Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

TIGHTROPE ABS AR-1588TB-3IB

Facility

$1,011.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$515.61
Max. Negotiated Rate	$980.67
Rate for Payer: Cash Price	$606.60
Rate for Payer: Hawaii Western Management Group Commercial	$707.70
Rate for Payer: Health Management Network Commercial	$859.35
Rate for Payer: Kaiser Permanente Commercial	$636.93
Rate for Payer: Kaiser Permanente Medicaid	$515.61
Rate for Payer: MDX Hawaii PPO	$980.67
Rate for Payer: University Health Alliance Commercial	$566.16

TIGHTROPE ABS AR-1588TB-3IB

Facility

$1,011.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$566.16
Max. Negotiated Rate	$980.67
Rate for Payer: Cash Price	$606.60
Rate for Payer: Hawaii Western Management Group Commercial	$707.70
Rate for Payer: Health Management Network Commercial	$859.35
Rate for Payer: MDX Hawaii PPO	$980.67
Rate for Payer: University Health Alliance Commercial	$566.16

TIGHTROPE ABS #AR-1588TN

Facility

$690.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$351.90
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$414.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$434.70
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

TIGHTROPE ABS #AR-1588TN

Facility

$690.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$414.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

TIGHTROPE ACL AR-1588RTT

Facility

$1,654.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$926.24
Max. Negotiated Rate	$1,604.38
Rate for Payer: Cash Price	$992.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,157.80
Rate for Payer: Health Management Network Commercial	$1,405.90
Rate for Payer: MDX Hawaii PPO	$1,604.38
Rate for Payer: University Health Alliance Commercial	$926.24

TIGHTROPE ACL AR-1588RTT

Facility

$1,654.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$843.54
Max. Negotiated Rate	$1,604.38
Rate for Payer: Cash Price	$992.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,157.80
Rate for Payer: Health Management Network Commercial	$1,405.90
Rate for Payer: Kaiser Permanente Commercial	$1,042.02
Rate for Payer: Kaiser Permanente Medicaid	$843.54
Rate for Payer: MDX Hawaii PPO	$1,604.38
Rate for Payer: University Health Alliance Commercial	$926.24

TIGHTROPE ACL RT #AR-1588RT

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

TIGHTROPE ACL RT #AR-1588RT

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$765.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

TIGHTROPE ACL RT #AR-1588RTS

Facility

$1,929.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.24
Max. Negotiated Rate	$1,871.13
Rate for Payer: Cash Price	$1,157.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,350.30
Rate for Payer: Health Management Network Commercial	$1,639.65
Rate for Payer: MDX Hawaii PPO	$1,871.13
Rate for Payer: University Health Alliance Commercial	$1,080.24

TIGHTROPE ACL RT #AR-1588RTS

Facility

$1,929.00

Hospital Revenue Code	278
Min. Negotiated Rate	$983.79
Max. Negotiated Rate	$1,871.13
Rate for Payer: Cash Price	$1,157.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,350.30
Rate for Payer: Health Management Network Commercial	$1,639.65
Rate for Payer: Kaiser Permanente Commercial	$1,215.27
Rate for Payer: Kaiser Permanente Medicaid	$983.79
Rate for Payer: MDX Hawaii PPO	$1,871.13
Rate for Payer: University Health Alliance Commercial	$1,080.24

TIGHTROPE ACL SUT AR-1588RT-J

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$725.20
Max. Negotiated Rate	$1,256.15
Rate for Payer: Cash Price	$777.00
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: University Health Alliance Commercial	$725.20

TIGHTROPE ACL SUT AR-1588RT-J

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$660.45
Max. Negotiated Rate	$1,256.15
Rate for Payer: Cash Price	$777.00
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Kaiser Permanente Commercial	$815.85
Rate for Payer: Kaiser Permanente Medicaid	$660.45
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: University Health Alliance Commercial	$725.20

TIGHT ROPE BTB AR-1588BTB-IB

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,085.50
Rate for Payer: Cash Price	$1,290.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,505.00
Rate for Payer: Health Management Network Commercial	$1,827.50
Rate for Payer: MDX Hawaii PPO	$2,085.50
Rate for Payer: University Health Alliance Commercial	$1,204.00

TIGHT ROPE BTB AR-1588BTB-IB

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,096.50
Max. Negotiated Rate	$2,085.50
Rate for Payer: Cash Price	$1,290.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,505.00
Rate for Payer: Health Management Network Commercial	$1,827.50
Rate for Payer: Kaiser Permanente Commercial	$1,354.50
Rate for Payer: Kaiser Permanente Medicaid	$1,096.50
Rate for Payer: MDX Hawaii PPO	$2,085.50
Rate for Payer: University Health Alliance Commercial	$1,204.00

