Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

MESH FLEX HD 8X16 PF2618

Facility

$11,412.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$5,820.12
Max. Negotiated Rate	$11,069.64
Rate for Payer: Cash Price	$6,847.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,988.40
Rate for Payer: Health Management Network Commercial	$9,700.20
Rate for Payer: Kaiser Permanente Commercial	$7,189.56
Rate for Payer: Kaiser Permanente Medicaid	$5,820.12
Rate for Payer: MDX Hawaii PPO	$11,069.64
Rate for Payer: University Health Alliance Commercial	$6,390.72

MESH FLEX HD 8X16 PF2618

Facility

$11,412.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$6,390.72
Max. Negotiated Rate	$11,069.64
Rate for Payer: Cash Price	$6,847.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,988.40
Rate for Payer: Health Management Network Commercial	$9,700.20
Rate for Payer: MDX Hawaii PPO	$11,069.64
Rate for Payer: University Health Alliance Commercial	$6,390.72

MESH HERNIA PLUG AND PATCH

Facility

$391.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$218.96
Max. Negotiated Rate	$379.27
Rate for Payer: Cash Price	$234.60
Rate for Payer: Hawaii Western Management Group Commercial	$273.70
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: MDX Hawaii PPO	$379.27
Rate for Payer: University Health Alliance Commercial	$218.96

MESH HERNIA PLUG AND PATCH

Facility

$391.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$199.41
Max. Negotiated Rate	$379.27
Rate for Payer: Cash Price	$234.60
Rate for Payer: Hawaii Western Management Group Commercial	$273.70
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: Kaiser Permanente Commercial	$246.33
Rate for Payer: Kaiser Permanente Medicaid	$199.41
Rate for Payer: MDX Hawaii PPO	$379.27
Rate for Payer: University Health Alliance Commercial	$218.96

MESH HERNIA SYNECOR 12C GKFC12

Facility

$1,863.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$950.13
Max. Negotiated Rate	$1,807.11
Rate for Payer: Cash Price	$1,117.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,304.10
Rate for Payer: Health Management Network Commercial	$1,583.55
Rate for Payer: Kaiser Permanente Commercial	$1,173.69
Rate for Payer: Kaiser Permanente Medicaid	$950.13
Rate for Payer: MDX Hawaii PPO	$1,807.11
Rate for Payer: University Health Alliance Commercial	$1,043.28

MESH HERNIA SYNECOR 12C GKFC12

Facility

$1,863.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,043.28
Max. Negotiated Rate	$1,807.11
Rate for Payer: Cash Price	$1,117.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,304.10
Rate for Payer: Health Management Network Commercial	$1,583.55
Rate for Payer: MDX Hawaii PPO	$1,807.11
Rate for Payer: University Health Alliance Commercial	$1,043.28

MESH LF NON ABS 0115311

Facility

$910.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$464.10
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Hawaii Western Management Group Commercial	$637.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Kaiser Permanente Commercial	$573.30
Rate for Payer: Kaiser Permanente Medicaid	$464.10
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: University Health Alliance Commercial	$509.60

MESH LF NON ABS 0115311

Facility

$910.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$509.60
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Hawaii Western Management Group Commercial	$637.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: University Health Alliance Commercial	$509.60

MESH LF NON ABS 0115312

Facility

$1,220.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$683.20
Max. Negotiated Rate	$1,183.40
Rate for Payer: Cash Price	$732.00
Rate for Payer: Hawaii Western Management Group Commercial	$854.00
Rate for Payer: Health Management Network Commercial	$1,037.00
Rate for Payer: MDX Hawaii PPO	$1,183.40
Rate for Payer: University Health Alliance Commercial	$683.20

MESH LF NON ABS 0115312

Facility

$1,220.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$622.20
Max. Negotiated Rate	$1,183.40
Rate for Payer: Cash Price	$732.00
Rate for Payer: Hawaii Western Management Group Commercial	$854.00
Rate for Payer: Health Management Network Commercial	$1,037.00
Rate for Payer: Kaiser Permanente Commercial	$768.60
Rate for Payer: Kaiser Permanente Medicaid	$622.20
Rate for Payer: MDX Hawaii PPO	$1,183.40
Rate for Payer: University Health Alliance Commercial	$683.20

MESH M FLAT 15X10 501320

Facility

$2,076.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,058.76
Max. Negotiated Rate	$2,013.72
Rate for Payer: Cash Price	$1,245.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,453.20
Rate for Payer: Health Management Network Commercial	$1,764.60
Rate for Payer: Kaiser Permanente Commercial	$1,307.88
Rate for Payer: Kaiser Permanente Medicaid	$1,058.76
Rate for Payer: MDX Hawaii PPO	$2,013.72
Rate for Payer: University Health Alliance Commercial	$1,162.56

MESH M FLAT 15X10 501320

Facility

$2,076.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.56
Max. Negotiated Rate	$2,013.72
Rate for Payer: Cash Price	$1,245.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,453.20
Rate for Payer: Health Management Network Commercial	$1,764.60
Rate for Payer: MDX Hawaii PPO	$2,013.72
Rate for Payer: University Health Alliance Commercial	$1,162.56

MESH MONOFILAMENT POLY 0112660

Facility

$523.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$266.73
Max. Negotiated Rate	$507.31
Rate for Payer: Cash Price	$313.80
Rate for Payer: Hawaii Western Management Group Commercial	$366.10
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Kaiser Permanente Commercial	$329.49
Rate for Payer: Kaiser Permanente Medicaid	$266.73
Rate for Payer: MDX Hawaii PPO	$507.31
Rate for Payer: University Health Alliance Commercial	$292.88

