Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); EACH SEPARATE/ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$2,837.00

Service Code	CPT 11105
Hospital Revenue Code	360
Min. Negotiated Rate	$25.66
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$25.66

PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION

Facility

$2,837.00

Service Code	CPT 11104
Hospital Revenue Code	360
Min. Negotiated Rate	$47.09
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$47.09
Rate for Payer: UnitedHealthcare Medicare	$480.23

PUNCH DISP 4.75/5.5 AR-1927PBS

Facility

$405.00

Hospital Revenue Code	272
Min. Negotiated Rate	$344.25
Max. Negotiated Rate	$392.85
Rate for Payer: Cash Price	$243.00
Rate for Payer: Health Management Network Commercial	$344.25
Rate for Payer: MDX Hawaii PPO	$392.85

PUNCH DISP 4.75/5.5 AR-1927PBS

Facility

$405.00

Hospital Revenue Code	272
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$392.85
Rate for Payer: Cash Price	$243.00
Rate for Payer: Hawaii Western Management Group Commercial	$384.75
Rate for Payer: Health Management Network Commercial	$344.25
Rate for Payer: Kaiser Permanente Commercial	$255.15
Rate for Payer: Kaiser Permanente Medicaid	$206.55
Rate for Payer: MDX Hawaii PPO	$392.85
Rate for Payer: University Health Alliance Commercial	$295.20

PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST

Facility

$4,035.20

Service Code	CPT 10160
Hospital Revenue Code	360
Min. Negotiated Rate	$57.25
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$57.25
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$4,035.20

PUSHER

Facility

$555.00

Hospital Revenue Code	272
Min. Negotiated Rate	$283.05
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Hawaii Western Management Group Commercial	$527.25
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$349.65
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: University Health Alliance Commercial	$404.54

PUSHER

Facility

$555.00

Hospital Revenue Code	272
Min. Negotiated Rate	$471.75
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: MDX Hawaii PPO	$538.35

PUSHLOCK KIT 2.9MM #AR-1923PK

Facility

$1,278.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,086.30
Max. Negotiated Rate	$1,239.66
Rate for Payer: Cash Price	$766.80
Rate for Payer: Health Management Network Commercial	$1,086.30
Rate for Payer: MDX Hawaii PPO	$1,239.66

PUSHLOCK KIT 2.9MM #AR-1923PK

Facility

$1,278.00

Hospital Revenue Code	272
Min. Negotiated Rate	$651.78
Max. Negotiated Rate	$1,239.66
Rate for Payer: Cash Price	$766.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,214.10
Rate for Payer: Health Management Network Commercial	$1,086.30
Rate for Payer: Kaiser Permanente Commercial	$805.14
Rate for Payer: Kaiser Permanente Medicaid	$651.78
Rate for Payer: MDX Hawaii PPO	$1,239.66
Rate for Payer: University Health Alliance Commercial	$931.53

PUTTY BONE DBX 10CC 038100

Facility

$2,760.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,545.60
Max. Negotiated Rate	$2,677.20
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,932.00
Rate for Payer: Health Management Network Commercial	$2,346.00
Rate for Payer: MDX Hawaii PPO	$2,677.20
Rate for Payer: University Health Alliance Commercial	$1,545.60

PUTTY BONE DBX 10CC 038100

Facility

$2,760.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,407.60
Max. Negotiated Rate	$2,677.20
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,932.00
Rate for Payer: Health Management Network Commercial	$2,346.00
Rate for Payer: Kaiser Permanente Commercial	$1,738.80
Rate for Payer: Kaiser Permanente Medicaid	$1,407.60
Rate for Payer: MDX Hawaii PPO	$2,677.20
Rate for Payer: University Health Alliance Commercial	$1,545.60

PUTTY BONE DBX 5CC

Facility

$2,738.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.28
Max. Negotiated Rate	$2,655.86
Rate for Payer: Cash Price	$1,642.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,916.60
Rate for Payer: Health Management Network Commercial	$2,327.30
Rate for Payer: MDX Hawaii PPO	$2,655.86
Rate for Payer: University Health Alliance Commercial	$1,533.28

PUTTY BONE DBX 5CC

Facility

$2,738.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,396.38
Max. Negotiated Rate	$2,655.86
Rate for Payer: Cash Price	$1,642.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,916.60
Rate for Payer: Health Management Network Commercial	$2,327.30
Rate for Payer: Kaiser Permanente Commercial	$1,724.94
Rate for Payer: Kaiser Permanente Medicaid	$1,396.38
Rate for Payer: MDX Hawaii PPO	$2,655.86
Rate for Payer: University Health Alliance Commercial	$1,533.28

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$19.00

Service Code	NDC 70954048410
Hospital Revenue Code	250
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: MDX Hawaii PPO	$18.43

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$19.00

Service Code	NDC 70954048410
Hospital Revenue Code	637
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$11.97
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: University Health Alliance Commercial	$13.85

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$19.00

Service Code	NDC 70954048420
Hospital Revenue Code	250
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: MDX Hawaii PPO	$18.43

PYRAZINAMIDE 500 MG TABLET [6738]

Facility

$19.00

Service Code	NDC 70954048420
Hospital Revenue Code	637
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$11.97
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: University Health Alliance Commercial	$13.85

PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]

Facility

$6.00

Service Code	NDC 68084049411
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]

Facility

$6.00

Service Code	NDC 68084049401
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]

Facility

$6.00

Service Code	NDC 68084049401
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]

Facility

$6.00

Service Code	NDC 68084049411
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION [6744]

Facility

$66.00

Service Code	HCPCS J3415
Hospital Revenue Code	636
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Hawaii Medical Service Association ABD	$12.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.80
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$41.58
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: UnitedHealthcare Medicaid	$39.60
Rate for Payer: University Health Alliance Commercial	$48.11

PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION [6744]

Facility

$66.00

Service Code	HCPCS J3415
Hospital Revenue Code	250
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: MDX Hawaii PPO	$64.02

PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]

Facility

$1.00

Service Code	NDC 85815000000
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

PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]

Facility

$1.00

Service Code	NDC 85811000000
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

Know your out-of-pocket cost for care.

All Charges