Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

RESONATE PACER HF CRT-D

Facility

$38,668.00

Service Code	HCPCS C1882
Hospital Revenue Code	275
Min. Negotiated Rate	$21,654.08
Max. Negotiated Rate	$37,507.96
Rate for Payer: Cash Price	$23,200.80
Rate for Payer: Hawaii Western Management Group Commercial	$27,067.60
Rate for Payer: Health Management Network Commercial	$32,867.80
Rate for Payer: MDX Hawaii PPO	$37,507.96
Rate for Payer: University Health Alliance Commercial	$21,654.08

RESPIRATORY FAILURE

Facility

$2,223.61

Service Code	APR-DRG 1331
Min. Negotiated Rate	$2,223.61
Max. Negotiated Rate	$2,223.61
Rate for Payer: AlohaCare Medicaid	$2,223.61
Rate for Payer: Hawaii Medical Service Association ABD	$2,223.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,223.61
Rate for Payer: Kaiser Permanente Medicaid	$2,223.61
Rate for Payer: Ohana Health Plan Medicaid	$2,223.61
Rate for Payer: UnitedHealthcare Medicaid	$2,223.61

RESPIRATORY FAILURE

Facility

$9,167.10

Service Code	APR-DRG 1334
Min. Negotiated Rate	$9,167.10
Max. Negotiated Rate	$9,167.10
Rate for Payer: AlohaCare Medicaid	$9,167.10
Rate for Payer: Hawaii Medical Service Association ABD	$9,167.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,167.10
Rate for Payer: Kaiser Permanente Medicaid	$9,167.10
Rate for Payer: Ohana Health Plan Medicaid	$9,167.10
Rate for Payer: UnitedHealthcare Medicaid	$9,167.10

RESPIRATORY FAILURE

Facility

$4,068.90

Service Code	APR-DRG 1332
Min. Negotiated Rate	$4,068.90
Max. Negotiated Rate	$4,068.90
Rate for Payer: AlohaCare Medicaid	$4,068.90
Rate for Payer: Hawaii Medical Service Association ABD	$4,068.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,068.90
Rate for Payer: Kaiser Permanente Medicaid	$4,068.90
Rate for Payer: Ohana Health Plan Medicaid	$4,068.90
Rate for Payer: UnitedHealthcare Medicaid	$4,068.90

RESPIRATORY FAILURE

Facility

$5,918.11

Service Code	APR-DRG 1333
Min. Negotiated Rate	$5,918.11
Max. Negotiated Rate	$5,918.11
Rate for Payer: AlohaCare Medicaid	$5,918.11
Rate for Payer: Hawaii Medical Service Association ABD	$5,918.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,918.11
Rate for Payer: Kaiser Permanente Medicaid	$5,918.11
Rate for Payer: Ohana Health Plan Medicaid	$5,918.11
Rate for Payer: UnitedHealthcare Medicaid	$5,918.11

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$43,144.95

Service Code	MSDRG 178
Min. Negotiated Rate	$11,101.27
Max. Negotiated Rate	$43,144.95
Rate for Payer: AlohaCare Medicare	$11,101.27
Rate for Payer: Devoted Health Medicare	$12,211.40
Rate for Payer: Hawaii Medical Service Association Commercial	$43,144.95
Rate for Payer: Hawaii Medical Service Association Medicare	$11,101.27
Rate for Payer: Humana Medicare	$11,101.27
Rate for Payer: Kaiser Permanente Commercial	$16,836.00
Rate for Payer: Kaiser Permanente Medicare	$11,101.27
Rate for Payer: Ohana Health Plan Medicare	$11,101.27
Rate for Payer: UnitedHealthcare Medicare	$11,101.27

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$43,144.95

Service Code	MSDRG 177
Min. Negotiated Rate	$17,774.56
Max. Negotiated Rate	$43,144.95
Rate for Payer: AlohaCare Medicare	$17,774.56
Rate for Payer: Devoted Health Medicare	$19,552.02
Rate for Payer: Hawaii Medical Service Association Commercial	$43,144.95
Rate for Payer: Hawaii Medical Service Association Medicare	$17,774.56
Rate for Payer: Humana Medicare	$17,774.56
Rate for Payer: Kaiser Permanente Commercial	$26,956.58
Rate for Payer: Kaiser Permanente Medicare	$17,774.56
Rate for Payer: Ohana Health Plan Medicare	$17,774.56
Rate for Payer: UnitedHealthcare Medicare	$17,774.56

