Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER INFECTIOUS & PARASITIC DISEASES

Facility

$6,299.69

Service Code	APR-DRG 7243
Min. Negotiated Rate	$6,299.69
Max. Negotiated Rate	$6,299.69
Rate for Payer: AlohaCare Medicaid	$6,299.69
Rate for Payer: Hawaii Medical Service Association ABD	$6,299.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,299.69
Rate for Payer: Kaiser Permanente Medicaid	$6,299.69
Rate for Payer: Ohana Health Plan Medicaid	$6,299.69
Rate for Payer: UnitedHealthcare Medicaid	$6,299.69

OTHER INFECTIOUS & PARASITIC DISEASES

Facility

$3,011.56

Service Code	APR-DRG 7241
Min. Negotiated Rate	$3,011.56
Max. Negotiated Rate	$3,011.56
Rate for Payer: AlohaCare Medicaid	$3,011.56
Rate for Payer: Hawaii Medical Service Association ABD	$3,011.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,011.56
Rate for Payer: Kaiser Permanente Medicaid	$3,011.56
Rate for Payer: Ohana Health Plan Medicaid	$3,011.56
Rate for Payer: UnitedHealthcare Medicaid	$3,011.56

OTHER INFECTIOUS & PARASITIC DISEASES

Facility

$3,674.28

Service Code	APR-DRG 7242
Min. Negotiated Rate	$3,674.28
Max. Negotiated Rate	$3,674.28
Rate for Payer: AlohaCare Medicaid	$3,674.28
Rate for Payer: Hawaii Medical Service Association ABD	$3,674.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,674.28
Rate for Payer: Kaiser Permanente Medicaid	$3,674.28
Rate for Payer: Ohana Health Plan Medicaid	$3,674.28
Rate for Payer: UnitedHealthcare Medicaid	$3,674.28

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC

Facility

$40,548.49

Service Code	MSDRG 922
Min. Negotiated Rate	$19,898.12
Max. Negotiated Rate	$40,548.49
Rate for Payer: AlohaCare Medicare	$19,898.12
Rate for Payer: Devoted Health Medicare	$21,887.93
Rate for Payer: Hawaii Medical Service Association Commercial	$40,548.49
Rate for Payer: Hawaii Medical Service Association Medicare	$19,898.12
Rate for Payer: Humana Medicare	$19,898.12
Rate for Payer: Kaiser Permanente Commercial	$30,177.15
Rate for Payer: Kaiser Permanente Medicare	$19,898.12
Rate for Payer: Ohana Health Plan Medicare	$19,898.12
Rate for Payer: UnitedHealthcare Medicare	$19,898.12

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC

Facility

$17,956.84

Service Code	MSDRG 923
Min. Negotiated Rate	$11,575.58
Max. Negotiated Rate	$17,956.84
Rate for Payer: AlohaCare Medicare	$11,575.58
Rate for Payer: Devoted Health Medicare	$12,733.14
Rate for Payer: Hawaii Medical Service Association Commercial	$17,956.84
Rate for Payer: Hawaii Medical Service Association Medicare	$11,575.58
Rate for Payer: Humana Medicare	$11,575.58
Rate for Payer: Kaiser Permanente Commercial	$17,555.33
Rate for Payer: Kaiser Permanente Medicare	$11,575.58
Rate for Payer: Ohana Health Plan Medicare	$11,575.58
Rate for Payer: UnitedHealthcare Medicare	$11,575.58

OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES

Facility

$5,319.32

Service Code	APR-DRG 8153
Min. Negotiated Rate	$5,319.32
Max. Negotiated Rate	$5,319.32
Rate for Payer: AlohaCare Medicaid	$5,319.32
Rate for Payer: Hawaii Medical Service Association ABD	$5,319.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,319.32
Rate for Payer: Kaiser Permanente Medicaid	$5,319.32
Rate for Payer: Ohana Health Plan Medicaid	$5,319.32
Rate for Payer: UnitedHealthcare Medicaid	$5,319.32

OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES

Facility

$13,243.83

Service Code	APR-DRG 8154
Min. Negotiated Rate	$13,243.83
Max. Negotiated Rate	$13,243.83
Rate for Payer: AlohaCare Medicaid	$13,243.83
Rate for Payer: Hawaii Medical Service Association ABD	$13,243.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,243.83
Rate for Payer: Kaiser Permanente Medicaid	$13,243.83
Rate for Payer: Ohana Health Plan Medicaid	$13,243.83
Rate for Payer: UnitedHealthcare Medicaid	$13,243.83

OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES

Facility

$2,106.85

Service Code	APR-DRG 8151
Min. Negotiated Rate	$2,106.85
Max. Negotiated Rate	$2,106.85
Rate for Payer: AlohaCare Medicaid	$2,106.85
Rate for Payer: Hawaii Medical Service Association ABD	$2,106.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,106.85
Rate for Payer: Kaiser Permanente Medicaid	$2,106.85
Rate for Payer: Ohana Health Plan Medicaid	$2,106.85
Rate for Payer: UnitedHealthcare Medicaid	$2,106.85

OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES

Facility

$3,165.50

Service Code	APR-DRG 8152
Min. Negotiated Rate	$3,165.50
Max. Negotiated Rate	$3,165.50
Rate for Payer: AlohaCare Medicaid	$3,165.50
Rate for Payer: Hawaii Medical Service Association ABD	$3,165.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,165.50
Rate for Payer: Kaiser Permanente Medicaid	$3,165.50
Rate for Payer: Ohana Health Plan Medicaid	$3,165.50
Rate for Payer: UnitedHealthcare Medicaid	$3,165.50

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC

Facility

$22,397.52

Service Code	MSDRG 699
Min. Negotiated Rate	$11,544.87
Max. Negotiated Rate	$22,397.52
Rate for Payer: AlohaCare Medicare	$11,544.87
Rate for Payer: Devoted Health Medicare	$12,699.36
Rate for Payer: Hawaii Medical Service Association Commercial	$22,397.52
Rate for Payer: Hawaii Medical Service Association Medicare	$11,544.87
Rate for Payer: Humana Medicare	$11,544.87
Rate for Payer: Kaiser Permanente Commercial	$17,508.75
Rate for Payer: Kaiser Permanente Medicare	$11,544.87
Rate for Payer: Ohana Health Plan Medicare	$11,544.87
Rate for Payer: UnitedHealthcare Medicare	$11,544.87

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC

Facility

$28,538.40

Service Code	MSDRG 698
Min. Negotiated Rate	$18,817.58
Max. Negotiated Rate	$28,538.40
Rate for Payer: AlohaCare Medicare	$18,817.58
Rate for Payer: Devoted Health Medicare	$20,699.34
Rate for Payer: Hawaii Medical Service Association Commercial	$22,421.78
Rate for Payer: Hawaii Medical Service Association Medicare	$18,817.58
Rate for Payer: Humana Medicare	$18,817.58
Rate for Payer: Kaiser Permanente Commercial	$28,538.40
Rate for Payer: Kaiser Permanente Medicare	$18,817.58
Rate for Payer: Ohana Health Plan Medicare	$18,817.58
Rate for Payer: UnitedHealthcare Medicare	$18,817.58

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC

Facility

$17,568.58

Service Code	MSDRG 700
Min. Negotiated Rate	$7,847.09
Max. Negotiated Rate	$17,568.58
Rate for Payer: AlohaCare Medicare	$7,847.09
Rate for Payer: Devoted Health Medicare	$8,631.80
Rate for Payer: Hawaii Medical Service Association Commercial	$17,568.58
Rate for Payer: Hawaii Medical Service Association Medicare	$7,847.09
Rate for Payer: Humana Medicare	$7,847.09
Rate for Payer: Kaiser Permanente Commercial	$11,900.77
Rate for Payer: Kaiser Permanente Medicare	$7,847.09
Rate for Payer: Ohana Health Plan Medicare	$7,847.09
Rate for Payer: UnitedHealthcare Medicare	$7,847.09

