Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PLATE BONE LCK LF 02.117.504

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 BONE LCK LF 02.117.504

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 BONE LCK RT 02.117.606

Facility

$2,837.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,588.72
Max. Negotiated Rate	$2,751.89
Rate for Payer: Cash Price	$1,702.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,985.90
Rate for Payer: Health Management Network Commercial	$2,411.45
Rate for Payer: MDX Hawaii PPO	$2,751.89
Rate for Payer: University Health Alliance Commercial	$1,588.72

PLATE BONE LCK RT 02.117.606

Facility

$2,837.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,446.87
Max. Negotiated Rate	$2,751.89
Rate for Payer: Cash Price	$1,702.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,985.90
Rate for Payer: Health Management Network Commercial	$2,411.45
Rate for Payer: Kaiser Permanente Commercial	$1,787.31
Rate for Payer: Kaiser Permanente Medicaid	$1,446.87
Rate for Payer: MDX Hawaii PPO	$2,751.89
Rate for Payer: University Health Alliance Commercial	$1,588.72

PLATE BONE LCK T-SHP 247.351

Facility

$1,627.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$911.12
Max. Negotiated Rate	$1,578.19
Rate for Payer: Cash Price	$976.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,138.90
Rate for Payer: Health Management Network Commercial	$1,382.95
Rate for Payer: MDX Hawaii PPO	$1,578.19
Rate for Payer: University Health Alliance Commercial	$911.12

PLATE BONE LCK T-SHP 247.351

Facility

$1,627.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$829.77
Max. Negotiated Rate	$1,578.19
Rate for Payer: Cash Price	$976.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,138.90
Rate for Payer: Health Management Network Commercial	$1,382.95
Rate for Payer: Kaiser Permanente Commercial	$1,025.01
Rate for Payer: Kaiser Permanente Medicaid	$829.77
Rate for Payer: MDX Hawaii PPO	$1,578.19
Rate for Payer: University Health Alliance Commercial	$911.12

PLATE BONE UNI 7HOLE 482.823

Facility

$1,611.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$902.16
Max. Negotiated Rate	$1,562.67
Rate for Payer: Cash Price	$966.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.70
Rate for Payer: Health Management Network Commercial	$1,369.35
Rate for Payer: MDX Hawaii PPO	$1,562.67
Rate for Payer: University Health Alliance Commercial	$902.16

PLATE BONE UNI 7HOLE 482.823

Facility

$1,611.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$821.61
Max. Negotiated Rate	$1,562.67
Rate for Payer: Cash Price	$966.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.70
Rate for Payer: Health Management Network Commercial	$1,369.35
Rate for Payer: Kaiser Permanente Commercial	$1,014.93
Rate for Payer: Kaiser Permanente Medicaid	$821.61
Rate for Payer: MDX Hawaii PPO	$1,562.67
Rate for Payer: University Health Alliance Commercial	$902.16

PLATE BROAD 8H 629748

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.46
Max. Negotiated Rate	$2,372.62
Rate for Payer: Cash Price	$1,467.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,712.20
Rate for Payer: Health Management Network Commercial	$2,079.10
Rate for Payer: Kaiser Permanente Commercial	$1,540.98
Rate for Payer: Kaiser Permanente Medicaid	$1,247.46
Rate for Payer: MDX Hawaii PPO	$2,372.62
Rate for Payer: University Health Alliance Commercial	$1,369.76

PLATE BROAD 8H 629748

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,369.76
Max. Negotiated Rate	$2,372.62
Rate for Payer: Cash Price	$1,467.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,712.20
Rate for Payer: Health Management Network Commercial	$2,079.10
Rate for Payer: MDX Hawaii PPO	$2,372.62
Rate for Payer: University Health Alliance Commercial	$1,369.76

PLATE BUTT-L RT 4H 86MM 240.54

Facility

$1,506.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$843.36
Max. Negotiated Rate	$1,460.82
Rate for Payer: Cash Price	$903.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,054.20
Rate for Payer: Health Management Network Commercial	$1,280.10
Rate for Payer: MDX Hawaii PPO	$1,460.82
Rate for Payer: University Health Alliance Commercial	$843.36

PLATE BUTT-L RT 4H 86MM 240.54

Facility

$1,506.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$768.06
Max. Negotiated Rate	$1,460.82
Rate for Payer: Cash Price	$903.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,054.20
Rate for Payer: Health Management Network Commercial	$1,280.10
Rate for Payer: Kaiser Permanente Commercial	$948.78
Rate for Payer: Kaiser Permanente Medicaid	$768.06
Rate for Payer: MDX Hawaii PPO	$1,460.82
Rate for Payer: University Health Alliance Commercial	$843.36

PLATE BUTTRESS AR-8959TDS

Facility

$13,318.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$6,792.18
Max. Negotiated Rate	$12,918.46
Rate for Payer: Cash Price	$7,990.80
Rate for Payer: Hawaii Western Management Group Commercial	$9,322.60
Rate for Payer: Health Management Network Commercial	$11,320.30
Rate for Payer: Kaiser Permanente Commercial	$8,390.34
Rate for Payer: Kaiser Permanente Medicaid	$6,792.18
Rate for Payer: MDX Hawaii PPO	$12,918.46
Rate for Payer: University Health Alliance Commercial	$7,458.08

