Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DRILL FREEHAND 2351-4218S

Facility

$1,096.00

Hospital Revenue Code	272
Min. Negotiated Rate	$558.96
Max. Negotiated Rate	$1,063.12
Rate for Payer: Cash Price	$657.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.20
Rate for Payer: Health Management Network Commercial	$931.60
Rate for Payer: Kaiser Permanente Commercial	$690.48
Rate for Payer: Kaiser Permanente Medicaid	$558.96
Rate for Payer: MDX Hawaii PPO	$1,063.12
Rate for Payer: University Health Alliance Commercial	$798.87

DRILL FREEHAND 4.2X130MM

Facility

$1,274.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,082.90
Max. Negotiated Rate	$1,235.78
Rate for Payer: Cash Price	$764.40
Rate for Payer: Health Management Network Commercial	$1,082.90
Rate for Payer: MDX Hawaii PPO	$1,235.78

DRILL FREEHAND 4.2X130MM

Facility

$1,274.00

Hospital Revenue Code	272
Min. Negotiated Rate	$649.74
Max. Negotiated Rate	$1,235.78
Rate for Payer: Cash Price	$764.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,210.30
Rate for Payer: Health Management Network Commercial	$1,082.90
Rate for Payer: Kaiser Permanente Commercial	$802.62
Rate for Payer: Kaiser Permanente Medicaid	$649.74
Rate for Payer: MDX Hawaii PPO	$1,235.78
Rate for Payer: University Health Alliance Commercial	$928.62

DRILL GUIDE 2.0MM LCP 313.353

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$712.95
Rate for Payer: Cash Price	$441.00
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: MDX Hawaii PPO	$712.95

DRILL GUIDE 2.0MM LCP 313.353

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$374.85
Max. Negotiated Rate	$712.95
Rate for Payer: Cash Price	$441.00
Rate for Payer: Hawaii Western Management Group Commercial	$698.25
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Kaiser Permanente Commercial	$463.05
Rate for Payer: Kaiser Permanente Medicaid	$374.85
Rate for Payer: MDX Hawaii PPO	$712.95
Rate for Payer: University Health Alliance Commercial	$535.74

DRILL GUIDE 2.3 GUIDELCBS-2.3

Facility

$562.50

Hospital Revenue Code	272
Min. Negotiated Rate	$286.88
Max. Negotiated Rate	$545.62
Rate for Payer: Cash Price	$337.50
Rate for Payer: Hawaii Western Management Group Commercial	$534.38
Rate for Payer: Health Management Network Commercial	$478.12
Rate for Payer: Kaiser Permanente Commercial	$354.38
Rate for Payer: Kaiser Permanente Medicaid	$286.88
Rate for Payer: MDX Hawaii PPO	$545.62
Rate for Payer: University Health Alliance Commercial	$410.01

DRILL GUIDE 2.3 GUIDELCBS-2.3

Facility

$562.50

Hospital Revenue Code	272
Min. Negotiated Rate	$478.12
Max. Negotiated Rate	$545.62
Rate for Payer: Cash Price	$337.50
Rate for Payer: Health Management Network Commercial	$478.12
Rate for Payer: MDX Hawaii PPO	$545.62

DRILL GUIDE 3.5MM UNIV 323.36

Facility

$1,586.00

Hospital Revenue Code	272
Min. Negotiated Rate	$808.86
Max. Negotiated Rate	$1,538.42
Rate for Payer: Cash Price	$951.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,506.70
Rate for Payer: Health Management Network Commercial	$1,348.10
Rate for Payer: Kaiser Permanente Commercial	$999.18
Rate for Payer: Kaiser Permanente Medicaid	$808.86
Rate for Payer: MDX Hawaii PPO	$1,538.42
Rate for Payer: University Health Alliance Commercial	$1,156.04

DRILL GUIDE 3.5MM UNIV 323.36

Facility

$1,586.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,348.10
Max. Negotiated Rate	$1,538.42
Rate for Payer: Cash Price	$951.60
Rate for Payer: Health Management Network Commercial	$1,348.10
Rate for Payer: MDX Hawaii PPO	$1,538.42

DRILL ICONX 1.4MM 3910-500-568

Facility

$870.00

Hospital Revenue Code	272
Min. Negotiated Rate	$443.70
Max. Negotiated Rate	$843.90
Rate for Payer: Cash Price	$522.00
Rate for Payer: Hawaii Western Management Group Commercial	$826.50
Rate for Payer: Health Management Network Commercial	$739.50
Rate for Payer: Kaiser Permanente Commercial	$548.10
Rate for Payer: Kaiser Permanente Medicaid	$443.70
Rate for Payer: MDX Hawaii PPO	$843.90
Rate for Payer: University Health Alliance Commercial	$634.14

