Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

THRD 2.4 X78 HEX 03.507.002

Facility

$1,054.00

Hospital Revenue Code	272
Min. Negotiated Rate	$537.54
Max. Negotiated Rate	$1,022.38
Rate for Payer: Cash Price	$632.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,001.30
Rate for Payer: Health Management Network Commercial	$895.90
Rate for Payer: Kaiser Permanente Commercial	$664.02
Rate for Payer: Kaiser Permanente Medicaid	$537.54
Rate for Payer: MDX Hawaii PPO	$1,022.38
Rate for Payer: University Health Alliance Commercial	$768.26

THREE-FLUTTED DRILL BIT 315.92

Facility

$838.00

Hospital Revenue Code	272
Min. Negotiated Rate	$427.38
Max. Negotiated Rate	$812.86
Rate for Payer: Cash Price	$502.80
Rate for Payer: Hawaii Western Management Group Commercial	$796.10
Rate for Payer: Health Management Network Commercial	$712.30
Rate for Payer: Kaiser Permanente Commercial	$527.94
Rate for Payer: Kaiser Permanente Medicaid	$427.38
Rate for Payer: MDX Hawaii PPO	$812.86
Rate for Payer: University Health Alliance Commercial	$610.82

THREE-FLUTTED DRILL BIT 315.92

Facility

$838.00

Hospital Revenue Code	272
Min. Negotiated Rate	$712.30
Max. Negotiated Rate	$812.86
Rate for Payer: Cash Price	$502.80
Rate for Payer: Health Management Network Commercial	$712.30
Rate for Payer: MDX Hawaii PPO	$812.86

THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)

Facility

$24,500.00

Service Code	CPT 36831
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Devoted Health Medicare	$7,230.94
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	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$24,500.00

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]

Facility

$155.00

Service Code	NDC 00338032201
Hospital Revenue Code	250
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: MDX Hawaii PPO	$150.35

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]

Facility

$155.00

Service Code	NDC 00338032401
Hospital Revenue Code	250
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: MDX Hawaii PPO	$150.35

THYROID DISORDERS

Facility

$5,152.99

Service Code	APR-DRG 4273
Min. Negotiated Rate	$5,152.99
Max. Negotiated Rate	$5,152.99
Rate for Payer: AlohaCare Medicaid	$5,152.99
Rate for Payer: Hawaii Medical Service Association ABD	$5,152.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,152.99
Rate for Payer: Kaiser Permanente Medicaid	$5,152.99
Rate for Payer: Ohana Health Plan Medicaid	$5,152.99
Rate for Payer: UnitedHealthcare Medicaid	$5,152.99

THYROID DISORDERS

Facility

$3,464.90

Service Code	APR-DRG 4272
Min. Negotiated Rate	$3,464.90
Max. Negotiated Rate	$3,464.90
Rate for Payer: AlohaCare Medicaid	$3,464.90
Rate for Payer: Hawaii Medical Service Association ABD	$3,464.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,464.90
Rate for Payer: Kaiser Permanente Medicaid	$3,464.90
Rate for Payer: Ohana Health Plan Medicaid	$3,464.90
Rate for Payer: UnitedHealthcare Medicaid	$3,464.90

THYROID DISORDERS

Facility

$2,537.36

Service Code	APR-DRG 4271
Min. Negotiated Rate	$2,537.36
Max. Negotiated Rate	$2,537.36
Rate for Payer: AlohaCare Medicaid	$2,537.36
Rate for Payer: Hawaii Medical Service Association ABD	$2,537.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,537.36
Rate for Payer: Kaiser Permanente Medicaid	$2,537.36
Rate for Payer: Ohana Health Plan Medicaid	$2,537.36
Rate for Payer: UnitedHealthcare Medicaid	$2,537.36

THYROID DISORDERS

Facility

$9,602.17

Service Code	APR-DRG 4274
Min. Negotiated Rate	$9,602.17
Max. Negotiated Rate	$9,602.17
Rate for Payer: AlohaCare Medicaid	$9,602.17
Rate for Payer: Hawaii Medical Service Association ABD	$9,602.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,602.17
Rate for Payer: Kaiser Permanente Medicaid	$9,602.17
Rate for Payer: Ohana Health Plan Medicaid	$9,602.17
Rate for Payer: UnitedHealthcare Medicaid	$9,602.17

