Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PLATE Y 629770

Facility

$2,739.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.84
Max. Negotiated Rate	$2,656.83
Rate for Payer: Cash Price	$1,643.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,917.30
Rate for Payer: Health Management Network Commercial	$2,328.15
Rate for Payer: MDX Hawaii PPO	$2,656.83
Rate for Payer: University Health Alliance Commercial	$1,533.84

PLATE Y NARROW 7H 57-10170

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 Y NARROW 7H 57-10170

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

PLATFORM GELPOINT 11CM C2A11

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: University Health Alliance Commercial	$1,640.03

PLATFORM GELPOINT 11CM C2A11

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: MDX Hawaii PPO	$2,182.50

PLATFORM GELPOINT 12CM C2A12

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: MDX Hawaii PPO	$2,182.50

PLATFORM GELPOINT 12CM C2A12

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: University Health Alliance Commercial	$1,640.03

PLATFORM GELPOINT 7CM C2A15

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: MDX Hawaii PPO	$2,182.50

PLATFORM GELPOINT 7CM C2A15

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: University Health Alliance Commercial	$1,640.03

PLAT LCDCP 9H 4.5X160MM 224.59

Facility

$896.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$456.96
Max. Negotiated Rate	$869.12
Rate for Payer: Cash Price	$537.60
Rate for Payer: Hawaii Western Management Group Commercial	$627.20
Rate for Payer: Health Management Network Commercial	$761.60
Rate for Payer: Kaiser Permanente Commercial	$564.48
Rate for Payer: Kaiser Permanente Medicaid	$456.96
Rate for Payer: MDX Hawaii PPO	$869.12
Rate for Payer: University Health Alliance Commercial	$501.76

PLAT LCDCP 9H 4.5X160MM 224.59

Facility

$896.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$501.76
Max. Negotiated Rate	$869.12
Rate for Payer: Cash Price	$537.60
Rate for Payer: Hawaii Western Management Group Commercial	$627.20
Rate for Payer: Health Management Network Commercial	$761.60
Rate for Payer: MDX Hawaii PPO	$869.12
Rate for Payer: University Health Alliance Commercial	$501.76

PLAT LCP 10H 3.5X137MM 223.601

Facility

$1,497.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$763.47
Max. Negotiated Rate	$1,452.09
Rate for Payer: Cash Price	$898.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.90
Rate for Payer: Health Management Network Commercial	$1,272.45
Rate for Payer: Kaiser Permanente Commercial	$943.11
Rate for Payer: Kaiser Permanente Medicaid	$763.47
Rate for Payer: MDX Hawaii PPO	$1,452.09
Rate for Payer: University Health Alliance Commercial	$838.32

PLAT LCP 10H 3.5X137MM 223.601

Facility

$1,497.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$838.32
Max. Negotiated Rate	$1,452.09
Rate for Payer: Cash Price	$898.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.90
Rate for Payer: Health Management Network Commercial	$1,272.45
Rate for Payer: MDX Hawaii PPO	$1,452.09
Rate for Payer: University Health Alliance Commercial	$838.32

PLAT LCP 10H 4.5X188MM 224.601

Facility

$2,409.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,349.04
Max. Negotiated Rate	$2,336.73
Rate for Payer: Cash Price	$1,445.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,686.30
Rate for Payer: Health Management Network Commercial	$2,047.65
Rate for Payer: MDX Hawaii PPO	$2,336.73
Rate for Payer: University Health Alliance Commercial	$1,349.04

PLAT LCP 10H 4.5X188MM 224.601

Facility

$2,409.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,228.59
Max. Negotiated Rate	$2,336.73
Rate for Payer: Cash Price	$1,445.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,686.30
Rate for Payer: Health Management Network Commercial	$2,047.65
Rate for Payer: Kaiser Permanente Commercial	$1,517.67
Rate for Payer: Kaiser Permanente Medicaid	$1,228.59
Rate for Payer: MDX Hawaii PPO	$2,336.73
Rate for Payer: University Health Alliance Commercial	$1,349.04

PLAT LCP 10H 4.5X188MM 226.601

Facility

$2,790.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,422.90
Max. Negotiated Rate	$2,706.30
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,953.00
Rate for Payer: Health Management Network Commercial	$2,371.50
Rate for Payer: Kaiser Permanente Commercial	$1,757.70
Rate for Payer: Kaiser Permanente Medicaid	$1,422.90
Rate for Payer: MDX Hawaii PPO	$2,706.30
Rate for Payer: University Health Alliance Commercial	$1,562.40

