Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NATURELLE STY SALINE 684HP-500

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

NEBIVOLOL 5 MG TABLET [89284]

Facility

$13.00

Service Code	NDC 60687064121
Hospital Revenue Code	637
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$8.19
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: University Health Alliance Commercial	$9.48

NEBIVOLOL 5 MG TABLET [89284]

Facility

$13.00

Service Code	NDC 60687064121
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: MDX Hawaii PPO	$12.61

NEBIVOLOL 5 MG TABLET [89284]

Facility

$13.00

Service Code	NDC 60687064111
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: MDX Hawaii PPO	$12.61

NEBIVOLOL 5 MG TABLET [89284]

Facility

$13.00

Service Code	NDC 60687064111
Hospital Revenue Code	637
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$8.19
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: University Health Alliance Commercial	$9.48

NEEDLE 10X3.25 DECOMPRESSION

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Hawaii Western Management Group Commercial	$102.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$68.04
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: University Health Alliance Commercial	$78.72

NEEDLE 10X3.25 DECOMPRESSION

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$104.76

NEEDLE 14G BIOPSY SOFT TISSUE

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$60.48
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: University Health Alliance Commercial	$69.97

NEEDLE 14G BIOPSY SOFT TISSUE

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: MDX Hawaii PPO	$93.12

NEEDLE 14GX4.5 BIOPSY

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: MDX Hawaii PPO	$93.12

NEEDLE 14GX4.5 BIOPSY

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$60.48
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: University Health Alliance Commercial	$69.97

NEEDLE 150MM INSUFFLATION

Facility

$89.00

Hospital Revenue Code	272
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$53.40
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: MDX Hawaii PPO	$86.33

NEEDLE 150MM INSUFFLATION

Facility

$89.00

Hospital Revenue Code	272
Min. Negotiated Rate	$45.39
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$53.40
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$56.07
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: University Health Alliance Commercial	$64.87

NEEDLE 15GX70MM BONE MARROW

Facility

$90.00

Hospital Revenue Code	272
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

NEEDLE 15GX70MM BONE MARROW

Facility

$90.00

Hospital Revenue Code	272
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
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: University Health Alliance Commercial	$65.60

NEEDLE 15X13 8CM TRUGUIDE

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: MDX Hawaii PPO	$91.18

NEEDLE 15X13 8CM TRUGUIDE

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$47.94
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$59.22
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: University Health Alliance Commercial	$68.52

NEEDLE 18X16 MONOPTY CORE

Facility

$141.00

Hospital Revenue Code	272
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: MDX Hawaii PPO	$136.77

NEEDLE 18X16 MONOPTY CORE

Facility

$141.00

Hospital Revenue Code	272
Min. Negotiated Rate	$71.91
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$88.83
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: University Health Alliance Commercial	$102.77

NEEDLE 20G TRANSBRONCH ASP

Facility

$328.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$278.80
Max. Negotiated Rate	$318.16
Rate for Payer: Cash Price	$196.80
Rate for Payer: Health Management Network Commercial	$278.80
Rate for Payer: MDX Hawaii PPO	$318.16

NEEDLE 20G TRANSBRONCH ASP

Facility

$328.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$167.28
Max. Negotiated Rate	$318.16
Rate for Payer: Cash Price	$196.80
Rate for Payer: Hawaii Western Management Group Commercial	$311.60
Rate for Payer: Health Management Network Commercial	$278.80
Rate for Payer: Kaiser Permanente Commercial	$206.64
Rate for Payer: Kaiser Permanente Medicaid	$167.28
Rate for Payer: MDX Hawaii PPO	$318.16
Rate for Payer: University Health Alliance Commercial	$239.08

NEEDLE ACCESS PERC 18X12

Facility

$379.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$322.15
Max. Negotiated Rate	$367.63
Rate for Payer: Cash Price	$227.40
Rate for Payer: Health Management Network Commercial	$322.15
Rate for Payer: MDX Hawaii PPO	$367.63

NEEDLE ACCESS PERC 18X12

Facility

$379.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$193.29
Max. Negotiated Rate	$367.63
Rate for Payer: Cash Price	$227.40
Rate for Payer: Hawaii Western Management Group Commercial	$360.05
Rate for Payer: Health Management Network Commercial	$322.15
Rate for Payer: Kaiser Permanente Commercial	$238.77
Rate for Payer: Kaiser Permanente Medicaid	$193.29
Rate for Payer: MDX Hawaii PPO	$367.63
Rate for Payer: University Health Alliance Commercial	$276.25

NEEDLE ACCESS PERC 18X20

Facility

$155.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
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

NEEDLE ACCESS PERC 18X20

Facility

$155.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$97.65
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: University Health Alliance Commercial	$112.98

Know your out-of-pocket cost for care.

All Charges