Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER OPEN CRANIOTOMY

Facility

$27,254.09

Service Code	APR-DRG 0274
Min. Negotiated Rate	$27,254.09
Max. Negotiated Rate	$27,254.09
Rate for Payer: AlohaCare Medicaid	$27,254.09
Rate for Payer: Hawaii Medical Service Association ABD	$27,254.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27,254.09
Rate for Payer: Kaiser Permanente Medicaid	$27,254.09
Rate for Payer: Ohana Health Plan Medicaid	$27,254.09
Rate for Payer: UnitedHealthcare Medicaid	$27,254.09

OTHER OPEN CRANIOTOMY

Facility

$13,605.19

Service Code	APR-DRG 0273
Min. Negotiated Rate	$13,605.19
Max. Negotiated Rate	$13,605.19
Rate for Payer: AlohaCare Medicaid	$13,605.19
Rate for Payer: Hawaii Medical Service Association ABD	$13,605.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,605.19
Rate for Payer: Kaiser Permanente Medicaid	$13,605.19
Rate for Payer: Ohana Health Plan Medicaid	$13,605.19
Rate for Payer: UnitedHealthcare Medicaid	$13,605.19

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$45,425.95

Service Code	MSDRG 908
Min. Negotiated Rate	$22,693.91
Max. Negotiated Rate	$45,425.95
Rate for Payer: AlohaCare Medicare	$22,693.91
Rate for Payer: Devoted Health Medicare	$24,963.30
Rate for Payer: Hawaii Medical Service Association Commercial	$45,425.95
Rate for Payer: Hawaii Medical Service Association Medicare	$22,693.91
Rate for Payer: Humana Medicare	$22,693.91
Rate for Payer: Kaiser Permanente Commercial	$34,417.20
Rate for Payer: Kaiser Permanente Medicare	$22,693.91
Rate for Payer: Ohana Health Plan Medicare	$22,693.91
Rate for Payer: UnitedHealthcare Medicare	$22,693.91

OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$66,227.93

Service Code	MSDRG 907
Min. Negotiated Rate	$43,669.18
Max. Negotiated Rate	$66,227.93
Rate for Payer: AlohaCare Medicare	$43,669.18
Rate for Payer: Devoted Health Medicare	$48,036.10
Rate for Payer: Hawaii Medical Service Association Commercial	$48,604.80
Rate for Payer: Hawaii Medical Service Association Medicare	$43,669.18
Rate for Payer: Humana Medicare	$43,669.18
Rate for Payer: Kaiser Permanente Commercial	$66,227.93
Rate for Payer: Kaiser Permanente Medicare	$43,669.18
Rate for Payer: Ohana Health Plan Medicare	$43,669.18
Rate for Payer: UnitedHealthcare Medicare	$43,669.18

OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$23,538.02

Service Code	MSDRG 909
Min. Negotiated Rate	$14,930.99
Max. Negotiated Rate	$23,538.02
Rate for Payer: AlohaCare Medicare	$14,930.99
Rate for Payer: Devoted Health Medicare	$16,424.09
Rate for Payer: Hawaii Medical Service Association Commercial	$23,538.02
Rate for Payer: Hawaii Medical Service Association Medicare	$14,930.99
Rate for Payer: Humana Medicare	$14,930.99
Rate for Payer: Kaiser Permanente Commercial	$22,644.08
Rate for Payer: Kaiser Permanente Medicare	$14,930.99
Rate for Payer: Ohana Health Plan Medicare	$14,930.99
Rate for Payer: UnitedHealthcare Medicare	$14,930.99

OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$14,117.88

Service Code	APR-DRG 6813
Min. Negotiated Rate	$14,117.88
Max. Negotiated Rate	$14,117.88
Rate for Payer: AlohaCare Medicaid	$14,117.88
Rate for Payer: Hawaii Medical Service Association ABD	$14,117.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,117.88
Rate for Payer: Kaiser Permanente Medicaid	$14,117.88
Rate for Payer: Ohana Health Plan Medicaid	$14,117.88
Rate for Payer: UnitedHealthcare Medicaid	$14,117.88

OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$6,141.84

Service Code	APR-DRG 6811
Min. Negotiated Rate	$6,141.84
Max. Negotiated Rate	$6,141.84
Rate for Payer: AlohaCare Medicaid	$6,141.84
Rate for Payer: Hawaii Medical Service Association ABD	$6,141.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,141.84
Rate for Payer: Kaiser Permanente Medicaid	$6,141.84
Rate for Payer: Ohana Health Plan Medicaid	$6,141.84
Rate for Payer: UnitedHealthcare Medicaid	$6,141.84

OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$8,138.46

Service Code	APR-DRG 6812
Min. Negotiated Rate	$8,138.46
Max. Negotiated Rate	$8,138.46
Rate for Payer: AlohaCare Medicaid	$8,138.46
Rate for Payer: Hawaii Medical Service Association ABD	$8,138.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,138.46
Rate for Payer: Kaiser Permanente Medicaid	$8,138.46
Rate for Payer: Ohana Health Plan Medicaid	$8,138.46
Rate for Payer: UnitedHealthcare Medicaid	$8,138.46

OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$28,399.49

Service Code	APR-DRG 6814
Min. Negotiated Rate	$28,399.49
Max. Negotiated Rate	$28,399.49
Rate for Payer: AlohaCare Medicaid	$28,399.49
Rate for Payer: Hawaii Medical Service Association ABD	$28,399.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28,399.49
Rate for Payer: Kaiser Permanente Medicaid	$28,399.49
Rate for Payer: Ohana Health Plan Medicaid	$28,399.49
Rate for Payer: UnitedHealthcare Medicaid	$28,399.49

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$156,394.37

Service Code	MSDRG 958
Min. Negotiated Rate	$47,929.97
Max. Negotiated Rate	$156,394.37
Rate for Payer: AlohaCare Medicare	$47,929.97
Rate for Payer: Devoted Health Medicare	$52,722.97
Rate for Payer: Hawaii Medical Service Association Commercial	$156,394.37
Rate for Payer: Hawaii Medical Service Association Medicare	$47,929.97
Rate for Payer: Humana Medicare	$47,929.97
Rate for Payer: Kaiser Permanente Commercial	$72,689.77
Rate for Payer: Kaiser Permanente Medicare	$47,929.97
Rate for Payer: Ohana Health Plan Medicare	$47,929.97
Rate for Payer: UnitedHealthcare Medicare	$47,929.97

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$156,394.37

Service Code	MSDRG 957
Min. Negotiated Rate	$86,670.69
Max. Negotiated Rate	$156,394.37
Rate for Payer: AlohaCare Medicare	$86,670.69
Rate for Payer: Devoted Health Medicare	$95,337.76
Rate for Payer: Hawaii Medical Service Association Commercial	$156,394.37
Rate for Payer: Hawaii Medical Service Association Medicare	$86,670.69
Rate for Payer: Humana Medicare	$86,670.69
Rate for Payer: Kaiser Permanente Commercial	$131,443.27
Rate for Payer: Kaiser Permanente Medicare	$86,670.69
Rate for Payer: Ohana Health Plan Medicare	$86,670.69
Rate for Payer: UnitedHealthcare Medicare	$86,670.69

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$156,394.37

Service Code	MSDRG 959
Min. Negotiated Rate	$33,486.94
Max. Negotiated Rate	$156,394.37
Rate for Payer: AlohaCare Medicare	$33,486.94
Rate for Payer: Devoted Health Medicare	$36,835.63
Rate for Payer: Hawaii Medical Service Association Commercial	$156,394.37
Rate for Payer: Hawaii Medical Service Association Medicare	$33,486.94
Rate for Payer: Humana Medicare	$33,486.94
Rate for Payer: Kaiser Permanente Commercial	$50,785.72
Rate for Payer: Kaiser Permanente Medicare	$33,486.94
Rate for Payer: Ohana Health Plan Medicare	$33,486.94
Rate for Payer: UnitedHealthcare Medicare	$33,486.94

