Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

K-WIRE 2.0X285MM 292.21

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 2.0X285MM 292.21

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 2.3X230MM P99-192-2323

Facility

$158.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$134.30
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$94.80
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: MDX Hawaii PPO	$153.26

K-WIRE 2.3X230MM P99-192-2323

Facility

$158.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$80.58
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$94.80
Rate for Payer: Hawaii Western Management Group Commercial	$150.10
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$99.54
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: University Health Alliance Commercial	$115.17

K-WIRE 2X150MM 11.146

Facility

$135.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: MDX Hawaii PPO	$130.95

K-WIRE 2X150MM 11.146

Facility

$135.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$81.00
Rate for Payer: Hawaii Western Management Group Commercial	$128.25
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Kaiser Permanente Commercial	$85.05
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: University Health Alliance Commercial	$98.40

K-WIRE 2X150MM 6052-02-150

Facility

$360.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$252.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: University Health Alliance Commercial	$201.60

K-WIRE 2X150MM 6052-02-150

Facility

$360.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$252.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: University Health Alliance Commercial	$201.60

K-WIRE 3.2X450MM 1210-6450S

Facility

$516.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$438.60
Max. Negotiated Rate	$500.52
Rate for Payer: Cash Price	$309.60
Rate for Payer: Health Management Network Commercial	$438.60
Rate for Payer: MDX Hawaii PPO	$500.52

K-WIRE 3.2X450MM 1210-6450S

Facility

$516.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$263.16
Max. Negotiated Rate	$500.52
Rate for Payer: Cash Price	$309.60
Rate for Payer: Hawaii Western Management Group Commercial	$490.20
Rate for Payer: Health Management Network Commercial	$438.60
Rate for Payer: Kaiser Permanente Commercial	$325.08
Rate for Payer: Kaiser Permanente Medicaid	$263.16
Rate for Payer: MDX Hawaii PPO	$500.52
Rate for Payer: University Health Alliance Commercial	$376.11

K-WIRE .35X6 DBL TRO 164206035

Facility

$875.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: MDX Hawaii PPO	$848.75

K-WIRE .35X6 DBL TRO 164206035

Facility

$875.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$551.25
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$637.79

KWIRE 390142

Facility

$92.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: MDX Hawaii PPO	$89.24

KWIRE 390142

Facility

$92.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$46.92
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$57.96
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: University Health Alliance Commercial	$67.06

K-WIRE 3X285MM 1806-0050S

Facility

$489.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: MDX Hawaii PPO	$474.33

K-WIRE 3X285MM 1806-0050S

Facility

$489.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$249.39
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.55
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Kaiser Permanente Commercial	$308.07
Rate for Payer: Kaiser Permanente Medicaid	$249.39
Rate for Payer: MDX Hawaii PPO	$474.33
Rate for Payer: University Health Alliance Commercial	$356.43

K-WIRE 3X285MM 2351-3028S

Facility

$754.00

Hospital Revenue Code	272
Min. Negotiated Rate	$640.90
Max. Negotiated Rate	$731.38
Rate for Payer: Cash Price	$452.40
Rate for Payer: Health Management Network Commercial	$640.90
Rate for Payer: MDX Hawaii PPO	$731.38

K-WIRE 3X285MM 2351-3028S

Facility

$754.00

Hospital Revenue Code	272
Min. Negotiated Rate	$384.54
Max. Negotiated Rate	$731.38
Rate for Payer: Cash Price	$452.40
Rate for Payer: Hawaii Western Management Group Commercial	$716.30
Rate for Payer: Health Management Network Commercial	$640.90
Rate for Payer: Kaiser Permanente Commercial	$475.02
Rate for Payer: Kaiser Permanente Medicaid	$384.54
Rate for Payer: MDX Hawaii PPO	$731.38
Rate for Payer: University Health Alliance Commercial	$549.59

K-WIRE 4.2X185MM 2351-3340S

Facility

$1,343.00

Hospital Revenue Code	272
Min. Negotiated Rate	$684.93
Max. Negotiated Rate	$1,302.71
Rate for Payer: Cash Price	$805.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,275.85
Rate for Payer: Health Management Network Commercial	$1,141.55
Rate for Payer: Kaiser Permanente Commercial	$846.09
Rate for Payer: Kaiser Permanente Medicaid	$684.93
Rate for Payer: MDX Hawaii PPO	$1,302.71
Rate for Payer: University Health Alliance Commercial	$978.91

K-WIRE 4.2X185MM 2351-3340S

Facility

$1,343.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,141.55
Max. Negotiated Rate	$1,302.71
Rate for Payer: Cash Price	$805.80
Rate for Payer: Health Management Network Commercial	$1,141.55
Rate for Payer: MDX Hawaii PPO	$1,302.71

KWIRE 702459

Facility

$447.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$379.95
Max. Negotiated Rate	$433.59
Rate for Payer: Cash Price	$268.20
Rate for Payer: Health Management Network Commercial	$379.95
Rate for Payer: MDX Hawaii PPO	$433.59

KWIRE 702459

Facility

$447.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$227.97
Max. Negotiated Rate	$433.59
Rate for Payer: Cash Price	$268.20
Rate for Payer: Hawaii Western Management Group Commercial	$424.65
Rate for Payer: Health Management Network Commercial	$379.95
Rate for Payer: Kaiser Permanente Commercial	$281.61
Rate for Payer: Kaiser Permanente Medicaid	$227.97
Rate for Payer: MDX Hawaii PPO	$433.59
Rate for Payer: University Health Alliance Commercial	$325.82

K-WIRE DBL END 9" 47-186-46

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 DBL END 9" 47-186-46

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

K-WIRE DB TR 045X6 1642-06-045

Facility

$133.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$67.83
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$79.80
Rate for Payer: Hawaii Western Management Group Commercial	$93.10
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$83.79
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: University Health Alliance Commercial	$74.48

Know your out-of-pocket cost for care.

All Charges