DRILL ICONX 1.4MM 3910-500-568

Facility

$870.00

Hospital Revenue Code	272
Min. Negotiated Rate	$739.50
Max. Negotiated Rate	$843.90
Rate for Payer: Cash Price	$522.00
Rate for Payer: Health Management Network Commercial	$739.50
Rate for Payer: MDX Hawaii PPO	$843.90

DRILL LCK 2351-4236S

Facility

$891.00

Hospital Revenue Code	272
Min. Negotiated Rate	$757.35
Max. Negotiated Rate	$864.27
Rate for Payer: Cash Price	$534.60
Rate for Payer: Health Management Network Commercial	$757.35
Rate for Payer: MDX Hawaii PPO	$864.27

DRILL LCK 2351-4236S

Facility

$891.00

Hospital Revenue Code	272
Min. Negotiated Rate	$454.41
Max. Negotiated Rate	$864.27
Rate for Payer: Cash Price	$534.60
Rate for Payer: Hawaii Western Management Group Commercial	$846.45
Rate for Payer: Health Management Network Commercial	$757.35
Rate for Payer: Kaiser Permanente Commercial	$561.33
Rate for Payer: Kaiser Permanente Medicaid	$454.41
Rate for Payer: MDX Hawaii PPO	$864.27
Rate for Payer: University Health Alliance Commercial	$649.45

DRILL LCK 4.2X360MM

Facility

$891.00

Hospital Revenue Code	272
Min. Negotiated Rate	$454.41
Max. Negotiated Rate	$864.27
Rate for Payer: Cash Price	$534.60
Rate for Payer: Hawaii Western Management Group Commercial	$846.45
Rate for Payer: Health Management Network Commercial	$757.35
Rate for Payer: Kaiser Permanente Commercial	$561.33
Rate for Payer: Kaiser Permanente Medicaid	$454.41
Rate for Payer: MDX Hawaii PPO	$864.27
Rate for Payer: University Health Alliance Commercial	$649.45

DRILL LCK 4.2X360MM

Facility

$891.00

Hospital Revenue Code	272
Min. Negotiated Rate	$757.35
Max. Negotiated Rate	$864.27
Rate for Payer: Cash Price	$534.60
Rate for Payer: Health Management Network Commercial	$757.35
Rate for Payer: MDX Hawaii PPO	$864.27

DRILL LG BB-TAK AR-8970-09

Facility

$506.00

Service Code	HCPCS C1713
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 LG BB-TAK AR-8970-09

Facility

$506.00

Service Code	HCPCS C1713
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 LONG 3.0MM QR 320-2130

Facility

$538.00

Hospital Revenue Code	272
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$521.86
Rate for Payer: Cash Price	$322.80
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: MDX Hawaii PPO	$521.86

DRILL LONG 3.0MM QR 320-2130

Facility

$538.00

Hospital Revenue Code	272
Min. Negotiated Rate	$274.38
Max. Negotiated Rate	$521.86
Rate for Payer: Cash Price	$322.80
Rate for Payer: Hawaii Western Management Group Commercial	$511.10
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: Kaiser Permanente Commercial	$338.94
Rate for Payer: Kaiser Permanente Medicaid	$274.38
Rate for Payer: MDX Hawaii PPO	$521.86
Rate for Payer: University Health Alliance Commercial	$392.15

DRILL NON-CAN DRILL-2.3/120

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: University Health Alliance Commercial	$459.21

DRILL NON-CAN DRILL-2.3/120

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: MDX Hawaii PPO	$611.10

DRILL NON-CANN 4MM #AR-1204D

Facility

$431.00

Hospital Revenue Code	272
Min. Negotiated Rate	$366.35
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$258.60
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: MDX Hawaii PPO	$418.07

DRILL NON-CANN 4MM #AR-1204D

Facility

$431.00

Hospital Revenue Code	272
Min. Negotiated Rate	$219.81
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$258.60
Rate for Payer: Hawaii Western Management Group Commercial	$409.45
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Kaiser Permanente Commercial	$271.53
Rate for Payer: Kaiser Permanente Medicaid	$219.81
Rate for Payer: MDX Hawaii PPO	$418.07
Rate for Payer: University Health Alliance Commercial	$314.16

DRILL OVER 2.4 703696

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 OVER 2.4 703696

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

Know your out-of-pocket cost for care.

All Charges