THYROIDECTOMY, REMOVAL OF ALL REMAINING THYROID TISSUE FOLLOWING PREVIOUS REMOVAL OF A PORTION OF THYROID

Facility

$24,500.00

Service Code	CPT 60260
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$6,993.36
Rate for Payer: AlohaCare Medicare	$6,993.36
Rate for Payer: Devoted Health Medicare	$7,692.70
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,993.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Humana Medicare	$6,993.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,993.36
Rate for Payer: Ohana Health Plan Medicaid	$7,692.70
Rate for Payer: Ohana Health Plan Medicare	$6,993.36
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,993.36
Rate for Payer: University Health Alliance Commercial	$24,500.00

THYROIDECTOMY, TOTAL OR COMPLETE

Facility

$24,500.00

Service Code	CPT 60240
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,395.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85
Rate for Payer: University Health Alliance Commercial	$24,500.00

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$25,864.65

Service Code	MSDRG 626
Min. Negotiated Rate	$17,054.57
Max. Negotiated Rate	$25,864.65
Rate for Payer: AlohaCare Medicare	$17,054.57
Rate for Payer: Devoted Health Medicare	$18,760.03
Rate for Payer: Hawaii Medical Service Association Commercial	$21,548.21
Rate for Payer: Hawaii Medical Service Association Medicare	$17,054.57
Rate for Payer: Humana Medicare	$17,054.57
Rate for Payer: Kaiser Permanente Commercial	$25,864.65
Rate for Payer: Kaiser Permanente Medicare	$17,054.57
Rate for Payer: Ohana Health Plan Medicare	$17,054.57
Rate for Payer: UnitedHealthcare Medicare	$17,054.57

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$52,096.72

Service Code	MSDRG 625
Min. Negotiated Rate	$21,548.21
Max. Negotiated Rate	$52,096.72
Rate for Payer: AlohaCare Medicare	$34,351.39
Rate for Payer: Devoted Health Medicare	$37,786.53
Rate for Payer: Hawaii Medical Service Association Commercial	$21,548.21
Rate for Payer: Hawaii Medical Service Association Medicare	$34,351.39
Rate for Payer: Humana Medicare	$34,351.39
Rate for Payer: Kaiser Permanente Commercial	$52,096.72
Rate for Payer: Kaiser Permanente Medicare	$34,351.39
Rate for Payer: Ohana Health Plan Medicare	$34,351.39
Rate for Payer: UnitedHealthcare Medicare	$34,351.39

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$22,913.17

Service Code	MSDRG 627
Min. Negotiated Rate	$15,108.42
Max. Negotiated Rate	$22,913.17
Rate for Payer: AlohaCare Medicare	$15,108.42
Rate for Payer: Devoted Health Medicare	$16,619.26
Rate for Payer: Hawaii Medical Service Association Commercial	$21,548.21
Rate for Payer: Hawaii Medical Service Association Medicare	$15,108.42
Rate for Payer: Humana Medicare	$15,108.42
Rate for Payer: Kaiser Permanente Commercial	$22,913.17
Rate for Payer: Kaiser Permanente Medicare	$15,108.42
Rate for Payer: Ohana Health Plan Medicare	$15,108.42
Rate for Payer: UnitedHealthcare Medicare	$15,108.42

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES

Facility

$11,311.14

Service Code	APR-DRG 4043
Min. Negotiated Rate	$11,311.14
Max. Negotiated Rate	$11,311.14
Rate for Payer: AlohaCare Medicaid	$11,311.14
Rate for Payer: Hawaii Medical Service Association ABD	$11,311.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,311.14
Rate for Payer: Kaiser Permanente Medicaid	$11,311.14
Rate for Payer: Ohana Health Plan Medicaid	$11,311.14
Rate for Payer: UnitedHealthcare Medicaid	$11,311.14

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES

Facility

$4,864.03

Service Code	APR-DRG 4041
Min. Negotiated Rate	$4,864.03
Max. Negotiated Rate	$4,864.03
Rate for Payer: AlohaCare Medicaid	$4,864.03
Rate for Payer: Hawaii Medical Service Association ABD	$4,864.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,864.03
Rate for Payer: Kaiser Permanente Medicaid	$4,864.03
Rate for Payer: Ohana Health Plan Medicaid	$4,864.03
Rate for Payer: UnitedHealthcare Medicaid	$4,864.03

