Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$12,994.30

Service Code	APR-DRG 9112
Min. Negotiated Rate	$12,994.30
Max. Negotiated Rate	$12,994.30
Rate for Payer: AlohaCare Medicaid	$12,994.30
Rate for Payer: Hawaii Medical Service Association ABD	$12,994.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,994.30
Rate for Payer: Kaiser Permanente Medicaid	$12,994.30
Rate for Payer: Ohana Health Plan Medicaid	$12,994.30
Rate for Payer: UnitedHealthcare Medicaid	$12,994.30

EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$9,757.54

Service Code	APR-DRG 9111
Min. Negotiated Rate	$9,757.54
Max. Negotiated Rate	$9,757.54
Rate for Payer: AlohaCare Medicaid	$9,757.54
Rate for Payer: Hawaii Medical Service Association ABD	$9,757.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,757.54
Rate for Payer: Kaiser Permanente Medicaid	$9,757.54
Rate for Payer: Ohana Health Plan Medicaid	$9,757.54
Rate for Payer: UnitedHealthcare Medicaid	$9,757.54

EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$16,978.18

Service Code	APR-DRG 9113
Min. Negotiated Rate	$16,978.18
Max. Negotiated Rate	$16,978.18
Rate for Payer: AlohaCare Medicaid	$16,978.18
Rate for Payer: Hawaii Medical Service Association ABD	$16,978.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,978.18
Rate for Payer: Kaiser Permanente Medicaid	$16,978.18
Rate for Payer: Ohana Health Plan Medicaid	$16,978.18
Rate for Payer: UnitedHealthcare Medicaid	$16,978.18

EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$35,662.89

Service Code	APR-DRG 9114
Min. Negotiated Rate	$35,662.89
Max. Negotiated Rate	$35,662.89
Rate for Payer: AlohaCare Medicaid	$35,662.89
Rate for Payer: Hawaii Medical Service Association ABD	$35,662.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$35,662.89
Rate for Payer: Kaiser Permanente Medicaid	$35,662.89
Rate for Payer: Ohana Health Plan Medicaid	$35,662.89
Rate for Payer: UnitedHealthcare Medicaid	$35,662.89

EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT

Facility

$65,838.07

Service Code	MSDRG 933
Min. Negotiated Rate	$44,293.62
Max. Negotiated Rate	$65,838.07
Rate for Payer: AlohaCare Medicare	$44,293.62
Rate for Payer: Devoted Health Medicare	$48,722.98
Rate for Payer: Hawaii Medical Service Association Commercial	$63,091.60
Rate for Payer: Hawaii Medical Service Association Medicare	$44,293.62
Rate for Payer: Humana Medicare	$44,293.62
Rate for Payer: Kaiser Permanente Commercial	$65,838.07
Rate for Payer: Kaiser Permanente Medicare	$44,293.62
Rate for Payer: Ohana Health Plan Medicare	$44,293.62
Rate for Payer: UnitedHealthcare Medicare	$44,293.62

EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT

Facility

$391,604.71

Service Code	MSDRG 927
Min. Negotiated Rate	$242,846.05
Max. Negotiated Rate	$391,604.71
Rate for Payer: AlohaCare Medicare	$242,846.05
Rate for Payer: Devoted Health Medicare	$267,130.66
Rate for Payer: Hawaii Medical Service Association Commercial	$391,604.71
Rate for Payer: Hawaii Medical Service Association Medicare	$242,846.05
Rate for Payer: Humana Medicare	$242,846.05
Rate for Payer: Kaiser Permanente Commercial	$317,920.95
Rate for Payer: Kaiser Permanente Medicare	$242,846.05
Rate for Payer: Ohana Health Plan Medicare	$242,846.05
Rate for Payer: UnitedHealthcare Medicare	$242,846.05

EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$13,411.47

Service Code	APR-DRG 7923
Min. Negotiated Rate	$13,411.47
Max. Negotiated Rate	$13,411.47
Rate for Payer: AlohaCare Medicaid	$13,411.47
Rate for Payer: Hawaii Medical Service Association ABD	$13,411.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,411.47
Rate for Payer: Kaiser Permanente Medicaid	$13,411.47
Rate for Payer: Ohana Health Plan Medicaid	$13,411.47
Rate for Payer: UnitedHealthcare Medicaid	$13,411.47

EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$9,123.40

Service Code	APR-DRG 7922
Min. Negotiated Rate	$9,123.40
Max. Negotiated Rate	$9,123.40
Rate for Payer: AlohaCare Medicaid	$9,123.40
Rate for Payer: Hawaii Medical Service Association ABD	$9,123.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,123.40
Rate for Payer: Kaiser Permanente Medicaid	$9,123.40
Rate for Payer: Ohana Health Plan Medicaid	$9,123.40
Rate for Payer: UnitedHealthcare Medicaid	$9,123.40

EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$26,061.73

Service Code	APR-DRG 7924
Min. Negotiated Rate	$26,061.73
Max. Negotiated Rate	$26,061.73
Rate for Payer: AlohaCare Medicaid	$26,061.73
Rate for Payer: Hawaii Medical Service Association ABD	$26,061.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,061.73
Rate for Payer: Kaiser Permanente Medicaid	$26,061.73
Rate for Payer: Ohana Health Plan Medicaid	$26,061.73
Rate for Payer: UnitedHealthcare Medicaid	$26,061.73

EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$7,768.62

Service Code	APR-DRG 7921
Min. Negotiated Rate	$7,768.62
Max. Negotiated Rate	$7,768.62
Rate for Payer: AlohaCare Medicaid	$7,768.62
Rate for Payer: Hawaii Medical Service Association ABD	$7,768.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,768.62
Rate for Payer: Kaiser Permanente Medicaid	$7,768.62
Rate for Payer: Ohana Health Plan Medicaid	$7,768.62
Rate for Payer: UnitedHealthcare Medicaid	$7,768.62

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$46,736.32

Service Code	MSDRG 982
Min. Negotiated Rate	$27,963.61
Max. Negotiated Rate	$46,736.32
Rate for Payer: AlohaCare Medicare	$27,963.61
Rate for Payer: Devoted Health Medicare	$30,759.97
Rate for Payer: Hawaii Medical Service Association Commercial	$46,736.32
Rate for Payer: Hawaii Medical Service Association Medicare	$27,963.61
Rate for Payer: Humana Medicare	$27,963.61
Rate for Payer: Kaiser Permanente Commercial	$42,409.12
Rate for Payer: Kaiser Permanente Medicare	$27,963.61
Rate for Payer: Ohana Health Plan Medicare	$27,963.61
Rate for Payer: UnitedHealthcare Medicare	$27,963.61

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$80,933.55

Service Code	MSDRG 981
Min. Negotiated Rate	$53,365.73
Max. Negotiated Rate	$80,933.55
Rate for Payer: AlohaCare Medicare	$53,365.73
Rate for Payer: Devoted Health Medicare	$58,702.30
Rate for Payer: Hawaii Medical Service Association Commercial	$78,330.65
Rate for Payer: Hawaii Medical Service Association Medicare	$53,365.73
Rate for Payer: Humana Medicare	$53,365.73
Rate for Payer: Kaiser Permanente Commercial	$80,933.55
Rate for Payer: Kaiser Permanente Medicare	$53,365.73
Rate for Payer: Ohana Health Plan Medicare	$53,365.73
Rate for Payer: UnitedHealthcare Medicare	$53,365.73

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$31,011.95

Service Code	MSDRG 983
Min. Negotiated Rate	$19,495.48
Max. Negotiated Rate	$31,011.95
Rate for Payer: AlohaCare Medicare	$19,495.48
Rate for Payer: Devoted Health Medicare	$21,445.03
Rate for Payer: Hawaii Medical Service Association Commercial	$31,011.95
Rate for Payer: Hawaii Medical Service Association Medicare	$19,495.48
Rate for Payer: Humana Medicare	$19,495.48
Rate for Payer: Kaiser Permanente Commercial	$29,566.50
Rate for Payer: Kaiser Permanente Medicare	$19,495.48
Rate for Payer: Ohana Health Plan Medicare	$19,495.48
Rate for Payer: UnitedHealthcare Medicare	$19,495.48

EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$12,330.64

Service Code	APR-DRG 9503
Min. Negotiated Rate	$12,330.64
Max. Negotiated Rate	$12,330.64
Rate for Payer: AlohaCare Medicaid	$12,330.64
Rate for Payer: Hawaii Medical Service Association ABD	$12,330.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,330.64
Rate for Payer: Kaiser Permanente Medicaid	$12,330.64
Rate for Payer: Ohana Health Plan Medicaid	$12,330.64
Rate for Payer: UnitedHealthcare Medicaid	$12,330.64

EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$7,587.29

Service Code	APR-DRG 9501
Min. Negotiated Rate	$7,587.29
Max. Negotiated Rate	$7,587.29
Rate for Payer: AlohaCare Medicaid	$7,587.29
Rate for Payer: Hawaii Medical Service Association ABD	$7,587.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,587.29
Rate for Payer: Kaiser Permanente Medicaid	$7,587.29
Rate for Payer: Ohana Health Plan Medicaid	$7,587.29
Rate for Payer: UnitedHealthcare Medicaid	$7,587.29

EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$9,670.01

Service Code	APR-DRG 9502
Min. Negotiated Rate	$9,670.01
Max. Negotiated Rate	$9,670.01
Rate for Payer: AlohaCare Medicaid	$9,670.01
Rate for Payer: Hawaii Medical Service Association ABD	$9,670.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,670.01
Rate for Payer: Kaiser Permanente Medicaid	$9,670.01
Rate for Payer: Ohana Health Plan Medicaid	$9,670.01
Rate for Payer: UnitedHealthcare Medicaid	$9,670.01

EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$25,281.60

Service Code	APR-DRG 9504
Min. Negotiated Rate	$25,281.60
Max. Negotiated Rate	$25,281.60
Rate for Payer: AlohaCare Medicaid	$25,281.60
Rate for Payer: Hawaii Medical Service Association ABD	$25,281.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25,281.60
Rate for Payer: Kaiser Permanente Medicaid	$25,281.60
Rate for Payer: Ohana Health Plan Medicaid	$25,281.60
Rate for Payer: UnitedHealthcare Medicaid	$25,281.60

EXTERNAL FIXATOR 03.305.006

Facility

$2,574.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,441.44
Max. Negotiated Rate	$2,496.78
Rate for Payer: Cash Price	$1,544.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,801.80
Rate for Payer: Health Management Network Commercial	$2,187.90
Rate for Payer: MDX Hawaii PPO	$2,496.78
Rate for Payer: University Health Alliance Commercial	$1,441.44

EXTERNAL FIXATOR 03.305.006

Facility

$2,574.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.74
Max. Negotiated Rate	$2,496.78
Rate for Payer: Cash Price	$1,544.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,801.80
Rate for Payer: Health Management Network Commercial	$2,187.90
Rate for Payer: Kaiser Permanente Commercial	$1,621.62
Rate for Payer: Kaiser Permanente Medicaid	$1,312.74
Rate for Payer: MDX Hawaii PPO	$2,496.78
Rate for Payer: University Health Alliance Commercial	$1,441.44

EXTERNAL HEART ASSIST SYSTEMS

Facility

$41,183.47

Service Code	APR-DRG 1784
Min. Negotiated Rate	$41,183.47
Max. Negotiated Rate	$41,183.47
Rate for Payer: AlohaCare Medicaid	$41,183.47
Rate for Payer: Hawaii Medical Service Association ABD	$41,183.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41,183.47
Rate for Payer: Kaiser Permanente Medicaid	$41,183.47
Rate for Payer: Ohana Health Plan Medicaid	$41,183.47
Rate for Payer: UnitedHealthcare Medicaid	$41,183.47

EXTERNAL HEART ASSIST SYSTEMS

Facility

$31,620.43

Service Code	APR-DRG 1783
Min. Negotiated Rate	$31,620.43
Max. Negotiated Rate	$31,620.43
Rate for Payer: AlohaCare Medicaid	$31,620.43
Rate for Payer: Hawaii Medical Service Association ABD	$31,620.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31,620.43
Rate for Payer: Kaiser Permanente Medicaid	$31,620.43
Rate for Payer: Ohana Health Plan Medicaid	$31,620.43
Rate for Payer: UnitedHealthcare Medicaid	$31,620.43

EXTERNAL HEART ASSIST SYSTEMS

Facility

$26,779.88

Service Code	APR-DRG 1782
Min. Negotiated Rate	$26,779.88
Max. Negotiated Rate	$26,779.88
Rate for Payer: AlohaCare Medicaid	$26,779.88
Rate for Payer: Hawaii Medical Service Association ABD	$26,779.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,779.88
Rate for Payer: Kaiser Permanente Medicaid	$26,779.88
Rate for Payer: Ohana Health Plan Medicaid	$26,779.88
Rate for Payer: UnitedHealthcare Medicaid	$26,779.88

EXTERNAL HEART ASSIST SYSTEMS

Facility

$22,838.17

Service Code	APR-DRG 1781
Min. Negotiated Rate	$22,838.17
Max. Negotiated Rate	$22,838.17
Rate for Payer: AlohaCare Medicaid	$22,838.17
Rate for Payer: Hawaii Medical Service Association ABD	$22,838.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,838.17
Rate for Payer: Kaiser Permanente Medicaid	$22,838.17
Rate for Payer: Ohana Health Plan Medicaid	$22,838.17
Rate for Payer: UnitedHealthcare Medicaid	$22,838.17

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$26,428.96

Service Code	APR-DRG 0092
Min. Negotiated Rate	$26,428.96
Max. Negotiated Rate	$26,428.96
Rate for Payer: AlohaCare Medicaid	$26,428.96
Rate for Payer: Hawaii Medical Service Association ABD	$26,428.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,428.96
Rate for Payer: Kaiser Permanente Medicaid	$26,428.96
Rate for Payer: Ohana Health Plan Medicaid	$26,428.96
Rate for Payer: UnitedHealthcare Medicaid	$26,428.96

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$20,534.33

Service Code	APR-DRG 0091
Min. Negotiated Rate	$20,534.33
Max. Negotiated Rate	$20,534.33
Rate for Payer: AlohaCare Medicaid	$20,534.33
Rate for Payer: Hawaii Medical Service Association ABD	$20,534.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,534.33
Rate for Payer: Kaiser Permanente Medicaid	$20,534.33
Rate for Payer: Ohana Health Plan Medicaid	$20,534.33
Rate for Payer: UnitedHealthcare Medicaid	$20,534.33

Know your out-of-pocket cost for care.

All Charges