Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$6,710.20

Service Code	APR-DRG 6341
Min. Negotiated Rate	$6,710.20
Max. Negotiated Rate	$6,710.20
Rate for Payer: AlohaCare Medicaid	$6,710.20
Rate for Payer: Hawaii Medical Service Association ABD	$6,710.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,710.20
Rate for Payer: Kaiser Permanente Medicaid	$6,710.20
Rate for Payer: Ohana Health Plan Medicaid	$6,710.20
Rate for Payer: UnitedHealthcare Medicaid	$6,710.20

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

Facility

$12,621.69

Service Code	APR-DRG 6342
Min. Negotiated Rate	$12,621.69
Max. Negotiated Rate	$12,621.69
Rate for Payer: AlohaCare Medicaid	$12,621.69
Rate for Payer: Hawaii Medical Service Association ABD	$12,621.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,621.69
Rate for Payer: Kaiser Permanente Medicaid	$12,621.69
Rate for Payer: Ohana Health Plan Medicaid	$12,621.69
Rate for Payer: UnitedHealthcare Medicaid	$12,621.69

NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$1,917.92

Service Code	APR-DRG 5911
Min. Negotiated Rate	$1,917.92
Max. Negotiated Rate	$1,917.92
Rate for Payer: AlohaCare Medicaid	$1,917.92
Rate for Payer: Hawaii Medical Service Association ABD	$1,917.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,917.92
Rate for Payer: Kaiser Permanente Medicaid	$1,917.92
Rate for Payer: Ohana Health Plan Medicaid	$1,917.92
Rate for Payer: UnitedHealthcare Medicaid	$1,917.92

NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$137,237.12

Service Code	APR-DRG 5912
Min. Negotiated Rate	$137,237.12
Max. Negotiated Rate	$137,237.12
Rate for Payer: AlohaCare Medicaid	$137,237.12
Rate for Payer: Hawaii Medical Service Association ABD	$137,237.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$137,237.12
Rate for Payer: Kaiser Permanente Medicaid	$137,237.12
Rate for Payer: Ohana Health Plan Medicaid	$137,237.12
Rate for Payer: UnitedHealthcare Medicaid	$137,237.12

NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$198,269.93

Service Code	APR-DRG 5914
Min. Negotiated Rate	$198,269.93
Max. Negotiated Rate	$198,269.93
Rate for Payer: AlohaCare Medicaid	$198,269.93
Rate for Payer: Hawaii Medical Service Association ABD	$198,269.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$198,269.93
Rate for Payer: Kaiser Permanente Medicaid	$198,269.93
Rate for Payer: Ohana Health Plan Medicaid	$198,269.93
Rate for Payer: UnitedHealthcare Medicaid	$198,269.93

NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$156,291.99

Service Code	APR-DRG 5913
Min. Negotiated Rate	$156,291.99
Max. Negotiated Rate	$156,291.99
Rate for Payer: AlohaCare Medicaid	$156,291.99
Rate for Payer: Hawaii Medical Service Association ABD	$156,291.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$156,291.99
Rate for Payer: Kaiser Permanente Medicaid	$156,291.99
Rate for Payer: Ohana Health Plan Medicaid	$156,291.99
Rate for Payer: UnitedHealthcare Medicaid	$156,291.99

NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$108,049.72

Service Code	APR-DRG 5932
Min. Negotiated Rate	$108,049.72
Max. Negotiated Rate	$108,049.72
Rate for Payer: AlohaCare Medicaid	$108,049.72
Rate for Payer: Hawaii Medical Service Association ABD	$108,049.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$108,049.72
Rate for Payer: Kaiser Permanente Medicaid	$108,049.72
Rate for Payer: Ohana Health Plan Medicaid	$108,049.72
Rate for Payer: UnitedHealthcare Medicaid	$108,049.72

NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$5,527.30

Service Code	APR-DRG 5931
Min. Negotiated Rate	$5,527.30
Max. Negotiated Rate	$5,527.30
Rate for Payer: AlohaCare Medicaid	$5,527.30
Rate for Payer: Hawaii Medical Service Association ABD	$5,527.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,527.30
Rate for Payer: Kaiser Permanente Medicaid	$5,527.30
Rate for Payer: Ohana Health Plan Medicaid	$5,527.30
Rate for Payer: UnitedHealthcare Medicaid	$5,527.30

NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$125,311.02

Service Code	APR-DRG 5933
Min. Negotiated Rate	$125,311.02
Max. Negotiated Rate	$125,311.02
Rate for Payer: AlohaCare Medicaid	$125,311.02
Rate for Payer: Hawaii Medical Service Association ABD	$125,311.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$125,311.02
Rate for Payer: Kaiser Permanente Medicaid	$125,311.02
Rate for Payer: Ohana Health Plan Medicaid	$125,311.02
Rate for Payer: UnitedHealthcare Medicaid	$125,311.02

NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$170,906.42

Service Code	APR-DRG 5934
Min. Negotiated Rate	$170,906.42
Max. Negotiated Rate	$170,906.42
Rate for Payer: AlohaCare Medicaid	$170,906.42
Rate for Payer: Hawaii Medical Service Association ABD	$170,906.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$170,906.42
Rate for Payer: Kaiser Permanente Medicaid	$170,906.42
Rate for Payer: Ohana Health Plan Medicaid	$170,906.42
Rate for Payer: UnitedHealthcare Medicaid	$170,906.42

NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$77,568.19

Service Code	APR-DRG 6022
Min. Negotiated Rate	$77,568.19
Max. Negotiated Rate	$77,568.19
Rate for Payer: AlohaCare Medicaid	$77,568.19
Rate for Payer: Hawaii Medical Service Association ABD	$77,568.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$77,568.19
Rate for Payer: Kaiser Permanente Medicaid	$77,568.19
Rate for Payer: Ohana Health Plan Medicaid	$77,568.19
Rate for Payer: UnitedHealthcare Medicaid	$77,568.19

NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$99,297.24

Service Code	APR-DRG 6023
Min. Negotiated Rate	$99,297.24
Max. Negotiated Rate	$99,297.24
Rate for Payer: AlohaCare Medicaid	$99,297.24
Rate for Payer: Hawaii Medical Service Association ABD	$99,297.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$99,297.24
Rate for Payer: Kaiser Permanente Medicaid	$99,297.24
Rate for Payer: Ohana Health Plan Medicaid	$99,297.24
Rate for Payer: UnitedHealthcare Medicaid	$99,297.24

NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$138,335.10

Service Code	APR-DRG 6024
Min. Negotiated Rate	$138,335.10
Max. Negotiated Rate	$138,335.10
Rate for Payer: AlohaCare Medicaid	$138,335.10
Rate for Payer: Hawaii Medical Service Association ABD	$138,335.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$138,335.10
Rate for Payer: Kaiser Permanente Medicaid	$138,335.10
Rate for Payer: Ohana Health Plan Medicaid	$138,335.10
Rate for Payer: UnitedHealthcare Medicaid	$138,335.10

NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$34,948.25

Service Code	APR-DRG 6021
Min. Negotiated Rate	$34,948.25
Max. Negotiated Rate	$34,948.25
Rate for Payer: AlohaCare Medicaid	$34,948.25
Rate for Payer: Hawaii Medical Service Association ABD	$34,948.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$34,948.25
Rate for Payer: Kaiser Permanente Medicaid	$34,948.25
Rate for Payer: Ohana Health Plan Medicaid	$34,948.25
Rate for Payer: UnitedHealthcare Medicaid	$34,948.25

NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$22,826.01

Service Code	APR-DRG 6081
Min. Negotiated Rate	$22,826.01
Max. Negotiated Rate	$22,826.01
Rate for Payer: AlohaCare Medicaid	$22,826.01
Rate for Payer: Hawaii Medical Service Association ABD	$22,826.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,826.01
Rate for Payer: Kaiser Permanente Medicaid	$22,826.01
Rate for Payer: Ohana Health Plan Medicaid	$22,826.01
Rate for Payer: UnitedHealthcare Medicaid	$22,826.01

NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$100,544.85

Service Code	APR-DRG 6084
Min. Negotiated Rate	$100,544.85
Max. Negotiated Rate	$100,544.85
Rate for Payer: AlohaCare Medicaid	$100,544.85
Rate for Payer: Hawaii Medical Service Association ABD	$100,544.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$100,544.85
Rate for Payer: Kaiser Permanente Medicaid	$100,544.85
Rate for Payer: Ohana Health Plan Medicaid	$100,544.85
Rate for Payer: UnitedHealthcare Medicaid	$100,544.85

NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$58,875.27

Service Code	APR-DRG 6083
Min. Negotiated Rate	$58,875.27
Max. Negotiated Rate	$58,875.27
Rate for Payer: AlohaCare Medicaid	$58,875.27
Rate for Payer: Hawaii Medical Service Association ABD	$58,875.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58,875.27
Rate for Payer: Kaiser Permanente Medicaid	$58,875.27
Rate for Payer: Ohana Health Plan Medicaid	$58,875.27
Rate for Payer: UnitedHealthcare Medicaid	$58,875.27

NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$40,893.10

Service Code	APR-DRG 6082
Min. Negotiated Rate	$40,893.10
Max. Negotiated Rate	$40,893.10
Rate for Payer: AlohaCare Medicaid	$40,893.10
Rate for Payer: Hawaii Medical Service Association ABD	$40,893.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40,893.10
Rate for Payer: Kaiser Permanente Medicaid	$40,893.10
Rate for Payer: Ohana Health Plan Medicaid	$40,893.10
Rate for Payer: UnitedHealthcare Medicaid	$40,893.10

NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$40,934.56

Service Code	APR-DRG 6071
Min. Negotiated Rate	$40,934.56
Max. Negotiated Rate	$40,934.56
Rate for Payer: AlohaCare Medicaid	$40,934.56
Rate for Payer: Hawaii Medical Service Association ABD	$40,934.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40,934.56
Rate for Payer: Kaiser Permanente Medicaid	$40,934.56
Rate for Payer: Ohana Health Plan Medicaid	$40,934.56
Rate for Payer: UnitedHealthcare Medicaid	$40,934.56

NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$55,698.62

Service Code	APR-DRG 6072
Min. Negotiated Rate	$55,698.62
Max. Negotiated Rate	$55,698.62
Rate for Payer: AlohaCare Medicaid	$55,698.62
Rate for Payer: Hawaii Medical Service Association ABD	$55,698.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$55,698.62
Rate for Payer: Kaiser Permanente Medicaid	$55,698.62
Rate for Payer: Ohana Health Plan Medicaid	$55,698.62
Rate for Payer: UnitedHealthcare Medicaid	$55,698.62

NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$72,426.10

Service Code	APR-DRG 6073
Min. Negotiated Rate	$72,426.10
Max. Negotiated Rate	$72,426.10
Rate for Payer: AlohaCare Medicaid	$72,426.10
Rate for Payer: Hawaii Medical Service Association ABD	$72,426.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$72,426.10
Rate for Payer: Kaiser Permanente Medicaid	$72,426.10
Rate for Payer: Ohana Health Plan Medicaid	$72,426.10
Rate for Payer: UnitedHealthcare Medicaid	$72,426.10

NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$107,692.82

Service Code	APR-DRG 6074
Min. Negotiated Rate	$107,692.82
Max. Negotiated Rate	$107,692.82
Rate for Payer: AlohaCare Medicaid	$107,692.82
Rate for Payer: Hawaii Medical Service Association ABD	$107,692.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$107,692.82
Rate for Payer: Kaiser Permanente Medicaid	$107,692.82
Rate for Payer: Ohana Health Plan Medicaid	$107,692.82
Rate for Payer: UnitedHealthcare Medicaid	$107,692.82

NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$24,427.48

Service Code	APR-DRG 6142
Min. Negotiated Rate	$24,427.48
Max. Negotiated Rate	$24,427.48
Rate for Payer: AlohaCare Medicaid	$24,427.48
Rate for Payer: Hawaii Medical Service Association ABD	$24,427.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24,427.48
Rate for Payer: Kaiser Permanente Medicaid	$24,427.48
Rate for Payer: Ohana Health Plan Medicaid	$24,427.48
Rate for Payer: UnitedHealthcare Medicaid	$24,427.48

NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$12,574.17

Service Code	APR-DRG 6141
Min. Negotiated Rate	$12,574.17
Max. Negotiated Rate	$12,574.17
Rate for Payer: AlohaCare Medicaid	$12,574.17
Rate for Payer: Hawaii Medical Service Association ABD	$12,574.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,574.17
Rate for Payer: Kaiser Permanente Medicaid	$12,574.17
Rate for Payer: Ohana Health Plan Medicaid	$12,574.17
Rate for Payer: UnitedHealthcare Medicaid	$12,574.17

NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$41,968.84

Service Code	APR-DRG 6143
Min. Negotiated Rate	$41,968.84
Max. Negotiated Rate	$41,968.84
Rate for Payer: AlohaCare Medicaid	$41,968.84
Rate for Payer: Hawaii Medical Service Association ABD	$41,968.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41,968.84
Rate for Payer: Kaiser Permanente Medicaid	$41,968.84
Rate for Payer: Ohana Health Plan Medicaid	$41,968.84
Rate for Payer: UnitedHealthcare Medicaid	$41,968.84

Know your out-of-pocket cost for care.

All Charges