Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$5,552.18

Service Code	APR-DRG 2823
Min. Negotiated Rate	$5,552.18
Max. Negotiated Rate	$5,552.18
Rate for Payer: AlohaCare Medicaid	$5,552.18
Rate for Payer: Hawaii Medical Service Association ABD	$5,552.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,552.18
Rate for Payer: Kaiser Permanente Medicaid	$5,552.18
Rate for Payer: Ohana Health Plan Medicaid	$5,552.18
Rate for Payer: UnitedHealthcare Medicaid	$5,552.18

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$25,552.10

Service Code	MSDRG 439
Min. Negotiated Rate	$9,568.01
Max. Negotiated Rate	$25,552.10
Rate for Payer: AlohaCare Medicare	$9,568.01
Rate for Payer: Devoted Health Medicare	$10,524.81
Rate for Payer: Hawaii Medical Service Association Commercial	$25,552.10
Rate for Payer: Hawaii Medical Service Association Medicare	$9,568.01
Rate for Payer: Humana Medicare	$9,568.01
Rate for Payer: Kaiser Permanente Commercial	$14,510.70
Rate for Payer: Kaiser Permanente Medicare	$9,568.01
Rate for Payer: Ohana Health Plan Medicare	$9,568.01
Rate for Payer: UnitedHealthcare Medicare	$9,568.01

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$28,120.95

Service Code	MSDRG 438
Min. Negotiated Rate	$18,542.30
Max. Negotiated Rate	$28,120.95
Rate for Payer: AlohaCare Medicare	$18,542.30
Rate for Payer: Devoted Health Medicare	$20,396.53
Rate for Payer: Hawaii Medical Service Association Commercial	$25,552.10
Rate for Payer: Hawaii Medical Service Association Medicare	$18,542.30
Rate for Payer: Humana Medicare	$18,542.30
Rate for Payer: Kaiser Permanente Commercial	$28,120.95
Rate for Payer: Kaiser Permanente Medicare	$18,542.30
Rate for Payer: Ohana Health Plan Medicare	$18,542.30
Rate for Payer: UnitedHealthcare Medicare	$18,542.30

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$25,552.10

Service Code	MSDRG 440
Min. Negotiated Rate	$7,067.95
Max. Negotiated Rate	$25,552.10
Rate for Payer: AlohaCare Medicare	$7,067.95
Rate for Payer: Devoted Health Medicare	$7,774.74
Rate for Payer: Hawaii Medical Service Association Commercial	$25,552.10
Rate for Payer: Hawaii Medical Service Association Medicare	$7,067.95
Rate for Payer: Humana Medicare	$7,067.95
Rate for Payer: Kaiser Permanente Commercial	$10,719.15
Rate for Payer: Kaiser Permanente Medicare	$7,067.95
Rate for Payer: Ohana Health Plan Medicare	$7,067.95
Rate for Payer: UnitedHealthcare Medicare	$7,067.95

DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$33,918.68

Service Code	MSDRG 883
Min. Negotiated Rate	$21,621.01
Max. Negotiated Rate	$33,918.68
Rate for Payer: AlohaCare Medicare	$22,365.19
Rate for Payer: Devoted Health Medicare	$24,601.71
Rate for Payer: Hawaii Medical Service Association Commercial	$21,621.01
Rate for Payer: Hawaii Medical Service Association Medicare	$22,365.19
Rate for Payer: Humana Medicare	$22,365.19
Rate for Payer: Kaiser Permanente Commercial	$33,918.68
Rate for Payer: Kaiser Permanente Medicare	$22,365.19
Rate for Payer: Ohana Health Plan Medicare	$22,365.19
Rate for Payer: UnitedHealthcare Medicare	$22,365.19

