Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DECOMPRESSION HIP 800-0541

Facility

$4,464.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,276.64
Max. Negotiated Rate	$4,330.08
Rate for Payer: Cash Price	$2,678.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,240.80
Rate for Payer: Health Management Network Commercial	$3,794.40
Rate for Payer: Kaiser Permanente Commercial	$2,812.32
Rate for Payer: Kaiser Permanente Medicaid	$2,276.64
Rate for Payer: MDX Hawaii PPO	$4,330.08
Rate for Payer: University Health Alliance Commercial	$3,253.81

DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]

Facility

$45.00

Service Code	HCPCS J0895
Hospital Revenue Code	636
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Hawaii Medical Service Association ABD	$9.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.02
Rate for Payer: Hawaii Western Management Group Commercial	$42.75
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Kaiser Permanente Commercial	$28.35
Rate for Payer: Kaiser Permanente Medicaid	$22.95
Rate for Payer: MDX Hawaii PPO	$43.65
Rate for Payer: UnitedHealthcare Medicaid	$27.00
Rate for Payer: University Health Alliance Commercial	$32.80

DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]

Facility

$45.00

Service Code	HCPCS J0895
Hospital Revenue Code	250
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: MDX Hawaii PPO	$43.65

DEFIBRILLATOR IMPLANTS

Facility

$19,880.10

Service Code	APR-DRG 1791
Min. Negotiated Rate	$19,880.10
Max. Negotiated Rate	$19,880.10
Rate for Payer: AlohaCare Medicaid	$19,880.10
Rate for Payer: Hawaii Medical Service Association ABD	$19,880.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,880.10
Rate for Payer: Kaiser Permanente Medicaid	$19,880.10
Rate for Payer: Ohana Health Plan Medicaid	$19,880.10
Rate for Payer: UnitedHealthcare Medicaid	$19,880.10

DEFIBRILLATOR IMPLANTS

Facility

$25,614.92

Service Code	APR-DRG 1793
Min. Negotiated Rate	$25,614.92
Max. Negotiated Rate	$25,614.92
Rate for Payer: AlohaCare Medicaid	$25,614.92
Rate for Payer: Hawaii Medical Service Association ABD	$25,614.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25,614.92
Rate for Payer: Kaiser Permanente Medicaid	$25,614.92
Rate for Payer: Ohana Health Plan Medicaid	$25,614.92
Rate for Payer: UnitedHealthcare Medicaid	$25,614.92

DEFIBRILLATOR IMPLANTS

Facility

$35,736.95

Service Code	APR-DRG 1794
Min. Negotiated Rate	$35,736.95
Max. Negotiated Rate	$35,736.95
Rate for Payer: AlohaCare Medicaid	$35,736.95
Rate for Payer: Hawaii Medical Service Association ABD	$35,736.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$35,736.95
Rate for Payer: Kaiser Permanente Medicaid	$35,736.95
Rate for Payer: Ohana Health Plan Medicaid	$35,736.95
Rate for Payer: UnitedHealthcare Medicaid	$35,736.95

DEFIBRILLATOR IMPLANTS

Facility

$21,744.96

Service Code	APR-DRG 1792
Min. Negotiated Rate	$21,744.96
Max. Negotiated Rate	$21,744.96
Rate for Payer: AlohaCare Medicaid	$21,744.96
Rate for Payer: Hawaii Medical Service Association ABD	$21,744.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,744.96
Rate for Payer: Kaiser Permanente Medicaid	$21,744.96
Rate for Payer: Ohana Health Plan Medicaid	$21,744.96
Rate for Payer: UnitedHealthcare Medicaid	$21,744.96

DEGARELIX 120 MG SUBCUTANEOUS SOLUTION [171653]

Facility

$1,372.00

Service Code	HCPCS J9155
Hospital Revenue Code	636
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$1,330.84
Rate for Payer: AlohaCare Medicaid	$4.46
Rate for Payer: AlohaCare Medicare	$4.46
Rate for Payer: Cash Price	$823.20
Rate for Payer: Cash Price	$823.20
Rate for Payer: Devoted Health Medicare	$4.91
Rate for Payer: Hawaii Medical Service Association ABD	$4.36
Rate for Payer: Hawaii Medical Service Association Commercial	$5.58
Rate for Payer: Hawaii Medical Service Association Medicare	$4.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,303.40
Rate for Payer: Health Management Network Commercial	$1,166.20
Rate for Payer: Humana Medicare	$4.46
Rate for Payer: Kaiser Permanente Commercial	$864.36
Rate for Payer: Kaiser Permanente Medicaid	$699.72
Rate for Payer: Kaiser Permanente Medicare	$4.46
Rate for Payer: MDX Hawaii PPO	$1,330.84
Rate for Payer: Ohana Health Plan Medicaid	$4.91
Rate for Payer: Ohana Health Plan Medicare	$4.46
Rate for Payer: UnitedHealthcare Medicaid	$823.20
Rate for Payer: UnitedHealthcare Medicare	$4.46
Rate for Payer: University Health Alliance Commercial	$1,000.05

