Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER PNEUMONIA

Facility

$4,781.84

Service Code	APR-DRG 1393
Min. Negotiated Rate	$4,781.84
Max. Negotiated Rate	$4,781.84
Rate for Payer: AlohaCare Medicaid	$4,781.84
Rate for Payer: Hawaii Medical Service Association ABD	$4,781.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,781.84
Rate for Payer: Kaiser Permanente Medicaid	$4,781.84
Rate for Payer: Ohana Health Plan Medicaid	$4,781.84
Rate for Payer: UnitedHealthcare Medicaid	$4,781.84

OTHER PNEUMONIA

Facility

$7,163.96

Service Code	APR-DRG 1394
Min. Negotiated Rate	$7,163.96
Max. Negotiated Rate	$7,163.96
Rate for Payer: AlohaCare Medicaid	$7,163.96
Rate for Payer: Hawaii Medical Service Association ABD	$7,163.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,163.96
Rate for Payer: Kaiser Permanente Medicaid	$7,163.96
Rate for Payer: Ohana Health Plan Medicaid	$7,163.96
Rate for Payer: UnitedHealthcare Medicaid	$7,163.96

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS

Facility

$23,806.81

Service Code	APR-DRG 4054
Min. Negotiated Rate	$23,806.81
Max. Negotiated Rate	$23,806.81
Rate for Payer: AlohaCare Medicaid	$23,806.81
Rate for Payer: Hawaii Medical Service Association ABD	$23,806.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23,806.81
Rate for Payer: Kaiser Permanente Medicaid	$23,806.81
Rate for Payer: Ohana Health Plan Medicaid	$23,806.81
Rate for Payer: UnitedHealthcare Medicaid	$23,806.81

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS

Facility

$8,450.25

Service Code	APR-DRG 4052
Min. Negotiated Rate	$8,450.25
Max. Negotiated Rate	$8,450.25
Rate for Payer: AlohaCare Medicaid	$8,450.25
Rate for Payer: Hawaii Medical Service Association ABD	$8,450.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,450.25
Rate for Payer: Kaiser Permanente Medicaid	$8,450.25
Rate for Payer: Ohana Health Plan Medicaid	$8,450.25
Rate for Payer: UnitedHealthcare Medicaid	$8,450.25

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS

Facility

$6,963.06

Service Code	APR-DRG 4051
Min. Negotiated Rate	$6,963.06
Max. Negotiated Rate	$6,963.06
Rate for Payer: AlohaCare Medicaid	$6,963.06
Rate for Payer: Hawaii Medical Service Association ABD	$6,963.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,963.06
Rate for Payer: Kaiser Permanente Medicaid	$6,963.06
Rate for Payer: Ohana Health Plan Medicaid	$6,963.06
Rate for Payer: UnitedHealthcare Medicaid	$6,963.06

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS

Facility

$11,851.22

Service Code	APR-DRG 4053
Min. Negotiated Rate	$11,851.22
Max. Negotiated Rate	$11,851.22
Rate for Payer: AlohaCare Medicaid	$11,851.22
Rate for Payer: Hawaii Medical Service Association ABD	$11,851.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,851.22
Rate for Payer: Kaiser Permanente Medicaid	$11,851.22
Rate for Payer: Ohana Health Plan Medicaid	$11,851.22
Rate for Payer: UnitedHealthcare Medicaid	$11,851.22

OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$7,748.40

Service Code	APR-DRG 6512
Min. Negotiated Rate	$7,748.40
Max. Negotiated Rate	$7,748.40
Rate for Payer: AlohaCare Medicaid	$7,748.40
Rate for Payer: Hawaii Medical Service Association ABD	$7,748.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,748.40
Rate for Payer: Kaiser Permanente Medicaid	$7,748.40
Rate for Payer: Ohana Health Plan Medicaid	$7,748.40
Rate for Payer: UnitedHealthcare Medicaid	$7,748.40

OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$11,862.96

Service Code	APR-DRG 6513
Min. Negotiated Rate	$11,862.96
Max. Negotiated Rate	$11,862.96
Rate for Payer: AlohaCare Medicaid	$11,862.96
Rate for Payer: Hawaii Medical Service Association ABD	$11,862.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,862.96
Rate for Payer: Kaiser Permanente Medicaid	$11,862.96
Rate for Payer: Ohana Health Plan Medicaid	$11,862.96
Rate for Payer: UnitedHealthcare Medicaid	$11,862.96

OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$27,614.15

Service Code	APR-DRG 6514
Min. Negotiated Rate	$27,614.15
Max. Negotiated Rate	$27,614.15
Rate for Payer: AlohaCare Medicaid	$27,614.15
Rate for Payer: Hawaii Medical Service Association ABD	$27,614.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27,614.15
Rate for Payer: Kaiser Permanente Medicaid	$27,614.15
Rate for Payer: Ohana Health Plan Medicaid	$27,614.15
Rate for Payer: UnitedHealthcare Medicaid	$27,614.15

OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$5,578.93

Service Code	APR-DRG 6511
Min. Negotiated Rate	$5,578.93
Max. Negotiated Rate	$5,578.93
Rate for Payer: AlohaCare Medicaid	$5,578.93
Rate for Payer: Hawaii Medical Service Association ABD	$5,578.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,578.93
Rate for Payer: Kaiser Permanente Medicaid	$5,578.93
Rate for Payer: Ohana Health Plan Medicaid	$5,578.93
Rate for Payer: UnitedHealthcare Medicaid	$5,578.93

OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$22,605.31

Service Code	APR-DRG 1214
Min. Negotiated Rate	$22,605.31
Max. Negotiated Rate	$22,605.31
Rate for Payer: AlohaCare Medicaid	$22,605.31
Rate for Payer: Hawaii Medical Service Association ABD	$22,605.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,605.31
Rate for Payer: Kaiser Permanente Medicaid	$22,605.31
Rate for Payer: Ohana Health Plan Medicaid	$22,605.31
Rate for Payer: UnitedHealthcare Medicaid	$22,605.31

OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$13,208.61

Service Code	APR-DRG 1213
Min. Negotiated Rate	$13,208.61
Max. Negotiated Rate	$13,208.61
Rate for Payer: AlohaCare Medicaid	$13,208.61
Rate for Payer: Hawaii Medical Service Association ABD	$13,208.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,208.61
Rate for Payer: Kaiser Permanente Medicaid	$13,208.61
Rate for Payer: Ohana Health Plan Medicaid	$13,208.61
Rate for Payer: UnitedHealthcare Medicaid	$13,208.61

OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$7,186.14

Service Code	APR-DRG 1211
Min. Negotiated Rate	$7,186.14
Max. Negotiated Rate	$7,186.14
Rate for Payer: AlohaCare Medicaid	$7,186.14
Rate for Payer: Hawaii Medical Service Association ABD	$7,186.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,186.14
Rate for Payer: Kaiser Permanente Medicaid	$7,186.14
Rate for Payer: Ohana Health Plan Medicaid	$7,186.14
Rate for Payer: UnitedHealthcare Medicaid	$7,186.14

OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$8,942.72

Service Code	APR-DRG 1212
Min. Negotiated Rate	$8,942.72
Max. Negotiated Rate	$8,942.72
Rate for Payer: AlohaCare Medicaid	$8,942.72
Rate for Payer: Hawaii Medical Service Association ABD	$8,942.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,942.72
Rate for Payer: Kaiser Permanente Medicaid	$8,942.72
Rate for Payer: Ohana Health Plan Medicaid	$8,942.72
Rate for Payer: UnitedHealthcare Medicaid	$8,942.72

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$5,142.55

Service Code	APR-DRG 1433
Min. Negotiated Rate	$5,142.55
Max. Negotiated Rate	$5,142.55
Rate for Payer: AlohaCare Medicaid	$5,142.55
Rate for Payer: Hawaii Medical Service Association ABD	$5,142.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,142.55
Rate for Payer: Kaiser Permanente Medicaid	$5,142.55
Rate for Payer: Ohana Health Plan Medicaid	$5,142.55
Rate for Payer: UnitedHealthcare Medicaid	$5,142.55

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$2,608.46

Service Code	APR-DRG 1431
Min. Negotiated Rate	$2,608.46
Max. Negotiated Rate	$2,608.46
Rate for Payer: AlohaCare Medicaid	$2,608.46
Rate for Payer: Hawaii Medical Service Association ABD	$2,608.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,608.46
Rate for Payer: Kaiser Permanente Medicaid	$2,608.46
Rate for Payer: Ohana Health Plan Medicaid	$2,608.46
Rate for Payer: UnitedHealthcare Medicaid	$2,608.46

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$3,627.31

Service Code	APR-DRG 1432
Min. Negotiated Rate	$3,627.31
Max. Negotiated Rate	$3,627.31
Rate for Payer: AlohaCare Medicaid	$3,627.31
Rate for Payer: Hawaii Medical Service Association ABD	$3,627.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,627.31
Rate for Payer: Kaiser Permanente Medicaid	$3,627.31
Rate for Payer: Ohana Health Plan Medicaid	$3,627.31
Rate for Payer: UnitedHealthcare Medicaid	$3,627.31

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$7,554.67

Service Code	APR-DRG 1434
Min. Negotiated Rate	$7,554.67
Max. Negotiated Rate	$7,554.67
Rate for Payer: AlohaCare Medicaid	$7,554.67
Rate for Payer: Hawaii Medical Service Association ABD	$7,554.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,554.67
Rate for Payer: Kaiser Permanente Medicaid	$7,554.67
Rate for Payer: Ohana Health Plan Medicaid	$7,554.67
Rate for Payer: UnitedHealthcare Medicaid	$7,554.67

