Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HEART &/OR LUNG TRANSPLANT

Facility

$53,560.42

Service Code	APR-DRG 0022
Min. Negotiated Rate	$53,560.42
Max. Negotiated Rate	$53,560.42
Rate for Payer: AlohaCare Medicaid	$53,560.42
Rate for Payer: Hawaii Medical Service Association ABD	$53,560.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53,560.42
Rate for Payer: Kaiser Permanente Medicaid	$53,560.42
Rate for Payer: Ohana Health Plan Medicaid	$53,560.42
Rate for Payer: UnitedHealthcare Medicaid	$53,560.42

HEART &/OR LUNG TRANSPLANT

Facility

$43,861.06

Service Code	APR-DRG 0021
Min. Negotiated Rate	$43,861.06
Max. Negotiated Rate	$43,861.06
Rate for Payer: AlohaCare Medicaid	$43,861.06
Rate for Payer: Hawaii Medical Service Association ABD	$43,861.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43,861.06
Rate for Payer: Kaiser Permanente Medicaid	$43,861.06
Rate for Payer: Ohana Health Plan Medicaid	$43,861.06
Rate for Payer: UnitedHealthcare Medicaid	$43,861.06

HEART &/OR LUNG TRANSPLANT

Facility

$106,587.93

Service Code	APR-DRG 0024
Min. Negotiated Rate	$106,587.93
Max. Negotiated Rate	$106,587.93
Rate for Payer: AlohaCare Medicaid	$106,587.93
Rate for Payer: Hawaii Medical Service Association ABD	$106,587.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$106,587.93
Rate for Payer: Kaiser Permanente Medicaid	$106,587.93
Rate for Payer: Ohana Health Plan Medicaid	$106,587.93
Rate for Payer: UnitedHealthcare Medicaid	$106,587.93

HEART &/OR LUNG TRANSPLANT

Facility

$74,881.40

Service Code	APR-DRG 0023
Min. Negotiated Rate	$74,881.40
Max. Negotiated Rate	$74,881.40
Rate for Payer: AlohaCare Medicaid	$74,881.40
Rate for Payer: Hawaii Medical Service Association ABD	$74,881.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$74,881.40
Rate for Payer: Kaiser Permanente Medicaid	$74,881.40
Rate for Payer: Ohana Health Plan Medicaid	$74,881.40
Rate for Payer: UnitedHealthcare Medicaid	$74,881.40

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility

$483,412.28

Service Code	MSDRG 001
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$483,412.28
Rate for Payer: AlohaCare Medicare	$318,751.00
Rate for Payer: Devoted Health Medicare	$350,626.10
Rate for Payer: Hawaii Medical Service Association Commercial	$276,462.54
Rate for Payer: Hawaii Medical Service Association Medicare	$318,751.00
Rate for Payer: Kaiser Permanente Commercial	$483,412.28
Rate for Payer: Kaiser Permanente Medicare	$318,751.00
Rate for Payer: Ohana Health Plan Medicare	$318,751.00
Rate for Payer: UnitedHealthcare Medicare	$318,751.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility

$276,462.54

Service Code	MSDRG 002
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$276,462.54
Rate for Payer: AlohaCare Medicare	$128,890.78
Rate for Payer: Devoted Health Medicare	$141,779.86
Rate for Payer: Hawaii Medical Service Association Commercial	$276,462.54
Rate for Payer: Hawaii Medical Service Association Medicare	$128,890.78
Rate for Payer: Kaiser Permanente Commercial	$195,473.55
Rate for Payer: Kaiser Permanente Medicare	$128,890.78
Rate for Payer: Ohana Health Plan Medicare	$128,890.78
Rate for Payer: UnitedHealthcare Medicare	$128,890.78
Rate for Payer: University Health Alliance Commercial	$10,400.00

HEMAGARD KNITTED 12X6 #HGK1206

Facility

$1,844.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$940.44
Max. Negotiated Rate	$1,788.68
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,290.80
Rate for Payer: Health Management Network Commercial	$1,567.40
Rate for Payer: Kaiser Permanente Commercial	$1,161.72
Rate for Payer: Kaiser Permanente Medicaid	$940.44
Rate for Payer: MDX Hawaii PPO	$1,788.68
Rate for Payer: University Health Alliance Commercial	$1,032.64

HEMAGARD KNITTED 12X6 #HGK1206

Facility

$1,844.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,032.64
Max. Negotiated Rate	$1,788.68
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,290.80
Rate for Payer: Health Management Network Commercial	$1,567.40
Rate for Payer: MDX Hawaii PPO	$1,788.68
Rate for Payer: University Health Alliance Commercial	$1,032.64

HEMOCLIP RESOLUTION M00522611

Facility

$591.00

Hospital Revenue Code	272
Min. Negotiated Rate	$502.35
Max. Negotiated Rate	$573.27
Rate for Payer: Cash Price	$354.60
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: MDX Hawaii PPO	$573.27

HEMOCLIP RESOLUTION M00522611

Facility

$591.00

Hospital Revenue Code	272
Min. Negotiated Rate	$301.41
Max. Negotiated Rate	$573.27
Rate for Payer: Cash Price	$354.60
Rate for Payer: Hawaii Western Management Group Commercial	$561.45
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Kaiser Permanente Commercial	$372.33
Rate for Payer: Kaiser Permanente Medicaid	$301.41
Rate for Payer: MDX Hawaii PPO	$573.27
Rate for Payer: University Health Alliance Commercial	$430.78

HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$3,498.16

Service Code	APR-DRG 8102
Min. Negotiated Rate	$3,498.16
Max. Negotiated Rate	$3,498.16
Rate for Payer: AlohaCare Medicaid	$3,498.16
Rate for Payer: Hawaii Medical Service Association ABD	$3,498.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,498.16
Rate for Payer: Kaiser Permanente Medicaid	$3,498.16
Rate for Payer: Ohana Health Plan Medicaid	$3,498.16
Rate for Payer: UnitedHealthcare Medicaid	$3,498.16

HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$2,574.54

Service Code	APR-DRG 8101
Min. Negotiated Rate	$2,574.54
Max. Negotiated Rate	$2,574.54
Rate for Payer: AlohaCare Medicaid	$2,574.54
Rate for Payer: Hawaii Medical Service Association ABD	$2,574.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,574.54
Rate for Payer: Kaiser Permanente Medicaid	$2,574.54
Rate for Payer: Ohana Health Plan Medicaid	$2,574.54
Rate for Payer: UnitedHealthcare Medicaid	$2,574.54

HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$5,491.52

Service Code	APR-DRG 8103
Min. Negotiated Rate	$5,491.52
Max. Negotiated Rate	$5,491.52
Rate for Payer: AlohaCare Medicaid	$5,491.52
Rate for Payer: Hawaii Medical Service Association ABD	$5,491.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,491.52
Rate for Payer: Kaiser Permanente Medicaid	$5,491.52
Rate for Payer: Ohana Health Plan Medicaid	$5,491.52
Rate for Payer: UnitedHealthcare Medicaid	$5,491.52

HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$10,097.90

Service Code	APR-DRG 8104
Min. Negotiated Rate	$10,097.90
Max. Negotiated Rate	$10,097.90
Rate for Payer: AlohaCare Medicaid	$10,097.90
Rate for Payer: Hawaii Medical Service Association ABD	$10,097.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,097.90
Rate for Payer: Kaiser Permanente Medicaid	$10,097.90
Rate for Payer: Ohana Health Plan Medicaid	$10,097.90
Rate for Payer: UnitedHealthcare Medicaid	$10,097.90

HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS

Facility

$6,743.44

Service Code	CPT 46250
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Devoted Health Medicare	$3,606.91
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	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01
Rate for Payer: University Health Alliance Commercial	$6,743.44

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS;

Facility

$8,270.00

Service Code	CPT 46260
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Devoted Health Medicare	$3,606.91
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01
Rate for Payer: University Health Alliance Commercial	$6,743.44

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;

Facility

$6,743.44

Service Code	CPT 46255
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Devoted Health Medicare	$3,606.91
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	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01
Rate for Payer: University Health Alliance Commercial	$6,743.44

HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)

Facility

$2,837.00

Service Code	CPT 46221
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Devoted Health Medicare	$1,208.46
Rate for Payer: Hawaii Medical Service Association Commercial	$1,373.25
Rate for Payer: Hawaii Medical Service Association Medicare	$1,098.60
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,098.60

HEMOST ABSORBALBLE 3X4

Facility

$552.00

Hospital Revenue Code	272
Min. Negotiated Rate	$281.52
Max. Negotiated Rate	$535.44
Rate for Payer: Cash Price	$331.20
Rate for Payer: Hawaii Western Management Group Commercial	$524.40
Rate for Payer: Health Management Network Commercial	$469.20
Rate for Payer: Kaiser Permanente Commercial	$347.76
Rate for Payer: Kaiser Permanente Medicaid	$281.52
Rate for Payer: MDX Hawaii PPO	$535.44
Rate for Payer: University Health Alliance Commercial	$402.35

HEMOST ABSORBALBLE 3X4

Facility

$552.00

Hospital Revenue Code	272
Min. Negotiated Rate	$469.20
Max. Negotiated Rate	$535.44
Rate for Payer: Cash Price	$331.20
Rate for Payer: Health Management Network Commercial	$469.20
Rate for Payer: MDX Hawaii PPO	$535.44

HEMOSTAT DSTAT DRY TOPIC 3001

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: University Health Alliance Commercial	$138.49

HEMOSTAT DSTAT DRY TOPIC 3001

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$161.50
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: MDX Hawaii PPO	$184.30

HEMOST FLEXITIP APPLICATOR

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

HEMOST FLEXITIP APPLICATOR

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

HEMOST PARTICLES 3G

Facility

$812.00

Hospital Revenue Code	272
Min. Negotiated Rate	$414.12
Max. Negotiated Rate	$787.64
Rate for Payer: Cash Price	$487.20
Rate for Payer: Hawaii Western Management Group Commercial	$771.40
Rate for Payer: Health Management Network Commercial	$690.20
Rate for Payer: Kaiser Permanente Commercial	$511.56
Rate for Payer: Kaiser Permanente Medicaid	$414.12
Rate for Payer: MDX Hawaii PPO	$787.64
Rate for Payer: University Health Alliance Commercial	$591.87

Know your out-of-pocket cost for care.

All Charges