Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$38,086.28

Service Code	MSDRG 808
Min. Negotiated Rate	$25,113.23
Max. Negotiated Rate	$38,086.28
Rate for Payer: AlohaCare Medicare	$25,113.23
Rate for Payer: Devoted Health Medicare	$27,624.55
Rate for Payer: Hawaii Medical Service Association Commercial	$35,743.82
Rate for Payer: Hawaii Medical Service Association Medicare	$25,113.23
Rate for Payer: Humana Medicare	$25,113.23
Rate for Payer: Kaiser Permanente Commercial	$38,086.28
Rate for Payer: Kaiser Permanente Medicare	$25,113.23
Rate for Payer: Ohana Health Plan Medicare	$25,113.23
Rate for Payer: UnitedHealthcare Medicare	$25,113.23

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility

$35,743.82

Service Code	MSDRG 810
Min. Negotiated Rate	$11,904.30
Max. Negotiated Rate	$35,743.82
Rate for Payer: AlohaCare Medicare	$11,904.30
Rate for Payer: Devoted Health Medicare	$13,094.73
Rate for Payer: Hawaii Medical Service Association Commercial	$35,743.82
Rate for Payer: Hawaii Medical Service Association Medicare	$11,904.30
Rate for Payer: Humana Medicare	$11,904.30
Rate for Payer: Kaiser Permanente Commercial	$18,053.85
Rate for Payer: Kaiser Permanente Medicare	$11,904.30
Rate for Payer: Ohana Health Plan Medicare	$11,904.30
Rate for Payer: UnitedHealthcare Medicare	$11,904.30

MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility

$4,111.95

Service Code	APR-DRG 6602
Min. Negotiated Rate	$4,111.95
Max. Negotiated Rate	$4,111.95
Rate for Payer: AlohaCare Medicaid	$4,111.95
Rate for Payer: Hawaii Medical Service Association ABD	$4,111.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,111.95
Rate for Payer: Kaiser Permanente Medicaid	$4,111.95
Rate for Payer: Ohana Health Plan Medicaid	$4,111.95
Rate for Payer: UnitedHealthcare Medicaid	$4,111.95

MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility

$3,289.43

Service Code	APR-DRG 6601
Min. Negotiated Rate	$3,289.43
Max. Negotiated Rate	$3,289.43
Rate for Payer: AlohaCare Medicaid	$3,289.43
Rate for Payer: Hawaii Medical Service Association ABD	$3,289.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,289.43
Rate for Payer: Kaiser Permanente Medicaid	$3,289.43
Rate for Payer: Ohana Health Plan Medicaid	$3,289.43
Rate for Payer: UnitedHealthcare Medicaid	$3,289.43

MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility

$14,504.68

Service Code	APR-DRG 6604
Min. Negotiated Rate	$14,504.68
Max. Negotiated Rate	$14,504.68
Rate for Payer: AlohaCare Medicaid	$14,504.68
Rate for Payer: Hawaii Medical Service Association ABD	$14,504.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,504.68
Rate for Payer: Kaiser Permanente Medicaid	$14,504.68
Rate for Payer: Ohana Health Plan Medicaid	$14,504.68
Rate for Payer: UnitedHealthcare Medicaid	$14,504.68

MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility

$6,582.78

Service Code	APR-DRG 6603
Min. Negotiated Rate	$6,582.78
Max. Negotiated Rate	$6,582.78
Rate for Payer: AlohaCare Medicaid	$6,582.78
Rate for Payer: Hawaii Medical Service Association ABD	$6,582.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,582.78
Rate for Payer: Kaiser Permanente Medicaid	$6,582.78
Rate for Payer: Ohana Health Plan Medicaid	$6,582.78
Rate for Payer: UnitedHealthcare Medicaid	$6,582.78

