Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$7,383.12

Service Code	APR-DRG 2201
Min. Negotiated Rate	$7,383.12
Max. Negotiated Rate	$7,383.12
Rate for Payer: AlohaCare Medicaid	$7,383.12
Rate for Payer: Hawaii Medical Service Association ABD	$7,383.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,383.12
Rate for Payer: Kaiser Permanente Medicaid	$7,383.12
Rate for Payer: Ohana Health Plan Medicaid	$7,383.12
Rate for Payer: UnitedHealthcare Medicaid	$7,383.12

MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$16,706.77

Service Code	APR-DRG 2203
Min. Negotiated Rate	$16,706.77
Max. Negotiated Rate	$16,706.77
Rate for Payer: AlohaCare Medicaid	$16,706.77
Rate for Payer: Hawaii Medical Service Association ABD	$16,706.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,706.77
Rate for Payer: Kaiser Permanente Medicaid	$16,706.77
Rate for Payer: Ohana Health Plan Medicaid	$16,706.77
Rate for Payer: UnitedHealthcare Medicaid	$16,706.77

MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$10,620.37

Service Code	APR-DRG 2202
Min. Negotiated Rate	$10,620.37
Max. Negotiated Rate	$10,620.37
Rate for Payer: AlohaCare Medicaid	$10,620.37
Rate for Payer: Hawaii Medical Service Association ABD	$10,620.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,620.37
Rate for Payer: Kaiser Permanente Medicaid	$10,620.37
Rate for Payer: Ohana Health Plan Medicaid	$10,620.37
Rate for Payer: UnitedHealthcare Medicaid	$10,620.37

MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$29,065.46

Service Code	APR-DRG 2204
Min. Negotiated Rate	$29,065.46
Max. Negotiated Rate	$29,065.46
Rate for Payer: AlohaCare Medicaid	$29,065.46
Rate for Payer: Hawaii Medical Service Association ABD	$29,065.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29,065.46
Rate for Payer: Kaiser Permanente Medicaid	$29,065.46
Rate for Payer: Ohana Health Plan Medicaid	$29,065.46
Rate for Payer: UnitedHealthcare Medicaid	$29,065.46

MAJOR THUMB OR JOINT PROCEDURES

Facility

$35,695.29

Service Code	MSDRG 506
Min. Negotiated Rate	$15,346.14
Max. Negotiated Rate	$35,695.29
Rate for Payer: AlohaCare Medicare	$15,346.14
Rate for Payer: Devoted Health Medicare	$16,880.75
Rate for Payer: Hawaii Medical Service Association Commercial	$35,695.29
Rate for Payer: Hawaii Medical Service Association Medicare	$15,346.14
Rate for Payer: Humana Medicare	$15,346.14
Rate for Payer: Kaiser Permanente Commercial	$20,693.10
Rate for Payer: Kaiser Permanente Medicare	$15,346.14
Rate for Payer: Ohana Health Plan Medicare	$15,346.14
Rate for Payer: UnitedHealthcare Medicare	$15,346.14

MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$3,105.49

Service Code	APR-DRG 5012
Min. Negotiated Rate	$3,105.49
Max. Negotiated Rate	$3,105.49
Rate for Payer: AlohaCare Medicaid	$3,105.49
Rate for Payer: Hawaii Medical Service Association ABD	$3,105.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,105.49
Rate for Payer: Kaiser Permanente Medicaid	$3,105.49
Rate for Payer: Ohana Health Plan Medicaid	$3,105.49
Rate for Payer: UnitedHealthcare Medicaid	$3,105.49

MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$2,432.99

Service Code	APR-DRG 5011
Min. Negotiated Rate	$2,432.99
Max. Negotiated Rate	$2,432.99
Rate for Payer: AlohaCare Medicaid	$2,432.99
Rate for Payer: Hawaii Medical Service Association ABD	$2,432.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,432.99
Rate for Payer: Kaiser Permanente Medicaid	$2,432.99
Rate for Payer: Ohana Health Plan Medicaid	$2,432.99
Rate for Payer: UnitedHealthcare Medicaid	$2,432.99

MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$4,637.04

Service Code	APR-DRG 5013
Min. Negotiated Rate	$4,637.04
Max. Negotiated Rate	$4,637.04
Rate for Payer: AlohaCare Medicaid	$4,637.04
Rate for Payer: Hawaii Medical Service Association ABD	$4,637.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,637.04
Rate for Payer: Kaiser Permanente Medicaid	$4,637.04
Rate for Payer: Ohana Health Plan Medicaid	$4,637.04
Rate for Payer: UnitedHealthcare Medicaid	$4,637.04

MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$9,626.30

Service Code	APR-DRG 5014
Min. Negotiated Rate	$9,626.30
Max. Negotiated Rate	$9,626.30
Rate for Payer: AlohaCare Medicaid	$9,626.30
Rate for Payer: Hawaii Medical Service Association ABD	$9,626.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,626.30
Rate for Payer: Kaiser Permanente Medicaid	$9,626.30
Rate for Payer: Ohana Health Plan Medicaid	$9,626.30
Rate for Payer: UnitedHealthcare Medicaid	$9,626.30

MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE

Facility

$5,134.72

Service Code	APR-DRG 2063
Min. Negotiated Rate	$5,134.72
Max. Negotiated Rate	$5,134.72
Rate for Payer: AlohaCare Medicaid	$5,134.72
Rate for Payer: Hawaii Medical Service Association ABD	$5,134.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,134.72
Rate for Payer: Kaiser Permanente Medicaid	$5,134.72
Rate for Payer: Ohana Health Plan Medicaid	$5,134.72
Rate for Payer: UnitedHealthcare Medicaid	$5,134.72

MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE

Facility

$3,233.34

Service Code	APR-DRG 2061
Min. Negotiated Rate	$3,233.34
Max. Negotiated Rate	$3,233.34
Rate for Payer: AlohaCare Medicaid	$3,233.34
Rate for Payer: Hawaii Medical Service Association ABD	$3,233.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,233.34
Rate for Payer: Kaiser Permanente Medicaid	$3,233.34
Rate for Payer: Ohana Health Plan Medicaid	$3,233.34
Rate for Payer: UnitedHealthcare Medicaid	$3,233.34

MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE

Facility

$9,817.42

Service Code	APR-DRG 2064
Min. Negotiated Rate	$9,817.42
Max. Negotiated Rate	$9,817.42
Rate for Payer: AlohaCare Medicaid	$9,817.42
Rate for Payer: Hawaii Medical Service Association ABD	$9,817.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,817.42
Rate for Payer: Kaiser Permanente Medicaid	$9,817.42
Rate for Payer: Ohana Health Plan Medicaid	$9,817.42
Rate for Payer: UnitedHealthcare Medicaid	$9,817.42

MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE

Facility

$3,376.84

Service Code	APR-DRG 2062
Min. Negotiated Rate	$3,376.84
Max. Negotiated Rate	$3,376.84
Rate for Payer: AlohaCare Medicaid	$3,376.84
Rate for Payer: Hawaii Medical Service Association ABD	$3,376.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,376.84
Rate for Payer: Kaiser Permanente Medicaid	$3,376.84
Rate for Payer: Ohana Health Plan Medicaid	$3,376.84
Rate for Payer: UnitedHealthcare Medicaid	$3,376.84

MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$3,597.96

Service Code	APR-DRG 2522
Min. Negotiated Rate	$3,597.96
Max. Negotiated Rate	$3,597.96
Rate for Payer: AlohaCare Medicaid	$3,597.96
Rate for Payer: Hawaii Medical Service Association ABD	$3,597.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,597.96
Rate for Payer: Kaiser Permanente Medicaid	$3,597.96
Rate for Payer: Ohana Health Plan Medicaid	$3,597.96
Rate for Payer: UnitedHealthcare Medicaid	$3,597.96

MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$5,179.73

Service Code	APR-DRG 2523
Min. Negotiated Rate	$5,179.73
Max. Negotiated Rate	$5,179.73
Rate for Payer: AlohaCare Medicaid	$5,179.73
Rate for Payer: Hawaii Medical Service Association ABD	$5,179.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,179.73
Rate for Payer: Kaiser Permanente Medicaid	$5,179.73
Rate for Payer: Ohana Health Plan Medicaid	$5,179.73
Rate for Payer: UnitedHealthcare Medicaid	$5,179.73

MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$10,006.58

Service Code	APR-DRG 2524
Min. Negotiated Rate	$10,006.58
Max. Negotiated Rate	$10,006.58
Rate for Payer: AlohaCare Medicaid	$10,006.58
Rate for Payer: Hawaii Medical Service Association ABD	$10,006.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,006.58
Rate for Payer: Kaiser Permanente Medicaid	$10,006.58
Rate for Payer: Ohana Health Plan Medicaid	$10,006.58
Rate for Payer: UnitedHealthcare Medicaid	$10,006.58

MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$2,978.95

Service Code	APR-DRG 2521
Min. Negotiated Rate	$2,978.95
Max. Negotiated Rate	$2,978.95
Rate for Payer: AlohaCare Medicaid	$2,978.95
Rate for Payer: Hawaii Medical Service Association ABD	$2,978.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,978.95
Rate for Payer: Kaiser Permanente Medicaid	$2,978.95
Rate for Payer: Ohana Health Plan Medicaid	$2,978.95
Rate for Payer: UnitedHealthcare Medicaid	$2,978.95

MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$2,314.28

Service Code	APR-DRG 4661
Min. Negotiated Rate	$2,314.28
Max. Negotiated Rate	$2,314.28
Rate for Payer: AlohaCare Medicaid	$2,314.28
Rate for Payer: Hawaii Medical Service Association ABD	$2,314.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,314.28
Rate for Payer: Kaiser Permanente Medicaid	$2,314.28
Rate for Payer: Ohana Health Plan Medicaid	$2,314.28
Rate for Payer: UnitedHealthcare Medicaid	$2,314.28

MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$3,260.73

Service Code	APR-DRG 4662
Min. Negotiated Rate	$3,260.73
Max. Negotiated Rate	$3,260.73
Rate for Payer: AlohaCare Medicaid	$3,260.73
Rate for Payer: Hawaii Medical Service Association ABD	$3,260.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,260.73
Rate for Payer: Kaiser Permanente Medicaid	$3,260.73
Rate for Payer: Ohana Health Plan Medicaid	$3,260.73
Rate for Payer: UnitedHealthcare Medicaid	$3,260.73

MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$7,760.14

Service Code	APR-DRG 4664
Min. Negotiated Rate	$7,760.14
Max. Negotiated Rate	$7,760.14
Rate for Payer: AlohaCare Medicaid	$7,760.14
Rate for Payer: Hawaii Medical Service Association ABD	$7,760.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,760.14
Rate for Payer: Kaiser Permanente Medicaid	$7,760.14
Rate for Payer: Ohana Health Plan Medicaid	$7,760.14
Rate for Payer: UnitedHealthcare Medicaid	$7,760.14

MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$4,699.66

Service Code	APR-DRG 4663
Min. Negotiated Rate	$4,699.66
Max. Negotiated Rate	$4,699.66
Rate for Payer: AlohaCare Medicaid	$4,699.66
Rate for Payer: Hawaii Medical Service Association ABD	$4,699.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,699.66
Rate for Payer: Kaiser Permanente Medicaid	$4,699.66
Rate for Payer: Ohana Health Plan Medicaid	$4,699.66
Rate for Payer: UnitedHealthcare Medicaid	$4,699.66

MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$3,505.34

Service Code	APR-DRG 3492
Min. Negotiated Rate	$3,505.34
Max. Negotiated Rate	$3,505.34
Rate for Payer: AlohaCare Medicaid	$3,505.34
Rate for Payer: Hawaii Medical Service Association ABD	$3,505.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,505.34
Rate for Payer: Kaiser Permanente Medicaid	$3,505.34
Rate for Payer: Ohana Health Plan Medicaid	$3,505.34
Rate for Payer: UnitedHealthcare Medicaid	$3,505.34

MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$5,116.46

Service Code	APR-DRG 3493
Min. Negotiated Rate	$5,116.46
Max. Negotiated Rate	$5,116.46
Rate for Payer: AlohaCare Medicaid	$5,116.46
Rate for Payer: Hawaii Medical Service Association ABD	$5,116.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,116.46
Rate for Payer: Kaiser Permanente Medicaid	$5,116.46
Rate for Payer: Ohana Health Plan Medicaid	$5,116.46
Rate for Payer: UnitedHealthcare Medicaid	$5,116.46

MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$8,841.61

Service Code	APR-DRG 3494
Min. Negotiated Rate	$8,841.61
Max. Negotiated Rate	$8,841.61
Rate for Payer: AlohaCare Medicaid	$8,841.61
Rate for Payer: Hawaii Medical Service Association ABD	$8,841.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,841.61
Rate for Payer: Kaiser Permanente Medicaid	$8,841.61
Rate for Payer: Ohana Health Plan Medicaid	$8,841.61
Rate for Payer: UnitedHealthcare Medicaid	$8,841.61

MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$2,500.18

Service Code	APR-DRG 3491
Min. Negotiated Rate	$2,500.18
Max. Negotiated Rate	$2,500.18
Rate for Payer: AlohaCare Medicaid	$2,500.18
Rate for Payer: Hawaii Medical Service Association ABD	$2,500.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,500.18
Rate for Payer: Kaiser Permanente Medicaid	$2,500.18
Rate for Payer: Ohana Health Plan Medicaid	$2,500.18
Rate for Payer: UnitedHealthcare Medicaid	$2,500.18

Know your out-of-pocket cost for care.

All Charges