Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$2,750.65

Service Code	APR-DRG 6631
Min. Negotiated Rate	$2,750.65
Max. Negotiated Rate	$2,750.65
Rate for Payer: AlohaCare Medicaid	$2,750.65
Rate for Payer: Hawaii Medical Service Association ABD	$2,750.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,750.65
Rate for Payer: Kaiser Permanente Medicaid	$2,750.65
Rate for Payer: Ohana Health Plan Medicaid	$2,750.65
Rate for Payer: UnitedHealthcare Medicaid	$2,750.65

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$18,184.95

Service Code	MSDRG 818
Min. Negotiated Rate	$10,871.17
Max. Negotiated Rate	$18,184.95
Rate for Payer: AlohaCare Medicare	$13,185.06
Rate for Payer: Devoted Health Medicare	$14,503.57
Rate for Payer: Hawaii Medical Service Association Commercial	$10,871.17
Rate for Payer: Hawaii Medical Service Association Medicare	$13,185.06
Rate for Payer: Humana Medicare	$13,185.06
Rate for Payer: Kaiser Permanente Commercial	$18,184.95
Rate for Payer: Kaiser Permanente Medicare	$13,185.06
Rate for Payer: Ohana Health Plan Medicare	$13,185.06
Rate for Payer: UnitedHealthcare Medicare	$13,185.06

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$29,118.00

Service Code	MSDRG 817
Min. Negotiated Rate	$10,871.17
Max. Negotiated Rate	$29,118.00
Rate for Payer: AlohaCare Medicare	$25,951.49
Rate for Payer: Devoted Health Medicare	$28,546.64
Rate for Payer: Hawaii Medical Service Association Commercial	$10,871.17
Rate for Payer: Hawaii Medical Service Association Medicare	$25,951.49
Rate for Payer: Humana Medicare	$25,951.49
Rate for Payer: Kaiser Permanente Commercial	$29,118.00
Rate for Payer: Kaiser Permanente Medicare	$25,951.49
Rate for Payer: Ohana Health Plan Medicare	$25,951.49
Rate for Payer: UnitedHealthcare Medicare	$25,951.49

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$14,833.27

Service Code	MSDRG 819
Min. Negotiated Rate	$9,780.73
Max. Negotiated Rate	$14,833.27
Rate for Payer: AlohaCare Medicare	$9,780.73
Rate for Payer: Devoted Health Medicare	$10,758.80
Rate for Payer: Hawaii Medical Service Association Commercial	$10,579.98
Rate for Payer: Hawaii Medical Service Association Medicare	$9,780.73
Rate for Payer: Humana Medicare	$9,780.73
Rate for Payer: Kaiser Permanente Commercial	$14,833.27
Rate for Payer: Kaiser Permanente Medicare	$9,780.73
Rate for Payer: Ohana Health Plan Medicare	$9,780.73
Rate for Payer: UnitedHealthcare Medicare	$9,780.73

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$12,447.60

Service Code	MSDRG 832
Min. Negotiated Rate	$8,207.66
Max. Negotiated Rate	$12,447.60
Rate for Payer: AlohaCare Medicare	$8,207.66
Rate for Payer: Devoted Health Medicare	$9,028.43
Rate for Payer: Hawaii Medical Service Association Commercial	$9,536.54
Rate for Payer: Hawaii Medical Service Association Medicare	$8,207.66
Rate for Payer: Humana Medicare	$8,207.66
Rate for Payer: Kaiser Permanente Commercial	$12,447.60
Rate for Payer: Kaiser Permanente Medicare	$8,207.66
Rate for Payer: Ohana Health Plan Medicare	$8,207.66
Rate for Payer: UnitedHealthcare Medicare	$8,207.66

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$20,743.12

Service Code	MSDRG 831
Min. Negotiated Rate	$9,536.54
Max. Negotiated Rate	$20,743.12
Rate for Payer: AlohaCare Medicare	$13,677.53
Rate for Payer: Devoted Health Medicare	$15,045.28
Rate for Payer: Hawaii Medical Service Association Commercial	$9,536.54
Rate for Payer: Hawaii Medical Service Association Medicare	$13,677.53
Rate for Payer: Humana Medicare	$13,677.53
Rate for Payer: Kaiser Permanente Commercial	$20,743.12
Rate for Payer: Kaiser Permanente Medicare	$13,677.53
Rate for Payer: Ohana Health Plan Medicare	$13,677.53
Rate for Payer: UnitedHealthcare Medicare	$13,677.53

