Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CONCUSSION WITH CC

Facility

$23,028.43

Service Code	MSDRG 089
Min. Negotiated Rate	$12,495.74
Max. Negotiated Rate	$23,028.43
Rate for Payer: AlohaCare Medicare	$12,495.74
Rate for Payer: Devoted Health Medicare	$13,745.31
Rate for Payer: Hawaii Medical Service Association Commercial	$23,028.43
Rate for Payer: Hawaii Medical Service Association Medicare	$12,495.74
Rate for Payer: Humana Medicare	$12,495.74
Rate for Payer: Kaiser Permanente Commercial	$18,950.85
Rate for Payer: Kaiser Permanente Medicare	$12,495.74
Rate for Payer: Ohana Health Plan Medicare	$12,495.74
Rate for Payer: UnitedHealthcare Medicare	$12,495.74

CONCUSSION WITH MCC

Facility

$23,318.55

Service Code	MSDRG 088
Min. Negotiated Rate	$15,375.71
Max. Negotiated Rate	$23,318.55
Rate for Payer: AlohaCare Medicare	$15,375.71
Rate for Payer: Devoted Health Medicare	$16,913.28
Rate for Payer: Hawaii Medical Service Association Commercial	$23,028.43
Rate for Payer: Hawaii Medical Service Association Medicare	$15,375.71
Rate for Payer: Humana Medicare	$15,375.71
Rate for Payer: Kaiser Permanente Commercial	$23,318.55
Rate for Payer: Kaiser Permanente Medicare	$15,375.71
Rate for Payer: Ohana Health Plan Medicare	$15,375.71
Rate for Payer: UnitedHealthcare Medicare	$15,375.71

CONCUSSION WITHOUT CC/MCC

Facility

$17,180.33

Service Code	MSDRG 090
Min. Negotiated Rate	$9,363.30
Max. Negotiated Rate	$17,180.33
Rate for Payer: AlohaCare Medicare	$9,363.30
Rate for Payer: Devoted Health Medicare	$10,299.63
Rate for Payer: Hawaii Medical Service Association Commercial	$17,180.33
Rate for Payer: Hawaii Medical Service Association Medicare	$9,363.30
Rate for Payer: Humana Medicare	$9,363.30
Rate for Payer: Kaiser Permanente Commercial	$14,200.20
Rate for Payer: Kaiser Permanente Medicare	$9,363.30
Rate for Payer: Ohana Health Plan Medicare	$9,363.30
Rate for Payer: UnitedHealthcare Medicare	$9,363.30

CONDITIONER CAVITY 6GM 3337058

Facility

$251.00

Hospital Revenue Code	272
Min. Negotiated Rate	$213.35
Max. Negotiated Rate	$243.47
Rate for Payer: Cash Price	$150.60
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: MDX Hawaii PPO	$243.47

CONDITIONER CAVITY 6GM 3337058

Facility

$251.00

Hospital Revenue Code	272
Min. Negotiated Rate	$128.01
Max. Negotiated Rate	$243.47
Rate for Payer: Cash Price	$150.60
Rate for Payer: Hawaii Western Management Group Commercial	$238.45
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Kaiser Permanente Commercial	$158.13
Rate for Payer: Kaiser Permanente Medicaid	$128.01
Rate for Payer: MDX Hawaii PPO	$243.47
Rate for Payer: University Health Alliance Commercial	$182.95

CONE AUGMENT 5549-A-110

Facility

$10,933.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,575.83
Max. Negotiated Rate	$10,605.01
Rate for Payer: Cash Price	$6,559.80
Rate for Payer: Hawaii Western Management Group Commercial	$7,653.10
Rate for Payer: Health Management Network Commercial	$9,293.05
Rate for Payer: Kaiser Permanente Commercial	$6,887.79
Rate for Payer: Kaiser Permanente Medicaid	$5,575.83
Rate for Payer: MDX Hawaii PPO	$10,605.01
Rate for Payer: University Health Alliance Commercial	$6,122.48

CONE AUGMENT 5549-A-110

Facility

$10,933.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,122.48
Max. Negotiated Rate	$10,605.01
Rate for Payer: Cash Price	$6,559.80
Rate for Payer: Hawaii Western Management Group Commercial	$7,653.10
Rate for Payer: Health Management Network Commercial	$9,293.05
Rate for Payer: MDX Hawaii PPO	$10,605.01
Rate for Payer: University Health Alliance Commercial	$6,122.48

