Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NAIL TFNA 9X440 L 04.037.965S

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 R 04.037.964S

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 9X440 R 04.037.964S

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 THREAD IM 45 IMN2.7-45 T

Facility

$2,450.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,470.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,715.00
Rate for Payer: Health Management Network Commercial	$2,082.50
Rate for Payer: Kaiser Permanente Commercial	$1,543.50
Rate for Payer: Kaiser Permanente Medicaid	$1,249.50
Rate for Payer: MDX Hawaii PPO	$2,376.50
Rate for Payer: University Health Alliance Commercial	$1,372.00

NAIL THREAD IM 45 IMN2.7-45 T

Facility

$2,450.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,372.00
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,470.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,715.00
Rate for Payer: Health Management Network Commercial	$2,082.50
Rate for Payer: MDX Hawaii PPO	$2,376.50
Rate for Payer: University Health Alliance Commercial	$1,372.00

NAIL TI 10X320/LT 04.003.345S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,193.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X320/LT 04.003.345S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X340/LT 04.003.349S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X340/LT 04.003.349S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,193.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X340/RT 04.003.348S

Facility

$4,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.80
Max. Negotiated Rate	$4,297.10
Rate for Payer: Cash Price	$2,658.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,101.00
Rate for Payer: Health Management Network Commercial	$3,765.50
Rate for Payer: MDX Hawaii PPO	$4,297.10
Rate for Payer: University Health Alliance Commercial	$2,480.80

NAIL TI 10X340/RT 04.003.348S

Facility

$4,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,259.30
Max. Negotiated Rate	$4,297.10
Rate for Payer: Cash Price	$2,658.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,101.00
Rate for Payer: Health Management Network Commercial	$3,765.50
Rate for Payer: Kaiser Permanente Commercial	$2,790.90
Rate for Payer: Kaiser Permanente Medicaid	$2,259.30
Rate for Payer: MDX Hawaii PPO	$4,297.10
Rate for Payer: University Health Alliance Commercial	$2,480.80

NAIL TI 10X360/LT 04.003.353S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X360/LT 04.003.353S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,193.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X360/RT 04.003.352S

Facility

$4,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,259.30
Max. Negotiated Rate	$4,297.10
Rate for Payer: Cash Price	$2,658.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,101.00
Rate for Payer: Health Management Network Commercial	$3,765.50
Rate for Payer: Kaiser Permanente Commercial	$2,790.90
Rate for Payer: Kaiser Permanente Medicaid	$2,259.30
Rate for Payer: MDX Hawaii PPO	$4,297.10
Rate for Payer: University Health Alliance Commercial	$2,480.80

NAIL TI 10X360/RT 04.003.352S

Facility

$4,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.80
Max. Negotiated Rate	$4,297.10
Rate for Payer: Cash Price	$2,658.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,101.00
Rate for Payer: Health Management Network Commercial	$3,765.50
Rate for Payer: MDX Hawaii PPO	$4,297.10
Rate for Payer: University Health Alliance Commercial	$2,480.80

NAIL TI 10X380/LT 04.003.357S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,193.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X380/LT 04.003.357S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X400/LT 04.003.361S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X400/LT 04.003.361S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,193.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X420/LT 04.003.365S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X420/LT 04.003.365S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,193.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X420/RT 04.003.364S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X420/RT 04.003.364S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,193.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 11X320/LT 04.003.445S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 11X320/LT 04.003.445S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,193.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

Know your out-of-pocket cost for care.

All Charges