Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$36,204.87

Service Code	MSDRG 148
Min. Negotiated Rate	$9,066.42
Max. Negotiated Rate	$36,204.87
Rate for Payer: AlohaCare Medicare	$9,066.42
Rate for Payer: Devoted Health Medicare	$9,973.06
Rate for Payer: Hawaii Medical Service Association Commercial	$36,204.87
Rate for Payer: Hawaii Medical Service Association Medicare	$9,066.42
Rate for Payer: Humana Medicare	$9,066.42
Rate for Payer: Kaiser Permanente Commercial	$13,749.98
Rate for Payer: Kaiser Permanente Medicare	$9,066.42
Rate for Payer: Ohana Health Plan Medicare	$9,066.42
Rate for Payer: UnitedHealthcare Medicare	$9,066.42

EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility

$10,249.88

Service Code	APR-DRG 1104
Min. Negotiated Rate	$10,249.88
Max. Negotiated Rate	$10,249.88
Rate for Payer: AlohaCare Medicaid	$10,249.88
Rate for Payer: Hawaii Medical Service Association ABD	$10,249.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,249.88
Rate for Payer: Kaiser Permanente Medicaid	$10,249.88
Rate for Payer: Ohana Health Plan Medicaid	$10,249.88
Rate for Payer: UnitedHealthcare Medicaid	$10,249.88

EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility

$5,899.85

Service Code	APR-DRG 1103
Min. Negotiated Rate	$5,899.85
Max. Negotiated Rate	$5,899.85
Rate for Payer: AlohaCare Medicaid	$5,899.85
Rate for Payer: Hawaii Medical Service Association ABD	$5,899.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,899.85
Rate for Payer: Kaiser Permanente Medicaid	$5,899.85
Rate for Payer: Ohana Health Plan Medicaid	$5,899.85
Rate for Payer: UnitedHealthcare Medicaid	$5,899.85

EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility

$4,261.33

Service Code	APR-DRG 1102
Min. Negotiated Rate	$4,261.33
Max. Negotiated Rate	$4,261.33
Rate for Payer: AlohaCare Medicaid	$4,261.33
Rate for Payer: Hawaii Medical Service Association ABD	$4,261.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,261.33
Rate for Payer: Kaiser Permanente Medicaid	$4,261.33
Rate for Payer: Ohana Health Plan Medicaid	$4,261.33
Rate for Payer: UnitedHealthcare Medicaid	$4,261.33

EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility

$3,788.42

Service Code	APR-DRG 1101
Min. Negotiated Rate	$3,788.42
Max. Negotiated Rate	$3,788.42
Rate for Payer: AlohaCare Medicaid	$3,788.42
Rate for Payer: Hawaii Medical Service Association ABD	$3,788.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,788.42
Rate for Payer: Kaiser Permanente Medicaid	$3,788.42
Rate for Payer: Ohana Health Plan Medicaid	$3,788.42
Rate for Payer: UnitedHealthcare Medicaid	$3,788.42

EATING DISORDERS

Facility

$14,136.73

Service Code	APR-DRG 7594
Min. Negotiated Rate	$14,136.73
Max. Negotiated Rate	$14,136.73
Rate for Payer: AlohaCare Medicaid	$14,136.73
Rate for Payer: Hawaii Medical Service Association ABD	$14,136.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,136.73
Rate for Payer: Kaiser Permanente Medicaid	$14,136.73
Rate for Payer: Ohana Health Plan Medicaid	$14,136.73
Rate for Payer: UnitedHealthcare Medicaid	$14,136.73

EATING DISORDERS

Facility

$4,430.95

Service Code	APR-DRG 7591
Min. Negotiated Rate	$4,430.95
Max. Negotiated Rate	$4,430.95
Rate for Payer: AlohaCare Medicaid	$4,430.95
Rate for Payer: Hawaii Medical Service Association ABD	$4,430.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,430.95
Rate for Payer: Kaiser Permanente Medicaid	$4,430.95
Rate for Payer: Ohana Health Plan Medicaid	$4,430.95
Rate for Payer: UnitedHealthcare Medicaid	$4,430.95

EATING DISORDERS

Facility

$5,805.17

Service Code	APR-DRG 7592
Min. Negotiated Rate	$5,805.17
Max. Negotiated Rate	$5,805.17
Rate for Payer: AlohaCare Medicaid	$5,805.17
Rate for Payer: Hawaii Medical Service Association ABD	$5,805.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,805.17
Rate for Payer: Kaiser Permanente Medicaid	$5,805.17
Rate for Payer: Ohana Health Plan Medicaid	$5,805.17
Rate for Payer: UnitedHealthcare Medicaid	$5,805.17

EATING DISORDERS

Facility

$8,393.83

Service Code	APR-DRG 7593
Min. Negotiated Rate	$8,393.83
Max. Negotiated Rate	$8,393.83
Rate for Payer: AlohaCare Medicaid	$8,393.83
Rate for Payer: Hawaii Medical Service Association ABD	$8,393.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,393.83
Rate for Payer: Kaiser Permanente Medicaid	$8,393.83
Rate for Payer: Ohana Health Plan Medicaid	$8,393.83
Rate for Payer: UnitedHealthcare Medicaid	$8,393.83

