Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PLATE LF 4X6 0.7MM 04.503.364

Facility

$2,079.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.24
Max. Negotiated Rate	$2,016.63
Rate for Payer: Cash Price	$1,247.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,455.30
Rate for Payer: Health Management Network Commercial	$1,767.15
Rate for Payer: MDX Hawaii PPO	$2,016.63
Rate for Payer: University Health Alliance Commercial	$1,164.24

PLATE LF 4X6 0.7MM 04.503.364

Facility

$2,079.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,060.29
Max. Negotiated Rate	$2,016.63
Rate for Payer: Cash Price	$1,247.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,455.30
Rate for Payer: Health Management Network Commercial	$1,767.15
Rate for Payer: Kaiser Permanente Commercial	$1,309.77
Rate for Payer: Kaiser Permanente Medicaid	$1,060.29
Rate for Payer: MDX Hawaii PPO	$2,016.63
Rate for Payer: University Health Alliance Commercial	$1,164.24

PLATE LF MED 8H 93M AR-2651CL

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 LF MED 8H 93M AR-2651CL

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 LF MI 3.5X65MM 336-3541

Facility

$2,884.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,470.84
Max. Negotiated Rate	$2,797.48
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Kaiser Permanente Commercial	$1,816.92
Rate for Payer: Kaiser Permanente Medicaid	$1,470.84
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: University Health Alliance Commercial	$1,615.04

PLATE LF MI 3.5X65MM 336-3541

Facility

$2,884.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.04
Max. Negotiated Rate	$2,797.48
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: University Health Alliance Commercial	$1,615.04

PLATE LKG ST 12H AR-8943C-12

Facility

$2,189.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.84
Max. Negotiated Rate	$2,123.33
Rate for Payer: Cash Price	$1,313.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,532.30
Rate for Payer: Health Management Network Commercial	$1,860.65
Rate for Payer: MDX Hawaii PPO	$2,123.33
Rate for Payer: University Health Alliance Commercial	$1,225.84

PLATE LKG ST 12H AR-8943C-12

Facility

$2,189.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,116.39
Max. Negotiated Rate	$2,123.33
Rate for Payer: Cash Price	$1,313.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,532.30
Rate for Payer: Health Management Network Commercial	$1,860.65
Rate for Payer: Kaiser Permanente Commercial	$1,379.07
Rate for Payer: Kaiser Permanente Medicaid	$1,116.39
Rate for Payer: MDX Hawaii PPO	$2,123.33
Rate for Payer: University Health Alliance Commercial	$1,225.84

PLATE L OBLIQUE 04.503.365

Facility

$2,079.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.24
Max. Negotiated Rate	$2,016.63
Rate for Payer: Cash Price	$1,247.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,455.30
Rate for Payer: Health Management Network Commercial	$1,767.15
Rate for Payer: MDX Hawaii PPO	$2,016.63
Rate for Payer: University Health Alliance Commercial	$1,164.24

PLATE L OBLIQUE 04.503.365

Facility

$2,079.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,060.29
Max. Negotiated Rate	$2,016.63
Rate for Payer: Cash Price	$1,247.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,455.30
Rate for Payer: Health Management Network Commercial	$1,767.15
Rate for Payer: Kaiser Permanente Commercial	$1,309.77
Rate for Payer: Kaiser Permanente Medicaid	$1,060.29
Rate for Payer: MDX Hawaii PPO	$2,016.63
Rate for Payer: University Health Alliance Commercial	$1,164.24

PLATE LOCKING 2.3MM 57-15370

Facility

$1,900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$969.00
Max. Negotiated Rate	$1,843.00
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,615.00
Rate for Payer: Kaiser Permanente Commercial	$1,197.00
Rate for Payer: Kaiser Permanente Medicaid	$969.00
Rate for Payer: MDX Hawaii PPO	$1,843.00
Rate for Payer: University Health Alliance Commercial	$1,064.00

PLATE LOCKING 2.3MM 57-15370

Facility

$1,900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.00
Max. Negotiated Rate	$1,843.00
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,615.00
Rate for Payer: MDX Hawaii PPO	$1,843.00
Rate for Payer: University Health Alliance Commercial	$1,064.00

PLATE LOCKING STR 12H PS12

Facility

$2,920.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,489.20
Max. Negotiated Rate	$2,832.40
Rate for Payer: Cash Price	$1,752.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,044.00
Rate for Payer: Health Management Network Commercial	$2,482.00
Rate for Payer: Kaiser Permanente Commercial	$1,839.60
Rate for Payer: Kaiser Permanente Medicaid	$1,489.20
Rate for Payer: MDX Hawaii PPO	$2,832.40
Rate for Payer: University Health Alliance Commercial	$1,635.20

PLATE LOCKING STR 12H PS12

Facility

$2,920.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,635.20
Max. Negotiated Rate	$2,832.40
Rate for Payer: Cash Price	$1,752.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,044.00
Rate for Payer: Health Management Network Commercial	$2,482.00
Rate for Payer: MDX Hawaii PPO	$2,832.40
Rate for Payer: University Health Alliance Commercial	$1,635.20

