Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$15,554.51

Service Code	MSDRG 310
Min. Negotiated Rate	$6,438.97
Max. Negotiated Rate	$15,554.51
Rate for Payer: AlohaCare Medicare	$6,438.97
Rate for Payer: Devoted Health Medicare	$7,082.87
Rate for Payer: Hawaii Medical Service Association Commercial	$15,554.51
Rate for Payer: Hawaii Medical Service Association Medicare	$6,438.97
Rate for Payer: Humana Medicare	$6,438.97
Rate for Payer: Kaiser Permanente Commercial	$9,765.23
Rate for Payer: Kaiser Permanente Medicare	$6,438.97
Rate for Payer: Ohana Health Plan Medicare	$6,438.97
Rate for Payer: UnitedHealthcare Medicare	$6,438.97

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS

Facility

$2,381.46

Service Code	APR-DRG 2011
Min. Negotiated Rate	$2,381.46
Max. Negotiated Rate	$2,381.46
Rate for Payer: AlohaCare Medicaid	$2,381.46
Rate for Payer: Hawaii Medical Service Association ABD	$2,381.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,381.46
Rate for Payer: Kaiser Permanente Medicaid	$2,381.46
Rate for Payer: Ohana Health Plan Medicaid	$2,381.46
Rate for Payer: UnitedHealthcare Medicaid	$2,381.46

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS

Facility

$4,517.67

Service Code	APR-DRG 2013
Min. Negotiated Rate	$4,517.67
Max. Negotiated Rate	$4,517.67
Rate for Payer: AlohaCare Medicaid	$4,517.67
Rate for Payer: Hawaii Medical Service Association ABD	$4,517.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,517.67
Rate for Payer: Kaiser Permanente Medicaid	$4,517.67
Rate for Payer: Ohana Health Plan Medicaid	$4,517.67
Rate for Payer: UnitedHealthcare Medicaid	$4,517.67

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS

Facility

$3,093.10

Service Code	APR-DRG 2012
Min. Negotiated Rate	$3,093.10
Max. Negotiated Rate	$3,093.10
Rate for Payer: AlohaCare Medicaid	$3,093.10
Rate for Payer: Hawaii Medical Service Association ABD	$3,093.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,093.10
Rate for Payer: Kaiser Permanente Medicaid	$3,093.10
Rate for Payer: Ohana Health Plan Medicaid	$3,093.10
Rate for Payer: UnitedHealthcare Medicaid	$3,093.10

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS

Facility

$7,574.24

Service Code	APR-DRG 2014
Min. Negotiated Rate	$7,574.24
Max. Negotiated Rate	$7,574.24
Rate for Payer: AlohaCare Medicaid	$7,574.24
Rate for Payer: Hawaii Medical Service Association ABD	$7,574.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,574.24
Rate for Payer: Kaiser Permanente Medicaid	$7,574.24
Rate for Payer: Ohana Health Plan Medicaid	$7,574.24
Rate for Payer: UnitedHealthcare Medicaid	$7,574.24

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$7,203.75

Service Code	APR-DRG 1913
Min. Negotiated Rate	$7,203.75
Max. Negotiated Rate	$7,203.75
Rate for Payer: AlohaCare Medicaid	$7,203.75
Rate for Payer: Hawaii Medical Service Association ABD	$7,203.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,203.75
Rate for Payer: Kaiser Permanente Medicaid	$7,203.75
Rate for Payer: Ohana Health Plan Medicaid	$7,203.75
Rate for Payer: UnitedHealthcare Medicaid	$7,203.75

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$4,863.38

Service Code	APR-DRG 1911
Min. Negotiated Rate	$4,863.38
Max. Negotiated Rate	$4,863.38
Rate for Payer: AlohaCare Medicaid	$4,863.38
Rate for Payer: Hawaii Medical Service Association ABD	$4,863.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,863.38
Rate for Payer: Kaiser Permanente Medicaid	$4,863.38
Rate for Payer: Ohana Health Plan Medicaid	$4,863.38
Rate for Payer: UnitedHealthcare Medicaid	$4,863.38

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$5,588.06

Service Code	APR-DRG 1912
Min. Negotiated Rate	$5,588.06
Max. Negotiated Rate	$5,588.06
Rate for Payer: AlohaCare Medicaid	$5,588.06
Rate for Payer: Hawaii Medical Service Association ABD	$5,588.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,588.06
Rate for Payer: Kaiser Permanente Medicaid	$5,588.06
Rate for Payer: Ohana Health Plan Medicaid	$5,588.06
Rate for Payer: UnitedHealthcare Medicaid	$5,588.06

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$10,640.59

Service Code	APR-DRG 1914
Min. Negotiated Rate	$10,640.59
Max. Negotiated Rate	$10,640.59
Rate for Payer: AlohaCare Medicaid	$10,640.59
Rate for Payer: Hawaii Medical Service Association ABD	$10,640.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,640.59
Rate for Payer: Kaiser Permanente Medicaid	$10,640.59
Rate for Payer: Ohana Health Plan Medicaid	$10,640.59
Rate for Payer: UnitedHealthcare Medicaid	$10,640.59

