Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NAIL FEMORA 11X420 04.013.564S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X420 04.013.564S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,024.70
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$2,501.10
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORAL 12X300 2339-1230S

Facility

$6,838.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,487.38
Max. Negotiated Rate	$6,632.86
Rate for Payer: Cash Price	$4,102.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,786.60
Rate for Payer: Health Management Network Commercial	$5,812.30
Rate for Payer: Kaiser Permanente Commercial	$4,307.94
Rate for Payer: Kaiser Permanente Medicaid	$3,487.38
Rate for Payer: MDX Hawaii PPO	$6,632.86
Rate for Payer: University Health Alliance Commercial	$3,829.28

NAIL FEMORAL 12X300 2339-1230S

Facility

$6,838.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,829.28
Max. Negotiated Rate	$6,632.86
Rate for Payer: Cash Price	$4,102.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,786.60
Rate for Payer: Health Management Network Commercial	$5,812.30
Rate for Payer: MDX Hawaii PPO	$6,632.86
Rate for Payer: University Health Alliance Commercial	$3,829.28

NAIL FEMORAL 13X380 2339-1336S

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,786.13
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: Kaiser Permanente Commercial	$3,441.69
Rate for Payer: Kaiser Permanente Medicaid	$2,786.13
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL 13X380 2339-1336S

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,059.28
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL GT LEFT

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.52
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT LEFT

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,482.17
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Kaiser Permanente Commercial	$3,066.21
Rate for Payer: Kaiser Permanente Medicaid	$2,482.17
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT LF

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,482.17
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Kaiser Permanente Commercial	$3,066.21
Rate for Payer: Kaiser Permanente Medicaid	$2,482.17
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT LF

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.52
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT RIGHT

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,482.17
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Kaiser Permanente Commercial	$3,066.21
Rate for Payer: Kaiser Permanente Medicaid	$2,482.17
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT RIGHT

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.52
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT RT 2333-0934S

Facility

$6,082.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,405.92
Max. Negotiated Rate	$5,899.54
Rate for Payer: Cash Price	$3,649.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,257.40
Rate for Payer: Health Management Network Commercial	$5,169.70
Rate for Payer: MDX Hawaii PPO	$5,899.54
Rate for Payer: University Health Alliance Commercial	$3,405.92

NAIL FEMORAL GT RT 2333-0934S

Facility

$6,082.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,101.82
Max. Negotiated Rate	$5,899.54
Rate for Payer: Cash Price	$3,649.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,257.40
Rate for Payer: Health Management Network Commercial	$5,169.70
Rate for Payer: Kaiser Permanente Commercial	$3,831.66
Rate for Payer: Kaiser Permanente Medicaid	$3,101.82
Rate for Payer: MDX Hawaii PPO	$5,899.54
Rate for Payer: University Health Alliance Commercial	$3,405.92

NAIL FEMORAL GT RT 2333-0936S

Facility

$6,082.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,101.82
Max. Negotiated Rate	$5,899.54
Rate for Payer: Cash Price	$3,649.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,257.40
Rate for Payer: Health Management Network Commercial	$5,169.70
Rate for Payer: Kaiser Permanente Commercial	$3,831.66
Rate for Payer: Kaiser Permanente Medicaid	$3,101.82
Rate for Payer: MDX Hawaii PPO	$5,899.54
Rate for Payer: University Health Alliance Commercial	$3,405.92

NAIL FEMORAL GT RT 2333-0936S

Facility

$6,082.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,405.92
Max. Negotiated Rate	$5,899.54
Rate for Payer: Cash Price	$3,649.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,257.40
Rate for Payer: Health Management Network Commercial	$5,169.70
Rate for Payer: MDX Hawaii PPO	$5,899.54
Rate for Payer: University Health Alliance Commercial	$3,405.92

NAIL FEMORAL GT RT 2333-1032S

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,482.17
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Kaiser Permanente Commercial	$3,066.21
Rate for Payer: Kaiser Permanente Medicaid	$2,482.17
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT RT 2333-1032S

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.52
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL RETRO 2339-1138S

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,059.28
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL RETRO 2339-1138S

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,786.13
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: Kaiser Permanente Commercial	$3,441.69
Rate for Payer: Kaiser Permanente Medicaid	$2,786.13
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL RETROGRADE

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,059.28
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL RETROGRADE

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,786.13
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: Kaiser Permanente Commercial	$3,441.69
Rate for Payer: Kaiser Permanente Medicaid	$2,786.13
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL RETROGRADE 13X340

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,059.28
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL RETROGRADE 13X340

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,786.13
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: Kaiser Permanente Commercial	$3,441.69
Rate for Payer: Kaiser Permanente Medicaid	$2,786.13
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMOR RETRGRDE 2339-1036S

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,059.28
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

Know your out-of-pocket cost for care.

All Charges