Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DRILL BIT 2.5MMX215MM

Facility

$1,225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$1,188.25
Rate for Payer: Cash Price	$735.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,163.75
Rate for Payer: Health Management Network Commercial	$1,041.25
Rate for Payer: Kaiser Permanente Commercial	$771.75
Rate for Payer: Kaiser Permanente Medicaid	$624.75
Rate for Payer: MDX Hawaii PPO	$1,188.25
Rate for Payer: University Health Alliance Commercial	$892.90

DRILL BIT 2.5MMX215MM

Facility

$1,225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,041.25
Max. Negotiated Rate	$1,188.25
Rate for Payer: Cash Price	$735.00
Rate for Payer: Health Management Network Commercial	$1,041.25
Rate for Payer: MDX Hawaii PPO	$1,188.25

DRILL BIT 2.6MM AR-8943-02

Facility

$689.00

Hospital Revenue Code	272
Min. Negotiated Rate	$351.39
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$413.40
Rate for Payer: Hawaii Western Management Group Commercial	$654.55
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$434.07
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: University Health Alliance Commercial	$502.21

DRILL BIT 2.6MM AR-8943-02

Facility

$689.00

Hospital Revenue Code	272
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$413.40
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: MDX Hawaii PPO	$668.33

DRILL BIT 2.7/100MM QC 310.26

Facility

$348.00

Hospital Revenue Code	272
Min. Negotiated Rate	$295.80
Max. Negotiated Rate	$337.56
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Management Network Commercial	$295.80
Rate for Payer: MDX Hawaii PPO	$337.56

DRILL BIT 2.7/100MM QC 310.26

Facility

$348.00

Hospital Revenue Code	272
Min. Negotiated Rate	$177.48
Max. Negotiated Rate	$337.56
Rate for Payer: Cash Price	$208.80
Rate for Payer: Hawaii Western Management Group Commercial	$330.60
Rate for Payer: Health Management Network Commercial	$295.80
Rate for Payer: Kaiser Permanente Commercial	$219.24
Rate for Payer: Kaiser Permanente Medicaid	$177.48
Rate for Payer: MDX Hawaii PPO	$337.56
Rate for Payer: University Health Alliance Commercial	$253.66

DRILL BIT 2.7 703897

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 2.7 703897

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 2.7 D 125MM L 700348

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 2.7 D 125MM L 700348

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 2.7MM 13550

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 2.7MM 13550

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 2.7MM 13550A

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 2.7MM 13550A

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 2.7MM 214227070

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$606.05
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: MDX Hawaii PPO	$691.61

DRILL BIT 2.7MM 214227070

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

DRILL BIT 2.7MM AR-8827D-01

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: MDX Hawaii PPO	$329.80

DRILL BIT 2.7MM AR-8827D-01

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Hawaii Western Management Group Commercial	$323.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: University Health Alliance Commercial	$247.83

DRILL BIT 2.7MM CORTEX 310.87

Facility

$672.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$342.72
Max. Negotiated Rate	$651.84
Rate for Payer: Cash Price	$403.20
Rate for Payer: Hawaii Western Management Group Commercial	$638.40
Rate for Payer: Health Management Network Commercial	$571.20
Rate for Payer: Kaiser Permanente Commercial	$423.36
Rate for Payer: Kaiser Permanente Medicaid	$342.72
Rate for Payer: MDX Hawaii PPO	$651.84
Rate for Payer: University Health Alliance Commercial	$489.82

DRILL BIT 2.7MM CORTEX 310.87

Facility

$672.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$571.20
Max. Negotiated Rate	$651.84
Rate for Payer: Cash Price	$403.20
Rate for Payer: Health Management Network Commercial	$571.20
Rate for Payer: MDX Hawaii PPO	$651.84

DRILL BIT 2.7X155MM 7117-3581

Facility

$2,529.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,149.65
Max. Negotiated Rate	$2,453.13
Rate for Payer: Cash Price	$1,517.40
Rate for Payer: Health Management Network Commercial	$2,149.65
Rate for Payer: MDX Hawaii PPO	$2,453.13

DRILL BIT 2.7X155MM 7117-3581

Facility

$2,529.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,289.79
Max. Negotiated Rate	$2,453.13
Rate for Payer: Cash Price	$1,517.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,402.55
Rate for Payer: Health Management Network Commercial	$2,149.65
Rate for Payer: Kaiser Permanente Commercial	$1,593.27
Rate for Payer: Kaiser Permanente Medicaid	$1,289.79
Rate for Payer: MDX Hawaii PPO	$2,453.13
Rate for Payer: University Health Alliance Commercial	$1,843.39

DRILL BIT 2.7X205 2360-205-27

Facility

$622.00

Hospital Revenue Code	272
Min. Negotiated Rate	$528.70
Max. Negotiated Rate	$603.34
Rate for Payer: Cash Price	$373.20
Rate for Payer: Health Management Network Commercial	$528.70
Rate for Payer: MDX Hawaii PPO	$603.34

DRILL BIT 2.7X205 2360-205-27

Facility

$622.00

Hospital Revenue Code	272
Min. Negotiated Rate	$317.22
Max. Negotiated Rate	$603.34
Rate for Payer: Cash Price	$373.20
Rate for Payer: Hawaii Western Management Group Commercial	$590.90
Rate for Payer: Health Management Network Commercial	$528.70
Rate for Payer: Kaiser Permanente Commercial	$391.86
Rate for Payer: Kaiser Permanente Medicaid	$317.22
Rate for Payer: MDX Hawaii PPO	$603.34
Rate for Payer: University Health Alliance Commercial	$453.38

DRILL BIT 280X4.8MM 11007

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

Know your out-of-pocket cost for care.

All Charges