Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$21,014.36

Service Code	MSDRG 696
Min. Negotiated Rate	$7,836.85
Max. Negotiated Rate	$21,014.36
Rate for Payer: AlohaCare Medicare	$7,836.85
Rate for Payer: Devoted Health Medicare	$8,620.53
Rate for Payer: Hawaii Medical Service Association Commercial	$21,014.36
Rate for Payer: Hawaii Medical Service Association Medicare	$7,836.85
Rate for Payer: Humana Medicare	$7,836.85
Rate for Payer: Kaiser Permanente Commercial	$11,885.25
Rate for Payer: Kaiser Permanente Medicare	$7,836.85
Rate for Payer: Ohana Health Plan Medicare	$7,836.85
Rate for Payer: UnitedHealthcare Medicare	$7,836.85

KIDNEY TRANSPLANT

Facility

$158,408.45

Service Code	MSDRG 652
Min. Negotiated Rate	$36,733.15
Max. Negotiated Rate	$158,408.45
Rate for Payer: AlohaCare Medicare	$36,733.15
Rate for Payer: Devoted Health Medicare	$40,406.46
Rate for Payer: Hawaii Medical Service Association Commercial	$158,408.45
Rate for Payer: Hawaii Medical Service Association Medicare	$36,733.15
Rate for Payer: Kaiser Permanente Commercial	$55,708.88
Rate for Payer: Kaiser Permanente Medicare	$36,733.15
Rate for Payer: Ohana Health Plan Medicare	$36,733.15
Rate for Payer: UnitedHealthcare Medicare	$36,733.15

KIDNEY TRANSPLANT

Facility

$27,198.65

Service Code	APR-DRG 4402
Min. Negotiated Rate	$27,198.65
Max. Negotiated Rate	$27,198.65
Rate for Payer: AlohaCare Medicaid	$27,198.65
Rate for Payer: Hawaii Medical Service Association ABD	$27,198.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27,198.65
Rate for Payer: Kaiser Permanente Medicaid	$27,198.65
Rate for Payer: Ohana Health Plan Medicaid	$27,198.65
Rate for Payer: UnitedHealthcare Medicaid	$27,198.65

KIDNEY TRANSPLANT

Facility

$24,484.52

Service Code	APR-DRG 4401
Min. Negotiated Rate	$24,484.52
Max. Negotiated Rate	$24,484.52
Rate for Payer: AlohaCare Medicaid	$24,484.52
Rate for Payer: Hawaii Medical Service Association ABD	$24,484.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24,484.52
Rate for Payer: Kaiser Permanente Medicaid	$24,484.52
Rate for Payer: Ohana Health Plan Medicaid	$24,484.52
Rate for Payer: UnitedHealthcare Medicaid	$24,484.52

KIDNEY TRANSPLANT

Facility

$47,914.31

Service Code	APR-DRG 4404
Min. Negotiated Rate	$47,914.31
Max. Negotiated Rate	$47,914.31
Rate for Payer: AlohaCare Medicaid	$47,914.31
Rate for Payer: Hawaii Medical Service Association ABD	$47,914.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$47,914.31
Rate for Payer: Kaiser Permanente Medicaid	$47,914.31
Rate for Payer: Ohana Health Plan Medicaid	$47,914.31
Rate for Payer: UnitedHealthcare Medicaid	$47,914.31

KIDNEY TRANSPLANT

Facility

$32,553.84

Service Code	APR-DRG 4403
Min. Negotiated Rate	$32,553.84
Max. Negotiated Rate	$32,553.84
Rate for Payer: AlohaCare Medicaid	$32,553.84
Rate for Payer: Hawaii Medical Service Association ABD	$32,553.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$32,553.84
Rate for Payer: Kaiser Permanente Medicaid	$32,553.84
Rate for Payer: Ohana Health Plan Medicaid	$32,553.84
Rate for Payer: UnitedHealthcare Medicaid	$32,553.84

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$158,408.45

Service Code	MSDRG 650
Min. Negotiated Rate	$53,474.93
Max. Negotiated Rate	$158,408.45
Rate for Payer: AlohaCare Medicare	$53,474.93
Rate for Payer: Devoted Health Medicare	$58,822.42
Rate for Payer: Hawaii Medical Service Association Commercial	$158,408.45
Rate for Payer: Hawaii Medical Service Association Medicare	$53,474.93
Rate for Payer: Humana Medicare	$53,474.93
Rate for Payer: Kaiser Permanente Commercial	$81,099.15
Rate for Payer: Kaiser Permanente Medicare	$53,474.93
Rate for Payer: Ohana Health Plan Medicare	$53,474.93
Rate for Payer: UnitedHealthcare Medicare	$53,474.93

