Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

SCREW 3.5 NON-LCK 36MM 657436

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$371.84
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW 3.5 NON-LCK 36MM 657436

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$338.64
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Kaiser Permanente Commercial	$418.32
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW 3.5 NON-LCK 38MM 657438

Facility

$417.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$212.67
Max. Negotiated Rate	$404.49
Rate for Payer: Cash Price	$250.20
Rate for Payer: Hawaii Western Management Group Commercial	$291.90
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Kaiser Permanente Commercial	$262.71
Rate for Payer: Kaiser Permanente Medicaid	$212.67
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: University Health Alliance Commercial	$233.52

SCREW 3.5 NON-LCK 38MM 657438

Facility

$417.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$233.52
Max. Negotiated Rate	$404.49
Rate for Payer: Cash Price	$250.20
Rate for Payer: Hawaii Western Management Group Commercial	$291.90
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: University Health Alliance Commercial	$233.52

SCREW 3.5 NON-LCK 70MM 657470

Facility

$417.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$233.52
Max. Negotiated Rate	$404.49
Rate for Payer: Cash Price	$250.20
Rate for Payer: Hawaii Western Management Group Commercial	$291.90
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: University Health Alliance Commercial	$233.52

SCREW 3.5 NON-LCK 70MM 657470

Facility

$417.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$212.67
Max. Negotiated Rate	$404.49
Rate for Payer: Cash Price	$250.20
Rate for Payer: Hawaii Western Management Group Commercial	$291.90
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Kaiser Permanente Commercial	$262.71
Rate for Payer: Kaiser Permanente Medicaid	$212.67
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: University Health Alliance Commercial	$233.52

SCREW 3.5X10MM 00-2348-010-35

Facility

$216.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$110.16
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$129.60
Rate for Payer: Hawaii Western Management Group Commercial	$151.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$136.08
Rate for Payer: Kaiser Permanente Medicaid	$110.16
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: University Health Alliance Commercial	$120.96

SCREW 3.5X10MM 00-2348-010-35

Facility

$216.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$120.96
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$129.60
Rate for Payer: Hawaii Western Management Group Commercial	$151.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: University Health Alliance Commercial	$120.96

SCREW 3.5X4.0MM CANC 310.89

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$338.64
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Kaiser Permanente Commercial	$418.32
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW 3.5X4.0MM CANC 310.89

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$371.84
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW 3.5X44MM 00-2348-044-35

Facility

$161.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$90.16
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$96.60
Rate for Payer: Hawaii Western Management Group Commercial	$112.70
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: University Health Alliance Commercial	$90.16

SCREW 3.5X44MM 00-2348-044-35

Facility

$161.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$82.11
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$96.60
Rate for Payer: Hawaii Western Management Group Commercial	$112.70
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Kaiser Permanente Commercial	$101.43
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: University Health Alliance Commercial	$90.16

SCREW 4.5MM CANNULATED 30MM

Facility

$1,317.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$671.67
Max. Negotiated Rate	$1,277.49
Rate for Payer: Cash Price	$790.20
Rate for Payer: Hawaii Western Management Group Commercial	$921.90
Rate for Payer: Health Management Network Commercial	$1,119.45
Rate for Payer: Kaiser Permanente Commercial	$829.71
Rate for Payer: Kaiser Permanente Medicaid	$671.67
Rate for Payer: MDX Hawaii PPO	$1,277.49
Rate for Payer: University Health Alliance Commercial	$737.52

SCREW 4.5MM CANNULATED 30MM

Facility

$1,317.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$737.52
Max. Negotiated Rate	$1,277.49
Rate for Payer: Cash Price	$790.20
Rate for Payer: Hawaii Western Management Group Commercial	$921.90
Rate for Payer: Health Management Network Commercial	$1,119.45
Rate for Payer: MDX Hawaii PPO	$1,277.49
Rate for Payer: University Health Alliance Commercial	$737.52

SCREW 4.5MM CANNULATED 32MM

Facility

$1,317.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$737.52
Max. Negotiated Rate	$1,277.49
Rate for Payer: Cash Price	$790.20
Rate for Payer: Hawaii Western Management Group Commercial	$921.90
Rate for Payer: Health Management Network Commercial	$1,119.45
Rate for Payer: MDX Hawaii PPO	$1,277.49
Rate for Payer: University Health Alliance Commercial	$737.52

SCREW 4.5MM CANNULATED 32MM

Facility

$1,317.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$671.67
Max. Negotiated Rate	$1,277.49
Rate for Payer: Cash Price	$790.20
Rate for Payer: Hawaii Western Management Group Commercial	$921.90
Rate for Payer: Health Management Network Commercial	$1,119.45
Rate for Payer: Kaiser Permanente Commercial	$829.71
Rate for Payer: Kaiser Permanente Medicaid	$671.67
Rate for Payer: MDX Hawaii PPO	$1,277.49
Rate for Payer: University Health Alliance Commercial	$737.52

SCREW 4.5MM CORTEX 85MM

Facility

$216.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$120.96
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$129.60
Rate for Payer: Hawaii Western Management Group Commercial	$151.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: University Health Alliance Commercial	$120.96

SCREW 4.5MM CORTEX 85MM

Facility

$216.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$110.16
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$129.60
Rate for Payer: Hawaii Western Management Group Commercial	$151.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$136.08
Rate for Payer: Kaiser Permanente Medicaid	$110.16
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: University Health Alliance Commercial	$120.96

SCREW 5.0 LCK SELF TAP 661134

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$411.06
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$507.78
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK SELF TAP 661134

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK SP 30MM 661130

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$411.06
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$507.78
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK SP 30MM 661130

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK S/T 24MM 661124

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$411.06
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$507.78
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK S/T 24MM 661124

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK S/T 46MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

Know your out-of-pocket cost for care.

All Charges