Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

ANCHOR 2.9X15.5MM #AR-1923BC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$875.16
Max. Negotiated Rate	$1,664.52
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Kaiser Permanente Commercial	$1,081.08
Rate for Payer: Kaiser Permanente Medicaid	$875.16
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: University Health Alliance Commercial	$960.96

ANCHOR 2.9X15.5MM #AR-1923BC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$960.96
Max. Negotiated Rate	$1,664.52
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: University Health Alliance Commercial	$960.96

ANCHOR 4.5 TWINFIX 72202893

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$625.52
Max. Negotiated Rate	$1,083.49
Rate for Payer: Cash Price	$670.20
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR 4.5 TWINFIX 72202893

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$569.67
Max. Negotiated Rate	$1,083.49
Rate for Payer: Cash Price	$670.20
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Kaiser Permanente Commercial	$703.71
Rate for Payer: Kaiser Permanente Medicaid	$569.67
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR 4.75 KNOTLESS SP

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,262.25
Max. Negotiated Rate	$2,400.75
Rate for Payer: Cash Price	$1,485.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,732.50
Rate for Payer: Health Management Network Commercial	$2,103.75
Rate for Payer: Kaiser Permanente Commercial	$1,559.25
Rate for Payer: Kaiser Permanente Medicaid	$1,262.25
Rate for Payer: MDX Hawaii PPO	$2,400.75
Rate for Payer: University Health Alliance Commercial	$1,386.00

ANCHOR 4.75 KNOTLESS SP

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,386.00
Max. Negotiated Rate	$2,400.75
Rate for Payer: Cash Price	$1,485.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,732.50
Rate for Payer: Health Management Network Commercial	$2,103.75
Rate for Payer: MDX Hawaii PPO	$2,400.75
Rate for Payer: University Health Alliance Commercial	$1,386.00

ANCHOR 5.5 TWINFIX 72202895

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$625.52
Max. Negotiated Rate	$1,083.49
Rate for Payer: Cash Price	$670.20
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR 5.5 TWINFIX 72202895

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$569.67
Max. Negotiated Rate	$1,083.49
Rate for Payer: Cash Price	$670.20
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Kaiser Permanente Commercial	$703.71
Rate for Payer: Kaiser Permanente Medicaid	$569.67
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR 6.5 TI TWINFIX 72202898

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$625.52
Max. Negotiated Rate	$1,083.49
Rate for Payer: Cash Price	$670.20
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR 6.5 TI TWINFIX 72202898

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$569.67
Max. Negotiated Rate	$1,083.49
Rate for Payer: Cash Price	$670.20
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Kaiser Permanente Commercial	$703.71
Rate for Payer: Kaiser Permanente Medicaid	$569.67
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR BILATERAL KIT 2X ES0172

Facility

$1,383.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$774.48
Max. Negotiated Rate	$1,341.51
Rate for Payer: Cash Price	$829.80
Rate for Payer: Hawaii Western Management Group Commercial	$968.10
Rate for Payer: Health Management Network Commercial	$1,175.55
Rate for Payer: MDX Hawaii PPO	$1,341.51
Rate for Payer: University Health Alliance Commercial	$774.48

ANCHOR BILATERAL KIT 2X ES0172

Facility

$1,383.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$705.33
Max. Negotiated Rate	$1,341.51
Rate for Payer: Cash Price	$829.80
Rate for Payer: Hawaii Western Management Group Commercial	$968.10
Rate for Payer: Health Management Network Commercial	$1,175.55
Rate for Payer: Kaiser Permanente Commercial	$871.29
Rate for Payer: Kaiser Permanente Medicaid	$705.33
Rate for Payer: MDX Hawaii PPO	$1,341.51
Rate for Payer: University Health Alliance Commercial	$774.48

ANCHOR CORKSCREW AR-1927BCT

Facility

$1,243.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$633.93
Max. Negotiated Rate	$1,205.71
Rate for Payer: Cash Price	$745.80
Rate for Payer: Hawaii Western Management Group Commercial	$870.10
Rate for Payer: Health Management Network Commercial	$1,056.55
Rate for Payer: Kaiser Permanente Commercial	$783.09
Rate for Payer: Kaiser Permanente Medicaid	$633.93
Rate for Payer: MDX Hawaii PPO	$1,205.71
Rate for Payer: University Health Alliance Commercial	$696.08

