Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DRILL OVER 2.7 703695

Facility

$648.00

Hospital Revenue Code	272
Min. Negotiated Rate	$330.48
Max. Negotiated Rate	$628.56
Rate for Payer: Cash Price	$388.80
Rate for Payer: Hawaii Western Management Group Commercial	$615.60
Rate for Payer: Health Management Network Commercial	$550.80
Rate for Payer: Kaiser Permanente Commercial	$408.24
Rate for Payer: Kaiser Permanente Medicaid	$330.48
Rate for Payer: MDX Hawaii PPO	$628.56
Rate for Payer: University Health Alliance Commercial	$472.33

DRILL OVER 2.7 703695

Facility

$648.00

Hospital Revenue Code	272
Min. Negotiated Rate	$550.80
Max. Negotiated Rate	$628.56
Rate for Payer: Cash Price	$388.80
Rate for Payer: Health Management Network Commercial	$550.80
Rate for Payer: MDX Hawaii PPO	$628.56

DRILL OVER 2.7MM QR 320-2027

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 OVER 2.7MM QR 320-2027

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 OVER 3.5MM QR 320-2035

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 OVER 3.5MM QR 320-2035

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 OVER 4.0MM QR 320-2040

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 OVER 4.0MM QR 320-2040

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 PIN 3.7MM AR-2272

Facility

$814.00

Hospital Revenue Code	278
Min. Negotiated Rate	$415.14
Max. Negotiated Rate	$789.58
Rate for Payer: Cash Price	$488.40
Rate for Payer: Hawaii Western Management Group Commercial	$569.80
Rate for Payer: Health Management Network Commercial	$691.90
Rate for Payer: Kaiser Permanente Commercial	$512.82
Rate for Payer: Kaiser Permanente Medicaid	$415.14
Rate for Payer: MDX Hawaii PPO	$789.58
Rate for Payer: University Health Alliance Commercial	$455.84

DRILL PIN 3.7MM AR-2272

Facility

$814.00

Hospital Revenue Code	278
Min. Negotiated Rate	$455.84
Max. Negotiated Rate	$789.58
Rate for Payer: Cash Price	$488.40
Rate for Payer: Hawaii Western Management Group Commercial	$569.80
Rate for Payer: Health Management Network Commercial	$691.90
Rate for Payer: MDX Hawaii PPO	$789.58
Rate for Payer: University Health Alliance Commercial	$455.84

DRILL PIN 75MM 00-5901-020-00

Facility

$1,190.00

Hospital Revenue Code	278
Min. Negotiated Rate	$606.90
Max. Negotiated Rate	$1,154.30
Rate for Payer: Cash Price	$714.00
Rate for Payer: Hawaii Western Management Group Commercial	$833.00
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: Kaiser Permanente Commercial	$749.70
Rate for Payer: Kaiser Permanente Medicaid	$606.90
Rate for Payer: MDX Hawaii PPO	$1,154.30
Rate for Payer: University Health Alliance Commercial	$666.40

DRILL PIN 75MM 00-5901-020-00

Facility

$1,190.00

Hospital Revenue Code	278
Min. Negotiated Rate	$666.40
Max. Negotiated Rate	$1,154.30
Rate for Payer: Cash Price	$714.00
Rate for Payer: Hawaii Western Management Group Commercial	$833.00
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: MDX Hawaii PPO	$1,154.30
Rate for Payer: University Health Alliance Commercial	$666.40

DRILL PIN EYELET 4MM AR-1595TC

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$398.65
Max. Negotiated Rate	$454.93
Rate for Payer: Cash Price	$281.40
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: MDX Hawaii PPO	$454.93

DRILL PIN EYELET 4MM AR-1595TC

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$239.19
Max. Negotiated Rate	$454.93
Rate for Payer: Cash Price	$281.40
Rate for Payer: Hawaii Western Management Group Commercial	$445.55
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Kaiser Permanente Commercial	$295.47
Rate for Payer: Kaiser Permanente Medicaid	$239.19
Rate for Payer: MDX Hawaii PPO	$454.93
Rate for Payer: University Health Alliance Commercial	$341.85

DRILL PIN TRIM 2X100 AR-4152DS

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$765.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

DRILL PIN TRIM 2X100 AR-4152DS

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

DRILL QC 00-4806-100-20

Facility

$258.00

Hospital Revenue Code	272
Min. Negotiated Rate	$131.58
Max. Negotiated Rate	$250.26
Rate for Payer: Cash Price	$154.80
Rate for Payer: Hawaii Western Management Group Commercial	$245.10
Rate for Payer: Health Management Network Commercial	$219.30
Rate for Payer: Kaiser Permanente Commercial	$162.54
Rate for Payer: Kaiser Permanente Medicaid	$131.58
Rate for Payer: MDX Hawaii PPO	$250.26
Rate for Payer: University Health Alliance Commercial	$188.06

DRILL QC 00-4806-100-20

Facility

$258.00

Hospital Revenue Code	272
Min. Negotiated Rate	$219.30
Max. Negotiated Rate	$250.26
Rate for Payer: Cash Price	$154.80
Rate for Payer: Health Management Network Commercial	$219.30
Rate for Payer: MDX Hawaii PPO	$250.26

DRILL QC 12MM CANN #03.010.036

Facility

$1,892.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,608.20
Max. Negotiated Rate	$1,835.24
Rate for Payer: Cash Price	$1,135.20
Rate for Payer: Health Management Network Commercial	$1,608.20
Rate for Payer: MDX Hawaii PPO	$1,835.24

DRILL QC 12MM CANN #03.010.036

Facility

$1,892.00

Hospital Revenue Code	272
Min. Negotiated Rate	$964.92
Max. Negotiated Rate	$1,835.24
Rate for Payer: Cash Price	$1,135.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,797.40
Rate for Payer: Health Management Network Commercial	$1,608.20
Rate for Payer: Kaiser Permanente Commercial	$1,191.96
Rate for Payer: Kaiser Permanente Medicaid	$964.92
Rate for Payer: MDX Hawaii PPO	$1,835.24
Rate for Payer: University Health Alliance Commercial	$1,379.08

DRILL QC 2.7X100MM

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$267.75
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$330.75
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: University Health Alliance Commercial	$382.67

DRILL QC 2.7X100MM

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: MDX Hawaii PPO	$509.25

DRILL QC 3.2MM #03.010.103

Facility

$761.00

Hospital Revenue Code	272
Min. Negotiated Rate	$388.11
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$456.60
Rate for Payer: Hawaii Western Management Group Commercial	$722.95
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Kaiser Permanente Commercial	$479.43
Rate for Payer: Kaiser Permanente Medicaid	$388.11
Rate for Payer: MDX Hawaii PPO	$738.17
Rate for Payer: University Health Alliance Commercial	$554.69

DRILL QC 3.2MM #03.010.103

Facility

$761.00

Hospital Revenue Code	272
Min. Negotiated Rate	$646.85
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$456.60
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: MDX Hawaii PPO	$738.17

DRILL SHORT 3.1 705031

Facility

$1,372.00

Hospital Revenue Code	272
Min. Negotiated Rate	$699.72
Max. Negotiated Rate	$1,330.84
Rate for Payer: Cash Price	$823.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,303.40
Rate for Payer: Health Management Network Commercial	$1,166.20
Rate for Payer: Kaiser Permanente Commercial	$864.36
Rate for Payer: Kaiser Permanente Medicaid	$699.72
Rate for Payer: MDX Hawaii PPO	$1,330.84
Rate for Payer: University Health Alliance Commercial	$1,000.05

Know your out-of-pocket cost for care.

All Charges