Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NEXGEN 35 POLY PAT 5972-65-35

Facility

$1,635.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$915.60
Max. Negotiated Rate	$1,585.95
Rate for Payer: Cash Price	$981.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: University Health Alliance Commercial	$915.60

NEXGEN 35 POLY PAT 5972-65-35

Facility

$1,635.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$833.85
Max. Negotiated Rate	$1,585.95
Rate for Payer: Cash Price	$981.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: Kaiser Permanente Commercial	$1,030.05
Rate for Payer: Kaiser Permanente Medicaid	$833.85
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: University Health Alliance Commercial	$915.60

NEXGEN AC 7-10M 00-5976-050-12

Facility

$2,227.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.12
Max. Negotiated Rate	$2,160.19
Rate for Payer: Cash Price	$1,336.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,558.90
Rate for Payer: Health Management Network Commercial	$1,892.95
Rate for Payer: MDX Hawaii PPO	$2,160.19
Rate for Payer: University Health Alliance Commercial	$1,247.12

NEXGEN AC 7-10M 00-5976-050-12

Facility

$2,227.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,135.77
Max. Negotiated Rate	$2,160.19
Rate for Payer: Cash Price	$1,336.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,558.90
Rate for Payer: Health Management Network Commercial	$1,892.95
Rate for Payer: Kaiser Permanente Commercial	$1,403.01
Rate for Payer: Kaiser Permanente Medicaid	$1,135.77
Rate for Payer: MDX Hawaii PPO	$2,160.19
Rate for Payer: University Health Alliance Commercial	$1,247.12

NEXGEN AC ART SUFT 5-6/GRN, 14

Facility

$2,227.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,135.77
Max. Negotiated Rate	$2,160.19
Rate for Payer: Cash Price	$1,336.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,558.90
Rate for Payer: Health Management Network Commercial	$1,892.95
Rate for Payer: Kaiser Permanente Commercial	$1,403.01
Rate for Payer: Kaiser Permanente Medicaid	$1,135.77
Rate for Payer: MDX Hawaii PPO	$2,160.19
Rate for Payer: University Health Alliance Commercial	$1,247.12

NEXGEN AC ART SUFT 5-6/GRN, 14

Facility

$2,227.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.12
Max. Negotiated Rate	$2,160.19
Rate for Payer: Cash Price	$1,336.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,558.90
Rate for Payer: Health Management Network Commercial	$1,892.95
Rate for Payer: MDX Hawaii PPO	$2,160.19
Rate for Payer: University Health Alliance Commercial	$1,247.12

NEX GEN ALL-POLY PATELLA, 26MM

Facility

$1,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$560.00
Max. Negotiated Rate	$970.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Hawaii Western Management Group Commercial	$700.00
Rate for Payer: Health Management Network Commercial	$850.00
Rate for Payer: MDX Hawaii PPO	$970.00
Rate for Payer: University Health Alliance Commercial	$560.00

NEX GEN ALL-POLY PATELLA, 26MM

Facility

$1,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$970.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Hawaii Western Management Group Commercial	$700.00
Rate for Payer: Health Management Network Commercial	$850.00
Rate for Payer: Kaiser Permanente Commercial	$630.00
Rate for Payer: Kaiser Permanente Medicaid	$510.00
Rate for Payer: MDX Hawaii PPO	$970.00
Rate for Payer: University Health Alliance Commercial	$560.00

NEX GEN ALL-POLY PATELLA, 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$765.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

NEX GEN ALL-POLY PATELLA, 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

NEXGEN ALL-POLY PATELLA, 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$765.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

NEXGEN ALL-POLY PATELLA, 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

NEXGEN ART SURF 00-5976-030-14

Facility

$2,016.00

Service Code	HCPCS C1776
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

NEXGEN ART SURF 00-5976-030-14

Facility

$2,016.00

Service Code	HCPCS C1776
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

NEXGEN COMP KNEE SOL, CRUCIATE

Facility

$7,795.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,365.20
Max. Negotiated Rate	$7,561.15
Rate for Payer: Cash Price	$4,677.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,456.50
Rate for Payer: Health Management Network Commercial	$6,625.75
Rate for Payer: MDX Hawaii PPO	$7,561.15
Rate for Payer: University Health Alliance Commercial	$4,365.20

NEXGEN COMP KNEE SOL, CRUCIATE

Facility

$7,795.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,975.45
Max. Negotiated Rate	$7,561.15
Rate for Payer: Cash Price	$4,677.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,456.50
Rate for Payer: Health Management Network Commercial	$6,625.75
Rate for Payer: Kaiser Permanente Commercial	$4,910.85
Rate for Payer: Kaiser Permanente Medicaid	$3,975.45
Rate for Payer: MDX Hawaii PPO	$7,561.15
Rate for Payer: University Health Alliance Commercial	$4,365.20

NEXGEN CR-FLEX #90-5970-021-14

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,266.33
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$1,564.29
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX #90-5970-021-14

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,266.33
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$1,564.29
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF, 14MM

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,266.33
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$1,564.29
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF, 14MM

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF BLUE

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF BLUE

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,266.33
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$1,564.29
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF YELLOW

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,266.33
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$1,564.29
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

Know your out-of-pocket cost for care.

All Charges