Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

ACUTE ANXIETY & DELIRIUM STATES

Facility

$3,758.84

Service Code	APR-DRG 7563
Min. Negotiated Rate	$3,758.84
Max. Negotiated Rate	$3,758.84
Rate for Payer: AlohaCare Medicaid	$3,758.84
Rate for Payer: Hawaii Medical Service Association ABD	$3,758.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,758.84
Rate for Payer: Kaiser Permanente Medicaid	$3,758.84
Rate for Payer: Ohana Health Plan Medicaid	$3,758.84
Rate for Payer: UnitedHealthcare Medicaid	$3,758.84

ACUTE BRONCHITIS & RELATED SYMPTOMS

Facility

$6,759.55

Service Code	APR-DRG 1454
Min. Negotiated Rate	$6,759.55
Max. Negotiated Rate	$6,759.55
Rate for Payer: AlohaCare Medicaid	$6,759.55
Rate for Payer: Hawaii Medical Service Association ABD	$6,759.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,759.55
Rate for Payer: Kaiser Permanente Medicaid	$6,759.55
Rate for Payer: Ohana Health Plan Medicaid	$6,759.55
Rate for Payer: UnitedHealthcare Medicaid	$6,759.55

ACUTE BRONCHITIS & RELATED SYMPTOMS

Facility

$4,138.05

Service Code	APR-DRG 1453
Min. Negotiated Rate	$4,138.05
Max. Negotiated Rate	$4,138.05
Rate for Payer: AlohaCare Medicaid	$4,138.05
Rate for Payer: Hawaii Medical Service Association ABD	$4,138.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,138.05
Rate for Payer: Kaiser Permanente Medicaid	$4,138.05
Rate for Payer: Ohana Health Plan Medicaid	$4,138.05
Rate for Payer: UnitedHealthcare Medicaid	$4,138.05

ACUTE BRONCHITIS & RELATED SYMPTOMS

Facility

$2,547.79

Service Code	APR-DRG 1451
Min. Negotiated Rate	$2,547.79
Max. Negotiated Rate	$2,547.79
Rate for Payer: AlohaCare Medicaid	$2,547.79
Rate for Payer: Hawaii Medical Service Association ABD	$2,547.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,547.79
Rate for Payer: Kaiser Permanente Medicaid	$2,547.79
Rate for Payer: Ohana Health Plan Medicaid	$2,547.79
Rate for Payer: UnitedHealthcare Medicaid	$2,547.79

ACUTE BRONCHITIS & RELATED SYMPTOMS

Facility

$3,100.92

Service Code	APR-DRG 1452
Min. Negotiated Rate	$3,100.92
Max. Negotiated Rate	$3,100.92
Rate for Payer: AlohaCare Medicaid	$3,100.92
Rate for Payer: Hawaii Medical Service Association ABD	$3,100.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,100.92
Rate for Payer: Kaiser Permanente Medicaid	$3,100.92
Rate for Payer: Ohana Health Plan Medicaid	$3,100.92
Rate for Payer: UnitedHealthcare Medicaid	$3,100.92

ACUTE KIDNEY INJURY

Facility

$2,525.62

Service Code	APR-DRG 4691
Min. Negotiated Rate	$2,525.62
Max. Negotiated Rate	$2,525.62
Rate for Payer: AlohaCare Medicaid	$2,525.62
Rate for Payer: Hawaii Medical Service Association ABD	$2,525.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,525.62
Rate for Payer: Kaiser Permanente Medicaid	$2,525.62
Rate for Payer: Ohana Health Plan Medicaid	$2,525.62
Rate for Payer: UnitedHealthcare Medicaid	$2,525.62

ACUTE KIDNEY INJURY

Facility

$9,026.21

Service Code	APR-DRG 4694
Min. Negotiated Rate	$9,026.21
Max. Negotiated Rate	$9,026.21
Rate for Payer: AlohaCare Medicaid	$9,026.21
Rate for Payer: Hawaii Medical Service Association ABD	$9,026.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,026.21
Rate for Payer: Kaiser Permanente Medicaid	$9,026.21
Rate for Payer: Ohana Health Plan Medicaid	$9,026.21
Rate for Payer: UnitedHealthcare Medicaid	$9,026.21