PLATE BUTTRESS AR-8959TDS

Facility

$13,318.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$7,458.08
Max. Negotiated Rate	$12,918.46
Rate for Payer: Cash Price	$7,990.80
Rate for Payer: Hawaii Western Management Group Commercial	$9,322.60
Rate for Payer: Health Management Network Commercial	$11,320.30
Rate for Payer: MDX Hawaii PPO	$12,918.46
Rate for Payer: University Health Alliance Commercial	$7,458.08

PLATE BUTTRES-T 4H 80MM 240.34

Facility

$2,094.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,172.64
Max. Negotiated Rate	$2,031.18
Rate for Payer: Cash Price	$1,256.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,465.80
Rate for Payer: Health Management Network Commercial	$1,779.90
Rate for Payer: MDX Hawaii PPO	$2,031.18
Rate for Payer: University Health Alliance Commercial	$1,172.64

PLATE BUTTRES-T 4H 80MM 240.34

Facility

$2,094.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,067.94
Max. Negotiated Rate	$2,031.18
Rate for Payer: Cash Price	$1,256.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,465.80
Rate for Payer: Health Management Network Commercial	$1,779.90
Rate for Payer: Kaiser Permanente Commercial	$1,319.22
Rate for Payer: Kaiser Permanente Medicaid	$1,067.94
Rate for Payer: MDX Hawaii PPO	$2,031.18
Rate for Payer: University Health Alliance Commercial	$1,172.64

PLATE BUTTRES-T 5H 96MM 240.35

Facility

$2,202.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.12
Max. Negotiated Rate	$2,135.94
Rate for Payer: Cash Price	$1,321.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,541.40
Rate for Payer: Health Management Network Commercial	$1,871.70
Rate for Payer: MDX Hawaii PPO	$2,135.94
Rate for Payer: University Health Alliance Commercial	$1,233.12

PLATE BUTTRES-T 5H 96MM 240.35

Facility

$2,202.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,123.02
Max. Negotiated Rate	$2,135.94
Rate for Payer: Cash Price	$1,321.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,541.40
Rate for Payer: Health Management Network Commercial	$1,871.70
Rate for Payer: Kaiser Permanente Commercial	$1,387.26
Rate for Payer: Kaiser Permanente Medicaid	$1,123.02
Rate for Payer: MDX Hawaii PPO	$2,135.94
Rate for Payer: University Health Alliance Commercial	$1,233.12

PLATE CALCANEAL64MM02.211.403

Facility

$2,296.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,285.76
Max. Negotiated Rate	$2,227.12
Rate for Payer: Cash Price	$1,377.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,607.20
Rate for Payer: Health Management Network Commercial	$1,951.60
Rate for Payer: MDX Hawaii PPO	$2,227.12
Rate for Payer: University Health Alliance Commercial	$1,285.76

PLATE CALCANEAL64MM02.211.403

Facility

$2,296.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.96
Max. Negotiated Rate	$2,227.12
Rate for Payer: Cash Price	$1,377.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,607.20
Rate for Payer: Health Management Network Commercial	$1,951.60
Rate for Payer: Kaiser Permanente Commercial	$1,446.48
Rate for Payer: Kaiser Permanente Medicaid	$1,170.96
Rate for Payer: MDX Hawaii PPO	$2,227.12
Rate for Payer: University Health Alliance Commercial	$1,285.76

PLATE CALCANEAL70MM 02.211.404

Facility

$2,313.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,295.28
Max. Negotiated Rate	$2,243.61
Rate for Payer: Cash Price	$1,387.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,619.10
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: MDX Hawaii PPO	$2,243.61
Rate for Payer: University Health Alliance Commercial	$1,295.28

PLATE CALCANEAL70MM 02.211.404

Facility

$2,313.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,179.63
Max. Negotiated Rate	$2,243.61
Rate for Payer: Cash Price	$1,387.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,619.10
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Kaiser Permanente Commercial	$1,457.19
Rate for Payer: Kaiser Permanente Medicaid	$1,179.63
Rate for Payer: MDX Hawaii PPO	$2,243.61
Rate for Payer: University Health Alliance Commercial	$1,295.28

PLATE CALC SHORT-LEFT 241.625

Facility

$2,274.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,159.74
Max. Negotiated Rate	$2,205.78
Rate for Payer: Cash Price	$1,364.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,591.80
Rate for Payer: Health Management Network Commercial	$1,932.90
Rate for Payer: Kaiser Permanente Commercial	$1,432.62
Rate for Payer: Kaiser Permanente Medicaid	$1,159.74
Rate for Payer: MDX Hawaii PPO	$2,205.78
Rate for Payer: University Health Alliance Commercial	$1,273.44

PLATE CALC SHORT-LEFT 241.625

Facility

$2,274.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,273.44
Max. Negotiated Rate	$2,205.78
Rate for Payer: Cash Price	$1,364.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,591.80
Rate for Payer: Health Management Network Commercial	$1,932.90
Rate for Payer: MDX Hawaii PPO	$2,205.78
Rate for Payer: University Health Alliance Commercial	$1,273.44

PLATE CENTRAL R SM AR-2652CR

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.78
Max. Negotiated Rate	$2,597.66
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Kaiser Permanente Commercial	$1,687.14
Rate for Payer: Kaiser Permanente Medicaid	$1,365.78
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: University Health Alliance Commercial	$1,499.68

Know your out-of-pocket cost for care.

All Charges