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$9,390.94

Service Code	MSDRG 833
Min. Negotiated Rate	$5,947.59
Max. Negotiated Rate	$9,390.94
Rate for Payer: AlohaCare Medicare	$5,947.59
Rate for Payer: Devoted Health Medicare	$6,542.35
Rate for Payer: Hawaii Medical Service Association Commercial	$9,390.94
Rate for Payer: Hawaii Medical Service Association Medicare	$5,947.59
Rate for Payer: Humana Medicare	$5,947.59
Rate for Payer: Kaiser Permanente Commercial	$9,020.02
Rate for Payer: Kaiser Permanente Medicare	$5,947.59
Rate for Payer: Ohana Health Plan Medicare	$5,947.59
Rate for Payer: UnitedHealthcare Medicare	$5,947.59

OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$3,142.67

Service Code	APR-DRG 3471
Min. Negotiated Rate	$3,142.67
Max. Negotiated Rate	$3,142.67
Rate for Payer: AlohaCare Medicaid	$3,142.67
Rate for Payer: Hawaii Medical Service Association ABD	$3,142.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,142.67
Rate for Payer: Kaiser Permanente Medicaid	$3,142.67
Rate for Payer: Ohana Health Plan Medicaid	$3,142.67
Rate for Payer: UnitedHealthcare Medicaid	$3,142.67

OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$3,807.34

Service Code	APR-DRG 3472
Min. Negotiated Rate	$3,807.34
Max. Negotiated Rate	$3,807.34
Rate for Payer: AlohaCare Medicaid	$3,807.34
Rate for Payer: Hawaii Medical Service Association ABD	$3,807.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,807.34
Rate for Payer: Kaiser Permanente Medicaid	$3,807.34
Rate for Payer: Ohana Health Plan Medicaid	$3,807.34
Rate for Payer: UnitedHealthcare Medicaid	$3,807.34

OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$5,023.84

Service Code	APR-DRG 3473
Min. Negotiated Rate	$5,023.84
Max. Negotiated Rate	$5,023.84
Rate for Payer: AlohaCare Medicaid	$5,023.84
Rate for Payer: Hawaii Medical Service Association ABD	$5,023.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,023.84
Rate for Payer: Kaiser Permanente Medicaid	$5,023.84
Rate for Payer: Ohana Health Plan Medicaid	$5,023.84
Rate for Payer: UnitedHealthcare Medicaid	$5,023.84

OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$9,487.37

Service Code	APR-DRG 3474
Min. Negotiated Rate	$9,487.37
Max. Negotiated Rate	$9,487.37
Rate for Payer: AlohaCare Medicaid	$9,487.37
Rate for Payer: Hawaii Medical Service Association ABD	$9,487.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,487.37
Rate for Payer: Kaiser Permanente Medicaid	$9,487.37
Rate for Payer: Ohana Health Plan Medicaid	$9,487.37
Rate for Payer: UnitedHealthcare Medicaid	$9,487.37

OTHER BLADDER PROCEDURES

Facility

$9,112.31

Service Code	APR-DRG 4453
Min. Negotiated Rate	$9,112.31
Max. Negotiated Rate	$9,112.31
Rate for Payer: AlohaCare Medicaid	$9,112.31
Rate for Payer: Hawaii Medical Service Association ABD	$9,112.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,112.31
Rate for Payer: Kaiser Permanente Medicaid	$9,112.31
Rate for Payer: Ohana Health Plan Medicaid	$9,112.31
Rate for Payer: UnitedHealthcare Medicaid	$9,112.31

OTHER BLADDER PROCEDURES

Facility

$6,542.34

Service Code	APR-DRG 4452
Min. Negotiated Rate	$6,542.34
Max. Negotiated Rate	$6,542.34
Rate for Payer: AlohaCare Medicaid	$6,542.34
Rate for Payer: Hawaii Medical Service Association ABD	$6,542.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,542.34
Rate for Payer: Kaiser Permanente Medicaid	$6,542.34
Rate for Payer: Ohana Health Plan Medicaid	$6,542.34
Rate for Payer: UnitedHealthcare Medicaid	$6,542.34

