Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DRILL BIT 2.0 03.133.101

Facility

$792.00

Hospital Revenue Code	272
Min. Negotiated Rate	$403.92
Max. Negotiated Rate	$768.24
Rate for Payer: Cash Price	$475.20
Rate for Payer: Hawaii Western Management Group Commercial	$752.40
Rate for Payer: Health Management Network Commercial	$673.20
Rate for Payer: Kaiser Permanente Commercial	$498.96
Rate for Payer: Kaiser Permanente Medicaid	$403.92
Rate for Payer: MDX Hawaii PPO	$768.24
Rate for Payer: University Health Alliance Commercial	$577.29

DRILL BIT 2.0 03.133.101

Facility

$792.00

Hospital Revenue Code	272
Min. Negotiated Rate	$673.20
Max. Negotiated Rate	$768.24
Rate for Payer: Cash Price	$475.20
Rate for Payer: Health Management Network Commercial	$673.20
Rate for Payer: MDX Hawaii PPO	$768.24

DRILL BIT 200X3.2MM 11.003

Facility

$473.00

Hospital Revenue Code	272
Min. Negotiated Rate	$402.05
Max. Negotiated Rate	$458.81
Rate for Payer: Cash Price	$283.80
Rate for Payer: Health Management Network Commercial	$402.05
Rate for Payer: MDX Hawaii PPO	$458.81

DRILL BIT 200X3.2MM 11.003

Facility

$473.00

Hospital Revenue Code	272
Min. Negotiated Rate	$241.23
Max. Negotiated Rate	$458.81
Rate for Payer: Cash Price	$283.80
Rate for Payer: Hawaii Western Management Group Commercial	$449.35
Rate for Payer: Health Management Network Commercial	$402.05
Rate for Payer: Kaiser Permanente Commercial	$297.99
Rate for Payer: Kaiser Permanente Medicaid	$241.23
Rate for Payer: MDX Hawaii PPO	$458.81
Rate for Payer: University Health Alliance Commercial	$344.77

DRILL BIT 200X3.2MM 11003A

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$290.70
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$205.20
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: MDX Hawaii PPO	$331.74

DRILL BIT 200X3.2MM 11003A

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$174.42
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$205.20
Rate for Payer: Hawaii Western Management Group Commercial	$324.90
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Kaiser Permanente Commercial	$215.46
Rate for Payer: Kaiser Permanente Medicaid	$174.42
Rate for Payer: MDX Hawaii PPO	$331.74
Rate for Payer: University Health Alliance Commercial	$249.28

DRILL BIT 200X3.2MM 1-1100301

Facility

$382.00

Hospital Revenue Code	272
Min. Negotiated Rate	$194.82
Max. Negotiated Rate	$370.54
Rate for Payer: Cash Price	$229.20
Rate for Payer: Hawaii Western Management Group Commercial	$362.90
Rate for Payer: Health Management Network Commercial	$324.70
Rate for Payer: Kaiser Permanente Commercial	$240.66
Rate for Payer: Kaiser Permanente Medicaid	$194.82
Rate for Payer: MDX Hawaii PPO	$370.54
Rate for Payer: University Health Alliance Commercial	$278.44

DRILL BIT 200X3.2MM 1-1100301

Facility

$382.00

Hospital Revenue Code	272
Min. Negotiated Rate	$324.70
Max. Negotiated Rate	$370.54
Rate for Payer: Cash Price	$229.20
Rate for Payer: Health Management Network Commercial	$324.70
Rate for Payer: MDX Hawaii PPO	$370.54

DRILL BIT 2.0 705134

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 BIT 2.0 705134

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 BIT 2.0 DB20

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Hawaii Western Management Group Commercial	$427.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$283.50
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: University Health Alliance Commercial	$328.00

DRILL BIT 2.0 DB20

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: MDX Hawaii PPO	$436.50

DRILL BIT 2.0MM 125MM 700346

Facility

$591.00

Hospital Revenue Code	272
Min. Negotiated Rate	$502.35
Max. Negotiated Rate	$573.27
Rate for Payer: Cash Price	$354.60
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: MDX Hawaii PPO	$573.27

