Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

SCREW LCK 2.7XMM 657026

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 5.0 SELF TAP 661128

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 5.0 SELF TAP 661128

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 5.0 SELF TAP 661160

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 5.0 SELF TAP 661160

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 5.0X36 661136

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 5.0X36 661136

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 LCKIN 3.5MMX24MM 657324

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 LCKIN 3.5MMX24MM 657324

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 LCKIN 3.5MMX30MM 657330

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 LCKIN 3.5MMX30MM 657330

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 LOCK 2.7X20MM 02.211.020

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 LOCK 2.7X20MM 02.211.020

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 LOCK 2.7X30MM 02.211.030

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 LOCK 2.7X30MM 02.211.030

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 LOCK 2.7X36MM 02.211.036

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 LOCK 2.7X36MM 02.211.036

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 LOCKING 2.7MM 10MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$411.06
Max. Negotiated Rate	$781.82
Rate for Payer: Kaiser Permanente Commercial	$507.78
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 Medicaid	$411.06
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW LOCKING 2.7MM 10MM

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 LOCKING 3.5 X10MM

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 LOCKING 3.5 X10MM

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 LO-PRO PT THD TI 4.5X50

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 LO-PRO PT THD TI 4.5X50

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 LP 2.7X14 131227214

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 LP 2.7X14 131227214

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

Know your out-of-pocket cost for care.

All Charges