Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR PANCREAS, LIVER & SHUNT PROCEDURES

Facility

$12,247.15

Service Code	APR-DRG 2602
Min. Negotiated Rate	$12,247.15
Max. Negotiated Rate	$12,247.15
Rate for Payer: AlohaCare Medicaid	$12,247.15
Rate for Payer: Hawaii Medical Service Association ABD	$12,247.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,247.15
Rate for Payer: Kaiser Permanente Medicaid	$12,247.15
Rate for Payer: Ohana Health Plan Medicaid	$12,247.15
Rate for Payer: UnitedHealthcare Medicaid	$12,247.15

MAJOR PANCREAS, LIVER & SHUNT PROCEDURES

Facility

$17,570.39

Service Code	APR-DRG 2603
Min. Negotiated Rate	$17,570.39
Max. Negotiated Rate	$17,570.39
Rate for Payer: AlohaCare Medicaid	$17,570.39
Rate for Payer: Hawaii Medical Service Association ABD	$17,570.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,570.39
Rate for Payer: Kaiser Permanente Medicaid	$17,570.39
Rate for Payer: Ohana Health Plan Medicaid	$17,570.39
Rate for Payer: UnitedHealthcare Medicaid	$17,570.39

MAJOR RESPIRATORY & CHEST PROCEDURES

Facility

$9,911.35

Service Code	APR-DRG 1201
Min. Negotiated Rate	$9,911.35
Max. Negotiated Rate	$9,911.35
Rate for Payer: AlohaCare Medicaid	$9,911.35
Rate for Payer: Hawaii Medical Service Association ABD	$9,911.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,911.35
Rate for Payer: Kaiser Permanente Medicaid	$9,911.35
Rate for Payer: Ohana Health Plan Medicaid	$9,911.35
Rate for Payer: UnitedHealthcare Medicaid	$9,911.35

MAJOR RESPIRATORY & CHEST PROCEDURES

Facility

$30,830.52

Service Code	APR-DRG 1204
Min. Negotiated Rate	$30,830.52
Max. Negotiated Rate	$30,830.52
Rate for Payer: AlohaCare Medicaid	$30,830.52
Rate for Payer: Hawaii Medical Service Association ABD	$30,830.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30,830.52
Rate for Payer: Kaiser Permanente Medicaid	$30,830.52
Rate for Payer: Ohana Health Plan Medicaid	$30,830.52
Rate for Payer: UnitedHealthcare Medicaid	$30,830.52

MAJOR RESPIRATORY & CHEST PROCEDURES

Facility

$12,170.84

Service Code	APR-DRG 1202
Min. Negotiated Rate	$12,170.84
Max. Negotiated Rate	$12,170.84
Rate for Payer: AlohaCare Medicaid	$12,170.84
Rate for Payer: Hawaii Medical Service Association ABD	$12,170.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,170.84
Rate for Payer: Kaiser Permanente Medicaid	$12,170.84
Rate for Payer: Ohana Health Plan Medicaid	$12,170.84
Rate for Payer: UnitedHealthcare Medicaid	$12,170.84

MAJOR RESPIRATORY & CHEST PROCEDURES

Facility

$17,324.48

Service Code	APR-DRG 1203
Min. Negotiated Rate	$17,324.48
Max. Negotiated Rate	$17,324.48
Rate for Payer: AlohaCare Medicaid	$17,324.48
Rate for Payer: Hawaii Medical Service Association ABD	$17,324.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,324.48
Rate for Payer: Kaiser Permanente Medicaid	$17,324.48
Rate for Payer: Ohana Health Plan Medicaid	$17,324.48
Rate for Payer: UnitedHealthcare Medicaid	$17,324.48

MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

Facility

$5,852.23

Service Code	APR-DRG 1373
Min. Negotiated Rate	$5,852.23
Max. Negotiated Rate	$5,852.23
Rate for Payer: AlohaCare Medicaid	$5,852.23
Rate for Payer: Hawaii Medical Service Association ABD	$5,852.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,852.23
Rate for Payer: Kaiser Permanente Medicaid	$5,852.23
Rate for Payer: Ohana Health Plan Medicaid	$5,852.23
Rate for Payer: UnitedHealthcare Medicaid	$5,852.23

MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

Facility

$8,250.65

Service Code	APR-DRG 1374
Min. Negotiated Rate	$8,250.65
Max. Negotiated Rate	$8,250.65
Rate for Payer: AlohaCare Medicaid	$8,250.65
Rate for Payer: Hawaii Medical Service Association ABD	$8,250.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,250.65
Rate for Payer: Kaiser Permanente Medicaid	$8,250.65
Rate for Payer: Ohana Health Plan Medicaid	$8,250.65
Rate for Payer: UnitedHealthcare Medicaid	$8,250.65

MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

Facility

$3,415.32

Service Code	APR-DRG 1371
Min. Negotiated Rate	$3,415.32
Max. Negotiated Rate	$3,415.32
Rate for Payer: AlohaCare Medicaid	$3,415.32
Rate for Payer: Hawaii Medical Service Association ABD	$3,415.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,415.32
Rate for Payer: Kaiser Permanente Medicaid	$3,415.32
Rate for Payer: Ohana Health Plan Medicaid	$3,415.32
Rate for Payer: UnitedHealthcare Medicaid	$3,415.32

MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

Facility

$4,276.33

Service Code	APR-DRG 1372
Min. Negotiated Rate	$4,276.33
Max. Negotiated Rate	$4,276.33
Rate for Payer: AlohaCare Medicaid	$4,276.33
Rate for Payer: Hawaii Medical Service Association ABD	$4,276.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,276.33
Rate for Payer: Kaiser Permanente Medicaid	$4,276.33
Rate for Payer: Ohana Health Plan Medicaid	$4,276.33
Rate for Payer: UnitedHealthcare Medicaid	$4,276.33

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC

Facility

$31,160.40

Service Code	MSDRG 507
Min. Negotiated Rate	$20,546.46
Max. Negotiated Rate	$31,160.40
Rate for Payer: AlohaCare Medicare	$20,546.46
Rate for Payer: Devoted Health Medicare	$22,601.11
Rate for Payer: Hawaii Medical Service Association Commercial	$23,732.15
Rate for Payer: Hawaii Medical Service Association Medicare	$20,546.46
Rate for Payer: Humana Medicare	$20,546.46
Rate for Payer: Kaiser Permanente Commercial	$31,160.40
Rate for Payer: Kaiser Permanente Medicare	$20,546.46
Rate for Payer: Ohana Health Plan Medicare	$20,546.46
Rate for Payer: UnitedHealthcare Medicare	$20,546.46

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC

Facility

$26,123.40

Service Code	MSDRG 508
Min. Negotiated Rate	$17,225.18
Max. Negotiated Rate	$26,123.40
Rate for Payer: AlohaCare Medicare	$17,225.18
Rate for Payer: Devoted Health Medicare	$18,947.70
Rate for Payer: Hawaii Medical Service Association Commercial	$23,732.15
Rate for Payer: Hawaii Medical Service Association Medicare	$17,225.18
Rate for Payer: Humana Medicare	$17,225.18
Rate for Payer: Kaiser Permanente Commercial	$26,123.40
Rate for Payer: Kaiser Permanente Medicare	$17,225.18
Rate for Payer: Ohana Health Plan Medicare	$17,225.18
Rate for Payer: UnitedHealthcare Medicare	$17,225.18

MAJOR SKIN DISORDERS

Facility

$3,277.04

Service Code	APR-DRG 3812
Min. Negotiated Rate	$3,277.04
Max. Negotiated Rate	$3,277.04
Rate for Payer: AlohaCare Medicaid	$3,277.04
Rate for Payer: Hawaii Medical Service Association ABD	$3,277.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,277.04
Rate for Payer: Kaiser Permanente Medicaid	$3,277.04
Rate for Payer: Ohana Health Plan Medicaid	$3,277.04
Rate for Payer: UnitedHealthcare Medicaid	$3,277.04