TIGHTROPE BUTTON AR-1588TB-3

Facility

$882.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$493.92
Max. Negotiated Rate	$855.54
Rate for Payer: Cash Price	$529.20
Rate for Payer: Hawaii Western Management Group Commercial	$617.40
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: MDX Hawaii PPO	$855.54
Rate for Payer: University Health Alliance Commercial	$493.92

TIGHTROPE BUTTON AR-1588TB-3

Facility

$882.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$449.82
Max. Negotiated Rate	$855.54
Rate for Payer: Cash Price	$529.20
Rate for Payer: Hawaii Western Management Group Commercial	$617.40
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: Kaiser Permanente Commercial	$555.66
Rate for Payer: Kaiser Permanente Medicaid	$449.82
Rate for Payer: MDX Hawaii PPO	$855.54
Rate for Payer: University Health Alliance Commercial	$493.92

TIGHTROPE II ABS AR-1588TN-21

Facility

$1,084.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$607.04
Max. Negotiated Rate	$1,051.48
Rate for Payer: Cash Price	$650.40
Rate for Payer: Hawaii Western Management Group Commercial	$758.80
Rate for Payer: Health Management Network Commercial	$921.40
Rate for Payer: MDX Hawaii PPO	$1,051.48
Rate for Payer: University Health Alliance Commercial	$607.04

TIGHTROPE II ABS AR-1588TN-21

Facility

$1,084.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$552.84
Max. Negotiated Rate	$1,051.48
Rate for Payer: Cash Price	$650.40
Rate for Payer: Hawaii Western Management Group Commercial	$758.80
Rate for Payer: Health Management Network Commercial	$921.40
Rate for Payer: Kaiser Permanente Commercial	$682.92
Rate for Payer: Kaiser Permanente Medicaid	$552.84
Rate for Payer: MDX Hawaii PPO	$1,051.48
Rate for Payer: University Health Alliance Commercial	$607.04

TIGHTROPE KNOTLESS AR-2371BL

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,500.00
Max. Negotiated Rate	$6,062.50
Rate for Payer: Cash Price	$3,750.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,375.00
Rate for Payer: Health Management Network Commercial	$5,312.50
Rate for Payer: MDX Hawaii PPO	$6,062.50
Rate for Payer: University Health Alliance Commercial	$3,500.00

TIGHTROPE KNOTLESS AR-2371BL

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$6,062.50
Rate for Payer: Cash Price	$3,750.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,375.00
Rate for Payer: Health Management Network Commercial	$5,312.50
Rate for Payer: Kaiser Permanente Commercial	$3,937.50
Rate for Payer: Kaiser Permanente Medicaid	$3,187.50
Rate for Payer: MDX Hawaii PPO	$6,062.50
Rate for Payer: University Health Alliance Commercial	$3,500.00

TIGHTROPE KNTLSS AC AR-2372BLO

Facility

$5,818.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,967.18
Max. Negotiated Rate	$5,643.46
Rate for Payer: Cash Price	$3,490.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,072.60
Rate for Payer: Health Management Network Commercial	$4,945.30
Rate for Payer: Kaiser Permanente Commercial	$3,665.34
Rate for Payer: Kaiser Permanente Medicaid	$2,967.18
Rate for Payer: MDX Hawaii PPO	$5,643.46
Rate for Payer: University Health Alliance Commercial	$3,258.08

TIGHTROPE KNTLSS AC AR-2372BLO

Facility

$5,818.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,258.08
Max. Negotiated Rate	$5,643.46
Rate for Payer: Cash Price	$3,490.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,072.60
Rate for Payer: Health Management Network Commercial	$4,945.30
Rate for Payer: MDX Hawaii PPO	$5,643.46
Rate for Payer: University Health Alliance Commercial	$3,258.08

TIGHTROPE SUTURE AR-1588BTB-J

Facility

$1,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$915.60
Max. Negotiated Rate	$1,585.95
Rate for Payer: Cash Price	$981.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: University Health Alliance Commercial	$915.60

TIGHTROPE SUTURE AR-1588BTB-J

Facility

$1,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$833.85
Max. Negotiated Rate	$1,585.95
Rate for Payer: Cash Price	$981.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: Kaiser Permanente Commercial	$1,030.05
Rate for Payer: Kaiser Permanente Medicaid	$833.85
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: University Health Alliance Commercial	$915.60

TIGHTROPE SYS AR-1288BTBIB-FC3

Facility

$2,384.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.04
Max. Negotiated Rate	$2,312.48
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,668.80
Rate for Payer: Health Management Network Commercial	$2,026.40
Rate for Payer: MDX Hawaii PPO	$2,312.48
Rate for Payer: University Health Alliance Commercial	$1,335.04

Know your out-of-pocket cost for care.

All Charges