Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

INTERCEED BARRIER 3X4IN

Facility

$1,741.00

Hospital Revenue Code	272
Min. Negotiated Rate	$887.91
Max. Negotiated Rate	$1,688.77
Rate for Payer: Cash Price	$1,044.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,653.95
Rate for Payer: Health Management Network Commercial	$1,479.85
Rate for Payer: Kaiser Permanente Commercial	$1,096.83
Rate for Payer: Kaiser Permanente Medicaid	$887.91
Rate for Payer: MDX Hawaii PPO	$1,688.77
Rate for Payer: University Health Alliance Commercial	$1,269.01

INTERGARD KNITTED IGK0022-40

Facility

$1,953.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$996.03
Max. Negotiated Rate	$1,894.41
Rate for Payer: Cash Price	$1,171.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,367.10
Rate for Payer: Health Management Network Commercial	$1,660.05
Rate for Payer: Kaiser Permanente Commercial	$1,230.39
Rate for Payer: Kaiser Permanente Medicaid	$996.03
Rate for Payer: MDX Hawaii PPO	$1,894.41
Rate for Payer: University Health Alliance Commercial	$1,093.68

INTERGARD KNITTED IGK0022-40

Facility

$1,953.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.68
Max. Negotiated Rate	$1,894.41
Rate for Payer: Cash Price	$1,171.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,367.10
Rate for Payer: Health Management Network Commercial	$1,660.05
Rate for Payer: MDX Hawaii PPO	$1,894.41
Rate for Payer: University Health Alliance Commercial	$1,093.68

INTERGARD KNITTED IGK2211

Facility

$1,570.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$879.20
Max. Negotiated Rate	$1,522.90
Rate for Payer: Cash Price	$942.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,099.00
Rate for Payer: Health Management Network Commercial	$1,334.50
Rate for Payer: MDX Hawaii PPO	$1,522.90
Rate for Payer: University Health Alliance Commercial	$879.20

INTERGARD KNITTED IGK2211

Facility

$1,570.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$800.70
Max. Negotiated Rate	$1,522.90
Rate for Payer: Cash Price	$942.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,099.00
Rate for Payer: Health Management Network Commercial	$1,334.50
Rate for Payer: Kaiser Permanente Commercial	$989.10
Rate for Payer: Kaiser Permanente Medicaid	$800.70
Rate for Payer: MDX Hawaii PPO	$1,522.90
Rate for Payer: University Health Alliance Commercial	$879.20

INTERGARD KNITTED, IGK2412

Facility

$2,886.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.16
Max. Negotiated Rate	$2,799.42
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.20
Rate for Payer: Health Management Network Commercial	$2,453.10
Rate for Payer: MDX Hawaii PPO	$2,799.42
Rate for Payer: University Health Alliance Commercial	$1,616.16

INTERGARD KNITTED, IGK2412

Facility

$2,886.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,471.86
Max. Negotiated Rate	$2,799.42
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.20
Rate for Payer: Health Management Network Commercial	$2,453.10
Rate for Payer: Kaiser Permanente Commercial	$1,818.18
Rate for Payer: Kaiser Permanente Medicaid	$1,471.86
Rate for Payer: MDX Hawaii PPO	$2,799.42
Rate for Payer: University Health Alliance Commercial	$1,616.16

INTERGUARD KNITTED IGK0020-40

Facility

$1,497.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$763.47
Max. Negotiated Rate	$1,452.09
Rate for Payer: Cash Price	$898.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.90
Rate for Payer: Health Management Network Commercial	$1,272.45
Rate for Payer: Kaiser Permanente Commercial	$943.11
Rate for Payer: Kaiser Permanente Medicaid	$763.47
Rate for Payer: MDX Hawaii PPO	$1,452.09
Rate for Payer: University Health Alliance Commercial	$838.32

INTERGUARD KNITTED IGK0020-40

Facility

$1,497.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$838.32
Max. Negotiated Rate	$1,452.09
Rate for Payer: Cash Price	$898.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.90
Rate for Payer: Health Management Network Commercial	$1,272.45
Rate for Payer: MDX Hawaii PPO	$1,452.09
Rate for Payer: University Health Alliance Commercial	$838.32

INTERNALBRACE KIT AR-1688-CP

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,096.50
Max. Negotiated Rate	$2,085.50
Rate for Payer: Cash Price	$1,290.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,505.00
Rate for Payer: Health Management Network Commercial	$1,827.50
Rate for Payer: Kaiser Permanente Commercial	$1,354.50
Rate for Payer: Kaiser Permanente Medicaid	$1,096.50
Rate for Payer: MDX Hawaii PPO	$2,085.50
Rate for Payer: University Health Alliance Commercial	$1,204.00

