Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$1,199.44

Service Code	APR-DRG 6402
Min. Negotiated Rate	$1,199.44
Max. Negotiated Rate	$1,199.44
Rate for Payer: AlohaCare Medicaid	$1,199.44
Rate for Payer: Hawaii Medical Service Association ABD	$1,199.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,199.44
Rate for Payer: Kaiser Permanente Medicaid	$1,199.44
Rate for Payer: Ohana Health Plan Medicaid	$1,199.44
Rate for Payer: UnitedHealthcare Medicaid	$1,199.44

NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$2,321.62

Service Code	APR-DRG 6403
Min. Negotiated Rate	$2,321.62
Max. Negotiated Rate	$2,321.62
Rate for Payer: AlohaCare Medicaid	$2,321.62
Rate for Payer: Hawaii Medical Service Association ABD	$2,321.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,321.62
Rate for Payer: Kaiser Permanente Medicaid	$2,321.62
Rate for Payer: Ohana Health Plan Medicaid	$2,321.62
Rate for Payer: UnitedHealthcare Medicaid	$2,321.62

NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$19,706.36

Service Code	APR-DRG 6404
Min. Negotiated Rate	$19,706.36
Max. Negotiated Rate	$19,706.36
Rate for Payer: AlohaCare Medicaid	$19,706.36
Rate for Payer: Hawaii Medical Service Association ABD	$19,706.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,706.36
Rate for Payer: Kaiser Permanente Medicaid	$19,706.36
Rate for Payer: Ohana Health Plan Medicaid	$19,706.36
Rate for Payer: UnitedHealthcare Medicaid	$19,706.36

NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility

$9,570.40

Service Code	APR-DRG 6362
Min. Negotiated Rate	$9,570.40
Max. Negotiated Rate	$9,570.40
Rate for Payer: AlohaCare Medicaid	$9,570.40
Rate for Payer: Hawaii Medical Service Association ABD	$9,570.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,570.40
Rate for Payer: Kaiser Permanente Medicaid	$9,570.40
Rate for Payer: Ohana Health Plan Medicaid	$9,570.40
Rate for Payer: UnitedHealthcare Medicaid	$9,570.40

NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility

$19,368.29

Service Code	APR-DRG 6363
Min. Negotiated Rate	$19,368.29
Max. Negotiated Rate	$19,368.29
Rate for Payer: AlohaCare Medicaid	$19,368.29
Rate for Payer: Hawaii Medical Service Association ABD	$19,368.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,368.29
Rate for Payer: Kaiser Permanente Medicaid	$19,368.29
Rate for Payer: Ohana Health Plan Medicaid	$19,368.29
Rate for Payer: UnitedHealthcare Medicaid	$19,368.29

NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility

$6,326.01

Service Code	APR-DRG 6361
Min. Negotiated Rate	$6,326.01
Max. Negotiated Rate	$6,326.01
Rate for Payer: AlohaCare Medicaid	$6,326.01
Rate for Payer: Hawaii Medical Service Association ABD	$6,326.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,326.01
Rate for Payer: Kaiser Permanente Medicaid	$6,326.01
Rate for Payer: Ohana Health Plan Medicaid	$6,326.01
Rate for Payer: UnitedHealthcare Medicaid	$6,326.01

NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility

$28,978.12

Service Code	APR-DRG 6364
Min. Negotiated Rate	$28,978.12
Max. Negotiated Rate	$28,978.12
Rate for Payer: AlohaCare Medicaid	$28,978.12
Rate for Payer: Hawaii Medical Service Association ABD	$28,978.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28,978.12
Rate for Payer: Kaiser Permanente Medicaid	$28,978.12
Rate for Payer: Ohana Health Plan Medicaid	$28,978.12
Rate for Payer: UnitedHealthcare Medicaid	$28,978.12

NEONATE BIRTHWT >2499G W MAJOR ANOMALY

Facility

$9,700.83

Service Code	APR-DRG 6332
Min. Negotiated Rate	$9,700.83
Max. Negotiated Rate	$9,700.83
Rate for Payer: AlohaCare Medicaid	$9,700.83
Rate for Payer: Hawaii Medical Service Association ABD	$9,700.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,700.83
Rate for Payer: Kaiser Permanente Medicaid	$9,700.83
Rate for Payer: Ohana Health Plan Medicaid	$9,700.83
Rate for Payer: UnitedHealthcare Medicaid	$9,700.83

