Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DRILL 1.6/090

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: University Health Alliance Commercial	$459.21

DRILL 1.6/090

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: MDX Hawaii PPO	$611.10

DRILL-1.6/095C

Facility

$825.00

Hospital Revenue Code	272
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: MDX Hawaii PPO	$800.25

DRILL-1.6/095C

Facility

$825.00

Hospital Revenue Code	272
Min. Negotiated Rate	$420.75
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Hawaii Western Management Group Commercial	$783.75
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Kaiser Permanente Commercial	$519.75
Rate for Payer: Kaiser Permanente Medicaid	$420.75
Rate for Payer: MDX Hawaii PPO	$800.25
Rate for Payer: University Health Alliance Commercial	$601.34

DRILL 1.7MM CANN QR 316-0013

Facility

$879.00

Hospital Revenue Code	272
Min. Negotiated Rate	$747.15
Max. Negotiated Rate	$852.63
Rate for Payer: Cash Price	$527.40
Rate for Payer: Health Management Network Commercial	$747.15
Rate for Payer: MDX Hawaii PPO	$852.63

DRILL 1.7MM CANN QR 316-0013

Facility

$879.00

Hospital Revenue Code	272
Min. Negotiated Rate	$448.29
Max. Negotiated Rate	$852.63
Rate for Payer: Cash Price	$527.40
Rate for Payer: Hawaii Western Management Group Commercial	$835.05
Rate for Payer: Health Management Network Commercial	$747.15
Rate for Payer: Kaiser Permanente Commercial	$553.77
Rate for Payer: Kaiser Permanente Medicaid	$448.29
Rate for Payer: MDX Hawaii PPO	$852.63
Rate for Payer: University Health Alliance Commercial	$640.70

DRILL 1.7MM LONG CANN 316-0014

Facility

$879.00

Hospital Revenue Code	272
Min. Negotiated Rate	$448.29
Max. Negotiated Rate	$852.63
Rate for Payer: Cash Price	$527.40
Rate for Payer: Hawaii Western Management Group Commercial	$835.05
Rate for Payer: Health Management Network Commercial	$747.15
Rate for Payer: Kaiser Permanente Commercial	$553.77
Rate for Payer: Kaiser Permanente Medicaid	$448.29
Rate for Payer: MDX Hawaii PPO	$852.63
Rate for Payer: University Health Alliance Commercial	$640.70

DRILL 1.7MM LONG CANN 316-0014

Facility

$879.00

Hospital Revenue Code	272
Min. Negotiated Rate	$747.15
Max. Negotiated Rate	$852.63
Rate for Payer: Cash Price	$527.40
Rate for Payer: Health Management Network Commercial	$747.15
Rate for Payer: MDX Hawaii PPO	$852.63

DRILL 1.7MM MANUAL 316-0105

Facility

$879.00

Hospital Revenue Code	272
Min. Negotiated Rate	$448.29
Max. Negotiated Rate	$852.63
Rate for Payer: Cash Price	$527.40
Rate for Payer: Hawaii Western Management Group Commercial	$835.05
Rate for Payer: Health Management Network Commercial	$747.15
Rate for Payer: Kaiser Permanente Commercial	$553.77
Rate for Payer: Kaiser Permanente Medicaid	$448.29
Rate for Payer: MDX Hawaii PPO	$852.63
Rate for Payer: University Health Alliance Commercial	$640.70

DRILL 1.7MM MANUAL 316-0105

Facility

$879.00

Hospital Revenue Code	272
Min. Negotiated Rate	$747.15
Max. Negotiated Rate	$852.63
Rate for Payer: Cash Price	$527.40
Rate for Payer: Health Management Network Commercial	$747.15
Rate for Payer: MDX Hawaii PPO	$852.63

DRILL 1.8MM #DRILL-1.8/090

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: MDX Hawaii PPO	$611.10

DRILL 1.8MM #DRILL-1.8/090

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: University Health Alliance Commercial	$459.21

DRILL-2.0/095

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: University Health Alliance Commercial	$459.21

DRILL-2.0/095

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: MDX Hawaii PPO	$611.10

DRILL 2.0 703896

Facility

$648.00

Hospital Revenue Code	272
Min. Negotiated Rate	$550.80
Max. Negotiated Rate	$628.56
Rate for Payer: Cash Price	$388.80
Rate for Payer: Health Management Network Commercial	$550.80
Rate for Payer: MDX Hawaii PPO	$628.56