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$158,408.45

Service Code	MSDRG 651
Min. Negotiated Rate	$42,150.71
Max. Negotiated Rate	$158,408.45
Rate for Payer: AlohaCare Medicare	$42,150.71
Rate for Payer: Devoted Health Medicare	$46,365.78
Rate for Payer: Hawaii Medical Service Association Commercial	$158,408.45
Rate for Payer: Hawaii Medical Service Association Medicare	$42,150.71
Rate for Payer: Humana Medicare	$42,150.71
Rate for Payer: Kaiser Permanente Commercial	$63,925.05
Rate for Payer: Kaiser Permanente Medicare	$42,150.71
Rate for Payer: Ohana Health Plan Medicare	$42,150.71
Rate for Payer: UnitedHealthcare Medicare	$42,150.71

KIDNEY & URINARY TRACT INFECTIONS

Facility

$2,513.22

Service Code	APR-DRG 4631
Min. Negotiated Rate	$2,513.22
Max. Negotiated Rate	$2,513.22
Rate for Payer: AlohaCare Medicaid	$2,513.22
Rate for Payer: Hawaii Medical Service Association ABD	$2,513.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,513.22
Rate for Payer: Kaiser Permanente Medicaid	$2,513.22
Rate for Payer: Ohana Health Plan Medicaid	$2,513.22
Rate for Payer: UnitedHealthcare Medicaid	$2,513.22

KIDNEY & URINARY TRACT INFECTIONS

Facility

$6,871.74

Service Code	APR-DRG 4634
Min. Negotiated Rate	$6,871.74
Max. Negotiated Rate	$6,871.74
Rate for Payer: AlohaCare Medicaid	$6,871.74
Rate for Payer: Hawaii Medical Service Association ABD	$6,871.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,871.74
Rate for Payer: Kaiser Permanente Medicaid	$6,871.74
Rate for Payer: Ohana Health Plan Medicaid	$6,871.74
Rate for Payer: UnitedHealthcare Medicaid	$6,871.74

KIDNEY & URINARY TRACT INFECTIONS

Facility

$4,143.92

Service Code	APR-DRG 4633
Min. Negotiated Rate	$4,143.92
Max. Negotiated Rate	$4,143.92
Rate for Payer: AlohaCare Medicaid	$4,143.92
Rate for Payer: Hawaii Medical Service Association ABD	$4,143.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,143.92
Rate for Payer: Kaiser Permanente Medicaid	$4,143.92
Rate for Payer: Ohana Health Plan Medicaid	$4,143.92
Rate for Payer: UnitedHealthcare Medicaid	$4,143.92

KIDNEY & URINARY TRACT INFECTIONS

Facility

$3,113.97

Service Code	APR-DRG 4632
Min. Negotiated Rate	$3,113.97
Max. Negotiated Rate	$3,113.97
Rate for Payer: AlohaCare Medicaid	$3,113.97
Rate for Payer: Hawaii Medical Service Association ABD	$3,113.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,113.97
Rate for Payer: Kaiser Permanente Medicaid	$3,113.97
Rate for Payer: Ohana Health Plan Medicaid	$3,113.97
Rate for Payer: UnitedHealthcare Medicaid	$3,113.97

KIDNEY & URINARY TRACT MALIGNANCY

Facility

$9,504.98

Service Code	APR-DRG 4614
Min. Negotiated Rate	$9,504.98
Max. Negotiated Rate	$9,504.98
Rate for Payer: AlohaCare Medicaid	$9,504.98
Rate for Payer: Hawaii Medical Service Association ABD	$9,504.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,504.98
Rate for Payer: Kaiser Permanente Medicaid	$9,504.98
Rate for Payer: Ohana Health Plan Medicaid	$9,504.98
Rate for Payer: UnitedHealthcare Medicaid	$9,504.98

KIDNEY & URINARY TRACT MALIGNANCY

Facility

$4,092.39

Service Code	APR-DRG 4612
Min. Negotiated Rate	$4,092.39
Max. Negotiated Rate	$4,092.39
Rate for Payer: AlohaCare Medicaid	$4,092.39
Rate for Payer: Hawaii Medical Service Association ABD	$4,092.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,092.39
Rate for Payer: Kaiser Permanente Medicaid	$4,092.39
Rate for Payer: Ohana Health Plan Medicaid	$4,092.39
Rate for Payer: UnitedHealthcare Medicaid	$4,092.39

KIDNEY & URINARY TRACT MALIGNANCY

Facility

$3,647.53

Service Code	APR-DRG 4611
Min. Negotiated Rate	$3,647.53
Max. Negotiated Rate	$3,647.53
Rate for Payer: AlohaCare Medicaid	$3,647.53
Rate for Payer: Hawaii Medical Service Association ABD	$3,647.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,647.53
Rate for Payer: Kaiser Permanente Medicaid	$3,647.53
Rate for Payer: Ohana Health Plan Medicaid	$3,647.53
Rate for Payer: UnitedHealthcare Medicaid	$3,647.53

