Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PIN GLENOID 7000-35-230

Facility

$5,047.00

Service Code	HCPCS C1769
Hospital Revenue Code	278
Min. Negotiated Rate	$2,573.97
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: Kaiser Permanente Commercial	$3,179.61
Rate for Payer: Kaiser Permanente Medicaid	$2,573.97
Rate for Payer: MDX Hawaii PPO	$4,895.59
Rate for Payer: University Health Alliance Commercial	$2,826.32

PIN HALF TL 4MMX180MM 54-11230

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: MDX Hawaii PPO	$474.33

PIN HALF TL 4MMX180MM 54-11230

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.39
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.55
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Kaiser Permanente Commercial	$308.07
Rate for Payer: Kaiser Permanente Medicaid	$249.39
Rate for Payer: MDX Hawaii PPO	$474.33
Rate for Payer: University Health Alliance Commercial	$356.43

PIN HALF TL 5MMX180MM 54-11240

Facility

$490.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$475.30
Rate for Payer: Cash Price	$294.00
Rate for Payer: Hawaii Western Management Group Commercial	$465.50
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Kaiser Permanente Commercial	$308.70
Rate for Payer: Kaiser Permanente Medicaid	$249.90
Rate for Payer: MDX Hawaii PPO	$475.30
Rate for Payer: University Health Alliance Commercial	$357.16

PIN HALF TL 5MMX180MM 54-11240

Facility

$490.00

Hospital Revenue Code	272
Min. Negotiated Rate	$416.50
Max. Negotiated Rate	$475.30
Rate for Payer: Cash Price	$294.00
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: MDX Hawaii PPO	$475.30

PIN HALF TL 6MMX180MM 54-11250

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: MDX Hawaii PPO	$474.33

PIN HALF TL 6MMX180MM 54-11250

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.39
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.55
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Kaiser Permanente Commercial	$308.07
Rate for Payer: Kaiser Permanente Medicaid	$249.39
Rate for Payer: MDX Hawaii PPO	$474.33
Rate for Payer: University Health Alliance Commercial	$356.43

PINNING SYSTEM 2544-00-111

Facility

$875.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$551.25
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

PINNING SYSTEM 2544-00-111

Facility

$875.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

PIN PRECISION 1420-0060S

Facility

$896.00

Hospital Revenue Code	272
Min. Negotiated Rate	$456.96
Max. Negotiated Rate	$869.12
Rate for Payer: Cash Price	$537.60
Rate for Payer: Hawaii Western Management Group Commercial	$851.20
Rate for Payer: Health Management Network Commercial	$761.60
Rate for Payer: Kaiser Permanente Commercial	$564.48
Rate for Payer: Kaiser Permanente Medicaid	$456.96
Rate for Payer: MDX Hawaii PPO	$869.12
Rate for Payer: University Health Alliance Commercial	$653.09

PIN PRECISION 1420-0060S

Facility

$896.00

Hospital Revenue Code	272
Min. Negotiated Rate	$761.60
Max. Negotiated Rate	$869.12
Rate for Payer: Cash Price	$537.60
Rate for Payer: Health Management Network Commercial	$761.60
Rate for Payer: MDX Hawaii PPO	$869.12

PIN SET UNIVERS II AR-9207S

Facility

$963.00

Hospital Revenue Code	272
Min. Negotiated Rate	$818.55
Max. Negotiated Rate	$934.11
Rate for Payer: Cash Price	$577.80
Rate for Payer: Health Management Network Commercial	$818.55
Rate for Payer: MDX Hawaii PPO	$934.11

PIN SET UNIVERS II AR-9207S

Facility

$963.00

Hospital Revenue Code	272
Min. Negotiated Rate	$491.13
Max. Negotiated Rate	$934.11
Rate for Payer: Cash Price	$577.80
Rate for Payer: Hawaii Western Management Group Commercial	$914.85
Rate for Payer: Health Management Network Commercial	$818.55
Rate for Payer: Kaiser Permanente Commercial	$606.69
Rate for Payer: Kaiser Permanente Medicaid	$491.13
Rate for Payer: MDX Hawaii PPO	$934.11
Rate for Payer: University Health Alliance Commercial	$701.93