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$34,069.46

Service Code	MSDRG 179
Min. Negotiated Rate	$8,587.56
Max. Negotiated Rate	$34,069.46
Rate for Payer: AlohaCare Medicare	$8,587.56
Rate for Payer: Devoted Health Medicare	$9,446.32
Rate for Payer: Hawaii Medical Service Association Commercial	$34,069.46
Rate for Payer: Hawaii Medical Service Association Medicare	$8,587.56
Rate for Payer: Humana Medicare	$8,587.56
Rate for Payer: Kaiser Permanente Commercial	$13,023.75
Rate for Payer: Kaiser Permanente Medicare	$8,587.56
Rate for Payer: Ohana Health Plan Medicare	$8,587.56
Rate for Payer: UnitedHealthcare Medicare	$8,587.56

RESPIRATORY MALIGNANCY

Facility

$4,112.61

Service Code	APR-DRG 1361
Min. Negotiated Rate	$4,112.61
Max. Negotiated Rate	$4,112.61
Rate for Payer: AlohaCare Medicaid	$4,112.61
Rate for Payer: Hawaii Medical Service Association ABD	$4,112.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,112.61
Rate for Payer: Kaiser Permanente Medicaid	$4,112.61
Rate for Payer: Ohana Health Plan Medicaid	$4,112.61
Rate for Payer: UnitedHealthcare Medicaid	$4,112.61

RESPIRATORY MALIGNANCY

Facility

$4,549.63

Service Code	APR-DRG 1362
Min. Negotiated Rate	$4,549.63
Max. Negotiated Rate	$4,549.63
Rate for Payer: AlohaCare Medicaid	$4,549.63
Rate for Payer: Hawaii Medical Service Association ABD	$4,549.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,549.63
Rate for Payer: Kaiser Permanente Medicaid	$4,549.63
Rate for Payer: Ohana Health Plan Medicaid	$4,549.63
Rate for Payer: UnitedHealthcare Medicaid	$4,549.63

RESPIRATORY MALIGNANCY

Facility

$6,260.55

Service Code	APR-DRG 1363
Min. Negotiated Rate	$6,260.55
Max. Negotiated Rate	$6,260.55
Rate for Payer: AlohaCare Medicaid	$6,260.55
Rate for Payer: Hawaii Medical Service Association ABD	$6,260.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,260.55
Rate for Payer: Kaiser Permanente Medicaid	$6,260.55
Rate for Payer: Ohana Health Plan Medicaid	$6,260.55
Rate for Payer: UnitedHealthcare Medicaid	$6,260.55

RESPIRATORY MALIGNANCY

Facility

$8,877.49

Service Code	APR-DRG 1364
Min. Negotiated Rate	$8,877.49
Max. Negotiated Rate	$8,877.49
Rate for Payer: AlohaCare Medicaid	$8,877.49
Rate for Payer: Hawaii Medical Service Association ABD	$8,877.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,877.49
Rate for Payer: Kaiser Permanente Medicaid	$8,877.49
Rate for Payer: Ohana Health Plan Medicaid	$8,877.49
Rate for Payer: UnitedHealthcare Medicaid	$8,877.49

RESPIRATORY NEOPLASMS WITH CC

Facility

$36,787.26

Service Code	MSDRG 181
Min. Negotiated Rate	$12,181.83
Max. Negotiated Rate	$36,787.26
Rate for Payer: AlohaCare Medicare	$12,181.83
Rate for Payer: Devoted Health Medicare	$13,400.01
Rate for Payer: Hawaii Medical Service Association Commercial	$36,787.26
Rate for Payer: Hawaii Medical Service Association Medicare	$12,181.83
Rate for Payer: Humana Medicare	$12,181.83
Rate for Payer: Kaiser Permanente Commercial	$18,474.75
Rate for Payer: Kaiser Permanente Medicare	$12,181.83
Rate for Payer: Ohana Health Plan Medicare	$12,181.83
Rate for Payer: UnitedHealthcare Medicare	$12,181.83

