Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

POSTLAT DSTL HUM 02.117.307

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.99
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Kaiser Permanente Commercial	$1,731.87
Rate for Payer: Kaiser Permanente Medicaid	$1,401.99
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

POSTLAT DSTL HUM 02.117.307

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.44
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$31,458.83

Service Code	MSDRG 862
Min. Negotiated Rate	$20,743.21
Max. Negotiated Rate	$31,458.83
Rate for Payer: AlohaCare Medicare	$20,743.21
Rate for Payer: Devoted Health Medicare	$22,817.53
Rate for Payer: Hawaii Medical Service Association Commercial	$22,057.79
Rate for Payer: Hawaii Medical Service Association Medicare	$20,743.21
Rate for Payer: Humana Medicare	$20,743.21
Rate for Payer: Kaiser Permanente Commercial	$31,458.83
Rate for Payer: Kaiser Permanente Medicare	$20,743.21
Rate for Payer: Ohana Health Plan Medicare	$20,743.21
Rate for Payer: UnitedHealthcare Medicare	$20,743.21

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$22,057.79

Service Code	MSDRG 863
Min. Negotiated Rate	$11,350.37
Max. Negotiated Rate	$22,057.79
Rate for Payer: AlohaCare Medicare	$11,350.37
Rate for Payer: Devoted Health Medicare	$12,485.41
Rate for Payer: Hawaii Medical Service Association Commercial	$22,057.79
Rate for Payer: Hawaii Medical Service Association Medicare	$11,350.37
Rate for Payer: Humana Medicare	$11,350.37
Rate for Payer: Kaiser Permanente Commercial	$17,213.78
Rate for Payer: Kaiser Permanente Medicare	$11,350.37
Rate for Payer: Ohana Health Plan Medicare	$11,350.37
Rate for Payer: UnitedHealthcare Medicare	$11,350.37

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$38,801.33

Service Code	MSDRG 857
Min. Negotiated Rate	$24,357.98
Max. Negotiated Rate	$38,801.33
Rate for Payer: AlohaCare Medicare	$24,357.98
Rate for Payer: Devoted Health Medicare	$26,793.78
Rate for Payer: Hawaii Medical Service Association Commercial	$38,801.33
Rate for Payer: Hawaii Medical Service Association Medicare	$24,357.98
Rate for Payer: Humana Medicare	$24,357.98
Rate for Payer: Kaiser Permanente Commercial	$36,940.88
Rate for Payer: Kaiser Permanente Medicare	$24,357.98
Rate for Payer: Ohana Health Plan Medicare	$24,357.98
Rate for Payer: UnitedHealthcare Medicare	$24,357.98

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$78,465.07

Service Code	MSDRG 856
Min. Negotiated Rate	$38,801.33
Max. Negotiated Rate	$78,465.07
Rate for Payer: AlohaCare Medicare	$51,738.07
Rate for Payer: Devoted Health Medicare	$56,911.88
Rate for Payer: Hawaii Medical Service Association Commercial	$38,801.33
Rate for Payer: Hawaii Medical Service Association Medicare	$51,738.07
Rate for Payer: Humana Medicare	$51,738.07
Rate for Payer: Kaiser Permanente Commercial	$78,465.07
Rate for Payer: Kaiser Permanente Medicare	$51,738.07
Rate for Payer: Ohana Health Plan Medicare	$51,738.07
Rate for Payer: UnitedHealthcare Medicare	$51,738.07

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$38,801.33

Service Code	MSDRG 858
Min. Negotiated Rate	$15,843.20
Max. Negotiated Rate	$38,801.33
Rate for Payer: AlohaCare Medicare	$15,843.20
Rate for Payer: Devoted Health Medicare	$17,427.52
Rate for Payer: Hawaii Medical Service Association Commercial	$38,801.33
Rate for Payer: Hawaii Medical Service Association Medicare	$15,843.20
Rate for Payer: Humana Medicare	$15,843.20
Rate for Payer: Kaiser Permanente Commercial	$24,027.53
Rate for Payer: Kaiser Permanente Medicare	$15,843.20
Rate for Payer: Ohana Health Plan Medicare	$15,843.20
Rate for Payer: UnitedHealthcare Medicare	$15,843.20

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$2,886.33

Service Code	APR-DRG 7211
Min. Negotiated Rate	$2,886.33
Max. Negotiated Rate	$2,886.33
Rate for Payer: AlohaCare Medicaid	$2,886.33
Rate for Payer: Hawaii Medical Service Association ABD	$2,886.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,886.33
Rate for Payer: Kaiser Permanente Medicaid	$2,886.33
Rate for Payer: Ohana Health Plan Medicaid	$2,886.33
Rate for Payer: UnitedHealthcare Medicaid	$2,886.33

