Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PLATE LCK TIB LT DIST 627412

Facility

$3,890.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,983.90
Max. Negotiated Rate	$3,773.30
Rate for Payer: Cash Price	$2,334.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,723.00
Rate for Payer: Health Management Network Commercial	$3,306.50
Rate for Payer: Kaiser Permanente Commercial	$2,450.70
Rate for Payer: Kaiser Permanente Medicaid	$1,983.90
Rate for Payer: MDX Hawaii PPO	$3,773.30
Rate for Payer: University Health Alliance Commercial	$2,178.40

PLATE LCK TUBU 10H AR-8943T-10

Facility

$1,029.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$524.79
Max. Negotiated Rate	$998.13
Rate for Payer: Cash Price	$617.40
Rate for Payer: Hawaii Western Management Group Commercial	$720.30
Rate for Payer: Health Management Network Commercial	$874.65
Rate for Payer: Kaiser Permanente Commercial	$648.27
Rate for Payer: Kaiser Permanente Medicaid	$524.79
Rate for Payer: MDX Hawaii PPO	$998.13
Rate for Payer: University Health Alliance Commercial	$576.24

PLATE LCK TUBU 10H AR-8943T-10

Facility

$1,029.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$576.24
Max. Negotiated Rate	$998.13
Rate for Payer: Cash Price	$617.40
Rate for Payer: Hawaii Western Management Group Commercial	$720.30
Rate for Payer: Health Management Network Commercial	$874.65
Rate for Payer: MDX Hawaii PPO	$998.13
Rate for Payer: University Health Alliance Commercial	$576.24

PLATE LCK TUBUL 5H AR-8943T-05

Facility

$925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$471.75
Max. Negotiated Rate	$897.25
Rate for Payer: Cash Price	$555.00
Rate for Payer: Hawaii Western Management Group Commercial	$647.50
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: Kaiser Permanente Commercial	$582.75
Rate for Payer: Kaiser Permanente Medicaid	$471.75
Rate for Payer: MDX Hawaii PPO	$897.25
Rate for Payer: University Health Alliance Commercial	$518.00

PLATE LCK TUBUL 5H AR-8943T-05

Facility

$925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$518.00
Max. Negotiated Rate	$897.25
Rate for Payer: Cash Price	$555.00
Rate for Payer: Hawaii Western Management Group Commercial	$647.50
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: MDX Hawaii PPO	$897.25
Rate for Payer: University Health Alliance Commercial	$518.00

PLATE LCP 10H 3.5X159 #239.940

Facility

$4,952.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,525.52
Max. Negotiated Rate	$4,803.44
Rate for Payer: Cash Price	$2,971.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,466.40
Rate for Payer: Health Management Network Commercial	$4,209.20
Rate for Payer: Kaiser Permanente Commercial	$3,119.76
Rate for Payer: Kaiser Permanente Medicaid	$2,525.52
Rate for Payer: MDX Hawaii PPO	$4,803.44
Rate for Payer: University Health Alliance Commercial	$2,773.12

PLATE LCP 10H 3.5X159 #239.940

Facility

$4,952.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$4,803.44
Rate for Payer: Cash Price	$2,971.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,466.40
Rate for Payer: Health Management Network Commercial	$4,209.20
Rate for Payer: MDX Hawaii PPO	$4,803.44
Rate for Payer: University Health Alliance Commercial	$2,773.12

PLATE LCP 10H 3.5X159 #239.941

Facility

$4,628.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,360.28
Max. Negotiated Rate	$4,489.16
Rate for Payer: Cash Price	$2,776.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,239.60
Rate for Payer: Health Management Network Commercial	$3,933.80
Rate for Payer: Kaiser Permanente Commercial	$2,915.64
Rate for Payer: Kaiser Permanente Medicaid	$2,360.28
Rate for Payer: MDX Hawaii PPO	$4,489.16
Rate for Payer: University Health Alliance Commercial	$2,591.68

