Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PLATE STR NARROW 54MM 4H

Facility

$1,331.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$745.36
Max. Negotiated Rate	$1,291.07
Rate for Payer: Cash Price	$798.60
Rate for Payer: Hawaii Western Management Group Commercial	$931.70
Rate for Payer: Health Management Network Commercial	$1,131.35
Rate for Payer: MDX Hawaii PPO	$1,291.07
Rate for Payer: University Health Alliance Commercial	$745.36

PLATE STR NARROW 66MM 5H

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 STR NARROW 66MM 5H

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 SUPERIOR MIDSHAFT

Facility

$2,985.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,522.35
Max. Negotiated Rate	$2,895.45
Rate for Payer: Cash Price	$1,791.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Kaiser Permanente Commercial	$1,880.55
Rate for Payer: Kaiser Permanente Medicaid	$1,522.35
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: University Health Alliance Commercial	$1,671.60

PLATE SUPERIOR MIDSHAFT

Facility

$2,985.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.60
Max. Negotiated Rate	$2,895.45
Rate for Payer: Cash Price	$1,791.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: University Health Alliance Commercial	$1,671.60

PLATE-T 3.5MM/3-HOLE 241.13

Facility

$401.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$204.51
Max. Negotiated Rate	$388.97
Rate for Payer: Cash Price	$240.60
Rate for Payer: Hawaii Western Management Group Commercial	$280.70
Rate for Payer: Health Management Network Commercial	$340.85
Rate for Payer: Kaiser Permanente Commercial	$252.63
Rate for Payer: Kaiser Permanente Medicaid	$204.51
Rate for Payer: MDX Hawaii PPO	$388.97
Rate for Payer: University Health Alliance Commercial	$224.56

PLATE-T 3.5MM/3-HOLE 241.13

Facility

$401.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$224.56
Max. Negotiated Rate	$388.97
Rate for Payer: Cash Price	$240.60
Rate for Payer: Hawaii Western Management Group Commercial	$280.70
Rate for Payer: Health Management Network Commercial	$340.85
Rate for Payer: MDX Hawaii PPO	$388.97
Rate for Payer: University Health Alliance Commercial	$224.56

PLATE-T 3.5MM/3-HOLE 241.23

Facility

$525.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$294.00
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Hawaii Western Management Group Commercial	$367.50
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: University Health Alliance Commercial	$294.00

PLATE-T 3.5MM/3-HOLE 241.23

Facility

$525.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$267.75
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Hawaii Western Management Group Commercial	$367.50
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$330.75
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: University Health Alliance Commercial	$294.00

PLATE-T 3.5MM/4-HOLE 241.14

Facility

$413.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$210.63
Max. Negotiated Rate	$400.61
Rate for Payer: Cash Price	$247.80
Rate for Payer: Hawaii Western Management Group Commercial	$289.10
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Kaiser Permanente Commercial	$260.19
Rate for Payer: Kaiser Permanente Medicaid	$210.63
Rate for Payer: MDX Hawaii PPO	$400.61
Rate for Payer: University Health Alliance Commercial	$231.28

PLATE-T 3.5MM/4-HOLE 241.14

Facility

$413.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$231.28
Max. Negotiated Rate	$400.61
Rate for Payer: Cash Price	$247.80
Rate for Payer: Hawaii Western Management Group Commercial	$289.10
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: MDX Hawaii PPO	$400.61
Rate for Payer: University Health Alliance Commercial	$231.28

PLATE-T 3.5MM/5-HOLE 241.25

Facility

$761.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$426.16
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$456.60
Rate for Payer: Hawaii Western Management Group Commercial	$532.70
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: MDX Hawaii PPO	$738.17
Rate for Payer: University Health Alliance Commercial	$426.16

PLATE-T 3.5MM/5-HOLE 241.25

Facility

$761.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$388.11
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$456.60
Rate for Payer: Hawaii Western Management Group Commercial	$532.70
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Kaiser Permanente Commercial	$479.43
Rate for Payer: Kaiser Permanente Medicaid	$388.11
Rate for Payer: MDX Hawaii PPO	$738.17
Rate for Payer: University Health Alliance Commercial	$426.16

PLATE-T 3.5MM/5-HOLE RT 241.15

Facility

$461.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$258.16
Max. Negotiated Rate	$447.17
Rate for Payer: Cash Price	$276.60
Rate for Payer: Hawaii Western Management Group Commercial	$322.70
Rate for Payer: Health Management Network Commercial	$391.85
Rate for Payer: MDX Hawaii PPO	$447.17
Rate for Payer: University Health Alliance Commercial	$258.16

