Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR BILIARY TRACT PROCEDURES

Facility

$15,228.06

Service Code	APR-DRG 2613
Min. Negotiated Rate	$15,228.06
Max. Negotiated Rate	$15,228.06
Rate for Payer: AlohaCare Medicaid	$15,228.06
Rate for Payer: Hawaii Medical Service Association ABD	$15,228.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,228.06
Rate for Payer: Kaiser Permanente Medicaid	$15,228.06
Rate for Payer: Ohana Health Plan Medicaid	$15,228.06
Rate for Payer: UnitedHealthcare Medicaid	$15,228.06

MAJOR BILIARY TRACT PROCEDURES

Facility

$25,603.83

Service Code	APR-DRG 2614
Min. Negotiated Rate	$25,603.83
Max. Negotiated Rate	$25,603.83
Rate for Payer: AlohaCare Medicaid	$25,603.83
Rate for Payer: Hawaii Medical Service Association ABD	$25,603.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25,603.83
Rate for Payer: Kaiser Permanente Medicaid	$25,603.83
Rate for Payer: Ohana Health Plan Medicaid	$25,603.83
Rate for Payer: UnitedHealthcare Medicaid	$25,603.83

MAJOR BILIARY TRACT PROCEDURES

Facility

$7,584.68

Service Code	APR-DRG 2611
Min. Negotiated Rate	$7,584.68
Max. Negotiated Rate	$7,584.68
Rate for Payer: AlohaCare Medicaid	$7,584.68
Rate for Payer: Hawaii Medical Service Association ABD	$7,584.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,584.68
Rate for Payer: Kaiser Permanente Medicaid	$7,584.68
Rate for Payer: Ohana Health Plan Medicaid	$7,584.68
Rate for Payer: UnitedHealthcare Medicaid	$7,584.68

MAJOR BLADDER PROCEDURES

Facility

$7,788.19

Service Code	APR-DRG 4411
Min. Negotiated Rate	$7,788.19
Max. Negotiated Rate	$7,788.19
Rate for Payer: AlohaCare Medicaid	$7,788.19
Rate for Payer: Hawaii Medical Service Association ABD	$7,788.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,788.19
Rate for Payer: Kaiser Permanente Medicaid	$7,788.19
Rate for Payer: Ohana Health Plan Medicaid	$7,788.19
Rate for Payer: UnitedHealthcare Medicaid	$7,788.19

MAJOR BLADDER PROCEDURES

Facility

$15,904.47

Service Code	APR-DRG 4413
Min. Negotiated Rate	$15,904.47
Max. Negotiated Rate	$15,904.47
Rate for Payer: AlohaCare Medicaid	$15,904.47
Rate for Payer: Hawaii Medical Service Association ABD	$15,904.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,904.47
Rate for Payer: Kaiser Permanente Medicaid	$15,904.47
Rate for Payer: Ohana Health Plan Medicaid	$15,904.47
Rate for Payer: UnitedHealthcare Medicaid	$15,904.47

MAJOR BLADDER PROCEDURES

Facility

$31,383.66

Service Code	APR-DRG 4414
Min. Negotiated Rate	$31,383.66
Max. Negotiated Rate	$31,383.66
Rate for Payer: AlohaCare Medicaid	$31,383.66
Rate for Payer: Hawaii Medical Service Association ABD	$31,383.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31,383.66
Rate for Payer: Kaiser Permanente Medicaid	$31,383.66
Rate for Payer: Ohana Health Plan Medicaid	$31,383.66
Rate for Payer: UnitedHealthcare Medicaid	$31,383.66

MAJOR BLADDER PROCEDURES

Facility

$12,404.35

Service Code	APR-DRG 4412
Min. Negotiated Rate	$12,404.35
Max. Negotiated Rate	$12,404.35
Rate for Payer: AlohaCare Medicaid	$12,404.35
Rate for Payer: Hawaii Medical Service Association ABD	$12,404.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,404.35
Rate for Payer: Kaiser Permanente Medicaid	$12,404.35
Rate for Payer: Ohana Health Plan Medicaid	$12,404.35
Rate for Payer: UnitedHealthcare Medicaid	$12,404.35