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC

Facility

$56,297.12

Service Code	MSDRG 674
Min. Negotiated Rate	$26,599.84
Max. Negotiated Rate	$56,297.12
Rate for Payer: AlohaCare Medicare	$26,599.84
Rate for Payer: Devoted Health Medicare	$29,259.82
Rate for Payer: Hawaii Medical Service Association Commercial	$56,297.12
Rate for Payer: Hawaii Medical Service Association Medicare	$26,599.84
Rate for Payer: Humana Medicare	$26,599.84
Rate for Payer: Kaiser Permanente Commercial	$40,340.85
Rate for Payer: Kaiser Permanente Medicare	$26,599.84
Rate for Payer: Ohana Health Plan Medicare	$26,599.84
Rate for Payer: UnitedHealthcare Medicare	$26,599.84

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC

Facility

$72,477.60

Service Code	MSDRG 673
Min. Negotiated Rate	$47,790.08
Max. Negotiated Rate	$72,477.60
Rate for Payer: AlohaCare Medicare	$47,790.08
Rate for Payer: Devoted Health Medicare	$52,569.09
Rate for Payer: Hawaii Medical Service Association Commercial	$56,297.12
Rate for Payer: Hawaii Medical Service Association Medicare	$47,790.08
Rate for Payer: Humana Medicare	$47,790.08
Rate for Payer: Kaiser Permanente Commercial	$72,477.60
Rate for Payer: Kaiser Permanente Medicare	$47,790.08
Rate for Payer: Ohana Health Plan Medicare	$47,790.08
Rate for Payer: UnitedHealthcare Medicare	$47,790.08

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC

Facility

$56,297.12

Service Code	MSDRG 675
Min. Negotiated Rate	$18,669.70
Max. Negotiated Rate	$56,297.12
Rate for Payer: AlohaCare Medicare	$18,669.70
Rate for Payer: Devoted Health Medicare	$20,536.67
Rate for Payer: Hawaii Medical Service Association Commercial	$56,297.12
Rate for Payer: Hawaii Medical Service Association Medicare	$18,669.70
Rate for Payer: Humana Medicare	$18,669.70
Rate for Payer: Kaiser Permanente Commercial	$28,314.15
Rate for Payer: Kaiser Permanente Medicare	$18,669.70
Rate for Payer: Ohana Health Plan Medicare	$18,669.70
Rate for Payer: UnitedHealthcare Medicare	$18,669.70

OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS

Facility

$3,326.61

Service Code	APR-DRG 4682
Min. Negotiated Rate	$3,326.61
Max. Negotiated Rate	$3,326.61
Rate for Payer: AlohaCare Medicaid	$3,326.61
Rate for Payer: Hawaii Medical Service Association ABD	$3,326.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,326.61
Rate for Payer: Kaiser Permanente Medicaid	$3,326.61
Rate for Payer: Ohana Health Plan Medicaid	$3,326.61
Rate for Payer: UnitedHealthcare Medicaid	$3,326.61

OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS

Facility

$4,785.76

Service Code	APR-DRG 4683
Min. Negotiated Rate	$4,785.76
Max. Negotiated Rate	$4,785.76
Rate for Payer: AlohaCare Medicaid	$4,785.76
Rate for Payer: Hawaii Medical Service Association ABD	$4,785.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,785.76
Rate for Payer: Kaiser Permanente Medicaid	$4,785.76
Rate for Payer: Ohana Health Plan Medicaid	$4,785.76
Rate for Payer: UnitedHealthcare Medicaid	$4,785.76

OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS

Facility

$2,487.78

Service Code	APR-DRG 4681
Min. Negotiated Rate	$2,487.78
Max. Negotiated Rate	$2,487.78
Rate for Payer: AlohaCare Medicaid	$2,487.78
Rate for Payer: Hawaii Medical Service Association ABD	$2,487.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,487.78
Rate for Payer: Kaiser Permanente Medicaid	$2,487.78
Rate for Payer: Ohana Health Plan Medicaid	$2,487.78
Rate for Payer: UnitedHealthcare Medicaid	$2,487.78

OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS

Facility

$8,550.05

Service Code	APR-DRG 4684
Min. Negotiated Rate	$8,550.05
Max. Negotiated Rate	$8,550.05
Rate for Payer: AlohaCare Medicaid	$8,550.05
Rate for Payer: Hawaii Medical Service Association ABD	$8,550.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,550.05
Rate for Payer: Kaiser Permanente Medicaid	$8,550.05
Rate for Payer: Ohana Health Plan Medicaid	$8,550.05
Rate for Payer: UnitedHealthcare Medicaid	$8,550.05

OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES

Facility

$6,694.97

Service Code	APR-DRG 4471
Min. Negotiated Rate	$6,694.97
Max. Negotiated Rate	$6,694.97
Rate for Payer: AlohaCare Medicaid	$6,694.97
Rate for Payer: Hawaii Medical Service Association ABD	$6,694.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,694.97
Rate for Payer: Kaiser Permanente Medicaid	$6,694.97
Rate for Payer: Ohana Health Plan Medicaid	$6,694.97
Rate for Payer: UnitedHealthcare Medicaid	$6,694.97

OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES

Facility

$22,850.57

Service Code	APR-DRG 4474
Min. Negotiated Rate	$22,850.57
Max. Negotiated Rate	$22,850.57
Rate for Payer: AlohaCare Medicaid	$22,850.57
Rate for Payer: Hawaii Medical Service Association ABD	$22,850.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,850.57
Rate for Payer: Kaiser Permanente Medicaid	$22,850.57
Rate for Payer: Ohana Health Plan Medicaid	$22,850.57
Rate for Payer: UnitedHealthcare Medicaid	$22,850.57

OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES

Facility

$7,891.25

Service Code	APR-DRG 4472
Min. Negotiated Rate	$7,891.25
Max. Negotiated Rate	$7,891.25
Rate for Payer: AlohaCare Medicaid	$7,891.25
Rate for Payer: Hawaii Medical Service Association ABD	$7,891.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,891.25
Rate for Payer: Kaiser Permanente Medicaid	$7,891.25
Rate for Payer: Ohana Health Plan Medicaid	$7,891.25
Rate for Payer: UnitedHealthcare Medicaid	$7,891.25

OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES

Facility

$10,707.13

Service Code	APR-DRG 4473
Min. Negotiated Rate	$10,707.13
Max. Negotiated Rate	$10,707.13
Rate for Payer: AlohaCare Medicaid	$10,707.13
Rate for Payer: Hawaii Medical Service Association ABD	$10,707.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,707.13
Rate for Payer: Kaiser Permanente Medicaid	$10,707.13
Rate for Payer: Ohana Health Plan Medicaid	$10,707.13
Rate for Payer: UnitedHealthcare Medicaid	$10,707.13

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC

Facility

$98,325.83

Service Code	MSDRG 271
Min. Negotiated Rate	$40,450.27
Max. Negotiated Rate	$98,325.83
Rate for Payer: AlohaCare Medicare	$40,450.27
Rate for Payer: Devoted Health Medicare	$44,495.30
Rate for Payer: Hawaii Medical Service Association Commercial	$98,325.83
Rate for Payer: Hawaii Medical Service Association Medicare	$40,450.27
Rate for Payer: Humana Medicare	$40,450.27
Rate for Payer: Kaiser Permanente Commercial	$61,346.18
Rate for Payer: Kaiser Permanente Medicare	$40,450.27
Rate for Payer: Ohana Health Plan Medicare	$40,450.27
Rate for Payer: UnitedHealthcare Medicare	$40,450.27

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC

Facility

$113,928.87

Service Code	MSDRG 270
Min. Negotiated Rate	$60,013.96
Max. Negotiated Rate	$113,928.87
Rate for Payer: AlohaCare Medicare	$60,013.96
Rate for Payer: Devoted Health Medicare	$66,015.36
Rate for Payer: Hawaii Medical Service Association Commercial	$113,928.87
Rate for Payer: Hawaii Medical Service Association Medicare	$60,013.96
Rate for Payer: Humana Medicare	$60,013.96
Rate for Payer: Kaiser Permanente Commercial	$91,016.18
Rate for Payer: Kaiser Permanente Medicare	$60,013.96
Rate for Payer: Ohana Health Plan Medicare	$60,013.96
Rate for Payer: UnitedHealthcare Medicare	$60,013.96

Know your out-of-pocket cost for care.

All Charges