Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PACKING 8CM NASAL

Facility

$146.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$87.60
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: MDX Hawaii PPO	$141.62

PACKING POPE EAR 24MM

Facility

$142.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.42
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$85.20
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$89.46
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: University Health Alliance Commercial	$103.50

PACKING POPE EAR 24MM

Facility

$142.00

Hospital Revenue Code	272
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$85.20
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: MDX Hawaii PPO	$137.74

PACK LAP CHOLE

Facility

$1,218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,035.30
Max. Negotiated Rate	$1,181.46
Rate for Payer: Cash Price	$730.80
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: MDX Hawaii PPO	$1,181.46

PACK LAP CHOLE

Facility

$1,218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$621.18
Max. Negotiated Rate	$1,181.46
Rate for Payer: Cash Price	$730.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,157.10
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: Kaiser Permanente Commercial	$767.34
Rate for Payer: Kaiser Permanente Medicaid	$621.18
Rate for Payer: MDX Hawaii PPO	$1,181.46
Rate for Payer: University Health Alliance Commercial	$887.80

PACK NASAL GEL 5.5CM

Facility

$194.00

Hospital Revenue Code	272
Min. Negotiated Rate	$164.90
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$116.40
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: MDX Hawaii PPO	$188.18

PACK NASAL GEL 5.5CM

Facility

$194.00

Hospital Revenue Code	272
Min. Negotiated Rate	$98.94
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$116.40
Rate for Payer: Hawaii Western Management Group Commercial	$184.30
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Kaiser Permanente Commercial	$122.22
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: University Health Alliance Commercial	$141.41

PACK ORTHO EXTREMITY

Facility

$147.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: MDX Hawaii PPO	$142.59

PACK ORTHO EXTREMITY

Facility

$147.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$107.15

PACK ROBOTIC PG55KRHH1

Facility

$292.00

Hospital Revenue Code	272
Min. Negotiated Rate	$248.20
Max. Negotiated Rate	$283.24
Rate for Payer: Cash Price	$175.20
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: MDX Hawaii PPO	$283.24

PACK ROBOTIC PG55KRHH1

Facility

$292.00

Hospital Revenue Code	272
Min. Negotiated Rate	$148.92
Max. Negotiated Rate	$283.24
Rate for Payer: Cash Price	$175.20
Rate for Payer: Hawaii Western Management Group Commercial	$277.40
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: Kaiser Permanente Commercial	$183.96
Rate for Payer: Kaiser Permanente Medicaid	$148.92
Rate for Payer: MDX Hawaii PPO	$283.24
Rate for Payer: University Health Alliance Commercial	$212.84

PACK SINUS ENDOSCOPY

Facility

$389.00

Hospital Revenue Code	272
Min. Negotiated Rate	$330.65
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$233.40
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: MDX Hawaii PPO	$377.33

PACK SINUS ENDOSCOPY

Facility

$389.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.39
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$233.40
Rate for Payer: Hawaii Western Management Group Commercial	$369.55
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: Kaiser Permanente Commercial	$245.07
Rate for Payer: Kaiser Permanente Medicaid	$198.39
Rate for Payer: MDX Hawaii PPO	$377.33
Rate for Payer: University Health Alliance Commercial	$283.54

PACK TOTAL JOINT

Facility

$506.00

Hospital Revenue Code	272
Min. Negotiated Rate	$258.06
Max. Negotiated Rate	$490.82
Rate for Payer: Cash Price	$303.60
Rate for Payer: Hawaii Western Management Group Commercial	$480.70
Rate for Payer: Health Management Network Commercial	$430.10
Rate for Payer: Kaiser Permanente Commercial	$318.78
Rate for Payer: Kaiser Permanente Medicaid	$258.06
Rate for Payer: MDX Hawaii PPO	$490.82
Rate for Payer: University Health Alliance Commercial	$368.82