CONICAL BURR 9.5MM #358.682

Facility

$1,628.00

Hospital Revenue Code	272
Min. Negotiated Rate	$830.28
Max. Negotiated Rate	$1,579.16
Rate for Payer: Cash Price	$976.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,546.60
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: Kaiser Permanente Commercial	$1,025.64
Rate for Payer: Kaiser Permanente Medicaid	$830.28
Rate for Payer: MDX Hawaii PPO	$1,579.16
Rate for Payer: University Health Alliance Commercial	$1,186.65

CONICAL BURR 9.5MM #358.682

Facility

$1,628.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,383.80
Max. Negotiated Rate	$1,579.16
Rate for Payer: Cash Price	$976.80
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: MDX Hawaii PPO	$1,579.16

CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER

Facility

$5,509.00

Service Code	CPT 57520
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$5,160.40

CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION

Facility

$5,509.00

Service Code	CPT 57522
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$5,160.40

CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [187009]

Facility

$1,383.00

Service Code	NDC 00046087221
Hospital Revenue Code	250
Min. Negotiated Rate	$1,175.55
Max. Negotiated Rate	$1,341.51
Rate for Payer: Cash Price	$829.80
Rate for Payer: Health Management Network Commercial	$1,175.55
Rate for Payer: MDX Hawaii PPO	$1,341.51

CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [187009]

Facility

$1,383.00

Service Code	NDC 00046087221
Hospital Revenue Code	637
Min. Negotiated Rate	$705.33
Max. Negotiated Rate	$1,341.51
Rate for Payer: Cash Price	$829.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,313.85
Rate for Payer: Health Management Network Commercial	$1,175.55
Rate for Payer: Kaiser Permanente Commercial	$871.29
Rate for Payer: Kaiser Permanente Medicaid	$705.33
Rate for Payer: MDX Hawaii PPO	$1,341.51
Rate for Payer: University Health Alliance Commercial	$1,008.07

CONJUGATED ESTROGENS 0.625 MG TABLET [9974]

Facility

$26.00

Service Code	NDC 00046110281
Hospital Revenue Code	637
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$15.60
Rate for Payer: Hawaii Western Management Group Commercial	$24.70
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$16.38
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: University Health Alliance Commercial	$18.95

CONJUGATED ESTROGENS 0.625 MG TABLET [9974]

Facility

$26.00

Service Code	NDC 00046110281
Hospital Revenue Code	250
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: MDX Hawaii PPO	$25.22

CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]

Facility

$679.00

Service Code	HCPCS J1410
Hospital Revenue Code	636
Min. Negotiated Rate	$346.29
Max. Negotiated Rate	$658.63
Rate for Payer: AlohaCare Medicaid	$391.72
Rate for Payer: AlohaCare Medicare	$391.72
Rate for Payer: Cash Price	$407.40
Rate for Payer: Cash Price	$407.40
Rate for Payer: Devoted Health Medicare	$430.89
Rate for Payer: Hawaii Medical Service Association ABD	$390.74
Rate for Payer: Hawaii Medical Service Association Commercial	$489.65
Rate for Payer: Hawaii Medical Service Association Medicare	$391.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$390.74
Rate for Payer: Hawaii Western Management Group Commercial	$645.05
Rate for Payer: Health Management Network Commercial	$577.15
Rate for Payer: Humana Medicare	$391.72
Rate for Payer: Kaiser Permanente Commercial	$427.77
Rate for Payer: Kaiser Permanente Medicaid	$346.29
Rate for Payer: Kaiser Permanente Medicare	$391.72
Rate for Payer: MDX Hawaii PPO	$658.63
Rate for Payer: Ohana Health Plan Medicaid	$430.89
Rate for Payer: Ohana Health Plan Medicare	$391.72
Rate for Payer: UnitedHealthcare Medicaid	$407.40
Rate for Payer: UnitedHealthcare Medicare	$391.72
Rate for Payer: University Health Alliance Commercial	$494.92

CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]

Facility

$679.00

Service Code	HCPCS J1410
Hospital Revenue Code	250
Min. Negotiated Rate	$577.15
Max. Negotiated Rate	$658.63
Rate for Payer: Cash Price	$407.40
Rate for Payer: Health Management Network Commercial	$577.15
Rate for Payer: MDX Hawaii PPO	$658.63

CONNECTIVE TISSUE DISORDERS

Facility

$13,692.60

Service Code	APR-DRG 3464
Min. Negotiated Rate	$13,692.60
Max. Negotiated Rate	$13,692.60
Rate for Payer: AlohaCare Medicaid	$13,692.60
Rate for Payer: Hawaii Medical Service Association ABD	$13,692.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,692.60
Rate for Payer: Kaiser Permanente Medicaid	$13,692.60
Rate for Payer: Ohana Health Plan Medicaid	$13,692.60
Rate for Payer: UnitedHealthcare Medicaid	$13,692.60

