Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

ORBIT & EYE PROCEDURES

Facility

$4,817.07

Service Code	APR-DRG 0731
Min. Negotiated Rate	$4,817.07
Max. Negotiated Rate	$4,817.07
Rate for Payer: AlohaCare Medicaid	$4,817.07
Rate for Payer: Hawaii Medical Service Association ABD	$4,817.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,817.07
Rate for Payer: Kaiser Permanente Medicaid	$4,817.07
Rate for Payer: Ohana Health Plan Medicaid	$4,817.07
Rate for Payer: UnitedHealthcare Medicaid	$4,817.07

ORBIT & EYE PROCEDURES

Facility

$9,073.83

Service Code	APR-DRG 0733
Min. Negotiated Rate	$9,073.83
Max. Negotiated Rate	$9,073.83
Rate for Payer: AlohaCare Medicaid	$9,073.83
Rate for Payer: Hawaii Medical Service Association ABD	$9,073.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,073.83
Rate for Payer: Kaiser Permanente Medicaid	$9,073.83
Rate for Payer: Ohana Health Plan Medicaid	$9,073.83
Rate for Payer: UnitedHealthcare Medicaid	$9,073.83

ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH

Facility

$10,679.55

Service Code	CPT 54530
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$4,229.69
Rate for Payer: AlohaCare Medicare	$4,229.69
Rate for Payer: Devoted Health Medicare	$4,652.66
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,229.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$4,229.69
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,229.69
Rate for Payer: Ohana Health Plan Medicaid	$4,652.66
Rate for Payer: Ohana Health Plan Medicare	$4,229.69
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,229.69
Rate for Payer: University Health Alliance Commercial	$10,679.55

ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH

Facility

$8,270.00

Service Code	CPT 54520
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Devoted Health Medicare	$4,580.64
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$6,743.44

ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY

Facility

$27,753.53

Service Code	MSDRG 884
Min. Negotiated Rate	$18,300.04
Max. Negotiated Rate	$27,753.53
Rate for Payer: AlohaCare Medicare	$18,300.04
Rate for Payer: Devoted Health Medicare	$20,130.04
Rate for Payer: Hawaii Medical Service Association Commercial	$26,280.08
Rate for Payer: Hawaii Medical Service Association Medicare	$18,300.04
Rate for Payer: Humana Medicare	$18,300.04
Rate for Payer: Kaiser Permanente Commercial	$27,753.53
Rate for Payer: Kaiser Permanente Medicare	$18,300.04
Rate for Payer: Ohana Health Plan Medicare	$18,300.04
Rate for Payer: UnitedHealthcare Medicare	$18,300.04

ORGANIC MENTAL HEALTH DISTURBANCES

Facility

$6,193.73

Service Code	APR-DRG 7573
Min. Negotiated Rate	$6,193.73
Max. Negotiated Rate	$6,193.73
Rate for Payer: AlohaCare Medicaid	$6,193.73
Rate for Payer: Hawaii Medical Service Association ABD	$6,193.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,193.73
Rate for Payer: Kaiser Permanente Medicaid	$6,193.73
Rate for Payer: Ohana Health Plan Medicaid	$6,193.73
Rate for Payer: UnitedHealthcare Medicaid	$6,193.73

ORGANIC MENTAL HEALTH DISTURBANCES

Facility

$3,522.56

Service Code	APR-DRG 7572
Min. Negotiated Rate	$3,522.56
Max. Negotiated Rate	$3,522.56
Rate for Payer: AlohaCare Medicaid	$3,522.56
Rate for Payer: Hawaii Medical Service Association ABD	$3,522.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,522.56
Rate for Payer: Kaiser Permanente Medicaid	$3,522.56
Rate for Payer: Ohana Health Plan Medicaid	$3,522.56
Rate for Payer: UnitedHealthcare Medicaid	$3,522.56

ORGANIC MENTAL HEALTH DISTURBANCES

Facility

$2,818.20

Service Code	APR-DRG 7571
Min. Negotiated Rate	$2,818.20
Max. Negotiated Rate	$2,818.20
Rate for Payer: AlohaCare Medicaid	$2,818.20
Rate for Payer: Hawaii Medical Service Association ABD	$2,818.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,818.20
Rate for Payer: Kaiser Permanente Medicaid	$2,818.20
Rate for Payer: Ohana Health Plan Medicaid	$2,818.20
Rate for Payer: UnitedHealthcare Medicaid	$2,818.20

