Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PLATE CENTRAL R SM AR-2652CR

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.68
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: MDX Hawaii PPO	$2,597.66
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE CENTRAL THIRD AR-2654CL

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

PLATE CENTRAL THIRD AR-2654CL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.68
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: MDX Hawaii PPO	$2,597.66
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE CLAVICEL RT 6H 628026

Facility

$2,381.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.36
Max. Negotiated Rate	$2,309.57
Rate for Payer: Cash Price	$1,428.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,666.70
Rate for Payer: Health Management Network Commercial	$2,023.85
Rate for Payer: MDX Hawaii PPO	$2,309.57
Rate for Payer: University Health Alliance Commercial	$1,333.36

PLATE CLAVICEL RT 6H 628026

Facility

$2,381.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,214.31
Max. Negotiated Rate	$2,309.57
Rate for Payer: Cash Price	$1,428.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,666.70
Rate for Payer: Health Management Network Commercial	$2,023.85
Rate for Payer: Kaiser Permanente Commercial	$1,500.03
Rate for Payer: Kaiser Permanente Medicaid	$1,214.31
Rate for Payer: MDX Hawaii PPO	$2,309.57
Rate for Payer: University Health Alliance Commercial	$1,333.36

PLATE CLAVICLE 3RD L AR-2656DL

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

PLATE CLAVICLE 3RD L AR-2656DL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.68
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: MDX Hawaii PPO	$2,597.66
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE CLAVICLE 628008

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,759.50
Max. Negotiated Rate	$3,346.50
Rate for Payer: Cash Price	$2,070.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,415.00
Rate for Payer: Health Management Network Commercial	$2,932.50
Rate for Payer: Kaiser Permanente Commercial	$2,173.50
Rate for Payer: Kaiser Permanente Medicaid	$1,759.50
Rate for Payer: MDX Hawaii PPO	$3,346.50
Rate for Payer: University Health Alliance Commercial	$1,932.00

PLATE CLAVICLE 628008

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,932.00
Max. Negotiated Rate	$3,346.50
Rate for Payer: Cash Price	$2,070.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,415.00
Rate for Payer: Health Management Network Commercial	$2,932.50
Rate for Payer: MDX Hawaii PPO	$3,346.50
Rate for Payer: University Health Alliance Commercial	$1,932.00

PLATE CLAVICLE 628108

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,759.50
Max. Negotiated Rate	$3,346.50
Rate for Payer: Cash Price	$2,070.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,415.00
Rate for Payer: Health Management Network Commercial	$2,932.50
Rate for Payer: Kaiser Permanente Commercial	$2,173.50
Rate for Payer: Kaiser Permanente Medicaid	$1,759.50
Rate for Payer: MDX Hawaii PPO	$3,346.50
Rate for Payer: University Health Alliance Commercial	$1,932.00

PLATE CLAVICLE 628108

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,932.00
Max. Negotiated Rate	$3,346.50
Rate for Payer: Cash Price	$2,070.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,415.00
Rate for Payer: Health Management Network Commercial	$2,932.50
Rate for Payer: MDX Hawaii PPO	$3,346.50
Rate for Payer: University Health Alliance Commercial	$1,932.00

PLATE CLUSTER CLST-6-6

Facility

$2,230.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,248.80
Max. Negotiated Rate	$2,163.10
Rate for Payer: Cash Price	$1,338.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,561.00
Rate for Payer: Health Management Network Commercial	$1,895.50
Rate for Payer: MDX Hawaii PPO	$2,163.10
Rate for Payer: University Health Alliance Commercial	$1,248.80

PLATE CLUSTER CLST-6-6

Facility

$2,230.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,137.30
Max. Negotiated Rate	$2,163.10
Rate for Payer: Cash Price	$1,338.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,561.00
Rate for Payer: Health Management Network Commercial	$1,895.50
Rate for Payer: Kaiser Permanente Commercial	$1,404.90
Rate for Payer: Kaiser Permanente Medicaid	$1,137.30
Rate for Payer: MDX Hawaii PPO	$2,163.10
Rate for Payer: University Health Alliance Commercial	$1,248.80

