Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PIN 4.5 POSITIONING #298.803S

Facility

$815.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$790.55
Rate for Payer: Cash Price	$489.00
Rate for Payer: Hawaii Western Management Group Commercial	$570.50
Rate for Payer: Health Management Network Commercial	$692.75
Rate for Payer: Kaiser Permanente Commercial	$513.45
Rate for Payer: Kaiser Permanente Medicaid	$415.65
Rate for Payer: MDX Hawaii PPO	$790.55
Rate for Payer: University Health Alliance Commercial	$456.40

PIN 4.5 POSITIONING #298.803S

Facility

$815.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$456.40
Max. Negotiated Rate	$790.55
Rate for Payer: Cash Price	$489.00
Rate for Payer: Hawaii Western Management Group Commercial	$570.50
Rate for Payer: Health Management Network Commercial	$692.75
Rate for Payer: MDX Hawaii PPO	$790.55
Rate for Payer: University Health Alliance Commercial	$456.40

PIN 5018-5-150

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$353.36
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN 5018-5-150

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$321.81
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$397.53
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN 5X250 APEX HALF 5018-7-250

Facility

$852.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$477.12
Max. Negotiated Rate	$826.44
Rate for Payer: Cash Price	$511.20
Rate for Payer: Hawaii Western Management Group Commercial	$596.40
Rate for Payer: Health Management Network Commercial	$724.20
Rate for Payer: MDX Hawaii PPO	$826.44
Rate for Payer: University Health Alliance Commercial	$477.12

PIN 5X250 APEX HALF 5018-7-250

Facility

$852.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$434.52
Max. Negotiated Rate	$826.44
Rate for Payer: Cash Price	$511.20
Rate for Payer: Hawaii Western Management Group Commercial	$596.40
Rate for Payer: Health Management Network Commercial	$724.20
Rate for Payer: Kaiser Permanente Commercial	$536.76
Rate for Payer: Kaiser Permanente Medicaid	$434.52
Rate for Payer: MDX Hawaii PPO	$826.44
Rate for Payer: University Health Alliance Commercial	$477.12

PIN 5X25 APEX HALF 5018-6-200

Facility

$547.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$306.32
Max. Negotiated Rate	$530.59
Rate for Payer: Cash Price	$328.20
Rate for Payer: Hawaii Western Management Group Commercial	$382.90
Rate for Payer: Health Management Network Commercial	$464.95
Rate for Payer: MDX Hawaii PPO	$530.59
Rate for Payer: University Health Alliance Commercial	$306.32

PIN 5X25 APEX HALF 5018-6-200

Facility

$547.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$278.97
Max. Negotiated Rate	$530.59
Rate for Payer: Cash Price	$328.20
Rate for Payer: Hawaii Western Management Group Commercial	$382.90
Rate for Payer: Health Management Network Commercial	$464.95
Rate for Payer: Kaiser Permanente Commercial	$344.61
Rate for Payer: Kaiser Permanente Medicaid	$278.97
Rate for Payer: MDX Hawaii PPO	$530.59
Rate for Payer: University Health Alliance Commercial	$306.32

PIN APEX 5MM 5018-6-150

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$321.81
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$397.53
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN APEX 5MM 5018-6-150

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$353.36
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN APEX S/D HALF 5018-5-120

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$321.81
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$397.53
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN APEX S/D HALF 5018-5-120

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$353.36
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN APEX SELF-DRILL 5018-5-200

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$321.81
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$397.53
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN APEX SELF-DRILL 5018-5-200

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$353.36
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN AXIS 2.5X40 IJS-EAP-25400

Facility

$1,127.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$631.12
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Hawaii Western Management Group Commercial	$788.90
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: University Health Alliance Commercial	$631.12

PIN AXIS 2.5X40 IJS-EAP-25400

Facility

$1,127.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$574.77
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Hawaii Western Management Group Commercial	$788.90
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$710.01
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: University Health Alliance Commercial	$631.12

