Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

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

MESH POLY 9CM DIA W/COLLAGEN

Facility

$1,100.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$561.00
Max. Negotiated Rate	$1,067.00
Rate for Payer: Cash Price	$660.00
Rate for Payer: Hawaii Western Management Group Commercial	$770.00
Rate for Payer: Health Management Network Commercial	$935.00
Rate for Payer: Kaiser Permanente Commercial	$693.00
Rate for Payer: Kaiser Permanente Medicaid	$561.00
Rate for Payer: MDX Hawaii PPO	$1,067.00
Rate for Payer: University Health Alliance Commercial	$616.00

MESH POLY 9CM DIA W/COLLAGEN

Facility

$1,100.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$616.00
Max. Negotiated Rate	$1,067.00
Rate for Payer: Cash Price	$660.00
Rate for Payer: Hawaii Western Management Group Commercial	$770.00
Rate for Payer: Health Management Network Commercial	$935.00
Rate for Payer: MDX Hawaii PPO	$1,067.00
Rate for Payer: University Health Alliance Commercial	$616.00

MESH POLYESTER 30X20CM PCO3020

Facility

$2,874.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,609.44
Max. Negotiated Rate	$2,787.78
Rate for Payer: Cash Price	$1,724.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,011.80
Rate for Payer: Health Management Network Commercial	$2,442.90
Rate for Payer: MDX Hawaii PPO	$2,787.78
Rate for Payer: University Health Alliance Commercial	$1,609.44

MESH POLYESTER 30X20CM PCO3020

Facility

$2,874.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,465.74
Max. Negotiated Rate	$2,787.78
Rate for Payer: Cash Price	$1,724.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,011.80
Rate for Payer: Health Management Network Commercial	$2,442.90
Rate for Payer: Kaiser Permanente Commercial	$1,810.62
Rate for Payer: Kaiser Permanente Medicaid	$1,465.74
Rate for Payer: MDX Hawaii PPO	$2,787.78
Rate for Payer: University Health Alliance Commercial	$1,609.44

MESH PTEX PCOX ROUND 12CM

Facility

$1,584.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$887.04
Max. Negotiated Rate	$1,536.48
Rate for Payer: Cash Price	$950.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,108.80
Rate for Payer: Health Management Network Commercial	$1,346.40
Rate for Payer: MDX Hawaii PPO	$1,536.48
Rate for Payer: University Health Alliance Commercial	$887.04

MESH PTEX PCOX ROUND 12CM

Facility

$1,584.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$807.84
Max. Negotiated Rate	$1,536.48
Rate for Payer: Cash Price	$950.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,108.80
Rate for Payer: Health Management Network Commercial	$1,346.40
Rate for Payer: Kaiser Permanente Commercial	$997.92
Rate for Payer: Kaiser Permanente Medicaid	$807.84
Rate for Payer: MDX Hawaii PPO	$1,536.48
Rate for Payer: University Health Alliance Commercial	$887.04

MESH RT NON ABS 0115321

Facility

$1,106.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$564.06
Max. Negotiated Rate	$1,072.82
Rate for Payer: Cash Price	$663.60
Rate for Payer: Hawaii Western Management Group Commercial	$774.20
Rate for Payer: Health Management Network Commercial	$940.10
Rate for Payer: Kaiser Permanente Commercial	$696.78
Rate for Payer: Kaiser Permanente Medicaid	$564.06
Rate for Payer: MDX Hawaii PPO	$1,072.82
Rate for Payer: University Health Alliance Commercial	$619.36

MESH RT NON ABS 0115321

Facility

$1,106.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$619.36
Max. Negotiated Rate	$1,072.82
Rate for Payer: Cash Price	$663.60
Rate for Payer: Hawaii Western Management Group Commercial	$774.20
Rate for Payer: Health Management Network Commercial	$940.10
Rate for Payer: MDX Hawaii PPO	$1,072.82
Rate for Payer: University Health Alliance Commercial	$619.36

MESH RT NON ABS 0115322

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 RT NON ABS 0115322

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 SELF GRIPPING LT 12X8

Facility

$981.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$549.36
Max. Negotiated Rate	$951.57
Rate for Payer: Cash Price	$588.60
Rate for Payer: Hawaii Western Management Group Commercial	$686.70
Rate for Payer: Health Management Network Commercial	$833.85
Rate for Payer: MDX Hawaii PPO	$951.57
Rate for Payer: University Health Alliance Commercial	$549.36

MESH SELF GRIPPING LT 12X8

Facility

$981.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$500.31
Max. Negotiated Rate	$951.57
Rate for Payer: Cash Price	$588.60
Rate for Payer: Hawaii Western Management Group Commercial	$686.70
Rate for Payer: Health Management Network Commercial	$833.85
Rate for Payer: Kaiser Permanente Commercial	$618.03
Rate for Payer: Kaiser Permanente Medicaid	$500.31
Rate for Payer: MDX Hawaii PPO	$951.57
Rate for Payer: University Health Alliance Commercial	$549.36

