Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$9,660.87

Service Code	APR-DRG 3092
Min. Negotiated Rate	$9,660.87
Max. Negotiated Rate	$9,660.87
Rate for Payer: AlohaCare Medicaid	$9,660.87
Rate for Payer: Hawaii Medical Service Association ABD	$9,660.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,660.87
Rate for Payer: Kaiser Permanente Medicaid	$9,660.87
Rate for Payer: Ohana Health Plan Medicaid	$9,660.87
Rate for Payer: UnitedHealthcare Medicaid	$9,660.87

OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$7,373.99

Service Code	APR-DRG 3091
Min. Negotiated Rate	$7,373.99
Max. Negotiated Rate	$7,373.99
Rate for Payer: AlohaCare Medicaid	$7,373.99
Rate for Payer: Hawaii Medical Service Association ABD	$7,373.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,373.99
Rate for Payer: Kaiser Permanente Medicaid	$7,373.99
Rate for Payer: Ohana Health Plan Medicaid	$7,373.99
Rate for Payer: UnitedHealthcare Medicaid	$7,373.99

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$29,992.78

Service Code	MSDRG 580
Min. Negotiated Rate	$19,654.71
Max. Negotiated Rate	$29,992.78
Rate for Payer: AlohaCare Medicare	$19,654.71
Rate for Payer: Devoted Health Medicare	$21,620.18
Rate for Payer: Hawaii Medical Service Association Commercial	$29,992.78
Rate for Payer: Hawaii Medical Service Association Medicare	$19,654.71
Rate for Payer: Humana Medicare	$19,654.71
Rate for Payer: Kaiser Permanente Commercial	$29,808.00
Rate for Payer: Kaiser Permanente Medicare	$19,654.71
Rate for Payer: Ohana Health Plan Medicare	$19,654.71
Rate for Payer: UnitedHealthcare Medicare	$19,654.71

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$55,864.12

Service Code	MSDRG 579
Min. Negotiated Rate	$36,835.52
Max. Negotiated Rate	$55,864.12
Rate for Payer: AlohaCare Medicare	$36,835.52
Rate for Payer: Devoted Health Medicare	$40,519.07
Rate for Payer: Hawaii Medical Service Association Commercial	$47,925.35
Rate for Payer: Hawaii Medical Service Association Medicare	$36,835.52
Rate for Payer: Humana Medicare	$36,835.52
Rate for Payer: Kaiser Permanente Commercial	$55,864.12
Rate for Payer: Kaiser Permanente Medicare	$36,835.52
Rate for Payer: Ohana Health Plan Medicare	$36,835.52
Rate for Payer: UnitedHealthcare Medicare	$36,835.52

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$24,893.47

Service Code	MSDRG 581
Min. Negotiated Rate	$16,414.19
Max. Negotiated Rate	$24,893.47
Rate for Payer: AlohaCare Medicare	$16,414.19
Rate for Payer: Devoted Health Medicare	$18,055.61
Rate for Payer: Hawaii Medical Service Association Commercial	$24,629.99
Rate for Payer: Hawaii Medical Service Association Medicare	$16,414.19
Rate for Payer: Humana Medicare	$16,414.19
Rate for Payer: Kaiser Permanente Commercial	$24,893.47
Rate for Payer: Kaiser Permanente Medicare	$16,414.19
Rate for Payer: Ohana Health Plan Medicare	$16,414.19
Rate for Payer: UnitedHealthcare Medicare	$16,414.19

OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS

Facility

$8,486.78

Service Code	APR-DRG 3854
Min. Negotiated Rate	$8,486.78
Max. Negotiated Rate	$8,486.78
Rate for Payer: AlohaCare Medicaid	$8,486.78
Rate for Payer: Hawaii Medical Service Association ABD	$8,486.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,486.78
Rate for Payer: Kaiser Permanente Medicaid	$8,486.78
Rate for Payer: Ohana Health Plan Medicaid	$8,486.78
Rate for Payer: UnitedHealthcare Medicaid	$8,486.78

OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS

Facility

$2,999.82

Service Code	APR-DRG 3852
Min. Negotiated Rate	$2,999.82
Max. Negotiated Rate	$2,999.82
Rate for Payer: AlohaCare Medicaid	$2,999.82
Rate for Payer: Hawaii Medical Service Association ABD	$2,999.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,999.82
Rate for Payer: Kaiser Permanente Medicaid	$2,999.82
Rate for Payer: Ohana Health Plan Medicaid	$2,999.82
Rate for Payer: UnitedHealthcare Medicaid	$2,999.82

OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS

Facility

$4,550.28

Service Code	APR-DRG 3853
Min. Negotiated Rate	$4,550.28
Max. Negotiated Rate	$4,550.28
Rate for Payer: AlohaCare Medicaid	$4,550.28
Rate for Payer: Hawaii Medical Service Association ABD	$4,550.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,550.28
Rate for Payer: Kaiser Permanente Medicaid	$4,550.28
Rate for Payer: Ohana Health Plan Medicaid	$4,550.28
Rate for Payer: UnitedHealthcare Medicaid	$4,550.28

OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS

Facility

$2,177.95

Service Code	APR-DRG 3851
Min. Negotiated Rate	$2,177.95
Max. Negotiated Rate	$2,177.95
Rate for Payer: AlohaCare Medicaid	$2,177.95
Rate for Payer: Hawaii Medical Service Association ABD	$2,177.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,177.95
Rate for Payer: Kaiser Permanente Medicaid	$2,177.95
Rate for Payer: Ohana Health Plan Medicaid	$2,177.95
Rate for Payer: UnitedHealthcare Medicaid	$2,177.95

OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$3,928.66

Service Code	APR-DRG 3641
Min. Negotiated Rate	$3,928.66
Max. Negotiated Rate	$3,928.66
Rate for Payer: AlohaCare Medicaid	$3,928.66
Rate for Payer: Hawaii Medical Service Association ABD	$3,928.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,928.66
Rate for Payer: Kaiser Permanente Medicaid	$3,928.66
Rate for Payer: Ohana Health Plan Medicaid	$3,928.66
Rate for Payer: UnitedHealthcare Medicaid	$3,928.66

OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$5,516.96

Service Code	APR-DRG 3642
Min. Negotiated Rate	$5,516.96
Max. Negotiated Rate	$5,516.96
Rate for Payer: AlohaCare Medicaid	$5,516.96
Rate for Payer: Hawaii Medical Service Association ABD	$5,516.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,516.96
Rate for Payer: Kaiser Permanente Medicaid	$5,516.96
Rate for Payer: Ohana Health Plan Medicaid	$5,516.96
Rate for Payer: UnitedHealthcare Medicaid	$5,516.96

OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$15,631.17

Service Code	APR-DRG 3644
Min. Negotiated Rate	$15,631.17
Max. Negotiated Rate	$15,631.17
Rate for Payer: AlohaCare Medicaid	$15,631.17
Rate for Payer: Hawaii Medical Service Association ABD	$15,631.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,631.17
Rate for Payer: Kaiser Permanente Medicaid	$15,631.17
Rate for Payer: Ohana Health Plan Medicaid	$15,631.17
Rate for Payer: UnitedHealthcare Medicaid	$15,631.17

OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$8,621.80

Service Code	APR-DRG 3643
Min. Negotiated Rate	$8,621.80
Max. Negotiated Rate	$8,621.80
Rate for Payer: AlohaCare Medicaid	$8,621.80
Rate for Payer: Hawaii Medical Service Association ABD	$8,621.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,621.80
Rate for Payer: Kaiser Permanente Medicaid	$8,621.80
Rate for Payer: Ohana Health Plan Medicaid	$8,621.80
Rate for Payer: UnitedHealthcare Medicaid	$8,621.80

OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$20,541.51

Service Code	APR-DRG 2234
Min. Negotiated Rate	$20,541.51
Max. Negotiated Rate	$20,541.51
Rate for Payer: AlohaCare Medicaid	$20,541.51
Rate for Payer: Hawaii Medical Service Association ABD	$20,541.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,541.51
Rate for Payer: Kaiser Permanente Medicaid	$20,541.51
Rate for Payer: Ohana Health Plan Medicaid	$20,541.51
Rate for Payer: UnitedHealthcare Medicaid	$20,541.51

OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$12,236.06

Service Code	APR-DRG 2233
Min. Negotiated Rate	$12,236.06
Max. Negotiated Rate	$12,236.06
Rate for Payer: AlohaCare Medicaid	$12,236.06
Rate for Payer: Hawaii Medical Service Association ABD	$12,236.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,236.06
Rate for Payer: Kaiser Permanente Medicaid	$12,236.06
Rate for Payer: Ohana Health Plan Medicaid	$12,236.06
Rate for Payer: UnitedHealthcare Medicaid	$12,236.06

OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$5,694.38

Service Code	APR-DRG 2231
Min. Negotiated Rate	$5,694.38
Max. Negotiated Rate	$5,694.38
Rate for Payer: AlohaCare Medicaid	$5,694.38
Rate for Payer: Hawaii Medical Service Association ABD	$5,694.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,694.38
Rate for Payer: Kaiser Permanente Medicaid	$5,694.38
Rate for Payer: Ohana Health Plan Medicaid	$5,694.38
Rate for Payer: UnitedHealthcare Medicaid	$5,694.38

OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$8,104.54

Service Code	APR-DRG 2232
Min. Negotiated Rate	$8,104.54
Max. Negotiated Rate	$8,104.54
Rate for Payer: AlohaCare Medicaid	$8,104.54
Rate for Payer: Hawaii Medical Service Association ABD	$8,104.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,104.54
Rate for Payer: Kaiser Permanente Medicaid	$8,104.54
Rate for Payer: Ohana Health Plan Medicaid	$8,104.54
Rate for Payer: UnitedHealthcare Medicaid	$8,104.54

OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$18,339.42

Service Code	APR-DRG 2224
Min. Negotiated Rate	$18,339.42
Max. Negotiated Rate	$18,339.42
Rate for Payer: AlohaCare Medicaid	$18,339.42
Rate for Payer: Hawaii Medical Service Association ABD	$18,339.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,339.42
Rate for Payer: Kaiser Permanente Medicaid	$18,339.42
Rate for Payer: Ohana Health Plan Medicaid	$18,339.42
Rate for Payer: UnitedHealthcare Medicaid	$18,339.42

OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$6,034.87

Service Code	APR-DRG 2222
Min. Negotiated Rate	$6,034.87
Max. Negotiated Rate	$6,034.87
Rate for Payer: AlohaCare Medicaid	$6,034.87
Rate for Payer: Hawaii Medical Service Association ABD	$6,034.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,034.87
Rate for Payer: Kaiser Permanente Medicaid	$6,034.87
Rate for Payer: Ohana Health Plan Medicaid	$6,034.87
Rate for Payer: UnitedHealthcare Medicaid	$6,034.87

OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$3,866.05

Service Code	APR-DRG 2221
Min. Negotiated Rate	$3,866.05
Max. Negotiated Rate	$3,866.05
Rate for Payer: AlohaCare Medicaid	$3,866.05
Rate for Payer: Hawaii Medical Service Association ABD	$3,866.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,866.05
Rate for Payer: Kaiser Permanente Medicaid	$3,866.05
Rate for Payer: Ohana Health Plan Medicaid	$3,866.05
Rate for Payer: UnitedHealthcare Medicaid	$3,866.05

OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$9,376.48

Service Code	APR-DRG 2223
Min. Negotiated Rate	$9,376.48
Max. Negotiated Rate	$9,376.48
Rate for Payer: AlohaCare Medicaid	$9,376.48
Rate for Payer: Hawaii Medical Service Association ABD	$9,376.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,376.48
Rate for Payer: Kaiser Permanente Medicaid	$9,376.48
Rate for Payer: Ohana Health Plan Medicaid	$9,376.48
Rate for Payer: UnitedHealthcare Medicaid	$9,376.48

OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$9,146.23

Service Code	APR-DRG 2534
Min. Negotiated Rate	$9,146.23
Max. Negotiated Rate	$9,146.23
Rate for Payer: AlohaCare Medicaid	$9,146.23
Rate for Payer: Hawaii Medical Service Association ABD	$9,146.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,146.23
Rate for Payer: Kaiser Permanente Medicaid	$9,146.23
Rate for Payer: Ohana Health Plan Medicaid	$9,146.23
Rate for Payer: UnitedHealthcare Medicaid	$9,146.23

OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$3,807.34

Service Code	APR-DRG 2532
Min. Negotiated Rate	$3,807.34
Max. Negotiated Rate	$3,807.34
Rate for Payer: AlohaCare Medicaid	$3,807.34
Rate for Payer: Hawaii Medical Service Association ABD	$3,807.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,807.34
Rate for Payer: Kaiser Permanente Medicaid	$3,807.34
Rate for Payer: Ohana Health Plan Medicaid	$3,807.34
Rate for Payer: UnitedHealthcare Medicaid	$3,807.34

OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$2,995.26

Service Code	APR-DRG 2531
Min. Negotiated Rate	$2,995.26
Max. Negotiated Rate	$2,995.26
Rate for Payer: AlohaCare Medicaid	$2,995.26
Rate for Payer: Hawaii Medical Service Association ABD	$2,995.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,995.26
Rate for Payer: Kaiser Permanente Medicaid	$2,995.26
Rate for Payer: Ohana Health Plan Medicaid	$2,995.26
Rate for Payer: UnitedHealthcare Medicaid	$2,995.26

OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$5,479.13

Service Code	APR-DRG 2533
Min. Negotiated Rate	$5,479.13
Max. Negotiated Rate	$5,479.13
Rate for Payer: AlohaCare Medicaid	$5,479.13
Rate for Payer: Hawaii Medical Service Association ABD	$5,479.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,479.13
Rate for Payer: Kaiser Permanente Medicaid	$5,479.13
Rate for Payer: Ohana Health Plan Medicaid	$5,479.13
Rate for Payer: UnitedHealthcare Medicaid	$5,479.13

Know your out-of-pocket cost for care.

All Charges