RESPIRATORY NEOPLASMS WITH MCC

Facility

$36,787.26

Service Code	MSDRG 180
Min. Negotiated Rate	$20,086.93
Max. Negotiated Rate	$36,787.26
Rate for Payer: AlohaCare Medicare	$20,086.93
Rate for Payer: Devoted Health Medicare	$22,095.62
Rate for Payer: Hawaii Medical Service Association Commercial	$36,787.26
Rate for Payer: Hawaii Medical Service Association Medicare	$20,086.93
Rate for Payer: Humana Medicare	$20,086.93
Rate for Payer: Kaiser Permanente Commercial	$30,463.50
Rate for Payer: Kaiser Permanente Medicare	$20,086.93
Rate for Payer: Ohana Health Plan Medicare	$20,086.93
Rate for Payer: UnitedHealthcare Medicare	$20,086.93

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$36,787.26

Service Code	MSDRG 182
Min. Negotiated Rate	$8,573.92
Max. Negotiated Rate	$36,787.26
Rate for Payer: AlohaCare Medicare	$8,573.92
Rate for Payer: Devoted Health Medicare	$9,431.31
Rate for Payer: Hawaii Medical Service Association Commercial	$36,787.26
Rate for Payer: Hawaii Medical Service Association Medicare	$8,573.92
Rate for Payer: Humana Medicare	$8,573.92
Rate for Payer: Kaiser Permanente Commercial	$12,834.00
Rate for Payer: Kaiser Permanente Medicare	$8,573.92
Rate for Payer: Ohana Health Plan Medicare	$8,573.92
Rate for Payer: UnitedHealthcare Medicare	$8,573.92

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$13,927.65

Service Code	MSDRG 204
Min. Negotiated Rate	$9,183.57
Max. Negotiated Rate	$13,927.65
Rate for Payer: AlohaCare Medicare	$9,183.57
Rate for Payer: Devoted Health Medicare	$10,101.93
Rate for Payer: Hawaii Medical Service Association Commercial	$13,807.35
Rate for Payer: Hawaii Medical Service Association Medicare	$9,183.57
Rate for Payer: Humana Medicare	$9,183.57
Rate for Payer: Kaiser Permanente Commercial	$13,927.65
Rate for Payer: Kaiser Permanente Medicare	$9,183.57
Rate for Payer: Ohana Health Plan Medicare	$9,183.57
Rate for Payer: UnitedHealthcare Medicare	$9,183.57

RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$2,574.54

Service Code	APR-DRG 1441
Min. Negotiated Rate	$2,574.54
Max. Negotiated Rate	$2,574.54
Rate for Payer: AlohaCare Medicaid	$2,574.54
Rate for Payer: Hawaii Medical Service Association ABD	$2,574.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,574.54
Rate for Payer: Kaiser Permanente Medicaid	$2,574.54
Rate for Payer: Ohana Health Plan Medicaid	$2,574.54
Rate for Payer: UnitedHealthcare Medicaid	$2,574.54

RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$3,374.23

Service Code	APR-DRG 1442
Min. Negotiated Rate	$3,374.23
Max. Negotiated Rate	$3,374.23
Rate for Payer: AlohaCare Medicaid	$3,374.23
Rate for Payer: Hawaii Medical Service Association ABD	$3,374.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,374.23
Rate for Payer: Kaiser Permanente Medicaid	$3,374.23
Rate for Payer: Ohana Health Plan Medicaid	$3,374.23
Rate for Payer: UnitedHealthcare Medicaid	$3,374.23

RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$4,694.44

Service Code	APR-DRG 1443
Min. Negotiated Rate	$4,694.44
Max. Negotiated Rate	$4,694.44
Rate for Payer: AlohaCare Medicaid	$4,694.44
Rate for Payer: Hawaii Medical Service Association ABD	$4,694.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,694.44
Rate for Payer: Kaiser Permanente Medicaid	$4,694.44
Rate for Payer: Ohana Health Plan Medicaid	$4,694.44
Rate for Payer: UnitedHealthcare Medicaid	$4,694.44

RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$7,530.54

Service Code	APR-DRG 1444
Min. Negotiated Rate	$7,530.54
Max. Negotiated Rate	$7,530.54
Rate for Payer: AlohaCare Medicaid	$7,530.54
Rate for Payer: Hawaii Medical Service Association ABD	$7,530.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,530.54
Rate for Payer: Kaiser Permanente Medicaid	$7,530.54
Rate for Payer: Ohana Health Plan Medicaid	$7,530.54
Rate for Payer: UnitedHealthcare Medicaid	$7,530.54

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$71,875.89

Service Code	MSDRG 208
Min. Negotiated Rate	$31,264.40
Max. Negotiated Rate	$71,875.89
Rate for Payer: AlohaCare Medicare	$31,264.40
Rate for Payer: Devoted Health Medicare	$34,390.84
Rate for Payer: Hawaii Medical Service Association Commercial	$71,875.89
Rate for Payer: Hawaii Medical Service Association Medicare	$31,264.40
Rate for Payer: Humana Medicare	$31,264.40
Rate for Payer: Kaiser Permanente Commercial	$47,415.07
Rate for Payer: Kaiser Permanente Medicare	$31,264.40
Rate for Payer: Ohana Health Plan Medicare	$31,264.40
Rate for Payer: UnitedHealthcare Medicare	$31,264.40

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$189,638.79

Service Code	MSDRG 207
Min. Negotiated Rate	$73,189.92
Max. Negotiated Rate	$189,638.79
Rate for Payer: AlohaCare Medicare	$73,189.92
Rate for Payer: Devoted Health Medicare	$80,508.91
Rate for Payer: Hawaii Medical Service Association Commercial	$189,638.79
Rate for Payer: Hawaii Medical Service Association Medicare	$73,189.92
Rate for Payer: Humana Medicare	$73,189.92
Rate for Payer: Kaiser Permanente Commercial	$110,998.57
Rate for Payer: Kaiser Permanente Medicare	$73,189.92
Rate for Payer: Ohana Health Plan Medicare	$73,189.92
Rate for Payer: UnitedHealthcare Medicare	$73,189.92

RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$17,751.07

Service Code	APR-DRG 1302
Min. Negotiated Rate	$17,751.07
Max. Negotiated Rate	$17,751.07
Rate for Payer: AlohaCare Medicaid	$17,751.07
Rate for Payer: Hawaii Medical Service Association ABD	$17,751.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,751.07
Rate for Payer: Kaiser Permanente Medicaid	$17,751.07
Rate for Payer: Ohana Health Plan Medicaid	$17,751.07
Rate for Payer: UnitedHealthcare Medicaid	$17,751.07

RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$17,454.28

Service Code	APR-DRG 1301
Min. Negotiated Rate	$17,454.28
Max. Negotiated Rate	$17,454.28
Rate for Payer: AlohaCare Medicaid	$17,454.28
Rate for Payer: Hawaii Medical Service Association ABD	$17,454.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,454.28
Rate for Payer: Kaiser Permanente Medicaid	$17,454.28
Rate for Payer: Ohana Health Plan Medicaid	$17,454.28
Rate for Payer: UnitedHealthcare Medicaid	$17,454.28

RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$26,898.60

Service Code	APR-DRG 1304
Min. Negotiated Rate	$26,898.60
Max. Negotiated Rate	$26,898.60
Rate for Payer: AlohaCare Medicaid	$26,898.60
Rate for Payer: Hawaii Medical Service Association ABD	$26,898.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,898.60
Rate for Payer: Kaiser Permanente Medicaid	$26,898.60
Rate for Payer: Ohana Health Plan Medicaid	$26,898.60
Rate for Payer: UnitedHealthcare Medicaid	$26,898.60

Know your out-of-pocket cost for care.

All Charges