Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER ESOPHAGEAL DISORDERS

Facility

$5,149.73

Service Code	APR-DRG 2433
Min. Negotiated Rate	$5,149.73
Max. Negotiated Rate	$5,149.73
Rate for Payer: AlohaCare Medicaid	$5,149.73
Rate for Payer: Hawaii Medical Service Association ABD	$5,149.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,149.73
Rate for Payer: Kaiser Permanente Medicaid	$5,149.73
Rate for Payer: Ohana Health Plan Medicaid	$5,149.73
Rate for Payer: UnitedHealthcare Medicaid	$5,149.73

OTHER ESOPHAGEAL DISORDERS

Facility

$2,648.90

Service Code	APR-DRG 2431
Min. Negotiated Rate	$2,648.90
Max. Negotiated Rate	$2,648.90
Rate for Payer: AlohaCare Medicaid	$2,648.90
Rate for Payer: Hawaii Medical Service Association ABD	$2,648.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,648.90
Rate for Payer: Kaiser Permanente Medicaid	$2,648.90
Rate for Payer: Ohana Health Plan Medicaid	$2,648.90
Rate for Payer: UnitedHealthcare Medicaid	$2,648.90

OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$11,696.21

Service Code	MSDRG 951
Min. Negotiated Rate	$6,324.09
Max. Negotiated Rate	$11,696.21
Rate for Payer: AlohaCare Medicare	$6,324.09
Rate for Payer: Devoted Health Medicare	$6,956.50
Rate for Payer: Hawaii Medical Service Association Commercial	$11,696.21
Rate for Payer: Hawaii Medical Service Association Medicare	$6,324.09
Rate for Payer: Humana Medicare	$6,324.09
Rate for Payer: Kaiser Permanente Commercial	$9,591.00
Rate for Payer: Kaiser Permanente Medicare	$6,324.09
Rate for Payer: Ohana Health Plan Medicare	$6,324.09
Rate for Payer: UnitedHealthcare Medicare	$6,324.09

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC

Facility

$44,291.10

Service Code	MSDRG 749
Min. Negotiated Rate	$29,204.53
Max. Negotiated Rate	$44,291.10
Rate for Payer: AlohaCare Medicare	$29,204.53
Rate for Payer: Devoted Health Medicare	$32,124.98
Rate for Payer: Hawaii Medical Service Association Commercial	$33,851.07
Rate for Payer: Hawaii Medical Service Association Medicare	$29,204.53
Rate for Payer: Humana Medicare	$29,204.53
Rate for Payer: Kaiser Permanente Commercial	$44,291.10
Rate for Payer: Kaiser Permanente Medicare	$29,204.53
Rate for Payer: Ohana Health Plan Medicare	$29,204.53
Rate for Payer: UnitedHealthcare Medicare	$29,204.53

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$33,851.07

Service Code	MSDRG 750
Min. Negotiated Rate	$16,786.13
Max. Negotiated Rate	$33,851.07
Rate for Payer: AlohaCare Medicare	$16,786.13
Rate for Payer: Devoted Health Medicare	$18,464.74
Rate for Payer: Hawaii Medical Service Association Commercial	$33,851.07
Rate for Payer: Hawaii Medical Service Association Medicare	$16,786.13
Rate for Payer: Humana Medicare	$16,786.13
Rate for Payer: Kaiser Permanente Commercial	$25,457.55
Rate for Payer: Kaiser Permanente Medicare	$16,786.13
Rate for Payer: Ohana Health Plan Medicare	$16,786.13
Rate for Payer: UnitedHealthcare Medicare	$16,786.13

OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$3,989.33

Service Code	APR-DRG 5181
Min. Negotiated Rate	$3,989.33
Max. Negotiated Rate	$3,989.33
Rate for Payer: AlohaCare Medicaid	$3,989.33
Rate for Payer: Hawaii Medical Service Association ABD	$3,989.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,989.33
Rate for Payer: Kaiser Permanente Medicaid	$3,989.33
Rate for Payer: Ohana Health Plan Medicaid	$3,989.33
Rate for Payer: UnitedHealthcare Medicaid	$3,989.33

OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$19,683.76

Service Code	APR-DRG 5184
Min. Negotiated Rate	$19,683.76
Max. Negotiated Rate	$19,683.76
Rate for Payer: AlohaCare Medicaid	$19,683.76
Rate for Payer: Hawaii Medical Service Association ABD	$19,683.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,683.76
Rate for Payer: Kaiser Permanente Medicaid	$19,683.76
Rate for Payer: Ohana Health Plan Medicaid	$19,683.76
Rate for Payer: UnitedHealthcare Medicaid	$19,683.76

OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$10,153.34

Service Code	APR-DRG 5183
Min. Negotiated Rate	$10,153.34
Max. Negotiated Rate	$10,153.34
Rate for Payer: AlohaCare Medicaid	$10,153.34
Rate for Payer: Hawaii Medical Service Association ABD	$10,153.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,153.34
Rate for Payer: Kaiser Permanente Medicaid	$10,153.34
Rate for Payer: Ohana Health Plan Medicaid	$10,153.34
Rate for Payer: UnitedHealthcare Medicaid	$10,153.34

OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$5,918.76

Service Code	APR-DRG 5182
Min. Negotiated Rate	$5,918.76
Max. Negotiated Rate	$5,918.76
Rate for Payer: AlohaCare Medicaid	$5,918.76
Rate for Payer: Hawaii Medical Service Association ABD	$5,918.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,918.76
Rate for Payer: Kaiser Permanente Medicaid	$5,918.76
Rate for Payer: Ohana Health Plan Medicaid	$5,918.76
Rate for Payer: UnitedHealthcare Medicaid	$5,918.76

OTHER GASTROENTERITIS, NAUSEA & VOMITING

Facility

$8,004.09

Service Code	APR-DRG 2494
Min. Negotiated Rate	$8,004.09
Max. Negotiated Rate	$8,004.09
Rate for Payer: AlohaCare Medicaid	$8,004.09
Rate for Payer: Hawaii Medical Service Association ABD	$8,004.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,004.09
Rate for Payer: Kaiser Permanente Medicaid	$8,004.09
Rate for Payer: Ohana Health Plan Medicaid	$8,004.09
Rate for Payer: UnitedHealthcare Medicaid	$8,004.09

OTHER GASTROENTERITIS, NAUSEA & VOMITING

Facility

$4,213.71

Service Code	APR-DRG 2493
Min. Negotiated Rate	$4,213.71
Max. Negotiated Rate	$4,213.71
Rate for Payer: AlohaCare Medicaid	$4,213.71
Rate for Payer: Hawaii Medical Service Association ABD	$4,213.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,213.71
Rate for Payer: Kaiser Permanente Medicaid	$4,213.71
Rate for Payer: Ohana Health Plan Medicaid	$4,213.71
Rate for Payer: UnitedHealthcare Medicaid	$4,213.71

OTHER GASTROENTERITIS, NAUSEA & VOMITING

Facility

$2,356.68

Service Code	APR-DRG 2491
Min. Negotiated Rate	$2,356.68
Max. Negotiated Rate	$2,356.68
Rate for Payer: AlohaCare Medicaid	$2,356.68
Rate for Payer: Hawaii Medical Service Association ABD	$2,356.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,356.68
Rate for Payer: Kaiser Permanente Medicaid	$2,356.68
Rate for Payer: Ohana Health Plan Medicaid	$2,356.68
Rate for Payer: UnitedHealthcare Medicaid	$2,356.68

OTHER GASTROENTERITIS, NAUSEA & VOMITING

Facility

$2,930.03

Service Code	APR-DRG 2492
Min. Negotiated Rate	$2,930.03
Max. Negotiated Rate	$2,930.03
Rate for Payer: AlohaCare Medicaid	$2,930.03
Rate for Payer: Hawaii Medical Service Association ABD	$2,930.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,930.03
Rate for Payer: Kaiser Permanente Medicaid	$2,930.03
Rate for Payer: Ohana Health Plan Medicaid	$2,930.03
Rate for Payer: UnitedHealthcare Medicaid	$2,930.03