ANCHOR CORKSCREW AR-1927BCT

Facility

$1,243.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$696.08
Max. Negotiated Rate	$1,205.71
Rate for Payer: Cash Price	$745.80
Rate for Payer: Hawaii Western Management Group Commercial	$870.10
Rate for Payer: Health Management Network Commercial	$1,056.55
Rate for Payer: MDX Hawaii PPO	$1,205.71
Rate for Payer: University Health Alliance Commercial	$696.08

ANCHOR DBL 4.75MM AR-2324BCT-2

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

ANCHOR DBL 4.75MM AR-2324BCT-2

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

ANCHOR DOUBLE LOADED 2 #2

Facility

$1,830.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$933.30
Max. Negotiated Rate	$1,775.10
Rate for Payer: Cash Price	$1,098.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,281.00
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: Kaiser Permanente Commercial	$1,152.90
Rate for Payer: Kaiser Permanente Medicaid	$933.30
Rate for Payer: MDX Hawaii PPO	$1,775.10
Rate for Payer: University Health Alliance Commercial	$1,024.80

ANCHOR DOUBLE LOADED 2 #2

Facility

$1,830.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,024.80
Max. Negotiated Rate	$1,775.10
Rate for Payer: Cash Price	$1,098.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,281.00
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: MDX Hawaii PPO	$1,775.10
Rate for Payer: University Health Alliance Commercial	$1,024.80

ANCHOR ICONIX 2.3MM 3910500422

Facility

$1,569.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$800.19
Max. Negotiated Rate	$1,521.93
Rate for Payer: Cash Price	$941.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,098.30
Rate for Payer: Health Management Network Commercial	$1,333.65
Rate for Payer: Kaiser Permanente Commercial	$988.47
Rate for Payer: Kaiser Permanente Medicaid	$800.19
Rate for Payer: MDX Hawaii PPO	$1,521.93
Rate for Payer: University Health Alliance Commercial	$878.64

ANCHOR ICONIX 2.3MM 3910500422

Facility

$1,569.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$878.64
Max. Negotiated Rate	$1,521.93
Rate for Payer: Cash Price	$941.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,098.30
Rate for Payer: Health Management Network Commercial	$1,333.65
Rate for Payer: MDX Hawaii PPO	$1,521.93
Rate for Payer: University Health Alliance Commercial	$878.64

ANCHOR ICONIX 3910-500-921

Facility

$2,499.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,274.49
Max. Negotiated Rate	$2,424.03
Rate for Payer: Cash Price	$1,499.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,749.30
Rate for Payer: Health Management Network Commercial	$2,124.15
Rate for Payer: Kaiser Permanente Commercial	$1,574.37
Rate for Payer: Kaiser Permanente Medicaid	$1,274.49
Rate for Payer: MDX Hawaii PPO	$2,424.03
Rate for Payer: University Health Alliance Commercial	$1,399.44

ANCHOR ICONIX 3910-500-921

Facility

$2,499.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,399.44
Max. Negotiated Rate	$2,424.03
Rate for Payer: Cash Price	$1,499.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,749.30
Rate for Payer: Health Management Network Commercial	$2,124.15
Rate for Payer: MDX Hawaii PPO	$2,424.03
Rate for Payer: University Health Alliance Commercial	$1,399.44

ANCHOR PROXIMAL TENDO AR-2290

Facility

$2,126.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,084.26
Max. Negotiated Rate	$2,062.22
Rate for Payer: Cash Price	$1,275.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,488.20
Rate for Payer: Health Management Network Commercial	$1,807.10
Rate for Payer: Kaiser Permanente Commercial	$1,339.38
Rate for Payer: Kaiser Permanente Medicaid	$1,084.26
Rate for Payer: MDX Hawaii PPO	$2,062.22
Rate for Payer: University Health Alliance Commercial	$1,190.56

ANCHOR PROXIMAL TENDO AR-2290

Facility

$2,126.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,190.56
Max. Negotiated Rate	$2,062.22
Rate for Payer: Cash Price	$1,275.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,488.20
Rate for Payer: Health Management Network Commercial	$1,807.10
Rate for Payer: MDX Hawaii PPO	$2,062.22
Rate for Payer: University Health Alliance Commercial	$1,190.56

ANCHOR REELX 5.5 #3910-600-060

Facility

$1,566.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$876.96
Max. Negotiated Rate	$1,519.02
Rate for Payer: Cash Price	$939.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,096.20
Rate for Payer: Health Management Network Commercial	$1,331.10
Rate for Payer: MDX Hawaii PPO	$1,519.02
Rate for Payer: University Health Alliance Commercial	$876.96

Know your out-of-pocket cost for care.

All Charges