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$477,894.60

Service Code	MSDRG 003
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$477,894.60
Rate for Payer: AlohaCare Medicare	$241,420.87
Rate for Payer: Devoted Health Medicare	$265,562.96
Rate for Payer: Hawaii Medical Service Association Commercial	$477,894.60
Rate for Payer: Hawaii Medical Service Association Medicare	$241,420.87
Rate for Payer: Humana Medicare	$241,420.87
Rate for Payer: Kaiser Permanente Commercial	$366,134.70
Rate for Payer: Kaiser Permanente Medicare	$241,420.87
Rate for Payer: Ohana Health Plan Medicare	$241,420.87
Rate for Payer: UnitedHealthcare Medicare	$241,420.87
Rate for Payer: University Health Alliance Commercial	$10,400.00

ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]

Facility

$106.00

Service Code	NDC 45802046635
Hospital Revenue Code	250
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: MDX Hawaii PPO	$102.82

ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]

Facility

$397.00

Service Code	NDC 45802046653
Hospital Revenue Code	250
Min. Negotiated Rate	$337.45
Max. Negotiated Rate	$385.09
Rate for Payer: Cash Price	$238.20
Rate for Payer: Health Management Network Commercial	$337.45
Rate for Payer: MDX Hawaii PPO	$385.09

ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]

Facility

$106.00

Service Code	NDC 45802046635
Hospital Revenue Code	637
Min. Negotiated Rate	$54.06
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$66.78
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: University Health Alliance Commercial	$77.26

ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]

Facility

$397.00

Service Code	NDC 45802046653
Hospital Revenue Code	637
Min. Negotiated Rate	$202.47
Max. Negotiated Rate	$385.09
Rate for Payer: Cash Price	$238.20
Rate for Payer: Hawaii Western Management Group Commercial	$377.15
Rate for Payer: Health Management Network Commercial	$337.45
Rate for Payer: Kaiser Permanente Commercial	$250.11
Rate for Payer: Kaiser Permanente Medicaid	$202.47
Rate for Payer: MDX Hawaii PPO	$385.09
Rate for Payer: University Health Alliance Commercial	$289.37

ECO SUCTIONER MAT USA-XG8

Facility

$276.00

Hospital Revenue Code	271
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: MDX Hawaii PPO	$267.72

ECO SUCTIONER MAT USA-XG8

Facility

$276.00

Hospital Revenue Code	271
Min. Negotiated Rate	$140.76
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Hawaii Western Management Group Commercial	$262.20
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$173.88
Rate for Payer: Kaiser Permanente Medicaid	$140.76
Rate for Payer: MDX Hawaii PPO	$267.72
Rate for Payer: University Health Alliance Commercial	$201.18

EDORA SR-T PROMRI W/HM 431749

Facility

$10,500.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,355.00
Max. Negotiated Rate	$10,185.00
Rate for Payer: Cash Price	$6,300.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,350.00
Rate for Payer: Health Management Network Commercial	$8,925.00
Rate for Payer: Kaiser Permanente Commercial	$6,615.00
Rate for Payer: Kaiser Permanente Medicaid	$5,355.00
Rate for Payer: MDX Hawaii PPO	$10,185.00
Rate for Payer: University Health Alliance Commercial	$5,880.00

EDORA SR-T PROMRI W/HM 431749

Facility

$10,500.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,880.00
Max. Negotiated Rate	$10,185.00
Rate for Payer: Cash Price	$6,300.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,350.00
Rate for Payer: Health Management Network Commercial	$8,925.00
Rate for Payer: MDX Hawaii PPO	$10,185.00
Rate for Payer: University Health Alliance Commercial	$5,880.00

EGG BURR 4.0MM #1607-002-035

Facility

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$118.83
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$139.80
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$146.79
Rate for Payer: Kaiser Permanente Medicaid	$118.83
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: University Health Alliance Commercial	$169.83

EGG BURR 4.0MM #1607-002-035

Facility

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$139.80
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: MDX Hawaii PPO	$226.01

ELECTROCATHETER S 53-J 107237

Facility

$200.00

Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: University Health Alliance Commercial	$112.00

ELECTROCATHETER S 53-J 107237

Facility

$200.00

Hospital Revenue Code	278
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: University Health Alliance Commercial	$112.00

ELECTROCATHETER S 53-K 107235

Facility

$200.00

Hospital Revenue Code	278
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: University Health Alliance Commercial	$112.00

ELECTROCATHETER S 53-K 107235

Facility

$200.00

Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: University Health Alliance Commercial	$112.00

ELECTRODE BALL

Facility

$90.00

Hospital Revenue Code	272
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: University Health Alliance Commercial	$65.60

Know your out-of-pocket cost for care.

All Charges