Service Association ABD	$2,833.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,833.95
Rate for Payer: Kaiser Permanente Medicaid	$2,833.95
Rate for Payer: Ohana Health Plan Medicaid	$2,833.95
Rate for Payer: UnitedHealthcare Medicaid	$2,833.95

BEHAVIORAL DISORDERS

Facility

$5,801.42

Service Code	APR-DRG 7584
Min. Negotiated Rate	$5,801.42
Max. Negotiated Rate	$5,801.42
Rate for Payer: AlohaCare Medicaid	$5,801.42
Rate for Payer: Hawaii Medical Service Association ABD	$5,801.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,801.42
Rate for Payer: Kaiser Permanente Medicaid	$5,801.42
Rate for Payer: Ohana Health Plan Medicaid	$5,801.42
Rate for Payer: UnitedHealthcare Medicaid	$5,801.42

BEHAVIORAL DISORDERS

Facility

$3,596.07

Service Code	APR-DRG 7582
Min. Negotiated Rate	$3,596.07
Max. Negotiated Rate	$3,596.07
Rate for Payer: AlohaCare Medicaid	$3,596.07
Rate for Payer: Hawaii Medical Service Association ABD	$3,596.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,596.07
Rate for Payer: Kaiser Permanente Medicaid	$3,596.07
Rate for Payer: Ohana Health Plan Medicaid	$3,596.07
Rate for Payer: UnitedHealthcare Medicaid	$3,596.07

BELL SHAPE BODY HOOD PROTECTOR

Facility

$125.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$78.75
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: University Health Alliance Commercial	$91.11

BELL SHAPE BODY HOOD PROTECTOR

Facility

$125.00

Hospital Revenue Code	272
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: MDX Hawaii PPO	$121.25

BENDAMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION [91300]

Facility

$4,067.00

Service Code	HCPCS J9033
Hospital Revenue Code	250
Min. Negotiated Rate	$3,456.95
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: MDX Hawaii PPO	$611.10

BENDAMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION [91300]

Facility

$630.00

Service Code	HCPCS J9033
Hospital Revenue Code	636
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$611.10
Rate for Payer: AlohaCare Medicaid	$2.16
Rate for Payer: AlohaCare Medicaid	$2.16
Rate for Payer: AlohaCare Medicare	$2.16
Rate for Payer: AlohaCare Medicare	$2.16
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Devoted Health Medicare	$2.38
Rate for Payer: Devoted Health Medicare	$2.38
Rate for Payer: Hawaii Medical Service Association ABD	$1.85
Rate for Payer: Hawaii Medical Service Association ABD	$1.85
Rate for Payer: Hawaii Medical Service Association Commercial	$2.70
Rate for Payer: Hawaii Medical Service Association Commercial	$2.70
Rate for Payer: Hawaii Medical Service Association Medicare	$2.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.85
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,863.65
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Humana Medicare	$2.16
Rate for Payer: Humana Medicare	$2.16
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Commercial	$2,562.21
Rate for Payer: Kaiser Permanente Medicaid	$2,074.17
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: Kaiser Permanente Medicare	$2.16
Rate for Payer: Kaiser Permanente Medicare	$2.16
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: Ohana Health Plan Medicaid	$2.38
Rate for Payer: Ohana Health Plan Medicaid	$2.38
Rate for Payer: Ohana Health Plan Medicare	$2.16
Rate for Payer: Ohana Health Plan Medicare	$2.16
Rate for Payer: UnitedHealthcare Medicaid	$378.00
Rate for Payer: UnitedHealthcare Medicaid	$2,440.20
Rate for Payer: UnitedHealthcare Medicare	$2.16
Rate for Payer: UnitedHealthcare Medicare	$2.16
Rate for Payer: University Health Alliance Commercial	$2,964.44
Rate for Payer: University Health Alliance Commercial	$459.21

BENDAMUSTINE HCL 100 MG/4ML IV SOLN (BENDEKA) [440131644]

Facility

$4,453.00

Service Code	HCPCS J9034
Hospital Revenue Code	250
Min. Negotiated Rate	$3,785.05
Max. Negotiated Rate	$4,319.41
Rate for Payer: Cash Price	$2,671.80
Rate for Payer: Cash Price	$3,559.20
Rate for Payer: Health Management Network Commercial	$3,785.05
Rate for Payer: Health Management Network Commercial	$5,042.20
Rate for Payer: MDX Hawaii PPO	$4,319.41
Rate for Payer: MDX Hawaii PPO	$5,754.04

