Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

DRILL TWIST 1.9X27 60-19426

Facility

$606.00

Hospital Revenue Code	272
Min. Negotiated Rate	$309.06
Max. Negotiated Rate	$587.82
Rate for Payer: Cash Price	$363.60
Rate for Payer: Hawaii Western Management Group Commercial	$575.70
Rate for Payer: Health Management Network Commercial	$515.10
Rate for Payer: Kaiser Permanente Commercial	$381.78
Rate for Payer: Kaiser Permanente Medicaid	$309.06
Rate for Payer: MDX Hawaii PPO	$587.82
Rate for Payer: University Health Alliance Commercial	$441.71

DRILL TWIST 1.9X27 60-19426

Facility

$606.00

Hospital Revenue Code	272
Min. Negotiated Rate	$515.10
Max. Negotiated Rate	$587.82
Rate for Payer: Cash Price	$363.60
Rate for Payer: Health Management Network Commercial	$515.10
Rate for Payer: MDX Hawaii PPO	$587.82

DRILL TWIST 1.9X27MM 60-19126

Facility

$571.00

Hospital Revenue Code	272
Min. Negotiated Rate	$485.35
Max. Negotiated Rate	$553.87
Rate for Payer: Cash Price	$342.60
Rate for Payer: Health Management Network Commercial	$485.35
Rate for Payer: MDX Hawaii PPO	$553.87

DRILL TWIST 1.9X27MM 60-19126

Facility

$571.00

Hospital Revenue Code	272
Min. Negotiated Rate	$291.21
Max. Negotiated Rate	$553.87
Rate for Payer: Cash Price	$342.60
Rate for Payer: Hawaii Western Management Group Commercial	$542.45
Rate for Payer: Health Management Network Commercial	$485.35
Rate for Payer: Kaiser Permanente Commercial	$359.73
Rate for Payer: Kaiser Permanente Medicaid	$291.21
Rate for Payer: MDX Hawaii PPO	$553.87
Rate for Payer: University Health Alliance Commercial	$416.20

DRILL TWIST 1.9X41MM 60-19340

Facility

$571.00

Hospital Revenue Code	272
Min. Negotiated Rate	$485.35
Max. Negotiated Rate	$553.87
Rate for Payer: Cash Price	$342.60
Rate for Payer: Health Management Network Commercial	$485.35
Rate for Payer: MDX Hawaii PPO	$553.87

DRILL TWIST 1.9X41MM 60-19340

Facility

$571.00

Hospital Revenue Code	272
Min. Negotiated Rate	$291.21
Max. Negotiated Rate	$553.87
Rate for Payer: Cash Price	$342.60
Rate for Payer: Hawaii Western Management Group Commercial	$542.45
Rate for Payer: Health Management Network Commercial	$485.35
Rate for Payer: Kaiser Permanente Commercial	$359.73
Rate for Payer: Kaiser Permanente Medicaid	$291.21
Rate for Payer: MDX Hawaii PPO	$553.87
Rate for Payer: University Health Alliance Commercial	$416.20

DRILL TWIST 2.0MM DRILL-2.00L

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 TWIST 2.0MM DRILL-2.00L

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 TWIST 2.5X2 AO 60-25326

Facility

$606.00

Hospital Revenue Code	272
Min. Negotiated Rate	$309.06
Max. Negotiated Rate	$587.82
Rate for Payer: Cash Price	$363.60
Rate for Payer: Hawaii Western Management Group Commercial	$575.70
Rate for Payer: Health Management Network Commercial	$515.10
Rate for Payer: Kaiser Permanente Commercial	$381.78
Rate for Payer: Kaiser Permanente Medicaid	$309.06
Rate for Payer: MDX Hawaii PPO	$587.82
Rate for Payer: University Health Alliance Commercial	$441.71

DRILL TWIST 2.5X2 AO 60-25326

Facility

$606.00

Hospital Revenue Code	272
Min. Negotiated Rate	$515.10
Max. Negotiated Rate	$587.82
Rate for Payer: Cash Price	$363.60
Rate for Payer: Health Management Network Commercial	$515.10
Rate for Payer: MDX Hawaii PPO	$587.82

