Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DRILL BIT 4.5x10MM #2318-45-06

Facility

$213.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$127.80
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: MDX Hawaii PPO	$206.61

DRILL BIT 4.5X195MM 310.48

Facility

$536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$455.60
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: MDX Hawaii PPO	$519.92

DRILL BIT 4.5X195MM 310.48

Facility

$536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$273.36
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Hawaii Western Management Group Commercial	$509.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$337.68
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: University Health Alliance Commercial	$390.69

DRILL BIT 4.8/180MM 1-1102101

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 4.8/180MM 1-1102101

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 4.8/280MM 1-1101201

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 4.8/280MM 1-1101201

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 4.8/280MM 1-1102701

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 4.8/280MM 1-1102701

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 4.9MM 6.5/8.0 702601

Facility

$1,517.00

Hospital Revenue Code	272
Min. Negotiated Rate	$773.67
Max. Negotiated Rate	$1,471.49
Rate for Payer: Cash Price	$910.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,441.15
Rate for Payer: Health Management Network Commercial	$1,289.45
Rate for Payer: Kaiser Permanente Commercial	$955.71
Rate for Payer: Kaiser Permanente Medicaid	$773.67
Rate for Payer: MDX Hawaii PPO	$1,471.49
Rate for Payer: University Health Alliance Commercial	$1,105.74

DRILL BIT 4.9MM 6.5/8.0 702601

Facility

$1,517.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,289.45
Max. Negotiated Rate	$1,471.49
Rate for Payer: Cash Price	$910.20
Rate for Payer: Health Management Network Commercial	$1,289.45
Rate for Payer: MDX Hawaii PPO	$1,471.49

DRILL BIT 5.0 126MM 03.008.008

Facility

$1,019.00

Hospital Revenue Code	272
Min. Negotiated Rate	$519.69
Max. Negotiated Rate	$988.43
Rate for Payer: Cash Price	$611.40
Rate for Payer: Hawaii Western Management Group Commercial	$968.05
Rate for Payer: Health Management Network Commercial	$866.15
Rate for Payer: Kaiser Permanente Commercial	$641.97
Rate for Payer: Kaiser Permanente Medicaid	$519.69
Rate for Payer: MDX Hawaii PPO	$988.43
Rate for Payer: University Health Alliance Commercial	$742.75

DRILL BIT 5.0 126MM 03.008.008

Facility

$1,019.00

Hospital Revenue Code	272
Min. Negotiated Rate	$866.15
Max. Negotiated Rate	$988.43
Rate for Payer: Cash Price	$611.40
Rate for Payer: Health Management Network Commercial	$866.15
Rate for Payer: MDX Hawaii PPO	$988.43

DRILL BIT 5.0MM PRECISION

Facility

$894.00

Hospital Revenue Code	272
Min. Negotiated Rate	$759.90
Max. Negotiated Rate	$867.18
Rate for Payer: Cash Price	$536.40
Rate for Payer: Health Management Network Commercial	$759.90
Rate for Payer: MDX Hawaii PPO	$867.18

DRILL BIT 5.0MM PRECISION

Facility

$894.00

Hospital Revenue Code	272
Min. Negotiated Rate	$455.94
Max. Negotiated Rate	$867.18
Rate for Payer: Cash Price	$536.40
Rate for Payer: Hawaii Western Management Group Commercial	$849.30
Rate for Payer: Health Management Network Commercial	$759.90
Rate for Payer: Kaiser Permanente Commercial	$563.22
Rate for Payer: Kaiser Permanente Medicaid	$455.94
Rate for Payer: MDX Hawaii PPO	$867.18
Rate for Payer: University Health Alliance Commercial	$651.64

DRILL BIT 5.0X145MM 03.010.102

Facility

$1,029.00

Hospital Revenue Code	272
Min. Negotiated Rate	$874.65
Max. Negotiated Rate	$998.13
Rate for Payer: Cash Price	$617.40
Rate for Payer: Health Management Network Commercial	$874.65
Rate for Payer: MDX Hawaii PPO	$998.13

DRILL BIT 5.0X145MM 03.010.102

Facility

$1,029.00

Hospital Revenue Code	272
Min. Negotiated Rate	$524.79
Max. Negotiated Rate	$998.13
Rate for Payer: Cash Price	$617.40
Rate for Payer: Hawaii Western Management Group Commercial	$977.55
Rate for Payer: Health Management Network Commercial	$874.65
Rate for Payer: Kaiser Permanente Commercial	$648.27
Rate for Payer: Kaiser Permanente Medicaid	$524.79
Rate for Payer: MDX Hawaii PPO	$998.13
Rate for Payer: University Health Alliance Commercial	$750.04

DRILL BIT 5.0X145MM 03.010.105

Facility

$900.00

Hospital Revenue Code	272
Min. Negotiated Rate	$459.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$855.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: Kaiser Permanente Medicaid	$459.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$656.01

DRILL BIT 5.0X145MM 03.010.105

Facility

$900.00

Hospital Revenue Code	272
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: MDX Hawaii PPO	$873.00

DRILL BIT 5.0X330MM 03.010.062

Facility

$1,260.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,071.00
Max. Negotiated Rate	$1,222.20
Rate for Payer: Cash Price	$756.00
Rate for Payer: Health Management Network Commercial	$1,071.00
Rate for Payer: MDX Hawaii PPO	$1,222.20

DRILL BIT 5.0X330MM 03.010.062

Facility

$1,260.00

Hospital Revenue Code	272
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$1,222.20
Rate for Payer: Cash Price	$756.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,197.00
Rate for Payer: Health Management Network Commercial	$1,071.00
Rate for Payer: Kaiser Permanente Commercial	$793.80
Rate for Payer: Kaiser Permanente Medicaid	$642.60
Rate for Payer: MDX Hawaii PPO	$1,222.20
Rate for Payer: University Health Alliance Commercial	$918.41

DRILL BIT 6.5 CANULATED 702603

Facility

$2,165.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,104.15
Max. Negotiated Rate	$2,100.05
Rate for Payer: Cash Price	$1,299.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,056.75
Rate for Payer: Health Management Network Commercial	$1,840.25
Rate for Payer: Kaiser Permanente Commercial	$1,363.95
Rate for Payer: Kaiser Permanente Medicaid	$1,104.15
Rate for Payer: MDX Hawaii PPO	$2,100.05
Rate for Payer: University Health Alliance Commercial	$1,578.07

DRILL BIT 6.5 CANULATED 702603

Facility

$2,165.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,840.25
Max. Negotiated Rate	$2,100.05
Rate for Payer: Cash Price	$1,299.00
Rate for Payer: Health Management Network Commercial	$1,840.25
Rate for Payer: MDX Hawaii PPO	$2,100.05

DRILL BIT 702449

Facility

$1,644.00

Hospital Revenue Code	272
Min. Negotiated Rate	$838.44
Max. Negotiated Rate	$1,594.68
Rate for Payer: Cash Price	$986.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,561.80
Rate for Payer: Health Management Network Commercial	$1,397.40
Rate for Payer: Kaiser Permanente Commercial	$1,035.72
Rate for Payer: Kaiser Permanente Medicaid	$838.44
Rate for Payer: MDX Hawaii PPO	$1,594.68
Rate for Payer: University Health Alliance Commercial	$1,198.31

DRILL BIT 702449

Facility

$1,644.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,397.40
Max. Negotiated Rate	$1,594.68
Rate for Payer: Cash Price	$986.40
Rate for Payer: Health Management Network Commercial	$1,397.40
Rate for Payer: MDX Hawaii PPO	$1,594.68

Know your out-of-pocket cost for care.

All Charges