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$52,322.70

Service Code	MSDRG 469
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$52,322.70
Rate for Payer: AlohaCare Medicare	$34,500.39
Rate for Payer: Devoted Health Medicare	$37,950.43
Rate for Payer: Hawaii Medical Service Association Commercial	$41,931.65
Rate for Payer: Hawaii Medical Service Association Medicare	$34,500.39
Rate for Payer: Humana Medicare	$34,500.39
Rate for Payer: Kaiser Permanente Commercial	$52,322.70
Rate for Payer: Kaiser Permanente Medicare	$34,500.39
Rate for Payer: Ohana Health Plan Medicare	$34,500.39
Rate for Payer: UnitedHealthcare Medicare	$34,500.39
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$33,273.53

Service Code	MSDRG 470
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$33,273.53
Rate for Payer: AlohaCare Medicare	$21,939.80
Rate for Payer: Devoted Health Medicare	$24,133.78
Rate for Payer: Hawaii Medical Service Association Commercial	$28,464.02
Rate for Payer: Hawaii Medical Service Association Medicare	$21,939.80
Rate for Payer: Humana Medicare	$21,939.80
Rate for Payer: Kaiser Permanente Commercial	$33,273.53
Rate for Payer: Kaiser Permanente Medicare	$21,939.80
Rate for Payer: Ohana Health Plan Medicare	$21,939.80
Rate for Payer: UnitedHealthcare Medicare	$21,939.80
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$47,815.28

Service Code	MSDRG 483
Min. Negotiated Rate	$31,528.29
Max. Negotiated Rate	$47,815.28
Rate for Payer: AlohaCare Medicare	$31,528.29
Rate for Payer: Devoted Health Medicare	$34,681.12
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.90
Rate for Payer: Hawaii Medical Service Association Medicare	$31,528.29
Rate for Payer: Humana Medicare	$31,528.29
Rate for Payer: Kaiser Permanente Commercial	$47,815.28
Rate for Payer: Kaiser Permanente Medicare	$31,528.29
Rate for Payer: Ohana Health Plan Medicare	$31,528.29
Rate for Payer: UnitedHealthcare Medicare	$31,528.29

MAJOR LARGE BOWEL PROCEDURES

Facility

$9,860.47

Service Code	APR-DRG 2312
Min. Negotiated Rate	$9,860.47
Max. Negotiated Rate	$9,860.47
Rate for Payer: AlohaCare Medicaid	$9,860.47
Rate for Payer: Hawaii Medical Service Association ABD	$9,860.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,860.47
Rate for Payer: Kaiser Permanente Medicaid	$9,860.47
Rate for Payer: Ohana Health Plan Medicaid	$9,860.47
Rate for Payer: UnitedHealthcare Medicaid	$9,860.47

MAJOR LARGE BOWEL PROCEDURES

Facility

$14,588.83

Service Code	APR-DRG 2313
Min. Negotiated Rate	$14,588.83
Max. Negotiated Rate	$14,588.83
Rate for Payer: AlohaCare Medicaid	$14,588.83
Rate for Payer: Hawaii Medical Service Association ABD	$14,588.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,588.83
Rate for Payer: Kaiser Permanente Medicaid	$14,588.83
Rate for Payer: Ohana Health Plan Medicaid	$14,588.83
Rate for Payer: UnitedHealthcare Medicaid	$14,588.83

MAJOR LARGE BOWEL PROCEDURES

Facility

$23,789.85

Service Code	APR-DRG 2314
Min. Negotiated Rate	$23,789.85
Max. Negotiated Rate	$23,789.85
Rate for Payer: AlohaCare Medicaid	$23,789.85
Rate for Payer: Hawaii Medical Service Association ABD	$23,789.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23,789.85
Rate for Payer: Kaiser Permanente Medicaid	$23,789.85
Rate for Payer: Ohana Health Plan Medicaid	$23,789.85
Rate for Payer: UnitedHealthcare Medicaid	$23,789.85