OTHER HEART ASSIST SYSTEM IMPLANT

Facility

$174,690.93

Service Code	MSDRG 215
Min. Negotiated Rate	$113,253.46
Max. Negotiated Rate	$174,690.93
Rate for Payer: AlohaCare Medicare	$113,253.46
Rate for Payer: Devoted Health Medicare	$124,578.81
Rate for Payer: Hawaii Medical Service Association Commercial	$174,690.93
Rate for Payer: Hawaii Medical Service Association Medicare	$113,253.46
Rate for Payer: Humana Medicare	$113,253.46
Rate for Payer: Kaiser Permanente Commercial	$171,758.25
Rate for Payer: Kaiser Permanente Medicare	$113,253.46
Rate for Payer: Ohana Health Plan Medicare	$113,253.46
Rate for Payer: UnitedHealthcare Medicare	$113,253.46

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC

Facility

$99,126.61

Service Code	MSDRG 424
Min. Negotiated Rate	$24,885.73
Max. Negotiated Rate	$99,126.61
Rate for Payer: AlohaCare Medicare	$24,885.73
Rate for Payer: Devoted Health Medicare	$27,374.30
Rate for Payer: Hawaii Medical Service Association Commercial	$99,126.61
Rate for Payer: Hawaii Medical Service Association Medicare	$24,885.73
Rate for Payer: Humana Medicare	$24,885.73
Rate for Payer: Kaiser Permanente Commercial	$37,741.28
Rate for Payer: Kaiser Permanente Medicare	$24,885.73
Rate for Payer: Ohana Health Plan Medicare	$24,885.73
Rate for Payer: UnitedHealthcare Medicare	$24,885.73

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC

Facility

$99,126.61

Service Code	MSDRG 423
Min. Negotiated Rate	$47,237.28
Max. Negotiated Rate	$99,126.61
Rate for Payer: AlohaCare Medicare	$47,237.28
Rate for Payer: Devoted Health Medicare	$51,961.01
Rate for Payer: Hawaii Medical Service Association Commercial	$99,126.61
Rate for Payer: Hawaii Medical Service Association Medicare	$47,237.28
Rate for Payer: Humana Medicare	$47,237.28
Rate for Payer: Kaiser Permanente Commercial	$71,639.25
Rate for Payer: Kaiser Permanente Medicare	$47,237.28
Rate for Payer: Ohana Health Plan Medicare	$47,237.28
Rate for Payer: UnitedHealthcare Medicare	$47,237.28

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC

Facility

$99,126.61

Service Code	MSDRG 425
Min. Negotiated Rate	$17,064.81
Max. Negotiated Rate	$99,126.61
Rate for Payer: AlohaCare Medicare	$17,064.81
Rate for Payer: Devoted Health Medicare	$18,771.29
Rate for Payer: Hawaii Medical Service Association Commercial	$99,126.61
Rate for Payer: Hawaii Medical Service Association Medicare	$17,064.81
Rate for Payer: Humana Medicare	$17,064.81
Rate for Payer: Kaiser Permanente Commercial	$25,880.17
Rate for Payer: Kaiser Permanente Medicare	$17,064.81
Rate for Payer: Ohana Health Plan Medicare	$17,064.81
Rate for Payer: UnitedHealthcare Medicare	$17,064.81

OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES

Facility

$7,678.60

Service Code	APR-DRG 2642
Min. Negotiated Rate	$7,678.60
Max. Negotiated Rate	$7,678.60
Rate for Payer: AlohaCare Medicaid	$7,678.60
Rate for Payer: Hawaii Medical Service Association ABD	$7,678.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,678.60
Rate for Payer: Kaiser Permanente Medicaid	$7,678.60
Rate for Payer: Ohana Health Plan Medicaid	$7,678.60
Rate for Payer: UnitedHealthcare Medicaid	$7,678.60

OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES

Facility

$25,162.24

Service Code	APR-DRG 2644
Min. Negotiated Rate	$25,162.24
Max. Negotiated Rate	$25,162.24
Rate for Payer: AlohaCare Medicaid	$25,162.24
Rate for Payer: Hawaii Medical Service Association ABD	$25,162.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25,162.24
Rate for Payer: Kaiser Permanente Medicaid	$25,162.24
Rate for Payer: Ohana Health Plan Medicaid	$25,162.24
Rate for Payer: UnitedHealthcare Medicaid	$25,162.24

OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES

Facility

$11,623.58

Service Code	APR-DRG 2643
Min. Negotiated Rate	$11,623.58
Max. Negotiated Rate	$11,623.58
Rate for Payer: AlohaCare Medicaid	$11,623.58
Rate for Payer: Hawaii Medical Service Association ABD	$11,623.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,623.58
Rate for Payer: Kaiser Permanente Medicaid	$11,623.58
Rate for Payer: Ohana Health Plan Medicaid	$11,623.58
Rate for Payer: UnitedHealthcare Medicaid	$11,623.58

OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES

Facility

$7,208.97

Service Code	APR-DRG 2641
Min. Negotiated Rate	$7,208.97
Max. Negotiated Rate	$7,208.97
Rate for Payer: AlohaCare Medicaid	$7,208.97
Rate for Payer: Hawaii Medical Service Association ABD	$7,208.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,208.97
Rate for Payer: Kaiser Permanente Medicaid	$7,208.97
Rate for Payer: Ohana Health Plan Medicaid	$7,208.97
Rate for Payer: UnitedHealthcare Medicaid	$7,208.97

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC

Facility

$58,553.86

Service Code	MSDRG 868
Min. Negotiated Rate	$11,728.01
Max. Negotiated Rate	$58,553.86
Rate for Payer: AlohaCare Medicare	$11,728.01
Rate for Payer: Devoted Health Medicare	$12,900.81
Rate for Payer: Hawaii Medical Service Association Commercial	$58,553.86
Rate for Payer: Hawaii Medical Service Association Medicare	$11,728.01
Rate for Payer: Humana Medicare	$11,728.01
Rate for Payer: Kaiser Permanente Commercial	$17,786.47
Rate for Payer: Kaiser Permanente Medicare	$11,728.01
Rate for Payer: Ohana Health Plan Medicare	$11,728.01
Rate for Payer: UnitedHealthcare Medicare	$11,728.01

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC

Facility

$58,553.86

Service Code	MSDRG 867
Min. Negotiated Rate	$23,808.58
Max. Negotiated Rate	$58,553.86
Rate for Payer: AlohaCare Medicare	$23,808.58
Rate for Payer: Devoted Health Medicare	$26,189.44
Rate for Payer: Hawaii Medical Service Association Commercial	$58,553.86
Rate for Payer: Hawaii Medical Service Association Medicare	$23,808.58
Rate for Payer: Humana Medicare	$23,808.58
Rate for Payer: Kaiser Permanente Commercial	$36,107.70
Rate for Payer: Kaiser Permanente Medicare	$23,808.58
Rate for Payer: Ohana Health Plan Medicare	$23,808.58
Rate for Payer: UnitedHealthcare Medicare	$23,808.58

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC

Facility

$58,553.86

Service Code	MSDRG 869
Min. Negotiated Rate	$8,299.79
Max. Negotiated Rate	$58,553.86
Rate for Payer: AlohaCare Medicare	$8,299.79
Rate for Payer: Devoted Health Medicare	$9,129.77
Rate for Payer: Hawaii Medical Service Association Commercial	$58,553.86
Rate for Payer: Hawaii Medical Service Association Medicare	$8,299.79
Rate for Payer: Humana Medicare	$8,299.79
Rate for Payer: Kaiser Permanente Commercial	$12,587.33
Rate for Payer: Kaiser Permanente Medicare	$8,299.79
Rate for Payer: Ohana Health Plan Medicare	$8,299.79
Rate for Payer: UnitedHealthcare Medicare	$8,299.79

OTHER INFECTIOUS & PARASITIC DISEASES

Facility

$12,984.23

Service Code	APR-DRG 7244
Min. Negotiated Rate	$12,984.23
Max. Negotiated Rate	$12,984.23
Rate for Payer: AlohaCare Medicaid	$12,984.23
Rate for Payer: Hawaii Medical Service Association ABD	$12,984.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,984.23
Rate for Payer: Kaiser Permanente Medicaid	$12,984.23
Rate for Payer: Ohana Health Plan Medicaid	$12,984.23
Rate for Payer: UnitedHealthcare Medicaid	$12,984.23

Know your out-of-pocket cost for care.

All Charges