Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER CHEMOTHERAPY

Facility

$3,749.29

Service Code	APR-DRG 6961
Min. Negotiated Rate	$3,749.29
Max. Negotiated Rate	$3,749.29
Rate for Payer: AlohaCare Medicaid	$3,749.29
Rate for Payer: Hawaii Medical Service Association ABD	$3,749.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,749.29
Rate for Payer: Kaiser Permanente Medicaid	$3,749.29
Rate for Payer: Ohana Health Plan Medicaid	$3,749.29
Rate for Payer: UnitedHealthcare Medicaid	$3,749.29

OTHER CHEMOTHERAPY

Facility

$14,074.83

Service Code	APR-DRG 6964
Min. Negotiated Rate	$14,074.83
Max. Negotiated Rate	$14,074.83
Rate for Payer: AlohaCare Medicaid	$14,074.83
Rate for Payer: Hawaii Medical Service Association ABD	$14,074.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,074.83
Rate for Payer: Kaiser Permanente Medicaid	$14,074.83
Rate for Payer: Ohana Health Plan Medicaid	$14,074.83
Rate for Payer: UnitedHealthcare Medicaid	$14,074.83

OTHER CHEMOTHERAPY

Facility

$4,940.35

Service Code	APR-DRG 6962
Min. Negotiated Rate	$4,940.35
Max. Negotiated Rate	$4,940.35
Rate for Payer: AlohaCare Medicaid	$4,940.35
Rate for Payer: Hawaii Medical Service Association ABD	$4,940.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,940.35
Rate for Payer: Kaiser Permanente Medicaid	$4,940.35
Rate for Payer: Ohana Health Plan Medicaid	$4,940.35
Rate for Payer: UnitedHealthcare Medicaid	$4,940.35

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$4,862.73

Service Code	APR-DRG 2073
Min. Negotiated Rate	$4,862.73
Max. Negotiated Rate	$4,862.73
Rate for Payer: AlohaCare Medicaid	$4,862.73
Rate for Payer: Hawaii Medical Service Association ABD	$4,862.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,862.73
Rate for Payer: Kaiser Permanente Medicaid	$4,862.73
Rate for Payer: Ohana Health Plan Medicaid	$4,862.73
Rate for Payer: UnitedHealthcare Medicaid	$4,862.73

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$2,864.15

Service Code	APR-DRG 2071
Min. Negotiated Rate	$2,864.15
Max. Negotiated Rate	$2,864.15
Rate for Payer: AlohaCare Medicaid	$2,864.15
Rate for Payer: Hawaii Medical Service Association ABD	$2,864.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,864.15
Rate for Payer: Kaiser Permanente Medicaid	$2,864.15
Rate for Payer: Ohana Health Plan Medicaid	$2,864.15
Rate for Payer: UnitedHealthcare Medicaid	$2,864.15

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$8,612.01

Service Code	APR-DRG 2074
Min. Negotiated Rate	$8,612.01
Max. Negotiated Rate	$8,612.01
Rate for Payer: AlohaCare Medicaid	$8,612.01
Rate for Payer: Hawaii Medical Service Association ABD	$8,612.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,612.01
Rate for Payer: Kaiser Permanente Medicaid	$8,612.01
Rate for Payer: Ohana Health Plan Medicaid	$8,612.01
Rate for Payer: UnitedHealthcare Medicaid	$8,612.01

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$3,536.65

Service Code	APR-DRG 2072
Min. Negotiated Rate	$3,536.65
Max. Negotiated Rate	$3,536.65
Rate for Payer: AlohaCare Medicaid	$3,536.65
Rate for Payer: Hawaii Medical Service Association ABD	$3,536.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,536.65
Rate for Payer: Kaiser Permanente Medicaid	$3,536.65
Rate for Payer: Ohana Health Plan Medicaid	$3,536.65
Rate for Payer: UnitedHealthcare Medicaid	$3,536.65

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility

$27,274.98

Service Code	MSDRG 315
Min. Negotiated Rate	$10,956.82
Max. Negotiated Rate	$27,274.98
Rate for Payer: AlohaCare Medicare	$10,956.82
Rate for Payer: Devoted Health Medicare	$12,052.50
Rate for Payer: Hawaii Medical Service Association Commercial	$27,274.98
Rate for Payer: Hawaii Medical Service Association Medicare	$10,956.82
Rate for Payer: Humana Medicare	$10,956.82
Rate for Payer: Kaiser Permanente Commercial	$16,616.92
Rate for Payer: Kaiser Permanente Medicare	$10,956.82
Rate for Payer: Ohana Health Plan Medicare	$10,956.82
Rate for Payer: UnitedHealthcare Medicare	$10,956.82

