Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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

DRILL 2.3MM, DRILL-2.3/080

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 2.3MM, DRILL-2.3/080

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 2.4/120C

Facility

$619.00

Hospital Revenue Code	272
Min. Negotiated Rate	$315.69
Max. Negotiated Rate	$600.43
Rate for Payer: Cash Price	$371.40
Rate for Payer: Hawaii Western Management Group Commercial	$588.05
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Kaiser Permanente Commercial	$389.97
Rate for Payer: Kaiser Permanente Medicaid	$315.69
Rate for Payer: MDX Hawaii PPO	$600.43
Rate for Payer: University Health Alliance Commercial	$451.19

DRILL 2.4/120C

Facility

$619.00

Hospital Revenue Code	272
Min. Negotiated Rate	$526.15
Max. Negotiated Rate	$600.43
Rate for Payer: Cash Price	$371.40
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: MDX Hawaii PPO	$600.43

DRILL 2.4MM PROXIMAL 316-0322

Facility

$683.00

Hospital Revenue Code	272
Min. Negotiated Rate	$580.55
Max. Negotiated Rate	$662.51
Rate for Payer: Cash Price	$409.80
Rate for Payer: Health Management Network Commercial	$580.55
Rate for Payer: MDX Hawaii PPO	$662.51

DRILL 2.4MM PROXIMAL 316-0322

Facility

$683.00

Hospital Revenue Code	272
Min. Negotiated Rate	$348.33
Max. Negotiated Rate	$662.51
Rate for Payer: Cash Price	$409.80
Rate for Payer: Hawaii Western Management Group Commercial	$648.85
Rate for Payer: Health Management Network Commercial	$580.55
Rate for Payer: Kaiser Permanente Commercial	$430.29
Rate for Payer: Kaiser Permanente Medicaid	$348.33
Rate for Payer: MDX Hawaii PPO	$662.51
Rate for Payer: University Health Alliance Commercial	$497.84

DRILL 2.4 QC STERILE

Facility

$242.00

Hospital Revenue Code	272
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$234.74
Rate for Payer: Cash Price	$145.20
Rate for Payer: Health Management Network Commercial	$205.70
Rate for Payer: MDX Hawaii PPO	$234.74

DRILL 2.4 QC STERILE

Facility

$242.00

Hospital Revenue Code	272
Min. Negotiated Rate	$123.42
Max. Negotiated Rate	$234.74
Rate for Payer: Cash Price	$145.20
Rate for Payer: Hawaii Western Management Group Commercial	$229.90
Rate for Payer: Health Management Network Commercial	$205.70
Rate for Payer: Kaiser Permanente Commercial	$152.46
Rate for Payer: Kaiser Permanente Medicaid	$123.42
Rate for Payer: MDX Hawaii PPO	$234.74
Rate for Payer: University Health Alliance Commercial	$176.39

DRILL 2.5 703586

Facility

$856.00

Hospital Revenue Code	272
Min. Negotiated Rate	$436.56
Max. Negotiated Rate	$830.32
Rate for Payer: Cash Price	$513.60
Rate for Payer: Hawaii Western Management Group Commercial	$813.20
Rate for Payer: Health Management Network Commercial	$727.60
Rate for Payer: Kaiser Permanente Commercial	$539.28
Rate for Payer: Kaiser Permanente Medicaid	$436.56
Rate for Payer: MDX Hawaii PPO	$830.32
Rate for Payer: University Health Alliance Commercial	$623.94

DRILL 2.5 703586

Facility

$856.00

Hospital Revenue Code	272
Min. Negotiated Rate	$727.60
Max. Negotiated Rate	$830.32
Rate for Payer: Cash Price	$513.60
Rate for Payer: Health Management Network Commercial	$727.60
Rate for Payer: MDX Hawaii PPO	$830.32

DRILL 2.5MM GLENOID AR-9145K

Facility

$675.00

Hospital Revenue Code	272
Min. Negotiated Rate	$344.25
Max. Negotiated Rate	$654.75
Rate for Payer: Cash Price	$405.00
Rate for Payer: Hawaii Western Management Group Commercial	$641.25
Rate for Payer: Health Management Network Commercial	$573.75
Rate for Payer: Kaiser Permanente Commercial	$425.25
Rate for Payer: Kaiser Permanente Medicaid	$344.25
Rate for Payer: MDX Hawaii PPO	$654.75
Rate for Payer: University Health Alliance Commercial	$492.01

