Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$56,110.80

Service Code	MSDRG 260
Min. Negotiated Rate	$31,909.79
Max. Negotiated Rate	$56,110.80
Rate for Payer: AlohaCare Medicare	$36,998.18
Rate for Payer: Devoted Health Medicare	$40,698.00
Rate for Payer: Hawaii Medical Service Association Commercial	$31,909.79
Rate for Payer: Hawaii Medical Service Association Medicare	$36,998.18
Rate for Payer: Humana Medicare	$36,998.18
Rate for Payer: Kaiser Permanente Commercial	$56,110.80
Rate for Payer: Kaiser Permanente Medicare	$36,998.18
Rate for Payer: Ohana Health Plan Medicare	$36,998.18
Rate for Payer: UnitedHealthcare Medicare	$36,998.18

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$31,909.79

Service Code	MSDRG 262
Min. Negotiated Rate	$18,538.91
Max. Negotiated Rate	$31,909.79
Rate for Payer: AlohaCare Medicare	$18,538.91
Rate for Payer: Devoted Health Medicare	$20,392.80
Rate for Payer: Hawaii Medical Service Association Commercial	$31,909.79
Rate for Payer: Hawaii Medical Service Association Medicare	$18,538.91
Rate for Payer: Humana Medicare	$18,538.91
Rate for Payer: Kaiser Permanente Commercial	$28,115.78
Rate for Payer: Kaiser Permanente Medicare	$18,538.91
Rate for Payer: Ohana Health Plan Medicare	$18,538.91
Rate for Payer: UnitedHealthcare Medicare	$18,538.91

CARDIAC STRUCTURAL & VALVULAR DISORDERS

Facility

$3,273.13

Service Code	APR-DRG 2002
Min. Negotiated Rate	$3,273.13
Max. Negotiated Rate	$3,273.13
Rate for Payer: AlohaCare Medicaid	$3,273.13
Rate for Payer: Hawaii Medical Service Association ABD	$3,273.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,273.13
Rate for Payer: Kaiser Permanente Medicaid	$3,273.13
Rate for Payer: Ohana Health Plan Medicaid	$3,273.13
Rate for Payer: UnitedHealthcare Medicaid	$3,273.13

CARDIAC STRUCTURAL & VALVULAR DISORDERS

Facility

$4,679.44

Service Code	APR-DRG 2003
Min. Negotiated Rate	$4,679.44
Max. Negotiated Rate	$4,679.44
Rate for Payer: AlohaCare Medicaid	$4,679.44
Rate for Payer: Hawaii Medical Service Association ABD	$4,679.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,679.44
Rate for Payer: Kaiser Permanente Medicaid	$4,679.44
Rate for Payer: Ohana Health Plan Medicaid	$4,679.44
Rate for Payer: UnitedHealthcare Medicaid	$4,679.44

CARDIAC STRUCTURAL & VALVULAR DISORDERS

Facility

$7,823.41

Service Code	APR-DRG 2004
Min. Negotiated Rate	$7,823.41
Max. Negotiated Rate	$7,823.41
Rate for Payer: AlohaCare Medicaid	$7,823.41
Rate for Payer: Hawaii Medical Service Association ABD	$7,823.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,823.41
Rate for Payer: Kaiser Permanente Medicaid	$7,823.41
Rate for Payer: Ohana Health Plan Medicaid	$7,823.41
Rate for Payer: UnitedHealthcare Medicaid	$7,823.41

CARDIAC STRUCTURAL & VALVULAR DISORDERS

Facility

$2,573.89

Service Code	APR-DRG 2001
Min. Negotiated Rate	$2,573.89
Max. Negotiated Rate	$2,573.89
Rate for Payer: AlohaCare Medicaid	$2,573.89
Rate for Payer: Hawaii Medical Service Association ABD	$2,573.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,573.89
Rate for Payer: Kaiser Permanente Medicaid	$2,573.89
Rate for Payer: Ohana Health Plan Medicaid	$2,573.89
Rate for Payer: UnitedHealthcare Medicaid	$2,573.89

