Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PLATE 3.5MM LAPIDUS 336-3560

Facility

$3,031.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,545.81
Max. Negotiated Rate	$2,940.07
Rate for Payer: Cash Price	$1,818.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,121.70
Rate for Payer: Health Management Network Commercial	$2,576.35
Rate for Payer: Kaiser Permanente Commercial	$1,909.53
Rate for Payer: Kaiser Permanente Medicaid	$1,545.81
Rate for Payer: MDX Hawaii PPO	$2,940.07
Rate for Payer: University Health Alliance Commercial	$1,697.36

PLATE 3.5MM LAPIDUS 336-3560

Facility

$3,031.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,697.36
Max. Negotiated Rate	$2,940.07
Rate for Payer: Cash Price	$1,818.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,121.70
Rate for Payer: Health Management Network Commercial	$2,576.35
Rate for Payer: MDX Hawaii PPO	$2,940.07
Rate for Payer: University Health Alliance Commercial	$1,697.36

PLATE 3.5 TIBIA RT 02.127.210

Facility

$3,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,051.84
Max. Negotiated Rate	$3,554.08
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.80
Rate for Payer: Health Management Network Commercial	$3,114.40
Rate for Payer: MDX Hawaii PPO	$3,554.08
Rate for Payer: University Health Alliance Commercial	$2,051.84

PLATE 3.5 TIBIA RT 02.127.210

Facility

$3,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.64
Max. Negotiated Rate	$3,554.08
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.80
Rate for Payer: Health Management Network Commercial	$3,114.40
Rate for Payer: Kaiser Permanente Commercial	$2,308.32
Rate for Payer: Kaiser Permanente Medicaid	$1,868.64
Rate for Payer: MDX Hawaii PPO	$3,554.08
Rate for Payer: University Health Alliance Commercial	$2,051.84

PLATE 3.5X158 6H/RT 02.104.006

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,820.00
Max. Negotiated Rate	$3,152.50
Rate for Payer: Cash Price	$1,950.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,275.00
Rate for Payer: Health Management Network Commercial	$2,762.50
Rate for Payer: MDX Hawaii PPO	$3,152.50
Rate for Payer: University Health Alliance Commercial	$1,820.00

PLATE 3.5X158 6H/RT 02.104.006

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$3,152.50
Rate for Payer: Cash Price	$1,950.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,275.00
Rate for Payer: Health Management Network Commercial	$2,762.50
Rate for Payer: Kaiser Permanente Commercial	$2,047.50
Rate for Payer: Kaiser Permanente Medicaid	$1,657.50
Rate for Payer: MDX Hawaii PPO	$3,152.50
Rate for Payer: University Health Alliance Commercial	$1,820.00

PLATE 3.5X86MM 2HOLE 236.503

Facility

$2,073.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.23
Max. Negotiated Rate	$2,010.81
Rate for Payer: Cash Price	$1,243.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.10
Rate for Payer: Health Management Network Commercial	$1,762.05
Rate for Payer: Kaiser Permanente Commercial	$1,305.99
Rate for Payer: Kaiser Permanente Medicaid	$1,057.23
Rate for Payer: MDX Hawaii PPO	$2,010.81
Rate for Payer: University Health Alliance Commercial	$1,160.88

PLATE 3.5X86MM 2HOLE 236.503

Facility

$2,073.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,160.88
Max. Negotiated Rate	$2,010.81
Rate for Payer: Cash Price	$1,243.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.10
Rate for Payer: Health Management Network Commercial	$1,762.05
Rate for Payer: MDX Hawaii PPO	$2,010.81
Rate for Payer: University Health Alliance Commercial	$1,160.88

PLATE 3 HOLE 629363

Facility

$2,858.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.48
Max. Negotiated Rate	$2,772.26
Rate for Payer: Cash Price	$1,714.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,000.60
Rate for Payer: Health Management Network Commercial	$2,429.30
Rate for Payer: MDX Hawaii PPO	$2,772.26
Rate for Payer: University Health Alliance Commercial	$1,600.48

PLATE 3 HOLE 629363

Facility

$2,858.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,457.58
Max. Negotiated Rate	$2,772.26
Rate for Payer: Cash Price	$1,714.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,000.60
Rate for Payer: Health Management Network Commercial	$2,429.30
Rate for Payer: Kaiser Permanente Commercial	$1,800.54
Rate for Payer: Kaiser Permanente Medicaid	$1,457.58
Rate for Payer: MDX Hawaii PPO	$2,772.26
Rate for Payer: University Health Alliance Commercial	$1,600.48

PLATE 3 HOLE 7 PEG VLBPR-3-7N

Facility

$3,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,691.20
Max. Negotiated Rate	$2,929.40
Rate for Payer: Cash Price	$1,812.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,114.00
Rate for Payer: Health Management Network Commercial	$2,567.00
Rate for Payer: MDX Hawaii PPO	$2,929.40
Rate for Payer: University Health Alliance Commercial	$1,691.20