DRILL 2.5MM GLENOID AR-9145K

Facility

$675.00

Hospital Revenue Code	272
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$654.75
Rate for Payer: Cash Price	$405.00
Rate for Payer: Health Management Network Commercial	$573.75
Rate for Payer: MDX Hawaii PPO	$654.75

DRILL 2.6 703691

Facility

$924.00

Hospital Revenue Code	272
Min. Negotiated Rate	$471.24
Max. Negotiated Rate	$896.28
Rate for Payer: Cash Price	$554.40
Rate for Payer: Hawaii Western Management Group Commercial	$877.80
Rate for Payer: Health Management Network Commercial	$785.40
Rate for Payer: Kaiser Permanente Commercial	$582.12
Rate for Payer: Kaiser Permanente Medicaid	$471.24
Rate for Payer: MDX Hawaii PPO	$896.28
Rate for Payer: University Health Alliance Commercial	$673.50

DRILL 2.6 703691

Facility

$924.00

Hospital Revenue Code	272
Min. Negotiated Rate	$785.40
Max. Negotiated Rate	$896.28
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Management Network Commercial	$785.40
Rate for Payer: MDX Hawaii PPO	$896.28

DRILL 2.7 #00-2360-205-27

Facility

$863.00

Hospital Revenue Code	272
Min. Negotiated Rate	$440.13
Max. Negotiated Rate	$837.11
Rate for Payer: Cash Price	$517.80
Rate for Payer: Hawaii Western Management Group Commercial	$819.85
Rate for Payer: Health Management Network Commercial	$733.55
Rate for Payer: Kaiser Permanente Commercial	$543.69
Rate for Payer: Kaiser Permanente Medicaid	$440.13
Rate for Payer: MDX Hawaii PPO	$837.11
Rate for Payer: University Health Alliance Commercial	$629.04

DRILL 2.7 #00-2360-205-27

Facility

$863.00

Hospital Revenue Code	272
Min. Negotiated Rate	$733.55
Max. Negotiated Rate	$837.11
Rate for Payer: Cash Price	$517.80
Rate for Payer: Health Management Network Commercial	$733.55
Rate for Payer: MDX Hawaii PPO	$837.11

DRILL-2.7/110C S

Facility

$619.00

Hospital Revenue Code	272
Min. Negotiated Rate	$315.69
Max. Negotiated Rate	$600.43
Rate for Payer: Cash Price	$371.40
Rate for Payer: Hawaii Western Management Group Commercial	$588.05
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Kaiser Permanente Commercial	$389.97
Rate for Payer: Kaiser Permanente Medicaid	$315.69
Rate for Payer: MDX Hawaii PPO	$600.43
Rate for Payer: University Health Alliance Commercial	$451.19

DRILL-2.7/110C S

Facility

$619.00

Hospital Revenue Code	272
Min. Negotiated Rate	$526.15
Max. Negotiated Rate	$600.43
Rate for Payer: Cash Price	$371.40
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: MDX Hawaii PPO	$600.43

DRILL 2.75MM, .066 CANNULATION

Facility

$1,752.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,489.20
Max. Negotiated Rate	$1,699.44
Rate for Payer: Cash Price	$1,051.20
Rate for Payer: Health Management Network Commercial	$1,489.20
Rate for Payer: MDX Hawaii PPO	$1,699.44

DRILL 2.75MM, .066 CANNULATION

Facility

$1,752.00

Hospital Revenue Code	272
Min. Negotiated Rate	$893.52
Max. Negotiated Rate	$1,699.44
Rate for Payer: Cash Price	$1,051.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,664.40
Rate for Payer: Health Management Network Commercial	$1,489.20
Rate for Payer: Kaiser Permanente Commercial	$1,103.76
Rate for Payer: Kaiser Permanente Medicaid	$893.52
Rate for Payer: MDX Hawaii PPO	$1,699.44
Rate for Payer: University Health Alliance Commercial	$1,277.03

DRILL 2.7MM CANN QR 316-0427

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 2.7MM CANN QR 316-0427

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 2.7MM DISTAL LCK AR-2669

Facility

$394.00

Hospital Revenue Code	272
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: MDX Hawaii PPO	$382.18

DRILL 2.7MM DISTAL LCK AR-2669

Facility

$394.00

Hospital Revenue Code	272
Min. Negotiated Rate	$200.94
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Hawaii Western Management Group Commercial	$374.30
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$248.22
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: University Health Alliance Commercial	$287.19

Know your out-of-pocket cost for care.

All Charges