Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$8,724.86

Service Code	APR-DRG 5112
Min. Negotiated Rate	$8,724.86
Max. Negotiated Rate	$8,724.86
Rate for Payer: AlohaCare Medicaid	$8,724.86
Rate for Payer: Hawaii Medical Service Association ABD	$8,724.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,724.86
Rate for Payer: Kaiser Permanente Medicaid	$8,724.86
Rate for Payer: Ohana Health Plan Medicaid	$8,724.86
Rate for Payer: UnitedHealthcare Medicaid	$8,724.86

UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$12,966.61

Service Code	APR-DRG 5113
Min. Negotiated Rate	$12,966.61
Max. Negotiated Rate	$12,966.61
Rate for Payer: AlohaCare Medicaid	$12,966.61
Rate for Payer: Hawaii Medical Service Association ABD	$12,966.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,966.61
Rate for Payer: Kaiser Permanente Medicaid	$12,966.61
Rate for Payer: Ohana Health Plan Medicaid	$12,966.61
Rate for Payer: UnitedHealthcare Medicaid	$12,966.61

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$31,650.30

Service Code	MSDRG 742
Min. Negotiated Rate	$20,869.49
Max. Negotiated Rate	$31,650.30
Rate for Payer: AlohaCare Medicare	$20,869.49
Rate for Payer: Devoted Health Medicare	$22,956.44
Rate for Payer: Hawaii Medical Service Association Commercial	$22,810.04
Rate for Payer: Hawaii Medical Service Association Medicare	$20,869.49
Rate for Payer: Humana Medicare	$20,869.49
Rate for Payer: Kaiser Permanente Commercial	$31,650.30
Rate for Payer: Kaiser Permanente Medicare	$20,869.49
Rate for Payer: Ohana Health Plan Medicare	$20,869.49
Rate for Payer: UnitedHealthcare Medicare	$20,869.49

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$21,402.08

Service Code	MSDRG 743
Min. Negotiated Rate	$14,112.04
Max. Negotiated Rate	$21,402.08
Rate for Payer: AlohaCare Medicare	$14,112.04
Rate for Payer: Devoted Health Medicare	$15,523.24
Rate for Payer: Hawaii Medical Service Association Commercial	$20,504.77
Rate for Payer: Hawaii Medical Service Association Medicare	$14,112.04
Rate for Payer: Humana Medicare	$14,112.04
Rate for Payer: Kaiser Permanente Commercial	$21,402.08
Rate for Payer: Kaiser Permanente Medicare	$14,112.04
Rate for Payer: Ohana Health Plan Medicare	$14,112.04
Rate for Payer: UnitedHealthcare Medicare	$14,112.04

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$36,932.85

Service Code	MSDRG 740
Min. Negotiated Rate	$20,582.86
Max. Negotiated Rate	$36,932.85
Rate for Payer: AlohaCare Medicare	$20,582.86
Rate for Payer: Devoted Health Medicare	$22,641.15
Rate for Payer: Hawaii Medical Service Association Commercial	$36,932.85
Rate for Payer: Hawaii Medical Service Association Medicare	$20,582.86
Rate for Payer: Humana Medicare	$20,582.86
Rate for Payer: Kaiser Permanente Commercial	$31,215.60
Rate for Payer: Kaiser Permanente Medicare	$20,582.86
Rate for Payer: Ohana Health Plan Medicare	$20,582.86
Rate for Payer: UnitedHealthcare Medicare	$20,582.86

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$60,828.68

Service Code	MSDRG 739
Min. Negotiated Rate	$38,388.81
Max. Negotiated Rate	$60,828.68
Rate for Payer: AlohaCare Medicare	$40,751.68
Rate for Payer: Devoted Health Medicare	$44,826.85
Rate for Payer: Hawaii Medical Service Association Commercial	$38,388.81
Rate for Payer: Hawaii Medical Service Association Medicare	$40,751.68
Rate for Payer: Humana Medicare	$40,751.68
Rate for Payer: Kaiser Permanente Commercial	$60,828.68
Rate for Payer: Kaiser Permanente Medicare	$40,751.68
Rate for Payer: Ohana Health Plan Medicare	$40,751.68
Rate for Payer: UnitedHealthcare Medicare	$40,751.68

