Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$98,325.83

Service Code	MSDRG 272
Min. Negotiated Rate	$29,038.47
Max. Negotiated Rate	$98,325.83
Rate for Payer: AlohaCare Medicare	$29,038.47
Rate for Payer: Devoted Health Medicare	$31,942.32
Rate for Payer: Hawaii Medical Service Association Commercial	$98,325.83
Rate for Payer: Hawaii Medical Service Association Medicare	$29,038.47
Rate for Payer: Humana Medicare	$29,038.47
Rate for Payer: Kaiser Permanente Commercial	$44,039.25
Rate for Payer: Kaiser Permanente Medicare	$29,038.47
Rate for Payer: Ohana Health Plan Medicare	$29,038.47
Rate for Payer: UnitedHealthcare Medicare	$29,038.47

OTHER MAJOR HEAD & NECK PROCEDURES

Facility

$17,957.84

Service Code	APR-DRG 0913
Min. Negotiated Rate	$17,957.84
Max. Negotiated Rate	$17,957.84
Rate for Payer: AlohaCare Medicaid	$17,957.84
Rate for Payer: Hawaii Medical Service Association ABD	$17,957.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,957.84
Rate for Payer: Kaiser Permanente Medicaid	$17,957.84
Rate for Payer: Ohana Health Plan Medicaid	$17,957.84
Rate for Payer: UnitedHealthcare Medicaid	$17,957.84

OTHER MAJOR HEAD & NECK PROCEDURES

Facility

$33,999.29

Service Code	APR-DRG 0914
Min. Negotiated Rate	$33,999.29
Max. Negotiated Rate	$33,999.29
Rate for Payer: AlohaCare Medicaid	$33,999.29
Rate for Payer: Hawaii Medical Service Association ABD	$33,999.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33,999.29
Rate for Payer: Kaiser Permanente Medicaid	$33,999.29
Rate for Payer: Ohana Health Plan Medicaid	$33,999.29
Rate for Payer: UnitedHealthcare Medicaid	$33,999.29

OTHER MAJOR HEAD & NECK PROCEDURES

Facility

$10,181.39

Service Code	APR-DRG 0912
Min. Negotiated Rate	$10,181.39
Max. Negotiated Rate	$10,181.39
Rate for Payer: AlohaCare Medicaid	$10,181.39
Rate for Payer: Hawaii Medical Service Association ABD	$10,181.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,181.39
Rate for Payer: Kaiser Permanente Medicaid	$10,181.39
Rate for Payer: Ohana Health Plan Medicaid	$10,181.39
Rate for Payer: UnitedHealthcare Medicaid	$10,181.39

OTHER MAJOR HEAD & NECK PROCEDURES

Facility

$6,381.88

Service Code	APR-DRG 0911
Min. Negotiated Rate	$6,381.88
Max. Negotiated Rate	$6,381.88
Rate for Payer: AlohaCare Medicaid	$6,381.88
Rate for Payer: Hawaii Medical Service Association ABD	$6,381.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,381.88
Rate for Payer: Kaiser Permanente Medicaid	$6,381.88
Rate for Payer: Ohana Health Plan Medicaid	$6,381.88
Rate for Payer: UnitedHealthcare Medicaid	$6,381.88

OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC

Facility

$18,262.58

Service Code	MSDRG 729
Min. Negotiated Rate	$12,041.93
Max. Negotiated Rate	$18,262.58
Rate for Payer: AlohaCare Medicare	$12,041.93
Rate for Payer: Devoted Health Medicare	$13,246.12
Rate for Payer: Hawaii Medical Service Association Commercial	$13,661.76
Rate for Payer: Hawaii Medical Service Association Medicare	$12,041.93
Rate for Payer: Humana Medicare	$12,041.93
Rate for Payer: Kaiser Permanente Commercial	$18,262.58
Rate for Payer: Kaiser Permanente Medicare	$12,041.93
Rate for Payer: Ohana Health Plan Medicare	$12,041.93
Rate for Payer: UnitedHealthcare Medicare	$12,041.93

OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$13,661.76

Service Code	MSDRG 730
Min. Negotiated Rate	$7,643.49
Max. Negotiated Rate	$13,661.76
Rate for Payer: AlohaCare Medicare	$7,643.49
Rate for Payer: Devoted Health Medicare	$8,407.84
Rate for Payer: Hawaii Medical Service Association Commercial	$13,661.76
Rate for Payer: Hawaii Medical Service Association Medicare	$7,643.49
Rate for Payer: Humana Medicare	$7,643.49
Rate for Payer: Kaiser Permanente Commercial	$11,592.00
Rate for Payer: Kaiser Permanente Medicare	$7,643.49
Rate for Payer: Ohana Health Plan Medicare	$7,643.49
Rate for Payer: UnitedHealthcare Medicare	$7,643.49

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC

Facility

$32,611.12

Service Code	MSDRG 717
Min. Negotiated Rate	$21,503.02
Max. Negotiated Rate	$32,611.12
Rate for Payer: AlohaCare Medicare	$21,503.02
Rate for Payer: Devoted Health Medicare	$23,653.32
Rate for Payer: Hawaii Medical Service Association Commercial	$27,008.06
Rate for Payer: Hawaii Medical Service Association Medicare	$21,503.02
Rate for Payer: Humana Medicare	$21,503.02
Rate for Payer: Kaiser Permanente Commercial	$32,611.12
Rate for Payer: Kaiser Permanente Medicare	$21,503.02
Rate for Payer: Ohana Health Plan Medicare	$21,503.02
Rate for Payer: UnitedHealthcare Medicare	$21,503.02

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$27,008.06

Service Code	MSDRG 718
Min. Negotiated Rate	$15,276.75
Max. Negotiated Rate	$27,008.06
Rate for Payer: AlohaCare Medicare	$15,276.75
Rate for Payer: Devoted Health Medicare	$16,804.42
Rate for Payer: Hawaii Medical Service Association Commercial	$27,008.06
Rate for Payer: Hawaii Medical Service Association Medicare	$15,276.75
Rate for Payer: Humana Medicare	$15,276.75
Rate for Payer: Kaiser Permanente Commercial	$23,168.47
Rate for Payer: Kaiser Permanente Medicare	$15,276.75
Rate for Payer: Ohana Health Plan Medicare	$15,276.75
Rate for Payer: UnitedHealthcare Medicare	$15,276.75

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC

Facility

$42,586.83

Service Code	MSDRG 715
Min. Negotiated Rate	$25,447.63
Max. Negotiated Rate	$42,586.83
Rate for Payer: AlohaCare Medicare	$25,447.63
Rate for Payer: Devoted Health Medicare	$27,992.39
Rate for Payer: Hawaii Medical Service Association Commercial	$42,586.83
Rate for Payer: Hawaii Medical Service Association Medicare	$25,447.63
Rate for Payer: Humana Medicare	$25,447.63
Rate for Payer: Kaiser Permanente Commercial	$38,593.43
Rate for Payer: Kaiser Permanente Medicare	$25,447.63
Rate for Payer: Ohana Health Plan Medicare	$25,447.63
Rate for Payer: UnitedHealthcare Medicare	$25,447.63

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC

Facility

$42,586.83

Service Code	MSDRG 716
Min. Negotiated Rate	$16,731.53
Max. Negotiated Rate	$42,586.83
Rate for Payer: AlohaCare Medicare	$16,731.53
Rate for Payer: Devoted Health Medicare	$18,404.68
Rate for Payer: Hawaii Medical Service Association Commercial	$42,586.83
Rate for Payer: Hawaii Medical Service Association Medicare	$16,731.53
Rate for Payer: Humana Medicare	$16,731.53
Rate for Payer: Kaiser Permanente Commercial	$25,374.75
Rate for Payer: Kaiser Permanente Medicare	$16,731.53
Rate for Payer: Ohana Health Plan Medicare	$16,731.53
Rate for Payer: UnitedHealthcare Medicare	$16,731.53

OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$19,773.12

Service Code	APR-DRG 4844
Min. Negotiated Rate	$19,773.12
Max. Negotiated Rate	$19,773.12
Rate for Payer: AlohaCare Medicaid	$19,773.12
Rate for Payer: Hawaii Medical Service Association ABD	$19,773.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,773.12
Rate for Payer: Kaiser Permanente Medicaid	$19,773.12
Rate for Payer: Ohana Health Plan Medicaid	$19,773.12
Rate for Payer: UnitedHealthcare Medicaid	$19,773.12

OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$5,769.39

Service Code	APR-DRG 4841
Min. Negotiated Rate	$5,769.39
Max. Negotiated Rate	$5,769.39
Rate for Payer: AlohaCare Medicaid	$5,769.39
Rate for Payer: Hawaii Medical Service Association ABD	$5,769.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,769.39
Rate for Payer: Kaiser Permanente Medicaid	$5,769.39
Rate for Payer: Ohana Health Plan Medicaid	$5,769.39
Rate for Payer: UnitedHealthcare Medicaid	$5,769.39

OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$8,496.56

Service Code	APR-DRG 4843
Min. Negotiated Rate	$8,496.56
Max. Negotiated Rate	$8,496.56
Rate for Payer: AlohaCare Medicaid	$8,496.56
Rate for Payer: Hawaii Medical Service Association ABD	$8,496.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,496.56
Rate for Payer: Kaiser Permanente Medicaid	$8,496.56
Rate for Payer: Ohana Health Plan Medicaid	$8,496.56
Rate for Payer: UnitedHealthcare Medicaid	$8,496.56

OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$7,209.62

Service Code	APR-DRG 4842
Min. Negotiated Rate	$7,209.62
Max. Negotiated Rate	$7,209.62
Rate for Payer: AlohaCare Medicaid	$7,209.62
Rate for Payer: Hawaii Medical Service Association ABD	$7,209.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,209.62
Rate for Payer: Kaiser Permanente Medicaid	$7,209.62
Rate for Payer: Ohana Health Plan Medicaid	$7,209.62
Rate for Payer: UnitedHealthcare Medicaid	$7,209.62

OTHER MENTAL DISORDER DIAGNOSES

Facility

$37,345.37

Service Code	MSDRG 887
Min. Negotiated Rate	$12,180.69
Max. Negotiated Rate	$37,345.37
Rate for Payer: AlohaCare Medicare	$12,180.69
Rate for Payer: Devoted Health Medicare	$13,398.76
Rate for Payer: Hawaii Medical Service Association Commercial	$37,345.37
Rate for Payer: Hawaii Medical Service Association Medicare	$12,180.69
Rate for Payer: Humana Medicare	$12,180.69
Rate for Payer: Kaiser Permanente Commercial	$18,473.03
Rate for Payer: Kaiser Permanente Medicare	$12,180.69
Rate for Payer: Ohana Health Plan Medicare	$12,180.69
Rate for Payer: UnitedHealthcare Medicare	$12,180.69

OTHER MENTAL HEALTH DISORDERS

Facility

$2,957.72

Service Code	APR-DRG 7601
Min. Negotiated Rate	$2,957.72
Max. Negotiated Rate	$2,957.72
Rate for Payer: AlohaCare Medicaid	$2,957.72
Rate for Payer: Hawaii Medical Service Association ABD	$2,957.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,957.72
Rate for Payer: Kaiser Permanente Medicaid	$2,957.72
Rate for Payer: Ohana Health Plan Medicaid	$2,957.72
Rate for Payer: UnitedHealthcare Medicaid	$2,957.72

OTHER MENTAL HEALTH DISORDERS

Facility

$6,134.47

Service Code	APR-DRG 7603
Min. Negotiated Rate	$6,134.47
Max. Negotiated Rate	$6,134.47
Rate for Payer: AlohaCare Medicaid	$6,134.47
Rate for Payer: Hawaii Medical Service Association ABD	$6,134.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,134.47
Rate for Payer: Kaiser Permanente Medicaid	$6,134.47
Rate for Payer: Ohana Health Plan Medicaid	$6,134.47
Rate for Payer: UnitedHealthcare Medicaid	$6,134.47

OTHER MENTAL HEALTH DISORDERS

Facility

$4,094.90

Service Code	APR-DRG 7602
Min. Negotiated Rate	$4,094.90
Max. Negotiated Rate	$4,094.90
Rate for Payer: AlohaCare Medicaid	$4,094.90
Rate for Payer: Hawaii Medical Service Association ABD	$4,094.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,094.90
Rate for Payer: Kaiser Permanente Medicaid	$4,094.90
Rate for Payer: Ohana Health Plan Medicaid	$4,094.90
Rate for Payer: UnitedHealthcare Medicaid	$4,094.90

