Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

MINIRAIL SHORT 32/5MM M103

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,266.84
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$1,564.92
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: University Health Alliance Commercial	$1,810.59

MINIRAIL SHORT SSM160

Facility

$2,835.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,409.75
Max. Negotiated Rate	$2,749.95
Rate for Payer: Cash Price	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,409.75
Rate for Payer: MDX Hawaii PPO	$2,749.95

MINIRAIL SHORT SSM160

Facility

$2,835.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,445.85
Max. Negotiated Rate	$2,749.95
Rate for Payer: Cash Price	$1,701.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,693.25
Rate for Payer: Health Management Network Commercial	$2,409.75
Rate for Payer: Kaiser Permanente Commercial	$1,786.05
Rate for Payer: Kaiser Permanente Medicaid	$1,445.85
Rate for Payer: MDX Hawaii PPO	$2,749.95
Rate for Payer: University Health Alliance Commercial	$2,066.43

MINIRAIL STD 57/5MM M101

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,266.84
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$1,564.92
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: University Health Alliance Commercial	$1,810.59

MINIRAIL STD 57/5MM M101

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: MDX Hawaii PPO	$2,409.48

MINIRAIL VERT ARTIC M122

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,266.84
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$1,564.92
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: University Health Alliance Commercial	$1,810.59

MINIRAIL VERT ARTIC M122

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: MDX Hawaii PPO	$2,409.48

MINIRAIL W/ HINGE #SSM512

Facility

$3,626.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,082.10
Max. Negotiated Rate	$3,517.22
Rate for Payer: Cash Price	$2,175.60
Rate for Payer: Health Management Network Commercial	$3,082.10
Rate for Payer: MDX Hawaii PPO	$3,517.22

MINIRAIL W/ HINGE #SSM512

Facility

$3,626.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,849.26
Max. Negotiated Rate	$3,517.22
Rate for Payer: Cash Price	$2,175.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,444.70
Rate for Payer: Health Management Network Commercial	$3,082.10
Rate for Payer: Kaiser Permanente Commercial	$2,284.38
Rate for Payer: Kaiser Permanente Medicaid	$1,849.26
Rate for Payer: MDX Hawaii PPO	$3,517.22
Rate for Payer: University Health Alliance Commercial	$2,642.99

MINOR BLADDER PROCEDURES WITH CC

Facility

$26,223.45

Service Code	MSDRG 663
Min. Negotiated Rate	$17,291.13
Max. Negotiated Rate	$26,223.45
Rate for Payer: AlohaCare Medicare	$17,291.13
Rate for Payer: Devoted Health Medicare	$19,020.24
Rate for Payer: Hawaii Medical Service Association Commercial	$24,945.45
Rate for Payer: Hawaii Medical Service Association Medicare	$17,291.13
Rate for Payer: Humana Medicare	$17,291.13
Rate for Payer: Kaiser Permanente Commercial	$26,223.45
Rate for Payer: Kaiser Permanente Medicare	$17,291.13
Rate for Payer: Ohana Health Plan Medicare	$17,291.13
Rate for Payer: UnitedHealthcare Medicare	$17,291.13

MINOR BLADDER PROCEDURES WITH MCC

Facility

$52,810.88

Service Code	MSDRG 662
Min. Negotiated Rate	$33,608.41
Max. Negotiated Rate	$52,810.88
Rate for Payer: AlohaCare Medicare	$34,822.27
Rate for Payer: Devoted Health Medicare	$38,304.50
Rate for Payer: Hawaii Medical Service Association Commercial	$33,608.41
Rate for Payer: Hawaii Medical Service Association Medicare	$34,822.27
Rate for Payer: Humana Medicare	$34,822.27
Rate for Payer: Kaiser Permanente Commercial	$52,810.88
Rate for Payer: Kaiser Permanente Medicare	$34,822.27
Rate for Payer: Ohana Health Plan Medicare	$34,822.27
Rate for Payer: UnitedHealthcare Medicare	$34,822.27

MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$19,606.93

Service Code	MSDRG 664
Min. Negotiated Rate	$11,907.71
Max. Negotiated Rate	$19,606.93
Rate for Payer: AlohaCare Medicare	$11,907.71
Rate for Payer: Devoted Health Medicare	$13,098.48
Rate for Payer: Hawaii Medical Service Association Commercial	$19,606.93
Rate for Payer: Hawaii Medical Service Association Medicare	$11,907.71
Rate for Payer: Humana Medicare	$11,907.71
Rate for Payer: Kaiser Permanente Commercial	$18,059.03
Rate for Payer: Kaiser Permanente Medicare	$11,907.71
Rate for Payer: Ohana Health Plan Medicare	$11,907.71
Rate for Payer: UnitedHealthcare Medicare	$11,907.71