ACUTE KIDNEY INJURY

Facility

$3,242.47

Service Code	APR-DRG 4692
Min. Negotiated Rate	$3,242.47
Max. Negotiated Rate	$3,242.47
Rate for Payer: AlohaCare Medicaid	$3,242.47
Rate for Payer: Hawaii Medical Service Association ABD	$3,242.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,242.47
Rate for Payer: Kaiser Permanente Medicaid	$3,242.47
Rate for Payer: Ohana Health Plan Medicaid	$3,242.47
Rate for Payer: UnitedHealthcare Medicaid	$3,242.47

ACUTE KIDNEY INJURY

Facility

$4,929.91

Service Code	APR-DRG 4693
Min. Negotiated Rate	$4,929.91
Max. Negotiated Rate	$4,929.91
Rate for Payer: AlohaCare Medicaid	$4,929.91
Rate for Payer: Hawaii Medical Service Association ABD	$4,929.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,929.91
Rate for Payer: Kaiser Permanente Medicaid	$4,929.91
Rate for Payer: Ohana Health Plan Medicaid	$4,929.91
Rate for Payer: UnitedHealthcare Medicaid	$4,929.91

ACUTE LEUKEMIA

Facility

$15,199.36

Service Code	APR-DRG 6903
Min. Negotiated Rate	$15,199.36
Max. Negotiated Rate	$15,199.36
Rate for Payer: AlohaCare Medicaid	$15,199.36
Rate for Payer: Hawaii Medical Service Association ABD	$15,199.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,199.36
Rate for Payer: Kaiser Permanente Medicaid	$15,199.36
Rate for Payer: Ohana Health Plan Medicaid	$15,199.36
Rate for Payer: UnitedHealthcare Medicaid	$15,199.36

ACUTE LEUKEMIA

Facility

$5,564.58

Service Code	APR-DRG 6901
Min. Negotiated Rate	$5,564.58
Max. Negotiated Rate	$5,564.58
Rate for Payer: AlohaCare Medicaid	$5,564.58
Rate for Payer: Hawaii Medical Service Association ABD	$5,564.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,564.58
Rate for Payer: Kaiser Permanente Medicaid	$5,564.58
Rate for Payer: Ohana Health Plan Medicaid	$5,564.58
Rate for Payer: UnitedHealthcare Medicaid	$5,564.58

ACUTE LEUKEMIA

Facility

$8,672.02

Service Code	APR-DRG 6902
Min. Negotiated Rate	$8,672.02
Max. Negotiated Rate	$8,672.02
Rate for Payer: AlohaCare Medicaid	$8,672.02
Rate for Payer: Hawaii Medical Service Association ABD	$8,672.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,672.02
Rate for Payer: Kaiser Permanente Medicaid	$8,672.02
Rate for Payer: Ohana Health Plan Medicaid	$8,672.02
Rate for Payer: UnitedHealthcare Medicaid	$8,672.02

ACUTE LEUKEMIA

Facility

$26,076.08

Service Code	APR-DRG 6904
Min. Negotiated Rate	$26,076.08
Max. Negotiated Rate	$26,076.08
Rate for Payer: AlohaCare Medicaid	$26,076.08
Rate for Payer: Hawaii Medical Service Association ABD	$26,076.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,076.08
Rate for Payer: Kaiser Permanente Medicaid	$26,076.08
Rate for Payer: Ohana Health Plan Medicaid	$26,076.08
Rate for Payer: UnitedHealthcare Medicaid	$26,076.08

ACUTE LEUKEMIA WITH CC

Facility

$143,023.80

Service Code	MSDRG 835
Min. Negotiated Rate	$23,724.42
Max. Negotiated Rate	$143,023.80
Rate for Payer: AlohaCare Medicare	$23,724.42
Rate for Payer: Devoted Health Medicare	$26,096.86
Rate for Payer: Hawaii Medical Service Association Commercial	$143,023.80
Rate for Payer: Hawaii Medical Service Association Medicare	$23,724.42
Rate for Payer: Humana Medicare	$23,724.42
Rate for Payer: Kaiser Permanente Commercial	$35,980.05
Rate for Payer: Kaiser Permanente Medicare	$23,724.42
Rate for Payer: Ohana Health Plan Medicare	$23,724.42
Rate for Payer: UnitedHealthcare Medicare	$23,724.42