NEONATE BIRTHWT >2499G W MAJOR ANOMALY

Facility

$24,355.70

Service Code	APR-DRG 6333
Min. Negotiated Rate	$24,355.70
Max. Negotiated Rate	$24,355.70
Rate for Payer: AlohaCare Medicaid	$24,355.70
Rate for Payer: Hawaii Medical Service Association ABD	$24,355.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24,355.70
Rate for Payer: Kaiser Permanente Medicaid	$24,355.70
Rate for Payer: Ohana Health Plan Medicaid	$24,355.70
Rate for Payer: UnitedHealthcare Medicaid	$24,355.70

NEONATE BIRTHWT >2499G W MAJOR ANOMALY

Facility

$53,184.19

Service Code	APR-DRG 6334
Min. Negotiated Rate	$53,184.19
Max. Negotiated Rate	$53,184.19
Rate for Payer: AlohaCare Medicaid	$53,184.19
Rate for Payer: Hawaii Medical Service Association ABD	$53,184.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53,184.19
Rate for Payer: Kaiser Permanente Medicaid	$53,184.19
Rate for Payer: Ohana Health Plan Medicaid	$53,184.19
Rate for Payer: UnitedHealthcare Medicaid	$53,184.19

NEONATE BIRTHWT >2499G W MAJOR ANOMALY

Facility

$3,036.12

Service Code	APR-DRG 6331
Min. Negotiated Rate	$3,036.12
Max. Negotiated Rate	$3,036.12
Rate for Payer: AlohaCare Medicaid	$3,036.12
Rate for Payer: Hawaii Medical Service Association ABD	$3,036.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,036.12
Rate for Payer: Kaiser Permanente Medicaid	$3,036.12
Rate for Payer: Ohana Health Plan Medicaid	$3,036.12
Rate for Payer: UnitedHealthcare Medicaid	$3,036.12

NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE

Facility

$43,665.35

Service Code	APR-DRG 6302
Min. Negotiated Rate	$43,665.35
Max. Negotiated Rate	$43,665.35
Rate for Payer: AlohaCare Medicaid	$43,665.35
Rate for Payer: Hawaii Medical Service Association ABD	$43,665.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43,665.35
Rate for Payer: Kaiser Permanente Medicaid	$43,665.35
Rate for Payer: Ohana Health Plan Medicaid	$43,665.35
Rate for Payer: UnitedHealthcare Medicaid	$43,665.35

NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE

Facility

$128,119.66

Service Code	APR-DRG 6304
Min. Negotiated Rate	$128,119.66
Max. Negotiated Rate	$128,119.66
Rate for Payer: AlohaCare Medicaid	$128,119.66
Rate for Payer: Hawaii Medical Service Association ABD	$128,119.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$128,119.66
Rate for Payer: Kaiser Permanente Medicaid	$128,119.66
Rate for Payer: Ohana Health Plan Medicaid	$128,119.66
Rate for Payer: UnitedHealthcare Medicaid	$128,119.66

NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE

Facility

$73,719.21

Service Code	APR-DRG 6303
Min. Negotiated Rate	$73,719.21
Max. Negotiated Rate	$73,719.21
Rate for Payer: AlohaCare Medicaid	$73,719.21
Rate for Payer: Hawaii Medical Service Association ABD	$73,719.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$73,719.21
Rate for Payer: Kaiser Permanente Medicaid	$73,719.21
Rate for Payer: Ohana Health Plan Medicaid	$73,719.21
Rate for Payer: UnitedHealthcare Medicaid	$73,719.21

NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE

Facility

$24,289.98

Service Code	APR-DRG 6301
Min. Negotiated Rate	$24,289.98
Max. Negotiated Rate	$24,289.98
Rate for Payer: AlohaCare Medicaid	$24,289.98
Rate for Payer: Hawaii Medical Service Association ABD	$24,289.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24,289.98
Rate for Payer: Kaiser Permanente Medicaid	$24,289.98
Rate for Payer: Ohana Health Plan Medicaid	$24,289.98
Rate for Payer: UnitedHealthcare Medicaid	$24,289.98

NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$14,062.41

Service Code	APR-DRG 6311
Min. Negotiated Rate	$14,062.41
Max. Negotiated Rate	$14,062.41
Rate for Payer: AlohaCare Medicaid	$14,062.41
Rate for Payer: Hawaii Medical Service Association ABD	$14,062.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,062.41
Rate for Payer: Kaiser Permanente Medicaid	$14,062.41
Rate for Payer: Ohana Health Plan Medicaid	$14,062.41
Rate for Payer: UnitedHealthcare Medicaid	$14,062.41

NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$52,019.48

Service Code	APR-DRG 6313
Min. Negotiated Rate	$52,019.48
Max. Negotiated Rate	$52,019.48
Rate for Payer: AlohaCare Medicaid	$52,019.48
Rate for Payer: Hawaii Medical Service Association ABD	$52,019.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$52,019.48
Rate for Payer: Kaiser Permanente Medicaid	$52,019.48
Rate for Payer: Ohana Health Plan Medicaid	$52,019.48
Rate for Payer: UnitedHealthcare Medicaid	$52,019.48

NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$111,316.35

Service Code	APR-DRG 6314
Min. Negotiated Rate	$111,316.35
Max. Negotiated Rate	$111,316.35
Rate for Payer: AlohaCare Medicaid	$111,316.35
Rate for Payer: Hawaii Medical Service Association ABD	$111,316.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$111,316.35
Rate for Payer: Kaiser Permanente Medicaid	$111,316.35
Rate for Payer: Ohana Health Plan Medicaid	$111,316.35
Rate for Payer: UnitedHealthcare Medicaid	$111,316.35

NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$30,823.25

Service Code	APR-DRG 6312
Min. Negotiated Rate	$30,823.25
Max. Negotiated Rate	$30,823.25
Rate for Payer: AlohaCare Medicaid	$30,823.25
Rate for Payer: Hawaii Medical Service Association ABD	$30,823.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30,823.25
Rate for Payer: Kaiser Permanente Medicaid	$30,823.25
Rate for Payer: Ohana Health Plan Medicaid	$30,823.25
Rate for Payer: UnitedHealthcare Medicaid	$30,823.25

NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$26,738.69

Service Code	APR-DRG 6394
Min. Negotiated Rate	$26,738.69
Max. Negotiated Rate	$26,738.69
Rate for Payer: AlohaCare Medicaid	$26,738.69
Rate for Payer: Hawaii Medical Service Association ABD	$26,738.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,738.69
Rate for Payer: Kaiser Permanente Medicaid	$26,738.69
Rate for Payer: Ohana Health Plan Medicaid	$26,738.69
Rate for Payer: UnitedHealthcare Medicaid	$26,738.69

NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$16,118.84

Service Code	APR-DRG 6393
Min. Negotiated Rate	$16,118.84
Max. Negotiated Rate	$16,118.84
Rate for Payer: AlohaCare Medicaid	$16,118.84
Rate for Payer: Hawaii Medical Service Association ABD	$16,118.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,118.84
Rate for Payer: Kaiser Permanente Medicaid	$16,118.84
Rate for Payer: Ohana Health Plan Medicaid	$16,118.84
Rate for Payer: UnitedHealthcare Medicaid	$16,118.84

NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$5,127.94

Service Code	APR-DRG 6391
Min. Negotiated Rate	$5,127.94
Max. Negotiated Rate	$5,127.94
Rate for Payer: AlohaCare Medicaid	$5,127.94
Rate for Payer: Hawaii Medical Service Association ABD	$5,127.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,127.94
Rate for Payer: Kaiser Permanente Medicaid	$5,127.94
Rate for Payer: Ohana Health Plan Medicaid	$5,127.94
Rate for Payer: UnitedHealthcare Medicaid	$5,127.94

NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$10,146.69

Service Code	APR-DRG 6392
Min. Negotiated Rate	$10,146.69
Max. Negotiated Rate	$10,146.69
Rate for Payer: AlohaCare Medicaid	$10,146.69
Rate for Payer: Hawaii Medical Service Association ABD	$10,146.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,146.69
Rate for Payer: Kaiser Permanente Medicaid	$10,146.69
Rate for Payer: Ohana Health Plan Medicaid	$10,146.69
Rate for Payer: UnitedHealthcare Medicaid	$10,146.69

NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$43,059.74

Service Code	APR-DRG 6344
Min. Negotiated Rate	$43,059.74
Max. Negotiated Rate	$43,059.74
Rate for Payer: AlohaCare Medicaid	$43,059.74
Rate for Payer: Hawaii Medical Service Association ABD	$43,059.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43,059.74
Rate for Payer: Kaiser Permanente Medicaid	$43,059.74
Rate for Payer: Ohana Health Plan Medicaid	$43,059.74
Rate for Payer: UnitedHealthcare Medicaid	$43,059.74

NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$17,030.79

Service Code	APR-DRG 6343
Min. Negotiated Rate	$17,030.79
Max. Negotiated Rate	$17,030.79
Rate for Payer: AlohaCare Medicaid	$17,030.79
Rate for Payer: Hawaii Medical Service Association ABD	$17,030.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,030.79
Rate for Payer: Kaiser Permanente Medicaid	$17,030.79
Rate for Payer: Ohana Health Plan Medicaid	$17,030.79
Rate for Payer: UnitedHealthcare Medicaid	$17,030.79

Know your out-of-pocket cost for care.

All Charges