Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

K-WIRE 1.6MM KW062SS

Facility

$288.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: MDX Hawaii PPO	$279.36

K-WIRE 1.6X100MM WIRE-1.6/100

Facility

$140.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: University Health Alliance Commercial	$102.05

K-WIRE 1.6X100MM WIRE-1.6/100

Facility

$140.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: MDX Hawaii PPO	$135.80

K-WIRE 1.6X150MM 292.71

Facility

$120.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: MDX Hawaii PPO	$116.40

K-WIRE 1.6X150MM 292.71

Facility

$120.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Hawaii Western Management Group Commercial	$114.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: University Health Alliance Commercial	$87.47

K-WIRE 1.6X150MM 4901-16-15

Facility

$94.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$47.94
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Hawaii Western Management Group Commercial	$65.80
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$59.22
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: University Health Alliance Commercial	$52.64

K-WIRE 1.6X150MM 4901-16-15

Facility

$94.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$52.64
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Hawaii Western Management Group Commercial	$65.80
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: University Health Alliance Commercial	$52.64

K-WIRE 1.6X285MM 292.18

Facility

$76.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$38.76
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$45.60
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$47.88
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: University Health Alliance Commercial	$55.40

K-WIRE 1.6X285MM 292.18

Facility

$76.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: MDX Hawaii PPO	$73.72

K-WIRE 1806-1417S

Facility

$512.00

Hospital Revenue Code	272
Min. Negotiated Rate	$261.12
Max. Negotiated Rate	$496.64
Rate for Payer: Cash Price	$307.20
Rate for Payer: Hawaii Western Management Group Commercial	$486.40
Rate for Payer: Health Management Network Commercial	$435.20
Rate for Payer: Kaiser Permanente Commercial	$322.56
Rate for Payer: Kaiser Permanente Medicaid	$261.12
Rate for Payer: MDX Hawaii PPO	$496.64
Rate for Payer: University Health Alliance Commercial	$373.20

K-WIRE 1806-1417S

Facility

$512.00

Hospital Revenue Code	272
Min. Negotiated Rate	$435.20
Max. Negotiated Rate	$496.64
Rate for Payer: Cash Price	$307.20
Rate for Payer: Health Management Network Commercial	$435.20
Rate for Payer: MDX Hawaii PPO	$496.64

K-WIRE 1.8X310MM 0152-0218S

Facility

$689.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$351.39
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$413.40
Rate for Payer: Hawaii Western Management Group Commercial	$654.55
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$434.07
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: University Health Alliance Commercial	$502.21

K-WIRE 1.8X310MM 0152-0218S

Facility

$689.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$413.40
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: MDX Hawaii PPO	$668.33

K-WIRE 2.0 230MM WIRE-2.0/230

Facility

$150.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: University Health Alliance Commercial	$109.33

K-WIRE 2.0 230MM WIRE-2.0/230

Facility

$150.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: MDX Hawaii PPO	$145.50

KWIRE 2.0 703583

Facility

$446.00

Hospital Revenue Code	272
Min. Negotiated Rate	$379.10
Max. Negotiated Rate	$432.62
Rate for Payer: Cash Price	$267.60
Rate for Payer: Health Management Network Commercial	$379.10
Rate for Payer: MDX Hawaii PPO	$432.62

KWIRE 2.0 703583

Facility

$446.00

Hospital Revenue Code	272
Min. Negotiated Rate	$227.46
Max. Negotiated Rate	$432.62
Rate for Payer: Cash Price	$267.60
Rate for Payer: Hawaii Western Management Group Commercial	$423.70
Rate for Payer: Health Management Network Commercial	$379.10
Rate for Payer: Kaiser Permanente Commercial	$280.98
Rate for Payer: Kaiser Permanente Medicaid	$227.46
Rate for Payer: MDX Hawaii PPO	$432.62
Rate for Payer: University Health Alliance Commercial	$325.09

K-WIRE 2.0 DRILL TIP 705002

Facility

$240.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Hawaii Western Management Group Commercial	$228.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$151.20
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: University Health Alliance Commercial	$174.94

K-WIRE 2.0 DRILL TIP 705002

Facility

$240.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: MDX Hawaii PPO	$232.80

K-WIRE 2.0X150MM 292.20

Facility

$73.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$37.23
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Hawaii Western Management Group Commercial	$69.35
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$45.99
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: University Health Alliance Commercial	$53.21

K-WIRE 2.0X150MM 292.20

Facility

$73.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: MDX Hawaii PPO	$70.81

K-WIRE 2.0X150MM 4901-20-15

Facility

$91.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$50.96
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$63.70
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: University Health Alliance Commercial	$50.96

K-WIRE 2.0X150MM 4901-20-15

Facility

$91.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$63.70
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: University Health Alliance Commercial	$50.96

K-WIRE 2.0X150MM P99-192-2015

Facility

$150.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: University Health Alliance Commercial	$109.33

K-WIRE 2.0X150MM P99-192-2015

Facility

$150.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: MDX Hawaii PPO	$145.50

Know your out-of-pocket cost for care.

All Charges