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$31,584.75

Service Code	MSDRG 205
Min. Negotiated Rate	$20,826.26
Max. Negotiated Rate	$31,584.75
Rate for Payer: AlohaCare Medicare	$20,826.26
Rate for Payer: Devoted Health Medicare	$22,908.89
Rate for Payer: Hawaii Medical Service Association Commercial	$20,941.56
Rate for Payer: Hawaii Medical Service Association Medicare	$20,826.26
Rate for Payer: Humana Medicare	$20,826.26
Rate for Payer: Kaiser Permanente Commercial	$31,584.75
Rate for Payer: Kaiser Permanente Medicare	$20,826.26
Rate for Payer: Ohana Health Plan Medicare	$20,826.26
Rate for Payer: UnitedHealthcare Medicare	$20,826.26

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$18,053.90

Service Code	MSDRG 206
Min. Negotiated Rate	$10,704.31
Max. Negotiated Rate	$18,053.90
Rate for Payer: AlohaCare Medicare	$10,704.31
Rate for Payer: Devoted Health Medicare	$11,774.74
Rate for Payer: Hawaii Medical Service Association Commercial	$18,053.90
Rate for Payer: Hawaii Medical Service Association Medicare	$10,704.31
Rate for Payer: Humana Medicare	$10,704.31
Rate for Payer: Kaiser Permanente Commercial	$16,233.98
Rate for Payer: Kaiser Permanente Medicare	$10,704.31
Rate for Payer: Ohana Health Plan Medicare	$10,704.31
Rate for Payer: UnitedHealthcare Medicare	$10,704.31

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$61,951.10

Service Code	MSDRG 167
Min. Negotiated Rate	$20,512.34
Max. Negotiated Rate	$61,951.10
Rate for Payer: AlohaCare Medicare	$20,512.34
Rate for Payer: Devoted Health Medicare	$22,563.57
Rate for Payer: Hawaii Medical Service Association Commercial	$61,951.10
Rate for Payer: Hawaii Medical Service Association Medicare	$20,512.34
Rate for Payer: Humana Medicare	$20,512.34
Rate for Payer: Kaiser Permanente Commercial	$31,108.65
Rate for Payer: Kaiser Permanente Medicare	$20,512.34
Rate for Payer: Ohana Health Plan Medicare	$20,512.34
Rate for Payer: UnitedHealthcare Medicare	$20,512.34

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$65,008.61

Service Code	MSDRG 166
Min. Negotiated Rate	$42,513.57
Max. Negotiated Rate	$65,008.61
Rate for Payer: AlohaCare Medicare	$42,513.57
Rate for Payer: Devoted Health Medicare	$46,764.93
Rate for Payer: Hawaii Medical Service Association Commercial	$65,008.61
Rate for Payer: Hawaii Medical Service Association Medicare	$42,513.57
Rate for Payer: Humana Medicare	$42,513.57
Rate for Payer: Kaiser Permanente Commercial	$64,475.32
Rate for Payer: Kaiser Permanente Medicare	$42,513.57
Rate for Payer: Ohana Health Plan Medicare	$42,513.57
Rate for Payer: UnitedHealthcare Medicare	$42,513.57

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$44,261.18

Service Code	MSDRG 168
Min. Negotiated Rate	$15,541.79
Max. Negotiated Rate	$44,261.18
Rate for Payer: AlohaCare Medicare	$15,541.79
Rate for Payer: Devoted Health Medicare	$17,095.97
Rate for Payer: Hawaii Medical Service Association Commercial	$44,261.18
Rate for Payer: Hawaii Medical Service Association Medicare	$15,541.79
Rate for Payer: Humana Medicare	$15,541.79
Rate for Payer: Kaiser Permanente Commercial	$23,570.40
Rate for Payer: Kaiser Permanente Medicare	$15,541.79
Rate for Payer: Ohana Health Plan Medicare	$15,541.79
Rate for Payer: UnitedHealthcare Medicare	$15,541.79

OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$12,797.67

Service Code	APR-DRG 3093
Min. Negotiated Rate	$12,797.67
Max. Negotiated Rate	$12,797.67
Rate for Payer: AlohaCare Medicaid	$12,797.67
Rate for Payer: Hawaii Medical Service Association ABD	$12,797.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,797.67
Rate for Payer: Kaiser Permanente Medicaid	$12,797.67
Rate for Payer: Ohana Health Plan Medicaid	$12,797.67
Rate for Payer: UnitedHealthcare Medicaid	$12,797.67

OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$21,389.47

Service Code	APR-DRG 3094
Min. Negotiated Rate	$21,389.47
Max. Negotiated Rate	$21,389.47
Rate for Payer: AlohaCare Medicaid	$21,389.47
Rate for Payer: Hawaii Medical Service Association ABD	$21,389.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,389.47
Rate for Payer: Kaiser Permanente Medicaid	$21,389.47
Rate for Payer: Ohana Health Plan Medicaid	$21,389.47
Rate for Payer: UnitedHealthcare Medicaid	$21,389.47

Know your out-of-pocket cost for care.

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