MAJOR SKIN DISORDERS

Facility

$13,285.58

Service Code	APR-DRG 3814
Min. Negotiated Rate	$13,285.58
Max. Negotiated Rate	$13,285.58
Rate for Payer: AlohaCare Medicaid	$13,285.58
Rate for Payer: Hawaii Medical Service Association ABD	$13,285.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,285.58
Rate for Payer: Kaiser Permanente Medicaid	$13,285.58
Rate for Payer: Ohana Health Plan Medicaid	$13,285.58
Rate for Payer: UnitedHealthcare Medicaid	$13,285.58

MAJOR SKIN DISORDERS

Facility

$6,068.79

Service Code	APR-DRG 3813
Min. Negotiated Rate	$6,068.79
Max. Negotiated Rate	$6,068.79
Rate for Payer: AlohaCare Medicaid	$6,068.79
Rate for Payer: Hawaii Medical Service Association ABD	$6,068.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,068.79
Rate for Payer: Kaiser Permanente Medicaid	$6,068.79
Rate for Payer: Ohana Health Plan Medicaid	$6,068.79
Rate for Payer: UnitedHealthcare Medicaid	$6,068.79

MAJOR SKIN DISORDERS

Facility

$2,170.78

Service Code	APR-DRG 3811
Min. Negotiated Rate	$2,170.78
Max. Negotiated Rate	$2,170.78
Rate for Payer: AlohaCare Medicaid	$2,170.78
Rate for Payer: Hawaii Medical Service Association ABD	$2,170.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,170.78
Rate for Payer: Kaiser Permanente Medicaid	$2,170.78
Rate for Payer: Ohana Health Plan Medicaid	$2,170.78
Rate for Payer: UnitedHealthcare Medicaid	$2,170.78

MAJOR SKIN DISORDERS WITH MCC

Facility

$41,470.59

Service Code	MSDRG 595
Min. Negotiated Rate	$24,121.39
Max. Negotiated Rate	$41,470.59
Rate for Payer: AlohaCare Medicare	$24,121.39
Rate for Payer: Devoted Health Medicare	$26,533.53
Rate for Payer: Hawaii Medical Service Association Commercial	$41,470.59
Rate for Payer: Hawaii Medical Service Association Medicare	$24,121.39
Rate for Payer: Humana Medicare	$24,121.39
Rate for Payer: Kaiser Permanente Commercial	$36,582.07
Rate for Payer: Kaiser Permanente Medicare	$24,121.39
Rate for Payer: Ohana Health Plan Medicare	$24,121.39
Rate for Payer: UnitedHealthcare Medicare	$24,121.39

MAJOR SKIN DISORDERS WITHOUT MCC

Facility

$33,268.69

Service Code	MSDRG 596
Min. Negotiated Rate	$12,312.64
Max. Negotiated Rate	$33,268.69
Rate for Payer: AlohaCare Medicare	$12,312.64
Rate for Payer: Devoted Health Medicare	$13,543.90
Rate for Payer: Hawaii Medical Service Association Commercial	$33,268.69
Rate for Payer: Hawaii Medical Service Association Medicare	$12,312.64
Rate for Payer: Humana Medicare	$12,312.64
Rate for Payer: Kaiser Permanente Commercial	$18,673.12
Rate for Payer: Kaiser Permanente Medicare	$12,312.64
Rate for Payer: Ohana Health Plan Medicare	$12,312.64
Rate for Payer: UnitedHealthcare Medicare	$12,312.64

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$66,780.03

Service Code	MSDRG 330
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$66,780.03
Rate for Payer: AlohaCare Medicare	$27,266.35
Rate for Payer: Devoted Health Medicare	$29,992.99
Rate for Payer: Hawaii Medical Service Association Commercial	$66,780.03
Rate for Payer: Hawaii Medical Service Association Medicare	$27,266.35
Rate for Payer: Humana Medicare	$27,266.35
Rate for Payer: Kaiser Permanente Commercial	$41,351.70
Rate for Payer: Kaiser Permanente Medicare	$27,266.35
Rate for Payer: Ohana Health Plan Medicare	$27,266.35
Rate for Payer: UnitedHealthcare Medicare	$27,266.35
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$82,480.13

