Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NAIL TIBIAL 11/420 04.004.564S

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 11 X 315MM

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 11 X 315MM

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 11X360 2341-1136S

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 11X360 2341-1136S

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 12/285 04.004.637S

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 12/285 04.004.637S

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 12/300 04.004.640S

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 12/300 04.004.640S

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 12/315 04.004.643S

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 12/315 04.004.643S

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 12/330 04.004.646S

Facility

$4,214.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,359.84
Max. Negotiated Rate	$4,087.58
Rate for Payer: Cash Price	$2,528.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.80
Rate for Payer: Health Management Network Commercial	$3,581.90
Rate for Payer: MDX Hawaii PPO	$4,087.58
Rate for Payer: University Health Alliance Commercial	$2,359.84

NAIL TIBIAL 12/330 04.004.646S

Facility

$4,214.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,149.14
Max. Negotiated Rate	$4,087.58
Rate for Payer: Cash Price	$2,528.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.80
Rate for Payer: Health Management Network Commercial	$3,581.90
Rate for Payer: Kaiser Permanente Commercial	$2,654.82
Rate for Payer: Kaiser Permanente Medicaid	$2,149.14
Rate for Payer: MDX Hawaii PPO	$4,087.58
Rate for Payer: University Health Alliance Commercial	$2,359.84

NAIL TIBIAL 12/345 04.004.649S

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 12/345 04.004.649S

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 12/360 04.004.652S

Facility

$5,268.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,950.08
Max. Negotiated Rate	$5,109.96
Rate for Payer: Cash Price	$3,160.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,687.60
Rate for Payer: Health Management Network Commercial	$4,477.80
Rate for Payer: MDX Hawaii PPO	$5,109.96
Rate for Payer: University Health Alliance Commercial	$2,950.08

NAIL TIBIAL 12/360 04.004.652S

Facility

$5,268.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,686.68
Max. Negotiated Rate	$5,109.96
Rate for Payer: Cash Price	$3,160.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,687.60
Rate for Payer: Health Management Network Commercial	$4,477.80
Rate for Payer: Kaiser Permanente Commercial	$3,318.84
Rate for Payer: Kaiser Permanente Medicaid	$2,686.68
Rate for Payer: MDX Hawaii PPO	$5,109.96
Rate for Payer: University Health Alliance Commercial	$2,950.08

NAIL TIBIAL 12/375 04.004.655S

Facility

$4,214.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,359.84
Max. Negotiated Rate	$4,087.58
Rate for Payer: Cash Price	$2,528.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.80
Rate for Payer: Health Management Network Commercial	$3,581.90
Rate for Payer: MDX Hawaii PPO	$4,087.58
Rate for Payer: University Health Alliance Commercial	$2,359.84

NAIL TIBIAL 12/375 04.004.655S

Facility

$4,214.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,149.14
Max. Negotiated Rate	$4,087.58
Rate for Payer: Cash Price	$2,528.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.80
Rate for Payer: Health Management Network Commercial	$3,581.90
Rate for Payer: Kaiser Permanente Commercial	$2,654.82
Rate for Payer: Kaiser Permanente Medicaid	$2,149.14
Rate for Payer: MDX Hawaii PPO	$4,087.58
Rate for Payer: University Health Alliance Commercial	$2,359.84

NAIL TIBIAL 12/390 04.004.658S

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 12/390 04.004.658S

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 12/405 04.004.661S

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 12/405 04.004.661S

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 12/420 04.004.664S

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 12/420 04.004.664S

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

Know your out-of-pocket cost for care.

All Charges