PIN CLAMP 10 HOLES 4921-2-060

Facility

$2,456.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,087.60
Max. Negotiated Rate	$2,382.32
Rate for Payer: Cash Price	$1,473.60
Rate for Payer: Health Management Network Commercial	$2,087.60
Rate for Payer: MDX Hawaii PPO	$2,382.32

PIN CLAMP 10 HOLES 4921-2-060

Facility

$2,456.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,252.56
Max. Negotiated Rate	$2,382.32
Rate for Payer: Cash Price	$1,473.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,333.20
Rate for Payer: Health Management Network Commercial	$2,087.60
Rate for Payer: Kaiser Permanente Commercial	$1,547.28
Rate for Payer: Kaiser Permanente Medicaid	$1,252.56
Rate for Payer: MDX Hawaii PPO	$2,382.32
Rate for Payer: University Health Alliance Commercial	$1,790.18

PIN CLAMP 4922-2-240

Facility

$2,452.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,373.12
Max. Negotiated Rate	$2,378.44
Rate for Payer: Cash Price	$1,471.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,716.40
Rate for Payer: Health Management Network Commercial	$2,084.20
Rate for Payer: MDX Hawaii PPO	$2,378.44
Rate for Payer: University Health Alliance Commercial	$1,373.12

PIN CLAMP 4922-2-240

Facility

$2,452.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.52
Max. Negotiated Rate	$2,378.44
Rate for Payer: Cash Price	$1,471.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,716.40
Rate for Payer: Health Management Network Commercial	$2,084.20
Rate for Payer: Kaiser Permanente Commercial	$1,544.76
Rate for Payer: Kaiser Permanente Medicaid	$1,250.52
Rate for Payer: MDX Hawaii PPO	$2,378.44
Rate for Payer: University Health Alliance Commercial	$1,373.12

PIN DRILL 1.5X100MM AR-4151DS

Facility

$1,225.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$686.00
Max. Negotiated Rate	$1,188.25
Rate for Payer: Cash Price	$735.00
Rate for Payer: Hawaii Western Management Group Commercial	$857.50
Rate for Payer: Health Management Network Commercial	$1,041.25
Rate for Payer: MDX Hawaii PPO	$1,188.25
Rate for Payer: University Health Alliance Commercial	$686.00

PIN DRILL 1.5X100MM AR-4151DS

Facility

$1,225.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$1,188.25
Rate for Payer: Cash Price	$735.00
Rate for Payer: Hawaii Western Management Group Commercial	$857.50
Rate for Payer: Health Management Network Commercial	$1,041.25
Rate for Payer: Kaiser Permanente Commercial	$771.75
Rate for Payer: Kaiser Permanente Medicaid	$624.75
Rate for Payer: MDX Hawaii PPO	$1,188.25
Rate for Payer: University Health Alliance Commercial	$686.00

PIN GAMMA4 PRECISIN 1420-0065S

Facility

$887.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$496.72
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$532.20
Rate for Payer: Hawaii Western Management Group Commercial	$620.90
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: University Health Alliance Commercial	$496.72

PIN GAMMA4 PRECISIN 1420-0065S

Facility

$887.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$452.37
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$532.20
Rate for Payer: Hawaii Western Management Group Commercial	$620.90
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$558.81
Rate for Payer: Kaiser Permanente Medicaid	$452.37
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: University Health Alliance Commercial	$496.72

PIN GLENOID 7000-35-230

Facility

$5,047.00

Service Code	HCPCS C1769
Hospital Revenue Code	278
Min. Negotiated Rate	$2,826.32
Max. Negotiated Rate	$4,895.59
Rate for Payer: Cash Price	$3,028.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,532.90
Rate for Payer: Health Management Network Commercial	$4,289.95
Rate for Payer: MDX Hawaii PPO	$4,895.59
Rate for Payer: University Health Alliance Commercial	$2,826.32

Know your out-of-pocket cost for care.

All Charges