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$5,264.53

Service Code	APR-DRG 1921
Min. Negotiated Rate	$5,264.53
Max. Negotiated Rate	$5,264.53
Rate for Payer: AlohaCare Medicaid	$5,264.53
Rate for Payer: Hawaii Medical Service Association ABD	$5,264.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,264.53
Rate for Payer: Kaiser Permanente Medicaid	$5,264.53
Rate for Payer: Ohana Health Plan Medicaid	$5,264.53
Rate for Payer: UnitedHealthcare Medicaid	$5,264.53

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$14,027.22

Service Code	APR-DRG 1924
Min. Negotiated Rate	$14,027.22
Max. Negotiated Rate	$14,027.22
Rate for Payer: AlohaCare Medicaid	$14,027.22
Rate for Payer: Hawaii Medical Service Association ABD	$14,027.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,027.22
Rate for Payer: Kaiser Permanente Medicaid	$14,027.22
Rate for Payer: Ohana Health Plan Medicaid	$14,027.22
Rate for Payer: UnitedHealthcare Medicaid	$14,027.22

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$9,032.73

Service Code	APR-DRG 1923
Min. Negotiated Rate	$9,032.73
Max. Negotiated Rate	$9,032.73
Rate for Payer: AlohaCare Medicaid	$9,032.73
Rate for Payer: Hawaii Medical Service Association ABD	$9,032.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,032.73
Rate for Payer: Kaiser Permanente Medicaid	$9,032.73
Rate for Payer: Ohana Health Plan Medicaid	$9,032.73
Rate for Payer: UnitedHealthcare Medicaid	$9,032.73

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$6,407.32

Service Code	APR-DRG 1922
Min. Negotiated Rate	$6,407.32
Max. Negotiated Rate	$6,407.32
Rate for Payer: AlohaCare Medicaid	$6,407.32
Rate for Payer: Hawaii Medical Service Association ABD	$6,407.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,407.32
Rate for Payer: Kaiser Permanente Medicaid	$6,407.32
Rate for Payer: Ohana Health Plan Medicaid	$6,407.32
Rate for Payer: UnitedHealthcare Medicaid	$6,407.32

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$27,182.55

Service Code	MSDRG 306
Min. Negotiated Rate	$14,292.67
Max. Negotiated Rate	$27,182.55
Rate for Payer: AlohaCare Medicare	$17,923.55
Rate for Payer: Devoted Health Medicare	$19,715.90
Rate for Payer: Hawaii Medical Service Association Commercial	$14,292.67
Rate for Payer: Hawaii Medical Service Association Medicare	$17,923.55
Rate for Payer: Humana Medicare	$17,923.55
Rate for Payer: Kaiser Permanente Commercial	$27,182.55
Rate for Payer: Kaiser Permanente Medicare	$17,923.55
Rate for Payer: Ohana Health Plan Medicare	$17,923.55
Rate for Payer: UnitedHealthcare Medicare	$17,923.55

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$15,752.70

Service Code	MSDRG 307
Min. Negotiated Rate	$10,386.97
Max. Negotiated Rate	$15,752.70
Rate for Payer: AlohaCare Medicare	$10,386.97
Rate for Payer: Devoted Health Medicare	$11,425.67
Rate for Payer: Hawaii Medical Service Association Commercial	$13,200.70
Rate for Payer: Hawaii Medical Service Association Medicare	$10,386.97
Rate for Payer: Humana Medicare	$10,386.97
Rate for Payer: Kaiser Permanente Commercial	$15,752.70
Rate for Payer: Kaiser Permanente Medicare	$10,386.97
Rate for Payer: Ohana Health Plan Medicare	$10,386.97
Rate for Payer: UnitedHealthcare Medicare	$10,386.97

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$163,844.03

Service Code	MSDRG 275
Min. Negotiated Rate	$81,103.00
Max. Negotiated Rate	$163,844.03
Rate for Payer: AlohaCare Medicare	$81,103.00
Rate for Payer: Devoted Health Medicare	$89,213.30
Rate for Payer: Hawaii Medical Service Association Commercial	$163,844.03
Rate for Payer: Hawaii Medical Service Association Medicare	$81,103.00
Rate for Payer: Humana Medicare	$81,103.00
Rate for Payer: Kaiser Permanente Commercial	$122,999.40
Rate for Payer: Kaiser Permanente Medicare	$81,103.00
Rate for Payer: Ohana Health Plan Medicare	$81,103.00
Rate for Payer: UnitedHealthcare Medicare	$81,103.00

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$105,460.04

Service Code	MSDRG 276
Min. Negotiated Rate	$68,320.59
Max. Negotiated Rate	$105,460.04
Rate for Payer: AlohaCare Medicare	$68,320.59
Rate for Payer: Devoted Health Medicare	$75,152.65
Rate for Payer: Hawaii Medical Service Association Commercial	$105,460.04
Rate for Payer: Hawaii Medical Service Association Medicare	$68,320.59
Rate for Payer: Humana Medicare	$68,320.59
Rate for Payer: Kaiser Permanente Commercial	$103,613.85
Rate for Payer: Kaiser Permanente Medicare	$68,320.59
Rate for Payer: Ohana Health Plan Medicare	$68,320.59
Rate for Payer: UnitedHealthcare Medicare	$68,320.59

