Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$5,171.25

Service Code	APR-DRG 2543
Min. Negotiated Rate	$5,171.25
Max. Negotiated Rate	$5,171.25
Rate for Payer: AlohaCare Medicaid	$5,171.25
Rate for Payer: Hawaii Medical Service Association ABD	$5,171.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,171.25
Rate for Payer: Kaiser Permanente Medicaid	$5,171.25
Rate for Payer: Ohana Health Plan Medicaid	$5,171.25
Rate for Payer: UnitedHealthcare Medicaid	$5,171.25

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$2,598.67

Service Code	APR-DRG 2541
Min. Negotiated Rate	$2,598.67
Max. Negotiated Rate	$2,598.67
Rate for Payer: AlohaCare Medicaid	$2,598.67
Rate for Payer: Hawaii Medical Service Association ABD	$2,598.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,598.67
Rate for Payer: Kaiser Permanente Medicaid	$2,598.67
Rate for Payer: Ohana Health Plan Medicaid	$2,598.67
Rate for Payer: UnitedHealthcare Medicaid	$2,598.67

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$18,757.62

Service Code	MSDRG 394
Min. Negotiated Rate	$10,642.89
Max. Negotiated Rate	$18,757.62
Rate for Payer: AlohaCare Medicare	$10,642.89
Rate for Payer: Devoted Health Medicare	$11,707.18
Rate for Payer: Hawaii Medical Service Association Commercial	$18,757.62
Rate for Payer: Hawaii Medical Service Association Medicare	$10,642.89
Rate for Payer: Humana Medicare	$10,642.89
Rate for Payer: Kaiser Permanente Commercial	$16,140.83
Rate for Payer: Kaiser Permanente Medicare	$10,642.89
Rate for Payer: Ohana Health Plan Medicare	$10,642.89
Rate for Payer: UnitedHealthcare Medicare	$10,642.89

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$27,587.92

Service Code	MSDRG 393
Min. Negotiated Rate	$18,190.86
Max. Negotiated Rate	$27,587.92
Rate for Payer: AlohaCare Medicare	$18,190.86
Rate for Payer: Devoted Health Medicare	$20,009.95
Rate for Payer: Hawaii Medical Service Association Commercial	$25,867.56
Rate for Payer: Hawaii Medical Service Association Medicare	$18,190.86
Rate for Payer: Humana Medicare	$18,190.86
Rate for Payer: Kaiser Permanente Commercial	$27,587.92
Rate for Payer: Kaiser Permanente Medicare	$18,190.86
Rate for Payer: Ohana Health Plan Medicare	$18,190.86
Rate for Payer: UnitedHealthcare Medicare	$18,190.86

OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$17,083.26

Service Code	MSDRG 395
Min. Negotiated Rate	$7,381.89
Max. Negotiated Rate	$17,083.26
Rate for Payer: AlohaCare Medicare	$7,381.89
Rate for Payer: Devoted Health Medicare	$8,120.08
Rate for Payer: Hawaii Medical Service Association Commercial	$17,083.26
Rate for Payer: Hawaii Medical Service Association Medicare	$7,381.89
Rate for Payer: Humana Medicare	$7,381.89
Rate for Payer: Kaiser Permanente Commercial	$11,195.25
Rate for Payer: Kaiser Permanente Medicare	$7,381.89
Rate for Payer: Ohana Health Plan Medicare	$7,381.89
Rate for Payer: UnitedHealthcare Medicare	$7,381.89

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$59,403.17

Service Code	MSDRG 357
Min. Negotiated Rate	$26,450.83
Max. Negotiated Rate	$59,403.17
Rate for Payer: AlohaCare Medicare	$26,450.83
Rate for Payer: Devoted Health Medicare	$29,095.91
Rate for Payer: Hawaii Medical Service Association Commercial	$59,403.17
Rate for Payer: Hawaii Medical Service Association Medicare	$26,450.83
Rate for Payer: Humana Medicare	$26,450.83
Rate for Payer: Kaiser Permanente Commercial	$40,114.88
Rate for Payer: Kaiser Permanente Medicare	$26,450.83
Rate for Payer: Ohana Health Plan Medicare	$26,450.83
Rate for Payer: UnitedHealthcare Medicare	$26,450.83