ACUTE LEUKEMIA WITH MCC

Facility

$143,023.80

Service Code	MSDRG 834
Min. Negotiated Rate	$62,443.53
Max. Negotiated Rate	$143,023.80
Rate for Payer: AlohaCare Medicare	$62,443.53
Rate for Payer: Devoted Health Medicare	$68,687.88
Rate for Payer: Hawaii Medical Service Association Commercial	$143,023.80
Rate for Payer: Hawaii Medical Service Association Medicare	$62,443.53
Rate for Payer: Humana Medicare	$62,443.53
Rate for Payer: Kaiser Permanente Commercial	$94,700.77
Rate for Payer: Kaiser Permanente Medicare	$62,443.53
Rate for Payer: Ohana Health Plan Medicare	$62,443.53
Rate for Payer: UnitedHealthcare Medicare	$62,443.53

ACUTE LEUKEMIA WITH OTHER PROCEDURES

Facility

$149,376.38

Service Code	MSDRG 850
Min. Negotiated Rate	$98,495.37
Max. Negotiated Rate	$149,376.38
Rate for Payer: AlohaCare Medicare	$98,495.37
Rate for Payer: Devoted Health Medicare	$108,344.91
Rate for Payer: Hawaii Medical Service Association Commercial	$143,023.80
Rate for Payer: Hawaii Medical Service Association Medicare	$98,495.37
Rate for Payer: Humana Medicare	$98,495.37
Rate for Payer: Kaiser Permanente Commercial	$149,376.38
Rate for Payer: Kaiser Permanente Medicare	$98,495.37
Rate for Payer: Ohana Health Plan Medicare	$98,495.37
Rate for Payer: UnitedHealthcare Medicare	$98,495.37

ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$143,023.80

Service Code	MSDRG 836
Min. Negotiated Rate	$13,870.91
Max. Negotiated Rate	$143,023.80
Rate for Payer: AlohaCare Medicare	$13,870.91
Rate for Payer: Devoted Health Medicare	$15,258.00
Rate for Payer: Hawaii Medical Service Association Commercial	$143,023.80
Rate for Payer: Hawaii Medical Service Association Medicare	$13,870.91
Rate for Payer: Humana Medicare	$13,870.91
Rate for Payer: Kaiser Permanente Commercial	$21,036.38
Rate for Payer: Kaiser Permanente Medicare	$13,870.91
Rate for Payer: Ohana Health Plan Medicare	$13,870.91
Rate for Payer: UnitedHealthcare Medicare	$13,870.91

ACUTE MAJOR EYE INFECTIONS WITH CC/MCC

Facility

$20,066.92

Service Code	MSDRG 121
Min. Negotiated Rate	$9,342.41
Max. Negotiated Rate	$20,066.92
Rate for Payer: AlohaCare Medicare	$13,231.67
Rate for Payer: Devoted Health Medicare	$14,554.84
Rate for Payer: Hawaii Medical Service Association Commercial	$9,342.41
Rate for Payer: Hawaii Medical Service Association Medicare	$13,231.67
Rate for Payer: Humana Medicare	$13,231.67
Rate for Payer: Kaiser Permanente Commercial	$20,066.92
Rate for Payer: Kaiser Permanente Medicare	$13,231.67
Rate for Payer: Ohana Health Plan Medicare	$13,231.67
Rate for Payer: UnitedHealthcare Medicare	$13,231.67

ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC

Facility

$13,555.05

Service Code	MSDRG 122
Min. Negotiated Rate	$8,937.89
Max. Negotiated Rate	$13,555.05
Rate for Payer: AlohaCare Medicare	$8,937.89
Rate for Payer: Devoted Health Medicare	$9,831.68
Rate for Payer: Hawaii Medical Service Association Commercial	$9,342.41
Rate for Payer: Hawaii Medical Service Association Medicare	$8,937.89
Rate for Payer: Humana Medicare	$8,937.89
Rate for Payer: Kaiser Permanente Commercial	$13,555.05
Rate for Payer: Kaiser Permanente Medicare	$8,937.89
Rate for Payer: Ohana Health Plan Medicare	$8,937.89
Rate for Payer: UnitedHealthcare Medicare	$8,937.89