MINOR SKIN DISORDERS WITH MCC

Facility

$26,102.70

Service Code	MSDRG 606
Min. Negotiated Rate	$14,244.14
Max. Negotiated Rate	$26,102.70
Rate for Payer: AlohaCare Medicare	$17,211.53
Rate for Payer: Devoted Health Medicare	$18,932.68
Rate for Payer: Hawaii Medical Service Association Commercial	$14,244.14
Rate for Payer: Hawaii Medical Service Association Medicare	$17,211.53
Rate for Payer: Humana Medicare	$17,211.53
Rate for Payer: Kaiser Permanente Commercial	$26,102.70
Rate for Payer: Kaiser Permanente Medicare	$17,211.53
Rate for Payer: Ohana Health Plan Medicare	$17,211.53
Rate for Payer: UnitedHealthcare Medicare	$17,211.53

MINOR SKIN DISORDERS WITHOUT MCC

Facility

$15,635.40

Service Code	MSDRG 607
Min. Negotiated Rate	$10,309.62
Max. Negotiated Rate	$15,635.40
Rate for Payer: AlohaCare Medicare	$10,309.62
Rate for Payer: Devoted Health Medicare	$11,340.58
Rate for Payer: Hawaii Medical Service Association Commercial	$12,836.71
Rate for Payer: Hawaii Medical Service Association Medicare	$10,309.62
Rate for Payer: Humana Medicare	$10,309.62
Rate for Payer: Kaiser Permanente Commercial	$15,635.40
Rate for Payer: Kaiser Permanente Medicare	$10,309.62
Rate for Payer: Ohana Health Plan Medicare	$10,309.62
Rate for Payer: UnitedHealthcare Medicare	$10,309.62

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$33,220.15

Service Code	MSDRG 345
Min. Negotiated Rate	$17,114.85
Max. Negotiated Rate	$33,220.15
Rate for Payer: AlohaCare Medicare	$17,114.85
Rate for Payer: Devoted Health Medicare	$18,826.33
Rate for Payer: Hawaii Medical Service Association Commercial	$33,220.15
Rate for Payer: Hawaii Medical Service Association Medicare	$17,114.85
Rate for Payer: Humana Medicare	$17,114.85
Rate for Payer: Kaiser Permanente Commercial	$25,956.08
Rate for Payer: Kaiser Permanente Medicare	$17,114.85
Rate for Payer: Ohana Health Plan Medicare	$17,114.85
Rate for Payer: UnitedHealthcare Medicare	$17,114.85

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$44,553.30

Service Code	MSDRG 344
Min. Negotiated Rate	$29,377.42
Max. Negotiated Rate	$44,553.30
Rate for Payer: AlohaCare Medicare	$29,377.42
Rate for Payer: Devoted Health Medicare	$32,315.16
Rate for Payer: Hawaii Medical Service Association Commercial	$37,151.25
Rate for Payer: Hawaii Medical Service Association Medicare	$29,377.42
Rate for Payer: Humana Medicare	$29,377.42
Rate for Payer: Kaiser Permanente Commercial	$44,553.30
Rate for Payer: Kaiser Permanente Medicare	$29,377.42
Rate for Payer: Ohana Health Plan Medicare	$29,377.42
Rate for Payer: UnitedHealthcare Medicare	$29,377.42

MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$27,323.52

Service Code	MSDRG 346
Min. Negotiated Rate	$13,492.13
Max. Negotiated Rate	$27,323.52
Rate for Payer: AlohaCare Medicare	$13,492.13
Rate for Payer: Devoted Health Medicare	$14,841.34
Rate for Payer: Hawaii Medical Service Association Commercial	$27,323.52
Rate for Payer: Hawaii Medical Service Association Medicare	$13,492.13
Rate for Payer: Humana Medicare	$13,492.13
Rate for Payer: Kaiser Permanente Commercial	$20,461.95
Rate for Payer: Kaiser Permanente Medicare	$13,492.13
Rate for Payer: Ohana Health Plan Medicare	$13,492.13
Rate for Payer: UnitedHealthcare Medicare	$13,492.13

MINOXIDIL 10 MG TABLET [5114]

Facility

$6.00

Service Code	NDC 49884025701
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

MINOXIDIL 10 MG TABLET [5114]

Facility

$6.00

Service Code	NDC 49884025701
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

MINOXIDIL 2.5 MG TABLET [5115]

Facility

$3.00

Service Code	NDC 49884025601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: MDX Hawaii PPO	$2.91

MINOXIDIL 2.5 MG TABLET [5115]

Facility

$3.00

Service Code	NDC 49884025601
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$1.89
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: University Health Alliance Commercial	$2.19

MIRTAZAPINE 15 MG TABLET [17466]

Facility

$4.00

Service Code	NDC 68084011911
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

MIRTAZAPINE 15 MG TABLET [17466]

Facility

$4.00

Service Code	NDC 68084011911
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

MIRTAZAPINE 15 MG TABLET [17466]

Facility

$4.00

Service Code	NDC 68084011901
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

MIRTAZAPINE 15 MG TABLET [17466]

Facility

$4.00

Service Code	NDC 68084011901
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

Know your out-of-pocket cost for care.

All Charges