Service Code	MSDRG 329
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$82,480.13
Rate for Payer: AlohaCare Medicare	$52,281.77
Rate for Payer: Devoted Health Medicare	$57,509.95
Rate for Payer: Hawaii Medical Service Association Commercial	$82,480.13
Rate for Payer: Hawaii Medical Service Association Medicare	$52,281.77
Rate for Payer: Humana Medicare	$52,281.77
Rate for Payer: Kaiser Permanente Commercial	$79,289.62
Rate for Payer: Kaiser Permanente Medicare	$52,281.77
Rate for Payer: Ohana Health Plan Medicare	$52,281.77
Rate for Payer: UnitedHealthcare Medicare	$52,281.77
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$37,393.91

Service Code	MSDRG 331
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$37,393.91
Rate for Payer: AlohaCare Medicare	$19,141.74
Rate for Payer: Devoted Health Medicare	$21,055.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37,393.91
Rate for Payer: Hawaii Medical Service Association Medicare	$19,141.74
Rate for Payer: Humana Medicare	$19,141.74
Rate for Payer: Kaiser Permanente Commercial	$29,030.03
Rate for Payer: Kaiser Permanente Medicare	$19,141.74
Rate for Payer: Ohana Health Plan Medicare	$19,141.74
Rate for Payer: UnitedHealthcare Medicare	$19,141.74
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR SMALL BOWEL PROCEDURES

Facility

$26,629.21

Service Code	APR-DRG 2304
Min. Negotiated Rate	$26,629.21
Max. Negotiated Rate	$26,629.21
Rate for Payer: AlohaCare Medicaid	$26,629.21
Rate for Payer: Hawaii Medical Service Association ABD	$26,629.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,629.21
Rate for Payer: Kaiser Permanente Medicaid	$26,629.21
Rate for Payer: Ohana Health Plan Medicaid	$26,629.21
Rate for Payer: UnitedHealthcare Medicaid	$26,629.21

MAJOR SMALL BOWEL PROCEDURES

Facility

$7,464.66

Service Code	APR-DRG 2301
Min. Negotiated Rate	$7,464.66
Max. Negotiated Rate	$7,464.66
Rate for Payer: AlohaCare Medicaid	$7,464.66
Rate for Payer: Hawaii Medical Service Association ABD	$7,464.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,464.66
Rate for Payer: Kaiser Permanente Medicaid	$7,464.66
Rate for Payer: Ohana Health Plan Medicaid	$7,464.66
Rate for Payer: UnitedHealthcare Medicaid	$7,464.66

MAJOR SMALL BOWEL PROCEDURES

Facility

$10,194.44

Service Code	APR-DRG 2302
Min. Negotiated Rate	$10,194.44
Max. Negotiated Rate	$10,194.44
Rate for Payer: AlohaCare Medicaid	$10,194.44
Rate for Payer: Hawaii Medical Service Association ABD	$10,194.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,194.44
Rate for Payer: Kaiser Permanente Medicaid	$10,194.44
Rate for Payer: Ohana Health Plan Medicaid	$10,194.44
Rate for Payer: UnitedHealthcare Medicaid	$10,194.44

MAJOR SMALL BOWEL PROCEDURES

Facility

$15,105.43

Service Code	APR-DRG 2303
Min. Negotiated Rate	$15,105.43
Max. Negotiated Rate	$15,105.43
Rate for Payer: AlohaCare Medicaid	$15,105.43
Rate for Payer: Hawaii Medical Service Association ABD	$15,105.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,105.43
Rate for Payer: Kaiser Permanente Medicaid	$15,105.43
Rate for Payer: Ohana Health Plan Medicaid	$15,105.43
Rate for Payer: UnitedHealthcare Medicaid	$15,105.43

Know your out-of-pocket cost for care.

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