ORGANIC MENTAL HEALTH DISTURBANCES

Facility

$13,195.34

Service Code	APR-DRG 7574
Min. Negotiated Rate	$13,195.34
Max. Negotiated Rate	$13,195.34
Rate for Payer: AlohaCare Medicaid	$13,195.34
Rate for Payer: Hawaii Medical Service Association ABD	$13,195.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,195.34
Rate for Payer: Kaiser Permanente Medicaid	$13,195.34
Rate for Payer: Ohana Health Plan Medicaid	$13,195.34
Rate for Payer: UnitedHealthcare Medicaid	$13,195.34

O.R. PROCEDURES FOR OBESITY WITH CC

Facility

$52,948.41

Service Code	MSDRG 620
Min. Negotiated Rate	$18,202.23
Max. Negotiated Rate	$52,948.41
Rate for Payer: AlohaCare Medicare	$18,202.23
Rate for Payer: Devoted Health Medicare	$20,022.45
Rate for Payer: Hawaii Medical Service Association Commercial	$52,948.41
Rate for Payer: Hawaii Medical Service Association Medicare	$18,202.23
Rate for Payer: Humana Medicare	$18,202.23
Rate for Payer: Kaiser Permanente Commercial	$27,605.17
Rate for Payer: Kaiser Permanente Medicare	$18,202.23
Rate for Payer: Ohana Health Plan Medicare	$18,202.23
Rate for Payer: UnitedHealthcare Medicare	$18,202.23

O.R. PROCEDURES FOR OBESITY WITH MCC

Facility

$52,948.41

Service Code	MSDRG 619
Min. Negotiated Rate	$32,842.03
Max. Negotiated Rate	$52,948.41
Rate for Payer: AlohaCare Medicare	$32,842.03
Rate for Payer: Devoted Health Medicare	$36,126.23
Rate for Payer: Hawaii Medical Service Association Commercial	$52,948.41
Rate for Payer: Hawaii Medical Service Association Medicare	$32,842.03
Rate for Payer: Humana Medicare	$32,842.03
Rate for Payer: Kaiser Permanente Commercial	$49,807.65
Rate for Payer: Kaiser Permanente Medicare	$32,842.03
Rate for Payer: Ohana Health Plan Medicare	$32,842.03
Rate for Payer: UnitedHealthcare Medicare	$32,842.03

O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC

Facility

$52,730.02

Service Code	MSDRG 621
Min. Negotiated Rate	$17,156.92
Max. Negotiated Rate	$52,730.02
Rate for Payer: AlohaCare Medicare	$17,156.92
Rate for Payer: Devoted Health Medicare	$18,872.61
Rate for Payer: Hawaii Medical Service Association Commercial	$52,730.02
Rate for Payer: Hawaii Medical Service Association Medicare	$17,156.92
Rate for Payer: Humana Medicare	$17,156.92
Rate for Payer: Kaiser Permanente Commercial	$26,019.90
Rate for Payer: Kaiser Permanente Medicare	$17,156.92
Rate for Payer: Ohana Health Plan Medicare	$17,156.92
Rate for Payer: UnitedHealthcare Medicare	$17,156.92

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility

$40,311.53

Service Code	MSDRG 940
Min. Negotiated Rate	$26,580.50
Max. Negotiated Rate	$40,311.53
Rate for Payer: AlohaCare Medicare	$26,580.50
Rate for Payer: Devoted Health Medicare	$29,238.55
Rate for Payer: Hawaii Medical Service Association Commercial	$39,505.05
Rate for Payer: Hawaii Medical Service Association Medicare	$26,580.50
Rate for Payer: Humana Medicare	$26,580.50
Rate for Payer: Kaiser Permanente Commercial	$40,311.53
Rate for Payer: Kaiser Permanente Medicare	$26,580.50
Rate for Payer: Ohana Health Plan Medicare	$26,580.50
Rate for Payer: UnitedHealthcare Medicare	$26,580.50

