Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PERSONA FEM PS POR STD SZ9 R

Facility

$7,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,144.00
Max. Negotiated Rate	$7,178.00
Rate for Payer: Cash Price	$4,440.00
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,180.00
Rate for Payer: Health Management Network Commercial	$6,290.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$7,178.00
Rate for Payer: University Health Alliance Commercial	$11,185.44
Rate for Payer: University Health Alliance Commercial	$4,144.00

PERSONA KNEE 4 42-5580-004-02

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA KNEE 4 42-5580-004-02

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,754.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$3,402.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA LF SZ 2 42-5580-002-01

Facility

$4,410.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,469.60
Max. Negotiated Rate	$4,277.70
Rate for Payer: Cash Price	$2,646.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,087.00
Rate for Payer: Health Management Network Commercial	$3,748.50
Rate for Payer: MDX Hawaii PPO	$4,277.70
Rate for Payer: University Health Alliance Commercial	$2,469.60

PERSONA LF SZ 2 42-5580-002-01

Facility

$4,410.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,249.10
Max. Negotiated Rate	$4,277.70
Rate for Payer: Cash Price	$2,646.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,087.00
Rate for Payer: Health Management Network Commercial	$3,748.50
Rate for Payer: Kaiser Permanente Commercial	$2,778.30
Rate for Payer: Kaiser Permanente Medicaid	$2,249.10
Rate for Payer: MDX Hawaii PPO	$4,277.70
Rate for Payer: University Health Alliance Commercial	$2,469.60

PERSONA LFT 4MM 42-5580-004-01

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,708.50
Max. Negotiated Rate	$3,249.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Kaiser Permanente Commercial	$2,110.50
Rate for Payer: Kaiser Permanente Medicaid	$1,708.50
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

PERSONA LFT 4MM 42-5580-004-01

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.00
Max. Negotiated Rate	$3,249.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

PERSONA RIGHT J 42-5380-009-02

Facility

$2,940.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.40
Max. Negotiated Rate	$2,851.80
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,058.00
Rate for Payer: Health Management Network Commercial	$2,499.00
Rate for Payer: Kaiser Permanente Commercial	$1,852.20
Rate for Payer: Kaiser Permanente Medicaid	$1,499.40
Rate for Payer: MDX Hawaii PPO	$2,851.80
Rate for Payer: University Health Alliance Commercial	$1,646.40

PERSONA RIGHT J 42-5380-009-02

Facility

$2,940.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.40
Max. Negotiated Rate	$2,851.80
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,058.00
Rate for Payer: Health Management Network Commercial	$2,499.00
Rate for Payer: MDX Hawaii PPO	$2,851.80
Rate for Payer: University Health Alliance Commercial	$1,646.40

PERSONA SZ G 42-5380-007-01

Facility

$2,940.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.40
Max. Negotiated Rate	$2,851.80
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,058.00
Rate for Payer: Health Management Network Commercial	$2,499.00
Rate for Payer: MDX Hawaii PPO	$2,851.80
Rate for Payer: University Health Alliance Commercial	$1,646.40

PERSONA SZ G 42-5380-007-01

Facility

$2,940.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.40
Max. Negotiated Rate	$2,851.80
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,058.00
Rate for Payer: Health Management Network Commercial	$2,499.00
Rate for Payer: Kaiser Permanente Commercial	$1,852.20
Rate for Payer: Kaiser Permanente Medicaid	$1,499.40
Rate for Payer: MDX Hawaii PPO	$2,851.80
Rate for Payer: University Health Alliance Commercial	$1,646.40

PERSONA SZG 8 42-5182-007-08

Facility

$2,520.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,285.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Kaiser Permanente Commercial	$1,587.60
Rate for Payer: Kaiser Permanente Medicaid	$1,285.20
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: University Health Alliance Commercial	$1,411.20

PERSONA SZG 8 42-5182-007-08

Facility

$2,520.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,411.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: University Health Alliance Commercial	$1,411.20

PERSONA TIB STM 5 DEG SZ E L

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$1,638.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

PERSONA TIB STM 5 DEG SZ E L

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

PERSONA TIB STM 5 DEG SZ E R

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Kaiser Permanente Commercial	$1,260.00
Rate for Payer: Kaiser Permanente Medicaid	$1,020.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

PERSONA TIB STM 5 DEG SZ E R

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

PERSONA TIB STM 5 DEG SZ H, L

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Kaiser Permanente Commercial	$1,260.00
Rate for Payer: Kaiser Permanente Medicaid	$1,020.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