PLATE LCP 10H 3.5X159 #239.941

Facility

$4,628.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,591.68
Max. Negotiated Rate	$4,489.16
Rate for Payer: Cash Price	$2,776.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,239.60
Rate for Payer: Health Management Network Commercial	$3,933.80
Rate for Payer: MDX Hawaii PPO	$4,489.16
Rate for Payer: University Health Alliance Commercial	$2,591.68

PLATE LCP 12H 3.5X185 #239.942

Facility

$3,462.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,938.72
Max. Negotiated Rate	$3,358.14
Rate for Payer: Cash Price	$2,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,423.40
Rate for Payer: Health Management Network Commercial	$2,942.70
Rate for Payer: MDX Hawaii PPO	$3,358.14
Rate for Payer: University Health Alliance Commercial	$1,938.72

PLATE LCP 12H 3.5X185 #239.942

Facility

$3,462.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,765.62
Max. Negotiated Rate	$3,358.14
Rate for Payer: Cash Price	$2,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,423.40
Rate for Payer: Health Management Network Commercial	$2,942.70
Rate for Payer: Kaiser Permanente Commercial	$2,181.06
Rate for Payer: Kaiser Permanente Medicaid	$1,765.62
Rate for Payer: MDX Hawaii PPO	$3,358.14
Rate for Payer: University Health Alliance Commercial	$1,938.72

PLATE LCP 12H 3.5X185 #239.943

Facility

$3,462.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,765.62
Max. Negotiated Rate	$3,358.14
Rate for Payer: Cash Price	$2,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,423.40
Rate for Payer: Health Management Network Commercial	$2,942.70
Rate for Payer: Kaiser Permanente Commercial	$2,181.06
Rate for Payer: Kaiser Permanente Medicaid	$1,765.62
Rate for Payer: MDX Hawaii PPO	$3,358.14
Rate for Payer: University Health Alliance Commercial	$1,938.72

PLATE LCP 12H 3.5X185 #239.943

Facility

$3,462.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,938.72
Max. Negotiated Rate	$3,358.14
Rate for Payer: Cash Price	$2,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,423.40
Rate for Payer: Health Management Network Commercial	$2,942.70
Rate for Payer: MDX Hawaii PPO	$3,358.14
Rate for Payer: University Health Alliance Commercial	$1,938.72

PLATE LCP 14H 3.5X211 #239.944

Facility

$4,738.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,653.28
Max. Negotiated Rate	$4,595.86
Rate for Payer: Cash Price	$2,842.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,316.60
Rate for Payer: Health Management Network Commercial	$4,027.30
Rate for Payer: MDX Hawaii PPO	$4,595.86
Rate for Payer: University Health Alliance Commercial	$2,653.28

PLATE LCP 14H 3.5X211 #239.944

Facility

$4,738.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,416.38
Max. Negotiated Rate	$4,595.86
Rate for Payer: Cash Price	$2,842.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,316.60
Rate for Payer: Health Management Network Commercial	$4,027.30
Rate for Payer: Kaiser Permanente Commercial	$2,984.94
Rate for Payer: Kaiser Permanente Medicaid	$2,416.38
Rate for Payer: MDX Hawaii PPO	$4,595.86
Rate for Payer: University Health Alliance Commercial	$2,653.28

PLATE LCP 14H 3.5X211 #239.945

Facility

$4,738.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,653.28
Max. Negotiated Rate	$4,595.86
Rate for Payer: Cash Price	$2,842.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,316.60
Rate for Payer: Health Management Network Commercial	$4,027.30
Rate for Payer: MDX Hawaii PPO	$4,595.86
Rate for Payer: University Health Alliance Commercial	$2,653.28

PLATE LCP 14H 3.5X211 #239.945

Facility

$4,738.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,416.38
Max. Negotiated Rate	$4,595.86
Rate for Payer: Cash Price	$2,842.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,316.60
Rate for Payer: Health Management Network Commercial	$4,027.30
Rate for Payer: Kaiser Permanente Commercial	$2,984.94
Rate for Payer: Kaiser Permanente Medicaid	$2,416.38
Rate for Payer: MDX Hawaii PPO	$4,595.86
Rate for Payer: University Health Alliance Commercial	$2,653.28