MAJOR BLADDER PROCEDURES WITH CC

Facility

$48,287.93

Service Code	MSDRG 654
Min. Negotiated Rate	$31,839.94
Max. Negotiated Rate	$48,287.93
Rate for Payer: AlohaCare Medicare	$31,839.94
Rate for Payer: Devoted Health Medicare	$35,023.93
Rate for Payer: Hawaii Medical Service Association Commercial	$46,881.91
Rate for Payer: Hawaii Medical Service Association Medicare	$31,839.94
Rate for Payer: Humana Medicare	$31,839.94
Rate for Payer: Kaiser Permanente Commercial	$48,287.93
Rate for Payer: Kaiser Permanente Medicare	$31,839.94
Rate for Payer: Ohana Health Plan Medicare	$31,839.94
Rate for Payer: UnitedHealthcare Medicare	$31,839.94

MAJOR BLADDER PROCEDURES WITH MCC

Facility

$89,637.90

Service Code	MSDRG 653
Min. Negotiated Rate	$46,881.91
Max. Negotiated Rate	$89,637.90
Rate for Payer: AlohaCare Medicare	$59,105.19
Rate for Payer: Devoted Health Medicare	$65,015.71
Rate for Payer: Hawaii Medical Service Association Commercial	$46,881.91
Rate for Payer: Hawaii Medical Service Association Medicare	$59,105.19
Rate for Payer: Humana Medicare	$59,105.19
Rate for Payer: Kaiser Permanente Commercial	$89,637.90
Rate for Payer: Kaiser Permanente Medicare	$59,105.19
Rate for Payer: Ohana Health Plan Medicare	$59,105.19
Rate for Payer: UnitedHealthcare Medicare	$59,105.19

MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$46,881.91

Service Code	MSDRG 655
Min. Negotiated Rate	$24,074.75
Max. Negotiated Rate	$46,881.91
Rate for Payer: AlohaCare Medicare	$24,074.75
Rate for Payer: Devoted Health Medicare	$26,482.22
Rate for Payer: Hawaii Medical Service Association Commercial	$46,881.91
Rate for Payer: Hawaii Medical Service Association Medicare	$24,074.75
Rate for Payer: Humana Medicare	$24,074.75
Rate for Payer: Kaiser Permanente Commercial	$36,511.35
Rate for Payer: Kaiser Permanente Medicare	$24,074.75
Rate for Payer: Ohana Health Plan Medicare	$24,074.75
Rate for Payer: UnitedHealthcare Medicare	$24,074.75

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$20,467.15

Service Code	APR-DRG 1601
Min. Negotiated Rate	$20,467.15
Max. Negotiated Rate	$20,467.15
Rate for Payer: AlohaCare Medicaid	$20,467.15
Rate for Payer: Hawaii Medical Service Association ABD	$20,467.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,467.15
Rate for Payer: Kaiser Permanente Medicaid	$20,467.15
Rate for Payer: Ohana Health Plan Medicaid	$20,467.15
Rate for Payer: UnitedHealthcare Medicaid	$20,467.15

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$30,767.91

Service Code	APR-DRG 1603
Min. Negotiated Rate	$30,767.91
Max. Negotiated Rate	$30,767.91
Rate for Payer: AlohaCare Medicaid	$30,767.91
Rate for Payer: Hawaii Medical Service Association ABD	$30,767.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30,767.91
Rate for Payer: Kaiser Permanente Medicaid	$30,767.91
Rate for Payer: Ohana Health Plan Medicaid	$30,767.91
Rate for Payer: UnitedHealthcare Medicaid	$30,767.91

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$53,563.03

Service Code	APR-DRG 1604
Min. Negotiated Rate	$53,563.03
Max. Negotiated Rate	$53,563.03
Rate for Payer: AlohaCare Medicaid	$53,563.03
Rate for Payer: Hawaii Medical Service Association ABD	$53,563.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53,563.03
Rate for Payer: Kaiser Permanente Medicaid	$53,563.03
Rate for Payer: Ohana Health Plan Medicaid	$53,563.03
Rate for Payer: UnitedHealthcare Medicaid	$53,563.03

