Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$31,276.68

Service Code	APR-DRG 0894
Min. Negotiated Rate	$31,276.68
Max. Negotiated Rate	$31,276.68
Rate for Payer: AlohaCare Medicaid	$31,276.68
Rate for Payer: Hawaii Medical Service Association ABD	$31,276.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31,276.68
Rate for Payer: Kaiser Permanente Medicaid	$31,276.68
Rate for Payer: Ohana Health Plan Medicaid	$31,276.68
Rate for Payer: UnitedHealthcare Medicaid	$31,276.68

MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$11,447.46

Service Code	APR-DRG 0892
Min. Negotiated Rate	$11,447.46
Max. Negotiated Rate	$11,447.46
Rate for Payer: AlohaCare Medicaid	$11,447.46
Rate for Payer: Hawaii Medical Service Association ABD	$11,447.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,447.46
Rate for Payer: Kaiser Permanente Medicaid	$11,447.46
Rate for Payer: Ohana Health Plan Medicaid	$11,447.46
Rate for Payer: UnitedHealthcare Medicaid	$11,447.46

MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$18,754.92

Service Code	APR-DRG 0893
Min. Negotiated Rate	$18,754.92
Max. Negotiated Rate	$18,754.92
Rate for Payer: AlohaCare Medicaid	$18,754.92
Rate for Payer: Hawaii Medical Service Association ABD	$18,754.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,754.92
Rate for Payer: Kaiser Permanente Medicaid	$18,754.92
Rate for Payer: Ohana Health Plan Medicaid	$18,754.92
Rate for Payer: UnitedHealthcare Medicaid	$18,754.92

MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES

Facility

$2,920.21

Service Code	APR-DRG 7511
Min. Negotiated Rate	$2,920.21
Max. Negotiated Rate	$2,920.21
Rate for Payer: AlohaCare Medicaid	$2,920.21
Rate for Payer: Hawaii Medical Service Association ABD	$2,920.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,920.21
Rate for Payer: Kaiser Permanente Medicaid	$2,920.21
Rate for Payer: Ohana Health Plan Medicaid	$2,920.21
Rate for Payer: UnitedHealthcare Medicaid	$2,920.21

MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES

Facility

$3,421.29

Service Code	APR-DRG 7512
Min. Negotiated Rate	$3,421.29
Max. Negotiated Rate	$3,421.29
Rate for Payer: AlohaCare Medicaid	$3,421.29
Rate for Payer: Hawaii Medical Service Association ABD	$3,421.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,421.29
Rate for Payer: Kaiser Permanente Medicaid	$3,421.29
Rate for Payer: Ohana Health Plan Medicaid	$3,421.29
Rate for Payer: UnitedHealthcare Medicaid	$3,421.29

MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES

Facility

$5,517.87

Service Code	APR-DRG 7513
Min. Negotiated Rate	$5,517.87
Max. Negotiated Rate	$5,517.87
Rate for Payer: AlohaCare Medicaid	$5,517.87
Rate for Payer: Hawaii Medical Service Association ABD	$5,517.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,517.87
Rate for Payer: Kaiser Permanente Medicaid	$5,517.87
Rate for Payer: Ohana Health Plan Medicaid	$5,517.87
Rate for Payer: UnitedHealthcare Medicaid	$5,517.87

MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES

Facility

$14,103.73

Service Code	APR-DRG 7514
Min. Negotiated Rate	$14,103.73
Max. Negotiated Rate	$14,103.73
Rate for Payer: AlohaCare Medicaid	$14,103.73
Rate for Payer: Hawaii Medical Service Association ABD	$14,103.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,103.73
Rate for Payer: Kaiser Permanente Medicaid	$14,103.73
Rate for Payer: Ohana Health Plan Medicaid	$14,103.73
Rate for Payer: UnitedHealthcare Medicaid	$14,103.73

MAJOR ESOPHAGEAL DISORDERS

Facility

$5,535.87

Service Code	APR-DRG 2423
Min. Negotiated Rate	$5,535.87
Max. Negotiated Rate	$5,535.87
Rate for Payer: AlohaCare Medicaid	$5,535.87
Rate for Payer: Hawaii Medical Service Association ABD	$5,535.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,535.87
Rate for Payer: Kaiser Permanente Medicaid	$5,535.87
Rate for Payer: Ohana Health Plan Medicaid	$5,535.87
Rate for Payer: UnitedHealthcare Medicaid	$5,535.87