DISORDERS OF PERSONALITY & IMPULSE CONTROL

Facility

$2,788.94

Service Code	APR-DRG 7522
Min. Negotiated Rate	$2,788.94
Max. Negotiated Rate	$2,788.94
Rate for Payer: AlohaCare Medicaid	$2,788.94
Rate for Payer: Hawaii Medical Service Association ABD	$2,788.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,788.94
Rate for Payer: Kaiser Permanente Medicaid	$2,788.94
Rate for Payer: Ohana Health Plan Medicaid	$2,788.94
Rate for Payer: UnitedHealthcare Medicaid	$2,788.94

DISORDERS OF PERSONALITY & IMPULSE CONTROL

Facility

$20,755.78

Service Code	APR-DRG 7524
Min. Negotiated Rate	$20,755.78
Max. Negotiated Rate	$20,755.78
Rate for Payer: AlohaCare Medicaid	$20,755.78
Rate for Payer: Hawaii Medical Service Association ABD	$20,755.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,755.78
Rate for Payer: Kaiser Permanente Medicaid	$20,755.78
Rate for Payer: Ohana Health Plan Medicaid	$20,755.78
Rate for Payer: UnitedHealthcare Medicaid	$20,755.78

DISORDERS OF PERSONALITY & IMPULSE CONTROL

Facility

$2,315.62

Service Code	APR-DRG 7521
Min. Negotiated Rate	$2,315.62
Max. Negotiated Rate	$2,315.62
Rate for Payer: AlohaCare Medicaid	$2,315.62
Rate for Payer: Hawaii Medical Service Association ABD	$2,315.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,315.62
Rate for Payer: Kaiser Permanente Medicaid	$2,315.62
Rate for Payer: Ohana Health Plan Medicaid	$2,315.62
Rate for Payer: UnitedHealthcare Medicaid	$2,315.62

DISORDERS OF PERSONALITY & IMPULSE CONTROL

Facility

$4,960.53

Service Code	APR-DRG 7523
Min. Negotiated Rate	$4,960.53
Max. Negotiated Rate	$4,960.53
Rate for Payer: AlohaCare Medicaid	$4,960.53
Rate for Payer: Hawaii Medical Service Association ABD	$4,960.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,960.53
Rate for Payer: Kaiser Permanente Medicaid	$4,960.53
Rate for Payer: Ohana Health Plan Medicaid	$4,960.53
Rate for Payer: UnitedHealthcare Medicaid	$4,960.53

DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$25,721.96

Service Code	MSDRG 445
Min. Negotiated Rate	$12,447.98
Max. Negotiated Rate	$25,721.96
Rate for Payer: AlohaCare Medicare	$12,447.98
Rate for Payer: Devoted Health Medicare	$13,692.78
Rate for Payer: Hawaii Medical Service Association Commercial	$25,721.96
Rate for Payer: Hawaii Medical Service Association Medicare	$12,447.98
Rate for Payer: Humana Medicare	$12,447.98
Rate for Payer: Kaiser Permanente Commercial	$18,878.40
Rate for Payer: Kaiser Permanente Medicare	$12,447.98
Rate for Payer: Ohana Health Plan Medicare	$12,447.98
Rate for Payer: UnitedHealthcare Medicare	$12,447.98

DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$28,823.03

Service Code	MSDRG 444
Min. Negotiated Rate	$19,005.24
Max. Negotiated Rate	$28,823.03
Rate for Payer: AlohaCare Medicare	$19,005.24
Rate for Payer: Devoted Health Medicare	$20,905.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26,255.81
Rate for Payer: Hawaii Medical Service Association Medicare	$19,005.24
Rate for Payer: Humana Medicare	$19,005.24
Rate for Payer: Kaiser Permanente Commercial	$28,823.03
Rate for Payer: Kaiser Permanente Medicare	$19,005.24
Rate for Payer: Ohana Health Plan Medicare	$19,005.24
Rate for Payer: UnitedHealthcare Medicare	$19,005.24

DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$16,961.93

Service Code	MSDRG 446
Min. Negotiated Rate	$9,409.91
Max. Negotiated Rate	$16,961.93
Rate for Payer: AlohaCare Medicare	$9,409.91
Rate for Payer: Devoted Health Medicare	$10,350.90
Rate for Payer: Hawaii Medical Service Association Commercial	$16,961.93
Rate for Payer: Hawaii Medical Service Association Medicare	$9,409.91
Rate for Payer: Humana Medicare	$9,409.91
Rate for Payer: Kaiser Permanente Commercial	$14,270.92
Rate for Payer: Kaiser Permanente Medicare	$9,409.91
Rate for Payer: Ohana Health Plan Medicare	$9,409.91
Rate for Payer: UnitedHealthcare Medicare	$9,409.91

DISP INSTR KIT MINI AR-1322DSC

Facility

$689.00

Hospital Revenue Code	272
Min. Negotiated Rate	$351.39
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$413.40
Rate for Payer: Hawaii Western Management Group Commercial	$654.55
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$434.07
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: University Health Alliance Commercial	$502.21

DISP INSTR KIT MINI AR-1322DSC

Facility

$689.00

Hospital Revenue Code	272
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$413.40
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: MDX Hawaii PPO	$668.33

DISP INTR KIT SM AR-8934DSC

Facility

$780.00

Hospital Revenue Code	272
Min. Negotiated Rate	$397.80
Max. Negotiated Rate	$756.60
Rate for Payer: Cash Price	$468.00
Rate for Payer: Hawaii Western Management Group Commercial	$741.00
Rate for Payer: Health Management Network Commercial	$663.00
Rate for Payer: Kaiser Permanente Commercial	$491.40
Rate for Payer: Kaiser Permanente Medicaid	$397.80
Rate for Payer: MDX Hawaii PPO	$756.60
Rate for Payer: University Health Alliance Commercial	$568.54

DISP INTR KIT SM AR-8934DSC

Facility

$780.00

Hospital Revenue Code	272
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$756.60
Rate for Payer: Cash Price	$468.00
Rate for Payer: Health Management Network Commercial	$663.00
Rate for Payer: MDX Hawaii PPO	$756.60

DISPOSABLE FACK MASK 7210559

Facility

$149.00

Hospital Revenue Code	272
Min. Negotiated Rate	$75.99
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$89.40
Rate for Payer: Hawaii Western Management Group Commercial	$141.55
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$93.87
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: University Health Alliance Commercial	$108.61

DISPOSABLE FACK MASK 7210559

Facility

$149.00

Hospital Revenue Code	272
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$89.40
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: MDX Hawaii PPO	$144.53

DISPSABLE KIT, HIP 1.8MM DRILL

Facility

$1,050.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Hawaii Western Management Group Commercial	$997.50
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$765.35

DISPSABLE KIT, HIP 1.8MM DRILL

Facility

$1,050.00

Hospital Revenue Code	272
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: MDX Hawaii PPO	$1,018.50

DISSECTOR 3.0MMX7CM AR-7300DS

Facility

$264.00

Hospital Revenue Code	272
Min. Negotiated Rate	$134.64
Max. Negotiated Rate	$256.08
Rate for Payer: Cash Price	$158.40
Rate for Payer: Hawaii Western Management Group Commercial	$250.80
Rate for Payer: Health Management Network Commercial	$224.40
Rate for Payer: Kaiser Permanente Commercial	$166.32
Rate for Payer: Kaiser Permanente Medicaid	$134.64
Rate for Payer: MDX Hawaii PPO	$256.08
Rate for Payer: University Health Alliance Commercial	$192.43

DISSECTOR 3.0MMX7CM AR-7300DS

Facility

$264.00

Hospital Revenue Code	272
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$256.08
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Management Network Commercial	$224.40
Rate for Payer: MDX Hawaii PPO	$256.08

DISSECTOR 3.5MMX13C AR-8350DS

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: MDX Hawaii PPO	$201.76

DISSECTOR 3.5MMX13C AR-8350DS

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$106.08
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$131.04
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: University Health Alliance Commercial	$151.61

DISTAL ATTACHMENT 11.35MM

Facility

$127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: MDX Hawaii PPO	$123.19

Know your out-of-pocket cost for care.

All Charges