Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$15,809.62

Service Code	MSDRG 155
Min. Negotiated Rate	$10,424.51
Max. Negotiated Rate	$15,809.62
Rate for Payer: AlohaCare Medicare	$10,424.51
Rate for Payer: Devoted Health Medicare	$11,466.96
Rate for Payer: Hawaii Medical Service Association Commercial	$15,166.25
Rate for Payer: Hawaii Medical Service Association Medicare	$10,424.51
Rate for Payer: Humana Medicare	$10,424.51
Rate for Payer: Kaiser Permanente Commercial	$15,809.62
Rate for Payer: Kaiser Permanente Medicare	$10,424.51
Rate for Payer: Ohana Health Plan Medicare	$10,424.51
Rate for Payer: UnitedHealthcare Medicare	$10,424.51

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$26,970.38

Service Code	MSDRG 154
Min. Negotiated Rate	$15,166.25
Max. Negotiated Rate	$26,970.38
Rate for Payer: AlohaCare Medicare	$17,783.65
Rate for Payer: Devoted Health Medicare	$19,562.01
Rate for Payer: Hawaii Medical Service Association Commercial	$15,166.25
Rate for Payer: Hawaii Medical Service Association Medicare	$17,783.65
Rate for Payer: Humana Medicare	$17,783.65
Rate for Payer: Kaiser Permanente Commercial	$26,970.38
Rate for Payer: Kaiser Permanente Medicare	$17,783.65
Rate for Payer: Ohana Health Plan Medicare	$17,783.65
Rate for Payer: UnitedHealthcare Medicare	$17,783.65

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$15,166.25

Service Code	MSDRG 156
Min. Negotiated Rate	$7,860.74
Max. Negotiated Rate	$15,166.25
Rate for Payer: AlohaCare Medicare	$7,860.74
Rate for Payer: Devoted Health Medicare	$8,646.81
Rate for Payer: Hawaii Medical Service Association Commercial	$15,166.25
Rate for Payer: Hawaii Medical Service Association Medicare	$7,860.74
Rate for Payer: Humana Medicare	$7,860.74
Rate for Payer: Kaiser Permanente Commercial	$11,921.48
Rate for Payer: Kaiser Permanente Medicare	$7,860.74
Rate for Payer: Ohana Health Plan Medicare	$7,860.74
Rate for Payer: UnitedHealthcare Medicare	$7,860.74

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$35,355.56

Service Code	MSDRG 144
Min. Negotiated Rate	$19,710.44
Max. Negotiated Rate	$35,355.56
Rate for Payer: AlohaCare Medicare	$19,710.44
Rate for Payer: Devoted Health Medicare	$21,681.48
Rate for Payer: Hawaii Medical Service Association Commercial	$35,355.56
Rate for Payer: Hawaii Medical Service Association Medicare	$19,710.44
Rate for Payer: Humana Medicare	$19,710.44
Rate for Payer: Kaiser Permanente Commercial	$29,892.53
Rate for Payer: Kaiser Permanente Medicare	$19,710.44
Rate for Payer: Ohana Health Plan Medicare	$19,710.44
Rate for Payer: UnitedHealthcare Medicare	$19,710.44

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$103,179.03

Service Code	MSDRG 143
Min. Negotiated Rate	$42,614.78
Max. Negotiated Rate	$103,179.03
Rate for Payer: AlohaCare Medicare	$42,614.78
Rate for Payer: Devoted Health Medicare	$46,876.26
Rate for Payer: Hawaii Medical Service Association Commercial	$103,179.03
Rate for Payer: Hawaii Medical Service Association Medicare	$42,614.78
Rate for Payer: Humana Medicare	$42,614.78
Rate for Payer: Kaiser Permanente Commercial	$64,628.85
Rate for Payer: Kaiser Permanente Medicare	$42,614.78
Rate for Payer: Ohana Health Plan Medicare	$42,614.78
Rate for Payer: UnitedHealthcare Medicare	$42,614.78