PLATE LOK COMPRES ST 6H 629546

Facility

$1,514.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$847.84
Max. Negotiated Rate	$1,468.58
Rate for Payer: Cash Price	$908.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,059.80
Rate for Payer: Health Management Network Commercial	$1,286.90
Rate for Payer: MDX Hawaii PPO	$1,468.58
Rate for Payer: University Health Alliance Commercial	$847.84

PLATE LOK COMPRES ST 6H 629546

Facility

$1,514.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$772.14
Max. Negotiated Rate	$1,468.58
Rate for Payer: Cash Price	$908.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,059.80
Rate for Payer: Health Management Network Commercial	$1,286.90
Rate for Payer: Kaiser Permanente Commercial	$953.82
Rate for Payer: Kaiser Permanente Medicaid	$772.14
Rate for Payer: MDX Hawaii PPO	$1,468.58
Rate for Payer: University Health Alliance Commercial	$847.84

PLATE LT10H 3.5X187 02.112.523

Facility

$3,324.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,861.44
Max. Negotiated Rate	$3,224.28
Rate for Payer: Cash Price	$1,994.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,326.80
Rate for Payer: Health Management Network Commercial	$2,825.40
Rate for Payer: MDX Hawaii PPO	$3,224.28
Rate for Payer: University Health Alliance Commercial	$1,861.44

PLATE LT10H 3.5X187 02.112.523

Facility

$3,324.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.24
Max. Negotiated Rate	$3,224.28
Rate for Payer: Cash Price	$1,994.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,326.80
Rate for Payer: Health Management Network Commercial	$2,825.40
Rate for Payer: Kaiser Permanente Commercial	$2,094.12
Rate for Payer: Kaiser Permanente Medicaid	$1,695.24
Rate for Payer: MDX Hawaii PPO	$3,224.28
Rate for Payer: University Health Alliance Commercial	$1,861.44

PLATE LT 4H 3.5X109 02.112.511

Facility

$3,221.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,642.71
Max. Negotiated Rate	$3,124.37
Rate for Payer: Cash Price	$1,932.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,254.70
Rate for Payer: Health Management Network Commercial	$2,737.85
Rate for Payer: Kaiser Permanente Commercial	$2,029.23
Rate for Payer: Kaiser Permanente Medicaid	$1,642.71
Rate for Payer: MDX Hawaii PPO	$3,124.37
Rate for Payer: University Health Alliance Commercial	$1,803.76

PLATE LT 4H 3.5X109 02.112.511

Facility

$3,221.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,803.76
Max. Negotiated Rate	$3,124.37
Rate for Payer: Cash Price	$1,932.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,254.70
Rate for Payer: Health Management Network Commercial	$2,737.85
Rate for Payer: MDX Hawaii PPO	$3,124.37
Rate for Payer: University Health Alliance Commercial	$1,803.76

PLATE LT 8H 3.5X161 02.112.519

Facility

$4,766.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,668.96
Max. Negotiated Rate	$4,623.02
Rate for Payer: Cash Price	$2,859.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,336.20
Rate for Payer: Health Management Network Commercial	$4,051.10
Rate for Payer: MDX Hawaii PPO	$4,623.02
Rate for Payer: University Health Alliance Commercial	$2,668.96

PLATE LT 8H 3.5X161 02.112.519

Facility

$4,766.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,430.66
Max. Negotiated Rate	$4,623.02
Rate for Payer: Cash Price	$2,859.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,336.20
Rate for Payer: Health Management Network Commercial	$4,051.10
Rate for Payer: Kaiser Permanente Commercial	$3,002.58
Rate for Payer: Kaiser Permanente Medicaid	$2,430.66
Rate for Payer: MDX Hawaii PPO	$4,623.02
Rate for Payer: University Health Alliance Commercial	$2,668.96

PLATE MANDI 4H 1.0 04.503.707

Facility

$1,662.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$847.62
Max. Negotiated Rate	$1,612.14
Rate for Payer: Cash Price	$997.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,163.40
Rate for Payer: Health Management Network Commercial	$1,412.70
Rate for Payer: Kaiser Permanente Commercial	$1,047.06
Rate for Payer: Kaiser Permanente Medicaid	$847.62
Rate for Payer: MDX Hawaii PPO	$1,612.14
Rate for Payer: University Health Alliance Commercial	$930.72

PLATE MANDI 4H 1.0 04.503.707

Facility

$1,662.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$930.72
Max. Negotiated Rate	$1,612.14
Rate for Payer: Cash Price	$997.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,163.40
Rate for Payer: Health Management Network Commercial	$1,412.70
Rate for Payer: MDX Hawaii PPO	$1,612.14
Rate for Payer: University Health Alliance Commercial	$930.72

PLATE MATRIX 20 H 03.503.174

Facility

$540.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$275.40
Max. Negotiated Rate	$523.80
Rate for Payer: Cash Price	$324.00
Rate for Payer: Hawaii Western Management Group Commercial	$378.00
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: Kaiser Permanente Commercial	$340.20
Rate for Payer: Kaiser Permanente Medicaid	$275.40
Rate for Payer: MDX Hawaii PPO	$523.80
Rate for Payer: University Health Alliance Commercial	$302.40

Know your out-of-pocket cost for care.

All Charges