Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

NEXGEN CR-FLEX ART SURF YELLOW

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 YLW 10

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 YLW 10

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 OPT FEM, C-LT

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

NEXGEN CR-FLEX OPT FEM, C-LT

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

NEXGEN CR-FLEX OPT FEM, E-LT

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 CR-FLEX OPT FEM, E-LT

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 OPTION FEMORAL

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

NEXGEN CR-FLEX OPTION FEMORAL

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

NEXGEN FLEX ART SURF BLU,10M

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 FLEX ART SURF BLU,10M

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 LCCK 20MM 5994-22-20

Facility

$4,213.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,359.28
Max. Negotiated Rate	$4,086.61
Rate for Payer: Cash Price	$2,527.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.10
Rate for Payer: Health Management Network Commercial	$3,581.05
Rate for Payer: MDX Hawaii PPO	$4,086.61
Rate for Payer: University Health Alliance Commercial	$2,359.28

NEXGEN LCCK 20MM 5994-22-20

Facility

$4,213.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,148.63
Max. Negotiated Rate	$4,086.61
Rate for Payer: Cash Price	$2,527.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.10
Rate for Payer: Health Management Network Commercial	$3,581.05
Rate for Payer: Kaiser Permanente Commercial	$2,654.19
Rate for Payer: Kaiser Permanente Medicaid	$2,148.63
Rate for Payer: MDX Hawaii PPO	$4,086.61
Rate for Payer: University Health Alliance Commercial	$2,359.28

NEXGEN LCCK SZ C RT 5994-13-92

Facility

$12,114.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,783.84
Max. Negotiated Rate	$11,750.58
Rate for Payer: Cash Price	$7,268.40
Rate for Payer: Hawaii Western Management Group Commercial	$8,479.80
Rate for Payer: Health Management Network Commercial	$10,296.90
Rate for Payer: MDX Hawaii PPO	$11,750.58
Rate for Payer: University Health Alliance Commercial	$6,783.84

NEXGEN LCCK SZ C RT 5994-13-92

Facility

$12,114.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,178.14
Max. Negotiated Rate	$11,750.58
Rate for Payer: Cash Price	$7,268.40
Rate for Payer: Hawaii Western Management Group Commercial	$8,479.80
Rate for Payer: Health Management Network Commercial	$10,296.90
Rate for Payer: Kaiser Permanente Commercial	$7,631.82
Rate for Payer: Kaiser Permanente Medicaid	$6,178.14
Rate for Payer: MDX Hawaii PPO	$11,750.58
Rate for Payer: University Health Alliance Commercial	$6,783.84

NEXGEN LPS-FLEX 00-5964-022-10

Facility

$2,803.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.68
Max. Negotiated Rate	$2,718.91
Rate for Payer: Cash Price	$1,681.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,962.10
Rate for Payer: Health Management Network Commercial	$2,382.55
Rate for Payer: MDX Hawaii PPO	$2,718.91
Rate for Payer: University Health Alliance Commercial	$1,569.68

NEXGEN LPS-FLEX 00-5964-022-10

Facility

$2,803.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,429.53
Max. Negotiated Rate	$2,718.91
Rate for Payer: Cash Price	$1,681.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,962.10
Rate for Payer: Health Management Network Commercial	$2,382.55
Rate for Payer: Kaiser Permanente Commercial	$1,765.89
Rate for Payer: Kaiser Permanente Medicaid	$1,429.53
Rate for Payer: MDX Hawaii PPO	$2,718.91
Rate for Payer: University Health Alliance Commercial	$1,569.68

NEXGEN LPS FLEX PRECOAT FEM

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

NEXGEN LPS FLEX PRECOAT FEM

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

NEXGEN LPS FLEX TITANIUM FEM

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

NEXGEN LPS FLEX TITANIUM FEM

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

NEXGEN LPS FLEX TIVANIUM FEM

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

NEXGEN LPS FLEX TIVANIUM FEM

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

NEXGEN OFFST 12X100 5988-20-12

Facility

$2,921.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,489.71
Max. Negotiated Rate	$2,833.37
Rate for Payer: Cash Price	$1,752.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,044.70
Rate for Payer: Health Management Network Commercial	$2,482.85
Rate for Payer: Kaiser Permanente Commercial	$1,840.23
Rate for Payer: Kaiser Permanente Medicaid	$1,489.71
Rate for Payer: MDX Hawaii PPO	$2,833.37
Rate for Payer: University Health Alliance Commercial	$1,635.76

NEXGEN OFFST 12X100 5988-20-12

Facility

$2,921.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,635.76
Max. Negotiated Rate	$2,833.37
Rate for Payer: Cash Price	$1,752.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,044.70
Rate for Payer: Health Management Network Commercial	$2,482.85
Rate for Payer: MDX Hawaii PPO	$2,833.37
Rate for Payer: University Health Alliance Commercial	$1,635.76

Know your out-of-pocket cost for care.

All Charges