DRILL BIT 2.0MM 125MM 700346

Facility

$591.00

Hospital Revenue Code	272
Min. Negotiated Rate	$301.41
Max. Negotiated Rate	$573.27
Rate for Payer: Cash Price	$354.60
Rate for Payer: Hawaii Western Management Group Commercial	$561.45
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Kaiser Permanente Commercial	$372.33
Rate for Payer: Kaiser Permanente Medicaid	$301.41
Rate for Payer: MDX Hawaii PPO	$573.27
Rate for Payer: University Health Alliance Commercial	$430.78

DRILL BIT 2.0MM 13551

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: MDX Hawaii PPO	$474.33

DRILL BIT 2.0MM 13551

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.39
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.55
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Kaiser Permanente Commercial	$308.07
Rate for Payer: Kaiser Permanente Medicaid	$249.39
Rate for Payer: MDX Hawaii PPO	$474.33
Rate for Payer: University Health Alliance Commercial	$356.43

DRILL BIT 2.0MM 13551A

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$174.42
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$205.20
Rate for Payer: Hawaii Western Management Group Commercial	$324.90
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Kaiser Permanente Commercial	$215.46
Rate for Payer: Kaiser Permanente Medicaid	$174.42
Rate for Payer: MDX Hawaii PPO	$331.74
Rate for Payer: University Health Alliance Commercial	$249.28

DRILL BIT 2.0MM 13551A

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$290.70
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$205.20
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: MDX Hawaii PPO	$331.74

DRILL BIT 2.0MM/2.4MM 310.972

Facility

$506.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$430.10
Max. Negotiated Rate	$490.82
Rate for Payer: Cash Price	$303.60
Rate for Payer: Health Management Network Commercial	$430.10
Rate for Payer: MDX Hawaii PPO	$490.82

DRILL BIT 2.0MM/2.4MM 310.972

Facility

$506.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$258.06
Max. Negotiated Rate	$490.82
Rate for Payer: Cash Price	$303.60
Rate for Payer: Hawaii Western Management Group Commercial	$480.70
Rate for Payer: Health Management Network Commercial	$430.10
Rate for Payer: Kaiser Permanente Commercial	$318.78
Rate for Payer: Kaiser Permanente Medicaid	$258.06
Rate for Payer: MDX Hawaii PPO	$490.82
Rate for Payer: University Health Alliance Commercial	$368.82

DRILL BIT 2.0MM CAL AR-8943-16

Facility

$399.00

Hospital Revenue Code	272
Min. Negotiated Rate	$339.15
Max. Negotiated Rate	$387.03
Rate for Payer: Cash Price	$239.40
Rate for Payer: Health Management Network Commercial	$339.15
Rate for Payer: MDX Hawaii PPO	$387.03

DRILL BIT 2.0MM CAL AR-8943-16

Facility

$399.00

Hospital Revenue Code	272
Min. Negotiated Rate	$203.49
Max. Negotiated Rate	$387.03
Rate for Payer: Cash Price	$239.40
Rate for Payer: Hawaii Western Management Group Commercial	$379.05
Rate for Payer: Health Management Network Commercial	$339.15
Rate for Payer: Kaiser Permanente Commercial	$251.37
Rate for Payer: Kaiser Permanente Medicaid	$203.49
Rate for Payer: MDX Hawaii PPO	$387.03
Rate for Payer: University Health Alliance Commercial	$290.83

DRILL BIT 2.0MM DIAMOND

Facility

$494.00

Hospital Revenue Code	272
Min. Negotiated Rate	$419.90
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$296.40
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: MDX Hawaii PPO	$479.18

DRILL BIT 2.0MM DIAMOND

Facility

$494.00

Hospital Revenue Code	272
Min. Negotiated Rate	$251.94
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$296.40
Rate for Payer: Hawaii Western Management Group Commercial	$469.30
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Kaiser Permanente Commercial	$311.22
Rate for Payer: Kaiser Permanente Medicaid	$251.94
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: University Health Alliance Commercial	$360.08

DRILL BIT 2.0MM FDB20

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$363.63
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$677.35
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Kaiser Permanente Commercial	$449.19
Rate for Payer: Kaiser Permanente Medicaid	$363.63
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: University Health Alliance Commercial	$519.71

Know your out-of-pocket cost for care.

All Charges