BENDAMUSTINE HCL 100 MG/4ML IV SOLN (BENDEKA) [440131644]

Facility

$5,932.00

Service Code	HCPCS J9034
Hospital Revenue Code	636
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$5,754.04
Rate for Payer: AlohaCare Medicaid	$12.90
Rate for Payer: AlohaCare Medicaid	$12.90
Rate for Payer: AlohaCare Medicare	$12.90
Rate for Payer: AlohaCare Medicare	$12.90
Rate for Payer: Cash Price	$3,559.20
Rate for Payer: Cash Price	$3,559.20
Rate for Payer: Cash Price	$2,671.80
Rate for Payer: Cash Price	$2,671.80
Rate for Payer: Devoted Health Medicare	$14.19
Rate for Payer: Devoted Health Medicare	$14.19
Rate for Payer: Hawaii Medical Service Association ABD	$13.12
Rate for Payer: Hawaii Medical Service Association ABD	$13.12
Rate for Payer: Hawaii Medical Service Association Commercial	$16.12
Rate for Payer: Hawaii Medical Service Association Commercial	$16.12
Rate for Payer: Hawaii Medical Service Association Medicare	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$12.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.12
Rate for Payer: Hawaii Western Management Group Commercial	$4,230.35
Rate for Payer: Hawaii Western Management Group Commercial	$5,635.40
Rate for Payer: Health Management Network Commercial	$3,785.05
Rate for Payer: Health Management Network Commercial	$5,042.20
Rate for Payer: Humana Medicare	$12.90
Rate for Payer: Humana Medicare	$12.90
Rate for Payer: Kaiser Permanente Commercial	$2,805.39
Rate for Payer: Kaiser Permanente Commercial	$3,737.16
Rate for Payer: Kaiser Permanente Medicaid	$3,025.32
Rate for Payer: Kaiser Permanente Medicaid	$2,271.03
Rate for Payer: Kaiser Permanente Medicare	$12.90
Rate for Payer: Kaiser Permanente Medicare	$12.90
Rate for Payer: MDX Hawaii PPO	$5,754.04
Rate for Payer: MDX Hawaii PPO	$4,319.41
Rate for Payer: Ohana Health Plan Medicaid	$14.19
Rate for Payer: Ohana Health Plan Medicaid	$14.19
Rate for Payer: Ohana Health Plan Medicare	$12.90
Rate for Payer: Ohana Health Plan Medicare	$12.90
Rate for Payer: UnitedHealthcare Medicaid	$3,559.20
Rate for Payer: UnitedHealthcare Medicaid	$2,671.80
Rate for Payer: UnitedHealthcare Medicare	$12.90
Rate for Payer: UnitedHealthcare Medicare	$12.90
Rate for Payer: University Health Alliance Commercial	$4,323.83
Rate for Payer: University Health Alliance Commercial	$3,245.79

BENDAMUSTINE HCL 100 MG/4ML IV SOLN (UNBRANDED) [131577]