PLATE 3 HOLE 7 PEG VLBPR-3-7N

Facility

$3,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,540.20
Max. Negotiated Rate	$2,929.40
Rate for Payer: Cash Price	$1,812.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,114.00
Rate for Payer: Health Management Network Commercial	$2,567.00
Rate for Payer: Kaiser Permanente Commercial	$1,902.60
Rate for Payer: Kaiser Permanente Medicaid	$1,540.20
Rate for Payer: MDX Hawaii PPO	$2,929.40
Rate for Payer: University Health Alliance Commercial	$1,691.20

PLATE 3-HOLE/88MM 240.23

Facility

$914.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$466.14
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$548.40
Rate for Payer: Hawaii Western Management Group Commercial	$639.80
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Kaiser Permanente Commercial	$575.82
Rate for Payer: Kaiser Permanente Medicaid	$466.14
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: University Health Alliance Commercial	$511.84

PLATE 3-HOLE/88MM 240.23

Facility

$914.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$511.84
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$548.40
Rate for Payer: Hawaii Western Management Group Commercial	$639.80
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: University Health Alliance Commercial	$511.84

PLATE 3 HOLES 84MM

Facility

$2,193.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,118.43
Max. Negotiated Rate	$2,127.21
Rate for Payer: Cash Price	$1,315.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,535.10
Rate for Payer: Health Management Network Commercial	$1,864.05
Rate for Payer: Kaiser Permanente Commercial	$1,381.59
Rate for Payer: Kaiser Permanente Medicaid	$1,118.43
Rate for Payer: MDX Hawaii PPO	$2,127.21
Rate for Payer: University Health Alliance Commercial	$1,228.08

PLATE 3 HOLES 84MM

Facility

$2,193.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,228.08
Max. Negotiated Rate	$2,127.21
Rate for Payer: Cash Price	$1,315.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,535.10
Rate for Payer: Health Management Network Commercial	$1,864.05
Rate for Payer: MDX Hawaii PPO	$2,127.21
Rate for Payer: University Health Alliance Commercial	$1,228.08

PLATE 3H/RT/75MM 02.117.203

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.99
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Kaiser Permanente Commercial	$1,731.87
Rate for Payer: Kaiser Permanente Medicaid	$1,401.99
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

PLATE 3H/RT/75MM 02.117.203

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.44
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

PLATE 4.0MM COMP 162MM 12H

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

PLATE 4.0MM COMP 162MM 12H

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

PLATE 4.52 VA-LCP 02.124.412

Facility

$4,419.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,474.64
Max. Negotiated Rate	$4,286.43
Rate for Payer: Cash Price	$2,651.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,093.30
Rate for Payer: Health Management Network Commercial	$3,756.15
Rate for Payer: MDX Hawaii PPO	$4,286.43
Rate for Payer: University Health Alliance Commercial	$2,474.64

PLATE 4.52 VA-LCP 02.124.412

Facility

$4,419.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,253.69
Max. Negotiated Rate	$4,286.43
Rate for Payer: Cash Price	$2,651.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,093.30
Rate for Payer: Health Management Network Commercial	$3,756.15
Rate for Payer: Kaiser Permanente Commercial	$2,783.97
Rate for Payer: Kaiser Permanente Medicaid	$2,253.69
Rate for Payer: MDX Hawaii PPO	$4,286.43
Rate for Payer: University Health Alliance Commercial	$2,474.64

PLATE 4.5/6H/170MM LT 222.657

Facility

$3,479.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,774.29
Max. Negotiated Rate	$3,374.63
Rate for Payer: Cash Price	$2,087.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,435.30
Rate for Payer: Health Management Network Commercial	$2,957.15
Rate for Payer: Kaiser Permanente Commercial	$2,191.77
Rate for Payer: Kaiser Permanente Medicaid	$1,774.29
Rate for Payer: MDX Hawaii PPO	$3,374.63
Rate for Payer: University Health Alliance Commercial	$1,948.24

PLATE 4.5/6H/170MM LT 222.657

Facility

$3,479.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,948.24
Max. Negotiated Rate	$3,374.63
Rate for Payer: Cash Price	$2,087.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,435.30
Rate for Payer: Health Management Network Commercial	$2,957.15
Rate for Payer: MDX Hawaii PPO	$3,374.63
Rate for Payer: University Health Alliance Commercial	$1,948.24

PLATE 4.5/6H/170MM RT 222.656

Facility

$5,042.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,571.42
Max. Negotiated Rate	$4,890.74
Rate for Payer: Cash Price	$3,025.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,529.40
Rate for Payer: Health Management Network Commercial	$4,285.70
Rate for Payer: Kaiser Permanente Commercial	$3,176.46
Rate for Payer: Kaiser Permanente Medicaid	$2,571.42
Rate for Payer: MDX Hawaii PPO	$4,890.74
Rate for Payer: University Health Alliance Commercial	$2,823.52

Know your out-of-pocket cost for care.

All Charges