MAJOR LARGE BOWEL PROCEDURES

Facility

$7,865.16

Service Code	APR-DRG 2311
Min. Negotiated Rate	$7,865.16
Max. Negotiated Rate	$7,865.16
Rate for Payer: AlohaCare Medicaid	$7,865.16
Rate for Payer: Hawaii Medical Service Association ABD	$7,865.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,865.16
Rate for Payer: Kaiser Permanente Medicaid	$7,865.16
Rate for Payer: Ohana Health Plan Medicaid	$7,865.16
Rate for Payer: UnitedHealthcare Medicaid	$7,865.16

MAJOR MALE PELVIC PROCEDURES

Facility

$11,787.95

Service Code	APR-DRG 4803
Min. Negotiated Rate	$11,787.95
Max. Negotiated Rate	$11,787.95
Rate for Payer: AlohaCare Medicaid	$11,787.95
Rate for Payer: Hawaii Medical Service Association ABD	$11,787.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,787.95
Rate for Payer: Kaiser Permanente Medicaid	$11,787.95
Rate for Payer: Ohana Health Plan Medicaid	$11,787.95
Rate for Payer: UnitedHealthcare Medicaid	$11,787.95

MAJOR MALE PELVIC PROCEDURES

Facility

$7,570.98

Service Code	APR-DRG 4802
Min. Negotiated Rate	$7,570.98
Max. Negotiated Rate	$7,570.98
Rate for Payer: AlohaCare Medicaid	$7,570.98
Rate for Payer: Hawaii Medical Service Association ABD	$7,570.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,570.98
Rate for Payer: Kaiser Permanente Medicaid	$7,570.98
Rate for Payer: Ohana Health Plan Medicaid	$7,570.98
Rate for Payer: UnitedHealthcare Medicaid	$7,570.98

MAJOR MALE PELVIC PROCEDURES

Facility

$20,876.78

Service Code	APR-DRG 4804
Min. Negotiated Rate	$20,876.78
Max. Negotiated Rate	$20,876.78
Rate for Payer: AlohaCare Medicaid	$20,876.78
Rate for Payer: Hawaii Medical Service Association ABD	$20,876.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,876.78
Rate for Payer: Kaiser Permanente Medicaid	$20,876.78
Rate for Payer: Ohana Health Plan Medicaid	$20,876.78
Rate for Payer: UnitedHealthcare Medicaid	$20,876.78

MAJOR MALE PELVIC PROCEDURES

Facility

$6,569.73

Service Code	APR-DRG 4801
Min. Negotiated Rate	$6,569.73
Max. Negotiated Rate	$6,569.73
Rate for Payer: AlohaCare Medicaid	$6,569.73
Rate for Payer: Hawaii Medical Service Association ABD	$6,569.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,569.73
Rate for Payer: Kaiser Permanente Medicaid	$6,569.73
Rate for Payer: Ohana Health Plan Medicaid	$6,569.73
Rate for Payer: UnitedHealthcare Medicaid	$6,569.73

MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$34,505.18

Service Code	MSDRG 707
Min. Negotiated Rate	$22,751.93
Max. Negotiated Rate	$34,505.18
Rate for Payer: AlohaCare Medicare	$22,751.93
Rate for Payer: Devoted Health Medicare	$25,027.12
Rate for Payer: Hawaii Medical Service Association Commercial	$31,691.40
Rate for Payer: Hawaii Medical Service Association Medicare	$22,751.93
Rate for Payer: Humana Medicare	$22,751.93
Rate for Payer: Kaiser Permanente Commercial	$34,505.18
Rate for Payer: Kaiser Permanente Medicare	$22,751.93
Rate for Payer: Ohana Health Plan Medicare	$22,751.93
Rate for Payer: UnitedHealthcare Medicare	$22,751.93

MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$28,803.74

Service Code	MSDRG 708
Min. Negotiated Rate	$17,450.38
Max. Negotiated Rate	$28,803.74
Rate for Payer: AlohaCare Medicare	$17,450.38
Rate for Payer: Devoted Health Medicare	$19,195.42
Rate for Payer: Hawaii Medical Service Association Commercial	$28,803.74
Rate for Payer: Hawaii Medical Service Association Medicare	$17,450.38
Rate for Payer: Humana Medicare	$17,450.38
Rate for Payer: Kaiser Permanente Commercial	$26,464.95
Rate for Payer: Kaiser Permanente Medicare	$17,450.38
Rate for Payer: Ohana Health Plan Medicare	$17,450.38
Rate for Payer: UnitedHealthcare Medicare	$17,450.38

MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$32,693.43

Service Code	APR-DRG 6804
Min. Negotiated Rate	$32,693.43
Max. Negotiated Rate	$32,693.43
Rate for Payer: AlohaCare Medicaid	$32,693.43
Rate for Payer: Hawaii Medical Service Association ABD	$32,693.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$32,693.43
Rate for Payer: Kaiser Permanente Medicaid	$32,693.43
Rate for Payer: Ohana Health Plan Medicaid	$32,693.43
Rate for Payer: UnitedHealthcare Medicaid	$32,693.43

MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$8,197.82

Service Code	APR-DRG 6801
Min. Negotiated Rate	$8,197.82
Max. Negotiated Rate	$8,197.82
Rate for Payer: AlohaCare Medicaid	$8,197.82
Rate for Payer: Hawaii Medical Service Association ABD	$8,197.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,197.82
Rate for Payer: Kaiser Permanente Medicaid	$8,197.82
Rate for Payer: Ohana Health Plan Medicaid	$8,197.82
Rate for Payer: UnitedHealthcare Medicaid	$8,197.82

MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$11,255.04

Service Code	APR-DRG 6802
Min. Negotiated Rate	$11,255.04
Max. Negotiated Rate	$11,255.04
Rate for Payer: AlohaCare Medicaid	$11,255.04
Rate for Payer: Hawaii Medical Service Association ABD	$11,255.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,255.04
Rate for Payer: Kaiser Permanente Medicaid	$11,255.04
Rate for Payer: Ohana Health Plan Medicaid	$11,255.04
Rate for Payer: UnitedHealthcare Medicaid	$11,255.04

MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$17,604.30

Service Code	APR-DRG 6803
Min. Negotiated Rate	$17,604.30
Max. Negotiated Rate	$17,604.30
Rate for Payer: AlohaCare Medicaid	$17,604.30
Rate for Payer: Hawaii Medical Service Association ABD	$17,604.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,604.30
Rate for Payer: Kaiser Permanente Medicaid	$17,604.30
Rate for Payer: Ohana Health Plan Medicaid	$17,604.30
Rate for Payer: UnitedHealthcare Medicaid	$17,604.30

MAJOR PANCREAS, LIVER & SHUNT PROCEDURES

Facility

$9,554.55

Service Code	APR-DRG 2601
Min. Negotiated Rate	$9,554.55
Max. Negotiated Rate	$9,554.55
Rate for Payer: AlohaCare Medicaid	$9,554.55
Rate for Payer: Hawaii Medical Service Association ABD	$9,554.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,554.55
Rate for Payer: Kaiser Permanente Medicaid	$9,554.55
Rate for Payer: Ohana Health Plan Medicaid	$9,554.55
Rate for Payer: UnitedHealthcare Medicaid	$9,554.55

MAJOR PANCREAS, LIVER & SHUNT PROCEDURES

Facility

$31,992.23

Service Code	APR-DRG 2604
Min. Negotiated Rate	$31,992.23
Max. Negotiated Rate	$31,992.23
Rate for Payer: AlohaCare Medicaid	$31,992.23
Rate for Payer: Hawaii Medical Service Association ABD	$31,992.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31,992.23
Rate for Payer: Kaiser Permanente Medicaid	$31,992.23
Rate for Payer: Ohana Health Plan Medicaid	$31,992.23
Rate for Payer: UnitedHealthcare Medicaid	$31,992.23

Know your out-of-pocket cost for care.

All Charges