Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

FRACTURE OF FEMUR

Facility

$6,468.63

Service Code	APR-DRG 3404
Min. Negotiated Rate	$6,468.63
Max. Negotiated Rate	$6,468.63
Rate for Payer: AlohaCare Medicaid	$6,468.63
Rate for Payer: Hawaii Medical Service Association ABD	$6,468.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,468.63
Rate for Payer: Kaiser Permanente Medicaid	$6,468.63
Rate for Payer: Ohana Health Plan Medicaid	$6,468.63
Rate for Payer: UnitedHealthcare Medicaid	$6,468.63

FRACTURE OF FEMUR

Facility

$3,986.06

Service Code	APR-DRG 3403
Min. Negotiated Rate	$3,986.06
Max. Negotiated Rate	$3,986.06
Rate for Payer: AlohaCare Medicaid	$3,986.06
Rate for Payer: Hawaii Medical Service Association ABD	$3,986.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,986.06
Rate for Payer: Kaiser Permanente Medicaid	$3,986.06
Rate for Payer: Ohana Health Plan Medicaid	$3,986.06
Rate for Payer: UnitedHealthcare Medicaid	$3,986.06

FRACTURE OF FEMUR

Facility

$2,229.48

Service Code	APR-DRG 3401
Min. Negotiated Rate	$2,229.48
Max. Negotiated Rate	$2,229.48
Rate for Payer: AlohaCare Medicaid	$2,229.48
Rate for Payer: Hawaii Medical Service Association ABD	$2,229.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,229.48
Rate for Payer: Kaiser Permanente Medicaid	$2,229.48
Rate for Payer: Ohana Health Plan Medicaid	$2,229.48
Rate for Payer: UnitedHealthcare Medicaid	$2,229.48

FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$3,087.23

Service Code	APR-DRG 3412
Min. Negotiated Rate	$3,087.23
Max. Negotiated Rate	$3,087.23
Rate for Payer: AlohaCare Medicaid	$3,087.23
Rate for Payer: Hawaii Medical Service Association ABD	$3,087.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,087.23
Rate for Payer: Kaiser Permanente Medicaid	$3,087.23
Rate for Payer: Ohana Health Plan Medicaid	$3,087.23
Rate for Payer: UnitedHealthcare Medicaid	$3,087.23

FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$2,566.71

Service Code	APR-DRG 3411
Min. Negotiated Rate	$2,566.71
Max. Negotiated Rate	$2,566.71
Rate for Payer: AlohaCare Medicaid	$2,566.71
Rate for Payer: Hawaii Medical Service Association ABD	$2,566.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,566.71
Rate for Payer: Kaiser Permanente Medicaid	$2,566.71
Rate for Payer: Ohana Health Plan Medicaid	$2,566.71
Rate for Payer: UnitedHealthcare Medicaid	$2,566.71

FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$3,929.97

Service Code	APR-DRG 3413
Min. Negotiated Rate	$3,929.97
Max. Negotiated Rate	$3,929.97
Rate for Payer: AlohaCare Medicaid	$3,929.97
Rate for Payer: Hawaii Medical Service Association ABD	$3,929.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,929.97
Rate for Payer: Kaiser Permanente Medicaid	$3,929.97
Rate for Payer: Ohana Health Plan Medicaid	$3,929.97
Rate for Payer: UnitedHealthcare Medicaid	$3,929.97

FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$7,970.82

Service Code	APR-DRG 3414
Min. Negotiated Rate	$7,970.82
Max. Negotiated Rate	$7,970.82
Rate for Payer: AlohaCare Medicaid	$7,970.82
Rate for Payer: Hawaii Medical Service Association ABD	$7,970.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,970.82
Rate for Payer: Kaiser Permanente Medicaid	$7,970.82
Rate for Payer: Ohana Health Plan Medicaid	$7,970.82
Rate for Payer: UnitedHealthcare Medicaid	$7,970.82

FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK

Facility

$8,278.70

Service Code	APR-DRG 3424
Min. Negotiated Rate	$8,278.70
Max. Negotiated Rate	$8,278.70
Rate for Payer: AlohaCare Medicaid	$8,278.70
Rate for Payer: Hawaii Medical Service Association ABD	$8,278.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,278.70
Rate for Payer: Kaiser Permanente Medicaid	$8,278.70
Rate for Payer: Ohana Health Plan Medicaid	$8,278.70
Rate for Payer: UnitedHealthcare Medicaid	$8,278.70

FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK

Facility

$2,623.46

Service Code	APR-DRG 3421
Min. Negotiated Rate	$2,623.46
Max. Negotiated Rate	$2,623.46
Rate for Payer: AlohaCare Medicaid	$2,623.46
Rate for Payer: Hawaii Medical Service Association ABD	$2,623.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,623.46
Rate for Payer: Kaiser Permanente Medicaid	$2,623.46
Rate for Payer: Ohana Health Plan Medicaid	$2,623.46
Rate for Payer: UnitedHealthcare Medicaid	$2,623.46

FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK

Facility

$4,654.00

Service Code	APR-DRG 3423
Min. Negotiated Rate	$4,654.00
Max. Negotiated Rate	$4,654.00
Rate for Payer: AlohaCare Medicaid	$4,654.00
Rate for Payer: Hawaii Medical Service Association ABD	$4,654.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,654.00
Rate for Payer: Kaiser Permanente Medicaid	$4,654.00
Rate for Payer: Ohana Health Plan Medicaid	$4,654.00
Rate for Payer: UnitedHealthcare Medicaid	$4,654.00

FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK

Facility

$3,369.01

Service Code	APR-DRG 3422
Min. Negotiated Rate	$3,369.01
Max. Negotiated Rate	$3,369.01
Rate for Payer: AlohaCare Medicaid	$3,369.01
Rate for Payer: Hawaii Medical Service Association ABD	$3,369.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,369.01
Rate for Payer: Kaiser Permanente Medicaid	$3,369.01
Rate for Payer: Ohana Health Plan Medicaid	$3,369.01
Rate for Payer: UnitedHealthcare Medicaid	$3,369.01

FRACTURES OF FEMUR WITH MCC

Facility

$27,042.83

Service Code	MSDRG 533
Min. Negotiated Rate	$12,472.72
Max. Negotiated Rate	$27,042.83
Rate for Payer: AlohaCare Medicare	$17,831.41
Rate for Payer: Devoted Health Medicare	$19,614.55
Rate for Payer: Hawaii Medical Service Association Commercial	$12,472.72
Rate for Payer: Hawaii Medical Service Association Medicare	$17,831.41
Rate for Payer: Humana Medicare	$17,831.41
Rate for Payer: Kaiser Permanente Commercial	$27,042.83
Rate for Payer: Kaiser Permanente Medicare	$17,831.41
Rate for Payer: Ohana Health Plan Medicare	$17,831.41
Rate for Payer: UnitedHealthcare Medicare	$17,831.41

FRACTURES OF FEMUR WITHOUT MCC

Facility

$13,905.23

Service Code	MSDRG 534
Min. Negotiated Rate	$9,168.78
Max. Negotiated Rate	$13,905.23
Rate for Payer: AlohaCare Medicare	$9,168.78
Rate for Payer: Devoted Health Medicare	$10,085.66
Rate for Payer: Hawaii Medical Service Association Commercial	$12,472.72
Rate for Payer: Hawaii Medical Service Association Medicare	$9,168.78
Rate for Payer: Humana Medicare	$9,168.78
Rate for Payer: Kaiser Permanente Commercial	$13,905.23
Rate for Payer: Kaiser Permanente Medicare	$9,168.78
Rate for Payer: Ohana Health Plan Medicare	$9,168.78
Rate for Payer: UnitedHealthcare Medicare	$9,168.78

FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$22,114.50

Service Code	MSDRG 535
Min. Negotiated Rate	$14,581.80
Max. Negotiated Rate	$22,114.50
Rate for Payer: AlohaCare Medicare	$14,581.80
Rate for Payer: Devoted Health Medicare	$16,039.98
Rate for Payer: Hawaii Medical Service Association Commercial	$17,859.78
Rate for Payer: Hawaii Medical Service Association Medicare	$14,581.80
Rate for Payer: Humana Medicare	$14,581.80
Rate for Payer: Kaiser Permanente Commercial	$22,114.50
Rate for Payer: Kaiser Permanente Medicare	$14,581.80
Rate for Payer: Ohana Health Plan Medicare	$14,581.80
Rate for Payer: UnitedHealthcare Medicare	$14,581.80

FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$17,859.78

Service Code	MSDRG 536
Min. Negotiated Rate	$9,185.85
Max. Negotiated Rate	$17,859.78
Rate for Payer: AlohaCare Medicare	$9,185.85
Rate for Payer: Devoted Health Medicare	$10,104.43
Rate for Payer: Hawaii Medical Service Association Commercial	$17,859.78
Rate for Payer: Hawaii Medical Service Association Medicare	$9,185.85
Rate for Payer: Humana Medicare	$9,185.85
Rate for Payer: Kaiser Permanente Commercial	$13,931.10
Rate for Payer: Kaiser Permanente Medicare	$9,185.85
Rate for Payer: Ohana Health Plan Medicare	$9,185.85
Rate for Payer: UnitedHealthcare Medicare	$9,185.85

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$24,577.80

Service Code	MSDRG 562
Min. Negotiated Rate	$13,467.63
Max. Negotiated Rate	$24,577.80
Rate for Payer: AlohaCare Medicare	$16,206.04
Rate for Payer: Devoted Health Medicare	$17,826.64
Rate for Payer: Hawaii Medical Service Association Commercial	$13,467.63
Rate for Payer: Hawaii Medical Service Association Medicare	$16,206.04
Rate for Payer: Humana Medicare	$16,206.04
Rate for Payer: Kaiser Permanente Commercial	$24,577.80
Rate for Payer: Kaiser Permanente Medicare	$16,206.04
Rate for Payer: Ohana Health Plan Medicare	$16,206.04
Rate for Payer: UnitedHealthcare Medicare	$16,206.04

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$15,447.38

Service Code	MSDRG 563
Min. Negotiated Rate	$10,185.65
Max. Negotiated Rate	$15,447.38
Rate for Payer: AlohaCare Medicare	$10,185.65
Rate for Payer: Devoted Health Medicare	$11,204.22
Rate for Payer: Hawaii Medical Service Association Commercial	$13,467.63
Rate for Payer: Hawaii Medical Service Association Medicare	$10,185.65
Rate for Payer: Humana Medicare	$10,185.65
Rate for Payer: Kaiser Permanente Commercial	$15,447.38
Rate for Payer: Kaiser Permanente Medicare	$10,185.65
Rate for Payer: Ohana Health Plan Medicare	$10,185.65
Rate for Payer: UnitedHealthcare Medicare	$10,185.65

FRN/GT 10X300 LF 04.033.061S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.02
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$3,151.26
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X300 LF 04.033.061S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X300 RT 04.033.060S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X300 RT 04.033.060S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.02
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$3,151.26
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X320 RT 04.033.062S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X320 RT 04.033.062S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.02
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$3,151.26
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X360 RT 04.033.066S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X360 RT 04.033.066S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.02
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$3,151.26
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

Know your out-of-pocket cost for care.

All Charges