Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$4,366.34

Service Code	APR-DRG 5323
Min. Negotiated Rate	$4,366.34
Max. Negotiated Rate	$4,366.34
Rate for Payer: AlohaCare Medicaid	$4,366.34
Rate for Payer: Hawaii Medical Service Association ABD	$4,366.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,366.34
Rate for Payer: Kaiser Permanente Medicaid	$4,366.34
Rate for Payer: Ohana Health Plan Medicaid	$4,366.34
Rate for Payer: UnitedHealthcare Medicaid	$4,366.34

MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$2,408.86

Service Code	APR-DRG 5321
Min. Negotiated Rate	$2,408.86
Max. Negotiated Rate	$2,408.86
Rate for Payer: AlohaCare Medicaid	$2,408.86
Rate for Payer: Hawaii Medical Service Association ABD	$2,408.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,408.86
Rate for Payer: Kaiser Permanente Medicaid	$2,408.86
Rate for Payer: Ohana Health Plan Medicaid	$2,408.86
Rate for Payer: UnitedHealthcare Medicaid	$2,408.86

MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$9,368.65

Service Code	APR-DRG 5324
Min. Negotiated Rate	$9,368.65
Max. Negotiated Rate	$9,368.65
Rate for Payer: AlohaCare Medicaid	$9,368.65
Rate for Payer: Hawaii Medical Service Association ABD	$9,368.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,368.65
Rate for Payer: Kaiser Permanente Medicaid	$9,368.65
Rate for Payer: Ohana Health Plan Medicaid	$9,368.65
Rate for Payer: UnitedHealthcare Medicaid	$9,368.65

MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE

Facility

$7,625.71

Service Code	APR-DRG 7402
Min. Negotiated Rate	$7,625.71
Max. Negotiated Rate	$7,625.71
Rate for Payer: AlohaCare Medicaid	$7,625.71
Rate for Payer: Hawaii Medical Service Association ABD	$7,625.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,625.71
Rate for Payer: Kaiser Permanente Medicaid	$7,625.71
Rate for Payer: Ohana Health Plan Medicaid	$7,625.71
Rate for Payer: UnitedHealthcare Medicaid	$7,625.71

MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE

Facility

$7,248.40

Service Code	APR-DRG 7401
Min. Negotiated Rate	$7,248.40
Max. Negotiated Rate	$7,248.40
Rate for Payer: AlohaCare Medicaid	$7,248.40
Rate for Payer: Hawaii Medical Service Association ABD	$7,248.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,248.40
Rate for Payer: Kaiser Permanente Medicaid	$7,248.40
Rate for Payer: Ohana Health Plan Medicaid	$7,248.40
Rate for Payer: UnitedHealthcare Medicaid	$7,248.40

MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE

Facility

$15,591.96

Service Code	APR-DRG 7403
Min. Negotiated Rate	$15,591.96
Max. Negotiated Rate	$15,591.96
Rate for Payer: AlohaCare Medicaid	$15,591.96
Rate for Payer: Hawaii Medical Service Association ABD	$15,591.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,591.96
Rate for Payer: Kaiser Permanente Medicaid	$15,591.96
Rate for Payer: Ohana Health Plan Medicaid	$15,591.96
Rate for Payer: UnitedHealthcare Medicaid	$15,591.96

MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE

Facility

$33,512.30

Service Code	APR-DRG 7404
Min. Negotiated Rate	$33,512.30
Max. Negotiated Rate	$33,512.30
Rate for Payer: AlohaCare Medicaid	$33,512.30
Rate for Payer: Hawaii Medical Service Association ABD	$33,512.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33,512.30
Rate for Payer: Kaiser Permanente Medicaid	$33,512.30
Rate for Payer: Ohana Health Plan Medicaid	$33,512.30
Rate for Payer: UnitedHealthcare Medicaid	$33,512.30

MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION [4903]

Facility

$11.00

Service Code	HCPCS J2175
Hospital Revenue Code	636
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$15.69
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Medical Service Association ABD	$15.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.69
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: UnitedHealthcare Medicaid	$6.60
Rate for Payer: University Health Alliance Commercial	$8.02

MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION [4903]

Facility

$11.00

Service Code	HCPCS J2175
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION [4904]

Facility

$12.00

Service Code	HCPCS J2175
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: MDX Hawaii PPO	$11.64

MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION [4904]

Facility

$12.00

Service Code	HCPCS J2175
Hospital Revenue Code	636
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$15.69
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Hawaii Medical Service Association ABD	$15.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.69
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$7.56
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: University Health Alliance Commercial	$8.75

MEPILEX BORDER 3.6X4 498200

Facility

$75.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: MDX Hawaii PPO	$72.75

MEPILEX BORDER 3.6X4 498200

Facility

$75.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Hawaii Western Management Group Commercial	$71.25
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: Kaiser Permanente Commercial	$47.25
Rate for Payer: Kaiser Permanente Medicaid	$38.25
Rate for Payer: MDX Hawaii PPO	$72.75
Rate for Payer: UnitedHealthcare Medicaid	$10.11
Rate for Payer: University Health Alliance Commercial	$54.67

MEROPENEM 1 G/20ML IV (WET SOLR VIAL) [43017380]

Facility

$22.00

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$13.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.44
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$13.86
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: University Health Alliance Commercial	$16.04

MEROPENEM 1 G/20ML IV (WET SOLR VIAL) [43017380]

Facility

$22.00

Service Code	HCPCS J2185
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: MDX Hawaii PPO	$21.34

MEROPENEM 1 GRAM/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [130367]

Facility

$90.00

Service Code	HCPCS J2184
Hospital Revenue Code	636
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Hawaii Medical Service Association ABD	$2.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.08
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: UnitedHealthcare Medicaid	$54.00
Rate for Payer: University Health Alliance Commercial	$65.60

MEROPENEM 1 GRAM/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [130367]

Facility

$90.00

Service Code	HCPCS J2184
Hospital Revenue Code	250
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$87.30

MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]

Facility

$22.00

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$13.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.44
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$13.86
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: University Health Alliance Commercial	$16.04

MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]

Facility

$22.00

Service Code	HCPCS J2185
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: MDX Hawaii PPO	$21.34

MEROPENEM 500 MG/10 ML IV (WET SOLR VIAL) [43017379]

Facility

$11.00

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.44
Rate for Payer: Hawaii Medical Service Association ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.44
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Commercial	$8.19
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: UnitedHealthcare Medicaid	$6.60
Rate for Payer: UnitedHealthcare Medicaid	$7.80
Rate for Payer: University Health Alliance Commercial	$8.02
Rate for Payer: University Health Alliance Commercial	$9.48

MEROPENEM 500 MG/10 ML IV (WET SOLR VIAL) [43017379]

Facility

$13.00

Service Code	HCPCS J2185
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$10.67

MEROPENEM 500 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [130366]

Facility

$62.00

Service Code	HCPCS J2184
Hospital Revenue Code	636
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$37.20
Rate for Payer: Cash Price	$37.20
Rate for Payer: Hawaii Medical Service Association ABD	$2.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.08
Rate for Payer: Hawaii Western Management Group Commercial	$58.90
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Kaiser Permanente Commercial	$39.06
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: UnitedHealthcare Medicaid	$37.20
Rate for Payer: University Health Alliance Commercial	$45.19

MEROPENEM 500 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [130366]

Facility

$62.00

Service Code	HCPCS J2184
Hospital Revenue Code	250
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$37.20
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: MDX Hawaii PPO	$60.14

MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]

Facility

$22.00

Service Code	HCPCS J2185
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: MDX Hawaii PPO	$12.61

MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]

Facility

$13.00

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$13.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.44
Rate for Payer: Hawaii Medical Service Association ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.44
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$8.19
Rate for Payer: Kaiser Permanente Commercial	$13.86
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: UnitedHealthcare Medicaid	$7.80
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: University Health Alliance Commercial	$9.48
Rate for Payer: University Health Alliance Commercial	$16.04

Know your out-of-pocket cost for care.

All Charges