Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$133.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$74.48
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: MDX Hawaii PPO	$129.01
Rate for Payer: University Health Alliance Commercial	$74.48

K-WIRE DB TR 062X6 1642-06-062

Facility

$133.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$74.48
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: MDX Hawaii PPO	$129.01
Rate for Payer: University Health Alliance Commercial	$74.48

K-WIRE DB TR 062X6 1642-06-062

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

K-WIRE DOUBLE ENDED 47-186-62

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$122.22

K-WIRE DOUBLE ENDED 47-186-62

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$79.38
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$91.84

KWIRE DRILL TIP 2.0X315 703561

Facility

$390.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$378.30
Rate for Payer: Cash Price	$234.00
Rate for Payer: Hawaii Western Management Group Commercial	$370.50
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: Kaiser Permanente Commercial	$245.70
Rate for Payer: Kaiser Permanente Medicaid	$198.90
Rate for Payer: MDX Hawaii PPO	$378.30
Rate for Payer: University Health Alliance Commercial	$284.27

KWIRE DRILL TIP 2.0X315 703561

Facility

$390.00

Hospital Revenue Code	272
Min. Negotiated Rate	$331.50
Max. Negotiated Rate	$378.30
Rate for Payer: Cash Price	$234.00
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: MDX Hawaii PPO	$378.30

K-WIRE GUIDE .101X2.5 323-1300

Facility

$260.00

Hospital Revenue Code	272
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Hawaii Western Management Group Commercial	$247.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Kaiser Permanente Commercial	$163.80
Rate for Payer: Kaiser Permanente Medicaid	$132.60
Rate for Payer: MDX Hawaii PPO	$252.20
Rate for Payer: University Health Alliance Commercial	$189.51

K-WIRE GUIDE .101X2.5 323-1300

Facility

$260.00

Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: MDX Hawaii PPO	$252.20

K-WIRE KIRSC 2.5X285MM #292.26

Facility

$93.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Hawaii Western Management Group Commercial	$65.10
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$58.59
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: University Health Alliance Commercial	$52.08

K-WIRE KIRSC 2.5X285MM #292.26

Facility

$93.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$52.08
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Hawaii Western Management Group Commercial	$65.10
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: University Health Alliance Commercial	$52.08

K-WIRE OLI OLIVE-1.6/100

Facility

$428.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$218.28
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$256.80
Rate for Payer: Hawaii Western Management Group Commercial	$406.60
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Kaiser Permanente Commercial	$269.64
Rate for Payer: Kaiser Permanente Medicaid	$218.28
Rate for Payer: MDX Hawaii PPO	$415.16
Rate for Payer: University Health Alliance Commercial	$311.97

K-WIRE OLI OLIVE-1.6/100

Facility

$428.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$363.80
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$256.80
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: MDX Hawaii PPO	$415.16

KWIRE OLIVE 705150

Facility

$402.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$205.02
Max. Negotiated Rate	$389.94
Rate for Payer: Cash Price	$241.20
Rate for Payer: Hawaii Western Management Group Commercial	$381.90
Rate for Payer: Health Management Network Commercial	$341.70
Rate for Payer: Kaiser Permanente Commercial	$253.26
Rate for Payer: Kaiser Permanente Medicaid	$205.02
Rate for Payer: MDX Hawaii PPO	$389.94
Rate for Payer: University Health Alliance Commercial	$293.02

KWIRE OLIVE 705150

Facility

$402.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$341.70
Max. Negotiated Rate	$389.94
Rate for Payer: Cash Price	$241.20
Rate for Payer: Health Management Network Commercial	$341.70
Rate for Payer: MDX Hawaii PPO	$389.94

K-WIRE OLIVE TIP 1.6MMX100MM

Facility

$769.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$430.64
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$461.40
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: University Health Alliance Commercial	$430.64

K-WIRE OLIVE TIP 1.6MMX100MM

Facility

$769.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$392.19
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$461.40
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Kaiser Permanente Commercial	$484.47
Rate for Payer: Kaiser Permanente Medicaid	$392.19
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: University Health Alliance Commercial	$430.64

K-WIRE S3 2.0X152MM KW20SS

Facility

$288.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$146.88
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Hawaii Western Management Group Commercial	$273.60
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$181.44
Rate for Payer: Kaiser Permanente Medicaid	$146.88
Rate for Payer: MDX Hawaii PPO	$279.36
Rate for Payer: University Health Alliance Commercial	$209.92

K-WIRE S3 2.0X152MM KW20SS

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 TI 2.0X150MM 492.20

Facility

$131.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$78.60
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: MDX Hawaii PPO	$127.07

K-WIRE TI 2.0X150MM 492.20

Facility

$131.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$66.81
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$78.60
Rate for Payer: Hawaii Western Management Group Commercial	$124.45
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$82.53
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: University Health Alliance Commercial	$95.49

KWIRE W/STOP 2MM 703818

Facility

$392.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$199.92
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$235.20
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$246.96
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: University Health Alliance Commercial	$285.73

KWIRE W/STOP 2MM 703818

Facility

$392.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$235.20
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: MDX Hawaii PPO	$380.24

K-WIRE ZIMMER 4901-10-15

Facility

$90.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Hawaii Western Management Group Commercial	$63.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: University Health Alliance Commercial	$50.40

K-WIRE ZIMMER 4901-10-15

Facility

$90.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Hawaii Western Management Group Commercial	$63.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: University Health Alliance Commercial	$50.40

Know your out-of-pocket cost for care.

All Charges