Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DRILL BIT 280X4.8MM 11007

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 280X4.8MM 11007A

Facility

$380.00

Hospital Revenue Code	272
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$228.00
Rate for Payer: Hawaii Western Management Group Commercial	$361.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Kaiser Permanente Commercial	$239.40
Rate for Payer: Kaiser Permanente Medicaid	$193.80
Rate for Payer: MDX Hawaii PPO	$368.60
Rate for Payer: University Health Alliance Commercial	$276.98

DRILL BIT 280X4.8MM 11007A

Facility

$380.00

Hospital Revenue Code	272
Min. Negotiated Rate	$323.00
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$228.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: MDX Hawaii PPO	$368.60

DRILL BIT 280X4.8MM 1-1100701

Facility

$527.00

Hospital Revenue Code	272
Min. Negotiated Rate	$268.77
Max. Negotiated Rate	$511.19
Rate for Payer: Cash Price	$316.20
Rate for Payer: Hawaii Western Management Group Commercial	$500.65
Rate for Payer: Health Management Network Commercial	$447.95
Rate for Payer: Kaiser Permanente Commercial	$332.01
Rate for Payer: Kaiser Permanente Medicaid	$268.77
Rate for Payer: MDX Hawaii PPO	$511.19
Rate for Payer: University Health Alliance Commercial	$384.13

DRILL BIT 280X4.8MM 1-1100701

Facility

$527.00

Hospital Revenue Code	272
Min. Negotiated Rate	$447.95
Max. Negotiated Rate	$511.19
Rate for Payer: Cash Price	$316.20
Rate for Payer: Health Management Network Commercial	$447.95
Rate for Payer: MDX Hawaii PPO	$511.19

DRILL BIT 2.8MM 03.122.002

Facility

$712.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$605.20
Max. Negotiated Rate	$690.64
Rate for Payer: Cash Price	$427.20
Rate for Payer: Health Management Network Commercial	$605.20
Rate for Payer: MDX Hawaii PPO	$690.64

DRILL BIT 2.8MM 03.122.002

Facility

$712.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$363.12
Max. Negotiated Rate	$690.64
Rate for Payer: Cash Price	$427.20
Rate for Payer: Hawaii Western Management Group Commercial	$676.40
Rate for Payer: Health Management Network Commercial	$605.20
Rate for Payer: Kaiser Permanente Commercial	$448.56
Rate for Payer: Kaiser Permanente Medicaid	$363.12
Rate for Payer: MDX Hawaii PPO	$690.64
Rate for Payer: University Health Alliance Commercial	$518.98

DRILL BIT 2.8MM STERILE

Facility

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: MDX Hawaii PPO	$363.75

DRILL BIT 2.8MM STERILE

Facility

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$225.00
Rate for Payer: Hawaii Western Management Group Commercial	$356.25
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Kaiser Permanente Commercial	$236.25
Rate for Payer: Kaiser Permanente Medicaid	$191.25
Rate for Payer: MDX Hawaii PPO	$363.75
Rate for Payer: University Health Alliance Commercial	$273.34

DRILL BIT 2.8X250MM 03.113.024

Facility

$546.00

Hospital Revenue Code	272
Min. Negotiated Rate	$278.46
Max. Negotiated Rate	$529.62
Rate for Payer: Cash Price	$327.60
Rate for Payer: Hawaii Western Management Group Commercial	$518.70
Rate for Payer: Health Management Network Commercial	$464.10
Rate for Payer: Kaiser Permanente Commercial	$343.98
Rate for Payer: Kaiser Permanente Medicaid	$278.46
Rate for Payer: MDX Hawaii PPO	$529.62
Rate for Payer: University Health Alliance Commercial	$397.98

DRILL BIT 2.8X250MM 03.113.024

Facility

$546.00

Hospital Revenue Code	272
Min. Negotiated Rate	$464.10
Max. Negotiated Rate	$529.62
Rate for Payer: Cash Price	$327.60
Rate for Payer: Health Management Network Commercial	$464.10
Rate for Payer: MDX Hawaii PPO	$529.62

DRILL BIT 2MM AR-8944-22

Facility

$357.00

Hospital Revenue Code	272
Min. Negotiated Rate	$303.45
Max. Negotiated Rate	$346.29
Rate for Payer: Cash Price	$214.20
Rate for Payer: Health Management Network Commercial	$303.45
Rate for Payer: MDX Hawaii PPO	$346.29

DRILL BIT 2MM AR-8944-22

Facility

$357.00

Hospital Revenue Code	272
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$346.29
Rate for Payer: Cash Price	$214.20
Rate for Payer: Hawaii Western Management Group Commercial	$339.15
Rate for Payer: Health Management Network Commercial	$303.45
Rate for Payer: Kaiser Permanente Commercial	$224.91
Rate for Payer: Kaiser Permanente Medicaid	$182.07
Rate for Payer: MDX Hawaii PPO	$346.29
Rate for Payer: University Health Alliance Commercial	$260.22

