Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

AAA ILIAC 12MMX10CM CEB231210A

Facility

$24,810.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$12,653.10
Max. Negotiated Rate	$24,065.70
Rate for Payer: Cash Price	$14,886.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,367.00
Rate for Payer: Health Management Network Commercial	$21,088.50
Rate for Payer: Kaiser Permanente Commercial	$15,630.30
Rate for Payer: Kaiser Permanente Medicaid	$12,653.10
Rate for Payer: MDX Hawaii PPO	$24,065.70
Rate for Payer: University Health Alliance Commercial	$13,893.60

AAA ILIAC 12MMX10CM CEB231210A

Facility

$24,810.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$13,893.60
Max. Negotiated Rate	$24,065.70
Rate for Payer: Cash Price	$14,886.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,367.00
Rate for Payer: Health Management Network Commercial	$21,088.50
Rate for Payer: MDX Hawaii PPO	$24,065.70
Rate for Payer: University Health Alliance Commercial	$13,893.60

AAA ILIAC 12MMX7CM HGB161207A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$12,040.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 12MMX7CM HGB161207A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$10,965.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Kaiser Permanente Commercial	$13,545.00
Rate for Payer: Kaiser Permanente Medicaid	$10,965.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 14.5X10CM CEB231410A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$12,040.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 14.5X10CM CEB231410A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$10,965.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Kaiser Permanente Commercial	$13,545.00
Rate for Payer: Kaiser Permanente Medicaid	$10,965.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 14.5X7CM HGB161407A

Facility

$21,500.00

Hospital Revenue Code	278
Min. Negotiated Rate	$12,040.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 14.5X7CM HGB161407A

Facility

$21,500.00

Hospital Revenue Code	278
Min. Negotiated Rate	$10,965.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Kaiser Permanente Commercial	$13,545.00
Rate for Payer: Kaiser Permanente Medicaid	$10,965.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

ABDOMINAL PAIN

Facility

$3,261.39

Service Code	APR-DRG 2512
Min. Negotiated Rate	$3,261.39
Max. Negotiated Rate	$3,261.39
Rate for Payer: AlohaCare Medicaid	$3,261.39
Rate for Payer: Hawaii Medical Service Association ABD	$3,261.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,261.39
Rate for Payer: Kaiser Permanente Medicaid	$3,261.39
Rate for Payer: Ohana Health Plan Medicaid	$3,261.39
Rate for Payer: UnitedHealthcare Medicaid	$3,261.39

ABDOMINAL PAIN

Facility

$4,248.28

Service Code	APR-DRG 2513
Min. Negotiated Rate	$4,248.28
Max. Negotiated Rate	$4,248.28
Rate for Payer: AlohaCare Medicaid	$4,248.28
Rate for Payer: Hawaii Medical Service Association ABD	$4,248.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,248.28
Rate for Payer: Kaiser Permanente Medicaid	$4,248.28
Rate for Payer: Ohana Health Plan Medicaid	$4,248.28
Rate for Payer: UnitedHealthcare Medicaid	$4,248.28

ABDOMINAL PAIN

Facility

$2,577.15

Service Code	APR-DRG 2511
Min. Negotiated Rate	$2,577.15
Max. Negotiated Rate	$2,577.15
Rate for Payer: AlohaCare Medicaid	$2,577.15
Rate for Payer: Hawaii Medical Service Association ABD	$2,577.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,577.15
Rate for Payer: Kaiser Permanente Medicaid	$2,577.15
Rate for Payer: Ohana Health Plan Medicaid	$2,577.15
Rate for Payer: UnitedHealthcare Medicaid	$2,577.15

ABDOMINAL PAIN

Facility

$6,861.95

Service Code	APR-DRG 2514
Min. Negotiated Rate	$6,861.95
Max. Negotiated Rate	$6,861.95
Rate for Payer: AlohaCare Medicaid	$6,861.95
Rate for Payer: Hawaii Medical Service Association ABD	$6,861.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,861.95
Rate for Payer: Kaiser Permanente Medicaid	$6,861.95
Rate for Payer: Ohana Health Plan Medicaid	$6,861.95
Rate for Payer: UnitedHealthcare Medicaid	$6,861.95

ABLATION, PERCUTANEOUS, CRYOABLATION, INCLUDES IMAGING GUIDANCE; LOWER EXTREMITY DISTAL/PERIPHERAL NERVE

Facility

$2,883.55

Service Code	CPT 0441T
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$2,883.55
Rate for Payer: AlohaCare Medicaid	$2,306.84
Rate for Payer: AlohaCare Medicare	$2,306.84
Rate for Payer: Devoted Health Medicare	$2,537.52
Rate for Payer: Hawaii Medical Service Association Commercial	$2,883.55
Rate for Payer: Hawaii Medical Service Association Medicare	$2,306.84
Rate for Payer: Humana Medicare	$2,306.84
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,306.84
Rate for Payer: Ohana Health Plan Medicaid	$2,537.52
Rate for Payer: Ohana Health Plan Medicare	$2,306.84
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$2,306.84

ABLATOR APOLLO ASP 90° AR-9821

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$606.05
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: MDX Hawaii PPO	$691.61

ABLATOR APOLLO ASP 90° AR-9821

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$363.63
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$677.35
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Kaiser Permanente Commercial	$449.19
Rate for Payer: Kaiser Permanente Medicaid	$363.63
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: University Health Alliance Commercial	$519.71

ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$4,612.90

Service Code	APR-DRG 5433
Min. Negotiated Rate	$4,612.90
Max. Negotiated Rate	$4,612.90
Rate for Payer: AlohaCare Medicaid	$4,612.90
Rate for Payer: Hawaii Medical Service Association ABD	$4,612.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,612.90
Rate for Payer: Kaiser Permanente Medicaid	$4,612.90
Rate for Payer: Ohana Health Plan Medicaid	$4,612.90
Rate for Payer: UnitedHealthcare Medicaid	$4,612.90

ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$3,380.75

Service Code	APR-DRG 5432
Min. Negotiated Rate	$3,380.75
Max. Negotiated Rate	$3,380.75
Rate for Payer: AlohaCare Medicaid	$3,380.75
Rate for Payer: Hawaii Medical Service Association ABD	$3,380.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,380.75
Rate for Payer: Kaiser Permanente Medicaid	$3,380.75
Rate for Payer: Ohana Health Plan Medicaid	$3,380.75
Rate for Payer: UnitedHealthcare Medicaid	$3,380.75

ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,762.39

Service Code	APR-DRG 5431
Min. Negotiated Rate	$2,762.39
Max. Negotiated Rate	$2,762.39
Rate for Payer: AlohaCare Medicaid	$2,762.39
Rate for Payer: Hawaii Medical Service Association ABD	$2,762.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,762.39
Rate for Payer: Kaiser Permanente Medicaid	$2,762.39
Rate for Payer: Ohana Health Plan Medicaid	$2,762.39
Rate for Payer: UnitedHealthcare Medicaid	$2,762.39

ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$13,006.40

Service Code	APR-DRG 5434
Min. Negotiated Rate	$13,006.40
Max. Negotiated Rate	$13,006.40
Rate for Payer: AlohaCare Medicaid	$13,006.40
Rate for Payer: Hawaii Medical Service Association ABD	$13,006.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,006.40
Rate for Payer: Kaiser Permanente Medicaid	$13,006.40
Rate for Payer: Ohana Health Plan Medicaid	$13,006.40
Rate for Payer: UnitedHealthcare Medicaid	$13,006.40

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$17,296.58

Service Code	MSDRG 770
Min. Negotiated Rate	$11,016.76
Max. Negotiated Rate	$17,296.58
Rate for Payer: AlohaCare Medicare	$11,404.96
Rate for Payer: Devoted Health Medicare	$12,545.46
Rate for Payer: Hawaii Medical Service Association Commercial	$11,016.76
Rate for Payer: Hawaii Medical Service Association Medicare	$11,404.96
Rate for Payer: Humana Medicare	$11,404.96
Rate for Payer: Kaiser Permanente Commercial	$17,296.58
Rate for Payer: Kaiser Permanente Medicare	$11,404.96
Rate for Payer: Ohana Health Plan Medicare	$11,404.96
Rate for Payer: UnitedHealthcare Medicare	$11,404.96

ABORTION WITHOUT D&C

Facility

$12,300.98

Service Code	MSDRG 779
Min. Negotiated Rate	$7,522.46
Max. Negotiated Rate	$12,300.98
Rate for Payer: AlohaCare Medicare	$9,569.17
Rate for Payer: Devoted Health Medicare	$10,526.09
Rate for Payer: Hawaii Medical Service Association Commercial	$7,522.46
Rate for Payer: Hawaii Medical Service Association Medicare	$9,569.17
Rate for Payer: Humana Medicare	$9,569.17
Rate for Payer: Kaiser Permanente Commercial	$12,300.98
Rate for Payer: Kaiser Permanente Medicare	$9,569.17
Rate for Payer: Ohana Health Plan Medicare	$9,569.17
Rate for Payer: UnitedHealthcare Medicare	$9,569.17

ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$5,693.73

Service Code	APR-DRG 5644
Min. Negotiated Rate	$5,693.73
Max. Negotiated Rate	$5,693.73
Rate for Payer: AlohaCare Medicaid	$5,693.73
Rate for Payer: Hawaii Medical Service Association ABD	$5,693.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,693.73
Rate for Payer: Kaiser Permanente Medicaid	$5,693.73
Rate for Payer: Ohana Health Plan Medicaid	$5,693.73
Rate for Payer: UnitedHealthcare Medicaid	$5,693.73

ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$1,997.27

Service Code	APR-DRG 5641
Min. Negotiated Rate	$1,997.27
Max. Negotiated Rate	$1,997.27
Rate for Payer: AlohaCare Medicaid	$1,997.27
Rate for Payer: Hawaii Medical Service Association ABD	$1,997.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,997.27
Rate for Payer: Kaiser Permanente Medicaid	$1,997.27
Rate for Payer: Ohana Health Plan Medicaid	$1,997.27
Rate for Payer: UnitedHealthcare Medicaid	$1,997.27

ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,380.81

Service Code	APR-DRG 5642
Min. Negotiated Rate	$2,380.81
Max. Negotiated Rate	$2,380.81
Rate for Payer: AlohaCare Medicaid	$2,380.81
Rate for Payer: Hawaii Medical Service Association ABD	$2,380.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,380.81
Rate for Payer: Kaiser Permanente Medicaid	$2,380.81
Rate for Payer: Ohana Health Plan Medicaid	$2,380.81
Rate for Payer: UnitedHealthcare Medicaid	$2,380.81

ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,943.73

Service Code	APR-DRG 5643
Min. Negotiated Rate	$2,943.73
Max. Negotiated Rate	$2,943.73
Rate for Payer: AlohaCare Medicaid	$2,943.73
Rate for Payer: Hawaii Medical Service Association ABD	$2,943.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,943.73
Rate for Payer: Kaiser Permanente Medicaid	$2,943.73
Rate for Payer: Ohana Health Plan Medicaid	$2,943.73
Rate for Payer: UnitedHealthcare Medicaid	$2,943.73

Know your out-of-pocket cost for care.

All Charges