Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP

Professional

Both

$78.00

Service Code	HCPCS 93307 26
Min. Negotiated Rate	$44.31
Max. Negotiated Rate	$212.77
Rate for Payer: AlohaCare Medicaid	$150.89
Rate for Payer: AlohaCare Medicare	$44.31
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$48.74
Rate for Payer: Hawaii Medical Service Association Medicare	$44.31
Rate for Payer: Hawaii Western Management Group Commercial	$212.77
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$53.17
Rate for Payer: Kaiser Permanente Medicaid	$53.17
Rate for Payer: Kaiser Permanente Medicare	$53.17
Rate for Payer: Ohana Health Plan Medicaid	$150.89
Rate for Payer: Ohana Health Plan Medicare	$44.31
Rate for Payer: UnitedHealthcare Medicaid	$150.89
Rate for Payer: UnitedHealthcare Medicare	$44.31

PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP

Professional

Both

$421.00

Service Code	HCPCS 93307
Min. Negotiated Rate	$150.89
Max. Negotiated Rate	$357.85
Rate for Payer: AlohaCare Medicaid	$150.89
Rate for Payer: AlohaCare Medicare	$151.79
Rate for Payer: Cash Price	$252.60
Rate for Payer: Cash Price	$252.60
Rate for Payer: Devoted Health Medicare	$166.97
Rate for Payer: Hawaii Medical Service Association Medicare	$151.79
Rate for Payer: Hawaii Western Management Group Commercial	$212.77
Rate for Payer: Health Management Network Commercial	$357.85
Rate for Payer: Kaiser Permanente Commercial	$182.15
Rate for Payer: Kaiser Permanente Medicaid	$182.15
Rate for Payer: Kaiser Permanente Medicare	$182.15
Rate for Payer: Ohana Health Plan Medicaid	$150.89
Rate for Payer: Ohana Health Plan Medicare	$151.79
Rate for Payer: UnitedHealthcare Medicaid	$150.89
Rate for Payer: UnitedHealthcare Medicare	$151.79

PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD

Professional

Both

$44.00

Service Code	HCPCS 93308 26
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$109.80
Rate for Payer: AlohaCare Medicaid	$109.80
Rate for Payer: AlohaCare Medicare	$25.35
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Devoted Health Medicare	$27.89
Rate for Payer: Hawaii Medical Service Association Medicare	$25.35
Rate for Payer: Hawaii Western Management Group Commercial	$80.16
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Kaiser Permanente Commercial	$30.42
Rate for Payer: Kaiser Permanente Medicaid	$30.42
Rate for Payer: Kaiser Permanente Medicare	$30.42
Rate for Payer: Ohana Health Plan Medicaid	$109.80
Rate for Payer: Ohana Health Plan Medicare	$25.35
Rate for Payer: UnitedHealthcare Medicaid	$109.80
Rate for Payer: UnitedHealthcare Medicare	$25.35

PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD

Professional

Both

$271.00

Service Code	HCPCS 93308 TC
Min. Negotiated Rate	$80.16
Max. Negotiated Rate	$230.35
Rate for Payer: AlohaCare Medicaid	$109.80
Rate for Payer: AlohaCare Medicare	$86.59
Rate for Payer: Cash Price	$162.60
Rate for Payer: Cash Price	$162.60
Rate for Payer: Devoted Health Medicare	$95.25
Rate for Payer: Hawaii Medical Service Association Medicare	$86.59
Rate for Payer: Hawaii Western Management Group Commercial	$80.16
Rate for Payer: Health Management Network Commercial	$230.35
Rate for Payer: Kaiser Permanente Commercial	$103.91
Rate for Payer: Kaiser Permanente Medicaid	$103.91
Rate for Payer: Kaiser Permanente Medicare	$103.91
Rate for Payer: Ohana Health Plan Medicaid	$109.80
Rate for Payer: Ohana Health Plan Medicare	$86.59
Rate for Payer: UnitedHealthcare Medicaid	$109.80
Rate for Payer: UnitedHealthcare Medicare	$86.59

PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD

Professional

Both

$315.00

Service Code	HCPCS 93308
Min. Negotiated Rate	$80.16
Max. Negotiated Rate	$267.75
Rate for Payer: AlohaCare Medicaid	$109.80
Rate for Payer: AlohaCare Medicare	$111.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Devoted Health Medicare	$123.13
Rate for Payer: Hawaii Medical Service Association Medicare	$111.94
Rate for Payer: Hawaii Western Management Group Commercial	$80.16
Rate for Payer: Health Management Network Commercial	$267.75
Rate for Payer: Kaiser Permanente Commercial	$134.33
Rate for Payer: Kaiser Permanente Medicaid	$134.33
Rate for Payer: Kaiser Permanente Medicare	$134.33
Rate for Payer: Ohana Health Plan Medicaid	$109.80
Rate for Payer: Ohana Health Plan Medicare	$111.94
Rate for Payer: UnitedHealthcare Medicaid	$109.80
Rate for Payer: UnitedHealthcare Medicare	$111.94

PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST

Professional

Both

$121.00

Service Code	HCPCS 93350 26
Min. Negotiated Rate	$69.28
Max. Negotiated Rate	$204.04
Rate for Payer: AlohaCare Medicaid	$204.04
Rate for Payer: AlohaCare Medicare	$69.28
Rate for Payer: Cash Price	$72.60
Rate for Payer: Cash Price	$72.60
Rate for Payer: Devoted Health Medicare	$76.21
Rate for Payer: Hawaii Medical Service Association Medicare	$69.28
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$83.14
Rate for Payer: Kaiser Permanente Medicaid	$83.14
Rate for Payer: Kaiser Permanente Medicare	$83.14
Rate for Payer: Ohana Health Plan Medicaid	$204.04
Rate for Payer: Ohana Health Plan Medicare	$69.28
Rate for Payer: UnitedHealthcare Medicaid	$204.04
Rate for Payer: UnitedHealthcare Medicare	$69.28

PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST

Professional

Both

$549.00

Service Code	HCPCS 93350
Min. Negotiated Rate	$133.95
Max. Negotiated Rate	$466.65
Rate for Payer: AlohaCare Medicaid	$204.04
Rate for Payer: AlohaCare Medicare	$202.97
Rate for Payer: Cash Price	$329.40
Rate for Payer: Cash Price	$329.40
Rate for Payer: Devoted Health Medicare	$223.27
Rate for Payer: Hawaii Medical Service Association Medicare	$202.97
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$466.65
Rate for Payer: Kaiser Permanente Commercial	$243.56
Rate for Payer: Kaiser Permanente Medicaid	$243.56
Rate for Payer: Kaiser Permanente Medicare	$243.56
Rate for Payer: Ohana Health Plan Medicaid	$204.04
Rate for Payer: Ohana Health Plan Medicare	$202.97
Rate for Payer: UnitedHealthcare Medicaid	$204.04
Rate for Payer: UnitedHealthcare Medicare	$202.97

PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST

Professional

Both

$428.00

Service Code	HCPCS 93350 TC
Min. Negotiated Rate	$133.69
Max. Negotiated Rate	$363.80
Rate for Payer: AlohaCare Medicaid	$204.04
Rate for Payer: AlohaCare Medicare	$133.69
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cash Price	$256.80
Rate for Payer: Devoted Health Medicare	$147.06
Rate for Payer: Hawaii Medical Service Association Medicare	$133.69
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Kaiser Permanente Commercial	$160.43
Rate for Payer: Kaiser Permanente Medicaid	$160.43
Rate for Payer: Kaiser Permanente Medicare	$160.43
Rate for Payer: Ohana Health Plan Medicaid	$204.04
Rate for Payer: Ohana Health Plan Medicare	$133.69
Rate for Payer: UnitedHealthcare Medicaid	$204.04
Rate for Payer: UnitedHealthcare Medicare	$133.69

PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D

Professional

Both

$470.00

Service Code	HCPCS 93306 TC
Min. Negotiated Rate	$146.41
Max. Negotiated Rate	$399.50
Rate for Payer: AlohaCare Medicaid	$216.47
Rate for Payer: AlohaCare Medicare	$146.41
Rate for Payer: Cash Price	$282.00
Rate for Payer: Cash Price	$282.00
Rate for Payer: Devoted Health Medicare	$161.05
Rate for Payer: Hawaii Medical Service Association Medicare	$146.41
Rate for Payer: Hawaii Western Management Group Commercial	$270.09
Rate for Payer: Health Management Network Commercial	$399.50
Rate for Payer: Kaiser Permanente Commercial	$175.69
Rate for Payer: Kaiser Permanente Medicaid	$175.69
Rate for Payer: Kaiser Permanente Medicare	$175.69
Rate for Payer: Ohana Health Plan Medicaid	$216.47
Rate for Payer: Ohana Health Plan Medicare	$146.41
Rate for Payer: UnitedHealthcare Medicaid	$216.47
Rate for Payer: UnitedHealthcare Medicare	$146.41

PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D

Professional

Both

$591.00

Service Code	HCPCS 93306
Min. Negotiated Rate	$215.69
Max. Negotiated Rate	$502.35
Rate for Payer: AlohaCare Medicaid	$216.47
Rate for Payer: AlohaCare Medicare	$215.69
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Devoted Health Medicare	$237.26
Rate for Payer: Hawaii Medical Service Association Medicare	$215.69
Rate for Payer: Hawaii Western Management Group Commercial	$270.09
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Kaiser Permanente Commercial	$258.83
Rate for Payer: Kaiser Permanente Medicaid	$258.83
Rate for Payer: Kaiser Permanente Medicare	$258.83
Rate for Payer: Ohana Health Plan Medicaid	$216.47
Rate for Payer: Ohana Health Plan Medicare	$215.69
Rate for Payer: UnitedHealthcare Medicaid	$216.47
Rate for Payer: UnitedHealthcare Medicare	$215.69

PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D

Professional

Both

$121.00

Service Code	HCPCS 93306 26
Min. Negotiated Rate	$69.28
Max. Negotiated Rate	$270.09
Rate for Payer: AlohaCare Medicaid	$216.47
Rate for Payer: AlohaCare Medicare	$69.28
Rate for Payer: Cash Price	$72.60
Rate for Payer: Cash Price	$72.60
Rate for Payer: Devoted Health Medicare	$76.21
Rate for Payer: Hawaii Medical Service Association Medicare	$69.28
Rate for Payer: Hawaii Western Management Group Commercial	$270.09
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$83.14
Rate for Payer: Kaiser Permanente Medicaid	$83.14
Rate for Payer: Kaiser Permanente Medicare	$83.14
Rate for Payer: Ohana Health Plan Medicaid	$216.47
Rate for Payer: Ohana Health Plan Medicare	$69.28
Rate for Payer: UnitedHealthcare Medicaid	$216.47
Rate for Payer: UnitedHealthcare Medicare	$69.28

PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG

Professional

Both

$697.00

Service Code	HCPCS 93351
Min. Negotiated Rate	$255.56
Max. Negotiated Rate	$592.45
Rate for Payer: AlohaCare Medicaid	$255.56
Rate for Payer: AlohaCare Medicare	$255.77
Rate for Payer: Cash Price	$418.20
Rate for Payer: Cash Price	$418.20
Rate for Payer: Devoted Health Medicare	$281.35
Rate for Payer: Hawaii Medical Service Association Medicare	$255.77
Rate for Payer: Hawaii Western Management Group Commercial	$278.29
Rate for Payer: Health Management Network Commercial	$592.45
Rate for Payer: Kaiser Permanente Commercial	$306.92
Rate for Payer: Kaiser Permanente Medicaid	$306.92
Rate for Payer: Kaiser Permanente Medicare	$306.92
Rate for Payer: Ohana Health Plan Medicaid	$255.56
Rate for Payer: Ohana Health Plan Medicare	$255.77
Rate for Payer: UnitedHealthcare Medicaid	$255.56
Rate for Payer: UnitedHealthcare Medicare	$255.77

PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG

Professional

Both

$146.00

Service Code	HCPCS 93351 26
Min. Negotiated Rate	$83.34
Max. Negotiated Rate	$278.29
Rate for Payer: AlohaCare Medicaid	$255.56
Rate for Payer: AlohaCare Medicare	$83.34
Rate for Payer: Cash Price	$87.60
Rate for Payer: Cash Price	$87.60
Rate for Payer: Devoted Health Medicare	$91.67
Rate for Payer: Hawaii Medical Service Association Medicare	$83.34
Rate for Payer: Hawaii Western Management Group Commercial	$278.29
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$100.01
Rate for Payer: Kaiser Permanente Medicaid	$100.01
Rate for Payer: Kaiser Permanente Medicare	$100.01
Rate for Payer: Ohana Health Plan Medicaid	$255.56
Rate for Payer: Ohana Health Plan Medicare	$83.34
Rate for Payer: UnitedHealthcare Medicaid	$255.56
Rate for Payer: UnitedHealthcare Medicare	$83.34

PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG

Professional

Both

$551.00

Service Code	HCPCS 93351 TC
Min. Negotiated Rate	$172.43
Max. Negotiated Rate	$468.35
Rate for Payer: AlohaCare Medicaid	$255.56
Rate for Payer: AlohaCare Medicare	$172.43
Rate for Payer: Cash Price	$330.60
Rate for Payer: Cash Price	$330.60
Rate for Payer: Devoted Health Medicare	$189.67
Rate for Payer: Hawaii Medical Service Association Medicare	$172.43
Rate for Payer: Hawaii Western Management Group Commercial	$278.29
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Kaiser Permanente Commercial	$206.92
Rate for Payer: Kaiser Permanente Medicaid	$206.92
Rate for Payer: Kaiser Permanente Medicare	$206.92
Rate for Payer: Ohana Health Plan Medicaid	$255.56
Rate for Payer: Ohana Health Plan Medicare	$172.43
Rate for Payer: UnitedHealthcare Medicaid	$255.56
Rate for Payer: UnitedHealthcare Medicare	$172.43

PRECISION BLADE 2296-033-412

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$174.60

PRECISION BLADE 2296-033-412

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Hawaii Western Management Group Commercial	$171.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: University Health Alliance Commercial	$131.20

PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]

Facility

$139.00

Service Code	NDC 61314063705
Hospital Revenue Code	637
Min. Negotiated Rate	$70.89
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$83.40
Rate for Payer: Hawaii Western Management Group Commercial	$132.05
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$87.57
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: University Health Alliance Commercial	$101.32

PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]

Facility

$139.00

Service Code	NDC 61314063705
Hospital Revenue Code	250
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$83.40
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: MDX Hawaii PPO	$134.83

PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (5 ML) ORAL SOLUTION [205877]

Facility

$9.00

Service Code	NDC 17856081501
Hospital Revenue Code	637
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$5.67
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: University Health Alliance Commercial	$6.56

PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (5 ML) ORAL SOLUTION [205877]

Facility

$9.00

Service Code	NDC 17856081501
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: MDX Hawaii PPO	$8.73

PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML (6.7 MG/5 ML) ORAL SOLN [11118]

Facility

$344.00

Service Code	NDC 13925016604
Hospital Revenue Code	250
Min. Negotiated Rate	$292.40
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$206.40
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: MDX Hawaii PPO	$333.68

PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML (6.7 MG/5 ML) ORAL SOLN [11118]

Facility

$344.00

Service Code	NDC 13925016604
Hospital Revenue Code	637
Min. Negotiated Rate	$175.44
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$206.40
Rate for Payer: Hawaii Western Management Group Commercial	$326.80
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: Kaiser Permanente Commercial	$216.72
Rate for Payer: Kaiser Permanente Medicaid	$175.44
Rate for Payer: MDX Hawaii PPO	$333.68
Rate for Payer: University Health Alliance Commercial	$250.74

PREDNISOLONE SOD PHOSPHATE SOLUTION 15 MG/5 ML UDC (ORAPRED) (TAKE HOME) [4080390]

Facility

$15.00

Service Code	NDC 00004080178
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

PREDNISOLONE SOD PHOSPHATE SOLUTION 15 MG/5 ML UDC (ORAPRED) (TAKE HOME) [4080390]

Facility

$15.00

Service Code	NDC 00004080178
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

PREDNISONE 10 MG TABLET [6494]

Facility

$1.00

Service Code	HCPCS J7512
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97

Know your out-of-pocket cost for care.

All Charges