Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CALAMINE 8 %-ZINC OXIDE 8 % LOTION [78879]

Facility

$16.00

Service Code	NDC 00395041396
Hospital Revenue Code	637
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$10.08
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: University Health Alliance Commercial	$11.66

CALCANEAL KIT STERILE 99-M1450

Facility

$6,984.00

Hospital Revenue Code	272
Min. Negotiated Rate	$5,936.40
Max. Negotiated Rate	$6,774.48
Rate for Payer: Cash Price	$4,190.40
Rate for Payer: Health Management Network Commercial	$5,936.40
Rate for Payer: MDX Hawaii PPO	$6,774.48

CALCANEAL KIT STERILE 99-M1450

Facility

$6,984.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,561.84
Max. Negotiated Rate	$6,774.48
Rate for Payer: Cash Price	$4,190.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,634.80
Rate for Payer: Health Management Network Commercial	$5,936.40
Rate for Payer: Kaiser Permanente Commercial	$4,399.92
Rate for Payer: Kaiser Permanente Medicaid	$3,561.84
Rate for Payer: MDX Hawaii PPO	$6,774.48
Rate for Payer: University Health Alliance Commercial	$5,090.64

CALCIPOTRIENE 0.005 % TOPICAL CREAM [16034]

Facility

$3,495.00

Service Code	NDC 68462050166
Hospital Revenue Code	250
Min. Negotiated Rate	$2,970.75
Max. Negotiated Rate	$3,390.15
Rate for Payer: Cash Price	$2,097.00
Rate for Payer: Health Management Network Commercial	$2,970.75
Rate for Payer: MDX Hawaii PPO	$3,390.15

CALCIPOTRIENE 0.005 % TOPICAL CREAM [16034]

Facility

$3,495.00

Service Code	NDC 68462050166
Hospital Revenue Code	637
Min. Negotiated Rate	$1,782.45
Max. Negotiated Rate	$3,390.15
Rate for Payer: Cash Price	$2,097.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,320.25
Rate for Payer: Health Management Network Commercial	$2,970.75
Rate for Payer: Kaiser Permanente Commercial	$2,201.85
Rate for Payer: Kaiser Permanente Medicaid	$1,782.45
Rate for Payer: MDX Hawaii PPO	$3,390.15
Rate for Payer: University Health Alliance Commercial	$2,547.51

CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY [15738]

Facility

$297.00

Service Code	NDC 60505082306
Hospital Revenue Code	637
Min. Negotiated Rate	$151.47
Max. Negotiated Rate	$288.09
Rate for Payer: Cash Price	$178.20
Rate for Payer: Hawaii Western Management Group Commercial	$282.15
Rate for Payer: Health Management Network Commercial	$252.45
Rate for Payer: Kaiser Permanente Commercial	$187.11
Rate for Payer: Kaiser Permanente Medicaid	$151.47
Rate for Payer: MDX Hawaii PPO	$288.09
Rate for Payer: University Health Alliance Commercial	$216.48

CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY [15738]

Facility

$297.00

Service Code	NDC 60505082306
Hospital Revenue Code	250
Min. Negotiated Rate	$252.45
Max. Negotiated Rate	$288.09
Rate for Payer: Cash Price	$178.20
Rate for Payer: Health Management Network Commercial	$252.45
Rate for Payer: MDX Hawaii PPO	$288.09

CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]

Facility

$1,800.00

Service Code	HCPCS J0630
Hospital Revenue Code	636
Min. Negotiated Rate	$918.00
Max. Negotiated Rate	$1,746.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Hawaii Medical Service Association ABD	$1,142.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,142.41
Rate for Payer: Hawaii Western Management Group Commercial	$1,710.00
Rate for Payer: Health Management Network Commercial	$1,530.00
Rate for Payer: Kaiser Permanente Commercial	$1,134.00
Rate for Payer: Kaiser Permanente Medicaid	$918.00
Rate for Payer: MDX Hawaii PPO	$1,746.00
Rate for Payer: UnitedHealthcare Medicaid	$1,080.00
Rate for Payer: University Health Alliance Commercial	$1,312.02

CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]

Facility

$1,800.00

Service Code	HCPCS J0630
Hospital Revenue Code	250
Min. Negotiated Rate	$1,530.00
Max. Negotiated Rate	$1,746.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Health Management Network Commercial	$1,530.00
Rate for Payer: MDX Hawaii PPO	$1,746.00

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$4.00

Service Code	NDC 60687034501
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$4.00

Service Code	NDC 60687034511
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$4.00

Service Code	NDC 60687034501
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

CALCITRIOL 0.25 MCG CAPSULE [9350]

Facility

$4.00

Service Code	NDC 60687034511
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION [145997]

Facility

$11.00

Service Code	NDC 00121476605
Hospital Revenue Code	637
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: University Health Alliance Commercial	$8.02

CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION [145997]

Facility

$11.00

Service Code	NDC 00121476605
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) CHEWABLE TABLET [1298]

Facility

$1.00

Service Code	NDC 14913000000
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

CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) CHEWABLE TABLET [1298]

Facility

$1.00

Service Code	NDC 14913000000
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) TABLET [1290]

Facility

$1.00

Service Code	NDC 88361000000
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

CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) TABLET [1290]

Facility

$1.00

Service Code	NDC 88361000000
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

CALCIUM 500 MG (AS CARBONATE)-D3 2.5 MCG (100 UNIT) CHEWABLE TABLET [188171]

Facility

$1.00

Service Code	NDC 08900000000
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

CALCIUM 500 MG (AS CARBONATE)-D3 2.5 MCG (100 UNIT) CHEWABLE TABLET [188171]

Facility

$1.00

Service Code	NDC 08900000000
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

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [130458]

Facility

$5.00

Service Code	NDC 00904711906
Hospital Revenue Code	637
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$3.15
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: University Health Alliance Commercial	$3.64

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [130458]

Facility

$5.00

Service Code	NDC 00904711906
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: MDX Hawaii PPO	$4.85

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [200763]

Facility

$85.00

Service Code	NDC 00517671001
Hospital Revenue Code	250
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: MDX Hawaii PPO	$82.45

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE [1306]

Facility

$53.00

Service Code	NDC 00409163140
Hospital Revenue Code	250
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$31.80
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: MDX Hawaii PPO	$51.41

Know your out-of-pocket cost for care.

All Charges