PACK TOTAL JOINT

Facility

$506.00

Hospital Revenue Code	272
Min. Negotiated Rate	$430.10
Max. Negotiated Rate	$490.82
Rate for Payer: Cash Price	$303.60
Rate for Payer: Health Management Network Commercial	$430.10
Rate for Payer: MDX Hawaii PPO	$490.82

PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]

Facility

$119.00

Service Code	HCPCS J9267
Hospital Revenue Code	250
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$142.20
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Health Management Network Commercial	$462.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: MDX Hawaii PPO	$527.68
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: MDX Hawaii PPO	$229.89

PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]

Facility

$544.00

Service Code	HCPCS J9267
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$527.68
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$71.40
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$71.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Hawaii Western Management Group Commercial	$516.80
Rate for Payer: Hawaii Western Management Group Commercial	$225.15
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$462.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Kaiser Permanente Commercial	$149.31
Rate for Payer: Kaiser Permanente Commercial	$342.72
Rate for Payer: Kaiser Permanente Commercial	$74.97
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicaid	$120.87
Rate for Payer: Kaiser Permanente Medicaid	$277.44
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: MDX Hawaii PPO	$527.68
Rate for Payer: MDX Hawaii PPO	$229.89
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: UnitedHealthcare Medicaid	$142.20
Rate for Payer: UnitedHealthcare Medicaid	$84.00
Rate for Payer: UnitedHealthcare Medicaid	$71.40
Rate for Payer: UnitedHealthcare Medicaid	$326.40
Rate for Payer: University Health Alliance Commercial	$102.05
Rate for Payer: University Health Alliance Commercial	$396.52
Rate for Payer: University Health Alliance Commercial	$172.75
Rate for Payer: University Health Alliance Commercial	$86.74

PACLITAXEL PROTEIN-BOUND 100 MG/20ML IV (WET SUSR VIAL) [43040475]

Facility

$2,397.00

Service Code	HCPCS J9264
Hospital Revenue Code	250
Min. Negotiated Rate	$2,037.45
Max. Negotiated Rate	$2,325.09
Rate for Payer: Cash Price	$1,438.20
Rate for Payer: Health Management Network Commercial	$2,037.45
Rate for Payer: MDX Hawaii PPO	$2,325.09

PACLITAXEL PROTEIN-BOUND 100 MG/20ML IV (WET SUSR VIAL) [43040475]

Facility

$2,397.00

Service Code	HCPCS J9264
Hospital Revenue Code	636
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$2,325.09
Rate for Payer: AlohaCare Medicaid	$6.02
Rate for Payer: AlohaCare Medicare	$6.02
Rate for Payer: Cash Price	$1,438.20
Rate for Payer: Cash Price	$1,438.20
Rate for Payer: Devoted Health Medicare	$6.62
Rate for Payer: Hawaii Medical Service Association ABD	$12.12
Rate for Payer: Hawaii Medical Service Association Commercial	$7.53
Rate for Payer: Hawaii Medical Service Association Medicare	$6.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,277.15
Rate for Payer: Health Management Network Commercial	$2,037.45
Rate for Payer: Humana Medicare	$6.02
Rate for Payer: Kaiser Permanente Commercial	$1,510.11
Rate for Payer: Kaiser Permanente Medicaid	$1,222.47
Rate for Payer: Kaiser Permanente Medicare	$6.02
Rate for Payer: MDX Hawaii PPO	$2,325.09
Rate for Payer: Ohana Health Plan Medicaid	$6.62
Rate for Payer: Ohana Health Plan Medicare	$6.02
Rate for Payer: UnitedHealthcare Medicaid	$1,438.20
Rate for Payer: UnitedHealthcare Medicare	$6.02
Rate for Payer: University Health Alliance Commercial	$1,747.17

PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]

Facility

$2,397.00

Service Code	HCPCS J9264
Hospital Revenue Code	250
Min. Negotiated Rate	$2,037.45
Max. Negotiated Rate	$2,325.09
Rate for Payer: Cash Price	$1,438.20
Rate for Payer: Cash Price	$1,480.20
Rate for Payer: Health Management Network Commercial	$2,096.95
Rate for Payer: Health Management Network Commercial	$2,037.45
Rate for Payer: MDX Hawaii PPO	$2,325.09
Rate for Payer: MDX Hawaii PPO	$2,392.99

PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]

Facility

$2,467.00

Service Code	HCPCS J9264
Hospital Revenue Code	636
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$2,392.99
Rate for Payer: AlohaCare Medicaid	$6.02
Rate for Payer: AlohaCare Medicaid	$6.02
Rate for Payer: AlohaCare Medicare	$6.02
Rate for Payer: AlohaCare Medicare	$6.02
Rate for Payer: Cash Price	$1,438.20
Rate for Payer: Cash Price	$1,438.20
Rate for Payer: Cash Price	$1,480.20
Rate for Payer: Cash Price	$1,480.20
Rate for Payer: Devoted Health Medicare	$6.62
Rate for Payer: Devoted Health Medicare	$6.62
Rate for Payer: Hawaii Medical Service Association ABD	$12.12
Rate for Payer: Hawaii Medical Service Association ABD	$12.12
Rate for Payer: Hawaii Medical Service Association Commercial	$7.53
Rate for Payer: Hawaii Medical Service Association Commercial	$7.53
Rate for Payer: Hawaii Medical Service Association Medicare	$6.02
Rate for Payer: Hawaii Medical Service Association Medicare	$6.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,277.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,343.65
Rate for Payer: Health Management Network Commercial	$2,037.45
Rate for Payer: Health Management Network Commercial	$2,096.95
Rate for Payer: Humana Medicare	$6.02
Rate for Payer: Humana Medicare	$6.02
Rate for Payer: Kaiser Permanente Commercial	$1,510.11
Rate for Payer: Kaiser Permanente Commercial	$1,554.21
Rate for Payer: Kaiser Permanente Medicaid	$1,258.17
Rate for Payer: Kaiser Permanente Medicaid	$1,222.47
Rate for Payer: Kaiser Permanente Medicare	$6.02
Rate for Payer: Kaiser Permanente Medicare	$6.02
Rate for Payer: MDX Hawaii PPO	$2,325.09
Rate for Payer: MDX Hawaii PPO	$2,392.99
Rate for Payer: Ohana Health Plan Medicaid	$6.62
Rate for Payer: Ohana Health Plan Medicaid	$6.62
Rate for Payer: Ohana Health Plan Medicare	$6.02
Rate for Payer: Ohana Health Plan Medicare	$6.02
Rate for Payer: UnitedHealthcare Medicaid	$1,480.20
Rate for Payer: UnitedHealthcare Medicaid	$1,438.20
Rate for Payer: UnitedHealthcare Medicare	$6.02
Rate for Payer: UnitedHealthcare Medicare	$6.02
Rate for Payer: University Health Alliance Commercial	$1,747.17
Rate for Payer: University Health Alliance Commercial	$1,798.20

PADDING CAST MOLESKIN 683640

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$135.45
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: University Health Alliance Commercial	$156.71

PADDING CAST MOLESKIN 683640

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: MDX Hawaii PPO	$208.55

PADS PRESSURE IMP 907-GP-10

Facility

$239.00

Hospital Revenue Code	272
Min. Negotiated Rate	$203.15
Max. Negotiated Rate	$231.83
Rate for Payer: Cash Price	$143.40
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: MDX Hawaii PPO	$231.83

PADS PRESSURE IMP 907-GP-10

Facility

$239.00

Hospital Revenue Code	272
Min. Negotiated Rate	$121.89
Max. Negotiated Rate	$231.83
Rate for Payer: Cash Price	$143.40
Rate for Payer: Hawaii Western Management Group Commercial	$227.05
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: Kaiser Permanente Commercial	$150.57
Rate for Payer: Kaiser Permanente Medicaid	$121.89
Rate for Payer: MDX Hawaii PPO	$231.83
Rate for Payer: University Health Alliance Commercial	$174.21

Know your out-of-pocket cost for care.

All Charges