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility

$40,669.82

Service Code	MSDRG 314
Min. Negotiated Rate	$23,717.59
Max. Negotiated Rate	$40,669.82
Rate for Payer: AlohaCare Medicare	$23,717.59
Rate for Payer: Devoted Health Medicare	$26,089.35
Rate for Payer: Hawaii Medical Service Association Commercial	$40,669.82
Rate for Payer: Hawaii Medical Service Association Medicare	$23,717.59
Rate for Payer: Humana Medicare	$23,717.59
Rate for Payer: Kaiser Permanente Commercial	$35,969.70
Rate for Payer: Kaiser Permanente Medicare	$23,717.59
Rate for Payer: Ohana Health Plan Medicare	$23,717.59
Rate for Payer: UnitedHealthcare Medicare	$23,717.59

OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$17,398.72

Service Code	MSDRG 316
Min. Negotiated Rate	$7,758.38
Max. Negotiated Rate	$17,398.72
Rate for Payer: AlohaCare Medicare	$7,758.38
Rate for Payer: Devoted Health Medicare	$8,534.22
Rate for Payer: Hawaii Medical Service Association Commercial	$17,398.72
Rate for Payer: Hawaii Medical Service Association Medicare	$7,758.38
Rate for Payer: Humana Medicare	$7,758.38
Rate for Payer: Kaiser Permanente Commercial	$11,766.23
Rate for Payer: Kaiser Permanente Medicare	$7,758.38
Rate for Payer: Ohana Health Plan Medicare	$7,758.38
Rate for Payer: UnitedHealthcare Medicare	$7,758.38

OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$165,591.18

Service Code	MSDRG 264
Min. Negotiated Rate	$37,996.84
Max. Negotiated Rate	$165,591.18
Rate for Payer: AlohaCare Medicare	$37,996.84
Rate for Payer: Devoted Health Medicare	$41,796.52
Rate for Payer: Hawaii Medical Service Association Commercial	$165,591.18
Rate for Payer: Hawaii Medical Service Association Medicare	$37,996.84
Rate for Payer: Humana Medicare	$37,996.84
Rate for Payer: Kaiser Permanente Commercial	$57,625.35
Rate for Payer: Kaiser Permanente Medicare	$37,996.84
Rate for Payer: Ohana Health Plan Medicare	$37,996.84
Rate for Payer: UnitedHealthcare Medicare	$37,996.84

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$18,835.15

Service Code	APR-DRG 1804
Min. Negotiated Rate	$18,835.15
Max. Negotiated Rate	$18,835.15
Rate for Payer: AlohaCare Medicaid	$18,835.15
Rate for Payer: Hawaii Medical Service Association ABD	$18,835.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,835.15
Rate for Payer: Kaiser Permanente Medicaid	$18,835.15
Rate for Payer: Ohana Health Plan Medicaid	$18,835.15
Rate for Payer: UnitedHealthcare Medicaid	$18,835.15

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$10,608.63

Service Code	APR-DRG 1803
Min. Negotiated Rate	$10,608.63
Max. Negotiated Rate	$10,608.63
Rate for Payer: AlohaCare Medicaid	$10,608.63
Rate for Payer: Hawaii Medical Service Association ABD	$10,608.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,608.63
Rate for Payer: Kaiser Permanente Medicaid	$10,608.63
Rate for Payer: Ohana Health Plan Medicaid	$10,608.63
Rate for Payer: UnitedHealthcare Medicaid	$10,608.63

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$6,398.84

Service Code	APR-DRG 1801
Min. Negotiated Rate	$6,398.84
Max. Negotiated Rate	$6,398.84
Rate for Payer: AlohaCare Medicaid	$6,398.84
Rate for Payer: Hawaii Medical Service Association ABD	$6,398.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,398.84
Rate for Payer: Kaiser Permanente Medicaid	$6,398.84
Rate for Payer: Ohana Health Plan Medicaid	$6,398.84
Rate for Payer: UnitedHealthcare Medicaid	$6,398.84

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$7,597.07

Service Code	APR-DRG 1802
Min. Negotiated Rate	$7,597.07
Max. Negotiated Rate	$7,597.07
Rate for Payer: AlohaCare Medicaid	$7,597.07
Rate for Payer: Hawaii Medical Service Association ABD	$7,597.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,597.07
Rate for Payer: Kaiser Permanente Medicaid	$7,597.07
Rate for Payer: Ohana Health Plan Medicaid	$7,597.07
Rate for Payer: UnitedHealthcare Medicaid	$7,597.07

OTHER COMPLICATIONS OF TREATMENT

Facility

$9,250.59

Service Code	APR-DRG 8134
Min. Negotiated Rate	$9,250.59
Max. Negotiated Rate	$9,250.59
Rate for Payer: AlohaCare Medicaid	$9,250.59
Rate for Payer: Hawaii Medical Service Association ABD	$9,250.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,250.59
Rate for Payer: Kaiser Permanente Medicaid	$9,250.59
Rate for Payer: Ohana Health Plan Medicaid	$9,250.59
Rate for Payer: UnitedHealthcare Medicaid	$9,250.59