DRILL 2.0 703896

Facility

$648.00

Hospital Revenue Code	272
Min. Negotiated Rate	$330.48
Max. Negotiated Rate	$628.56
Rate for Payer: Cash Price	$388.80
Rate for Payer: Hawaii Western Management Group Commercial	$615.60
Rate for Payer: Health Management Network Commercial	$550.80
Rate for Payer: Kaiser Permanente Commercial	$408.24
Rate for Payer: Kaiser Permanente Medicaid	$330.48
Rate for Payer: MDX Hawaii PPO	$628.56
Rate for Payer: University Health Alliance Commercial	$472.33

DRILL 2.0MM SHORT PILOT DRILL

Facility

$1,005.00

Hospital Revenue Code	272
Min. Negotiated Rate	$512.55
Max. Negotiated Rate	$974.85
Rate for Payer: Cash Price	$603.00
Rate for Payer: Hawaii Western Management Group Commercial	$954.75
Rate for Payer: Health Management Network Commercial	$854.25
Rate for Payer: Kaiser Permanente Commercial	$633.15
Rate for Payer: Kaiser Permanente Medicaid	$512.55
Rate for Payer: MDX Hawaii PPO	$974.85
Rate for Payer: University Health Alliance Commercial	$732.54

DRILL 2.0MM SHORT PILOT DRILL

Facility

$1,005.00

Hospital Revenue Code	272
Min. Negotiated Rate	$854.25
Max. Negotiated Rate	$974.85
Rate for Payer: Cash Price	$603.00
Rate for Payer: Health Management Network Commercial	$854.25
Rate for Payer: MDX Hawaii PPO	$974.85

DRILL 2.1 100MM CANN SMTH

Facility

$825.00

Hospital Revenue Code	272
Min. Negotiated Rate	$420.75
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Hawaii Western Management Group Commercial	$783.75
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Kaiser Permanente Commercial	$519.75
Rate for Payer: Kaiser Permanente Medicaid	$420.75
Rate for Payer: MDX Hawaii PPO	$800.25
Rate for Payer: University Health Alliance Commercial	$601.34

DRILL 2.1 100MM CANN SMTH

Facility

$825.00

Hospital Revenue Code	272
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: MDX Hawaii PPO	$800.25

DRILL 2.1X110MM DRILL-2.1/110C

Facility

$825.00

Hospital Revenue Code	272
Min. Negotiated Rate	$420.75
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Hawaii Western Management Group Commercial	$783.75
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Kaiser Permanente Commercial	$519.75
Rate for Payer: Kaiser Permanente Medicaid	$420.75
Rate for Payer: MDX Hawaii PPO	$800.25
Rate for Payer: University Health Alliance Commercial	$601.34

DRILL 2.1X110MM DRILL-2.1/110C

Facility

$825.00

Hospital Revenue Code	272
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: MDX Hawaii PPO	$800.25

DRILL 2351-4213S

Facility

$823.00

Hospital Revenue Code	272
Min. Negotiated Rate	$699.55
Max. Negotiated Rate	$798.31
Rate for Payer: Cash Price	$493.80
Rate for Payer: Health Management Network Commercial	$699.55
Rate for Payer: MDX Hawaii PPO	$798.31

DRILL 2351-4213S

Facility

$823.00

Hospital Revenue Code	272
Min. Negotiated Rate	$419.73
Max. Negotiated Rate	$798.31
Rate for Payer: Cash Price	$493.80
Rate for Payer: Hawaii Western Management Group Commercial	$781.85
Rate for Payer: Health Management Network Commercial	$699.55
Rate for Payer: Kaiser Permanente Commercial	$518.49
Rate for Payer: Kaiser Permanente Medicaid	$419.73
Rate for Payer: MDX Hawaii PPO	$798.31
Rate for Payer: University Health Alliance Commercial	$599.88

DRILL 2.3 CANN MANUAL 316-0005

Facility

$879.00

Hospital Revenue Code	272
Min. Negotiated Rate	$448.29
Max. Negotiated Rate	$852.63
Rate for Payer: Cash Price	$527.40
Rate for Payer: Hawaii Western Management Group Commercial	$835.05
Rate for Payer: Health Management Network Commercial	$747.15
Rate for Payer: Kaiser Permanente Commercial	$553.77
Rate for Payer: Kaiser Permanente Medicaid	$448.29
Rate for Payer: MDX Hawaii PPO	$852.63
Rate for Payer: University Health Alliance Commercial	$640.70

Know your out-of-pocket cost for care.

All Charges