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$75,775.80

Service Code	MSDRG 356
Min. Negotiated Rate	$49,964.82
Max. Negotiated Rate	$75,775.80
Rate for Payer: AlohaCare Medicare	$49,964.82
Rate for Payer: Devoted Health Medicare	$54,961.30
Rate for Payer: Hawaii Medical Service Association Commercial	$64,523.29
Rate for Payer: Hawaii Medical Service Association Medicare	$49,964.82
Rate for Payer: Humana Medicare	$49,964.82
Rate for Payer: Kaiser Permanente Commercial	$75,775.80
Rate for Payer: Kaiser Permanente Medicare	$49,964.82
Rate for Payer: Ohana Health Plan Medicare	$49,964.82
Rate for Payer: UnitedHealthcare Medicare	$49,964.82

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$33,220.15

Service Code	MSDRG 358
Min. Negotiated Rate	$15,900.07
Max. Negotiated Rate	$33,220.15
Rate for Payer: AlohaCare Medicare	$15,900.07
Rate for Payer: Devoted Health Medicare	$17,490.08
Rate for Payer: Hawaii Medical Service Association Commercial	$33,220.15
Rate for Payer: Hawaii Medical Service Association Medicare	$15,900.07
Rate for Payer: Humana Medicare	$15,900.07
Rate for Payer: Kaiser Permanente Commercial	$24,113.78
Rate for Payer: Kaiser Permanente Medicare	$15,900.07
Rate for Payer: Ohana Health Plan Medicare	$15,900.07
Rate for Payer: UnitedHealthcare Medicare	$15,900.07

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$4,239.15

Service Code	APR-DRG 0582
Min. Negotiated Rate	$4,239.15
Max. Negotiated Rate	$4,239.15
Rate for Payer: AlohaCare Medicaid	$4,239.15
Rate for Payer: Hawaii Medical Service Association ABD	$4,239.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,239.15
Rate for Payer: Kaiser Permanente Medicaid	$4,239.15
Rate for Payer: Ohana Health Plan Medicaid	$4,239.15
Rate for Payer: UnitedHealthcare Medicaid	$4,239.15

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$10,077.68

Service Code	APR-DRG 0584
Min. Negotiated Rate	$10,077.68
Max. Negotiated Rate	$10,077.68
Rate for Payer: AlohaCare Medicaid	$10,077.68
Rate for Payer: Hawaii Medical Service Association ABD	$10,077.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,077.68
Rate for Payer: Kaiser Permanente Medicaid	$10,077.68
Rate for Payer: Ohana Health Plan Medicaid	$10,077.68
Rate for Payer: UnitedHealthcare Medicaid	$10,077.68

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$5,726.34

Service Code	APR-DRG 0583
Min. Negotiated Rate	$5,726.34
Max. Negotiated Rate	$5,726.34
Rate for Payer: AlohaCare Medicaid	$5,726.34
Rate for Payer: Hawaii Medical Service Association ABD	$5,726.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,726.34
Rate for Payer: Kaiser Permanente Medicaid	$5,726.34
Rate for Payer: Ohana Health Plan Medicaid	$5,726.34
Rate for Payer: UnitedHealthcare Medicaid	$5,726.34

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$3,313.57

Service Code	APR-DRG 0581
Min. Negotiated Rate	$3,313.57
Max. Negotiated Rate	$3,313.57
Rate for Payer: AlohaCare Medicaid	$3,313.57
Rate for Payer: Hawaii Medical Service Association ABD	$3,313.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,313.57
Rate for Payer: Kaiser Permanente Medicaid	$3,313.57
Rate for Payer: Ohana Health Plan Medicaid	$3,313.57
Rate for Payer: UnitedHealthcare Medicaid	$3,313.57

OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility

$21,378.35

Service Code	MSDRG 092
Min. Negotiated Rate	$11,635.87
Max. Negotiated Rate	$21,378.35
Rate for Payer: AlohaCare Medicare	$11,635.87
Rate for Payer: Devoted Health Medicare	$12,799.46
Rate for Payer: Hawaii Medical Service Association Commercial	$21,378.35
Rate for Payer: Hawaii Medical Service Association Medicare	$11,635.87
Rate for Payer: Humana Medicare	$11,635.87
Rate for Payer: Kaiser Permanente Commercial	$17,646.75
Rate for Payer: Kaiser Permanente Medicare	$11,635.87
Rate for Payer: Ohana Health Plan Medicare	$11,635.87
Rate for Payer: UnitedHealthcare Medicare	$11,635.87

OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$30,294.45

Service Code	MSDRG 091
Min. Negotiated Rate	$19,975.48
Max. Negotiated Rate	$30,294.45
Rate for Payer: AlohaCare Medicare	$19,975.48
Rate for Payer: Devoted Health Medicare	$21,973.03
Rate for Payer: Hawaii Medical Service Association Commercial	$25,552.10
Rate for Payer: Hawaii Medical Service Association Medicare	$19,975.48
Rate for Payer: Humana Medicare	$19,975.48
Rate for Payer: Kaiser Permanente Commercial	$30,294.45
Rate for Payer: Kaiser Permanente Medicare	$19,975.48
Rate for Payer: Ohana Health Plan Medicare	$19,975.48
Rate for Payer: UnitedHealthcare Medicare	$19,975.48

OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$17,714.18

Service Code	MSDRG 093
Min. Negotiated Rate	$9,057.31
Max. Negotiated Rate	$17,714.18
Rate for Payer: AlohaCare Medicare	$9,057.31
Rate for Payer: Devoted Health Medicare	$9,963.04
Rate for Payer: Hawaii Medical Service Association Commercial	$17,714.18
Rate for Payer: Hawaii Medical Service Association Medicare	$9,057.31
Rate for Payer: Humana Medicare	$9,057.31
Rate for Payer: Kaiser Permanente Commercial	$13,736.17
Rate for Payer: Kaiser Permanente Medicare	$9,057.31
Rate for Payer: Ohana Health Plan Medicare	$9,057.31
Rate for Payer: UnitedHealthcare Medicare	$9,057.31

OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$22,823.47

Service Code	MSDRG 124
Min. Negotiated Rate	$15,049.28
Max. Negotiated Rate	$22,823.47
Rate for Payer: AlohaCare Medicare	$15,049.28
Rate for Payer: Devoted Health Medicare	$16,554.21
Rate for Payer: Hawaii Medical Service Association Commercial	$16,282.49
Rate for Payer: Hawaii Medical Service Association Medicare	$15,049.28
Rate for Payer: Humana Medicare	$15,049.28
Rate for Payer: Kaiser Permanente Commercial	$22,823.47
Rate for Payer: Kaiser Permanente Medicare	$15,049.28
Rate for Payer: Ohana Health Plan Medicare	$15,049.28
Rate for Payer: UnitedHealthcare Medicare	$15,049.28

OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$13,244.55

Service Code	MSDRG 125
Min. Negotiated Rate	$8,226.17
Max. Negotiated Rate	$13,244.55
Rate for Payer: AlohaCare Medicare	$8,733.15
Rate for Payer: Devoted Health Medicare	$9,606.47
Rate for Payer: Hawaii Medical Service Association Commercial	$8,226.17
Rate for Payer: Hawaii Medical Service Association Medicare	$8,733.15
Rate for Payer: Humana Medicare	$8,733.15
Rate for Payer: Kaiser Permanente Commercial	$13,244.55
Rate for Payer: Kaiser Permanente Medicare	$8,733.15
Rate for Payer: Ohana Health Plan Medicare	$8,733.15
Rate for Payer: UnitedHealthcare Medicare	$8,733.15

OTHER DISORDERS OF THE LIVER

Facility

$3,474.03

Service Code	APR-DRG 2832
Min. Negotiated Rate	$3,474.03
Max. Negotiated Rate	$3,474.03
Rate for Payer: AlohaCare Medicaid	$3,474.03
Rate for Payer: Hawaii Medical Service Association ABD	$3,474.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,474.03
Rate for Payer: Kaiser Permanente Medicaid	$3,474.03
Rate for Payer: Ohana Health Plan Medicaid	$3,474.03
Rate for Payer: UnitedHealthcare Medicaid	$3,474.03