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$197,962.03

Service Code	MSDRG 217
Min. Negotiated Rate	$74,789.14
Max. Negotiated Rate	$197,962.03
Rate for Payer: AlohaCare Medicare	$74,789.14
Rate for Payer: Devoted Health Medicare	$82,268.05
Rate for Payer: Hawaii Medical Service Association Commercial	$197,962.03
Rate for Payer: Hawaii Medical Service Association Medicare	$74,789.14
Rate for Payer: Humana Medicare	$74,789.14
Rate for Payer: Kaiser Permanente Commercial	$113,423.93
Rate for Payer: Kaiser Permanente Medicare	$74,789.14
Rate for Payer: Ohana Health Plan Medicare	$74,789.14
Rate for Payer: UnitedHealthcare Medicare	$74,789.14

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$197,962.03

Service Code	MSDRG 216
Min. Negotiated Rate	$111,272.07
Max. Negotiated Rate	$197,962.03
Rate for Payer: AlohaCare Medicare	$111,272.07
Rate for Payer: Devoted Health Medicare	$122,399.28
Rate for Payer: Hawaii Medical Service Association Commercial	$197,962.03
Rate for Payer: Hawaii Medical Service Association Medicare	$111,272.07
Rate for Payer: Humana Medicare	$111,272.07
Rate for Payer: Kaiser Permanente Commercial	$168,753.30
Rate for Payer: Kaiser Permanente Medicare	$111,272.07
Rate for Payer: Ohana Health Plan Medicare	$111,272.07
Rate for Payer: UnitedHealthcare Medicare	$111,272.07

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$197,962.03

Service Code	MSDRG 218
Min. Negotiated Rate	$74,789.14
Max. Negotiated Rate	$197,962.03
Rate for Payer: AlohaCare Medicare	$74,789.14
Rate for Payer: Devoted Health Medicare	$82,268.05
Rate for Payer: Hawaii Medical Service Association Commercial	$197,962.03
Rate for Payer: Hawaii Medical Service Association Medicare	$74,789.14
Rate for Payer: Humana Medicare	$74,789.14
Rate for Payer: Kaiser Permanente Commercial	$113,423.93
Rate for Payer: Kaiser Permanente Medicare	$74,789.14
Rate for Payer: Ohana Health Plan Medicare	$74,789.14
Rate for Payer: UnitedHealthcare Medicare	$74,789.14

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$128,755.40

Service Code	MSDRG 220
Min. Negotiated Rate	$60,656.63
Max. Negotiated Rate	$128,755.40
Rate for Payer: AlohaCare Medicare	$60,656.63
Rate for Payer: Devoted Health Medicare	$66,722.29
Rate for Payer: Hawaii Medical Service Association Commercial	$128,755.40
Rate for Payer: Hawaii Medical Service Association Medicare	$60,656.63
Rate for Payer: Humana Medicare	$60,656.63
Rate for Payer: Kaiser Permanente Commercial	$91,990.80
Rate for Payer: Kaiser Permanente Medicare	$60,656.63
Rate for Payer: Ohana Health Plan Medicare	$60,656.63
Rate for Payer: UnitedHealthcare Medicare	$60,656.63

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$132,450.67

Service Code	MSDRG 219
Min. Negotiated Rate	$87,334.94
Max. Negotiated Rate	$132,450.67
Rate for Payer: AlohaCare Medicare	$87,334.94
Rate for Payer: Devoted Health Medicare	$96,068.43
Rate for Payer: Hawaii Medical Service Association Commercial	$128,755.40
Rate for Payer: Hawaii Medical Service Association Medicare	$87,334.94
Rate for Payer: Humana Medicare	$87,334.94
Rate for Payer: Kaiser Permanente Commercial	$132,450.67
Rate for Payer: Kaiser Permanente Medicare	$87,334.94
Rate for Payer: Ohana Health Plan Medicare	$87,334.94
Rate for Payer: UnitedHealthcare Medicare	$87,334.94

