Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

BUR DIAMOND 4MM 15 DEG

Facility

$998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$848.30
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$598.80
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: MDX Hawaii PPO	$968.06

BUR DIAMOND 4MM 70 DEG

Facility

$998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$508.98
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$598.80
Rate for Payer: Hawaii Western Management Group Commercial	$948.10
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: Kaiser Permanente Commercial	$628.74
Rate for Payer: Kaiser Permanente Medicaid	$508.98
Rate for Payer: MDX Hawaii PPO	$968.06
Rate for Payer: University Health Alliance Commercial	$727.44

BUR DIAMOND 4MM 70 DEG

Facility

$998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$848.30
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$598.80
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: MDX Hawaii PPO	$968.06

BURNS W SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$42,538.90

Service Code	APR-DRG 8424
Min. Negotiated Rate	$42,538.90
Max. Negotiated Rate	$42,538.90
Rate for Payer: AlohaCare Medicaid	$42,538.90
Rate for Payer: Hawaii Medical Service Association ABD	$42,538.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42,538.90
Rate for Payer: Kaiser Permanente Medicaid	$42,538.90
Rate for Payer: Ohana Health Plan Medicaid	$42,538.90
Rate for Payer: UnitedHealthcare Medicaid	$42,538.90

BURNS W SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$6,841.08

Service Code	APR-DRG 8421
Min. Negotiated Rate	$6,841.08
Max. Negotiated Rate	$6,841.08
Rate for Payer: AlohaCare Medicaid	$6,841.08
Rate for Payer: Hawaii Medical Service Association ABD	$6,841.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,841.08
Rate for Payer: Kaiser Permanente Medicaid	$6,841.08
Rate for Payer: Ohana Health Plan Medicaid	$6,841.08
Rate for Payer: UnitedHealthcare Medicaid	$6,841.08

BURNS W SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$18,456.83

Service Code	APR-DRG 8423
Min. Negotiated Rate	$18,456.83
Max. Negotiated Rate	$18,456.83
Rate for Payer: AlohaCare Medicaid	$18,456.83
Rate for Payer: Hawaii Medical Service Association ABD	$18,456.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,456.83
Rate for Payer: Kaiser Permanente Medicaid	$18,456.83
Rate for Payer: Ohana Health Plan Medicaid	$18,456.83
Rate for Payer: UnitedHealthcare Medicaid	$18,456.83

BURNS W SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$10,223.14

Service Code	APR-DRG 8422
Min. Negotiated Rate	$10,223.14
Max. Negotiated Rate	$10,223.14
Rate for Payer: AlohaCare Medicaid	$10,223.14
Rate for Payer: Hawaii Medical Service Association ABD	$10,223.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,223.14
Rate for Payer: Kaiser Permanente Medicaid	$10,223.14
Rate for Payer: Ohana Health Plan Medicaid	$10,223.14
Rate for Payer: UnitedHealthcare Medicaid	$10,223.14

BUR OVAL CUTTING 14-S0903

Facility

$91.00

Hospital Revenue Code	272
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: MDX Hawaii PPO	$88.27

BUR OVAL CUTTING 14-S0903

Facility

$91.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$86.45
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: University Health Alliance Commercial	$66.33

BURR 12 FLUTE OVAL AR-8550OBT

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: MDX Hawaii PPO	$201.76

BURR 12 FLUTE OVAL AR-8550OBT

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$106.08
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$131.04
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: University Health Alliance Commercial	$151.61

BURR 2.2 X 16MM NEURO 7021-815

Facility

$246.00

Hospital Revenue Code	272
Min. Negotiated Rate	$125.46
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$147.60
Rate for Payer: Hawaii Western Management Group Commercial	$233.70
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$154.98
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: University Health Alliance Commercial	$179.31

BURR 2.2 X 16MM NEURO 7021-815

Facility

$246.00

Hospital Revenue Code	272
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$147.60
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: MDX Hawaii PPO	$238.62

BURR 3MM 15 DEG

Facility

$2,430.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,239.30
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,308.50
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$1,530.90
Rate for Payer: Kaiser Permanente Medicaid	$1,239.30
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: University Health Alliance Commercial	$1,771.23

BURR 3MM 15 DEG

Facility

$2,430.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,065.50
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: MDX Hawaii PPO	$2,357.10

BURR 3MM X 25MM NEURO 7021-917

Facility

$216.00

Hospital Revenue Code	272
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$129.60
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$209.52

BURR 3MM X 25MM NEURO 7021-917

Facility

$216.00

Hospital Revenue Code	272
Min. Negotiated Rate	$110.16
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$129.60
Rate for Payer: Hawaii Western Management Group Commercial	$205.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$136.08
Rate for Payer: Kaiser Permanente Medicaid	$110.16
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: University Health Alliance Commercial	$157.44

BURR 4.0MM FLAT 180MM LG HIGH

Facility

$444.00

Hospital Revenue Code	272
Min. Negotiated Rate	$377.40
Max. Negotiated Rate	$430.68
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Management Network Commercial	$377.40
Rate for Payer: MDX Hawaii PPO	$430.68

BURR 4.0MM FLAT 180MM LG HIGH

Facility

$444.00

Hospital Revenue Code	272
Min. Negotiated Rate	$226.44
Max. Negotiated Rate	$430.68
Rate for Payer: Cash Price	$266.40
Rate for Payer: Hawaii Western Management Group Commercial	$421.80
Rate for Payer: Health Management Network Commercial	$377.40
Rate for Payer: Kaiser Permanente Commercial	$279.72
Rate for Payer: Kaiser Permanente Medicaid	$226.44
Rate for Payer: MDX Hawaii PPO	$430.68
Rate for Payer: University Health Alliance Commercial	$323.63

BURR 4MM 15 DEG

Facility

$2,160.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,836.00
Max. Negotiated Rate	$2,095.20
Rate for Payer: Cash Price	$1,296.00
Rate for Payer: Health Management Network Commercial	$1,836.00
Rate for Payer: MDX Hawaii PPO	$2,095.20

BURR 4MM 15 DEG

Facility

$2,160.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,101.60
Max. Negotiated Rate	$2,095.20
Rate for Payer: Cash Price	$1,296.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,052.00
Rate for Payer: Health Management Network Commercial	$1,836.00
Rate for Payer: Kaiser Permanente Commercial	$1,360.80
Rate for Payer: Kaiser Permanente Medicaid	$1,101.60
Rate for Payer: MDX Hawaii PPO	$2,095.20
Rate for Payer: University Health Alliance Commercial	$1,574.42

BURR 5.5MMX13CM AR-8550RBE

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$106.08
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$131.04
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: University Health Alliance Commercial	$151.61

BURR 5.5MMX13CM AR-8550RBE

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: MDX Hawaii PPO	$201.76

BUR RND CUTTING 17.5MM 3.1MM

Facility

$275.00

Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$165.00
Rate for Payer: Hawaii Western Management Group Commercial	$261.25
Rate for Payer: Health Management Network Commercial	$233.75
Rate for Payer: Kaiser Permanente Commercial	$173.25
Rate for Payer: Kaiser Permanente Medicaid	$140.25
Rate for Payer: MDX Hawaii PPO	$266.75
Rate for Payer: University Health Alliance Commercial	$200.45

BUR RND CUTTING 17.5MM 3.1MM

Facility

$275.00

Hospital Revenue Code	272
Min. Negotiated Rate	$233.75
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$165.00
Rate for Payer: Health Management Network Commercial	$233.75
Rate for Payer: MDX Hawaii PPO	$266.75

Know your out-of-pocket cost for care.

All Charges