CONNECTIVE TISSUE DISORDERS

Facility

$3,367.05

Service Code	APR-DRG 3461
Min. Negotiated Rate	$3,367.05
Max. Negotiated Rate	$3,367.05
Rate for Payer: AlohaCare Medicaid	$3,367.05
Rate for Payer: Hawaii Medical Service Association ABD	$3,367.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,367.05
Rate for Payer: Kaiser Permanente Medicaid	$3,367.05
Rate for Payer: Ohana Health Plan Medicaid	$3,367.05
Rate for Payer: UnitedHealthcare Medicaid	$3,367.05

CONNECTIVE TISSUE DISORDERS

Facility

$4,458.97

Service Code	APR-DRG 3462
Min. Negotiated Rate	$4,458.97
Max. Negotiated Rate	$4,458.97
Rate for Payer: AlohaCare Medicaid	$4,458.97
Rate for Payer: Hawaii Medical Service Association ABD	$4,458.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,458.97
Rate for Payer: Kaiser Permanente Medicaid	$4,458.97
Rate for Payer: Ohana Health Plan Medicaid	$4,458.97
Rate for Payer: UnitedHealthcare Medicaid	$4,458.97

CONNECTIVE TISSUE DISORDERS

Facility

$6,706.71

Service Code	APR-DRG 3463
Min. Negotiated Rate	$6,706.71
Max. Negotiated Rate	$6,706.71
Rate for Payer: AlohaCare Medicaid	$6,706.71
Rate for Payer: Hawaii Medical Service Association ABD	$6,706.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,706.71
Rate for Payer: Kaiser Permanente Medicaid	$6,706.71
Rate for Payer: Ohana Health Plan Medicaid	$6,706.71
Rate for Payer: UnitedHealthcare Medicaid	$6,706.71

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$35,476.89

Service Code	MSDRG 546
Min. Negotiated Rate	$13,119.07
Max. Negotiated Rate	$35,476.89
Rate for Payer: AlohaCare Medicare	$13,119.07
Rate for Payer: Devoted Health Medicare	$14,430.98
Rate for Payer: Hawaii Medical Service Association Commercial	$35,476.89
Rate for Payer: Hawaii Medical Service Association Medicare	$13,119.07
Rate for Payer: Humana Medicare	$13,119.07
Rate for Payer: Kaiser Permanente Commercial	$19,896.15
Rate for Payer: Kaiser Permanente Medicare	$13,119.07
Rate for Payer: Ohana Health Plan Medicare	$13,119.07
Rate for Payer: UnitedHealthcare Medicare	$13,119.07

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$42,809.32

Service Code	MSDRG 545
Min. Negotiated Rate	$28,227.48
Max. Negotiated Rate	$42,809.32
Rate for Payer: AlohaCare Medicare	$28,227.48
Rate for Payer: Devoted Health Medicare	$31,050.23
Rate for Payer: Hawaii Medical Service Association Commercial	$40,985.27
Rate for Payer: Hawaii Medical Service Association Medicare	$28,227.48
Rate for Payer: Humana Medicare	$28,227.48
Rate for Payer: Kaiser Permanente Commercial	$42,809.32
Rate for Payer: Kaiser Permanente Medicare	$28,227.48
Rate for Payer: Ohana Health Plan Medicare	$28,227.48
Rate for Payer: UnitedHealthcare Medicare	$28,227.48

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$29,992.78

Service Code	MSDRG 547
Min. Negotiated Rate	$9,511.15
Max. Negotiated Rate	$29,992.78
Rate for Payer: AlohaCare Medicare	$9,511.15
Rate for Payer: Devoted Health Medicare	$10,462.26
Rate for Payer: Hawaii Medical Service Association Commercial	$29,992.78
Rate for Payer: Hawaii Medical Service Association Medicare	$9,511.15
Rate for Payer: Humana Medicare	$9,511.15
Rate for Payer: Kaiser Permanente Commercial	$14,424.45
Rate for Payer: Kaiser Permanente Medicare	$9,511.15
Rate for Payer: Ohana Health Plan Medicare	$9,511.15
Rate for Payer: UnitedHealthcare Medicare	$9,511.15

CONTAINE CHEST TUBE ATRIUM RVR

Facility

$213.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$127.80
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: MDX Hawaii PPO	$206.61

Know your out-of-pocket cost for care.

All Charges