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$22,785.77

Service Code	MSDRG 145
Min. Negotiated Rate	$13,675.27
Max. Negotiated Rate	$22,785.77
Rate for Payer: AlohaCare Medicare	$13,675.27
Rate for Payer: Devoted Health Medicare	$15,042.80
Rate for Payer: Hawaii Medical Service Association Commercial	$22,785.77
Rate for Payer: Hawaii Medical Service Association Medicare	$13,675.27
Rate for Payer: Humana Medicare	$13,675.27
Rate for Payer: Kaiser Permanente Commercial	$20,739.67
Rate for Payer: Kaiser Permanente Medicare	$13,675.27
Rate for Payer: Ohana Health Plan Medicare	$13,675.27
Rate for Payer: UnitedHealthcare Medicare	$13,675.27

OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$3,310.31

Service Code	APR-DRG 1152
Min. Negotiated Rate	$3,310.31
Max. Negotiated Rate	$3,310.31
Rate for Payer: AlohaCare Medicaid	$3,310.31
Rate for Payer: Hawaii Medical Service Association ABD	$3,310.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,310.31
Rate for Payer: Kaiser Permanente Medicaid	$3,310.31
Rate for Payer: Ohana Health Plan Medicaid	$3,310.31
Rate for Payer: UnitedHealthcare Medicaid	$3,310.31

OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$5,045.36

Service Code	APR-DRG 1153
Min. Negotiated Rate	$5,045.36
Max. Negotiated Rate	$5,045.36
Rate for Payer: AlohaCare Medicaid	$5,045.36
Rate for Payer: Hawaii Medical Service Association ABD	$5,045.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,045.36
Rate for Payer: Kaiser Permanente Medicaid	$5,045.36
Rate for Payer: Ohana Health Plan Medicaid	$5,045.36
Rate for Payer: UnitedHealthcare Medicaid	$5,045.36

OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$9,500.41

Service Code	APR-DRG 1154
Min. Negotiated Rate	$9,500.41
Max. Negotiated Rate	$9,500.41
Rate for Payer: AlohaCare Medicaid	$9,500.41
Rate for Payer: Hawaii Medical Service Association ABD	$9,500.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,500.41
Rate for Payer: Kaiser Permanente Medicaid	$9,500.41
Rate for Payer: Ohana Health Plan Medicaid	$9,500.41
Rate for Payer: UnitedHealthcare Medicaid	$9,500.41

OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$2,441.47

Service Code	APR-DRG 1151
Min. Negotiated Rate	$2,441.47
Max. Negotiated Rate	$2,441.47
Rate for Payer: AlohaCare Medicaid	$2,441.47
Rate for Payer: Hawaii Medical Service Association ABD	$2,441.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,441.47
Rate for Payer: Kaiser Permanente Medicaid	$2,441.47
Rate for Payer: Ohana Health Plan Medicaid	$2,441.47
Rate for Payer: UnitedHealthcare Medicaid	$2,441.47

OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$6,215.55

Service Code	APR-DRG 0982
Min. Negotiated Rate	$6,215.55
Max. Negotiated Rate	$6,215.55
Rate for Payer: AlohaCare Medicaid	$6,215.55
Rate for Payer: Hawaii Medical Service Association ABD	$6,215.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,215.55
Rate for Payer: Kaiser Permanente Medicaid	$6,215.55
Rate for Payer: Ohana Health Plan Medicaid	$6,215.55
Rate for Payer: UnitedHealthcare Medicaid	$6,215.55

OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$10,460.57

Service Code	APR-DRG 0983
Min. Negotiated Rate	$10,460.57
Max. Negotiated Rate	$10,460.57
Rate for Payer: AlohaCare Medicaid	$10,460.57
Rate for Payer: Hawaii Medical Service Association ABD	$10,460.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,460.57
Rate for Payer: Kaiser Permanente Medicaid	$10,460.57
Rate for Payer: Ohana Health Plan Medicaid	$10,460.57
Rate for Payer: UnitedHealthcare Medicaid	$10,460.57

OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$18,752.96

Service Code	APR-DRG 0984
Min. Negotiated Rate	$18,752.96
Max. Negotiated Rate	$18,752.96
Rate for Payer: AlohaCare Medicaid	$18,752.96
Rate for Payer: Hawaii Medical Service Association ABD	$18,752.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,752.96
Rate for Payer: Kaiser Permanente Medicaid	$18,752.96
Rate for Payer: Ohana Health Plan Medicaid	$18,752.96
Rate for Payer: UnitedHealthcare Medicaid	$18,752.96

OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$4,854.25

Service Code	APR-DRG 0981
Min. Negotiated Rate	$4,854.25
Max. Negotiated Rate	$4,854.25
Rate for Payer: AlohaCare Medicaid	$4,854.25
Rate for Payer: Hawaii Medical Service Association ABD	$4,854.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,854.25
Rate for Payer: Kaiser Permanente Medicaid	$4,854.25
Rate for Payer: Ohana Health Plan Medicaid	$4,854.25
Rate for Payer: UnitedHealthcare Medicaid	$4,854.25

OTHER ENDOCRINE DISORDERS

Facility

$9,986.36

Service Code	APR-DRG 4244
Min. Negotiated Rate	$9,986.36
Max. Negotiated Rate	$9,986.36
Rate for Payer: AlohaCare Medicaid	$9,986.36
Rate for Payer: Hawaii Medical Service Association ABD	$9,986.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,986.36
Rate for Payer: Kaiser Permanente Medicaid	$9,986.36
Rate for Payer: Ohana Health Plan Medicaid	$9,986.36
Rate for Payer: UnitedHealthcare Medicaid	$9,986.36

OTHER ENDOCRINE DISORDERS

Facility

$5,388.46

Service Code	APR-DRG 4243
Min. Negotiated Rate	$5,388.46
Max. Negotiated Rate	$5,388.46
Rate for Payer: AlohaCare Medicaid	$5,388.46
Rate for Payer: Hawaii Medical Service Association ABD	$5,388.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,388.46
Rate for Payer: Kaiser Permanente Medicaid	$5,388.46
Rate for Payer: Ohana Health Plan Medicaid	$5,388.46
Rate for Payer: UnitedHealthcare Medicaid	$5,388.46

OTHER ENDOCRINE DISORDERS

Facility

$3,612.96

Service Code	APR-DRG 4242
Min. Negotiated Rate	$3,612.96
Max. Negotiated Rate	$3,612.96
Rate for Payer: AlohaCare Medicaid	$3,612.96
Rate for Payer: Hawaii Medical Service Association ABD	$3,612.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,612.96
Rate for Payer: Kaiser Permanente Medicaid	$3,612.96
Rate for Payer: Ohana Health Plan Medicaid	$3,612.96
Rate for Payer: UnitedHealthcare Medicaid	$3,612.96

OTHER ENDOCRINE DISORDERS

Facility

$2,673.68

Service Code	APR-DRG 4241
Min. Negotiated Rate	$2,673.68
Max. Negotiated Rate	$2,673.68
Rate for Payer: AlohaCare Medicaid	$2,673.68
Rate for Payer: Hawaii Medical Service Association ABD	$2,673.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,673.68
Rate for Payer: Kaiser Permanente Medicaid	$2,673.68
Rate for Payer: Ohana Health Plan Medicaid	$2,673.68
Rate for Payer: UnitedHealthcare Medicaid	$2,673.68

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility

$37,584.30

Service Code	MSDRG 629
Min. Negotiated Rate	$24,782.24
Max. Negotiated Rate	$37,584.30
Rate for Payer: AlohaCare Medicare	$24,782.24
Rate for Payer: Devoted Health Medicare	$27,260.46
Rate for Payer: Hawaii Medical Service Association Commercial	$28,512.55
Rate for Payer: Hawaii Medical Service Association Medicare	$24,782.24
Rate for Payer: Humana Medicare	$24,782.24
Rate for Payer: Kaiser Permanente Commercial	$37,584.30
Rate for Payer: Kaiser Permanente Medicare	$24,782.24
Rate for Payer: Ohana Health Plan Medicare	$24,782.24
Rate for Payer: UnitedHealthcare Medicare	$24,782.24