PINS SHORT THREADED 11.00007

Facility

$750.00

Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: MDX Hawaii PPO	$727.50

PINS SHORT THREADED 11.00007

Facility

$750.00

Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$712.50
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: University Health Alliance Commercial	$546.67

PIN STEIN BAY TIP 144256

Facility

$320.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$310.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Hawaii Western Management Group Commercial	$224.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: Kaiser Permanente Commercial	$201.60
Rate for Payer: Kaiser Permanente Medicaid	$163.20
Rate for Payer: MDX Hawaii PPO	$310.40
Rate for Payer: University Health Alliance Commercial	$179.20

PIN STEIN BAY TIP 144256

Facility

$320.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$310.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Hawaii Western Management Group Commercial	$224.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: MDX Hawaii PPO	$310.40
Rate for Payer: University Health Alliance Commercial	$179.20

PIN STEINMAN 5.0X200MM 293.74

Facility

$638.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$325.38
Max. Negotiated Rate	$618.86
Rate for Payer: Cash Price	$382.80
Rate for Payer: Hawaii Western Management Group Commercial	$446.60
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: Kaiser Permanente Commercial	$401.94
Rate for Payer: Kaiser Permanente Medicaid	$325.38
Rate for Payer: MDX Hawaii PPO	$618.86
Rate for Payer: University Health Alliance Commercial	$357.28

PIN STEINMAN 5.0X200MM 293.74

Facility

$638.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$357.28
Max. Negotiated Rate	$618.86
Rate for Payer: Cash Price	$382.80
Rate for Payer: Hawaii Western Management Group Commercial	$446.60
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: MDX Hawaii PPO	$618.86
Rate for Payer: University Health Alliance Commercial	$357.28

PIN STEINMANN 3.2MM 405800

Facility

$544.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$277.44
Max. Negotiated Rate	$527.68
Rate for Payer: Cash Price	$326.40
Rate for Payer: Hawaii Western Management Group Commercial	$380.80
Rate for Payer: Health Management Network Commercial	$462.40
Rate for Payer: Kaiser Permanente Commercial	$342.72
Rate for Payer: Kaiser Permanente Medicaid	$277.44
Rate for Payer: MDX Hawaii PPO	$527.68
Rate for Payer: University Health Alliance Commercial	$304.64

PIN STEINMANN 3.2MM 405800

Facility

$544.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$304.64
Max. Negotiated Rate	$527.68
Rate for Payer: Cash Price	$326.40
Rate for Payer: Hawaii Western Management Group Commercial	$380.80
Rate for Payer: Health Management Network Commercial	$462.40
Rate for Payer: MDX Hawaii PPO	$527.68
Rate for Payer: University Health Alliance Commercial	$304.64

PIN STEINMANN 3.2X9 110003484

Facility

$431.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$219.81
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$258.60
Rate for Payer: Hawaii Western Management Group Commercial	$301.70
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Kaiser Permanente Commercial	$271.53
Rate for Payer: Kaiser Permanente Medicaid	$219.81
Rate for Payer: MDX Hawaii PPO	$418.07
Rate for Payer: University Health Alliance Commercial	$241.36

PIN STEINMANN 3.2X9 110003484

Facility

$431.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$241.36
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$258.60
Rate for Payer: Hawaii Western Management Group Commercial	$301.70
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: MDX Hawaii PPO	$418.07
Rate for Payer: University Health Alliance Commercial	$241.36

PIN STEINMANN AR-5050K-2

Facility

$205.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$123.00
Rate for Payer: Hawaii Western Management Group Commercial	$194.75
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Kaiser Permanente Commercial	$129.15
Rate for Payer: Kaiser Permanente Medicaid	$104.55
Rate for Payer: MDX Hawaii PPO	$198.85
Rate for Payer: University Health Alliance Commercial	$149.42

PIN STEINMANN AR-5050K-2

Facility

$205.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$174.25
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$123.00
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: MDX Hawaii PPO	$198.85

Know your out-of-pocket cost for care.

All Charges