MAJOR ESOPHAGEAL DISORDERS

Facility

$10,980.43

Service Code	APR-DRG 2424
Min. Negotiated Rate	$10,980.43
Max. Negotiated Rate	$10,980.43
Rate for Payer: AlohaCare Medicaid	$10,980.43
Rate for Payer: Hawaii Medical Service Association ABD	$10,980.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,980.43
Rate for Payer: Kaiser Permanente Medicaid	$10,980.43
Rate for Payer: Ohana Health Plan Medicaid	$10,980.43
Rate for Payer: UnitedHealthcare Medicaid	$10,980.43

MAJOR ESOPHAGEAL DISORDERS

Facility

$3,005.04

Service Code	APR-DRG 2421
Min. Negotiated Rate	$3,005.04
Max. Negotiated Rate	$3,005.04
Rate for Payer: AlohaCare Medicaid	$3,005.04
Rate for Payer: Hawaii Medical Service Association ABD	$3,005.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,005.04
Rate for Payer: Kaiser Permanente Medicaid	$3,005.04
Rate for Payer: Ohana Health Plan Medicaid	$3,005.04
Rate for Payer: UnitedHealthcare Medicaid	$3,005.04

MAJOR ESOPHAGEAL DISORDERS

Facility

$3,860.18

Service Code	APR-DRG 2422
Min. Negotiated Rate	$3,860.18
Max. Negotiated Rate	$3,860.18
Rate for Payer: AlohaCare Medicaid	$3,860.18
Rate for Payer: Hawaii Medical Service Association ABD	$3,860.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,860.18
Rate for Payer: Kaiser Permanente Medicaid	$3,860.18
Rate for Payer: Ohana Health Plan Medicaid	$3,860.18
Rate for Payer: UnitedHealthcare Medicaid	$3,860.18

MAJOR ESOPHAGEAL DISORDERS WITH CC

Facility

$19,801.06

Service Code	MSDRG 369
Min. Negotiated Rate	$11,376.53
Max. Negotiated Rate	$19,801.06
Rate for Payer: AlohaCare Medicare	$11,376.53
Rate for Payer: Devoted Health Medicare	$12,514.18
Rate for Payer: Hawaii Medical Service Association Commercial	$19,801.06
Rate for Payer: Hawaii Medical Service Association Medicare	$11,376.53
Rate for Payer: Humana Medicare	$11,376.53
Rate for Payer: Kaiser Permanente Commercial	$17,253.45
Rate for Payer: Kaiser Permanente Medicare	$11,376.53
Rate for Payer: Ohana Health Plan Medicare	$11,376.53
Rate for Payer: UnitedHealthcare Medicare	$11,376.53

MAJOR ESOPHAGEAL DISORDERS WITH MCC

Facility

$27,460.28

Service Code	MSDRG 368
Min. Negotiated Rate	$18,106.68
Max. Negotiated Rate	$27,460.28
Rate for Payer: AlohaCare Medicare	$18,106.68
Rate for Payer: Devoted Health Medicare	$19,917.35
Rate for Payer: Hawaii Medical Service Association Commercial	$19,801.06
Rate for Payer: Hawaii Medical Service Association Medicare	$18,106.68
Rate for Payer: Humana Medicare	$18,106.68
Rate for Payer: Kaiser Permanente Commercial	$27,460.28
Rate for Payer: Kaiser Permanente Medicare	$18,106.68
Rate for Payer: Ohana Health Plan Medicare	$18,106.68
Rate for Payer: UnitedHealthcare Medicare	$18,106.68

MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC

Facility

$19,801.06

Service Code	MSDRG 370
Min. Negotiated Rate	$7,971.07
Max. Negotiated Rate	$19,801.06
Rate for Payer: AlohaCare Medicare	$7,971.07
Rate for Payer: Devoted Health Medicare	$8,768.18
Rate for Payer: Hawaii Medical Service Association Commercial	$19,801.06
Rate for Payer: Hawaii Medical Service Association Medicare	$7,971.07
Rate for Payer: Humana Medicare	$7,971.07
Rate for Payer: Kaiser Permanente Commercial	$12,088.80
Rate for Payer: Kaiser Permanente Medicare	$7,971.07
Rate for Payer: Ohana Health Plan Medicare	$7,971.07
Rate for Payer: UnitedHealthcare Medicare	$7,971.07

