Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NAIL TI 13X340/LT 04.003.649S

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 13X340/LT 04.003.649S

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 13X340/RT 04.003.648S

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 13X340/RT 04.003.648S

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 13X360/LT 04.003.653S

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 13X360/LT 04.003.653S

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 13X360/RT 04.003.652S

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 13X360/RT 04.003.652S

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 13X380/LT 04.003.657S

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 13X380/LT 04.003.657S

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 13X380/RT 04.003.656S

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 13X380/RT 04.003.656S

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 13X400/LT 04.003.661S

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 13X400/LT 04.003.661S

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 13X400/RT 04.003.660S

Facility

$6,342.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,551.52
Max. Negotiated Rate	$6,151.74
Rate for Payer: Cash Price	$3,805.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,439.40
Rate for Payer: Health Management Network Commercial	$5,390.70
Rate for Payer: MDX Hawaii PPO	$6,151.74
Rate for Payer: University Health Alliance Commercial	$3,551.52

NAIL TI 13X400/RT 04.003.660S

Facility

$6,342.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,234.42
Max. Negotiated Rate	$6,151.74
Rate for Payer: Cash Price	$3,805.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,439.40
Rate for Payer: Health Management Network Commercial	$5,390.70
Rate for Payer: Kaiser Permanente Commercial	$3,995.46
Rate for Payer: Kaiser Permanente Medicaid	$3,234.42
Rate for Payer: MDX Hawaii PPO	$6,151.74
Rate for Payer: University Health Alliance Commercial	$3,551.52

NAIL TI 13X420/LT 04.003.665S

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 13X420/LT 04.003.665S

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 13X420/RT 04.003.664S

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 13X420/RT 04.003.664S

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 TIBIA 10X330MM 2341-1033S

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,091.00
Max. Negotiated Rate	$3,977.00
Rate for Payer: Cash Price	$2,460.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,870.00
Rate for Payer: Health Management Network Commercial	$3,485.00
Rate for Payer: Kaiser Permanente Commercial	$2,583.00
Rate for Payer: Kaiser Permanente Medicaid	$2,091.00
Rate for Payer: MDX Hawaii PPO	$3,977.00
Rate for Payer: University Health Alliance Commercial	$2,296.00

NAIL TIBIA 10X330MM 2341-1033S

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,296.00
Max. Negotiated Rate	$3,977.00
Rate for Payer: Cash Price	$2,460.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,870.00
Rate for Payer: Health Management Network Commercial	$3,485.00
Rate for Payer: MDX Hawaii PPO	$3,977.00
Rate for Payer: University Health Alliance Commercial	$2,296.00

NAIL TIBIAL 10/285 04.034.437S

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,040.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

NAIL TIBIAL 10/285 04.034.437S

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

NAIL TIBIAL 10/300 04.034.440S

Facility

$4,280.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.80
Max. Negotiated Rate	$4,151.60
Rate for Payer: Cash Price	$2,568.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,996.00
Rate for Payer: Health Management Network Commercial	$3,638.00
Rate for Payer: MDX Hawaii PPO	$4,151.60
Rate for Payer: University Health Alliance Commercial	$2,396.80

Know your out-of-pocket cost for care.

All Charges