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$26,449.94

Service Code	MSDRG 741
Min. Negotiated Rate	$16,220.84
Max. Negotiated Rate	$26,449.94
Rate for Payer: AlohaCare Medicare	$16,220.84
Rate for Payer: Devoted Health Medicare	$17,842.92
Rate for Payer: Hawaii Medical Service Association Commercial	$26,449.94
Rate for Payer: Hawaii Medical Service Association Medicare	$16,220.84
Rate for Payer: Humana Medicare	$16,220.84
Rate for Payer: Kaiser Permanente Commercial	$24,600.22
Rate for Payer: Kaiser Permanente Medicare	$16,220.84
Rate for Payer: Ohana Health Plan Medicare	$16,220.84
Rate for Payer: UnitedHealthcare Medicare	$16,220.84

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$46,712.05

Service Code	MSDRG 737
Min. Negotiated Rate	$23,437.80
Max. Negotiated Rate	$46,712.05
Rate for Payer: AlohaCare Medicare	$23,437.80
Rate for Payer: Devoted Health Medicare	$25,781.58
Rate for Payer: Hawaii Medical Service Association Commercial	$46,712.05
Rate for Payer: Hawaii Medical Service Association Medicare	$23,437.80
Rate for Payer: Humana Medicare	$23,437.80
Rate for Payer: Kaiser Permanente Commercial	$35,545.35
Rate for Payer: Kaiser Permanente Medicare	$23,437.80
Rate for Payer: Ohana Health Plan Medicare	$23,437.80
Rate for Payer: UnitedHealthcare Medicare	$23,437.80

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$61,660.12

Service Code	MSDRG 736
Min. Negotiated Rate	$40,657.27
Max. Negotiated Rate	$61,660.12
Rate for Payer: AlohaCare Medicare	$40,657.27
Rate for Payer: Devoted Health Medicare	$44,723.00
Rate for Payer: Hawaii Medical Service Association Commercial	$46,712.05
Rate for Payer: Hawaii Medical Service Association Medicare	$40,657.27
Rate for Payer: Humana Medicare	$40,657.27
Rate for Payer: Kaiser Permanente Commercial	$61,660.12
Rate for Payer: Kaiser Permanente Medicare	$40,657.27
Rate for Payer: Ohana Health Plan Medicare	$40,657.27
Rate for Payer: UnitedHealthcare Medicare	$40,657.27

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$46,712.05

Service Code	MSDRG 738
Min. Negotiated Rate	$16,703.09
Max. Negotiated Rate	$46,712.05
Rate for Payer: AlohaCare Medicare	$16,703.09
Rate for Payer: Devoted Health Medicare	$18,373.40
Rate for Payer: Hawaii Medical Service Association Commercial	$46,712.05
Rate for Payer: Hawaii Medical Service Association Medicare	$16,703.09
Rate for Payer: Humana Medicare	$16,703.09
Rate for Payer: Kaiser Permanente Commercial	$25,331.62
Rate for Payer: Kaiser Permanente Medicare	$16,703.09
Rate for Payer: Ohana Health Plan Medicare	$16,703.09
Rate for Payer: UnitedHealthcare Medicare	$16,703.09

UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE

Facility

$11,157.19

Service Code	CPT 59870
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,157.19
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$11,157.19

UTERINE MANIPULATOR

Facility

$568.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.68
Max. Negotiated Rate	$550.96
Rate for Payer: Cash Price	$340.80
Rate for Payer: Hawaii Western Management Group Commercial	$539.60
Rate for Payer: Health Management Network Commercial	$482.80
Rate for Payer: Kaiser Permanente Commercial	$357.84
Rate for Payer: Kaiser Permanente Medicaid	$289.68
Rate for Payer: MDX Hawaii PPO	$550.96
Rate for Payer: University Health Alliance Commercial	$414.02

UTERINE MANIPULATOR

Facility

$568.00

Hospital Revenue Code	272
Min. Negotiated Rate	$482.80
Max. Negotiated Rate	$550.96
Rate for Payer: Cash Price	$340.80
Rate for Payer: Health Management Network Commercial	$482.80
Rate for Payer: MDX Hawaii PPO	$550.96

VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$29,964.97

Service Code	MSDRG 746
Min. Negotiated Rate	$19,758.20
Max. Negotiated Rate	$29,964.97
Rate for Payer: AlohaCare Medicare	$19,758.20
Rate for Payer: Devoted Health Medicare	$21,734.02
Rate for Payer: Hawaii Medical Service Association Commercial	$27,080.86
Rate for Payer: Hawaii Medical Service Association Medicare	$19,758.20
Rate for Payer: Humana Medicare	$19,758.20
Rate for Payer: Kaiser Permanente Commercial	$29,964.97
Rate for Payer: Kaiser Permanente Medicare	$19,758.20
Rate for Payer: Ohana Health Plan Medicare	$19,758.20
Rate for Payer: UnitedHealthcare Medicare	$19,758.20

VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility

$27,080.86

Service Code	MSDRG 747
Min. Negotiated Rate	$9,778.44
Max. Negotiated Rate	$27,080.86
Rate for Payer: AlohaCare Medicare	$9,778.44
Rate for Payer: Devoted Health Medicare	$10,756.28
Rate for Payer: Hawaii Medical Service Association Commercial	$27,080.86
Rate for Payer: Hawaii Medical Service Association Medicare	$9,778.44
Rate for Payer: Humana Medicare	$9,778.44
Rate for Payer: Kaiser Permanente Commercial	$14,481.38
Rate for Payer: Kaiser Permanente Medicare	$9,778.44
Rate for Payer: Ohana Health Plan Medicare	$9,778.44
Rate for Payer: UnitedHealthcare Medicare	$9,778.44

VAGINAL DELIVERY

Facility

$3,243.51

Service Code	APR-DRG 5602
Min. Negotiated Rate	$3,243.51
Max. Negotiated Rate	$3,243.51
Rate for Payer: AlohaCare Medicaid	$3,243.51
Rate for Payer: Hawaii Medical Service Association ABD	$3,243.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,243.51
Rate for Payer: Kaiser Permanente Medicaid	$3,243.51
Rate for Payer: Ohana Health Plan Medicaid	$3,243.51
Rate for Payer: UnitedHealthcare Medicaid	$3,243.51

VAGINAL DELIVERY

Facility

$2,854.95

Service Code	APR-DRG 5601
Min. Negotiated Rate	$2,854.95
Max. Negotiated Rate	$2,854.95
Rate for Payer: AlohaCare Medicaid	$2,854.95
Rate for Payer: Hawaii Medical Service Association ABD	$2,854.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,854.95
Rate for Payer: Kaiser Permanente Medicaid	$2,854.95
Rate for Payer: Ohana Health Plan Medicaid	$2,854.95
Rate for Payer: UnitedHealthcare Medicaid	$2,854.95

VAGINAL DELIVERY

Facility

$5,246.33

Service Code	APR-DRG 5604
Min. Negotiated Rate	$5,246.33
Max. Negotiated Rate	$5,246.33
Rate for Payer: AlohaCare Medicaid	$5,246.33
Rate for Payer: Hawaii Medical Service Association ABD	$5,246.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,246.33
Rate for Payer: Kaiser Permanente Medicaid	$5,246.33
Rate for Payer: Ohana Health Plan Medicaid	$5,246.33
Rate for Payer: UnitedHealthcare Medicaid	$5,246.33

VAGINAL DELIVERY

Facility

$3,999.63

Service Code	APR-DRG 5603
Min. Negotiated Rate	$3,999.63
Max. Negotiated Rate	$3,999.63
Rate for Payer: AlohaCare Medicaid	$3,999.63
Rate for Payer: Hawaii Medical Service Association ABD	$3,999.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,999.63
Rate for Payer: Kaiser Permanente Medicaid	$3,999.63
Rate for Payer: Ohana Health Plan Medicaid	$3,999.63
Rate for Payer: UnitedHealthcare Medicaid	$3,999.63

VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

$15,235.00

Service Code	MSDRG 768
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$15,235.00
Rate for Payer: AlohaCare Medicare	$12,188.65
Rate for Payer: Devoted Health Medicare	$13,407.51
Rate for Payer: Hawaii Medical Service Association Commercial	$12,788.18
Rate for Payer: Hawaii Medical Service Association Medicare	$12,188.65
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$12,188.65
Rate for Payer: Kaiser Permanente Commercial	$15,235.00
Rate for Payer: Kaiser Permanente Medicare	$12,188.65
Rate for Payer: Ohana Health Plan Medicare	$12,188.65
Rate for Payer: UnitedHealthcare Medicare	$12,188.65
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC

Facility

$15,235.00

Service Code	MSDRG 806
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$15,235.00
Rate for Payer: AlohaCare Medicare	$8,576.20
Rate for Payer: Devoted Health Medicare	$9,433.82
Rate for Payer: Hawaii Medical Service Association Commercial	$10,361.58
Rate for Payer: Hawaii Medical Service Association Medicare	$8,576.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$8,576.20
Rate for Payer: Kaiser Permanente Commercial	$15,235.00
Rate for Payer: Kaiser Permanente Medicare	$8,576.20
Rate for Payer: Ohana Health Plan Medicare	$8,576.20
Rate for Payer: UnitedHealthcare Medicare	$8,576.20
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC

Facility

$15,235.00

Service Code	MSDRG 805
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$15,235.00
Rate for Payer: AlohaCare Medicare	$12,275.08
Rate for Payer: Devoted Health Medicare	$13,502.59
Rate for Payer: Hawaii Medical Service Association Commercial	$10,361.58
Rate for Payer: Hawaii Medical Service Association Medicare	$12,275.08
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$12,275.08
Rate for Payer: Kaiser Permanente Commercial	$15,235.00
Rate for Payer: Kaiser Permanente Medicare	$12,275.08
Rate for Payer: Ohana Health Plan Medicare	$12,275.08
Rate for Payer: UnitedHealthcare Medicare	$12,275.08
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

Facility

$15,235.00

Service Code	MSDRG 807
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$15,235.00
Rate for Payer: AlohaCare Medicare	$7,668.52
Rate for Payer: Devoted Health Medicare	$8,435.37
Rate for Payer: Hawaii Medical Service Association Commercial	$9,342.41
Rate for Payer: Hawaii Medical Service Association Medicare	$7,668.52
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$7,668.52
Rate for Payer: Kaiser Permanente Commercial	$15,235.00
Rate for Payer: Kaiser Permanente Medicare	$7,668.52
Rate for Payer: Ohana Health Plan Medicare	$7,668.52
Rate for Payer: UnitedHealthcare Medicare	$7,668.52
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC

Facility

$15,235.00

Service Code	MSDRG 797
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$15,235.00
Rate for Payer: AlohaCare Medicare	$11,378.81
Rate for Payer: Devoted Health Medicare	$12,516.69
Rate for Payer: Hawaii Medical Service Association Commercial	$15,044.92
Rate for Payer: Hawaii Medical Service Association Medicare	$11,378.81
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$11,378.81
Rate for Payer: Kaiser Permanente Commercial	$15,235.00
Rate for Payer: Kaiser Permanente Medicare	$11,378.81
Rate for Payer: Ohana Health Plan Medicare	$11,378.81
Rate for Payer: UnitedHealthcare Medicare	$11,378.81
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC

Facility

$15,235.00

Service Code	MSDRG 796
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$15,235.00
Rate for Payer: AlohaCare Medicare	$13,273.76
Rate for Payer: Devoted Health Medicare	$14,601.14
Rate for Payer: Hawaii Medical Service Association Commercial	$15,044.92
Rate for Payer: Hawaii Medical Service Association Medicare	$13,273.76
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$13,273.76
Rate for Payer: Kaiser Permanente Commercial	$15,235.00
Rate for Payer: Kaiser Permanente Medicare	$13,273.76
Rate for Payer: Ohana Health Plan Medicare	$13,273.76
Rate for Payer: UnitedHealthcare Medicare	$13,273.76
Rate for Payer: University Health Alliance Commercial	$7,760.00

Know your out-of-pocket cost for care.

All Charges