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC

Facility

$22,518.85

Service Code	MSDRG 372
Min. Negotiated Rate	$11,613.11
Max. Negotiated Rate	$22,518.85
Rate for Payer: AlohaCare Medicare	$11,613.11
Rate for Payer: Devoted Health Medicare	$12,774.42
Rate for Payer: Hawaii Medical Service Association Commercial	$22,518.85
Rate for Payer: Hawaii Medical Service Association Medicare	$11,613.11
Rate for Payer: Humana Medicare	$11,613.11
Rate for Payer: Kaiser Permanente Commercial	$17,612.25
Rate for Payer: Kaiser Permanente Medicare	$11,613.11
Rate for Payer: Ohana Health Plan Medicare	$11,613.11
Rate for Payer: UnitedHealthcare Medicare	$11,613.11

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC

Facility

$30,585.97

Service Code	MSDRG 371
Min. Negotiated Rate	$20,167.68
Max. Negotiated Rate	$30,585.97
Rate for Payer: AlohaCare Medicare	$20,167.68
Rate for Payer: Devoted Health Medicare	$22,184.45
Rate for Payer: Hawaii Medical Service Association Commercial	$22,518.85
Rate for Payer: Hawaii Medical Service Association Medicare	$20,167.68
Rate for Payer: Humana Medicare	$20,167.68
Rate for Payer: Kaiser Permanente Commercial	$30,585.97
Rate for Payer: Kaiser Permanente Medicare	$20,167.68
Rate for Payer: Ohana Health Plan Medicare	$20,167.68
Rate for Payer: UnitedHealthcare Medicare	$20,167.68

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC

Facility

$22,518.85

Service Code	MSDRG 373
Min. Negotiated Rate	$8,273.64
Max. Negotiated Rate	$22,518.85
Rate for Payer: AlohaCare Medicare	$8,273.64
Rate for Payer: Devoted Health Medicare	$9,101.00
Rate for Payer: Hawaii Medical Service Association Commercial	$22,518.85
Rate for Payer: Hawaii Medical Service Association Medicare	$8,273.64
Rate for Payer: Humana Medicare	$8,273.64
Rate for Payer: Kaiser Permanente Commercial	$12,547.65
Rate for Payer: Kaiser Permanente Medicare	$8,273.64
Rate for Payer: Ohana Health Plan Medicare	$8,273.64
Rate for Payer: UnitedHealthcare Medicare	$8,273.64

MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS

Facility

$5,377.37

Service Code	APR-DRG 2483
Min. Negotiated Rate	$5,377.37
Max. Negotiated Rate	$5,377.37
Rate for Payer: AlohaCare Medicaid	$5,377.37
Rate for Payer: Hawaii Medical Service Association ABD	$5,377.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,377.37
Rate for Payer: Kaiser Permanente Medicaid	$5,377.37
Rate for Payer: Ohana Health Plan Medicaid	$5,377.37
Rate for Payer: UnitedHealthcare Medicaid	$5,377.37

MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS

Facility

$2,860.89

Service Code	APR-DRG 2481
Min. Negotiated Rate	$2,860.89
Max. Negotiated Rate	$2,860.89
Rate for Payer: AlohaCare Medicaid	$2,860.89
Rate for Payer: Hawaii Medical Service Association ABD	$2,860.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,860.89
Rate for Payer: Kaiser Permanente Medicaid	$2,860.89
Rate for Payer: Ohana Health Plan Medicaid	$2,860.89
Rate for Payer: UnitedHealthcare Medicaid	$2,860.89

MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS

Facility

$9,847.43

Service Code	APR-DRG 2484
Min. Negotiated Rate	$9,847.43
Max. Negotiated Rate	$9,847.43
Rate for Payer: AlohaCare Medicaid	$9,847.43
Rate for Payer: Hawaii Medical Service Association ABD	$9,847.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,847.43
Rate for Payer: Kaiser Permanente Medicaid	$9,847.43
Rate for Payer: Ohana Health Plan Medicaid	$9,847.43
Rate for Payer: UnitedHealthcare Medicaid	$9,847.43

MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS

Facility

$3,811.25

Service Code	APR-DRG 2482
Min. Negotiated Rate	$3,811.25
Max. Negotiated Rate	$3,811.25
Rate for Payer: AlohaCare Medicaid	$3,811.25
Rate for Payer: Hawaii Medical Service Association ABD	$3,811.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,811.25
Rate for Payer: Kaiser Permanente Medicaid	$3,811.25
Rate for Payer: Ohana Health Plan Medicaid	$3,811.25
Rate for Payer: UnitedHealthcare Medicaid	$3,811.25

MAJOR HEAD AND NECK PROCEDURES WITH CC

Facility

$51,589.52

Service Code	MSDRG 141
Min. Negotiated Rate	$24,808.40
Max. Negotiated Rate	$51,589.52
Rate for Payer: AlohaCare Medicare	$24,808.40
Rate for Payer: Devoted Health Medicare	$27,289.24
Rate for Payer: Hawaii Medical Service Association Commercial	$51,589.52
Rate for Payer: Hawaii Medical Service Association Medicare	$24,808.40
Rate for Payer: Humana Medicare	$24,808.40
Rate for Payer: Kaiser Permanente Commercial	$37,623.97
Rate for Payer: Kaiser Permanente Medicare	$24,808.40
Rate for Payer: Ohana Health Plan Medicare	$24,808.40
Rate for Payer: UnitedHealthcare Medicare	$24,808.40

MAJOR HEAD AND NECK PROCEDURES WITH MCC

Facility

$73,576.43

Service Code	MSDRG 140
Min. Negotiated Rate	$48,514.62
Max. Negotiated Rate	$73,576.43
Rate for Payer: AlohaCare Medicare	$48,514.62
Rate for Payer: Devoted Health Medicare	$53,366.08
Rate for Payer: Hawaii Medical Service Association Commercial	$62,800.41
Rate for Payer: Hawaii Medical Service Association Medicare	$48,514.62
Rate for Payer: Humana Medicare	$48,514.62
Rate for Payer: Kaiser Permanente Commercial	$73,576.43
Rate for Payer: Kaiser Permanente Medicare	$48,514.62
Rate for Payer: Ohana Health Plan Medicare	$48,514.62
Rate for Payer: UnitedHealthcare Medicare	$48,514.62

MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC

Facility

$28,755.21

Service Code	MSDRG 142
Min. Negotiated Rate	$18,157.86
Max. Negotiated Rate	$28,755.21
Rate for Payer: AlohaCare Medicare	$18,157.86
Rate for Payer: Devoted Health Medicare	$19,973.65
Rate for Payer: Hawaii Medical Service Association Commercial	$28,755.21
Rate for Payer: Hawaii Medical Service Association Medicare	$18,157.86
Rate for Payer: Humana Medicare	$18,157.86
Rate for Payer: Kaiser Permanente Commercial	$27,537.90
Rate for Payer: Kaiser Permanente Medicare	$18,157.86
Rate for Payer: Ohana Health Plan Medicare	$18,157.86
Rate for Payer: UnitedHealthcare Medicare	$18,157.86

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility

$35,743.82

Service Code	MSDRG 809
Min. Negotiated Rate	$14,398.66
Max. Negotiated Rate	$35,743.82
Rate for Payer: AlohaCare Medicare	$14,398.66
Rate for Payer: Devoted Health Medicare	$15,838.53
Rate for Payer: Hawaii Medical Service Association Commercial	$35,743.82
Rate for Payer: Hawaii Medical Service Association Medicare	$14,398.66
Rate for Payer: Humana Medicare	$14,398.66
Rate for Payer: Kaiser Permanente Commercial	$21,836.78
Rate for Payer: Kaiser Permanente Medicare	$14,398.66
Rate for Payer: Ohana Health Plan Medicare	$14,398.66
Rate for Payer: UnitedHealthcare Medicare	$14,398.66

Know your out-of-pocket cost for care.

All Charges