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$11,353.53

Service Code	APR-DRG 7214
Min. Negotiated Rate	$11,353.53
Max. Negotiated Rate	$11,353.53
Rate for Payer: AlohaCare Medicaid	$11,353.53
Rate for Payer: Hawaii Medical Service Association ABD	$11,353.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,353.53
Rate for Payer: Kaiser Permanente Medicaid	$11,353.53
Rate for Payer: Ohana Health Plan Medicaid	$11,353.53
Rate for Payer: UnitedHealthcare Medicaid	$11,353.53

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$6,201.20

Service Code	APR-DRG 7213
Min. Negotiated Rate	$6,201.20
Max. Negotiated Rate	$6,201.20
Rate for Payer: AlohaCare Medicaid	$6,201.20
Rate for Payer: Hawaii Medical Service Association ABD	$6,201.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,201.20
Rate for Payer: Kaiser Permanente Medicaid	$6,201.20
Rate for Payer: Ohana Health Plan Medicaid	$6,201.20
Rate for Payer: UnitedHealthcare Medicaid	$6,201.20

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$3,896.70

Service Code	APR-DRG 7212
Min. Negotiated Rate	$3,896.70
Max. Negotiated Rate	$3,896.70
Rate for Payer: AlohaCare Medicaid	$3,896.70
Rate for Payer: Hawaii Medical Service Association ABD	$3,896.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,896.70
Rate for Payer: Kaiser Permanente Medicaid	$3,896.70
Rate for Payer: Ohana Health Plan Medicaid	$3,896.70
Rate for Payer: UnitedHealthcare Medicaid	$3,896.70

POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE

Facility

$5,495.43

Service Code	APR-DRG 7111
Min. Negotiated Rate	$5,495.43
Max. Negotiated Rate	$5,495.43
Rate for Payer: AlohaCare Medicaid	$5,495.43
Rate for Payer: Hawaii Medical Service Association ABD	$5,495.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,495.43
Rate for Payer: Kaiser Permanente Medicaid	$5,495.43
Rate for Payer: Ohana Health Plan Medicaid	$5,495.43
Rate for Payer: UnitedHealthcare Medicaid	$5,495.43

POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE

Facility

$7,107.21

Service Code	APR-DRG 7112
Min. Negotiated Rate	$7,107.21
Max. Negotiated Rate	$7,107.21
Rate for Payer: AlohaCare Medicaid	$7,107.21
Rate for Payer: Hawaii Medical Service Association ABD	$7,107.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,107.21
Rate for Payer: Kaiser Permanente Medicaid	$7,107.21
Rate for Payer: Ohana Health Plan Medicaid	$7,107.21
Rate for Payer: UnitedHealthcare Medicaid	$7,107.21

POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE

Facility

$11,921.67

Service Code	APR-DRG 7113
Min. Negotiated Rate	$11,921.67
Max. Negotiated Rate	$11,921.67
Rate for Payer: AlohaCare Medicaid	$11,921.67
Rate for Payer: Hawaii Medical Service Association ABD	$11,921.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,921.67
Rate for Payer: Kaiser Permanente Medicaid	$11,921.67
Rate for Payer: Ohana Health Plan Medicaid	$11,921.67
Rate for Payer: UnitedHealthcare Medicaid	$11,921.67

POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE

Facility

$22,334.62

Service Code	APR-DRG 7114
Min. Negotiated Rate	$22,334.62
Max. Negotiated Rate	$22,334.62
Rate for Payer: AlohaCare Medicaid	$22,334.62
Rate for Payer: Hawaii Medical Service Association ABD	$22,334.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,334.62
Rate for Payer: Kaiser Permanente Medicaid	$22,334.62
Rate for Payer: Ohana Health Plan Medicaid	$22,334.62
Rate for Payer: UnitedHealthcare Medicaid	$22,334.62

POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$29,149.05

Service Code	MSDRG 769
Min. Negotiated Rate	$19,220.23
Max. Negotiated Rate	$29,149.05
Rate for Payer: AlohaCare Medicare	$19,220.23
Rate for Payer: Devoted Health Medicare	$21,142.25
Rate for Payer: Hawaii Medical Service Association Commercial	$25,721.96
Rate for Payer: Hawaii Medical Service Association Medicare	$19,220.23
Rate for Payer: Humana Medicare	$19,220.23
Rate for Payer: Kaiser Permanente Commercial	$29,149.05
Rate for Payer: Kaiser Permanente Medicare	$19,220.23
Rate for Payer: Ohana Health Plan Medicare	$19,220.23
Rate for Payer: UnitedHealthcare Medicare	$19,220.23