ACUTE MYOCARDIAL INFARCTION

Facility

$4,179.79

Service Code	APR-DRG 1902
Min. Negotiated Rate	$4,179.79
Max. Negotiated Rate	$4,179.79
Rate for Payer: AlohaCare Medicaid	$4,179.79
Rate for Payer: Hawaii Medical Service Association ABD	$4,179.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,179.79
Rate for Payer: Kaiser Permanente Medicaid	$4,179.79
Rate for Payer: Ohana Health Plan Medicaid	$4,179.79
Rate for Payer: UnitedHealthcare Medicaid	$4,179.79

ACUTE MYOCARDIAL INFARCTION

Facility

$7,773.19

Service Code	APR-DRG 1904
Min. Negotiated Rate	$7,773.19
Max. Negotiated Rate	$7,773.19
Rate for Payer: AlohaCare Medicaid	$7,773.19
Rate for Payer: Hawaii Medical Service Association ABD	$7,773.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,773.19
Rate for Payer: Kaiser Permanente Medicaid	$7,773.19
Rate for Payer: Ohana Health Plan Medicaid	$7,773.19
Rate for Payer: UnitedHealthcare Medicaid	$7,773.19

ACUTE MYOCARDIAL INFARCTION

Facility

$3,517.73

Service Code	APR-DRG 1901
Min. Negotiated Rate	$3,517.73
Max. Negotiated Rate	$3,517.73
Rate for Payer: AlohaCare Medicaid	$3,517.73
Rate for Payer: Hawaii Medical Service Association ABD	$3,517.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,517.73
Rate for Payer: Kaiser Permanente Medicaid	$3,517.73
Rate for Payer: Ohana Health Plan Medicaid	$3,517.73
Rate for Payer: UnitedHealthcare Medicaid	$3,517.73

ACUTE MYOCARDIAL INFARCTION

Facility

$5,515.65

Service Code	APR-DRG 1903
Min. Negotiated Rate	$5,515.65
Max. Negotiated Rate	$5,515.65
Rate for Payer: AlohaCare Medicaid	$5,515.65
Rate for Payer: Hawaii Medical Service Association ABD	$5,515.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,515.65
Rate for Payer: Kaiser Permanente Medicaid	$5,515.65
Rate for Payer: Ohana Health Plan Medicaid	$5,515.65
Rate for Payer: UnitedHealthcare Medicaid	$5,515.65

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC

Facility

$29,628.79

Service Code	MSDRG 281
Min. Negotiated Rate	$10,454.08
Max. Negotiated Rate	$29,628.79
Rate for Payer: AlohaCare Medicare	$10,454.08
Rate for Payer: Devoted Health Medicare	$11,499.49
Rate for Payer: Hawaii Medical Service Association Commercial	$29,628.79
Rate for Payer: Hawaii Medical Service Association Medicare	$10,454.08
Rate for Payer: Humana Medicare	$10,454.08
Rate for Payer: Kaiser Permanente Commercial	$15,854.48
Rate for Payer: Kaiser Permanente Medicare	$10,454.08
Rate for Payer: Ohana Health Plan Medicare	$10,454.08
Rate for Payer: UnitedHealthcare Medicare	$10,454.08

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC

Facility

$34,263.59

Service Code	MSDRG 280
Min. Negotiated Rate	$18,245.44
Max. Negotiated Rate	$34,263.59
Rate for Payer: AlohaCare Medicare	$18,245.44
Rate for Payer: Devoted Health Medicare	$20,069.98
Rate for Payer: Hawaii Medical Service Association Commercial	$34,263.59
Rate for Payer: Hawaii Medical Service Association Medicare	$18,245.44
Rate for Payer: Humana Medicare	$18,245.44
Rate for Payer: Kaiser Permanente Commercial	$27,670.72
Rate for Payer: Kaiser Permanente Medicare	$18,245.44
Rate for Payer: Ohana Health Plan Medicare	$18,245.44
Rate for Payer: UnitedHealthcare Medicare	$18,245.44

Know your out-of-pocket cost for care.

All Charges