Facility

$4,364.00

Service Code	HCPCS J9036
Hospital Revenue Code	636
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$4,233.08
Rate for Payer: AlohaCare Medicaid	$13.94
Rate for Payer: AlohaCare Medicaid	$13.94
Rate for Payer: AlohaCare Medicare	$13.94
Rate for Payer: AlohaCare Medicare	$13.94
Rate for Payer: Cash Price	$2,618.40
Rate for Payer: Cash Price	$2,618.40
Rate for Payer: Cash Price	$2,527.20
Rate for Payer: Cash Price	$2,527.20
Rate for Payer: Devoted Health Medicare	$15.33
Rate for Payer: Devoted Health Medicare	$15.33
Rate for Payer: Hawaii Medical Service Association ABD	$11.99
Rate for Payer: Hawaii Medical Service Association ABD	$11.99
Rate for Payer: Hawaii Medical Service Association Commercial	$17.43
Rate for Payer: Hawaii Medical Service Association Commercial	$17.43
Rate for Payer: Hawaii Medical Service Association Medicare	$13.94
Rate for Payer: Hawaii Medical Service Association Medicare	$13.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.99
Rate for Payer: Hawaii Western Management Group Commercial	$4,001.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,145.80
Rate for Payer: Health Management Network Commercial	$3,580.20
Rate for Payer: Health Management Network Commercial	$3,709.40
Rate for Payer: Humana Medicare	$13.94
Rate for Payer: Humana Medicare	$13.94
Rate for Payer: Kaiser Permanente Commercial	$2,653.56
Rate for Payer: Kaiser Permanente Commercial	$2,749.32
Rate for Payer: Kaiser Permanente Medicaid	$2,225.64
Rate for Payer: Kaiser Permanente Medicaid	$2,148.12
Rate for Payer: Kaiser Permanente Medicare	$13.94
Rate for Payer: Kaiser Permanente Medicare	$13.94
Rate for Payer: MDX Hawaii PPO	$4,233.08
Rate for Payer: MDX Hawaii PPO	$4,085.64
Rate for Payer: Ohana Health Plan Medicaid	$15.33
Rate for Payer: Ohana Health Plan Medicaid	$15.33
Rate for Payer: Ohana Health Plan Medicare	$13.94
Rate for Payer: Ohana Health Plan Medicare	$13.94
Rate for Payer: UnitedHealthcare Medicaid	$2,618.40
Rate for Payer: UnitedHealthcare Medicaid	$2,527.20
Rate for Payer: UnitedHealthcare Medicare	$13.94
Rate for Payer: UnitedHealthcare Medicare	$13.94
Rate for Payer: University Health Alliance Commercial	$3,180.92
Rate for Payer: University Health Alliance Commercial	$3,070.13

BENDAMUSTINE HCL 100 MG/4ML IV SOLN (UNBRANDED) [131577]

Facility

$4,212.00

Service Code	HCPCS J9036
Hospital Revenue Code	250
Min. Negotiated Rate	$3,580.20
Max. Negotiated Rate	$4,085.64
Rate for Payer: Cash Price	$2,527.20
Rate for Payer: Cash Price	$2,618.40
Rate for Payer: Health Management Network Commercial	$3,580.20
Rate for Payer: Health Management Network Commercial	$3,709.40
Rate for Payer: MDX Hawaii PPO	$4,085.64
Rate for Payer: MDX Hawaii PPO	$4,233.08

BENDING TEMPLATE

Facility

$668.00

Hospital Revenue Code	272
Min. Negotiated Rate	$340.68
Max. Negotiated Rate	$647.96
Rate for Payer: Cash Price	$400.80
Rate for Payer: Hawaii Western Management Group Commercial	$634.60
Rate for Payer: Health Management Network Commercial	$567.80
Rate for Payer: Kaiser Permanente Commercial	$420.84
Rate for Payer: Kaiser Permanente Medicaid	$340.68
Rate for Payer: MDX Hawaii PPO	$647.96
Rate for Payer: University Health Alliance Commercial	$486.91

BENDING TEMPLATE

Facility

$668.00

Hospital Revenue Code	272
Min. Negotiated Rate	$567.80
Max. Negotiated Rate	$647.96
Rate for Payer: Cash Price	$400.80
Rate for Payer: Health Management Network Commercial	$567.80
Rate for Payer: MDX Hawaii PPO	$647.96

BENIGN PROSTATIC HYPERTROPHY WITH MCC

Facility

$25,600.63

Service Code	MSDRG 725
Min. Negotiated Rate	$13,310.16
Max. Negotiated Rate	$25,600.63
Rate for Payer: AlohaCare Medicare	$13,310.16
Rate for Payer: Devoted Health Medicare	$14,641.18
Rate for Payer: Hawaii Medical Service Association Commercial	$25,600.63
Rate for Payer: Hawaii Medical Service Association Medicare	$13,310.16
Rate for Payer: Humana Medicare	$13,310.16
Rate for Payer: Kaiser Permanente Commercial	$20,185.95
Rate for Payer: Kaiser Permanente Medicare	$13,310.16
Rate for Payer: Ohana Health Plan Medicare	$13,310.16
Rate for Payer: UnitedHealthcare Medicare	$13,310.16

Know your out-of-pocket cost for care.

All Charges