INTERNALBRACE KIT AR-1688-CP

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,085.50
Rate for Payer: Cash Price	$1,290.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,505.00
Rate for Payer: Health Management Network Commercial	$1,827.50
Rate for Payer: MDX Hawaii PPO	$2,085.50
Rate for Payer: University Health Alliance Commercial	$1,204.00

INTERSTITIAL & ALVEOLAR LUNG DISEASES

Facility

$3,305.09

Service Code	APR-DRG 1421
Min. Negotiated Rate	$3,305.09
Max. Negotiated Rate	$3,305.09
Rate for Payer: AlohaCare Medicaid	$3,305.09
Rate for Payer: Hawaii Medical Service Association ABD	$3,305.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,305.09
Rate for Payer: Kaiser Permanente Medicaid	$3,305.09
Rate for Payer: Ohana Health Plan Medicaid	$3,305.09
Rate for Payer: UnitedHealthcare Medicaid	$3,305.09

INTERSTITIAL & ALVEOLAR LUNG DISEASES

Facility

$7,686.43

Service Code	APR-DRG 1424
Min. Negotiated Rate	$7,686.43
Max. Negotiated Rate	$7,686.43
Rate for Payer: AlohaCare Medicaid	$7,686.43
Rate for Payer: Hawaii Medical Service Association ABD	$7,686.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,686.43
Rate for Payer: Kaiser Permanente Medicaid	$7,686.43
Rate for Payer: Ohana Health Plan Medicaid	$7,686.43
Rate for Payer: UnitedHealthcare Medicaid	$7,686.43

INTERSTITIAL & ALVEOLAR LUNG DISEASES

Facility

$5,199.95

Service Code	APR-DRG 1423
Min. Negotiated Rate	$5,199.95
Max. Negotiated Rate	$5,199.95
Rate for Payer: AlohaCare Medicaid	$5,199.95
Rate for Payer: Hawaii Medical Service Association ABD	$5,199.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,199.95
Rate for Payer: Kaiser Permanente Medicaid	$5,199.95
Rate for Payer: Ohana Health Plan Medicaid	$5,199.95
Rate for Payer: UnitedHealthcare Medicaid	$5,199.95

INTERSTITIAL & ALVEOLAR LUNG DISEASES

Facility

$3,851.70

Service Code	APR-DRG 1422
Min. Negotiated Rate	$3,851.70
Max. Negotiated Rate	$3,851.70
Rate for Payer: AlohaCare Medicaid	$3,851.70
Rate for Payer: Hawaii Medical Service Association ABD	$3,851.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,851.70
Rate for Payer: Kaiser Permanente Medicaid	$3,851.70
Rate for Payer: Ohana Health Plan Medicaid	$3,851.70
Rate for Payer: UnitedHealthcare Medicaid	$3,851.70

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$35,209.97

Service Code	MSDRG 197
Min. Negotiated Rate	$10,795.30
Max. Negotiated Rate	$35,209.97
Rate for Payer: AlohaCare Medicare	$10,795.30
Rate for Payer: Devoted Health Medicare	$11,874.83
Rate for Payer: Hawaii Medical Service Association Commercial	$35,209.97
Rate for Payer: Hawaii Medical Service Association Medicare	$10,795.30
Rate for Payer: Humana Medicare	$10,795.30
Rate for Payer: Kaiser Permanente Commercial	$16,371.98
Rate for Payer: Kaiser Permanente Medicare	$10,795.30
Rate for Payer: Ohana Health Plan Medicare	$10,795.30
Rate for Payer: UnitedHealthcare Medicare	$10,795.30

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$35,209.97

Service Code	MSDRG 196
Min. Negotiated Rate	$21,465.50
Max. Negotiated Rate	$35,209.97
Rate for Payer: AlohaCare Medicare	$21,465.50
Rate for Payer: Devoted Health Medicare	$23,612.05
Rate for Payer: Hawaii Medical Service Association Commercial	$35,209.97
Rate for Payer: Hawaii Medical Service Association Medicare	$21,465.50
Rate for Payer: Humana Medicare	$21,465.50
Rate for Payer: Kaiser Permanente Commercial	$32,554.20
Rate for Payer: Kaiser Permanente Medicare	$21,465.50
Rate for Payer: Ohana Health Plan Medicare	$21,465.50
Rate for Payer: UnitedHealthcare Medicare	$21,465.50