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$105,460.04

Service Code	MSDRG 277
Min. Negotiated Rate	$52,532.00
Max. Negotiated Rate	$105,460.04
Rate for Payer: AlohaCare Medicare	$52,532.00
Rate for Payer: Devoted Health Medicare	$57,785.20
Rate for Payer: Hawaii Medical Service Association Commercial	$105,460.04
Rate for Payer: Hawaii Medical Service Association Medicare	$52,532.00
Rate for Payer: Humana Medicare	$52,532.00
Rate for Payer: Kaiser Permanente Commercial	$79,669.12
Rate for Payer: Kaiser Permanente Medicare	$52,532.00
Rate for Payer: Ohana Health Plan Medicare	$52,532.00
Rate for Payer: UnitedHealthcare Medicare	$52,532.00

CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$6,225.98

Service Code	APR-DRG 1771
Min. Negotiated Rate	$6,225.98
Max. Negotiated Rate	$6,225.98
Rate for Payer: AlohaCare Medicaid	$6,225.98
Rate for Payer: Hawaii Medical Service Association ABD	$6,225.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,225.98
Rate for Payer: Kaiser Permanente Medicaid	$6,225.98
Rate for Payer: Ohana Health Plan Medicaid	$6,225.98
Rate for Payer: UnitedHealthcare Medicaid	$6,225.98

CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$14,955.41

Service Code	APR-DRG 1774
Min. Negotiated Rate	$14,955.41
Max. Negotiated Rate	$14,955.41
Rate for Payer: AlohaCare Medicaid	$14,955.41
Rate for Payer: Hawaii Medical Service Association ABD	$14,955.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,955.41
Rate for Payer: Kaiser Permanente Medicaid	$14,955.41
Rate for Payer: Ohana Health Plan Medicaid	$14,955.41
Rate for Payer: UnitedHealthcare Medicaid	$14,955.41

CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$8,982.51

Service Code	APR-DRG 1772
Min. Negotiated Rate	$8,982.51
Max. Negotiated Rate	$8,982.51
Rate for Payer: AlohaCare Medicaid	$8,982.51
Rate for Payer: Hawaii Medical Service Association ABD	$8,982.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,982.51
Rate for Payer: Kaiser Permanente Medicaid	$8,982.51
Rate for Payer: Ohana Health Plan Medicaid	$8,982.51
Rate for Payer: UnitedHealthcare Medicaid	$8,982.51

CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$11,011.09

Service Code	APR-DRG 1773
Min. Negotiated Rate	$11,011.09
Max. Negotiated Rate	$11,011.09
Rate for Payer: AlohaCare Medicaid	$11,011.09
Rate for Payer: Hawaii Medical Service Association ABD	$11,011.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,011.09
Rate for Payer: Kaiser Permanente Medicaid	$11,011.09
Rate for Payer: Ohana Health Plan Medicaid	$11,011.09
Rate for Payer: UnitedHealthcare Medicaid	$11,011.09

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$54,201.22

Service Code	MSDRG 258
Min. Negotiated Rate	$23,635.08
Max. Negotiated Rate	$54,201.22
Rate for Payer: AlohaCare Medicare	$35,739.05
Rate for Payer: Devoted Health Medicare	$39,312.96
Rate for Payer: Hawaii Medical Service Association Commercial	$23,635.08
Rate for Payer: Hawaii Medical Service Association Medicare	$35,739.05
Rate for Payer: Humana Medicare	$35,739.05
Rate for Payer: Kaiser Permanente Commercial	$54,201.22
Rate for Payer: Kaiser Permanente Medicare	$35,739.05
Rate for Payer: Ohana Health Plan Medicare	$35,739.05
Rate for Payer: UnitedHealthcare Medicare	$35,739.05

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$34,881.22

Service Code	MSDRG 259
Min. Negotiated Rate	$22,999.88
Max. Negotiated Rate	$34,881.22
Rate for Payer: AlohaCare Medicare	$22,999.88
Rate for Payer: Devoted Health Medicare	$25,299.87
Rate for Payer: Hawaii Medical Service Association Commercial	$23,635.08
Rate for Payer: Hawaii Medical Service Association Medicare	$22,999.88
Rate for Payer: Humana Medicare	$22,999.88
Rate for Payer: Kaiser Permanente Commercial	$34,881.22
Rate for Payer: Kaiser Permanente Medicare	$22,999.88
Rate for Payer: Ohana Health Plan Medicare	$22,999.88
Rate for Payer: UnitedHealthcare Medicare	$22,999.88

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$32,611.12

Service Code	MSDRG 261
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	$31,909.79
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

Know your out-of-pocket cost for care.

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