Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DRILL BIT L 122 DIA 3.5 703694

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 L 122 DIA 3.5 703694

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 LCKNG MED 3.1 705077

Facility

$986.00

Hospital Revenue Code	272
Min. Negotiated Rate	$838.10
Max. Negotiated Rate	$956.42
Rate for Payer: Cash Price	$591.60
Rate for Payer: Health Management Network Commercial	$838.10
Rate for Payer: MDX Hawaii PPO	$956.42

DRILL BIT LCKNG MED 3.1 705077

Facility

$986.00

Hospital Revenue Code	272
Min. Negotiated Rate	$502.86
Max. Negotiated Rate	$956.42
Rate for Payer: Cash Price	$591.60
Rate for Payer: Hawaii Western Management Group Commercial	$936.70
Rate for Payer: Health Management Network Commercial	$838.10
Rate for Payer: Kaiser Permanente Commercial	$621.18
Rate for Payer: Kaiser Permanente Medicaid	$502.86
Rate for Payer: MDX Hawaii PPO	$956.42
Rate for Payer: University Health Alliance Commercial	$718.70

DRILL BIT LCKNG SHR 2.5 705025

Facility

$1,039.00

Hospital Revenue Code	272
Min. Negotiated Rate	$529.89
Max. Negotiated Rate	$1,007.83
Rate for Payer: Cash Price	$623.40
Rate for Payer: Hawaii Western Management Group Commercial	$987.05
Rate for Payer: Health Management Network Commercial	$883.15
Rate for Payer: Kaiser Permanente Commercial	$654.57
Rate for Payer: Kaiser Permanente Medicaid	$529.89
Rate for Payer: MDX Hawaii PPO	$1,007.83
Rate for Payer: University Health Alliance Commercial	$757.33

DRILL BIT LCKNG SHR 2.5 705025

Facility

$1,039.00

Hospital Revenue Code	272
Min. Negotiated Rate	$883.15
Max. Negotiated Rate	$1,007.83
Rate for Payer: Cash Price	$623.40
Rate for Payer: Health Management Network Commercial	$883.15
Rate for Payer: MDX Hawaii PPO	$1,007.83

DRILL BIT LONG 2.5

Facility

$600.00

Hospital Revenue Code	272
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Hawaii Western Management Group Commercial	$570.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: Kaiser Permanente Commercial	$378.00
Rate for Payer: Kaiser Permanente Medicaid	$306.00
Rate for Payer: MDX Hawaii PPO	$582.00
Rate for Payer: University Health Alliance Commercial	$437.34

DRILL BIT LONG 2.5

Facility

$600.00

Hospital Revenue Code	272
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: MDX Hawaii PPO	$582.00

DRILL BIT QC 1.0X160MM 310.401

Facility

$488.00

Hospital Revenue Code	272
Min. Negotiated Rate	$414.80
Max. Negotiated Rate	$473.36
Rate for Payer: Cash Price	$292.80
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: MDX Hawaii PPO	$473.36

DRILL BIT QC 1.0X160MM 310.401

Facility

$488.00

Hospital Revenue Code	272
Min. Negotiated Rate	$248.88
Max. Negotiated Rate	$473.36
Rate for Payer: Cash Price	$292.80
Rate for Payer: Hawaii Western Management Group Commercial	$463.60
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: Kaiser Permanente Commercial	$307.44
Rate for Payer: Kaiser Permanente Medicaid	$248.88
Rate for Payer: MDX Hawaii PPO	$473.36
Rate for Payer: University Health Alliance Commercial	$355.70

DRILL BIT QC 1.8X110MM 310.509

Facility

$670.00

Hospital Revenue Code	272
Min. Negotiated Rate	$569.50
Max. Negotiated Rate	$649.90
Rate for Payer: Cash Price	$402.00
Rate for Payer: Health Management Network Commercial	$569.50
Rate for Payer: MDX Hawaii PPO	$649.90

DRILL BIT QC 1.8X110MM 310.509

Facility

$670.00

Hospital Revenue Code	272
Min. Negotiated Rate	$341.70
Max. Negotiated Rate	$649.90
Rate for Payer: Cash Price	$402.00
Rate for Payer: Hawaii Western Management Group Commercial	$636.50
Rate for Payer: Health Management Network Commercial	$569.50
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: Kaiser Permanente Medicaid	$341.70
Rate for Payer: MDX Hawaii PPO	$649.90
Rate for Payer: University Health Alliance Commercial	$488.36