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$43,266.28

Service Code	MSDRG 803
Min. Negotiated Rate	$21,143.61
Max. Negotiated Rate	$43,266.28
Rate for Payer: AlohaCare Medicare	$21,143.61
Rate for Payer: Devoted Health Medicare	$23,257.97
Rate for Payer: Hawaii Medical Service Association Commercial	$43,266.28
Rate for Payer: Hawaii Medical Service Association Medicare	$21,143.61
Rate for Payer: Humana Medicare	$21,143.61
Rate for Payer: Kaiser Permanente Commercial	$32,066.03
Rate for Payer: Kaiser Permanente Medicare	$21,143.61
Rate for Payer: Ohana Health Plan Medicare	$21,143.61
Rate for Payer: UnitedHealthcare Medicare	$21,143.61

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$68,725.73

Service Code	MSDRG 802
Min. Negotiated Rate	$43,266.28
Max. Negotiated Rate	$68,725.73
Rate for Payer: AlohaCare Medicare	$45,316.18
Rate for Payer: Devoted Health Medicare	$49,847.80
Rate for Payer: Hawaii Medical Service Association Commercial	$43,266.28
Rate for Payer: Hawaii Medical Service Association Medicare	$45,316.18
Rate for Payer: Humana Medicare	$45,316.18
Rate for Payer: Kaiser Permanente Commercial	$68,725.73
Rate for Payer: Kaiser Permanente Medicare	$45,316.18
Rate for Payer: Ohana Health Plan Medicare	$45,316.18
Rate for Payer: UnitedHealthcare Medicare	$45,316.18

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$43,266.28

Service Code	MSDRG 804
Min. Negotiated Rate	$15,423.48
Max. Negotiated Rate	$43,266.28
Rate for Payer: AlohaCare Medicare	$15,423.48
Rate for Payer: Devoted Health Medicare	$16,965.83
Rate for Payer: Hawaii Medical Service Association Commercial	$43,266.28
Rate for Payer: Hawaii Medical Service Association Medicare	$15,423.48
Rate for Payer: Humana Medicare	$15,423.48
Rate for Payer: Kaiser Permanente Commercial	$23,391.00
Rate for Payer: Kaiser Permanente Medicare	$15,423.48
Rate for Payer: Ohana Health Plan Medicare	$15,423.48
Rate for Payer: UnitedHealthcare Medicare	$15,423.48

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$9,222.54

Service Code	APR-DRG 0292
Min. Negotiated Rate	$9,222.54
Max. Negotiated Rate	$9,222.54
Rate for Payer: AlohaCare Medicaid	$9,222.54
Rate for Payer: Hawaii Medical Service Association ABD	$9,222.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,222.54
Rate for Payer: Kaiser Permanente Medicaid	$9,222.54
Rate for Payer: Ohana Health Plan Medicaid	$9,222.54
Rate for Payer: UnitedHealthcare Medicaid	$9,222.54

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$8,300.22

Service Code	APR-DRG 0291
Min. Negotiated Rate	$8,300.22
Max. Negotiated Rate	$8,300.22
Rate for Payer: AlohaCare Medicaid	$8,300.22
Rate for Payer: Hawaii Medical Service Association ABD	$8,300.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,300.22
Rate for Payer: Kaiser Permanente Medicaid	$8,300.22
Rate for Payer: Ohana Health Plan Medicaid	$8,300.22
Rate for Payer: UnitedHealthcare Medicaid	$8,300.22

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$12,817.24

Service Code	APR-DRG 0293
Min. Negotiated Rate	$12,817.24
Max. Negotiated Rate	$12,817.24
Rate for Payer: AlohaCare Medicaid	$12,817.24
Rate for Payer: Hawaii Medical Service Association ABD	$12,817.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,817.24
Rate for Payer: Kaiser Permanente Medicaid	$12,817.24
Rate for Payer: Ohana Health Plan Medicaid	$12,817.24
Rate for Payer: UnitedHealthcare Medicaid	$12,817.24