PLATE LCP 16H 3.5X237 #239.946

Facility

$5,070.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,585.70
Max. Negotiated Rate	$4,917.90
Rate for Payer: Cash Price	$3,042.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,549.00
Rate for Payer: Health Management Network Commercial	$4,309.50
Rate for Payer: Kaiser Permanente Commercial	$3,194.10
Rate for Payer: Kaiser Permanente Medicaid	$2,585.70
Rate for Payer: MDX Hawaii PPO	$4,917.90
Rate for Payer: University Health Alliance Commercial	$2,839.20

PLATE LCP 16H 3.5X237 #239.946

Facility

$5,070.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,839.20
Max. Negotiated Rate	$4,917.90
Rate for Payer: Cash Price	$3,042.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,549.00
Rate for Payer: Health Management Network Commercial	$4,309.50
Rate for Payer: MDX Hawaii PPO	$4,917.90
Rate for Payer: University Health Alliance Commercial	$2,839.20

PLATE LCP 16H 3.5X237 #239.947

Facility

$5,070.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,839.20
Max. Negotiated Rate	$4,917.90
Rate for Payer: Cash Price	$3,042.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,549.00
Rate for Payer: Health Management Network Commercial	$4,309.50
Rate for Payer: MDX Hawaii PPO	$4,917.90
Rate for Payer: University Health Alliance Commercial	$2,839.20

PLATE LCP 16H 3.5X237 #239.947

Facility

$5,070.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,585.70
Max. Negotiated Rate	$4,917.90
Rate for Payer: Cash Price	$3,042.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,549.00
Rate for Payer: Health Management Network Commercial	$4,309.50
Rate for Payer: Kaiser Permanente Commercial	$3,194.10
Rate for Payer: Kaiser Permanente Medicaid	$2,585.70
Rate for Payer: MDX Hawaii PPO	$4,917.90
Rate for Payer: University Health Alliance Commercial	$2,839.20

PLATE LCP 2H 4.5X44MM 224.521

Facility

$1,673.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$853.23
Max. Negotiated Rate	$1,622.81
Rate for Payer: Cash Price	$1,003.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.10
Rate for Payer: Health Management Network Commercial	$1,422.05
Rate for Payer: Kaiser Permanente Commercial	$1,053.99
Rate for Payer: Kaiser Permanente Medicaid	$853.23
Rate for Payer: MDX Hawaii PPO	$1,622.81
Rate for Payer: University Health Alliance Commercial	$936.88

PLATE LCP 2H 4.5X44MM 224.521

Facility

$1,673.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$936.88
Max. Negotiated Rate	$1,622.81
Rate for Payer: Cash Price	$1,003.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.10
Rate for Payer: Health Management Network Commercial	$1,422.05
Rate for Payer: MDX Hawaii PPO	$1,622.81
Rate for Payer: University Health Alliance Commercial	$936.88

PLATE LCP 3.5/10H/L 02.127.341

Facility

$4,263.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,174.13
Max. Negotiated Rate	$4,135.11
Rate for Payer: Cash Price	$2,557.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,984.10
Rate for Payer: Health Management Network Commercial	$3,623.55
Rate for Payer: Kaiser Permanente Commercial	$2,685.69
Rate for Payer: Kaiser Permanente Medicaid	$2,174.13
Rate for Payer: MDX Hawaii PPO	$4,135.11
Rate for Payer: University Health Alliance Commercial	$2,387.28

PLATE LCP 3.5/10H/L 02.127.341

Facility

$4,263.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,387.28
Max. Negotiated Rate	$4,135.11
Rate for Payer: Cash Price	$2,557.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,984.10
Rate for Payer: Health Management Network Commercial	$3,623.55
Rate for Payer: MDX Hawaii PPO	$4,135.11
Rate for Payer: University Health Alliance Commercial	$2,387.28

Know your out-of-pocket cost for care.

All Charges