Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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

NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$36,888.42

Service Code	APR-DRG 6122
Min. Negotiated Rate	$36,888.42
Max. Negotiated Rate	$36,888.42
Rate for Payer: AlohaCare Medicaid	$36,888.42
Rate for Payer: Hawaii Medical Service Association ABD	$36,888.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36,888.42
Rate for Payer: Kaiser Permanente Medicaid	$36,888.42
Rate for Payer: Ohana Health Plan Medicaid	$36,888.42
Rate for Payer: UnitedHealthcare Medicaid	$36,888.42

NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$50,195.59

Service Code	APR-DRG 6123
Min. Negotiated Rate	$50,195.59
Max. Negotiated Rate	$50,195.59
Rate for Payer: AlohaCare Medicaid	$50,195.59
Rate for Payer: Hawaii Medical Service Association ABD	$50,195.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50,195.59
Rate for Payer: Kaiser Permanente Medicaid	$50,195.59
Rate for Payer: Ohana Health Plan Medicaid	$50,195.59
Rate for Payer: UnitedHealthcare Medicaid	$50,195.59

NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$26,174.54

Service Code	APR-DRG 6121
Min. Negotiated Rate	$26,174.54
Max. Negotiated Rate	$26,174.54
Rate for Payer: AlohaCare Medicaid	$26,174.54
Rate for Payer: Hawaii Medical Service Association ABD	$26,174.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,174.54
Rate for Payer: Kaiser Permanente Medicaid	$26,174.54
Rate for Payer: Ohana Health Plan Medicaid	$26,174.54
Rate for Payer: UnitedHealthcare Medicaid	$26,174.54

NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$72,443.29

Service Code	APR-DRG 6124
Min. Negotiated Rate	$72,443.29
Max. Negotiated Rate	$72,443.29
Rate for Payer: AlohaCare Medicaid	$72,443.29
Rate for Payer: Hawaii Medical Service Association ABD	$72,443.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$72,443.29
Rate for Payer: Kaiser Permanente Medicaid	$72,443.29
Rate for Payer: Ohana Health Plan Medicaid	$72,443.29
Rate for Payer: UnitedHealthcare Medicaid	$72,443.29

NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$156,389.05

Service Code	APR-DRG 6094
Min. Negotiated Rate	$156,389.05
Max. Negotiated Rate	$156,389.05
Rate for Payer: AlohaCare Medicaid	$156,389.05
Rate for Payer: Hawaii Medical Service Association ABD	$156,389.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$156,389.05
Rate for Payer: Kaiser Permanente Medicaid	$156,389.05
Rate for Payer: Ohana Health Plan Medicaid	$156,389.05
Rate for Payer: UnitedHealthcare Medicaid	$156,389.05

NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$44,060.66

Service Code	APR-DRG 6092
Min. Negotiated Rate	$44,060.66
Max. Negotiated Rate	$44,060.66
Rate for Payer: AlohaCare Medicaid	$44,060.66
Rate for Payer: Hawaii Medical Service Association ABD	$44,060.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$44,060.66
Rate for Payer: Kaiser Permanente Medicaid	$44,060.66
Rate for Payer: Ohana Health Plan Medicaid	$44,060.66
Rate for Payer: UnitedHealthcare Medicaid	$44,060.66

NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$13,760.11

Service Code	APR-DRG 6091
Min. Negotiated Rate	$13,760.11
Max. Negotiated Rate	$13,760.11
Rate for Payer: AlohaCare Medicaid	$13,760.11
Rate for Payer: Hawaii Medical Service Association ABD	$13,760.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,760.11
Rate for Payer: Kaiser Permanente Medicaid	$13,760.11
Rate for Payer: Ohana Health Plan Medicaid	$13,760.11
Rate for Payer: UnitedHealthcare Medicaid	$13,760.11

NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$72,556.52

Service Code	APR-DRG 6093
Min. Negotiated Rate	$72,556.52
Max. Negotiated Rate	$72,556.52
Rate for Payer: AlohaCare Medicaid	$72,556.52
Rate for Payer: Hawaii Medical Service Association ABD	$72,556.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$72,556.52
Rate for Payer: Kaiser Permanente Medicaid	$72,556.52
Rate for Payer: Ohana Health Plan Medicaid	$72,556.52
Rate for Payer: UnitedHealthcare Medicaid	$72,556.52

NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$197,466.16

Service Code	APR-DRG 5884
Min. Negotiated Rate	$197,466.16
Max. Negotiated Rate	$197,466.16
Rate for Payer: AlohaCare Medicaid	$197,466.16
Rate for Payer: Hawaii Medical Service Association ABD	$197,466.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$197,466.16
Rate for Payer: Kaiser Permanente Medicaid	$197,466.16
Rate for Payer: Ohana Health Plan Medicaid	$197,466.16
Rate for Payer: UnitedHealthcare Medicaid	$197,466.16

NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$126,663.78

Service Code	APR-DRG 5883
Min. Negotiated Rate	$126,663.78
Max. Negotiated Rate	$126,663.78
Rate for Payer: AlohaCare Medicaid	$126,663.78
Rate for Payer: Hawaii Medical Service Association ABD	$126,663.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$126,663.78
Rate for Payer: Kaiser Permanente Medicaid	$126,663.78
Rate for Payer: Ohana Health Plan Medicaid	$126,663.78
Rate for Payer: UnitedHealthcare Medicaid	$126,663.78

NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$83,137.95

Service Code	APR-DRG 5882
Min. Negotiated Rate	$83,137.95
Max. Negotiated Rate	$83,137.95
Rate for Payer: AlohaCare Medicaid	$83,137.95
Rate for Payer: Hawaii Medical Service Association ABD	$83,137.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$83,137.95
Rate for Payer: Kaiser Permanente Medicaid	$83,137.95
Rate for Payer: Ohana Health Plan Medicaid	$83,137.95
Rate for Payer: UnitedHealthcare Medicaid	$83,137.95

NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$57,466.91

Service Code	APR-DRG 5881
Min. Negotiated Rate	$57,466.91
Max. Negotiated Rate	$57,466.91
Rate for Payer: AlohaCare Medicaid	$57,466.91
Rate for Payer: Hawaii Medical Service Association ABD	$57,466.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$57,466.91
Rate for Payer: Kaiser Permanente Medicaid	$57,466.91
Rate for Payer: Ohana Health Plan Medicaid	$57,466.91
Rate for Payer: UnitedHealthcare Medicaid	$57,466.91

NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$1,221.94

Service Code	APR-DRG 6261
Min. Negotiated Rate	$1,221.94
Max. Negotiated Rate	$1,221.94
Rate for Payer: AlohaCare Medicaid	$1,221.94
Rate for Payer: Hawaii Medical Service Association ABD	$1,221.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,221.94
Rate for Payer: Kaiser Permanente Medicaid	$1,221.94
Rate for Payer: Ohana Health Plan Medicaid	$1,221.94
Rate for Payer: UnitedHealthcare Medicaid	$1,221.94

NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$1,652.51

Service Code	APR-DRG 6262
Min. Negotiated Rate	$1,652.51
Max. Negotiated Rate	$1,652.51
Rate for Payer: AlohaCare Medicaid	$1,652.51
Rate for Payer: Hawaii Medical Service Association ABD	$1,652.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,652.51
Rate for Payer: Kaiser Permanente Medicaid	$1,652.51
Rate for Payer: Ohana Health Plan Medicaid	$1,652.51
Rate for Payer: UnitedHealthcare Medicaid	$1,652.51

NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$21,480.39

Service Code	APR-DRG 6264
Min. Negotiated Rate	$21,480.39
Max. Negotiated Rate	$21,480.39
Rate for Payer: AlohaCare Medicaid	$21,480.39
Rate for Payer: Hawaii Medical Service Association ABD	$21,480.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,480.39
Rate for Payer: Kaiser Permanente Medicaid	$21,480.39
Rate for Payer: Ohana Health Plan Medicaid	$21,480.39
Rate for Payer: UnitedHealthcare Medicaid	$21,480.39

NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$4,438.45

Service Code	APR-DRG 6263
Min. Negotiated Rate	$4,438.45
Max. Negotiated Rate	$4,438.45
Rate for Payer: AlohaCare Medicaid	$4,438.45
Rate for Payer: Hawaii Medical Service Association ABD	$4,438.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,438.45
Rate for Payer: Kaiser Permanente Medicaid	$4,438.45
Rate for Payer: Ohana Health Plan Medicaid	$4,438.45
Rate for Payer: UnitedHealthcare Medicaid	$4,438.45

NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$28,628.31

Service Code	APR-DRG 6233
Min. Negotiated Rate	$28,628.31
Max. Negotiated Rate	$28,628.31
Rate for Payer: AlohaCare Medicaid	$28,628.31
Rate for Payer: Hawaii Medical Service Association ABD	$28,628.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28,628.31
Rate for Payer: Kaiser Permanente Medicaid	$28,628.31
Rate for Payer: Ohana Health Plan Medicaid	$28,628.31
Rate for Payer: UnitedHealthcare Medicaid	$28,628.31

NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$16,531.34

Service Code	APR-DRG 6232
Min. Negotiated Rate	$16,531.34
Max. Negotiated Rate	$16,531.34
Rate for Payer: AlohaCare Medicaid	$16,531.34
Rate for Payer: Hawaii Medical Service Association ABD	$16,531.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,531.34
Rate for Payer: Kaiser Permanente Medicaid	$16,531.34
Rate for Payer: Ohana Health Plan Medicaid	$16,531.34
Rate for Payer: UnitedHealthcare Medicaid	$16,531.34

NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$34,394.21

Service Code	APR-DRG 6234
Min. Negotiated Rate	$34,394.21
Max. Negotiated Rate	$34,394.21
Rate for Payer: AlohaCare Medicaid	$34,394.21
Rate for Payer: Hawaii Medical Service Association ABD	$34,394.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$34,394.21
Rate for Payer: Kaiser Permanente Medicaid	$34,394.21
Rate for Payer: Ohana Health Plan Medicaid	$34,394.21
Rate for Payer: UnitedHealthcare Medicaid	$34,394.21

NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$11,505.51

Service Code	APR-DRG 6231
Min. Negotiated Rate	$11,505.51
Max. Negotiated Rate	$11,505.51
Rate for Payer: AlohaCare Medicaid	$11,505.51
Rate for Payer: Hawaii Medical Service Association ABD	$11,505.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,505.51
Rate for Payer: Kaiser Permanente Medicaid	$11,505.51
Rate for Payer: Ohana Health Plan Medicaid	$11,505.51
Rate for Payer: UnitedHealthcare Medicaid	$11,505.51

NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$6,880.05

Service Code	APR-DRG 6211
Min. Negotiated Rate	$6,880.05
Max. Negotiated Rate	$6,880.05
Rate for Payer: AlohaCare Medicaid	$6,880.05
Rate for Payer: Hawaii Medical Service Association ABD	$6,880.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,880.05
Rate for Payer: Kaiser Permanente Medicaid	$6,880.05
Rate for Payer: Ohana Health Plan Medicaid	$6,880.05
Rate for Payer: UnitedHealthcare Medicaid	$6,880.05

NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$37,694.21

Service Code	APR-DRG 6213
Min. Negotiated Rate	$37,694.21
Max. Negotiated Rate	$37,694.21
Rate for Payer: AlohaCare Medicaid	$37,694.21
Rate for Payer: Hawaii Medical Service Association ABD	$37,694.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37,694.21
Rate for Payer: Kaiser Permanente Medicaid	$37,694.21
Rate for Payer: Ohana Health Plan Medicaid	$37,694.21
Rate for Payer: UnitedHealthcare Medicaid	$37,694.21

NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$70,729.59

Service Code	APR-DRG 6214
Min. Negotiated Rate	$70,729.59
Max. Negotiated Rate	$70,729.59
Rate for Payer: AlohaCare Medicaid	$70,729.59
Rate for Payer: Hawaii Medical Service Association ABD	$70,729.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$70,729.59
Rate for Payer: Kaiser Permanente Medicaid	$70,729.59
Rate for Payer: Ohana Health Plan Medicaid	$70,729.59
Rate for Payer: UnitedHealthcare Medicaid	$70,729.59

NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$18,923.44

Service Code	APR-DRG 6212
Min. Negotiated Rate	$18,923.44
Max. Negotiated Rate	$18,923.44
Rate for Payer: AlohaCare Medicaid	$18,923.44
Rate for Payer: Hawaii Medical Service Association ABD	$18,923.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,923.44
Rate for Payer: Kaiser Permanente Medicaid	$18,923.44
Rate for Payer: Ohana Health Plan Medicaid	$18,923.44
Rate for Payer: UnitedHealthcare Medicaid	$18,923.44

Know your out-of-pocket cost for care.

All Charges