OTHER BLADDER PROCEDURES

Facility

$5,055.80

Service Code	APR-DRG 4451
Min. Negotiated Rate	$5,055.80
Max. Negotiated Rate	$5,055.80
Rate for Payer: AlohaCare Medicaid	$5,055.80
Rate for Payer: Hawaii Medical Service Association ABD	$5,055.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,055.80
Rate for Payer: Kaiser Permanente Medicaid	$5,055.80
Rate for Payer: Ohana Health Plan Medicaid	$5,055.80
Rate for Payer: UnitedHealthcare Medicaid	$5,055.80

OTHER BLADDER PROCEDURES

Facility

$16,283.44

Service Code	APR-DRG 4454
Min. Negotiated Rate	$16,283.44
Max. Negotiated Rate	$16,283.44
Rate for Payer: AlohaCare Medicaid	$16,283.44
Rate for Payer: Hawaii Medical Service Association ABD	$16,283.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,283.44
Rate for Payer: Kaiser Permanente Medicaid	$16,283.44
Rate for Payer: Ohana Health Plan Medicaid	$16,283.44
Rate for Payer: UnitedHealthcare Medicaid	$16,283.44

OTHER CARDIOTHORACIC PROCEDURES WITH MCC

Facility

$115,360.56

Service Code	MSDRG 228
Min. Negotiated Rate	$56,272.98
Max. Negotiated Rate	$115,360.56
Rate for Payer: AlohaCare Medicare	$56,272.98
Rate for Payer: Devoted Health Medicare	$61,900.28
Rate for Payer: Hawaii Medical Service Association Commercial	$115,360.56
Rate for Payer: Hawaii Medical Service Association Medicare	$56,272.98
Rate for Payer: Humana Medicare	$56,272.98
Rate for Payer: Kaiser Permanente Commercial	$85,342.65
Rate for Payer: Kaiser Permanente Medicare	$56,272.98
Rate for Payer: Ohana Health Plan Medicare	$56,272.98
Rate for Payer: UnitedHealthcare Medicare	$56,272.98

OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$115,360.56

Service Code	MSDRG 229
Min. Negotiated Rate	$35,823.22
Max. Negotiated Rate	$115,360.56
Rate for Payer: AlohaCare Medicare	$35,823.22
Rate for Payer: Devoted Health Medicare	$39,405.54
Rate for Payer: Hawaii Medical Service Association Commercial	$115,360.56
Rate for Payer: Hawaii Medical Service Association Medicare	$35,823.22
Rate for Payer: Humana Medicare	$35,823.22
Rate for Payer: Kaiser Permanente Commercial	$54,328.88
Rate for Payer: Kaiser Permanente Medicare	$35,823.22
Rate for Payer: Ohana Health Plan Medicare	$35,823.22
Rate for Payer: UnitedHealthcare Medicare	$35,823.22

OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

Facility

$14,739.50

Service Code	APR-DRG 1671
Min. Negotiated Rate	$14,739.50
Max. Negotiated Rate	$14,739.50
Rate for Payer: AlohaCare Medicaid	$14,739.50
Rate for Payer: Hawaii Medical Service Association ABD	$14,739.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,739.50
Rate for Payer: Kaiser Permanente Medicaid	$14,739.50
Rate for Payer: Ohana Health Plan Medicaid	$14,739.50
Rate for Payer: UnitedHealthcare Medicaid	$14,739.50

OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

Facility

$37,671.61

Service Code	APR-DRG 1674
Min. Negotiated Rate	$37,671.61
Max. Negotiated Rate	$37,671.61
Rate for Payer: AlohaCare Medicaid	$37,671.61
Rate for Payer: Hawaii Medical Service Association ABD	$37,671.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37,671.61
Rate for Payer: Kaiser Permanente Medicaid	$37,671.61
Rate for Payer: Ohana Health Plan Medicaid	$37,671.61
Rate for Payer: UnitedHealthcare Medicaid	$37,671.61

OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

Facility

$21,168.35

Service Code	APR-DRG 1673
Min. Negotiated Rate	$21,168.35
Max. Negotiated Rate	$21,168.35
Rate for Payer: AlohaCare Medicaid	$21,168.35
Rate for Payer: Hawaii Medical Service Association ABD	$21,168.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,168.35
Rate for Payer: Kaiser Permanente Medicaid	$21,168.35
Rate for Payer: Ohana Health Plan Medicaid	$21,168.35
Rate for Payer: UnitedHealthcare Medicaid	$21,168.35

OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

Facility

$14,867.35

Service Code	APR-DRG 1672
Min. Negotiated Rate	$14,867.35
Max. Negotiated Rate	$14,867.35
Rate for Payer: AlohaCare Medicaid	$14,867.35
Rate for Payer: Hawaii Medical Service Association ABD	$14,867.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,867.35
Rate for Payer: Kaiser Permanente Medicaid	$14,867.35
Rate for Payer: Ohana Health Plan Medicaid	$14,867.35
Rate for Payer: UnitedHealthcare Medicaid	$14,867.35

OTHER CEREBROVASCULAR DISORDERS WITH CC

Facility

$26,862.46

Service Code	MSDRG 071
Min. Negotiated Rate	$11,670.00
Max. Negotiated Rate	$26,862.46
Rate for Payer: AlohaCare Medicare	$11,670.00
Rate for Payer: Devoted Health Medicare	$12,837.00
Rate for Payer: Hawaii Medical Service Association Commercial	$26,862.46
Rate for Payer: Hawaii Medical Service Association Medicare	$11,670.00
Rate for Payer: Humana Medicare	$11,670.00
Rate for Payer: Kaiser Permanente Commercial	$17,698.50
Rate for Payer: Kaiser Permanente Medicare	$11,670.00
Rate for Payer: Ohana Health Plan Medicare	$11,670.00
Rate for Payer: UnitedHealthcare Medicare	$11,670.00

OTHER CEREBROVASCULAR DISORDERS WITH MCC

Facility

$28,717.80

Service Code	MSDRG 070
Min. Negotiated Rate	$18,935.85
Max. Negotiated Rate	$28,717.80
Rate for Payer: AlohaCare Medicare	$18,935.85
Rate for Payer: Devoted Health Medicare	$20,829.44
Rate for Payer: Hawaii Medical Service Association Commercial	$28,633.88
Rate for Payer: Hawaii Medical Service Association Medicare	$18,935.85
Rate for Payer: Humana Medicare	$18,935.85
Rate for Payer: Kaiser Permanente Commercial	$28,717.80
Rate for Payer: Kaiser Permanente Medicare	$18,935.85
Rate for Payer: Ohana Health Plan Medicare	$18,935.85
Rate for Payer: UnitedHealthcare Medicare	$18,935.85

OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC

Facility

$16,622.21

Service Code	MSDRG 072
Min. Negotiated Rate	$8,601.22
Max. Negotiated Rate	$16,622.21
Rate for Payer: AlohaCare Medicare	$8,601.22
Rate for Payer: Devoted Health Medicare	$9,461.34
Rate for Payer: Hawaii Medical Service Association Commercial	$16,622.21
Rate for Payer: Hawaii Medical Service Association Medicare	$8,601.22
Rate for Payer: Humana Medicare	$8,601.22
Rate for Payer: Kaiser Permanente Commercial	$13,044.45
Rate for Payer: Kaiser Permanente Medicare	$8,601.22
Rate for Payer: Ohana Health Plan Medicare	$8,601.22
Rate for Payer: UnitedHealthcare Medicare	$8,601.22

OTHER CHEMOTHERAPY

Facility

$7,267.02

Service Code	APR-DRG 6963
Min. Negotiated Rate	$7,267.02
Max. Negotiated Rate	$7,267.02
Rate for Payer: AlohaCare Medicaid	$7,267.02
Rate for Payer: Hawaii Medical Service Association ABD	$7,267.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,267.02
Rate for Payer: Kaiser Permanente Medicaid	$7,267.02
Rate for Payer: Ohana Health Plan Medicaid	$7,267.02
Rate for Payer: UnitedHealthcare Medicaid	$7,267.02

Know your out-of-pocket cost for care.

All Charges