Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$17,083.26

Service Code	MSDRG 566
Min. Negotiated Rate	$8,522.74
Max. Negotiated Rate	$17,083.26
Rate for Payer: AlohaCare Medicare	$8,522.74
Rate for Payer: Devoted Health Medicare	$9,375.01
Rate for Payer: Hawaii Medical Service Association Commercial	$17,083.26
Rate for Payer: Hawaii Medical Service Association Medicare	$8,522.74
Rate for Payer: Humana Medicare	$8,522.74
Rate for Payer: Kaiser Permanente Commercial	$12,925.42
Rate for Payer: Kaiser Permanente Medicare	$8,522.74
Rate for Payer: Ohana Health Plan Medicare	$8,522.74
Rate for Payer: UnitedHealthcare Medicare	$8,522.74

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$62,897.47

Service Code	MSDRG 516
Min. Negotiated Rate	$23,636.84
Max. Negotiated Rate	$62,897.47
Rate for Payer: AlohaCare Medicare	$23,636.84
Rate for Payer: Devoted Health Medicare	$26,000.52
Rate for Payer: Hawaii Medical Service Association Commercial	$62,897.47
Rate for Payer: Hawaii Medical Service Association Medicare	$23,636.84
Rate for Payer: Humana Medicare	$23,636.84
Rate for Payer: Kaiser Permanente Commercial	$35,847.22
Rate for Payer: Kaiser Permanente Medicare	$23,636.84
Rate for Payer: Ohana Health Plan Medicare	$23,636.84
Rate for Payer: UnitedHealthcare Medicare	$23,636.84

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$62,897.47

Service Code	MSDRG 515
Min. Negotiated Rate	$36,248.62
Max. Negotiated Rate	$62,897.47
Rate for Payer: AlohaCare Medicare	$36,248.62
Rate for Payer: Devoted Health Medicare	$39,873.48
Rate for Payer: Hawaii Medical Service Association Commercial	$62,897.47
Rate for Payer: Hawaii Medical Service Association Medicare	$36,248.62
Rate for Payer: Humana Medicare	$36,248.62
Rate for Payer: Kaiser Permanente Commercial	$54,974.03
Rate for Payer: Kaiser Permanente Medicare	$36,248.62
Rate for Payer: Ohana Health Plan Medicare	$36,248.62
Rate for Payer: UnitedHealthcare Medicare	$36,248.62

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$34,894.51

Service Code	MSDRG 517
Min. Negotiated Rate	$17,478.83
Max. Negotiated Rate	$34,894.51
Rate for Payer: AlohaCare Medicare	$17,478.83
Rate for Payer: Devoted Health Medicare	$19,226.71
Rate for Payer: Hawaii Medical Service Association Commercial	$34,894.51
Rate for Payer: Hawaii Medical Service Association Medicare	$17,478.83
Rate for Payer: Humana Medicare	$17,478.83
Rate for Payer: Kaiser Permanente Commercial	$26,508.08
Rate for Payer: Kaiser Permanente Medicare	$17,478.83
Rate for Payer: Ohana Health Plan Medicare	$17,478.83
Rate for Payer: UnitedHealthcare Medicare	$17,478.83

OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility

$3,296.61

Service Code	APR-DRG 3512
Min. Negotiated Rate	$3,296.61
Max. Negotiated Rate	$3,296.61
Rate for Payer: AlohaCare Medicaid	$3,296.61
Rate for Payer: Hawaii Medical Service Association ABD	$3,296.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,296.61
Rate for Payer: Kaiser Permanente Medicaid	$3,296.61
Rate for Payer: Ohana Health Plan Medicaid	$3,296.61
Rate for Payer: UnitedHealthcare Medicaid	$3,296.61

OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility

$9,088.18

Service Code	APR-DRG 3514
Min. Negotiated Rate	$9,088.18
Max. Negotiated Rate	$9,088.18
Rate for Payer: AlohaCare Medicaid	$9,088.18
Rate for Payer: Hawaii Medical Service Association ABD	$9,088.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,088.18
Rate for Payer: Kaiser Permanente Medicaid	$9,088.18
Rate for Payer: Ohana Health Plan Medicaid	$9,088.18
Rate for Payer: UnitedHealthcare Medicaid	$9,088.18

OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility

$2,561.49

Service Code	APR-DRG 3511
Min. Negotiated Rate	$2,561.49
Max. Negotiated Rate	$2,561.49
Rate for Payer: AlohaCare Medicaid	$2,561.49
Rate for Payer: Hawaii Medical Service Association ABD	$2,561.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,561.49
Rate for Payer: Kaiser Permanente Medicaid	$2,561.49
Rate for Payer: Ohana Health Plan Medicaid	$2,561.49
Rate for Payer: UnitedHealthcare Medicaid	$2,561.49

OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility

$4,999.70

Service Code	APR-DRG 3513
Min. Negotiated Rate	$4,999.70
Max. Negotiated Rate	$4,999.70
Rate for Payer: AlohaCare Medicaid	$4,999.70
Rate for Payer: Hawaii Medical Service Association ABD	$4,999.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,999.70
Rate for Payer: Kaiser Permanente Medicaid	$4,999.70
Rate for Payer: Ohana Health Plan Medicaid	$4,999.70
Rate for Payer: UnitedHealthcare Medicaid	$4,999.70

OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES

Facility

$5,529.35

Service Code	APR-DRG 3201
Min. Negotiated Rate	$5,529.35
Max. Negotiated Rate	$5,529.35
Rate for Payer: AlohaCare Medicaid	$5,529.35
Rate for Payer: Hawaii Medical Service Association ABD	$5,529.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,529.35
Rate for Payer: Kaiser Permanente Medicaid	$5,529.35
Rate for Payer: Ohana Health Plan Medicaid	$5,529.35
Rate for Payer: UnitedHealthcare Medicaid	$5,529.35

OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES

Facility

$7,551.41

Service Code	APR-DRG 3202
Min. Negotiated Rate	$7,551.41
Max. Negotiated Rate	$7,551.41
Rate for Payer: AlohaCare Medicaid	$7,551.41
Rate for Payer: Hawaii Medical Service Association ABD	$7,551.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,551.41
Rate for Payer: Kaiser Permanente Medicaid	$7,551.41
Rate for Payer: Ohana Health Plan Medicaid	$7,551.41
Rate for Payer: UnitedHealthcare Medicaid	$7,551.41

OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES

Facility

$18,526.62

Service Code	APR-DRG 3204
Min. Negotiated Rate	$18,526.62
Max. Negotiated Rate	$18,526.62
Rate for Payer: AlohaCare Medicaid	$18,526.62
Rate for Payer: Hawaii Medical Service Association ABD	$18,526.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,526.62
Rate for Payer: Kaiser Permanente Medicaid	$18,526.62
Rate for Payer: Ohana Health Plan Medicaid	$18,526.62
Rate for Payer: UnitedHealthcare Medicaid	$18,526.62

OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES

Facility

$10,873.46

Service Code	APR-DRG 3203
Min. Negotiated Rate	$10,873.46
Max. Negotiated Rate	$10,873.46
Rate for Payer: AlohaCare Medicaid	$10,873.46
Rate for Payer: Hawaii Medical Service Association ABD	$10,873.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,873.46
Rate for Payer: Kaiser Permanente Medicaid	$10,873.46
Rate for Payer: Ohana Health Plan Medicaid	$10,873.46
Rate for Payer: UnitedHealthcare Medicaid	$10,873.46

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$42,611.10

Service Code	MSDRG 844
Min. Negotiated Rate	$13,847.02
Max. Negotiated Rate	$42,611.10
Rate for Payer: AlohaCare Medicare	$13,847.02
Rate for Payer: Devoted Health Medicare	$15,231.72
Rate for Payer: Hawaii Medical Service Association Commercial	$42,611.10
Rate for Payer: Hawaii Medical Service Association Medicare	$13,847.02
Rate for Payer: Humana Medicare	$13,847.02
Rate for Payer: Kaiser Permanente Commercial	$21,000.15
Rate for Payer: Kaiser Permanente Medicare	$13,847.02
Rate for Payer: Ohana Health Plan Medicare	$13,847.02
Rate for Payer: UnitedHealthcare Medicare	$13,847.02

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$47,148.84

Service Code	MSDRG 843
Min. Negotiated Rate	$22,689.38
Max. Negotiated Rate	$47,148.84
Rate for Payer: AlohaCare Medicare	$22,689.38
Rate for Payer: Devoted Health Medicare	$24,958.32
Rate for Payer: Hawaii Medical Service Association Commercial	$47,148.84
Rate for Payer: Hawaii Medical Service Association Medicare	$22,689.38
Rate for Payer: Humana Medicare	$22,689.38
Rate for Payer: Kaiser Permanente Commercial	$34,410.30
Rate for Payer: Kaiser Permanente Medicare	$22,689.38
Rate for Payer: Ohana Health Plan Medicare	$22,689.38
Rate for Payer: UnitedHealthcare Medicare	$22,689.38

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$42,611.10

Service Code	MSDRG 845
Min. Negotiated Rate	$9,686.30
Max. Negotiated Rate	$42,611.10
Rate for Payer: AlohaCare Medicare	$9,686.30
Rate for Payer: Devoted Health Medicare	$10,654.93
Rate for Payer: Hawaii Medical Service Association Commercial	$42,611.10
Rate for Payer: Hawaii Medical Service Association Medicare	$9,686.30
Rate for Payer: Humana Medicare	$9,686.30
Rate for Payer: Kaiser Permanente Commercial	$14,690.10
Rate for Payer: Kaiser Permanente Medicare	$9,686.30
Rate for Payer: Ohana Health Plan Medicare	$9,686.30
Rate for Payer: UnitedHealthcare Medicare	$9,686.30

OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$7,306.15

Service Code	APR-DRG 0261
Min. Negotiated Rate	$7,306.15
Max. Negotiated Rate	$7,306.15
Rate for Payer: AlohaCare Medicaid	$7,306.15
Rate for Payer: Hawaii Medical Service Association ABD	$7,306.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,306.15
Rate for Payer: Kaiser Permanente Medicaid	$7,306.15
Rate for Payer: Ohana Health Plan Medicaid	$7,306.15
Rate for Payer: UnitedHealthcare Medicaid	$7,306.15

OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$8,842.92

Service Code	APR-DRG 0262
Min. Negotiated Rate	$8,842.92
Max. Negotiated Rate	$8,842.92
Rate for Payer: AlohaCare Medicaid	$8,842.92
Rate for Payer: Hawaii Medical Service Association ABD	$8,842.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,842.92
Rate for Payer: Kaiser Permanente Medicaid	$8,842.92
Rate for Payer: Ohana Health Plan Medicaid	$8,842.92
Rate for Payer: UnitedHealthcare Medicaid	$8,842.92

OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$12,059.95

Service Code	APR-DRG 0263
Min. Negotiated Rate	$12,059.95
Max. Negotiated Rate	$12,059.95
Rate for Payer: AlohaCare Medicaid	$12,059.95
Rate for Payer: Hawaii Medical Service Association ABD	$12,059.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,059.95
Rate for Payer: Kaiser Permanente Medicaid	$12,059.95
Rate for Payer: Ohana Health Plan Medicaid	$12,059.95
Rate for Payer: UnitedHealthcare Medicaid	$12,059.95

OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$21,771.05

Service Code	APR-DRG 0264
Min. Negotiated Rate	$21,771.05
Max. Negotiated Rate	$21,771.05
Rate for Payer: AlohaCare Medicaid	$21,771.05
Rate for Payer: Hawaii Medical Service Association ABD	$21,771.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,771.05
Rate for Payer: Kaiser Permanente Medicaid	$21,771.05
Rate for Payer: Ohana Health Plan Medicaid	$21,771.05
Rate for Payer: UnitedHealthcare Medicaid	$21,771.05

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$7,272.24

Service Code	APR-DRG 4254
Min. Negotiated Rate	$7,272.24
Max. Negotiated Rate	$7,272.24
Rate for Payer: AlohaCare Medicaid	$7,272.24
Rate for Payer: Hawaii Medical Service Association ABD	$7,272.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,272.24
Rate for Payer: Kaiser Permanente Medicaid	$7,272.24
Rate for Payer: Ohana Health Plan Medicaid	$7,272.24
Rate for Payer: UnitedHealthcare Medicaid	$7,272.24

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$2,878.50

Service Code	APR-DRG 4252
Min. Negotiated Rate	$2,878.50
Max. Negotiated Rate	$2,878.50
Rate for Payer: AlohaCare Medicaid	$2,878.50
Rate for Payer: Hawaii Medical Service Association ABD	$2,878.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,878.50
Rate for Payer: Kaiser Permanente Medicaid	$2,878.50
Rate for Payer: Ohana Health Plan Medicaid	$2,878.50
Rate for Payer: UnitedHealthcare Medicaid	$2,878.50

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$2,383.42

Service Code	APR-DRG 4251
Min. Negotiated Rate	$2,383.42
Max. Negotiated Rate	$2,383.42
Rate for Payer: AlohaCare Medicaid	$2,383.42
Rate for Payer: Hawaii Medical Service Association ABD	$2,383.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,383.42
Rate for Payer: Kaiser Permanente Medicaid	$2,383.42
Rate for Payer: Ohana Health Plan Medicaid	$2,383.42
Rate for Payer: UnitedHealthcare Medicaid	$2,383.42

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$3,890.83

Service Code	APR-DRG 4253
Min. Negotiated Rate	$3,890.83
Max. Negotiated Rate	$3,890.83
Rate for Payer: AlohaCare Medicaid	$3,890.83
Rate for Payer: Hawaii Medical Service Association ABD	$3,890.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,890.83
Rate for Payer: Kaiser Permanente Medicaid	$3,890.83
Rate for Payer: Ohana Health Plan Medicaid	$3,890.83
Rate for Payer: UnitedHealthcare Medicaid	$3,890.83

OTHER OPEN CRANIOTOMY

Facility

$9,630.87

Service Code	APR-DRG 0272
Min. Negotiated Rate	$9,630.87
Max. Negotiated Rate	$9,630.87
Rate for Payer: AlohaCare Medicaid	$9,630.87
Rate for Payer: Hawaii Medical Service Association ABD	$9,630.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,630.87
Rate for Payer: Kaiser Permanente Medicaid	$9,630.87
Rate for Payer: Ohana Health Plan Medicaid	$9,630.87
Rate for Payer: UnitedHealthcare Medicaid	$9,630.87

OTHER OPEN CRANIOTOMY

Facility

$8,535.04

Service Code	APR-DRG 0271
Min. Negotiated Rate	$8,535.04
Max. Negotiated Rate	$8,535.04
Rate for Payer: AlohaCare Medicaid	$8,535.04
Rate for Payer: Hawaii Medical Service Association ABD	$8,535.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,535.04
Rate for Payer: Kaiser Permanente Medicaid	$8,535.04
Rate for Payer: Ohana Health Plan Medicaid	$8,535.04
Rate for Payer: UnitedHealthcare Medicaid	$8,535.04

Know your out-of-pocket cost for care.

All Charges