DRILL TWIST 2.7X125 502015217

Facility

$320.00

Hospital Revenue Code	272
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$310.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Hawaii Western Management Group Commercial	$304.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: Kaiser Permanente Commercial	$201.60
Rate for Payer: Kaiser Permanente Medicaid	$163.20
Rate for Payer: MDX Hawaii PPO	$310.40
Rate for Payer: University Health Alliance Commercial	$233.25

DRILL TWIST 2.7X125 502015217

Facility

$320.00

Hospital Revenue Code	272
Min. Negotiated Rate	$272.00
Max. Negotiated Rate	$310.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: MDX Hawaii PPO	$310.40

DRILL TWIST 3.20MM DRILL-3.20L

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: MDX Hawaii PPO	$436.50

DRILL TWIST 3.20MM DRILL-3.20L

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Hawaii Western Management Group Commercial	$427.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$283.50
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: University Health Alliance Commercial	$328.00

DRILL TWIST 4.00MM DRILL-4.00L

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Hawaii Western Management Group Commercial	$427.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$283.50
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: University Health Alliance Commercial	$328.00

DRILL TWIST 4.00MM DRILL-4.00L

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: MDX Hawaii PPO	$436.50

DRIVER T10 DRVR-UQC-T10

Facility

$383.00

Hospital Revenue Code	272
Min. Negotiated Rate	$195.33
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$229.80
Rate for Payer: Hawaii Western Management Group Commercial	$363.85
Rate for Payer: Health Management Network Commercial	$325.55
Rate for Payer: Kaiser Permanente Commercial	$241.29
Rate for Payer: Kaiser Permanente Medicaid	$195.33
Rate for Payer: MDX Hawaii PPO	$371.51
Rate for Payer: University Health Alliance Commercial	$279.17

DRIVER T10 DRVR-UQC-T10

Facility

$383.00

Hospital Revenue Code	272
Min. Negotiated Rate	$325.55
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$229.80
Rate for Payer: Health Management Network Commercial	$325.55
Rate for Payer: MDX Hawaii PPO	$371.51

DRSG 36X10 INTERDRY ANTIMICRO

Facility

$185.00

Service Code	HCPCS A6250
Hospital Revenue Code	272
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$111.00
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: MDX Hawaii PPO	$179.45

DRSG 36X10 INTERDRY ANTIMICRO

Facility

$185.00

Service Code	HCPCS A6250
Hospital Revenue Code	272
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$111.00
Rate for Payer: Hawaii Western Management Group Commercial	$175.75
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Kaiser Permanente Commercial	$116.55
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: University Health Alliance Commercial	$134.85

DRSG 4X10 MEPILEX AG ANTIMICRO

Facility

$127.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: MDX Hawaii PPO	$123.19

DRSG 4X10 MEPILEX AG ANTIMICRO

Facility

$127.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Cash Price	$76.20
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$80.01
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: UnitedHealthcare Medicaid	$10.11
Rate for Payer: University Health Alliance Commercial	$92.57

DRSG 4X12 MEPILEX AG ANTIMICRO

Facility

$145.00

Service Code	HCPCS A6213
Hospital Revenue Code	272
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

DRSG 4X12 MEPILEX AG ANTIMICRO

Facility

$145.00

Service Code	HCPCS A6213
Hospital Revenue Code	272
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Cash Price	$87.00
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$91.35
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: UnitedHealthcare Medicaid	$10.39
Rate for Payer: University Health Alliance Commercial	$105.69

DRSG 4X6 MEPILEX AG ANTIMICRO

Facility

$122.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$73.20
Rate for Payer: Cash Price	$73.20
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$76.86
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: UnitedHealthcare Medicaid	$10.11
Rate for Payer: University Health Alliance Commercial	$88.93

Know your out-of-pocket cost for care.

All Charges