Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PALACOS BONE CEMENT R+G

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$526.83
Max. Negotiated Rate	$1,002.01
Rate for Payer: Cash Price	$619.80
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Kaiser Permanente Commercial	$650.79
Rate for Payer: Kaiser Permanente Medicaid	$526.83
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: University Health Alliance Commercial	$578.48

PALACOS BONE CEMENT R+G

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$578.48
Max. Negotiated Rate	$1,002.01
Rate for Payer: Cash Price	$619.80
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: University Health Alliance Commercial	$578.48

PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)

Facility

$13,778.00

Service Code	CPT 42145
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,778.00
Rate for Payer: AlohaCare Medicaid	$6,993.36
Rate for Payer: AlohaCare Medicare	$6,993.36
Rate for Payer: Devoted Health Medicare	$7,692.70
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,993.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Humana Medicare	$6,993.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,993.36
Rate for Payer: Ohana Health Plan Medicaid	$7,692.70
Rate for Payer: Ohana Health Plan Medicare	$6,993.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$6,993.36
Rate for Payer: University Health Alliance Commercial	$11,157.19

PALINDROME CATH

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: MDX Hawaii PPO	$1,425.90

PALINDROME CATH

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$749.70
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: Kaiser Permanente Medicaid	$749.70
Rate for Payer: MDX Hawaii PPO	$1,425.90
Rate for Payer: University Health Alliance Commercial	$1,071.48

PALINDROME CATH 8888145018

Facility

$1,753.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,490.05
Max. Negotiated Rate	$1,700.41
Rate for Payer: Cash Price	$1,051.80
Rate for Payer: Health Management Network Commercial	$1,490.05
Rate for Payer: MDX Hawaii PPO	$1,700.41

PALINDROME CATH 8888145018

Facility

$1,753.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$894.03
Max. Negotiated Rate	$1,700.41
Rate for Payer: Cash Price	$1,051.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,665.35
Rate for Payer: Health Management Network Commercial	$1,490.05
Rate for Payer: Kaiser Permanente Commercial	$1,104.39
Rate for Payer: Kaiser Permanente Medicaid	$894.03
Rate for Payer: MDX Hawaii PPO	$1,700.41
Rate for Payer: University Health Alliance Commercial	$1,277.76

PALINDROME DIALY CATH 14.5 L

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$749.70
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: Kaiser Permanente Medicaid	$749.70
Rate for Payer: MDX Hawaii PPO	$1,425.90
Rate for Payer: University Health Alliance Commercial	$1,071.48

PALINDROME DIALY CATH 14.5 L

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: MDX Hawaii PPO	$1,425.90

PALINDROME SPORT 8888119368P

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: MDX Hawaii PPO	$1,425.90

PALINDROME SPORT 8888119368P

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$749.70
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: Kaiser Permanente Medicaid	$749.70
Rate for Payer: MDX Hawaii PPO	$1,425.90
Rate for Payer: University Health Alliance Commercial	$1,071.48

PALINDROME SPORT KIT

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: MDX Hawaii PPO	$1,425.90

PALINDROME SPORT KIT

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$749.70
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: Kaiser Permanente Medicaid	$749.70
Rate for Payer: MDX Hawaii PPO	$1,425.90
Rate for Payer: University Health Alliance Commercial	$1,071.48

PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR [78064]

Facility

$77.00

Service Code	NDC 27808022301
Hospital Revenue Code	250
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: MDX Hawaii PPO	$74.69

PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR [78064]

Facility

$77.00

Service Code	NDC 27808022301
Hospital Revenue Code	637
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$48.51
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: University Health Alliance Commercial	$56.13

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR [78065]

Facility

$77.00

Service Code	NDC 65162028203
Hospital Revenue Code	637
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$48.51
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: University Health Alliance Commercial	$56.13

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR [78065]

Facility

$77.00

Service Code	NDC 27808022401
Hospital Revenue Code	637
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$48.51
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: University Health Alliance Commercial	$56.13

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR [78065]

Facility

$77.00

Service Code	NDC 27808022401
Hospital Revenue Code	250
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: MDX Hawaii PPO	$74.69

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR [78065]

Facility

$77.00

Service Code	NDC 65162028203
Hospital Revenue Code	250
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: MDX Hawaii PPO	$74.69

