Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 68180067711
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

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 68180067711
Hospital Revenue Code	637
Min. Negotiated Rate	$19.89
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$24.57
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: University Health Alliance Commercial	$28.43

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 64380079901
Hospital Revenue Code	637
Min. Negotiated Rate	$19.89
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$24.57
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: University Health Alliance Commercial	$28.43

OSELTAMIVIR CAPSULES (TAMIFLU) 75 MG (TAKE HOME) [4080396]

Facility

$15.00

Service Code	NDC 00004080184
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

OSELTAMIVIR CAPSULES (TAMIFLU) 75 MG (TAKE HOME) [4080396]

Facility

$15.00

Service Code	NDC 00004080184
Hospital Revenue Code	253
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$6,081.83

Service Code	APR-DRG 3443
Min. Negotiated Rate	$6,081.83
Max. Negotiated Rate	$6,081.83
Rate for Payer: AlohaCare Medicaid	$6,081.83
Rate for Payer: Hawaii Medical Service Association ABD	$6,081.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,081.83
Rate for Payer: Kaiser Permanente Medicaid	$6,081.83
Rate for Payer: Ohana Health Plan Medicaid	$6,081.83
Rate for Payer: UnitedHealthcare Medicaid	$6,081.83

OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$10,542.10

Service Code	APR-DRG 3444
Min. Negotiated Rate	$10,542.10
Max. Negotiated Rate	$10,542.10
Rate for Payer: AlohaCare Medicaid	$10,542.10
Rate for Payer: Hawaii Medical Service Association ABD	$10,542.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,542.10
Rate for Payer: Kaiser Permanente Medicaid	$10,542.10
Rate for Payer: Ohana Health Plan Medicaid	$10,542.10
Rate for Payer: UnitedHealthcare Medicaid	$10,542.10

OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$4,372.87

Service Code	APR-DRG 3442
Min. Negotiated Rate	$4,372.87
Max. Negotiated Rate	$4,372.87
Rate for Payer: AlohaCare Medicaid	$4,372.87
Rate for Payer: Hawaii Medical Service Association ABD	$4,372.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,372.87
Rate for Payer: Kaiser Permanente Medicaid	$4,372.87
Rate for Payer: Ohana Health Plan Medicaid	$4,372.87
Rate for Payer: UnitedHealthcare Medicaid	$4,372.87

OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$3,465.55

Service Code	APR-DRG 3441
Min. Negotiated Rate	$3,465.55
Max. Negotiated Rate	$3,465.55
Rate for Payer: AlohaCare Medicaid	$3,465.55
Rate for Payer: Hawaii Medical Service Association ABD	$3,465.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,465.55
Rate for Payer: Kaiser Permanente Medicaid	$3,465.55
Rate for Payer: Ohana Health Plan Medicaid	$3,465.55
Rate for Payer: UnitedHealthcare Medicaid	$3,465.55

OSTEOMYELITIS WITH CC

Facility

$39,941.84

Service Code	MSDRG 540
Min. Negotiated Rate	$14,744.45
Max. Negotiated Rate	$39,941.84
Rate for Payer: AlohaCare Medicare	$14,744.45
Rate for Payer: Devoted Health Medicare	$16,218.90
Rate for Payer: Hawaii Medical Service Association Commercial	$39,941.84
Rate for Payer: Hawaii Medical Service Association Medicare	$14,744.45
Rate for Payer: Humana Medicare	$14,744.45
Rate for Payer: Kaiser Permanente Commercial	$22,361.17
Rate for Payer: Kaiser Permanente Medicare	$14,744.45
Rate for Payer: Ohana Health Plan Medicare	$14,744.45
Rate for Payer: UnitedHealthcare Medicare	$14,744.45

OSTEOMYELITIS WITH MCC

Facility

$39,941.84

Service Code	MSDRG 539
Min. Negotiated Rate	$22,403.88
Max. Negotiated Rate	$39,941.84
Rate for Payer: AlohaCare Medicare	$22,403.88
Rate for Payer: Devoted Health Medicare	$24,644.27
Rate for Payer: Hawaii Medical Service Association Commercial	$39,941.84
Rate for Payer: Hawaii Medical Service Association Medicare	$22,403.88
Rate for Payer: Humana Medicare	$22,403.88
Rate for Payer: Kaiser Permanente Commercial	$33,977.32
Rate for Payer: Kaiser Permanente Medicare	$22,403.88
Rate for Payer: Ohana Health Plan Medicare	$22,403.88
Rate for Payer: UnitedHealthcare Medicare	$22,403.88

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$39,941.84

Service Code	MSDRG 541
Min. Negotiated Rate	$8,956.09
Max. Negotiated Rate	$39,941.84
Rate for Payer: AlohaCare Medicare	$8,956.09
Rate for Payer: Devoted Health Medicare	$9,851.70
Rate for Payer: Hawaii Medical Service Association Commercial	$39,941.84
Rate for Payer: Hawaii Medical Service Association Medicare	$8,956.09
Rate for Payer: Humana Medicare	$8,956.09
Rate for Payer: Kaiser Permanente Commercial	$13,308.38
Rate for Payer: Kaiser Permanente Medicare	$8,956.09
Rate for Payer: Ohana Health Plan Medicare	$8,956.09
Rate for Payer: UnitedHealthcare Medicare	$8,956.09