PERSONA TIB STM 5 DEG SZ H, L

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

PERSON TIB STM 5 DEG SZ H, R

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$1,638.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

PERSON TIB STM 5 DEG SZ H, R

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

PERTUZUMAB 1,200 MG-TRASTUZUMAB 600 MG-HYALURON-ZZXF/15 ML SUBCUT SOLN [174456]

Facility

$17,200.00

Service Code	HCPCS J9316
Hospital Revenue Code	250
Min. Negotiated Rate	$14,620.00
Max. Negotiated Rate	$16,684.00
Rate for Payer: Cash Price	$10,320.00
Rate for Payer: Health Management Network Commercial	$14,620.00
Rate for Payer: MDX Hawaii PPO	$16,684.00

PERTUZUMAB 1,200 MG-TRASTUZUMAB 600 MG-HYALURON-ZZXF/15 ML SUBCUT SOLN [174456]

Facility

$17,200.00

Service Code	HCPCS J9316
Hospital Revenue Code	636
Min. Negotiated Rate	$60.23
Max. Negotiated Rate	$16,684.00
Rate for Payer: AlohaCare Medicaid	$60.23
Rate for Payer: AlohaCare Medicare	$60.23
Rate for Payer: Cash Price	$10,320.00
Rate for Payer: Cash Price	$10,320.00
Rate for Payer: Devoted Health Medicare	$66.25
Rate for Payer: Hawaii Medical Service Association ABD	$63.39
Rate for Payer: Hawaii Medical Service Association Commercial	$75.29
Rate for Payer: Hawaii Medical Service Association Medicare	$60.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$63.39
Rate for Payer: Hawaii Western Management Group Commercial	$16,340.00
Rate for Payer: Health Management Network Commercial	$14,620.00
Rate for Payer: Humana Medicare	$60.23
Rate for Payer: Kaiser Permanente Commercial	$10,836.00
Rate for Payer: Kaiser Permanente Medicaid	$8,772.00
Rate for Payer: Kaiser Permanente Medicare	$60.23
Rate for Payer: MDX Hawaii PPO	$16,684.00
Rate for Payer: Ohana Health Plan Medicaid	$66.25
Rate for Payer: Ohana Health Plan Medicare	$60.23
Rate for Payer: UnitedHealthcare Medicaid	$10,320.00
Rate for Payer: UnitedHealthcare Medicare	$60.23
Rate for Payer: University Health Alliance Commercial	$12,537.08

PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION [116596]

Facility

$11,459.00

Service Code	HCPCS J9306
Hospital Revenue Code	250
Min. Negotiated Rate	$9,740.15
Max. Negotiated Rate	$11,115.23
Rate for Payer: Cash Price	$6,875.40
Rate for Payer: Health Management Network Commercial	$9,740.15
Rate for Payer: MDX Hawaii PPO	$11,115.23

PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION [116596]

Facility

$11,459.00

Service Code	HCPCS J9306
Hospital Revenue Code	636
Min. Negotiated Rate	$16.89
Max. Negotiated Rate	$11,115.23
Rate for Payer: AlohaCare Medicaid	$17.02
Rate for Payer: AlohaCare Medicare	$17.02
Rate for Payer: Cash Price	$6,875.40
Rate for Payer: Cash Price	$6,875.40
Rate for Payer: Devoted Health Medicare	$18.72
Rate for Payer: Hawaii Medical Service Association ABD	$16.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.27
Rate for Payer: Hawaii Medical Service Association Medicare	$17.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.89
Rate for Payer: Hawaii Western Management Group Commercial	$10,886.05
Rate for Payer: Health Management Network Commercial	$9,740.15
Rate for Payer: Humana Medicare	$17.02
Rate for Payer: Kaiser Permanente Commercial	$7,219.17
Rate for Payer: Kaiser Permanente Medicaid	$5,844.09
Rate for Payer: Kaiser Permanente Medicare	$17.02
Rate for Payer: MDX Hawaii PPO	$11,115.23
Rate for Payer: Ohana Health Plan Medicaid	$18.72
Rate for Payer: Ohana Health Plan Medicare	$17.02
Rate for Payer: UnitedHealthcare Medicaid	$6,875.40
Rate for Payer: UnitedHealthcare Medicare	$17.02
Rate for Payer: University Health Alliance Commercial	$8,352.47

Know your out-of-pocket cost for care.

All Charges