OTHER MENTAL HEALTH DISORDERS

Facility

$10,464.15

Service Code	APR-DRG 7604
Min. Negotiated Rate	$10,464.15
Max. Negotiated Rate	$10,464.15
Rate for Payer: AlohaCare Medicaid	$10,464.15
Rate for Payer: Hawaii Medical Service Association ABD	$10,464.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,464.15
Rate for Payer: Kaiser Permanente Medicaid	$10,464.15
Rate for Payer: Ohana Health Plan Medicaid	$10,464.15
Rate for Payer: UnitedHealthcare Medicaid	$10,464.15

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$42,926.55

Service Code	MSDRG 964
Min. Negotiated Rate	$17,432.16
Max. Negotiated Rate	$42,926.55
Rate for Payer: AlohaCare Medicare	$17,432.16
Rate for Payer: Devoted Health Medicare	$19,175.38
Rate for Payer: Hawaii Medical Service Association Commercial	$42,926.55
Rate for Payer: Hawaii Medical Service Association Medicare	$17,432.16
Rate for Payer: Humana Medicare	$17,432.16
Rate for Payer: Kaiser Permanente Commercial	$26,437.35
Rate for Payer: Kaiser Permanente Medicare	$17,432.16
Rate for Payer: Ohana Health Plan Medicare	$17,432.16
Rate for Payer: UnitedHealthcare Medicare	$17,432.16

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$47,158.05

Service Code	MSDRG 963
Min. Negotiated Rate	$31,094.94
Max. Negotiated Rate	$47,158.05
Rate for Payer: AlohaCare Medicare	$31,094.94
Rate for Payer: Devoted Health Medicare	$34,204.43
Rate for Payer: Hawaii Medical Service Association Commercial	$42,926.55
Rate for Payer: Hawaii Medical Service Association Medicare	$31,094.94
Rate for Payer: Humana Medicare	$31,094.94
Rate for Payer: Kaiser Permanente Commercial	$47,158.05
Rate for Payer: Kaiser Permanente Medicare	$31,094.94
Rate for Payer: Ohana Health Plan Medicare	$31,094.94
Rate for Payer: UnitedHealthcare Medicare	$31,094.94

OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$42,926.55

Service Code	MSDRG 965
Min. Negotiated Rate	$10,697.48
Max. Negotiated Rate	$42,926.55
Rate for Payer: AlohaCare Medicare	$10,697.48
Rate for Payer: Devoted Health Medicare	$11,767.23
Rate for Payer: Hawaii Medical Service Association Commercial	$42,926.55
Rate for Payer: Hawaii Medical Service Association Medicare	$10,697.48
Rate for Payer: Humana Medicare	$10,697.48
Rate for Payer: Kaiser Permanente Commercial	$16,223.62
Rate for Payer: Kaiser Permanente Medicare	$10,697.48
Rate for Payer: Ohana Health Plan Medicare	$10,697.48
Rate for Payer: UnitedHealthcare Medicare	$10,697.48

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$17,083.26

Service Code	MSDRG 565
Min. Negotiated Rate	$11,083.07
Max. Negotiated Rate	$17,083.26
Rate for Payer: AlohaCare Medicare	$11,083.07
Rate for Payer: Devoted Health Medicare	$12,191.38
Rate for Payer: Hawaii Medical Service Association Commercial	$17,083.26
Rate for Payer: Hawaii Medical Service Association Medicare	$11,083.07
Rate for Payer: Humana Medicare	$11,083.07
Rate for Payer: Kaiser Permanente Commercial	$16,808.40
Rate for Payer: Kaiser Permanente Medicare	$11,083.07
Rate for Payer: Ohana Health Plan Medicare	$11,083.07
Rate for Payer: UnitedHealthcare Medicare	$11,083.07

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$26,627.10

Service Code	MSDRG 564
Min. Negotiated Rate	$17,083.26
Max. Negotiated Rate	$26,627.10
Rate for Payer: AlohaCare Medicare	$17,557.31
Rate for Payer: Devoted Health Medicare	$19,313.04
Rate for Payer: Hawaii Medical Service Association Commercial	$17,083.26
Rate for Payer: Hawaii Medical Service Association Medicare	$17,557.31
Rate for Payer: Humana Medicare	$17,557.31
Rate for Payer: Kaiser Permanente Commercial	$26,627.10
Rate for Payer: Kaiser Permanente Medicare	$17,557.31
Rate for Payer: Ohana Health Plan Medicare	$17,557.31
Rate for Payer: UnitedHealthcare Medicare	$17,557.31

Know your out-of-pocket cost for care.

All Charges