OSTEOSET BEAD KT 5ML 8400-0611

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.46
Max. Negotiated Rate	$2,372.62
Rate for Payer: Cash Price	$1,467.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,712.20
Rate for Payer: Health Management Network Commercial	$2,079.10
Rate for Payer: Kaiser Permanente Commercial	$1,540.98
Rate for Payer: Kaiser Permanente Medicaid	$1,247.46
Rate for Payer: MDX Hawaii PPO	$2,372.62
Rate for Payer: University Health Alliance Commercial	$1,369.76

OSTEOSET BEAD KT 5ML 8400-0611

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,369.76
Max. Negotiated Rate	$2,372.62
Rate for Payer: Cash Price	$1,467.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,712.20
Rate for Payer: Health Management Network Commercial	$2,079.10
Rate for Payer: MDX Hawaii PPO	$2,372.62
Rate for Payer: University Health Alliance Commercial	$1,369.76

OSTEOVATION 5CC FRMLA 390-0005

Facility

$105.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$73.50
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: University Health Alliance Commercial	$58.80

OSTEOVATION 5CC FRMLA 390-0005

Facility

$105.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$73.50
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$66.15
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: University Health Alliance Commercial	$58.80

OSTOMY CONE IRRIGATOR

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: MDX Hawaii PPO	$74.69

OSTOMY CONE IRRIGATOR

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$48.51
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: University Health Alliance Commercial	$56.13

OTHER AFTERCARE & CONVALESCENCE

Facility

$5,914.85

Service Code	APR-DRG 8623
Min. Negotiated Rate	$5,914.85
Max. Negotiated Rate	$5,914.85
Rate for Payer: AlohaCare Medicaid	$5,914.85
Rate for Payer: Hawaii Medical Service Association ABD	$5,914.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,914.85
Rate for Payer: Kaiser Permanente Medicaid	$5,914.85
Rate for Payer: Ohana Health Plan Medicaid	$5,914.85
Rate for Payer: UnitedHealthcare Medicaid	$5,914.85

OTHER AFTERCARE & CONVALESCENCE

Facility

$3,505.99

Service Code	APR-DRG 8621
Min. Negotiated Rate	$3,505.99
Max. Negotiated Rate	$3,505.99
Rate for Payer: AlohaCare Medicaid	$3,505.99
Rate for Payer: Hawaii Medical Service Association ABD	$3,505.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,505.99
Rate for Payer: Kaiser Permanente Medicaid	$3,505.99
Rate for Payer: Ohana Health Plan Medicaid	$3,505.99
Rate for Payer: UnitedHealthcare Medicaid	$3,505.99

OTHER AFTERCARE & CONVALESCENCE

Facility

$4,361.78

Service Code	APR-DRG 8622
Min. Negotiated Rate	$4,361.78
Max. Negotiated Rate	$4,361.78
Rate for Payer: AlohaCare Medicaid	$4,361.78
Rate for Payer: Hawaii Medical Service Association ABD	$4,361.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,361.78
Rate for Payer: Kaiser Permanente Medicaid	$4,361.78
Rate for Payer: Ohana Health Plan Medicaid	$4,361.78
Rate for Payer: UnitedHealthcare Medicaid	$4,361.78

OTHER AFTERCARE & CONVALESCENCE

Facility

$7,665.56

Service Code	APR-DRG 8624
Min. Negotiated Rate	$7,665.56
Max. Negotiated Rate	$7,665.56
Rate for Payer: AlohaCare Medicaid	$7,665.56
Rate for Payer: Hawaii Medical Service Association ABD	$7,665.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,665.56
Rate for Payer: Kaiser Permanente Medicaid	$7,665.56
Rate for Payer: Ohana Health Plan Medicaid	$7,665.56
Rate for Payer: UnitedHealthcare Medicaid	$7,665.56

OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$4,922.73

Service Code	APR-DRG 6633
Min. Negotiated Rate	$4,922.73
Max. Negotiated Rate	$4,922.73
Rate for Payer: AlohaCare Medicaid	$4,922.73
Rate for Payer: Hawaii Medical Service Association ABD	$4,922.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,922.73
Rate for Payer: Kaiser Permanente Medicaid	$4,922.73
Rate for Payer: Ohana Health Plan Medicaid	$4,922.73
Rate for Payer: UnitedHealthcare Medicaid	$4,922.73

OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$3,556.87

Service Code	APR-DRG 6632
Min. Negotiated Rate	$3,556.87
Max. Negotiated Rate	$3,556.87
Rate for Payer: AlohaCare Medicaid	$3,556.87
Rate for Payer: Hawaii Medical Service Association ABD	$3,556.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,556.87
Rate for Payer: Kaiser Permanente Medicaid	$3,556.87
Rate for Payer: Ohana Health Plan Medicaid	$3,556.87
Rate for Payer: UnitedHealthcare Medicaid	$3,556.87

OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$8,087.58

Service Code	APR-DRG 6634
Min. Negotiated Rate	$8,087.58
Max. Negotiated Rate	$8,087.58
Rate for Payer: AlohaCare Medicaid	$8,087.58
Rate for Payer: Hawaii Medical Service Association ABD	$8,087.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,087.58
Rate for Payer: Kaiser Permanente Medicaid	$8,087.58
Rate for Payer: Ohana Health Plan Medicaid	$8,087.58
Rate for Payer: UnitedHealthcare Medicaid	$8,087.58

Know your out-of-pocket cost for care.

All Charges