Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NAIL TROCH 10X320 8425-0320S

Facility

$7,092.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,971.52
Max. Negotiated Rate	$6,879.24
Rate for Payer: Cash Price	$4,255.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,964.40
Rate for Payer: Health Management Network Commercial	$6,028.20
Rate for Payer: MDX Hawaii PPO	$6,879.24
Rate for Payer: University Health Alliance Commercial	$3,971.52

NAIL TROCH 10X320 8425-0320S

Facility

$7,092.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,616.92
Max. Negotiated Rate	$6,879.24
Rate for Payer: Cash Price	$4,255.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,964.40
Rate for Payer: Health Management Network Commercial	$6,028.20
Rate for Payer: Kaiser Permanente Commercial	$4,467.96
Rate for Payer: Kaiser Permanente Medicaid	$3,616.92
Rate for Payer: MDX Hawaii PPO	$6,879.24
Rate for Payer: University Health Alliance Commercial	$3,971.52

NAIL TROCH 11X170 8125-1170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,438.31
Max. Negotiated Rate	$4,637.57
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: Kaiser Permanente Commercial	$3,012.03
Rate for Payer: Kaiser Permanente Medicaid	$2,438.31
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL TROCH 11X170 8125-1170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.36
Max. Negotiated Rate	$4,637.57
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL TROCHANTERIC 8130-0170S

Facility

$5,248.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,676.48
Max. Negotiated Rate	$5,090.56
Rate for Payer: Cash Price	$3,148.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,673.60
Rate for Payer: Health Management Network Commercial	$4,460.80
Rate for Payer: Kaiser Permanente Commercial	$3,306.24
Rate for Payer: Kaiser Permanente Medicaid	$2,676.48
Rate for Payer: MDX Hawaii PPO	$5,090.56
Rate for Payer: University Health Alliance Commercial	$2,938.88

NAIL TROCHANTERIC 8130-0170S

Facility

$5,248.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,938.88
Max. Negotiated Rate	$5,090.56
Rate for Payer: Cash Price	$3,148.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,673.60
Rate for Payer: Health Management Network Commercial	$4,460.80
Rate for Payer: MDX Hawaii PPO	$5,090.56
Rate for Payer: University Health Alliance Commercial	$2,938.88

NAIL TROCHANTERIC 8130-1170S

Facility

$5,248.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,938.88
Max. Negotiated Rate	$5,090.56
Rate for Payer: Cash Price	$3,148.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,673.60
Rate for Payer: Health Management Network Commercial	$4,460.80
Rate for Payer: MDX Hawaii PPO	$5,090.56
Rate for Payer: University Health Alliance Commercial	$2,938.88

NAIL TROCHANTERIC 8130-1170S

Facility

$5,248.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,676.48
Max. Negotiated Rate	$5,090.56
Rate for Payer: Cash Price	$3,148.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,673.60
Rate for Payer: Health Management Network Commercial	$4,460.80
Rate for Payer: Kaiser Permanente Commercial	$3,306.24
Rate for Payer: Kaiser Permanente Medicaid	$2,676.48
Rate for Payer: MDX Hawaii PPO	$5,090.56
Rate for Payer: University Health Alliance Commercial	$2,938.88

NAIL TROCHANTERIC 8130-2170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,438.31
Max. Negotiated Rate	$4,637.57
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: Kaiser Permanente Commercial	$3,012.03
Rate for Payer: Kaiser Permanente Medicaid	$2,438.31
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL TROCHANTERIC 8130-2170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.36
Max. Negotiated Rate	$4,637.57
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL TROCHANTERIC 8130-3170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.36
Max. Negotiated Rate	$4,637.57
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL TROCHANTERIC 8130-3170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,438.31
Max. Negotiated Rate	$4,637.57
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: Kaiser Permanente Commercial	$3,012.03
Rate for Payer: Kaiser Permanente Medicaid	$2,438.31
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAI TI 10X400/RT 04.003.360S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,193.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAI TI 10X400/RT 04.003.360S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]

Facility

$16.00

Service Code	HCPCS J2300
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: MDX Hawaii PPO	$15.52

NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]

Facility

$16.00

Service Code	HCPCS J2300
Hospital Revenue Code	636
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$11.40
Rate for Payer: Cash Price	$11.40
Rate for Payer: Cash Price	$9.60
Rate for Payer: Hawaii Medical Service Association ABD	$3.51
Rate for Payer: Hawaii Medical Service Association ABD	$3.51
Rate for Payer: Hawaii Medical Service Association ABD	$3.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.51
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$7.56
Rate for Payer: Kaiser Permanente Commercial	$10.08
Rate for Payer: Kaiser Permanente Commercial	$11.97
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: UnitedHealthcare Medicaid	$11.40
Rate for Payer: UnitedHealthcare Medicaid	$9.60
Rate for Payer: University Health Alliance Commercial	$13.85
Rate for Payer: University Health Alliance Commercial	$8.75
Rate for Payer: University Health Alliance Commercial	$11.66

NALOXONE 0.4 MG/10 ML (40 MCG/ML) DILUTE INJ (RN PREP) [401284]

Facility

$60.00

Service Code	HCPCS J2312
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$36.00
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Commercial	$11.34
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: UnitedHealthcare Medicaid	$10.80
Rate for Payer: UnitedHealthcare Medicaid	$36.00
Rate for Payer: University Health Alliance Commercial	$13.12
Rate for Payer: University Health Alliance Commercial	$43.73

NALOXONE 0.4 MG/10 ML (40 MCG/ML) DILUTE INJ (RN PREP) [401284]

Facility

$18.00

Service Code	HCPCS J2312
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: MDX Hawaii PPO	$58.20

NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]

Facility

$60.00

Service Code	HCPCS J2312
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Commercial	$11.34
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: UnitedHealthcare Medicaid	$36.00
Rate for Payer: UnitedHealthcare Medicaid	$10.80
Rate for Payer: University Health Alliance Commercial	$13.12
Rate for Payer: University Health Alliance Commercial	$43.73

NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]

Facility

$18.00

Service Code	HCPCS J2312
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: MDX Hawaii PPO	$58.20

NALOXONE 1 MG/ML INJECTION SYRINGE [134075]

Facility

$99.00

Service Code	HCPCS J2312
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$62.37
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: UnitedHealthcare Medicaid	$59.40
Rate for Payer: University Health Alliance Commercial	$72.16

NALOXONE 1 MG/ML INJECTION SYRINGE [134075]

Facility

$99.00

Service Code	HCPCS J2312
Hospital Revenue Code	250
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: MDX Hawaii PPO	$96.03

NALOXONE 4 MG/ACTUATION NASAL SPRAY [131429]

Facility

$68.00

Service Code	NDC 69547062702
Hospital Revenue Code	250
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

NALOXONE 4 MG/ACTUATION NASAL SPRAY [131429]

Facility

$120.00

Service Code	NDC 45802057884
Hospital Revenue Code	250
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: MDX Hawaii PPO	$116.40

NALTREXONE 50 MG TABLET [10685]

Facility

$15.00

Service Code	NDC 47335032683
Hospital Revenue Code	637
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

Know your out-of-pocket cost for care.

All Charges