PLAT LCP 10H 4.5X188MM 226.601

Facility

$2,790.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.40
Max. Negotiated Rate	$2,706.30
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,953.00
Rate for Payer: Health Management Network Commercial	$2,371.50
Rate for Payer: MDX Hawaii PPO	$2,706.30
Rate for Payer: University Health Alliance Commercial	$1,562.40

PLAT LCP 11H 4.5X206MM 224.611

Facility

$2,595.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,323.45
Max. Negotiated Rate	$2,517.15
Rate for Payer: Cash Price	$1,557.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,816.50
Rate for Payer: Health Management Network Commercial	$2,205.75
Rate for Payer: Kaiser Permanente Commercial	$1,634.85
Rate for Payer: Kaiser Permanente Medicaid	$1,323.45
Rate for Payer: MDX Hawaii PPO	$2,517.15
Rate for Payer: University Health Alliance Commercial	$1,453.20

PLAT LCP 11H 4.5X206MM 224.611

Facility

$2,595.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,453.20
Max. Negotiated Rate	$2,517.15
Rate for Payer: Cash Price	$1,557.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,816.50
Rate for Payer: Health Management Network Commercial	$2,205.75
Rate for Payer: MDX Hawaii PPO	$2,517.15
Rate for Payer: University Health Alliance Commercial	$1,453.20

PLAT LCP 11H 4.5X206MM 226.611

Facility

$2,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,514.70
Max. Negotiated Rate	$2,880.90
Rate for Payer: Cash Price	$1,782.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,079.00
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: Kaiser Permanente Commercial	$1,871.10
Rate for Payer: Kaiser Permanente Medicaid	$1,514.70
Rate for Payer: MDX Hawaii PPO	$2,880.90
Rate for Payer: University Health Alliance Commercial	$1,663.20

PLAT LCP 11H 4.5X206MM 226.611

Facility

$2,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,663.20
Max. Negotiated Rate	$2,880.90
Rate for Payer: Cash Price	$1,782.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,079.00
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: MDX Hawaii PPO	$2,880.90
Rate for Payer: University Health Alliance Commercial	$1,663.20

PLAT LCP 12H 3.5X163MM 223.621

Facility

$1,652.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$925.12
Max. Negotiated Rate	$1,602.44
Rate for Payer: Cash Price	$991.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,156.40
Rate for Payer: Health Management Network Commercial	$1,404.20
Rate for Payer: MDX Hawaii PPO	$1,602.44
Rate for Payer: University Health Alliance Commercial	$925.12

PLAT LCP 12H 3.5X163MM 223.621

Facility

$1,652.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$842.52
Max. Negotiated Rate	$1,602.44
Rate for Payer: Cash Price	$991.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,156.40
Rate for Payer: Health Management Network Commercial	$1,404.20
Rate for Payer: Kaiser Permanente Commercial	$1,040.76
Rate for Payer: Kaiser Permanente Medicaid	$842.52
Rate for Payer: MDX Hawaii PPO	$1,602.44
Rate for Payer: University Health Alliance Commercial	$925.12

PLAT LCP 12H 3.5X168MM 245.121

Facility

$2,037.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,140.72
Max. Negotiated Rate	$1,975.89
Rate for Payer: Cash Price	$1,222.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,425.90
Rate for Payer: Health Management Network Commercial	$1,731.45
Rate for Payer: MDX Hawaii PPO	$1,975.89
Rate for Payer: University Health Alliance Commercial	$1,140.72

PLAT LCP 12H 3.5X168MM 245.121

Facility

$2,037.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.87
Max. Negotiated Rate	$1,975.89
Rate for Payer: Cash Price	$1,222.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,425.90
Rate for Payer: Health Management Network Commercial	$1,731.45
Rate for Payer: Kaiser Permanente Commercial	$1,283.31
Rate for Payer: Kaiser Permanente Medicaid	$1,038.87
Rate for Payer: MDX Hawaii PPO	$1,975.89
Rate for Payer: University Health Alliance Commercial	$1,140.72

Know your out-of-pocket cost for care.

All Charges