Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

KNE FEM SZ:G/LT 00-5964-017-51

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:G/LT 00-5964-017-51

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNIFE RX NEEDLE KNIFE XL

Facility

$720.00

Hospital Revenue Code	272
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$698.40
Rate for Payer: Cash Price	$432.00
Rate for Payer: Hawaii Western Management Group Commercial	$684.00
Rate for Payer: Health Management Network Commercial	$612.00
Rate for Payer: Kaiser Permanente Commercial	$453.60
Rate for Payer: Kaiser Permanente Medicaid	$367.20
Rate for Payer: MDX Hawaii PPO	$698.40
Rate for Payer: University Health Alliance Commercial	$524.81

KNIFE RX NEEDLE KNIFE XL

Facility

$720.00

Hospital Revenue Code	272
Min. Negotiated Rate	$612.00
Max. Negotiated Rate	$698.40
Rate for Payer: Cash Price	$432.00
Rate for Payer: Health Management Network Commercial	$612.00
Rate for Payer: MDX Hawaii PPO	$698.40

KNIFE SLIT ANG 2.75

Facility

$134.00

Hospital Revenue Code	272
Min. Negotiated Rate	$68.34
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$80.40
Rate for Payer: Hawaii Western Management Group Commercial	$127.30
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$84.42
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: University Health Alliance Commercial	$97.67

KNIFE SLIT ANG 2.75

Facility

$134.00

Hospital Revenue Code	272
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$80.40
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: MDX Hawaii PPO	$129.98

KNOTLESS FIBERTAK AR-2600FSB-2

Facility

$9,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$4,717.50
Max. Negotiated Rate	$8,972.50
Rate for Payer: Cash Price	$5,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,475.00
Rate for Payer: Health Management Network Commercial	$7,862.50
Rate for Payer: Kaiser Permanente Commercial	$5,827.50
Rate for Payer: Kaiser Permanente Medicaid	$4,717.50
Rate for Payer: MDX Hawaii PPO	$8,972.50
Rate for Payer: University Health Alliance Commercial	$5,180.00

KNOTLESS FIBERTAK AR-2600FSB-2

Facility

$9,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$5,180.00
Max. Negotiated Rate	$8,972.50
Rate for Payer: Cash Price	$5,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,475.00
Rate for Payer: Health Management Network Commercial	$7,862.50
Rate for Payer: MDX Hawaii PPO	$8,972.50
Rate for Payer: University Health Alliance Commercial	$5,180.00

KNOTLESS TIGHTROPE AR-8925SS

Facility

$2,990.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,524.90
Max. Negotiated Rate	$2,900.30
Rate for Payer: Cash Price	$1,794.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,093.00
Rate for Payer: Health Management Network Commercial	$2,541.50
Rate for Payer: Kaiser Permanente Commercial	$1,883.70
Rate for Payer: Kaiser Permanente Medicaid	$1,524.90
Rate for Payer: MDX Hawaii PPO	$2,900.30
Rate for Payer: University Health Alliance Commercial	$1,674.40

KNOTLESS TIGHTROPE AR-8925SS

Facility

$2,990.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.40
Max. Negotiated Rate	$2,900.30
Rate for Payer: Cash Price	$1,794.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,093.00
Rate for Payer: Health Management Network Commercial	$2,541.50
Rate for Payer: MDX Hawaii PPO	$2,900.30
Rate for Payer: University Health Alliance Commercial	$1,674.40

KNOTLESS TIGHTROPE #AR-8926SSK

Facility

$2,516.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,283.16
Max. Negotiated Rate	$2,440.52
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.20
Rate for Payer: Health Management Network Commercial	$2,138.60
Rate for Payer: Kaiser Permanente Commercial	$1,585.08
Rate for Payer: Kaiser Permanente Medicaid	$1,283.16
Rate for Payer: MDX Hawaii PPO	$2,440.52
Rate for Payer: University Health Alliance Commercial	$1,408.96

KNOTLESS TIGHTROPE #AR-8926SSK

Facility

$2,516.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,408.96
Max. Negotiated Rate	$2,440.52
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.20
Rate for Payer: Health Management Network Commercial	$2,138.60
Rate for Payer: MDX Hawaii PPO	$2,440.52
Rate for Payer: University Health Alliance Commercial	$1,408.96

K-WIRE 0.062X3 AR-2663

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$122.22

K-WIRE 0.062X3 AR-2663

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$79.38
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$91.84

K-WIRE .035X4" 316-0114

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$107.15

K-WIRE .035X4" 316-0114

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: MDX Hawaii PPO	$142.59

K-WIRE .035X4" DBL 316-0119

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: MDX Hawaii PPO	$142.59

K-WIRE .035X4" DBL 316-0119

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$107.15

K-WIRE .035X6" 316-0106

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$79.38
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$91.84

K-WIRE .035X6" 316-0106

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$122.22

K-WIRE .035X6" DBL 316-0117

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$107.15

K-WIRE .035X6" DBL 316-0117

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: MDX Hawaii PPO	$142.59

K-WIRE .045" DIAMOND 186-27-12

Facility

$87.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$48.72
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Hawaii Western Management Group Commercial	$60.90
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: University Health Alliance Commercial	$48.72

K-WIRE .045" DIAMOND 186-27-12

Facility

$87.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$44.37
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Hawaii Western Management Group Commercial	$60.90
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$54.81
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: University Health Alliance Commercial	$48.72

K-WIRE .045X6" 316-0006

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$107.15

Know your out-of-pocket cost for care.

All Charges