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$21,865.63

Service Code	APR-DRG 0294
Min. Negotiated Rate	$21,865.63
Max. Negotiated Rate	$21,865.63
Rate for Payer: AlohaCare Medicaid	$21,865.63
Rate for Payer: Hawaii Medical Service Association ABD	$21,865.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,865.63
Rate for Payer: Kaiser Permanente Medicaid	$21,865.63
Rate for Payer: Ohana Health Plan Medicaid	$21,865.63
Rate for Payer: UnitedHealthcare Medicaid	$21,865.63

OTHER PERIPHERAL VASCULAR PROCEDURES

Facility

$23,419.35

Service Code	APR-DRG 1824
Min. Negotiated Rate	$23,419.35
Max. Negotiated Rate	$23,419.35
Rate for Payer: AlohaCare Medicaid	$23,419.35
Rate for Payer: Hawaii Medical Service Association ABD	$23,419.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23,419.35
Rate for Payer: Kaiser Permanente Medicaid	$23,419.35
Rate for Payer: Ohana Health Plan Medicaid	$23,419.35
Rate for Payer: UnitedHealthcare Medicaid	$23,419.35

OTHER PERIPHERAL VASCULAR PROCEDURES

Facility

$12,851.81

Service Code	APR-DRG 1823
Min. Negotiated Rate	$12,851.81
Max. Negotiated Rate	$12,851.81
Rate for Payer: AlohaCare Medicaid	$12,851.81
Rate for Payer: Hawaii Medical Service Association ABD	$12,851.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,851.81
Rate for Payer: Kaiser Permanente Medicaid	$12,851.81
Rate for Payer: Ohana Health Plan Medicaid	$12,851.81
Rate for Payer: UnitedHealthcare Medicaid	$12,851.81

OTHER PERIPHERAL VASCULAR PROCEDURES

Facility

$11,743.60

Service Code	APR-DRG 1822
Min. Negotiated Rate	$11,743.60
Max. Negotiated Rate	$11,743.60
Rate for Payer: AlohaCare Medicaid	$11,743.60
Rate for Payer: Hawaii Medical Service Association ABD	$11,743.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,743.60
Rate for Payer: Kaiser Permanente Medicaid	$11,743.60
Rate for Payer: Ohana Health Plan Medicaid	$11,743.60
Rate for Payer: UnitedHealthcare Medicaid	$11,743.60

OTHER PERIPHERAL VASCULAR PROCEDURES

Facility

$9,968.75

Service Code	APR-DRG 1821
Min. Negotiated Rate	$9,968.75
Max. Negotiated Rate	$9,968.75
Rate for Payer: AlohaCare Medicaid	$9,968.75
Rate for Payer: Hawaii Medical Service Association ABD	$9,968.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,968.75
Rate for Payer: Kaiser Permanente Medicaid	$9,968.75
Rate for Payer: Ohana Health Plan Medicaid	$9,968.75
Rate for Payer: UnitedHealthcare Medicaid	$9,968.75

OTHER PNEUMONIA

Facility

$3,384.67

Service Code	APR-DRG 1392
Min. Negotiated Rate	$3,384.67
Max. Negotiated Rate	$3,384.67
Rate for Payer: AlohaCare Medicaid	$3,384.67
Rate for Payer: Hawaii Medical Service Association ABD	$3,384.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,384.67
Rate for Payer: Kaiser Permanente Medicaid	$3,384.67
Rate for Payer: Ohana Health Plan Medicaid	$3,384.67
Rate for Payer: UnitedHealthcare Medicaid	$3,384.67

OTHER PNEUMONIA

Facility

$2,481.26

Service Code	APR-DRG 1391
Min. Negotiated Rate	$2,481.26
Max. Negotiated Rate	$2,481.26
Rate for Payer: AlohaCare Medicaid	$2,481.26
Rate for Payer: Hawaii Medical Service Association ABD	$2,481.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,481.26
Rate for Payer: Kaiser Permanente Medicaid	$2,481.26
Rate for Payer: Ohana Health Plan Medicaid	$2,481.26
Rate for Payer: UnitedHealthcare Medicaid	$2,481.26

Know your out-of-pocket cost for care.

All Charges