OTHER COMPLICATIONS OF TREATMENT

Facility

$2,821.75

Service Code	APR-DRG 8131
Min. Negotiated Rate	$2,821.75
Max. Negotiated Rate	$2,821.75
Rate for Payer: AlohaCare Medicaid	$2,821.75
Rate for Payer: Hawaii Medical Service Association ABD	$2,821.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,821.75
Rate for Payer: Kaiser Permanente Medicaid	$2,821.75
Rate for Payer: Ohana Health Plan Medicaid	$2,821.75
Rate for Payer: UnitedHealthcare Medicaid	$2,821.75

OTHER COMPLICATIONS OF TREATMENT

Facility

$3,530.12

Service Code	APR-DRG 8132
Min. Negotiated Rate	$3,530.12
Max. Negotiated Rate	$3,530.12
Rate for Payer: AlohaCare Medicaid	$3,530.12
Rate for Payer: Hawaii Medical Service Association ABD	$3,530.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,530.12
Rate for Payer: Kaiser Permanente Medicaid	$3,530.12
Rate for Payer: Ohana Health Plan Medicaid	$3,530.12
Rate for Payer: UnitedHealthcare Medicaid	$3,530.12

OTHER COMPLICATIONS OF TREATMENT

Facility

$5,085.80

Service Code	APR-DRG 8133
Min. Negotiated Rate	$5,085.80
Max. Negotiated Rate	$5,085.80
Rate for Payer: AlohaCare Medicaid	$5,085.80
Rate for Payer: Hawaii Medical Service Association ABD	$5,085.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,085.80
Rate for Payer: Kaiser Permanente Medicaid	$5,085.80
Rate for Payer: Ohana Health Plan Medicaid	$5,085.80
Rate for Payer: UnitedHealthcare Medicaid	$5,085.80

OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES

Facility

$7,446.39

Service Code	APR-DRG 2292
Min. Negotiated Rate	$7,446.39
Max. Negotiated Rate	$7,446.39
Rate for Payer: AlohaCare Medicaid	$7,446.39
Rate for Payer: Hawaii Medical Service Association ABD	$7,446.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,446.39
Rate for Payer: Kaiser Permanente Medicaid	$7,446.39
Rate for Payer: Ohana Health Plan Medicaid	$7,446.39
Rate for Payer: UnitedHealthcare Medicaid	$7,446.39

OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES

Facility

$6,037.48

Service Code	APR-DRG 2291
Min. Negotiated Rate	$6,037.48
Max. Negotiated Rate	$6,037.48
Rate for Payer: AlohaCare Medicaid	$6,037.48
Rate for Payer: Hawaii Medical Service Association ABD	$6,037.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,037.48
Rate for Payer: Kaiser Permanente Medicaid	$6,037.48
Rate for Payer: Ohana Health Plan Medicaid	$6,037.48
Rate for Payer: UnitedHealthcare Medicaid	$6,037.48

OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES

Facility

$10,536.23

Service Code	APR-DRG 2293
Min. Negotiated Rate	$10,536.23
Max. Negotiated Rate	$10,536.23
Rate for Payer: AlohaCare Medicaid	$10,536.23
Rate for Payer: Hawaii Medical Service Association ABD	$10,536.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,536.23
Rate for Payer: Kaiser Permanente Medicaid	$10,536.23
Rate for Payer: Ohana Health Plan Medicaid	$10,536.23
Rate for Payer: UnitedHealthcare Medicaid	$10,536.23

OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES

Facility

$18,560.54

Service Code	APR-DRG 2294
Min. Negotiated Rate	$18,560.54
Max. Negotiated Rate	$18,560.54
Rate for Payer: AlohaCare Medicaid	$18,560.54
Rate for Payer: Hawaii Medical Service Association ABD	$18,560.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,560.54
Rate for Payer: Kaiser Permanente Medicaid	$18,560.54
Rate for Payer: Ohana Health Plan Medicaid	$18,560.54
Rate for Payer: UnitedHealthcare Medicaid	$18,560.54

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$9,234.29

Service Code	APR-DRG 2544
Min. Negotiated Rate	$9,234.29
Max. Negotiated Rate	$9,234.29
Rate for Payer: AlohaCare Medicaid	$9,234.29
Rate for Payer: Hawaii Medical Service Association ABD	$9,234.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,234.29
Rate for Payer: Kaiser Permanente Medicaid	$9,234.29
Rate for Payer: Ohana Health Plan Medicaid	$9,234.29
Rate for Payer: UnitedHealthcare Medicaid	$9,234.29

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$3,573.83

Service Code	APR-DRG 2542
Min. Negotiated Rate	$3,573.83
Max. Negotiated Rate	$3,573.83
Rate for Payer: AlohaCare Medicaid	$3,573.83
Rate for Payer: Hawaii Medical Service Association ABD	$3,573.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,573.83
Rate for Payer: Kaiser Permanente Medicaid	$3,573.83
Rate for Payer: Ohana Health Plan Medicaid	$3,573.83
Rate for Payer: UnitedHealthcare Medicaid	$3,573.83

Know your out-of-pocket cost for care.

All Charges