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$128,755.40

Service Code	MSDRG 221
Min. Negotiated Rate	$57,328.52
Max. Negotiated Rate	$128,755.40
Rate for Payer: AlohaCare Medicare	$57,328.52
Rate for Payer: Devoted Health Medicare	$63,061.37
Rate for Payer: Hawaii Medical Service Association Commercial	$128,755.40
Rate for Payer: Hawaii Medical Service Association Medicare	$57,328.52
Rate for Payer: Humana Medicare	$57,328.52
Rate for Payer: Kaiser Permanente Commercial	$86,943.45
Rate for Payer: Kaiser Permanente Medicare	$57,328.52
Rate for Payer: Ohana Health Plan Medicare	$57,328.52
Rate for Payer: UnitedHealthcare Medicare	$57,328.52

CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

Facility

$24,183.82

Service Code	APR-DRG 1621
Min. Negotiated Rate	$24,183.82
Max. Negotiated Rate	$24,183.82
Rate for Payer: AlohaCare Medicaid	$24,183.82
Rate for Payer: Hawaii Medical Service Association ABD	$24,183.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24,183.82
Rate for Payer: Kaiser Permanente Medicaid	$24,183.82
Rate for Payer: Ohana Health Plan Medicaid	$24,183.82
Rate for Payer: UnitedHealthcare Medicaid	$24,183.82

CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

Facility

$27,220.82

Service Code	APR-DRG 1622
Min. Negotiated Rate	$27,220.82
Max. Negotiated Rate	$27,220.82
Rate for Payer: AlohaCare Medicaid	$27,220.82
Rate for Payer: Hawaii Medical Service Association ABD	$27,220.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27,220.82
Rate for Payer: Kaiser Permanente Medicaid	$27,220.82
Rate for Payer: Ohana Health Plan Medicaid	$27,220.82
Rate for Payer: UnitedHealthcare Medicaid	$27,220.82

CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

Facility

$34,889.64

Service Code	APR-DRG 1623
Min. Negotiated Rate	$34,889.64
Max. Negotiated Rate	$34,889.64
Rate for Payer: AlohaCare Medicaid	$34,889.64
Rate for Payer: Hawaii Medical Service Association ABD	$34,889.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$34,889.64
Rate for Payer: Kaiser Permanente Medicaid	$34,889.64
Rate for Payer: Ohana Health Plan Medicaid	$34,889.64
Rate for Payer: UnitedHealthcare Medicaid	$34,889.64

CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

Facility

$49,490.87

Service Code	APR-DRG 1624
Min. Negotiated Rate	$49,490.87
Max. Negotiated Rate	$49,490.87
Rate for Payer: AlohaCare Medicaid	$49,490.87
Rate for Payer: Hawaii Medical Service Association ABD	$49,490.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$49,490.87
Rate for Payer: Kaiser Permanente Medicaid	$49,490.87
Rate for Payer: Ohana Health Plan Medicaid	$49,490.87
Rate for Payer: UnitedHealthcare Medicaid	$49,490.87

CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

Facility

$28,170.54

Service Code	APR-DRG 1633
Min. Negotiated Rate	$28,170.54
Max. Negotiated Rate	$28,170.54
Rate for Payer: AlohaCare Medicaid	$28,170.54
Rate for Payer: Hawaii Medical Service Association ABD	$28,170.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28,170.54
Rate for Payer: Kaiser Permanente Medicaid	$28,170.54
Rate for Payer: Ohana Health Plan Medicaid	$28,170.54
Rate for Payer: UnitedHealthcare Medicaid	$28,170.54

CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

Facility

$41,955.11

Service Code	APR-DRG 1634
Min. Negotiated Rate	$41,955.11
Max. Negotiated Rate	$41,955.11
Rate for Payer: AlohaCare Medicaid	$41,955.11
Rate for Payer: Hawaii Medical Service Association ABD	$41,955.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41,955.11
Rate for Payer: Kaiser Permanente Medicaid	$41,955.11
Rate for Payer: Ohana Health Plan Medicaid	$41,955.11
Rate for Payer: UnitedHealthcare Medicaid	$41,955.11

CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

Facility

$20,469.10

Service Code	APR-DRG 1631
Min. Negotiated Rate	$20,469.10
Max. Negotiated Rate	$20,469.10
Rate for Payer: AlohaCare Medicaid	$20,469.10
Rate for Payer: Hawaii Medical Service Association ABD	$20,469.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,469.10
Rate for Payer: Kaiser Permanente Medicaid	$20,469.10
Rate for Payer: Ohana Health Plan Medicaid	$20,469.10
Rate for Payer: UnitedHealthcare Medicaid	$20,469.10

CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

Facility

$22,716.20

Service Code	APR-DRG 1632
Min. Negotiated Rate	$22,716.20
Max. Negotiated Rate	$22,716.20
Rate for Payer: AlohaCare Medicaid	$22,716.20
Rate for Payer: Hawaii Medical Service Association ABD	$22,716.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,716.20
Rate for Payer: Kaiser Permanente Medicaid	$22,716.20
Rate for Payer: Ohana Health Plan Medicaid	$22,716.20
Rate for Payer: UnitedHealthcare Medicaid	$22,716.20

CARDIOMYOPATHY

Facility

$3,363.79

Service Code	APR-DRG 2052
Min. Negotiated Rate	$3,363.79
Max. Negotiated Rate	$3,363.79
Rate for Payer: AlohaCare Medicaid	$3,363.79
Rate for Payer: Hawaii Medical Service Association ABD	$3,363.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,363.79
Rate for Payer: Kaiser Permanente Medicaid	$3,363.79
Rate for Payer: Ohana Health Plan Medicaid	$3,363.79
Rate for Payer: UnitedHealthcare Medicaid	$3,363.79

CARDIOMYOPATHY

Facility

$10,583.19

Service Code	APR-DRG 2054
Min. Negotiated Rate	$10,583.19
Max. Negotiated Rate	$10,583.19
Rate for Payer: AlohaCare Medicaid	$10,583.19
Rate for Payer: Hawaii Medical Service Association ABD	$10,583.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,583.19
Rate for Payer: Kaiser Permanente Medicaid	$10,583.19
Rate for Payer: Ohana Health Plan Medicaid	$10,583.19
Rate for Payer: UnitedHealthcare Medicaid	$10,583.19

CARDIOMYOPATHY

Facility

$5,004.92

Service Code	APR-DRG 2053
Min. Negotiated Rate	$5,004.92
Max. Negotiated Rate	$5,004.92
Rate for Payer: AlohaCare Medicaid	$5,004.92
Rate for Payer: Hawaii Medical Service Association ABD	$5,004.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,004.92
Rate for Payer: Kaiser Permanente Medicaid	$5,004.92
Rate for Payer: Ohana Health Plan Medicaid	$5,004.92
Rate for Payer: UnitedHealthcare Medicaid	$5,004.92

CARDIOMYOPATHY

Facility

$2,787.18

Service Code	APR-DRG 2051
Min. Negotiated Rate	$2,787.18
Max. Negotiated Rate	$2,787.18
Rate for Payer: AlohaCare Medicaid	$2,787.18
Rate for Payer: Hawaii Medical Service Association ABD	$2,787.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,787.18
Rate for Payer: Kaiser Permanente Medicaid	$2,787.18
Rate for Payer: Ohana Health Plan Medicaid	$2,787.18
Rate for Payer: UnitedHealthcare Medicaid	$2,787.18

CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [162615]

Facility

$1,062.00

Service Code	HCPCS J9047
Hospital Revenue Code	250
Min. Negotiated Rate	$902.70
Max. Negotiated Rate	$1,030.14
Rate for Payer: Cash Price	$637.20
Rate for Payer: Health Management Network Commercial	$902.70
Rate for Payer: MDX Hawaii PPO	$1,030.14

Know your out-of-pocket cost for care.

All Charges