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Package

ACL repair

Package

ACL repair

ACL repair is surgery to restore stability to a knee with a torn anterior cruciate ligament, most commonly by reconstructing the ligament using a tendon graft from the patient's own body. In select cases where the tear is close to the bone, a direct repair or augmentation may be possible. The procedure is performed arthroscopically through small incisions under anesthesia. Recovery involves a structured rehabilitation program focused on regaining motion, then strength and balance, with return to cutting or pivoting sports typically requiring several months.
You'd pay up to
$13,996 / Case Rate

A single, all-inclusive pricing methodology for a procedure in healthcare contracts, instead of separate charges for each service.

The estimated total cost of care without any insurance coverage or discounts.

$13,996

Without insurance

What goes into a price?

Negotiated prices across insurers

Lowest
$2,471
Highest
$32,733
Cash price
up to $13,996

Self pay or cash prices vary by facility when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts facilities charge for this service if you were paying without insurance benefits. If you're uninsured or not submitting a claim to insurance, you also have the right to a Good Faith Estimate under federal law. Contact the provider for a copy of your Good Faith Estimate or to better understand payment options available to you.

Procedures included in this package

This list includes the services and fees bundled into the ACL repair Standard Service Package (SSP MS007). The final price for the procedure will depend on which services your provider ultimately performs, your insurance plan and your medical benefits.

Code Code Type Description
HCPCS C1713 Facility Fee Implantable Anchor/Screw for Bone-to-bone/soft Tissue-to-bone Fixation
HCPCS J1885 Facility Fee Intramuscular injection of 15mg ketorolac tromethamine
HCPCS J3010 Facility Fee Intramuscular injection of fentanyl citrate, 0.1mg
HCPCS J0690 Facility Fee Intramuscular injection cefazolin sodium, 500mg
HCPCS 29888 Facility Fee Arthroscopically-assisted Acl Repair/Augmentation/reconstruction
HCPCS J2405 Facility Fee Intramuscular injection of ondansetron hydrochloride, 1mg
HCPCS 29888 Professional Fee Arthroscopically-assisted Acl Repair/Augmentation/reconstruction
HCPCS 29883 Facility Fee Arthroscopic Knee Surgery with Medial and Lateral Meniscus Repair
HCPCS J2250 Facility Fee Intramuscular injection of 1mg midazolam hydrochloride
HCPCS J1100 Facility Fee Intramuscular injection of 1mg dexamethasone sodium phosphate
HCPCS J1171 Facility Fee Injection, hydromorphone, 0.1mg
HCPCS J0134 Facility Fee INJECTION, ACETAMINOPHEN (FRESENIUS KABI), NOT THERAPEUTICALLY EQUIVALENT TO J0131, 10 MG
HCPCS 29883 Professional Fee Arthroscopic Knee Surgery with Medial and Lateral Meniscus Repair
Revenue Code 250 Facility Fee Pharmacy (Also see 063X, an extension of 250X) - General
HCPCS A9900 Facility Fee Additional Equipment or Service for Medical Supplies Under Specific Code

Disclaimer

Hawaii Health Systems Corporation is committed to empowering our patients to make informed decisions about their healthcare. This includes helping patients understand the cost of care and the availability of financial assistance.

In compliance with federal law, we provide a list of standard charges that are reviewed on an annual basis. Charges for hospital services are not equivalent to the actual amount paid by insurance companies or patients. The amount paid for services is based on many factors, including health insurance benefit plans, applicable discounts, and services provided based on each patient's unique needs.

You'd pay up to
$13,996 / Case Rate

A single, all-inclusive pricing methodology for a procedure in healthcare contracts, instead of separate charges for each service.

The estimated total cost of care without any insurance coverage or discounts.

Disclaimer

Hawaii Health Systems Corporation is committed to empowering our patients to make informed decisions about their healthcare. This includes helping patients understand the cost of care and the availability of financial assistance.

In compliance with federal law, we provide a list of standard charges that are reviewed on an annual basis. Charges for hospital services are not equivalent to the actual amount paid by insurance companies or patients. The amount paid for services is based on many factors, including health insurance benefit plans, applicable discounts, and services provided based on each patient's unique needs.

What’s the difference between an individual procedure and a Standard Service Package (SSP)?

Individual Procedure

Individual procedures, like blood tests, each have unique prices and billing codes (like a CPT or HCPCS code). While they can be billed alone, they're usually grouped with other procedures on a claim. This grouping is what determines the total cost of your care.

Standard Service Package (SSP)

A SSP combines all medical services, materials, and fees associated with a healthcare visit or procedure into a single bundle to offer a more comprehensive estimate.

Contact us to verify your estimate

Have your service name, codes, and payment preference ready. If you’re using insurance, you may be asked for insurance details like your Member or Group ID.

Service ACL repair
Service Codes HCPCS C1713, HCPCS J1885, HCPCS J3010, HCPCS J0690, HCPCS 29888
Insurance I'm not using insurance
Location Hilo Benioff Medical Center Main
When you contact us, you can say:
"Hi, I'm calling to verify a price for ACL repair I found through Hilo Benioff Medical Center Main's price estimate tool. Here are the codes I’m looking at: HCPCS C1713, HCPCS J1885, HCPCS J3010, HCPCS J0690, HCPCS 29888. I'm not using insurance, can you confirm the cash pay estimate and help me schedule if needed?"
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