Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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

ANCHORS SOFT SZ1 110005307

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$627.20
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Hawaii Western Management Group Commercial	$784.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: University Health Alliance Commercial	$627.20

ANCHORS SOFT SZ1 110005307

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$571.20
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Hawaii Western Management Group Commercial	$784.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Kaiser Permanente Commercial	$705.60
Rate for Payer: Kaiser Permanente Medicaid	$571.20
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: University Health Alliance Commercial	$627.20

ANCHORSURE STITCH #A-SURE02

Facility

$731.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$409.36
Max. Negotiated Rate	$709.07
Rate for Payer: Cash Price	$438.60
Rate for Payer: Hawaii Western Management Group Commercial	$511.70
Rate for Payer: Health Management Network Commercial	$621.35
Rate for Payer: MDX Hawaii PPO	$709.07
Rate for Payer: University Health Alliance Commercial	$409.36

ANCHORSURE STITCH #A-SURE02

Facility

$731.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$372.81
Max. Negotiated Rate	$709.07
Rate for Payer: Cash Price	$438.60
Rate for Payer: Hawaii Western Management Group Commercial	$511.70
Rate for Payer: Health Management Network Commercial	$621.35
Rate for Payer: Kaiser Permanente Commercial	$460.53
Rate for Payer: Kaiser Permanente Medicaid	$372.81
Rate for Payer: MDX Hawaii PPO	$709.07
Rate for Payer: University Health Alliance Commercial	$409.36

ANCHORSURE SUT DEVICE A-SURE

Facility

$1,747.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$890.97
Max. Negotiated Rate	$1,694.59
Rate for Payer: Cash Price	$1,048.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.90
Rate for Payer: Health Management Network Commercial	$1,484.95
Rate for Payer: Kaiser Permanente Commercial	$1,100.61
Rate for Payer: Kaiser Permanente Medicaid	$890.97
Rate for Payer: MDX Hawaii PPO	$1,694.59
Rate for Payer: University Health Alliance Commercial	$978.32

ANCHORSURE SUT DEVICE A-SURE

Facility

$1,747.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$978.32
Max. Negotiated Rate	$1,694.59
Rate for Payer: Cash Price	$1,048.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.90
Rate for Payer: Health Management Network Commercial	$1,484.95
Rate for Payer: MDX Hawaii PPO	$1,694.59
Rate for Payer: University Health Alliance Commercial	$978.32

ANCHOR SUT FIBRTAK DBL AR-3632

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

ANCHOR SUT FIBRTAK DBL AR-3632

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

ANCHOR SUTURE 3910-947-120

Facility

$2,059.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.09
Max. Negotiated Rate	$1,997.23
Rate for Payer: Cash Price	$1,235.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,441.30
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: Kaiser Permanente Commercial	$1,297.17
Rate for Payer: Kaiser Permanente Medicaid	$1,050.09
Rate for Payer: MDX Hawaii PPO	$1,997.23
Rate for Payer: University Health Alliance Commercial	$1,153.04

ANCHOR SUTURE 3910-947-120

Facility

$2,059.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,153.04
Max. Negotiated Rate	$1,997.23
Rate for Payer: Cash Price	$1,235.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,441.30
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: MDX Hawaii PPO	$1,997.23
Rate for Payer: University Health Alliance Commercial	$1,153.04

ANCHOR SUTURE 4.75 3910500471

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,052.80
Max. Negotiated Rate	$1,823.60
Rate for Payer: Cash Price	$1,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,316.00
Rate for Payer: Health Management Network Commercial	$1,598.00
Rate for Payer: MDX Hawaii PPO	$1,823.60
Rate for Payer: University Health Alliance Commercial	$1,052.80

ANCHOR SUTURE 4.75 3910500471

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$958.80
Max. Negotiated Rate	$1,823.60
Rate for Payer: Cash Price	$1,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,316.00
Rate for Payer: Health Management Network Commercial	$1,598.00
Rate for Payer: Kaiser Permanente Commercial	$1,184.40
Rate for Payer: Kaiser Permanente Medicaid	$958.80
Rate for Payer: MDX Hawaii PPO	$1,823.60
Rate for Payer: University Health Alliance Commercial	$1,052.80

ANCHOR SUTURE #AR-1927BCFT

Facility

$1,726.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$880.26
Max. Negotiated Rate	$1,674.22
Rate for Payer: Cash Price	$1,035.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,208.20
Rate for Payer: Health Management Network Commercial	$1,467.10
Rate for Payer: Kaiser Permanente Commercial	$1,087.38
Rate for Payer: Kaiser Permanente Medicaid	$880.26
Rate for Payer: MDX Hawaii PPO	$1,674.22
Rate for Payer: University Health Alliance Commercial	$966.56