DRILL BIT QC 2.0/65MM 310.201

Facility

$356.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$181.56
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$213.60
Rate for Payer: Hawaii Western Management Group Commercial	$338.20
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Kaiser Permanente Commercial	$224.28
Rate for Payer: Kaiser Permanente Medicaid	$181.56
Rate for Payer: MDX Hawaii PPO	$345.32
Rate for Payer: University Health Alliance Commercial	$259.49

DRILL BIT QC 2.0/65MM 310.201

Facility

$356.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$302.60
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$213.60
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: MDX Hawaii PPO	$345.32

DRILL BIT QC 2.0X100MM 310.19

Facility

$361.00

Hospital Revenue Code	272
Min. Negotiated Rate	$306.85
Max. Negotiated Rate	$350.17
Rate for Payer: Cash Price	$216.60
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: MDX Hawaii PPO	$350.17

DRILL BIT QC 2.0X100MM 310.19

Facility

$361.00

Hospital Revenue Code	272
Min. Negotiated Rate	$184.11
Max. Negotiated Rate	$350.17
Rate for Payer: Cash Price	$216.60
Rate for Payer: Hawaii Western Management Group Commercial	$342.95
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Kaiser Permanente Commercial	$227.43
Rate for Payer: Kaiser Permanente Medicaid	$184.11
Rate for Payer: MDX Hawaii PPO	$350.17
Rate for Payer: University Health Alliance Commercial	$263.13

DRILL BIT QC 2.0X125MM 310.21

Facility

$392.00

Hospital Revenue Code	272
Min. Negotiated Rate	$199.92
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$235.20
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$246.96
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: University Health Alliance Commercial	$285.73

DRILL BIT QC 2.0X125MM 310.21

Facility

$392.00

Hospital Revenue Code	272
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$235.20
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: MDX Hawaii PPO	$380.24

DRILL BIT QC 2.0X140MM 323.062

Facility

$700.00

Hospital Revenue Code	272
Min. Negotiated Rate	$595.00
Max. Negotiated Rate	$679.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Health Management Network Commercial	$595.00
Rate for Payer: MDX Hawaii PPO	$679.00

DRILL BIT QC 2.0X140MM 323.062

Facility

$700.00

Hospital Revenue Code	272
Min. Negotiated Rate	$357.00
Max. Negotiated Rate	$679.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Hawaii Western Management Group Commercial	$665.00
Rate for Payer: Health Management Network Commercial	$595.00
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: Kaiser Permanente Medicaid	$357.00
Rate for Payer: MDX Hawaii PPO	$679.00
Rate for Payer: University Health Alliance Commercial	$510.23

DRILL BIT QC 2.4/100MM 310.530

Facility

$914.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$466.14
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$548.40
Rate for Payer: Hawaii Western Management Group Commercial	$868.30
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Kaiser Permanente Commercial	$575.82
Rate for Payer: Kaiser Permanente Medicaid	$466.14
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: University Health Alliance Commercial	$666.21

DRILL BIT QC 2.4/100MM 310.530

Facility

$914.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$776.90
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$548.40
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: MDX Hawaii PPO	$886.58

DRILL BIT QC 2.7X125MM 315.28

Facility

$520.00

Hospital Revenue Code	272
Min. Negotiated Rate	$442.00
Max. Negotiated Rate	$504.40
Rate for Payer: Cash Price	$312.00
Rate for Payer: Health Management Network Commercial	$442.00
Rate for Payer: MDX Hawaii PPO	$504.40

DRILL BIT QC 2.7X125MM 315.28

Facility

$520.00

Hospital Revenue Code	272
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$504.40
Rate for Payer: Cash Price	$312.00
Rate for Payer: Hawaii Western Management Group Commercial	$494.00
Rate for Payer: Health Management Network Commercial	$442.00
Rate for Payer: Kaiser Permanente Commercial	$327.60
Rate for Payer: Kaiser Permanente Medicaid	$265.20
Rate for Payer: MDX Hawaii PPO	$504.40
Rate for Payer: University Health Alliance Commercial	$379.03

DRILL BIT QC 2.7X160MM 310.67

Facility

$1,545.00

Hospital Revenue Code	272
Min. Negotiated Rate	$787.95
Max. Negotiated Rate	$1,498.65
Rate for Payer: Cash Price	$927.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,467.75
Rate for Payer: Health Management Network Commercial	$1,313.25
Rate for Payer: Kaiser Permanente Commercial	$973.35
Rate for Payer: Kaiser Permanente Medicaid	$787.95
Rate for Payer: MDX Hawaii PPO	$1,498.65
Rate for Payer: University Health Alliance Commercial	$1,126.15

Know your out-of-pocket cost for care.

All Charges