MESH SELF GRIPPING RT 12X9

Facility

$1,665.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$849.15
Max. Negotiated Rate	$1,615.05
Rate for Payer: Cash Price	$999.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,165.50
Rate for Payer: Health Management Network Commercial	$1,415.25
Rate for Payer: Kaiser Permanente Commercial	$1,048.95
Rate for Payer: Kaiser Permanente Medicaid	$849.15
Rate for Payer: MDX Hawaii PPO	$1,615.05
Rate for Payer: University Health Alliance Commercial	$932.40

MESH SELF GRIPPING RT 12X9

Facility

$1,665.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$932.40
Max. Negotiated Rate	$1,615.05
Rate for Payer: Cash Price	$999.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,165.50
Rate for Payer: Health Management Network Commercial	$1,415.25
Rate for Payer: MDX Hawaii PPO	$1,615.05
Rate for Payer: University Health Alliance Commercial	$932.40

MESH STEX 15X10CM

Facility

$2,099.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,175.44
Max. Negotiated Rate	$2,036.03
Rate for Payer: Cash Price	$1,259.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,469.30
Rate for Payer: Health Management Network Commercial	$1,784.15
Rate for Payer: MDX Hawaii PPO	$2,036.03
Rate for Payer: University Health Alliance Commercial	$1,175.44

MESH STEX 15X10CM

Facility

$2,099.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,070.49
Max. Negotiated Rate	$2,036.03
Rate for Payer: Cash Price	$1,259.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,469.30
Rate for Payer: Health Management Network Commercial	$1,784.15
Rate for Payer: Kaiser Permanente Commercial	$1,322.37
Rate for Payer: Kaiser Permanente Medicaid	$1,070.49
Rate for Payer: MDX Hawaii PPO	$2,036.03
Rate for Payer: University Health Alliance Commercial	$1,175.44

MESH SURGICL W10XL10 GBWR1010

Facility

$2,688.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,370.88
Max. Negotiated Rate	$2,607.36
Rate for Payer: Cash Price	$1,612.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: Kaiser Permanente Commercial	$1,693.44
Rate for Payer: Kaiser Permanente Medicaid	$1,370.88
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: University Health Alliance Commercial	$1,505.28

MESH SURGICL W10XL10 GBWR1010

Facility

$2,688.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,505.28
Max. Negotiated Rate	$2,607.36
Rate for Payer: Cash Price	$1,612.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: University Health Alliance Commercial	$1,505.28

MESH SYNECOR 10X15CM GKFV1015

Facility

$2,295.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,285.20
Max. Negotiated Rate	$2,226.15
Rate for Payer: Cash Price	$1,377.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,606.50
Rate for Payer: Health Management Network Commercial	$1,950.75
Rate for Payer: MDX Hawaii PPO	$2,226.15
Rate for Payer: University Health Alliance Commercial	$1,285.20

MESH SYNECOR 10X15CM GKFV1015

Facility

$2,295.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.45
Max. Negotiated Rate	$2,226.15
Rate for Payer: Cash Price	$1,377.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,606.50
Rate for Payer: Health Management Network Commercial	$1,950.75
Rate for Payer: Kaiser Permanente Commercial	$1,445.85
Rate for Payer: Kaiser Permanente Medicaid	$1,170.45
Rate for Payer: MDX Hawaii PPO	$2,226.15
Rate for Payer: University Health Alliance Commercial	$1,285.20

MESH SYNTHETIC HERNIA TEM1509G

Facility

$923.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$516.88
Max. Negotiated Rate	$895.31
Rate for Payer: Cash Price	$553.80
Rate for Payer: Hawaii Western Management Group Commercial	$646.10
Rate for Payer: Health Management Network Commercial	$784.55
Rate for Payer: MDX Hawaii PPO	$895.31
Rate for Payer: University Health Alliance Commercial	$516.88

MESH SYNTHETIC HERNIA TEM1509G

Facility

$923.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$470.73
Max. Negotiated Rate	$895.31
Rate for Payer: Cash Price	$553.80
Rate for Payer: Hawaii Western Management Group Commercial	$646.10
Rate for Payer: Health Management Network Commercial	$784.55
Rate for Payer: Kaiser Permanente Commercial	$581.49
Rate for Payer: Kaiser Permanente Medicaid	$470.73
Rate for Payer: MDX Hawaii PPO	$895.31
Rate for Payer: University Health Alliance Commercial	$516.88

MESH SYNTHETIC NON AB LG

Facility

$2,016.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.16
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Commercial	$1,270.08
Rate for Payer: Kaiser Permanente Medicaid	$1,028.16
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

MESH SYNTHETIC NON AB LG

Facility

$2,016.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

Know your out-of-pocket cost for care.

All Charges