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES

Facility

$22,886.44

Service Code	APR-DRG 4044
Min. Negotiated Rate	$22,886.44
Max. Negotiated Rate	$22,886.44
Rate for Payer: AlohaCare Medicaid	$22,886.44
Rate for Payer: Hawaii Medical Service Association ABD	$22,886.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,886.44
Rate for Payer: Kaiser Permanente Medicaid	$22,886.44
Rate for Payer: Ohana Health Plan Medicaid	$22,886.44
Rate for Payer: UnitedHealthcare Medicaid	$22,886.44

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES

Facility

$7,141.78

Service Code	APR-DRG 4042
Min. Negotiated Rate	$7,141.78
Max. Negotiated Rate	$7,141.78
Rate for Payer: AlohaCare Medicaid	$7,141.78
Rate for Payer: Hawaii Medical Service Association ABD	$7,141.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,141.78
Rate for Payer: Kaiser Permanente Medicaid	$7,141.78
Rate for Payer: Ohana Health Plan Medicaid	$7,141.78
Rate for Payer: UnitedHealthcare Medicaid	$7,141.78

THYROID (PORK) 60 MG TABLET [150728]

Facility

$5.00

Service Code	NDC 42192033001
Hospital Revenue Code	637
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$3.15
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: University Health Alliance Commercial	$3.64

THYROID (PORK) 60 MG TABLET [150728]

Facility

$5.00

Service Code	NDC 42192033001
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: MDX Hawaii PPO	$4.85

THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION [180696]

Facility

$2,927.00

Service Code	HCPCS J3240
Hospital Revenue Code	250
Min. Negotiated Rate	$2,487.95
Max. Negotiated Rate	$2,839.19
Rate for Payer: Cash Price	$1,756.20
Rate for Payer: Health Management Network Commercial	$2,487.95
Rate for Payer: MDX Hawaii PPO	$2,839.19

THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION [180696]

Facility

$2,927.00

Service Code	HCPCS J3240
Hospital Revenue Code	636
Min. Negotiated Rate	$1,492.77
Max. Negotiated Rate	$2,839.19
Rate for Payer: AlohaCare Medicaid	$2,125.34
Rate for Payer: AlohaCare Medicare	$2,125.34
Rate for Payer: Cash Price	$1,756.20
Rate for Payer: Cash Price	$1,756.20
Rate for Payer: Devoted Health Medicare	$2,337.87
Rate for Payer: Hawaii Medical Service Association ABD	$2,113.24
Rate for Payer: Hawaii Medical Service Association Commercial	$2,656.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,125.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,113.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,780.65
Rate for Payer: Health Management Network Commercial	$2,487.95
Rate for Payer: Humana Medicare	$2,125.34
Rate for Payer: Kaiser Permanente Commercial	$1,844.01
Rate for Payer: Kaiser Permanente Medicaid	$1,492.77
Rate for Payer: Kaiser Permanente Medicare	$2,125.34
Rate for Payer: MDX Hawaii PPO	$2,839.19
Rate for Payer: Ohana Health Plan Medicaid	$2,337.87
Rate for Payer: Ohana Health Plan Medicare	$2,125.34
Rate for Payer: UnitedHealthcare Medicaid	$1,756.20
Rate for Payer: UnitedHealthcare Medicare	$2,125.34
Rate for Payer: University Health Alliance Commercial	$2,133.49

TI ANCHOR 5.5MM 3910-400-050

Facility

$1,306.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$666.06
Max. Negotiated Rate	$1,266.82
Rate for Payer: Cash Price	$783.60
Rate for Payer: Hawaii Western Management Group Commercial	$914.20
Rate for Payer: Health Management Network Commercial	$1,110.10
Rate for Payer: Kaiser Permanente Commercial	$822.78
Rate for Payer: Kaiser Permanente Medicaid	$666.06
Rate for Payer: MDX Hawaii PPO	$1,266.82
Rate for Payer: University Health Alliance Commercial	$731.36

TI ANCHOR 5.5MM 3910-400-050

Facility

$1,306.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$731.36
Max. Negotiated Rate	$1,266.82
Rate for Payer: Cash Price	$783.60
Rate for Payer: Hawaii Western Management Group Commercial	$914.20
Rate for Payer: Health Management Network Commercial	$1,110.10
Rate for Payer: MDX Hawaii PPO	$1,266.82
Rate for Payer: University Health Alliance Commercial	$731.36

Know your out-of-pocket cost for care.

All Charges