Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PLATE LCP 8H 3.5X133MM 239.938

Facility

$4,578.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,334.78
Max. Negotiated Rate	$4,440.66
Rate for Payer: Cash Price	$2,746.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,204.60
Rate for Payer: Health Management Network Commercial	$3,891.30
Rate for Payer: Kaiser Permanente Commercial	$2,884.14
Rate for Payer: Kaiser Permanente Medicaid	$2,334.78
Rate for Payer: MDX Hawaii PPO	$4,440.66
Rate for Payer: University Health Alliance Commercial	$2,563.68

PLATE LCP 8H 3.5X133MM 239.938

Facility

$4,578.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,563.68
Max. Negotiated Rate	$4,440.66
Rate for Payer: Cash Price	$2,746.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,204.60
Rate for Payer: Health Management Network Commercial	$3,891.30
Rate for Payer: MDX Hawaii PPO	$4,440.66
Rate for Payer: University Health Alliance Commercial	$2,563.68

PLATE LCP 8H 3.5X133MM 239.939

Facility

$4,989.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,544.39
Max. Negotiated Rate	$4,839.33
Rate for Payer: Cash Price	$2,993.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,492.30
Rate for Payer: Health Management Network Commercial	$4,240.65
Rate for Payer: Kaiser Permanente Commercial	$3,143.07
Rate for Payer: Kaiser Permanente Medicaid	$2,544.39
Rate for Payer: MDX Hawaii PPO	$4,839.33
Rate for Payer: University Health Alliance Commercial	$2,793.84

PLATE LCP 8H 3.5X133MM 239.939

Facility

$4,989.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.84
Max. Negotiated Rate	$4,839.33
Rate for Payer: Cash Price	$2,993.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,492.30
Rate for Payer: Health Management Network Commercial	$4,240.65
Rate for Payer: MDX Hawaii PPO	$4,839.33
Rate for Payer: University Health Alliance Commercial	$2,793.84

PLATE LCP 8H 4.5X152MM 224.581

Facility

$1,685.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$859.35
Max. Negotiated Rate	$1,634.45
Rate for Payer: Cash Price	$1,011.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,179.50
Rate for Payer: Health Management Network Commercial	$1,432.25
Rate for Payer: Kaiser Permanente Commercial	$1,061.55
Rate for Payer: Kaiser Permanente Medicaid	$859.35
Rate for Payer: MDX Hawaii PPO	$1,634.45
Rate for Payer: University Health Alliance Commercial	$943.60

PLATE LCP 8H 4.5X152MM 224.581

Facility

$1,685.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$943.60
Max. Negotiated Rate	$1,634.45
Rate for Payer: Cash Price	$1,011.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,179.50
Rate for Payer: Health Management Network Commercial	$1,432.25
Rate for Payer: MDX Hawaii PPO	$1,634.45
Rate for Payer: University Health Alliance Commercial	$943.60

PLATE LCP 8H 4.5X152MM 226.581

Facility

$1,904.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$971.04
Max. Negotiated Rate	$1,846.88
Rate for Payer: Cash Price	$1,142.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,332.80
Rate for Payer: Health Management Network Commercial	$1,618.40
Rate for Payer: Kaiser Permanente Commercial	$1,199.52
Rate for Payer: Kaiser Permanente Medicaid	$971.04
Rate for Payer: MDX Hawaii PPO	$1,846.88
Rate for Payer: University Health Alliance Commercial	$1,066.24

PLATE LCP 8H 4.5X152MM 226.581

Facility

$1,904.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,066.24
Max. Negotiated Rate	$1,846.88
Rate for Payer: Cash Price	$1,142.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,332.80
Rate for Payer: Health Management Network Commercial	$1,618.40
Rate for Payer: MDX Hawaii PPO	$1,846.88
Rate for Payer: University Health Alliance Commercial	$1,066.24

PLATE LCP 9H 3.5X124MM 223.591

Facility

$1,454.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$814.24
Max. Negotiated Rate	$1,410.38
Rate for Payer: Cash Price	$872.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.80
Rate for Payer: Health Management Network Commercial	$1,235.90
Rate for Payer: MDX Hawaii PPO	$1,410.38
Rate for Payer: University Health Alliance Commercial	$814.24

PLATE LCP 9H 3.5X124MM 223.591

Facility

$1,454.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$741.54
Max. Negotiated Rate	$1,410.38
Rate for Payer: Cash Price	$872.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.80
Rate for Payer: Health Management Network Commercial	$1,235.90
Rate for Payer: Kaiser Permanente Commercial	$916.02
Rate for Payer: Kaiser Permanente Medicaid	$741.54
Rate for Payer: MDX Hawaii PPO	$1,410.38
Rate for Payer: University Health Alliance Commercial	$814.24

PLATE LCP 9H 4.5X170MM 224.591

Facility

$1,762.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$986.72
Max. Negotiated Rate	$1,709.14
Rate for Payer: Cash Price	$1,057.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,233.40
Rate for Payer: Health Management Network Commercial	$1,497.70
Rate for Payer: MDX Hawaii PPO	$1,709.14
Rate for Payer: University Health Alliance Commercial	$986.72

PLATE LCP 9H 4.5X170MM 224.591

Facility

$1,762.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$898.62
Max. Negotiated Rate	$1,709.14
Rate for Payer: Cash Price	$1,057.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,233.40
Rate for Payer: Health Management Network Commercial	$1,497.70
Rate for Payer: Kaiser Permanente Commercial	$1,110.06
Rate for Payer: Kaiser Permanente Medicaid	$898.62
Rate for Payer: MDX Hawaii PPO	$1,709.14
Rate for Payer: University Health Alliance Commercial	$986.72

