Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$28,164.08

Service Code	MSDRG 299
Min. Negotiated Rate	$18,570.75
Max. Negotiated Rate	$28,164.08
Rate for Payer: AlohaCare Medicare	$18,570.75
Rate for Payer: Devoted Health Medicare	$20,427.83
Rate for Payer: Hawaii Medical Service Association Commercial	$26,644.07
Rate for Payer: Hawaii Medical Service Association Medicare	$18,570.75
Rate for Payer: Humana Medicare	$18,570.75
Rate for Payer: Kaiser Permanente Commercial	$28,164.08
Rate for Payer: Kaiser Permanente Medicare	$18,570.75
Rate for Payer: Ohana Health Plan Medicare	$18,570.75
Rate for Payer: UnitedHealthcare Medicare	$18,570.75

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$18,490.69

Service Code	MSDRG 301
Min. Negotiated Rate	$8,186.05
Max. Negotiated Rate	$18,490.69
Rate for Payer: AlohaCare Medicare	$8,186.05
Rate for Payer: Devoted Health Medicare	$9,004.66
Rate for Payer: Hawaii Medical Service Association Commercial	$18,490.69
Rate for Payer: Hawaii Medical Service Association Medicare	$8,186.05
Rate for Payer: Humana Medicare	$8,186.05
Rate for Payer: Kaiser Permanente Commercial	$12,414.83
Rate for Payer: Kaiser Permanente Medicare	$8,186.05
Rate for Payer: Ohana Health Plan Medicare	$8,186.05
Rate for Payer: UnitedHealthcare Medicare	$8,186.05

PERITONEAL ADHESIOLYSIS

Facility

$21,084.20

Service Code	APR-DRG 2244
Min. Negotiated Rate	$21,084.20
Max. Negotiated Rate	$21,084.20
Rate for Payer: AlohaCare Medicaid	$21,084.20
Rate for Payer: Hawaii Medical Service Association ABD	$21,084.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,084.20
Rate for Payer: Kaiser Permanente Medicaid	$21,084.20
Rate for Payer: Ohana Health Plan Medicaid	$21,084.20
Rate for Payer: UnitedHealthcare Medicaid	$21,084.20

PERITONEAL ADHESIOLYSIS

Facility

$12,755.93

Service Code	APR-DRG 2243
Min. Negotiated Rate	$12,755.93
Max. Negotiated Rate	$12,755.93
Rate for Payer: AlohaCare Medicaid	$12,755.93
Rate for Payer: Hawaii Medical Service Association ABD	$12,755.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,755.93
Rate for Payer: Kaiser Permanente Medicaid	$12,755.93
Rate for Payer: Ohana Health Plan Medicaid	$12,755.93
Rate for Payer: UnitedHealthcare Medicaid	$12,755.93

PERITONEAL ADHESIOLYSIS

Facility

$7,068.07

Service Code	APR-DRG 2241
Min. Negotiated Rate	$7,068.07
Max. Negotiated Rate	$7,068.07
Rate for Payer: AlohaCare Medicaid	$7,068.07
Rate for Payer: Hawaii Medical Service Association ABD	$7,068.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,068.07
Rate for Payer: Kaiser Permanente Medicaid	$7,068.07
Rate for Payer: Ohana Health Plan Medicaid	$7,068.07
Rate for Payer: UnitedHealthcare Medicaid	$7,068.07

PERITONEAL ADHESIOLYSIS

Facility

$8,824.00

Service Code	APR-DRG 2242
Min. Negotiated Rate	$8,824.00
Max. Negotiated Rate	$8,824.00
Rate for Payer: AlohaCare Medicaid	$8,824.00
Rate for Payer: Hawaii Medical Service Association ABD	$8,824.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,824.00
Rate for Payer: Kaiser Permanente Medicaid	$8,824.00
Rate for Payer: Ohana Health Plan Medicaid	$8,824.00
Rate for Payer: UnitedHealthcare Medicaid	$8,824.00

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$54,671.30

Service Code	MSDRG 336
Min. Negotiated Rate	$23,984.88
Max. Negotiated Rate	$54,671.30
Rate for Payer: AlohaCare Medicare	$23,984.88
Rate for Payer: Devoted Health Medicare	$26,383.37
Rate for Payer: Hawaii Medical Service Association Commercial	$54,671.30
Rate for Payer: Hawaii Medical Service Association Medicare	$23,984.88
Rate for Payer: Humana Medicare	$23,984.88
Rate for Payer: Kaiser Permanente Commercial	$36,375.07
Rate for Payer: Kaiser Permanente Medicare	$23,984.88
Rate for Payer: Ohana Health Plan Medicare	$23,984.88
Rate for Payer: UnitedHealthcare Medicare	$23,984.88