PALIPERIDONE PALMITATE 117 MG/0.75 ML INTRAMUSCULAR SYRINGE [166236]

Facility

$2,642.00

Service Code	HCPCS J2426
Hospital Revenue Code	250
Min. Negotiated Rate	$2,245.70
Max. Negotiated Rate	$2,562.74
Rate for Payer: Cash Price	$1,585.20
Rate for Payer: Health Management Network Commercial	$2,245.70
Rate for Payer: MDX Hawaii PPO	$2,562.74

PALIPERIDONE PALMITATE 117 MG/0.75 ML INTRAMUSCULAR SYRINGE [166236]

Facility

$2,642.00

Service Code	HCPCS J2426
Hospital Revenue Code	636
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$2,562.74
Rate for Payer: AlohaCare Medicaid	$15.08
Rate for Payer: AlohaCare Medicare	$15.08
Rate for Payer: Cash Price	$1,585.20
Rate for Payer: Cash Price	$1,585.20
Rate for Payer: Devoted Health Medicare	$16.59
Rate for Payer: Hawaii Medical Service Association ABD	$15.08
Rate for Payer: Hawaii Medical Service Association Commercial	$18.85
Rate for Payer: Hawaii Medical Service Association Medicare	$15.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,509.90
Rate for Payer: Health Management Network Commercial	$2,245.70
Rate for Payer: Humana Medicare	$15.08
Rate for Payer: Kaiser Permanente Commercial	$1,664.46
Rate for Payer: Kaiser Permanente Medicaid	$1,347.42
Rate for Payer: Kaiser Permanente Medicare	$15.08
Rate for Payer: MDX Hawaii PPO	$2,562.74
Rate for Payer: Ohana Health Plan Medicaid	$16.59
Rate for Payer: Ohana Health Plan Medicare	$15.08
Rate for Payer: UnitedHealthcare Medicaid	$1,585.20
Rate for Payer: UnitedHealthcare Medicare	$15.08
Rate for Payer: University Health Alliance Commercial	$1,925.75

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]

Facility

$38.00

Service Code	HCPCS J2469
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Health Management Network Commercial	$357.00
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$407.40
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: MDX Hawaii PPO	$73.72

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]

Facility

$38.00

Service Code	HCPCS J2469
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Cash Price	$22.80
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Hawaii Medical Service Association ABD	$0.45
Rate for Payer: Hawaii Medical Service Association ABD	$0.45
Rate for Payer: Hawaii Medical Service Association ABD	$0.45
Rate for Payer: Hawaii Medical Service Association ABD	$0.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.45
Rate for Payer: Hawaii Western Management Group Commercial	$36.10
Rate for Payer: Hawaii Western Management Group Commercial	$399.00
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Health Management Network Commercial	$357.00
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$23.94
Rate for Payer: Kaiser Permanente Commercial	$47.88
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: Kaiser Permanente Commercial	$79.38
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicaid	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: MDX Hawaii PPO	$407.40
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: UnitedHealthcare Medicaid	$22.80
Rate for Payer: UnitedHealthcare Medicaid	$45.60
Rate for Payer: UnitedHealthcare Medicaid	$252.00
Rate for Payer: UnitedHealthcare Medicaid	$75.60
Rate for Payer: University Health Alliance Commercial	$55.40
Rate for Payer: University Health Alliance Commercial	$91.84
Rate for Payer: University Health Alliance Commercial	$27.70
Rate for Payer: University Health Alliance Commercial	$306.14

PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]

Facility

$114.00

Service Code	HCPCS J2430
Hospital Revenue Code	250
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$49.20
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: MDX Hawaii PPO	$79.54

PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]

Facility

$82.00

Service Code	HCPCS J2430
Hospital Revenue Code	636
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$49.20
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$49.20
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.16
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Hawaii Western Management Group Commercial	$77.90
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$51.66
Rate for Payer: Kaiser Permanente Commercial	$71.82
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: UnitedHealthcare Medicaid	$49.20
Rate for Payer: UnitedHealthcare Medicaid	$68.40
Rate for Payer: University Health Alliance Commercial	$59.77
Rate for Payer: University Health Alliance Commercial	$83.09

Know your out-of-pocket cost for care.

All Charges