KIDNEY & URINARY TRACT MALIGNANCY

Facility

$6,012.69

Service Code	APR-DRG 4613
Min. Negotiated Rate	$6,012.69
Max. Negotiated Rate	$6,012.69
Rate for Payer: AlohaCare Medicaid	$6,012.69
Rate for Payer: Hawaii Medical Service Association ABD	$6,012.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,012.69
Rate for Payer: Kaiser Permanente Medicaid	$6,012.69
Rate for Payer: Ohana Health Plan Medicaid	$6,012.69
Rate for Payer: UnitedHealthcare Medicaid	$6,012.69

KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$7,504.45

Service Code	APR-DRG 4421
Min. Negotiated Rate	$7,504.45
Max. Negotiated Rate	$7,504.45
Rate for Payer: AlohaCare Medicaid	$7,504.45
Rate for Payer: Hawaii Medical Service Association ABD	$7,504.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,504.45
Rate for Payer: Kaiser Permanente Medicaid	$7,504.45
Rate for Payer: Ohana Health Plan Medicaid	$7,504.45
Rate for Payer: UnitedHealthcare Medicaid	$7,504.45

KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$21,980.43

Service Code	APR-DRG 4424
Min. Negotiated Rate	$21,980.43
Max. Negotiated Rate	$21,980.43
Rate for Payer: AlohaCare Medicaid	$21,980.43
Rate for Payer: Hawaii Medical Service Association ABD	$21,980.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,980.43
Rate for Payer: Kaiser Permanente Medicaid	$21,980.43
Rate for Payer: Ohana Health Plan Medicaid	$21,980.43
Rate for Payer: UnitedHealthcare Medicaid	$21,980.43

KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$13,012.27

Service Code	APR-DRG 4423
Min. Negotiated Rate	$13,012.27
Max. Negotiated Rate	$13,012.27
Rate for Payer: AlohaCare Medicaid	$13,012.27
Rate for Payer: Hawaii Medical Service Association ABD	$13,012.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,012.27
Rate for Payer: Kaiser Permanente Medicaid	$13,012.27
Rate for Payer: Ohana Health Plan Medicaid	$13,012.27
Rate for Payer: UnitedHealthcare Medicaid	$13,012.27

KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$8,745.73

Service Code	APR-DRG 4422
Min. Negotiated Rate	$8,745.73
Max. Negotiated Rate	$8,745.73
Rate for Payer: AlohaCare Medicaid	$8,745.73
Rate for Payer: Hawaii Medical Service Association ABD	$8,745.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,745.73
Rate for Payer: Kaiser Permanente Medicaid	$8,745.73
Rate for Payer: Ohana Health Plan Medicaid	$8,745.73
Rate for Payer: UnitedHealthcare Medicaid	$8,745.73

KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$10,566.24

Service Code	APR-DRG 4433
Min. Negotiated Rate	$10,566.24
Max. Negotiated Rate	$10,566.24
Rate for Payer: AlohaCare Medicaid	$10,566.24
Rate for Payer: Hawaii Medical Service Association ABD	$10,566.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,566.24
Rate for Payer: Kaiser Permanente Medicaid	$10,566.24
Rate for Payer: Ohana Health Plan Medicaid	$10,566.24
Rate for Payer: UnitedHealthcare Medicaid	$10,566.24

KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$7,319.20

Service Code	APR-DRG 4432
Min. Negotiated Rate	$7,319.20
Max. Negotiated Rate	$7,319.20
Rate for Payer: AlohaCare Medicaid	$7,319.20
Rate for Payer: Hawaii Medical Service Association ABD	$7,319.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,319.20
Rate for Payer: Kaiser Permanente Medicaid	$7,319.20
Rate for Payer: Ohana Health Plan Medicaid	$7,319.20
Rate for Payer: UnitedHealthcare Medicaid	$7,319.20

KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$6,075.31

Service Code	APR-DRG 4431
Min. Negotiated Rate	$6,075.31
Max. Negotiated Rate	$6,075.31
Rate for Payer: AlohaCare Medicaid	$6,075.31
Rate for Payer: Hawaii Medical Service Association ABD	$6,075.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,075.31
Rate for Payer: Kaiser Permanente Medicaid	$6,075.31
Rate for Payer: Ohana Health Plan Medicaid	$6,075.31
Rate for Payer: UnitedHealthcare Medicaid	$6,075.31

KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$19,430.68

Service Code	APR-DRG 4434
Min. Negotiated Rate	$19,430.68
Max. Negotiated Rate	$19,430.68
Rate for Payer: AlohaCare Medicaid	$19,430.68
Rate for Payer: Hawaii Medical Service Association ABD	$19,430.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,430.68
Rate for Payer: Kaiser Permanente Medicaid	$19,430.68
Rate for Payer: Ohana Health Plan Medicaid	$19,430.68
Rate for Payer: UnitedHealthcare Medicaid	$19,430.68

KII FIOS OBTURATOR 5X100 CTF03

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$349.20

Know your out-of-pocket cost for care.

All Charges