DEGARELIX 120 MG SUBCUTANEOUS SOLUTION [171653]

Facility

$1,372.00

Service Code	HCPCS J9155
Hospital Revenue Code	250
Min. Negotiated Rate	$1,166.20
Max. Negotiated Rate	$1,330.84
Rate for Payer: Cash Price	$823.20
Rate for Payer: Health Management Network Commercial	$1,166.20
Rate for Payer: MDX Hawaii PPO	$1,330.84

DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]

Facility

$880.00

Service Code	HCPCS J9155
Hospital Revenue Code	636
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$853.60
Rate for Payer: AlohaCare Medicaid	$4.46
Rate for Payer: AlohaCare Medicare	$4.46
Rate for Payer: Cash Price	$528.00
Rate for Payer: Cash Price	$528.00
Rate for Payer: Devoted Health Medicare	$4.91
Rate for Payer: Hawaii Medical Service Association ABD	$4.36
Rate for Payer: Hawaii Medical Service Association Commercial	$5.58
Rate for Payer: Hawaii Medical Service Association Medicare	$4.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.36
Rate for Payer: Hawaii Western Management Group Commercial	$836.00
Rate for Payer: Health Management Network Commercial	$748.00
Rate for Payer: Humana Medicare	$4.46
Rate for Payer: Kaiser Permanente Commercial	$554.40
Rate for Payer: Kaiser Permanente Medicaid	$448.80
Rate for Payer: Kaiser Permanente Medicare	$4.46
Rate for Payer: MDX Hawaii PPO	$853.60
Rate for Payer: Ohana Health Plan Medicaid	$4.91
Rate for Payer: Ohana Health Plan Medicare	$4.46
Rate for Payer: UnitedHealthcare Medicaid	$528.00
Rate for Payer: UnitedHealthcare Medicare	$4.46
Rate for Payer: University Health Alliance Commercial	$641.43

DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]

Facility

$880.00

Service Code	HCPCS J9155
Hospital Revenue Code	250
Min. Negotiated Rate	$748.00
Max. Negotiated Rate	$853.60
Rate for Payer: Cash Price	$528.00
Rate for Payer: Health Management Network Commercial	$748.00
Rate for Payer: MDX Hawaii PPO	$853.60

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

Facility

$5,401.51

Service Code	APR-DRG 0423
Min. Negotiated Rate	$5,401.51
Max. Negotiated Rate	$5,401.51
Rate for Payer: AlohaCare Medicaid	$5,401.51
Rate for Payer: Hawaii Medical Service Association ABD	$5,401.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,401.51
Rate for Payer: Kaiser Permanente Medicaid	$5,401.51
Rate for Payer: Ohana Health Plan Medicaid	$5,401.51
Rate for Payer: UnitedHealthcare Medicaid	$5,401.51

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

Facility

$3,779.29

Service Code	APR-DRG 0422
Min. Negotiated Rate	$3,779.29
Max. Negotiated Rate	$3,779.29
Rate for Payer: AlohaCare Medicaid	$3,779.29
Rate for Payer: Hawaii Medical Service Association ABD	$3,779.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,779.29
Rate for Payer: Kaiser Permanente Medicaid	$3,779.29
Rate for Payer: Ohana Health Plan Medicaid	$3,779.29
Rate for Payer: UnitedHealthcare Medicaid	$3,779.29

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

Facility

$11,643.14

Service Code	APR-DRG 0424
Min. Negotiated Rate	$11,643.14
Max. Negotiated Rate	$11,643.14
Rate for Payer: AlohaCare Medicaid	$11,643.14
Rate for Payer: Hawaii Medical Service Association ABD	$11,643.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,643.14
Rate for Payer: Kaiser Permanente Medicaid	$11,643.14
Rate for Payer: Ohana Health Plan Medicaid	$11,643.14
Rate for Payer: UnitedHealthcare Medicaid	$11,643.14

DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

Facility

$3,056.57

Service Code	APR-DRG 0421
Min. Negotiated Rate	$3,056.57
Max. Negotiated Rate	$3,056.57
Rate for Payer: AlohaCare Medicaid	$3,056.57
Rate for Payer: Hawaii Medical Service Association ABD	$3,056.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,056.57
Rate for Payer: Kaiser Permanente Medicaid	$3,056.57
Rate for Payer: Ohana Health Plan Medicaid	$3,056.57
Rate for Payer: UnitedHealthcare Medicaid	$3,056.57