PLATE-T 3.5MM/5-HOLE RT 241.15

Facility

$461.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$235.11
Max. Negotiated Rate	$447.17
Rate for Payer: Cash Price	$276.60
Rate for Payer: Hawaii Western Management Group Commercial	$322.70
Rate for Payer: Health Management Network Commercial	$391.85
Rate for Payer: Kaiser Permanente Commercial	$290.43
Rate for Payer: Kaiser Permanente Medicaid	$235.11
Rate for Payer: MDX Hawaii PPO	$447.17
Rate for Payer: University Health Alliance Commercial	$258.16

PLATE-T 4H 84MM 240.14

Facility

$1,176.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$658.56
Max. Negotiated Rate	$1,140.72
Rate for Payer: Cash Price	$705.60
Rate for Payer: Hawaii Western Management Group Commercial	$823.20
Rate for Payer: Health Management Network Commercial	$999.60
Rate for Payer: MDX Hawaii PPO	$1,140.72
Rate for Payer: University Health Alliance Commercial	$658.56

PLATE-T 4H 84MM 240.14

Facility

$1,176.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$599.76
Max. Negotiated Rate	$1,140.72
Rate for Payer: Cash Price	$705.60
Rate for Payer: Hawaii Western Management Group Commercial	$823.20
Rate for Payer: Health Management Network Commercial	$999.60
Rate for Payer: Kaiser Permanente Commercial	$740.88
Rate for Payer: Kaiser Permanente Medicaid	$599.76
Rate for Payer: MDX Hawaii PPO	$1,140.72
Rate for Payer: University Health Alliance Commercial	$658.56

PLATE T 5 HOLE 629778

Facility

$2,137.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,089.87
Max. Negotiated Rate	$2,072.89
Rate for Payer: Cash Price	$1,282.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,495.90
Rate for Payer: Health Management Network Commercial	$1,816.45
Rate for Payer: Kaiser Permanente Commercial	$1,346.31
Rate for Payer: Kaiser Permanente Medicaid	$1,089.87
Rate for Payer: MDX Hawaii PPO	$2,072.89
Rate for Payer: University Health Alliance Commercial	$1,196.72

PLATE T 5 HOLE 629778

Facility

$2,137.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.72
Max. Negotiated Rate	$2,072.89
Rate for Payer: Cash Price	$1,282.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,495.90
Rate for Payer: Health Management Network Commercial	$1,816.45
Rate for Payer: MDX Hawaii PPO	$2,072.89
Rate for Payer: University Health Alliance Commercial	$1,196.72

PLATE T-BONE SM 6HOLE 57-10140

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$796.62
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Kaiser Permanente Commercial	$984.06
Rate for Payer: Kaiser Permanente Medicaid	$796.62
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

PLATE T-BONE SM 6HOLE 57-10140

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$874.72
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

PLATE THIN 3-HOLE/88MM 241.83

Facility

$914.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$511.84
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$548.40
Rate for Payer: Hawaii Western Management Group Commercial	$639.80
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: University Health Alliance Commercial	$511.84

PLATE THIN 3-HOLE/88MM 241.83

Facility

$914.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$466.14
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$548.40
Rate for Payer: Hawaii Western Management Group Commercial	$639.80
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Kaiser Permanente Commercial	$575.82
Rate for Payer: Kaiser Permanente Medicaid	$466.14
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: University Health Alliance Commercial	$511.84

PLATE TIB 4HOLE RT 2347-07-04

Facility

$2,328.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.28
Max. Negotiated Rate	$2,258.16
Rate for Payer: Cash Price	$1,396.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,629.60
Rate for Payer: Health Management Network Commercial	$1,978.80
Rate for Payer: Kaiser Permanente Commercial	$1,466.64
Rate for Payer: Kaiser Permanente Medicaid	$1,187.28
Rate for Payer: MDX Hawaii PPO	$2,258.16
Rate for Payer: University Health Alliance Commercial	$1,303.68

PLATE TIB 4HOLE RT 2347-07-04

Facility

$2,328.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,303.68
Max. Negotiated Rate	$2,258.16
Rate for Payer: Cash Price	$1,396.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,629.60
Rate for Payer: Health Management Network Commercial	$1,978.80
Rate for Payer: MDX Hawaii PPO	$2,258.16
Rate for Payer: University Health Alliance Commercial	$1,303.68

Know your out-of-pocket cost for care.

All Charges