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility

$11,293.58

Service Code	MSDRG 776
Min. Negotiated Rate	$7,446.72
Max. Negotiated Rate	$11,293.58
Rate for Payer: AlohaCare Medicare	$7,446.72
Rate for Payer: Devoted Health Medicare	$8,191.39
Rate for Payer: Hawaii Medical Service Association Commercial	$9,827.73
Rate for Payer: Hawaii Medical Service Association Medicare	$7,446.72
Rate for Payer: Humana Medicare	$7,446.72
Rate for Payer: Kaiser Permanente Commercial	$11,293.58
Rate for Payer: Kaiser Permanente Medicare	$7,446.72
Rate for Payer: Ohana Health Plan Medicare	$7,446.72
Rate for Payer: UnitedHealthcare Medicare	$7,446.72

POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$1,883.12

Service Code	APR-DRG 5611
Min. Negotiated Rate	$1,883.12
Max. Negotiated Rate	$1,883.12
Rate for Payer: AlohaCare Medicaid	$1,883.12
Rate for Payer: Hawaii Medical Service Association ABD	$1,883.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,883.12
Rate for Payer: Kaiser Permanente Medicaid	$1,883.12
Rate for Payer: Ohana Health Plan Medicaid	$1,883.12
Rate for Payer: UnitedHealthcare Medicaid	$1,883.12

POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$7,098.73

Service Code	APR-DRG 5614
Min. Negotiated Rate	$7,098.73
Max. Negotiated Rate	$7,098.73
Rate for Payer: AlohaCare Medicaid	$7,098.73
Rate for Payer: Hawaii Medical Service Association ABD	$7,098.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,098.73
Rate for Payer: Kaiser Permanente Medicaid	$7,098.73
Rate for Payer: Ohana Health Plan Medicaid	$7,098.73
Rate for Payer: UnitedHealthcare Medicaid	$7,098.73

POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$3,297.91

Service Code	APR-DRG 5613
Min. Negotiated Rate	$3,297.91
Max. Negotiated Rate	$3,297.91
Rate for Payer: AlohaCare Medicaid	$3,297.91
Rate for Payer: Hawaii Medical Service Association ABD	$3,297.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,297.91
Rate for Payer: Kaiser Permanente Medicaid	$3,297.91
Rate for Payer: Ohana Health Plan Medicaid	$3,297.91
Rate for Payer: UnitedHealthcare Medicaid	$3,297.91

POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$2,302.54

Service Code	APR-DRG 5612
Min. Negotiated Rate	$2,302.54
Max. Negotiated Rate	$2,302.54
Rate for Payer: AlohaCare Medicaid	$2,302.54
Rate for Payer: Hawaii Medical Service Association ABD	$2,302.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,302.54
Rate for Payer: Kaiser Permanente Medicaid	$2,302.54
Rate for Payer: Ohana Health Plan Medicaid	$2,302.54
Rate for Payer: UnitedHealthcare Medicaid	$2,302.54

POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$3,645.58

Service Code	APR-DRG 5482
Min. Negotiated Rate	$3,645.58
Max. Negotiated Rate	$3,645.58
Rate for Payer: AlohaCare Medicaid	$3,645.58
Rate for Payer: Hawaii Medical Service Association ABD	$3,645.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,645.58
Rate for Payer: Kaiser Permanente Medicaid	$3,645.58
Rate for Payer: Ohana Health Plan Medicaid	$3,645.58
Rate for Payer: UnitedHealthcare Medicaid	$3,645.58

POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$2,374.94

Service Code	APR-DRG 5481
Min. Negotiated Rate	$2,374.94
Max. Negotiated Rate	$2,374.94
Rate for Payer: AlohaCare Medicaid	$2,374.94
Rate for Payer: Hawaii Medical Service Association ABD	$2,374.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,374.94
Rate for Payer: Kaiser Permanente Medicaid	$2,374.94
Rate for Payer: Ohana Health Plan Medicaid	$2,374.94
Rate for Payer: UnitedHealthcare Medicaid	$2,374.94

POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$6,754.98

Service Code	APR-DRG 5483
Min. Negotiated Rate	$6,754.98
Max. Negotiated Rate	$6,754.98
Rate for Payer: AlohaCare Medicaid	$6,754.98
Rate for Payer: Hawaii Medical Service Association ABD	$6,754.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,754.98
Rate for Payer: Kaiser Permanente Medicaid	$6,754.98
Rate for Payer: Ohana Health Plan Medicaid	$6,754.98
Rate for Payer: UnitedHealthcare Medicaid	$6,754.98

POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$15,099.56

Service Code	APR-DRG 5484
Min. Negotiated Rate	$15,099.56
Max. Negotiated Rate	$15,099.56
Rate for Payer: AlohaCare Medicaid	$15,099.56
Rate for Payer: Hawaii Medical Service Association ABD	$15,099.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,099.56
Rate for Payer: Kaiser Permanente Medicaid	$15,099.56
Rate for Payer: Ohana Health Plan Medicaid	$15,099.56
Rate for Payer: UnitedHealthcare Medicaid	$15,099.56

Know your out-of-pocket cost for care.

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