Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANNULATED 4MM 42MM

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 CANNULATED 4MM 42MM

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 CANNULATED 4MM 44MM

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 CANNULATED 4MM 44MM

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 CANNULATED 4MM 46MM

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 CANNULATED 4MM 46MM

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 CANNULATED 4MM 48MM

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 CANNULATED 4MM 48MM

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 CENTRAL 6.5 X 40

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 CENTRAL 6.5 X 40

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 CORT 4.5 60MM 661760

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 CORT 4.5 60MM 661760

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 DRILL 2.7MM #405889

Facility

$581.00

Hospital Revenue Code	272
Min. Negotiated Rate	$493.85
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$348.60
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: MDX Hawaii PPO	$563.57

SCREW DRILL 2.7MM #405889

Facility

$581.00

Hospital Revenue Code	272
Min. Negotiated Rate	$296.31
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$348.60
Rate for Payer: Hawaii Western Management Group Commercial	$551.95
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$366.03
Rate for Payer: Kaiser Permanente Medicaid	$296.31
Rate for Payer: MDX Hawaii PPO	$563.57
Rate for Payer: University Health Alliance Commercial	$423.49

SCREWDRIVER 2.0/2.4MM 316-0102

Facility

$722.00

Hospital Revenue Code	272
Min. Negotiated Rate	$613.70
Max. Negotiated Rate	$700.34
Rate for Payer: Cash Price	$433.20
Rate for Payer: Health Management Network Commercial	$613.70
Rate for Payer: MDX Hawaii PPO	$700.34

SCREWDRIVER 2.0/2.4MM 316-0102

Facility

$722.00

Hospital Revenue Code	272
Min. Negotiated Rate	$368.22
Max. Negotiated Rate	$700.34
Rate for Payer: Cash Price	$433.20
Rate for Payer: Hawaii Western Management Group Commercial	$685.90
Rate for Payer: Health Management Network Commercial	$613.70
Rate for Payer: Kaiser Permanente Commercial	$454.86
Rate for Payer: Kaiser Permanente Medicaid	$368.22
Rate for Payer: MDX Hawaii PPO	$700.34
Rate for Payer: University Health Alliance Commercial	$526.27

SCREW FTHRD CAN 6.5X80 606080S

Facility

$1,196.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$609.96
Max. Negotiated Rate	$1,160.12
Rate for Payer: Cash Price	$717.60
Rate for Payer: Hawaii Western Management Group Commercial	$837.20
Rate for Payer: Health Management Network Commercial	$1,016.60
Rate for Payer: Kaiser Permanente Commercial	$753.48
Rate for Payer: Kaiser Permanente Medicaid	$609.96
Rate for Payer: MDX Hawaii PPO	$1,160.12
Rate for Payer: University Health Alliance Commercial	$669.76

SCREW FTHRD CAN 6.5X80 606080S

Facility

$1,196.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$669.76
Max. Negotiated Rate	$1,160.12
Rate for Payer: Cash Price	$717.60
Rate for Payer: Hawaii Western Management Group Commercial	$837.20
Rate for Payer: Health Management Network Commercial	$1,016.60
Rate for Payer: MDX Hawaii PPO	$1,160.12
Rate for Payer: University Health Alliance Commercial	$669.76

SCREW IMF 2.0X8MM 201.928E

Facility

$1,196.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$669.76
Max. Negotiated Rate	$1,160.12
Rate for Payer: Cash Price	$717.60
Rate for Payer: Hawaii Western Management Group Commercial	$837.20
Rate for Payer: Health Management Network Commercial	$1,016.60
Rate for Payer: MDX Hawaii PPO	$1,160.12
Rate for Payer: University Health Alliance Commercial	$669.76

SCREW IMF 2.0X8MM 201.928E

Facility

$1,196.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$609.96
Max. Negotiated Rate	$1,160.12
Rate for Payer: Cash Price	$717.60
Rate for Payer: Hawaii Western Management Group Commercial	$837.20
Rate for Payer: Health Management Network Commercial	$1,016.60
Rate for Payer: Kaiser Permanente Commercial	$753.48
Rate for Payer: Kaiser Permanente Medicaid	$609.96
Rate for Payer: MDX Hawaii PPO	$1,160.12
Rate for Payer: University Health Alliance Commercial	$669.76

SCREW LCK 2.7MMX20MM 657020

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 LCK 2.7MMX20MM 657020

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 LCK 2.7MMX30MM 657030

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 LCK 2.7MMX30MM 657030

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 LCK 2.7XMM 657026

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

Know your out-of-pocket cost for care.

All Charges