DRILL BIT 2MMX135MM 542000

Facility

$1,148.00

Hospital Revenue Code	272
Min. Negotiated Rate	$585.48
Max. Negotiated Rate	$1,113.56
Rate for Payer: Cash Price	$688.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,090.60
Rate for Payer: Health Management Network Commercial	$975.80
Rate for Payer: Kaiser Permanente Commercial	$723.24
Rate for Payer: Kaiser Permanente Medicaid	$585.48
Rate for Payer: MDX Hawaii PPO	$1,113.56
Rate for Payer: University Health Alliance Commercial	$836.78

DRILL BIT 2MMX135MM 542000

Facility

$1,148.00

Hospital Revenue Code	272
Min. Negotiated Rate	$975.80
Max. Negotiated Rate	$1,113.56
Rate for Payer: Cash Price	$688.80
Rate for Payer: Health Management Network Commercial	$975.80
Rate for Payer: MDX Hawaii PPO	$1,113.56

DRILL BIT 2X110MM 4806-110-20

Facility

$638.00

Hospital Revenue Code	272
Min. Negotiated Rate	$542.30
Max. Negotiated Rate	$618.86
Rate for Payer: Cash Price	$382.80
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: MDX Hawaii PPO	$618.86

DRILL BIT 2X110MM 4806-110-20

Facility

$638.00

Hospital Revenue Code	272
Min. Negotiated Rate	$325.38
Max. Negotiated Rate	$618.86
Rate for Payer: Cash Price	$382.80
Rate for Payer: Hawaii Western Management Group Commercial	$606.10
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: Kaiser Permanente Commercial	$401.94
Rate for Payer: Kaiser Permanente Medicaid	$325.38
Rate for Payer: MDX Hawaii PPO	$618.86
Rate for Payer: University Health Alliance Commercial	$465.04

DRILL BIT 3.0MM AR-8943-36

Facility

$453.00

Hospital Revenue Code	272
Min. Negotiated Rate	$385.05
Max. Negotiated Rate	$439.41
Rate for Payer: Cash Price	$271.80
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: MDX Hawaii PPO	$439.41

DRILL BIT 3.0MM AR-8943-36

Facility

$453.00

Hospital Revenue Code	272
Min. Negotiated Rate	$231.03
Max. Negotiated Rate	$439.41
Rate for Payer: Cash Price	$271.80
Rate for Payer: Hawaii Western Management Group Commercial	$430.35
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Kaiser Permanente Commercial	$285.39
Rate for Payer: Kaiser Permanente Medicaid	$231.03
Rate for Payer: MDX Hawaii PPO	$439.41
Rate for Payer: University Health Alliance Commercial	$330.19

DRILL BIT 3.0MM CANN 310.804

Facility

$1,724.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$879.24
Max. Negotiated Rate	$1,672.28
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,637.80
Rate for Payer: Health Management Network Commercial	$1,465.40
Rate for Payer: Kaiser Permanente Commercial	$1,086.12
Rate for Payer: Kaiser Permanente Medicaid	$879.24
Rate for Payer: MDX Hawaii PPO	$1,672.28
Rate for Payer: University Health Alliance Commercial	$1,256.62

DRILL BIT 3.0MM CANN 310.804

Facility

$1,724.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,465.40
Max. Negotiated Rate	$1,672.28
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Health Management Network Commercial	$1,465.40
Rate for Payer: MDX Hawaii PPO	$1,672.28

DRILL BIT 3.0MM CANNULATED

Facility

$1,749.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,486.65
Max. Negotiated Rate	$1,696.53
Rate for Payer: Cash Price	$1,049.40
Rate for Payer: Health Management Network Commercial	$1,486.65
Rate for Payer: MDX Hawaii PPO	$1,696.53

DRILL BIT 3.0MM CANNULATED

Facility

$1,749.00

Hospital Revenue Code	272
Min. Negotiated Rate	$891.99
Max. Negotiated Rate	$1,696.53
Rate for Payer: Cash Price	$1,049.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,661.55
Rate for Payer: Health Management Network Commercial	$1,486.65
Rate for Payer: Kaiser Permanente Commercial	$1,101.87
Rate for Payer: Kaiser Permanente Medicaid	$891.99
Rate for Payer: MDX Hawaii PPO	$1,696.53
Rate for Payer: University Health Alliance Commercial	$1,274.85

DRILL BIT 3.0MM 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 3.0MM 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

Know your out-of-pocket cost for care.

All Charges