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$23,522.41

Service Code	APR-DRG 1602
Min. Negotiated Rate	$23,522.41
Max. Negotiated Rate	$23,522.41
Rate for Payer: AlohaCare Medicaid	$23,522.41
Rate for Payer: Hawaii Medical Service Association ABD	$23,522.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23,522.41
Rate for Payer: Kaiser Permanente Medicaid	$23,522.41
Rate for Payer: Ohana Health Plan Medicaid	$23,522.41
Rate for Payer: UnitedHealthcare Medicaid	$23,522.41

MAJOR CHEST PROCEDURES WITH CC

Facility

$64,717.42

Service Code	MSDRG 164
Min. Negotiated Rate	$28,708.62
Max. Negotiated Rate	$64,717.42
Rate for Payer: AlohaCare Medicare	$28,708.62
Rate for Payer: Devoted Health Medicare	$31,579.48
Rate for Payer: Hawaii Medical Service Association Commercial	$64,717.42
Rate for Payer: Hawaii Medical Service Association Medicare	$28,708.62
Rate for Payer: Humana Medicare	$28,708.62
Rate for Payer: Kaiser Permanente Commercial	$43,539.00
Rate for Payer: Kaiser Permanente Medicare	$28,708.62
Rate for Payer: Ohana Health Plan Medicare	$28,708.62
Rate for Payer: UnitedHealthcare Medicare	$28,708.62

MAJOR CHEST PROCEDURES WITH MCC

Facility

$77,311.05

Service Code	MSDRG 163
Min. Negotiated Rate	$50,977.16
Max. Negotiated Rate	$77,311.05
Rate for Payer: AlohaCare Medicare	$50,977.16
Rate for Payer: Devoted Health Medicare	$56,074.88
Rate for Payer: Hawaii Medical Service Association Commercial	$64,960.08
Rate for Payer: Hawaii Medical Service Association Medicare	$50,977.16
Rate for Payer: Humana Medicare	$50,977.16
Rate for Payer: Kaiser Permanente Commercial	$77,311.05
Rate for Payer: Kaiser Permanente Medicare	$50,977.16
Rate for Payer: Ohana Health Plan Medicare	$50,977.16
Rate for Payer: UnitedHealthcare Medicare	$50,977.16

MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Facility

$46,517.92

Service Code	MSDRG 165
Min. Negotiated Rate	$21,772.60
Max. Negotiated Rate	$46,517.92
Rate for Payer: AlohaCare Medicare	$21,772.60
Rate for Payer: Devoted Health Medicare	$23,949.86
Rate for Payer: Hawaii Medical Service Association Commercial	$46,517.92
Rate for Payer: Hawaii Medical Service Association Medicare	$21,772.60
Rate for Payer: Humana Medicare	$21,772.60
Rate for Payer: Kaiser Permanente Commercial	$33,019.95
Rate for Payer: Kaiser Permanente Medicare	$21,772.60
Rate for Payer: Ohana Health Plan Medicare	$21,772.60
Rate for Payer: UnitedHealthcare Medicare	$21,772.60

MAJOR CHEST & RESPIRATORY TRAUMA

Facility

$11,684.60

Service Code	APR-DRG 1354
Min. Negotiated Rate	$11,684.60
Max. Negotiated Rate	$11,684.60
Rate for Payer: AlohaCare Medicaid	$11,684.60
Rate for Payer: Hawaii Medical Service Association ABD	$11,684.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,684.60
Rate for Payer: Kaiser Permanente Medicaid	$11,684.60
Rate for Payer: Ohana Health Plan Medicaid	$11,684.60
Rate for Payer: UnitedHealthcare Medicaid	$11,684.60

MAJOR CHEST & RESPIRATORY TRAUMA

Facility

$6,893.59

Service Code	APR-DRG 1353
Min. Negotiated Rate	$6,893.59
Max. Negotiated Rate	$6,893.59
Rate for Payer: AlohaCare Medicaid	$6,893.59
Rate for Payer: Hawaii Medical Service Association ABD	$6,893.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,893.59
Rate for Payer: Kaiser Permanente Medicaid	$6,893.59
Rate for Payer: Ohana Health Plan Medicaid	$6,893.59
Rate for Payer: UnitedHealthcare Medicaid	$6,893.59