ANCHOR SUTURE #AR-1927BCFT

Facility

$1,726.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$966.56
Max. Negotiated Rate	$1,674.22
Rate for Payer: Cash Price	$1,035.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,208.20
Rate for Payer: Health Management Network Commercial	$1,467.10
Rate for Payer: MDX Hawaii PPO	$1,674.22
Rate for Payer: University Health Alliance Commercial	$966.56

ANCHOR SUTURE #AR-1927BCNF

Facility

$1,677.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$855.27
Max. Negotiated Rate	$1,626.69
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,173.90
Rate for Payer: Health Management Network Commercial	$1,425.45
Rate for Payer: Kaiser Permanente Commercial	$1,056.51
Rate for Payer: Kaiser Permanente Medicaid	$855.27
Rate for Payer: MDX Hawaii PPO	$1,626.69
Rate for Payer: University Health Alliance Commercial	$939.12

ANCHOR SUTURE #AR-1927BCNF

Facility

$1,677.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$939.12
Max. Negotiated Rate	$1,626.69
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,173.90
Rate for Payer: Health Management Network Commercial	$1,425.45
Rate for Payer: MDX Hawaii PPO	$1,626.69
Rate for Payer: University Health Alliance Commercial	$939.12

ANCHOR SUTURE #AR-1928SF-3

Facility

$1,225.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$1,188.25
Rate for Payer: Cash Price	$735.00
Rate for Payer: Hawaii Western Management Group Commercial	$857.50
Rate for Payer: Health Management Network Commercial	$1,041.25
Rate for Payer: Kaiser Permanente Commercial	$771.75
Rate for Payer: Kaiser Permanente Medicaid	$624.75
Rate for Payer: MDX Hawaii PPO	$1,188.25
Rate for Payer: University Health Alliance Commercial	$686.00

ANCHOR SUTURE #AR-1928SF-3

Facility

$1,225.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$686.00
Max. Negotiated Rate	$1,188.25
Rate for Payer: Cash Price	$735.00
Rate for Payer: Hawaii Western Management Group Commercial	$857.50
Rate for Payer: Health Management Network Commercial	$1,041.25
Rate for Payer: MDX Hawaii PPO	$1,188.25
Rate for Payer: University Health Alliance Commercial	$686.00

ANCHOR SUTURE #AR-1934BCF-24

Facility

$1,526.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$778.26
Max. Negotiated Rate	$1,480.22
Rate for Payer: Cash Price	$915.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,068.20
Rate for Payer: Health Management Network Commercial	$1,297.10
Rate for Payer: Kaiser Permanente Commercial	$961.38
Rate for Payer: Kaiser Permanente Medicaid	$778.26
Rate for Payer: MDX Hawaii PPO	$1,480.22
Rate for Payer: University Health Alliance Commercial	$854.56

ANCHOR SUTURE #AR-1934BCF-24

Facility

$1,526.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$854.56
Max. Negotiated Rate	$1,480.22
Rate for Payer: Cash Price	$915.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,068.20
Rate for Payer: Health Management Network Commercial	$1,297.10
Rate for Payer: MDX Hawaii PPO	$1,480.22
Rate for Payer: University Health Alliance Commercial	$854.56

ANCHOR SUTURE #AR-1934BCF-24-2

Facility

$1,603.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$897.68
Max. Negotiated Rate	$1,554.91
Rate for Payer: Cash Price	$961.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.10
Rate for Payer: Health Management Network Commercial	$1,362.55
Rate for Payer: MDX Hawaii PPO	$1,554.91
Rate for Payer: University Health Alliance Commercial	$897.68

ANCHOR SUTURE #AR-1934BCF-24-2

Facility

$1,603.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$817.53
Max. Negotiated Rate	$1,554.91
Rate for Payer: Cash Price	$961.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.10
Rate for Payer: Health Management Network Commercial	$1,362.55
Rate for Payer: Kaiser Permanente Commercial	$1,009.89
Rate for Payer: Kaiser Permanente Medicaid	$817.53
Rate for Payer: MDX Hawaii PPO	$1,554.91
Rate for Payer: University Health Alliance Commercial	$897.68

ANCHOR SUTURE #AR-2324BSLM

Facility

$1,629.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$830.79
Max. Negotiated Rate	$1,580.13
Rate for Payer: Cash Price	$977.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,140.30
Rate for Payer: Health Management Network Commercial	$1,384.65
Rate for Payer: Kaiser Permanente Commercial	$1,026.27
Rate for Payer: Kaiser Permanente Medicaid	$830.79
Rate for Payer: MDX Hawaii PPO	$1,580.13
Rate for Payer: University Health Alliance Commercial	$912.24

ANCHOR SUTURE #AR-2324BSLM

Facility

$1,629.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$912.24
Max. Negotiated Rate	$1,580.13
Rate for Payer: Cash Price	$977.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,140.30
Rate for Payer: Health Management Network Commercial	$1,384.65
Rate for Payer: MDX Hawaii PPO	$1,580.13
Rate for Payer: University Health Alliance Commercial	$912.24

Know your out-of-pocket cost for care.

All Charges