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$62,591.62

Service Code	MSDRG 939
Min. Negotiated Rate	$39,505.05
Max. Negotiated Rate	$62,591.62
Rate for Payer: AlohaCare Medicare	$41,271.50
Rate for Payer: Devoted Health Medicare	$45,398.65
Rate for Payer: Hawaii Medical Service Association Commercial	$39,505.05
Rate for Payer: Hawaii Medical Service Association Medicare	$41,271.50
Rate for Payer: Humana Medicare	$41,271.50
Rate for Payer: Kaiser Permanente Commercial	$62,591.62
Rate for Payer: Kaiser Permanente Medicare	$41,271.50
Rate for Payer: Ohana Health Plan Medicare	$41,271.50
Rate for Payer: UnitedHealthcare Medicare	$41,271.50

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$39,505.05

Service Code	MSDRG 941
Min. Negotiated Rate	$23,063.58
Max. Negotiated Rate	$39,505.05
Rate for Payer: AlohaCare Medicare	$23,063.58
Rate for Payer: Devoted Health Medicare	$25,369.94
Rate for Payer: Hawaii Medical Service Association Commercial	$39,505.05
Rate for Payer: Hawaii Medical Service Association Medicare	$23,063.58
Rate for Payer: Humana Medicare	$23,063.58
Rate for Payer: Kaiser Permanente Commercial	$34,977.82
Rate for Payer: Kaiser Permanente Medicare	$23,063.58
Rate for Payer: Ohana Health Plan Medicare	$23,063.58
Rate for Payer: UnitedHealthcare Medicare	$23,063.58

O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$88,037.05

Service Code	MSDRG 876
Min. Negotiated Rate	$43,960.35
Max. Negotiated Rate	$88,037.05
Rate for Payer: AlohaCare Medicare	$43,960.35
Rate for Payer: Devoted Health Medicare	$48,356.39
Rate for Payer: Hawaii Medical Service Association Commercial	$88,037.05
Rate for Payer: Hawaii Medical Service Association Medicare	$43,960.35
Rate for Payer: Humana Medicare	$43,960.35
Rate for Payer: Kaiser Permanente Commercial	$66,669.52
Rate for Payer: Kaiser Permanente Medicare	$43,960.35
Rate for Payer: Ohana Health Plan Medicare	$43,960.35
Rate for Payer: UnitedHealthcare Medicare	$43,960.35

ORTHALIGN PLUS 403001

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: University Health Alliance Commercial	$1,640.03

ORTHALIGN PLUS 403001

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: MDX Hawaii PPO	$2,182.50

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$36.00

Service Code	NDC 68180067511
Hospital Revenue Code	250
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$36.00

Service Code	NDC 68180067511
Hospital Revenue Code	637
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Hawaii Western Management Group Commercial	$34.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$22.68
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: University Health Alliance Commercial	$26.24

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 27241013909
Hospital Revenue Code	250
Min. Negotiated Rate	$209.95
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: MDX Hawaii PPO	$239.59

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 70710116506
Hospital Revenue Code	637
Min. Negotiated Rate	$125.97
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$148.20
Rate for Payer: Hawaii Western Management Group Commercial	$234.65
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Kaiser Permanente Commercial	$155.61
Rate for Payer: Kaiser Permanente Medicaid	$125.97
Rate for Payer: MDX Hawaii PPO	$239.59
Rate for Payer: University Health Alliance Commercial	$180.04

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 70710116506
Hospital Revenue Code	250
Min. Negotiated Rate	$209.95
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: MDX Hawaii PPO	$239.59

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 27241013909
Hospital Revenue Code	637
Min. Negotiated Rate	$125.97
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$148.20
Rate for Payer: Hawaii Western Management Group Commercial	$234.65
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Kaiser Permanente Commercial	$155.61
Rate for Payer: Kaiser Permanente Medicaid	$125.97
Rate for Payer: MDX Hawaii PPO	$239.59
Rate for Payer: University Health Alliance Commercial	$180.04

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 64380079901
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: MDX Hawaii PPO	$37.83

Know your out-of-pocket cost for care.

All Charges