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility

$64,287.30

Service Code	MSDRG 628
Min. Negotiated Rate	$40,135.96
Max. Negotiated Rate	$64,287.30
Rate for Payer: AlohaCare Medicare	$42,389.56
Rate for Payer: Devoted Health Medicare	$46,628.52
Rate for Payer: Hawaii Medical Service Association Commercial	$40,135.96
Rate for Payer: Hawaii Medical Service Association Medicare	$42,389.56
Rate for Payer: Humana Medicare	$42,389.56
Rate for Payer: Kaiser Permanente Commercial	$64,287.30
Rate for Payer: Kaiser Permanente Medicare	$42,389.56
Rate for Payer: Ohana Health Plan Medicare	$42,389.56
Rate for Payer: UnitedHealthcare Medicare	$42,389.56

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility

$27,129.39

Service Code	MSDRG 630
Min. Negotiated Rate	$16,600.74
Max. Negotiated Rate	$27,129.39
Rate for Payer: AlohaCare Medicare	$16,600.74
Rate for Payer: Devoted Health Medicare	$18,260.81
Rate for Payer: Hawaii Medical Service Association Commercial	$27,129.39
Rate for Payer: Hawaii Medical Service Association Medicare	$16,600.74
Rate for Payer: Humana Medicare	$16,600.74
Rate for Payer: Kaiser Permanente Commercial	$25,176.38
Rate for Payer: Kaiser Permanente Medicare	$16,600.74
Rate for Payer: Ohana Health Plan Medicare	$16,600.74
Rate for Payer: UnitedHealthcare Medicare	$16,600.74

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility

$135,307.22

Service Code	MSDRG 319
Min. Negotiated Rate	$50,762.16
Max. Negotiated Rate	$135,307.22
Rate for Payer: AlohaCare Medicare	$50,762.16
Rate for Payer: Devoted Health Medicare	$55,838.38
Rate for Payer: Hawaii Medical Service Association Commercial	$135,307.22
Rate for Payer: Hawaii Medical Service Association Medicare	$50,762.16
Rate for Payer: Humana Medicare	$50,762.16
Rate for Payer: Kaiser Permanente Commercial	$76,985.02
Rate for Payer: Kaiser Permanente Medicare	$50,762.16
Rate for Payer: Ohana Health Plan Medicare	$50,762.16
Rate for Payer: UnitedHealthcare Medicare	$50,762.16

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility

$135,307.22

Service Code	MSDRG 320
Min. Negotiated Rate	$27,358.48
Max. Negotiated Rate	$135,307.22
Rate for Payer: AlohaCare Medicare	$27,358.48
Rate for Payer: Devoted Health Medicare	$30,094.33
Rate for Payer: Hawaii Medical Service Association Commercial	$135,307.22
Rate for Payer: Hawaii Medical Service Association Medicare	$27,358.48
Rate for Payer: Humana Medicare	$27,358.48
Rate for Payer: Kaiser Permanente Commercial	$41,491.43
Rate for Payer: Kaiser Permanente Medicare	$27,358.48
Rate for Payer: Ohana Health Plan Medicare	$27,358.48
Rate for Payer: UnitedHealthcare Medicare	$27,358.48

OTHER ESOPHAGEAL DISORDERS

Facility

$3,496.86

Service Code	APR-DRG 2432
Min. Negotiated Rate	$3,496.86
Max. Negotiated Rate	$3,496.86
Rate for Payer: AlohaCare Medicaid	$3,496.86
Rate for Payer: Hawaii Medical Service Association ABD	$3,496.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,496.86
Rate for Payer: Kaiser Permanente Medicaid	$3,496.86
Rate for Payer: Ohana Health Plan Medicaid	$3,496.86
Rate for Payer: UnitedHealthcare Medicaid	$3,496.86

OTHER ESOPHAGEAL DISORDERS

Facility

$10,035.93

Service Code	APR-DRG 2434
Min. Negotiated Rate	$10,035.93
Max. Negotiated Rate	$10,035.93
Rate for Payer: AlohaCare Medicaid	$10,035.93
Rate for Payer: Hawaii Medical Service Association ABD	$10,035.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,035.93
Rate for Payer: Kaiser Permanente Medicaid	$10,035.93
Rate for Payer: Ohana Health Plan Medicaid	$10,035.93
Rate for Payer: UnitedHealthcare Medicaid	$10,035.93

Know your out-of-pocket cost for care.

All Charges