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$61,854.03

Service Code	MSDRG 335
Min. Negotiated Rate	$40,616.34
Max. Negotiated Rate	$61,854.03
Rate for Payer: AlohaCare Medicare	$40,616.34
Rate for Payer: Devoted Health Medicare	$44,677.97
Rate for Payer: Hawaii Medical Service Association Commercial	$61,854.03
Rate for Payer: Hawaii Medical Service Association Medicare	$40,616.34
Rate for Payer: Humana Medicare	$40,616.34
Rate for Payer: Kaiser Permanente Commercial	$61,598.03
Rate for Payer: Kaiser Permanente Medicare	$40,616.34
Rate for Payer: Ohana Health Plan Medicare	$40,616.34
Rate for Payer: UnitedHealthcare Medicare	$40,616.34

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$33,559.88

Service Code	MSDRG 337
Min. Negotiated Rate	$17,459.49
Max. Negotiated Rate	$33,559.88
Rate for Payer: AlohaCare Medicare	$17,459.49
Rate for Payer: Devoted Health Medicare	$19,205.44
Rate for Payer: Hawaii Medical Service Association Commercial	$33,559.88
Rate for Payer: Hawaii Medical Service Association Medicare	$17,459.49
Rate for Payer: Humana Medicare	$17,459.49
Rate for Payer: Kaiser Permanente Commercial	$26,478.75
Rate for Payer: Kaiser Permanente Medicare	$17,459.49
Rate for Payer: Ohana Health Plan Medicare	$17,459.49
Rate for Payer: UnitedHealthcare Medicare	$17,459.49

PERMACATH DURAFLOW 2 23CM

Facility

$1,050.00

Hospital Revenue Code	272
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: MDX Hawaii PPO	$1,018.50

PERMACATH DURAFLOW 2 23CM

Facility

$1,050.00

Hospital Revenue Code	272
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	$997.50
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	$765.35

PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$10,814.10

Service Code	APR-DRG 1701
Min. Negotiated Rate	$10,814.10
Max. Negotiated Rate	$10,814.10
Rate for Payer: AlohaCare Medicaid	$10,814.10
Rate for Payer: Hawaii Medical Service Association ABD	$10,814.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,814.10
Rate for Payer: Kaiser Permanente Medicaid	$10,814.10
Rate for Payer: Ohana Health Plan Medicaid	$10,814.10
Rate for Payer: UnitedHealthcare Medicaid	$10,814.10

PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$11,965.37

Service Code	APR-DRG 1702
Min. Negotiated Rate	$11,965.37
Max. Negotiated Rate	$11,965.37
Rate for Payer: AlohaCare Medicaid	$11,965.37
Rate for Payer: Hawaii Medical Service Association ABD	$11,965.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,965.37
Rate for Payer: Kaiser Permanente Medicaid	$11,965.37
Rate for Payer: Ohana Health Plan Medicaid	$11,965.37
Rate for Payer: UnitedHealthcare Medicaid	$11,965.37

PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$20,476.28

Service Code	APR-DRG 1704
Min. Negotiated Rate	$20,476.28
Max. Negotiated Rate	$20,476.28
Rate for Payer: AlohaCare Medicaid	$20,476.28
Rate for Payer: Hawaii Medical Service Association ABD	$20,476.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,476.28
Rate for Payer: Kaiser Permanente Medicaid	$20,476.28
Rate for Payer: Ohana Health Plan Medicaid	$20,476.28
Rate for Payer: UnitedHealthcare Medicaid	$20,476.28

PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$14,746.03

Service Code	APR-DRG 1703
Min. Negotiated Rate	$14,746.03
Max. Negotiated Rate	$14,746.03
Rate for Payer: AlohaCare Medicaid	$14,746.03
Rate for Payer: Hawaii Medical Service Association ABD	$14,746.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,746.03
Rate for Payer: Kaiser Permanente Medicaid	$14,746.03
Rate for Payer: Ohana Health Plan Medicaid	$14,746.03
Rate for Payer: UnitedHealthcare Medicaid	$14,746.03

PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$54,792.63

Service Code	MSDRG 243
Min. Negotiated Rate	$24,237.42
Max. Negotiated Rate	$54,792.63
Rate for Payer: AlohaCare Medicare	$24,237.42
Rate for Payer: Devoted Health Medicare	$26,661.16
Rate for Payer: Hawaii Medical Service Association Commercial	$54,792.63
Rate for Payer: Hawaii Medical Service Association Medicare	$24,237.42
Rate for Payer: Humana Medicare	$24,237.42
Rate for Payer: Kaiser Permanente Commercial	$36,758.03
Rate for Payer: Kaiser Permanente Medicare	$24,237.42
Rate for Payer: Ohana Health Plan Medicare	$24,237.42
Rate for Payer: UnitedHealthcare Medicare	$24,237.42

PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$73,283.32

Service Code	MSDRG 242
Min. Negotiated Rate	$36,315.74
Max. Negotiated Rate	$73,283.32
Rate for Payer: AlohaCare Medicare	$36,315.74
Rate for Payer: Devoted Health Medicare	$39,947.31
Rate for Payer: Hawaii Medical Service Association Commercial	$73,283.32
Rate for Payer: Hawaii Medical Service Association Medicare	$36,315.74
Rate for Payer: Humana Medicare	$36,315.74
Rate for Payer: Kaiser Permanente Commercial	$55,075.80
Rate for Payer: Kaiser Permanente Medicare	$36,315.74
Rate for Payer: Ohana Health Plan Medicare	$36,315.74
Rate for Payer: UnitedHealthcare Medicare	$36,315.74

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$45,013.43

Service Code	MSDRG 244
Min. Negotiated Rate	$20,558.96
Max. Negotiated Rate	$45,013.43
Rate for Payer: AlohaCare Medicare	$20,558.96
Rate for Payer: Devoted Health Medicare	$22,614.86
Rate for Payer: Hawaii Medical Service Association Commercial	$45,013.43
Rate for Payer: Hawaii Medical Service Association Medicare	$20,558.96
Rate for Payer: Humana Medicare	$20,558.96
Rate for Payer: Kaiser Permanente Commercial	$31,179.38
Rate for Payer: Kaiser Permanente Medicare	$20,558.96
Rate for Payer: Ohana Health Plan Medicare	$20,558.96
Rate for Payer: UnitedHealthcare Medicare	$20,558.96

PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$18,250.06

Service Code	APR-DRG 1714
Min. Negotiated Rate	$18,250.06
Max. Negotiated Rate	$18,250.06
Rate for Payer: AlohaCare Medicaid	$18,250.06
Rate for Payer: Hawaii Medical Service Association ABD	$18,250.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,250.06
Rate for Payer: Kaiser Permanente Medicaid	$18,250.06
Rate for Payer: Ohana Health Plan Medicaid	$18,250.06
Rate for Payer: UnitedHealthcare Medicaid	$18,250.06

PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$9,724.15

Service Code	APR-DRG 1712
Min. Negotiated Rate	$9,724.15
Max. Negotiated Rate	$9,724.15
Rate for Payer: AlohaCare Medicaid	$9,724.15
Rate for Payer: Hawaii Medical Service Association ABD	$9,724.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,724.15
Rate for Payer: Kaiser Permanente Medicaid	$9,724.15
Rate for Payer: Ohana Health Plan Medicaid	$9,724.15
Rate for Payer: UnitedHealthcare Medicaid	$9,724.15

PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$8,630.93

Service Code	APR-DRG 1711
Min. Negotiated Rate	$8,630.93
Max. Negotiated Rate	$8,630.93
Rate for Payer: AlohaCare Medicaid	$8,630.93
Rate for Payer: Hawaii Medical Service Association ABD	$8,630.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,630.93
Rate for Payer: Kaiser Permanente Medicaid	$8,630.93
Rate for Payer: Ohana Health Plan Medicaid	$8,630.93
Rate for Payer: UnitedHealthcare Medicaid	$8,630.93

PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$12,161.70

Service Code	APR-DRG 1713
Min. Negotiated Rate	$12,161.70
Max. Negotiated Rate	$12,161.70
Rate for Payer: AlohaCare Medicaid	$12,161.70
Rate for Payer: Hawaii Medical Service Association ABD	$12,161.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,161.70
Rate for Payer: Kaiser Permanente Medicaid	$12,161.70
Rate for Payer: Ohana Health Plan Medicaid	$12,161.70
Rate for Payer: UnitedHealthcare Medicaid	$12,161.70

PERMETHRIN 1 % TOPICAL LIQUID [10918]

Facility

$39.00

Service Code	NDC 46122010846
Hospital Revenue Code	637
Min. Negotiated Rate	$19.89
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$24.57
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: University Health Alliance Commercial	$28.43

PERMETHRIN 1 % TOPICAL LIQUID [10918]

Facility

$39.00

Service Code	NDC 46122010846
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: MDX Hawaii PPO	$37.83

PERMETHRIN 5% CREAM (ELIMITE) (60 GRAM) (TAKE HOME) [4080388]

Facility

$15.00

Service Code	NDC 00004080176
Hospital Revenue Code	253
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