OTHER DISORDERS OF THE LIVER

Facility

$4,901.86

Service Code	APR-DRG 2833
Min. Negotiated Rate	$4,901.86
Max. Negotiated Rate	$4,901.86
Rate for Payer: AlohaCare Medicaid	$4,901.86
Rate for Payer: Hawaii Medical Service Association ABD	$4,901.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,901.86
Rate for Payer: Kaiser Permanente Medicaid	$4,901.86
Rate for Payer: Ohana Health Plan Medicaid	$4,901.86
Rate for Payer: UnitedHealthcare Medicaid	$4,901.86

OTHER DISORDERS OF THE LIVER

Facility

$9,128.62

Service Code	APR-DRG 2834
Min. Negotiated Rate	$9,128.62
Max. Negotiated Rate	$9,128.62
Rate for Payer: AlohaCare Medicaid	$9,128.62
Rate for Payer: Hawaii Medical Service Association ABD	$9,128.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,128.62
Rate for Payer: Kaiser Permanente Medicaid	$9,128.62
Rate for Payer: Ohana Health Plan Medicaid	$9,128.62
Rate for Payer: UnitedHealthcare Medicaid	$9,128.62

OTHER DISORDERS OF THE LIVER

Facility

$2,782.61

Service Code	APR-DRG 2831
Min. Negotiated Rate	$2,782.61
Max. Negotiated Rate	$2,782.61
Rate for Payer: AlohaCare Medicaid	$2,782.61
Rate for Payer: Hawaii Medical Service Association ABD	$2,782.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,782.61
Rate for Payer: Kaiser Permanente Medicaid	$2,782.61
Rate for Payer: Ohana Health Plan Medicaid	$2,782.61
Rate for Payer: UnitedHealthcare Medicaid	$2,782.61

OTHER DRUG ABUSE & DEPENDENCE

Facility

$8,934.66

Service Code	APR-DRG 7764
Min. Negotiated Rate	$8,934.66
Max. Negotiated Rate	$8,934.66
Rate for Payer: AlohaCare Medicaid	$8,934.66
Rate for Payer: Hawaii Medical Service Association ABD	$8,934.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,934.66
Rate for Payer: Kaiser Permanente Medicaid	$8,934.66
Rate for Payer: Ohana Health Plan Medicaid	$8,934.66
Rate for Payer: UnitedHealthcare Medicaid	$8,934.66

OTHER DRUG ABUSE & DEPENDENCE

Facility

$2,670.42

Service Code	APR-DRG 7761
Min. Negotiated Rate	$2,670.42
Max. Negotiated Rate	$2,670.42
Rate for Payer: AlohaCare Medicaid	$2,670.42
Rate for Payer: Hawaii Medical Service Association ABD	$2,670.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,670.42
Rate for Payer: Kaiser Permanente Medicaid	$2,670.42
Rate for Payer: Ohana Health Plan Medicaid	$2,670.42
Rate for Payer: UnitedHealthcare Medicaid	$2,670.42

OTHER DRUG ABUSE & DEPENDENCE

Facility

$3,247.26

Service Code	APR-DRG 7762
Min. Negotiated Rate	$3,247.26
Max. Negotiated Rate	$3,247.26
Rate for Payer: AlohaCare Medicaid	$3,247.26
Rate for Payer: Hawaii Medical Service Association ABD	$3,247.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,247.26
Rate for Payer: Kaiser Permanente Medicaid	$3,247.26
Rate for Payer: Ohana Health Plan Medicaid	$3,247.26
Rate for Payer: UnitedHealthcare Medicaid	$3,247.26

OTHER DRUG ABUSE & DEPENDENCE

Facility

$5,010.79

Service Code	APR-DRG 7763
Min. Negotiated Rate	$5,010.79
Max. Negotiated Rate	$5,010.79
Rate for Payer: AlohaCare Medicaid	$5,010.79
Rate for Payer: Hawaii Medical Service Association ABD	$5,010.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,010.79
Rate for Payer: Kaiser Permanente Medicaid	$5,010.79
Rate for Payer: Ohana Health Plan Medicaid	$5,010.79
Rate for Payer: UnitedHealthcare Medicaid	$5,010.79

Know your out-of-pocket cost for care.

All Charges