Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NAIL TI 12X320/RT 04.003.544S

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 12X340/LT 04.003.549S

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 12X340/LT 04.003.549S

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 12X340/RT 04.003.548S

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 12X340/RT 04.003.548S

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 12X360/LT 04.003.553S

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 12X360/LT 04.003.553S

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 12X360/RT 04.003.552S

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 12X360/RT 04.003.552S

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 12X380/LT 04.003.557S

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 12X380/LT 04.003.557S

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 12X380/RT 04.003.556S

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 12X380/RT 04.003.556S

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 12X400/LT 04.003.561S

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 12X400/LT 04.003.561S

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 12X400/RT 04.003.560S

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 12X400/RT 04.003.560S

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 12X420/LT 04.003.565S

Facility

$3,806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,131.36
Max. Negotiated Rate	$3,691.82
Rate for Payer: Cash Price	$2,283.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,664.20
Rate for Payer: Health Management Network Commercial	$3,235.10
Rate for Payer: MDX Hawaii PPO	$3,691.82
Rate for Payer: University Health Alliance Commercial	$2,131.36

NAIL TI 12X420/LT 04.003.565S

Facility

$3,806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,941.06
Max. Negotiated Rate	$3,691.82
Rate for Payer: Cash Price	$2,283.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,664.20
Rate for Payer: Health Management Network Commercial	$3,235.10
Rate for Payer: Kaiser Permanente Commercial	$2,397.78
Rate for Payer: Kaiser Permanente Medicaid	$1,941.06
Rate for Payer: MDX Hawaii PPO	$3,691.82
Rate for Payer: University Health Alliance Commercial	$2,131.36

NAIL TI 12X420/RT 04.003.564S

Facility

$3,812.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,134.72
Max. Negotiated Rate	$3,697.64
Rate for Payer: Cash Price	$2,287.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,668.40
Rate for Payer: Health Management Network Commercial	$3,240.20
Rate for Payer: MDX Hawaii PPO	$3,697.64
Rate for Payer: University Health Alliance Commercial	$2,134.72

NAIL TI 12X420/RT 04.003.564S

Facility

$3,812.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,944.12
Max. Negotiated Rate	$3,697.64
Rate for Payer: Cash Price	$2,287.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,668.40
Rate for Payer: Health Management Network Commercial	$3,240.20
Rate for Payer: Kaiser Permanente Commercial	$2,401.56
Rate for Payer: Kaiser Permanente Medicaid	$1,944.12
Rate for Payer: MDX Hawaii PPO	$3,697.64
Rate for Payer: University Health Alliance Commercial	$2,134.72

NAIL TI 13X320/LT 04.003.645S

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 13X320/LT 04.003.645S

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 13X320/RT 04.003.644S

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 13X320/RT 04.003.644S

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

Know your out-of-pocket cost for care.

All Charges