Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NAIL TIBIAL 10/300 04.034.440S

Facility

$4,280.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,182.80
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: Kaiser Permanente Commercial	$2,696.40
Rate for Payer: Kaiser Permanente Medicaid	$2,182.80
Rate for Payer: MDX Hawaii PPO	$4,151.60
Rate for Payer: University Health Alliance Commercial	$2,396.80

NAIL TIBIAL 10/315 04.004.443S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 10/315 04.004.443S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,853.85
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$2,290.05
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 10/315 04.034.443S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,791.12
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$2,212.56
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 10/315 04.034.443S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 10/330 04.034.446S

Facility

$3,882.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,173.92
Max. Negotiated Rate	$3,765.54
Rate for Payer: Cash Price	$2,329.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,717.40
Rate for Payer: Health Management Network Commercial	$3,299.70
Rate for Payer: MDX Hawaii PPO	$3,765.54
Rate for Payer: University Health Alliance Commercial	$2,173.92

NAIL TIBIAL 10/330 04.034.446S

Facility

$3,882.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,979.82
Max. Negotiated Rate	$3,765.54
Rate for Payer: Cash Price	$2,329.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,717.40
Rate for Payer: Health Management Network Commercial	$3,299.70
Rate for Payer: Kaiser Permanente Commercial	$2,445.66
Rate for Payer: Kaiser Permanente Medicaid	$1,979.82
Rate for Payer: MDX Hawaii PPO	$3,765.54
Rate for Payer: University Health Alliance Commercial	$2,173.92

NAIL TIBIAL 10/345 04.004.449S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 10/345 04.004.449S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,853.85
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$2,290.05
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 10/345 04.034.449S

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

NAIL TIBIAL 10/345 04.034.449S

Facility

$4,280.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,182.80
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: Kaiser Permanente Commercial	$2,696.40
Rate for Payer: Kaiser Permanente Medicaid	$2,182.80
Rate for Payer: MDX Hawaii PPO	$4,151.60
Rate for Payer: University Health Alliance Commercial	$2,396.80

NAIL TIBIAL 10/360 04.034.452S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 10/360 04.034.452S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,853.85
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$2,290.05
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 10/375 04.034.455S

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 10/375 04.034.455S

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 10/390 04.034.458S

Facility

$4,580.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,335.80
Max. Negotiated Rate	$4,442.60
Rate for Payer: Cash Price	$2,748.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,206.00
Rate for Payer: Health Management Network Commercial	$3,893.00
Rate for Payer: Kaiser Permanente Commercial	$2,885.40
Rate for Payer: Kaiser Permanente Medicaid	$2,335.80
Rate for Payer: MDX Hawaii PPO	$4,442.60
Rate for Payer: University Health Alliance Commercial	$2,564.80

NAIL TIBIAL 10/390 04.034.458S

Facility

$4,580.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.80
Max. Negotiated Rate	$4,442.60
Rate for Payer: Cash Price	$2,748.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,206.00
Rate for Payer: Health Management Network Commercial	$3,893.00
Rate for Payer: MDX Hawaii PPO	$4,442.60
Rate for Payer: University Health Alliance Commercial	$2,564.80

NAIL TIBIAL 10/405 04.034.461S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,791.12
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$2,212.56
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 10/405 04.034.461S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 10/420 04.034.464S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,791.12
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$2,212.56
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 10/420 04.034.464S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 10X285MM

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 10X285MM

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 TIBIAL 10X315 2341-1031S

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 10X315 2341-1031S

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

Know your out-of-pocket cost for care.

All Charges