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$35,209.97

Service Code	MSDRG 198
Min. Negotiated Rate	$8,146.24
Max. Negotiated Rate	$35,209.97
Rate for Payer: AlohaCare Medicare	$8,146.24
Rate for Payer: Devoted Health Medicare	$8,960.86
Rate for Payer: Hawaii Medical Service Association Commercial	$35,209.97
Rate for Payer: Hawaii Medical Service Association Medicare	$8,146.24
Rate for Payer: Humana Medicare	$8,146.24
Rate for Payer: Kaiser Permanente Commercial	$12,354.45
Rate for Payer: Kaiser Permanente Medicare	$8,146.24
Rate for Payer: Ohana Health Plan Medicare	$8,146.24
Rate for Payer: UnitedHealthcare Medicare	$8,146.24

INTERVERTEBRAL DISC EXCISION & DECOMPRESSION

Facility

$5,674.81

Service Code	APR-DRG 3101
Min. Negotiated Rate	$5,674.81
Max. Negotiated Rate	$5,674.81
Rate for Payer: AlohaCare Medicaid	$5,674.81
Rate for Payer: Hawaii Medical Service Association ABD	$5,674.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,674.81
Rate for Payer: Kaiser Permanente Medicaid	$5,674.81
Rate for Payer: Ohana Health Plan Medicaid	$5,674.81
Rate for Payer: UnitedHealthcare Medicaid	$5,674.81

INTERVERTEBRAL DISC EXCISION & DECOMPRESSION

Facility

$7,059.59

Service Code	APR-DRG 3102
Min. Negotiated Rate	$7,059.59
Max. Negotiated Rate	$7,059.59
Rate for Payer: AlohaCare Medicaid	$7,059.59
Rate for Payer: Hawaii Medical Service Association ABD	$7,059.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,059.59
Rate for Payer: Kaiser Permanente Medicaid	$7,059.59
Rate for Payer: Ohana Health Plan Medicaid	$7,059.59
Rate for Payer: UnitedHealthcare Medicaid	$7,059.59

INTERVERTEBRAL DISC EXCISION & DECOMPRESSION

Facility

$9,464.54

Service Code	APR-DRG 3103
Min. Negotiated Rate	$9,464.54
Max. Negotiated Rate	$9,464.54
Rate for Payer: AlohaCare Medicaid	$9,464.54
Rate for Payer: Hawaii Medical Service Association ABD	$9,464.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,464.54
Rate for Payer: Kaiser Permanente Medicaid	$9,464.54
Rate for Payer: Ohana Health Plan Medicaid	$9,464.54
Rate for Payer: UnitedHealthcare Medicaid	$9,464.54

INTERVERTEBRAL DISC EXCISION & DECOMPRESSION

Facility

$18,006.11

Service Code	APR-DRG 3104
Min. Negotiated Rate	$18,006.11
Max. Negotiated Rate	$18,006.11
Rate for Payer: AlohaCare Medicaid	$18,006.11
Rate for Payer: Hawaii Medical Service Association ABD	$18,006.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,006.11
Rate for Payer: Kaiser Permanente Medicaid	$18,006.11
Rate for Payer: Ohana Health Plan Medicaid	$18,006.11
Rate for Payer: UnitedHealthcare Medicaid	$18,006.11

INTESTINAL OBSTRUCTION

Facility

$2,592.15

Service Code	APR-DRG 2471
Min. Negotiated Rate	$2,592.15
Max. Negotiated Rate	$2,592.15
Rate for Payer: AlohaCare Medicaid	$2,592.15
Rate for Payer: Hawaii Medical Service Association ABD	$2,592.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,592.15
Rate for Payer: Kaiser Permanente Medicaid	$2,592.15
Rate for Payer: Ohana Health Plan Medicaid	$2,592.15
Rate for Payer: UnitedHealthcare Medicaid	$2,592.15

INTESTINAL OBSTRUCTION

Facility

$8,961.63

Service Code	APR-DRG 2474
Min. Negotiated Rate	$8,961.63
Max. Negotiated Rate	$8,961.63
Rate for Payer: AlohaCare Medicaid	$8,961.63
Rate for Payer: Hawaii Medical Service Association ABD	$8,961.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,961.63
Rate for Payer: Kaiser Permanente Medicaid	$8,961.63
Rate for Payer: Ohana Health Plan Medicaid	$8,961.63
Rate for Payer: UnitedHealthcare Medicaid	$8,961.63

INTESTINAL OBSTRUCTION

Facility

$5,083.19

Service Code	APR-DRG 2473
Min. Negotiated Rate	$5,083.19
Max. Negotiated Rate	$5,083.19
Rate for Payer: AlohaCare Medicaid	$5,083.19
Rate for Payer: Hawaii Medical Service Association ABD	$5,083.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,083.19
Rate for Payer: Kaiser Permanente Medicaid	$5,083.19
Rate for Payer: Ohana Health Plan Medicaid	$5,083.19
Rate for Payer: UnitedHealthcare Medicaid	$5,083.19

Know your out-of-pocket cost for care.

All Charges