MAJOR CHEST & RESPIRATORY TRAUMA

Facility

$4,200.66

Service Code	APR-DRG 1351
Min. Negotiated Rate	$4,200.66
Max. Negotiated Rate	$4,200.66
Rate for Payer: AlohaCare Medicaid	$4,200.66
Rate for Payer: Hawaii Medical Service Association ABD	$4,200.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,200.66
Rate for Payer: Kaiser Permanente Medicaid	$4,200.66
Rate for Payer: Ohana Health Plan Medicaid	$4,200.66
Rate for Payer: UnitedHealthcare Medicaid	$4,200.66

MAJOR CHEST & RESPIRATORY TRAUMA

Facility

$4,783.51

Service Code	APR-DRG 1352
Min. Negotiated Rate	$4,783.51
Max. Negotiated Rate	$4,783.51
Rate for Payer: AlohaCare Medicaid	$4,783.51
Rate for Payer: Hawaii Medical Service Association ABD	$4,783.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,783.51
Rate for Payer: Kaiser Permanente Medicaid	$4,783.51
Rate for Payer: Ohana Health Plan Medicaid	$4,783.51
Rate for Payer: UnitedHealthcare Medicaid	$4,783.51

MAJOR CHEST TRAUMA WITH CC

Facility

$20,237.84

Service Code	MSDRG 184
Min. Negotiated Rate	$12,103.34
Max. Negotiated Rate	$20,237.84
Rate for Payer: AlohaCare Medicare	$12,103.34
Rate for Payer: Devoted Health Medicare	$13,313.67
Rate for Payer: Hawaii Medical Service Association Commercial	$20,237.84
Rate for Payer: Hawaii Medical Service Association Medicare	$12,103.34
Rate for Payer: Humana Medicare	$12,103.34
Rate for Payer: Kaiser Permanente Commercial	$18,355.72
Rate for Payer: Kaiser Permanente Medicare	$12,103.34
Rate for Payer: Ohana Health Plan Medicare	$12,103.34
Rate for Payer: UnitedHealthcare Medicare	$12,103.34

MAJOR CHEST TRAUMA WITH MCC

Facility

$26,390.78

Service Code	MSDRG 183
Min. Negotiated Rate	$17,401.48
Max. Negotiated Rate	$26,390.78
Rate for Payer: AlohaCare Medicare	$17,401.48
Rate for Payer: Devoted Health Medicare	$19,141.63
Rate for Payer: Hawaii Medical Service Association Commercial	$22,033.53
Rate for Payer: Hawaii Medical Service Association Medicare	$17,401.48
Rate for Payer: Humana Medicare	$17,401.48
Rate for Payer: Kaiser Permanente Commercial	$26,390.78
Rate for Payer: Kaiser Permanente Medicare	$17,401.48
Rate for Payer: Ohana Health Plan Medicare	$17,401.48
Rate for Payer: UnitedHealthcare Medicare	$17,401.48

MAJOR CHEST TRAUMA WITHOUT CC/MCC

Facility

$19,340.00

Service Code	MSDRG 185
Min. Negotiated Rate	$8,945.86
Max. Negotiated Rate	$19,340.00
Rate for Payer: AlohaCare Medicare	$8,945.86
Rate for Payer: Devoted Health Medicare	$9,840.45
Rate for Payer: Hawaii Medical Service Association Commercial	$19,340.00
Rate for Payer: Hawaii Medical Service Association Medicare	$8,945.86
Rate for Payer: Humana Medicare	$8,945.86
Rate for Payer: Kaiser Permanente Commercial	$13,567.12
Rate for Payer: Kaiser Permanente Medicare	$8,945.86
Rate for Payer: Ohana Health Plan Medicare	$8,945.86
Rate for Payer: UnitedHealthcare Medicare	$8,945.86

MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$8,866.40

Service Code	APR-DRG 0891
Min. Negotiated Rate	$8,866.40
Max. Negotiated Rate	$8,866.40
Rate for Payer: AlohaCare Medicaid	$8,866.40
Rate for Payer: Hawaii Medical Service Association ABD	$8,866.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,866.40
Rate for Payer: Kaiser Permanente Medicaid	$8,866.40
Rate for Payer: Ohana Health Plan Medicaid	$8,866.40
Rate for Payer: UnitedHealthcare Medicaid	$8,866.40

Know your out-of-pocket cost for care.

All Charges