Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NAIL T2 FE RETRO 2339-1020S

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 T2 FE RETRO 2339-1020S

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 TFNA 9X320 L 04.037.953S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X320 L 04.037.953S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X320 R 04.037.952S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X320 R 04.037.952S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X340 L 04.037.955S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X340 L 04.037.955S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X360 L 04.037.957S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X360 L 04.037.957S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X360 R 04.037.956S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X360 R 04.037.956S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X380 L 04.037.959S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X380 L 04.037.959S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X380 R 04.037.958S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X380 R 04.037.958S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X400 L 04.037.961S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X400 L 04.037.961S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X400 R 04.037.960S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X400 R 04.037.960S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X420 L 04.037.963S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X420 L 04.037.963S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X420 R 04.037.962S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X420 R 04.037.962S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,046.23
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: Kaiser Permanente Commercial	$3,762.99
Rate for Payer: Kaiser Permanente Medicaid	$3,046.23
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

NAIL TFNA 9X440 L 04.037.965S

Facility

$5,973.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,344.88
Max. Negotiated Rate	$5,793.81
Rate for Payer: Cash Price	$3,583.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,181.10
Rate for Payer: Health Management Network Commercial	$5,077.05
Rate for Payer: MDX Hawaii PPO	$5,793.81
Rate for Payer: University Health Alliance Commercial	$3,344.88

Know your out-of-pocket cost for care.

All Charges