PLATE LCP FIB-L 11H 01.118.413

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.40
Max. Negotiated Rate	$3,045.80
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: Kaiser Permanente Commercial	$1,978.20
Rate for Payer: Kaiser Permanente Medicaid	$1,601.40
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: University Health Alliance Commercial	$1,758.40

PLATE LCP FIB-L 11H 01.118.413

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.40
Max. Negotiated Rate	$3,045.80
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: University Health Alliance Commercial	$1,758.40

PLATE LCP FIB-L 13H 02.118.415

Facility

$3,378.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,891.68
Max. Negotiated Rate	$3,276.66
Rate for Payer: Cash Price	$2,026.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,364.60
Rate for Payer: Health Management Network Commercial	$2,871.30
Rate for Payer: MDX Hawaii PPO	$3,276.66
Rate for Payer: University Health Alliance Commercial	$1,891.68

PLATE LCP FIB-L 13H 02.118.415

Facility

$3,378.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,722.78
Max. Negotiated Rate	$3,276.66
Rate for Payer: Cash Price	$2,026.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,364.60
Rate for Payer: Health Management Network Commercial	$2,871.30
Rate for Payer: Kaiser Permanente Commercial	$2,128.14
Rate for Payer: Kaiser Permanente Medicaid	$1,722.78
Rate for Payer: MDX Hawaii PPO	$3,276.66
Rate for Payer: University Health Alliance Commercial	$1,891.68

PLATE LCP FIB-L 15H 02.118.417

Facility

$3,452.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,760.52
Max. Negotiated Rate	$3,348.44
Rate for Payer: Cash Price	$2,071.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,416.40
Rate for Payer: Health Management Network Commercial	$2,934.20
Rate for Payer: Kaiser Permanente Commercial	$2,174.76
Rate for Payer: Kaiser Permanente Medicaid	$1,760.52
Rate for Payer: MDX Hawaii PPO	$3,348.44
Rate for Payer: University Health Alliance Commercial	$1,933.12

PLATE LCP FIB-L 15H 02.118.417

Facility

$3,452.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,933.12
Max. Negotiated Rate	$3,348.44
Rate for Payer: Cash Price	$2,071.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,416.40
Rate for Payer: Health Management Network Commercial	$2,934.20
Rate for Payer: MDX Hawaii PPO	$3,348.44
Rate for Payer: University Health Alliance Commercial	$1,933.12

PLATE LCP FIB-L 3H 02.118.401

Facility

$2,629.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,472.24
Max. Negotiated Rate	$2,550.13
Rate for Payer: Cash Price	$1,577.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,840.30
Rate for Payer: Health Management Network Commercial	$2,234.65
Rate for Payer: MDX Hawaii PPO	$2,550.13
Rate for Payer: University Health Alliance Commercial	$1,472.24

PLATE LCP FIB-L 3H 02.118.401

Facility

$2,629.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,340.79
Max. Negotiated Rate	$2,550.13
Rate for Payer: Cash Price	$1,577.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,840.30
Rate for Payer: Health Management Network Commercial	$2,234.65
Rate for Payer: Kaiser Permanente Commercial	$1,656.27
Rate for Payer: Kaiser Permanente Medicaid	$1,340.79
Rate for Payer: MDX Hawaii PPO	$2,550.13
Rate for Payer: University Health Alliance Commercial	$1,472.24

PLATE LCP FIB-L 4H 02.118.403

Facility

$2,747.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.97
Max. Negotiated Rate	$2,664.59
Rate for Payer: Cash Price	$1,648.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,922.90
Rate for Payer: Health Management Network Commercial	$2,334.95
Rate for Payer: Kaiser Permanente Commercial	$1,730.61
Rate for Payer: Kaiser Permanente Medicaid	$1,400.97
Rate for Payer: MDX Hawaii PPO	$2,664.59
Rate for Payer: University Health Alliance Commercial	$1,538.32

PLATE LCP FIB-L 4H 02.118.403

Facility

$2,747.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.32
Max. Negotiated Rate	$2,664.59
Rate for Payer: Cash Price	$1,648.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,922.90
Rate for Payer: Health Management Network Commercial	$2,334.95
Rate for Payer: MDX Hawaii PPO	$2,664.59
Rate for Payer: University Health Alliance Commercial	$1,538.32

PLATE LCP FIB-L 5H 02.118.405

Facility

$2,886.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.16
Max. Negotiated Rate	$2,799.42
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.20
Rate for Payer: Health Management Network Commercial	$2,453.10
Rate for Payer: MDX Hawaii PPO	$2,799.42
Rate for Payer: University Health Alliance Commercial	$1,616.16

PLATE LCP FIB-L 5H 02.118.405

Facility

$2,886.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,471.86
Max. Negotiated Rate	$2,799.42
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.20
Rate for Payer: Health Management Network Commercial	$2,453.10
Rate for Payer: Kaiser Permanente Commercial	$1,818.18
Rate for Payer: Kaiser Permanente Medicaid	$1,471.86
Rate for Payer: MDX Hawaii PPO	$2,799.42
Rate for Payer: University Health Alliance Commercial	$1,616.16

PLATE LCP FIB-L 6H 02.118.407

Facility

$2,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,131.20
Max. Negotiated Rate	$1,959.40
Rate for Payer: Cash Price	$1,212.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,414.00
Rate for Payer: Health Management Network Commercial	$1,717.00
Rate for Payer: MDX Hawaii PPO	$1,959.40
Rate for Payer: University Health Alliance Commercial	$1,131.20

Know your out-of-pocket cost for care.

All Charges