PLATE COMPRESSION 7HOLE 629507

Facility

$1,976.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,007.76
Max. Negotiated Rate	$1,916.72
Rate for Payer: Cash Price	$1,185.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.20
Rate for Payer: Health Management Network Commercial	$1,679.60
Rate for Payer: Kaiser Permanente Commercial	$1,244.88
Rate for Payer: Kaiser Permanente Medicaid	$1,007.76
Rate for Payer: MDX Hawaii PPO	$1,916.72
Rate for Payer: University Health Alliance Commercial	$1,106.56

PLATE COMPRESSION 7HOLE 629507

Facility

$1,976.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.56
Max. Negotiated Rate	$1,916.72
Rate for Payer: Cash Price	$1,185.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.20
Rate for Payer: Health Management Network Commercial	$1,679.60
Rate for Payer: MDX Hawaii PPO	$1,916.72
Rate for Payer: University Health Alliance Commercial	$1,106.56

PLATE CROSSLCK M RT 131812060

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE CROSSLCK M RT 131812060

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.63
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$1,835.19
Rate for Payer: Kaiser Permanente Medicaid	$1,485.63
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE CRSLCK NARR RT 131811050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.63
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$1,835.19
Rate for Payer: Kaiser Permanente Medicaid	$1,485.63
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE CRSLCK NARR RT 131811050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DCP 11H 218MM #240.91

Facility

$2,580.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,444.80
Max. Negotiated Rate	$2,502.60
Rate for Payer: Cash Price	$1,548.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,806.00
Rate for Payer: Health Management Network Commercial	$2,193.00
Rate for Payer: MDX Hawaii PPO	$2,502.60
Rate for Payer: University Health Alliance Commercial	$1,444.80

PLATE DCP 11H 218MM #240.91

Facility

$2,580.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,315.80
Max. Negotiated Rate	$2,502.60
Rate for Payer: Cash Price	$1,548.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,806.00
Rate for Payer: Health Management Network Commercial	$2,193.00
Rate for Payer: Kaiser Permanente Commercial	$1,625.40
Rate for Payer: Kaiser Permanente Medicaid	$1,315.80
Rate for Payer: MDX Hawaii PPO	$2,502.60
Rate for Payer: University Health Alliance Commercial	$1,444.80

PLATE DCP 2X2 HOLE 04.503.710

Facility

$2,481.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.31
Max. Negotiated Rate	$2,406.57
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,736.70
Rate for Payer: Health Management Network Commercial	$2,108.85
Rate for Payer: Kaiser Permanente Commercial	$1,563.03
Rate for Payer: Kaiser Permanente Medicaid	$1,265.31
Rate for Payer: MDX Hawaii PPO	$2,406.57
Rate for Payer: University Health Alliance Commercial	$1,389.36

PLATE DCP 2X2 HOLE 04.503.710

Facility

$2,481.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.36
Max. Negotiated Rate	$2,406.57
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,736.70
Rate for Payer: Health Management Network Commercial	$2,108.85
Rate for Payer: MDX Hawaii PPO	$2,406.57
Rate for Payer: University Health Alliance Commercial	$1,389.36

PLATE DHS 130D/2H/46MM 281.021

Facility

$2,064.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.84
Max. Negotiated Rate	$2,002.08
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,444.80
Rate for Payer: Health Management Network Commercial	$1,754.40
Rate for Payer: MDX Hawaii PPO	$2,002.08
Rate for Payer: University Health Alliance Commercial	$1,155.84

PLATE DHS 130D/2H/46MM 281.021

Facility

$2,064.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,052.64
Max. Negotiated Rate	$2,002.08
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,444.80
Rate for Payer: Health Management Network Commercial	$1,754.40
Rate for Payer: Kaiser Permanente Commercial	$1,300.32
Rate for Payer: Kaiser Permanente Medicaid	$1,052.64
Rate for Payer: MDX Hawaii PPO	$2,002.08
Rate for Payer: University Health Alliance Commercial	$1,155.84

Know your out-of-pocket cost for care.

All Charges