MESH MONOFILAMENT POLY 0112660

Facility

$523.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$292.88
Max. Negotiated Rate	$507.31
Rate for Payer: Cash Price	$313.80
Rate for Payer: Hawaii Western Management Group Commercial	$366.10
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: MDX Hawaii PPO	$507.31
Rate for Payer: University Health Alliance Commercial	$292.88

MESH PARIETEX HERNIA PCO20X

Facility

$2,828.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,583.68
Max. Negotiated Rate	$2,743.16
Rate for Payer: Cash Price	$1,696.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,979.60
Rate for Payer: Health Management Network Commercial	$2,403.80
Rate for Payer: MDX Hawaii PPO	$2,743.16
Rate for Payer: University Health Alliance Commercial	$1,583.68

MESH PARIETEX HERNIA PCO20X

Facility

$2,828.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,442.28
Max. Negotiated Rate	$2,743.16
Rate for Payer: Cash Price	$1,696.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,979.60
Rate for Payer: Health Management Network Commercial	$2,403.80
Rate for Payer: Kaiser Permanente Commercial	$1,781.64
Rate for Payer: Kaiser Permanente Medicaid	$1,442.28
Rate for Payer: MDX Hawaii PPO	$2,743.16
Rate for Payer: University Health Alliance Commercial	$1,583.68

MESH PERFIX PLUG, LG 0112970

Facility

$1,025.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$574.00
Max. Negotiated Rate	$994.25
Rate for Payer: Cash Price	$615.00
Rate for Payer: Hawaii Western Management Group Commercial	$717.50
Rate for Payer: Health Management Network Commercial	$871.25
Rate for Payer: MDX Hawaii PPO	$994.25
Rate for Payer: University Health Alliance Commercial	$574.00

MESH PERFIX PLUG, LG 0112970

Facility

$1,025.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$522.75
Max. Negotiated Rate	$994.25
Rate for Payer: Cash Price	$615.00
Rate for Payer: Hawaii Western Management Group Commercial	$717.50
Rate for Payer: Health Management Network Commercial	$871.25
Rate for Payer: Kaiser Permanente Commercial	$645.75
Rate for Payer: Kaiser Permanente Medicaid	$522.75
Rate for Payer: MDX Hawaii PPO	$994.25
Rate for Payer: University Health Alliance Commercial	$574.00

MESH PHASIX 20X25 1202025

Facility

$28,644.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$14,608.44
Max. Negotiated Rate	$27,784.68
Rate for Payer: Cash Price	$17,186.40
Rate for Payer: Hawaii Western Management Group Commercial	$20,050.80
Rate for Payer: Health Management Network Commercial	$24,347.40
Rate for Payer: Kaiser Permanente Commercial	$18,045.72
Rate for Payer: Kaiser Permanente Medicaid	$14,608.44
Rate for Payer: MDX Hawaii PPO	$27,784.68
Rate for Payer: University Health Alliance Commercial	$16,040.64

MESH PHASIX 20X25 1202025

Facility

$28,644.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$16,040.64
Max. Negotiated Rate	$27,784.68
Rate for Payer: Cash Price	$17,186.40
Rate for Payer: Hawaii Western Management Group Commercial	$20,050.80
Rate for Payer: Health Management Network Commercial	$24,347.40
Rate for Payer: MDX Hawaii PPO	$27,784.68
Rate for Payer: University Health Alliance Commercial	$16,040.64

MESH PHSM SYNTHETIC NON AB

Facility

$1,842.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.52
Max. Negotiated Rate	$1,786.74
Rate for Payer: Cash Price	$1,105.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,289.40
Rate for Payer: Health Management Network Commercial	$1,565.70
Rate for Payer: MDX Hawaii PPO	$1,786.74
Rate for Payer: University Health Alliance Commercial	$1,031.52

MESH PHSM SYNTHETIC NON AB

Facility

$1,842.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$939.42
Max. Negotiated Rate	$1,786.74
Rate for Payer: Cash Price	$1,105.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,289.40
Rate for Payer: Health Management Network Commercial	$1,565.70
Rate for Payer: Kaiser Permanente Commercial	$1,160.46
Rate for Payer: Kaiser Permanente Medicaid	$939.42
Rate for Payer: MDX Hawaii PPO	$1,786.74
Rate for Payer: University Health Alliance Commercial	$1,031.52

MESH POLY 15CM W/COLLAGEN

Facility

$2,884.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.04
Max. Negotiated Rate	$2,797.48
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: University Health Alliance Commercial	$1,615.04

MESH POLY 15CM W/COLLAGEN

Facility

$2,884.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,470.84
Max. Negotiated Rate	$2,797.48
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Kaiser Permanente Commercial	$1,816.92
Rate for Payer: Kaiser Permanente Medicaid	$1,470.84
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: University Health Alliance Commercial	$1,615.04

MESH POLY 20X15 W/COLLAGEN

Facility

$2,074.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,161.44
Max. Negotiated Rate	$2,011.78
Rate for Payer: Cash Price	$1,244.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.80
Rate for Payer: Health Management Network Commercial	$1,762.90
Rate for Payer: MDX Hawaii PPO	$2,011.78
Rate for Payer: University Health Alliance Commercial	$1,161.44

Know your out-of-pocket cost for care.

All Charges