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC

Facility

$40,073.47

Service Code	MSDRG 056
Min. Negotiated Rate	$26,423.52
Max. Negotiated Rate	$40,073.47
Rate for Payer: AlohaCare Medicare	$26,423.52
Rate for Payer: Devoted Health Medicare	$29,065.87
Rate for Payer: Hawaii Medical Service Association Commercial	$26,449.94
Rate for Payer: Hawaii Medical Service Association Medicare	$26,423.52
Rate for Payer: Humana Medicare	$26,423.52
Rate for Payer: Kaiser Permanente Commercial	$40,073.47
Rate for Payer: Kaiser Permanente Medicare	$26,423.52
Rate for Payer: Ohana Health Plan Medicare	$26,423.52
Rate for Payer: UnitedHealthcare Medicare	$26,423.52

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC

Facility

$26,449.94

Service Code	MSDRG 057
Min. Negotiated Rate	$14,736.47
Max. Negotiated Rate	$26,449.94
Rate for Payer: AlohaCare Medicare	$14,736.47
Rate for Payer: Devoted Health Medicare	$16,210.12
Rate for Payer: Hawaii Medical Service Association Commercial	$26,449.94
Rate for Payer: Hawaii Medical Service Association Medicare	$14,736.47
Rate for Payer: Humana Medicare	$14,736.47
Rate for Payer: Kaiser Permanente Commercial	$22,349.10
Rate for Payer: Kaiser Permanente Medicare	$14,736.47
Rate for Payer: Ohana Health Plan Medicare	$14,736.47
Rate for Payer: UnitedHealthcare Medicare	$14,736.47

DELIVERY NEEDLE 10GAX10CM

Facility

$282.00

Hospital Revenue Code	272
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$169.20
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: MDX Hawaii PPO	$273.54

DELIVERY NEEDLE 10GAX10CM

Facility

$282.00

Hospital Revenue Code	272
Min. Negotiated Rate	$143.82
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$169.20
Rate for Payer: Hawaii Western Management Group Commercial	$267.90
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Kaiser Permanente Commercial	$177.66
Rate for Payer: Kaiser Permanente Medicaid	$143.82
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: University Health Alliance Commercial	$205.55

DEMECLOCYCLINE 150 MG TABLET [9726]

Facility

$48.00

Service Code	NDC 42806014301
Hospital Revenue Code	250
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: MDX Hawaii PPO	$46.56

DEMECLOCYCLINE 150 MG TABLET [9726]

Facility

$29.00

Service Code	NDC 53746055401
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: MDX Hawaii PPO	$28.13

DEMECLOCYCLINE 150 MG TABLET [9726]

Facility

$48.00

Service Code	NDC 42806014301
Hospital Revenue Code	637
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$45.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$30.24
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: University Health Alliance Commercial	$34.99

DEMECLOCYCLINE 150 MG TABLET [9726]

Facility

$29.00

Service Code	NDC 53746055401
Hospital Revenue Code	637
Min. Negotiated Rate	$14.79
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$18.27
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: University Health Alliance Commercial	$21.14

DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]

Facility

$4,640.00

Service Code	HCPCS J0897
Hospital Revenue Code	250
Min. Negotiated Rate	$3,944.00
Max. Negotiated Rate	$4,500.80
Rate for Payer: Cash Price	$2,784.00
Rate for Payer: Health Management Network Commercial	$3,944.00
Rate for Payer: MDX Hawaii PPO	$4,500.80

DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]

Facility

$4,640.00

Service Code	HCPCS J0897
Hospital Revenue Code	636
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$4,500.80
Rate for Payer: AlohaCare Medicaid	$29.51
Rate for Payer: AlohaCare Medicare	$29.51
Rate for Payer: Cash Price	$2,784.00
Rate for Payer: Cash Price	$2,784.00
Rate for Payer: Devoted Health Medicare	$32.46
Rate for Payer: Hawaii Medical Service Association ABD	$29.24
Rate for Payer: Hawaii Medical Service Association Commercial	$36.89
Rate for Payer: Hawaii Medical Service Association Medicare	$29.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.24
Rate for Payer: Hawaii Western Management Group Commercial	$4,408.00
Rate for Payer: Health Management Network Commercial	$3,944.00
Rate for Payer: Humana Medicare	$29.51
Rate for Payer: Kaiser Permanente Commercial	$2,923.20
Rate for Payer: Kaiser Permanente Medicaid	$2,366.40
Rate for Payer: Kaiser Permanente Medicare	$29.51
Rate for Payer: MDX Hawaii PPO	$4,500.80
Rate for Payer: Ohana Health Plan Medicaid	$32.46
Rate for Payer: Ohana Health Plan Medicare	$29.51
Rate for Payer: UnitedHealthcare Medicaid	$2,784.00
Rate for Payer: UnitedHealthcare Medicare	$29.51
Rate for Payer: University Health Alliance Commercial	$3,382.10

Know your out-of-pocket cost for care.

All Charges