Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

BLADE SPRL 5MM TI END CAP

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$571.20
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Hawaii Western Management Group Commercial	$784.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Kaiser Permanente Commercial	$705.60
Rate for Payer: Kaiser Permanente Medicaid	$571.20
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: University Health Alliance Commercial	$627.20

BLADE SPRL 5MM TI END CAP

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$627.20
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Hawaii Western Management Group Commercial	$784.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: University Health Alliance Commercial	$627.20

BLADE SURGICAL SAW STABLECUT

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: University Health Alliance Commercial	$1,640.03

BLADE SURGICAL SAW STABLECUT

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: MDX Hawaii PPO	$2,182.50

BLADE TI SPIRAL 34MM #462.634

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 34MM #462.634

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 36MM #462.636

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 36MM #462.636

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 38MM #462.638

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 38MM #462.638

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 40MM #462.640

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 40MM #462.640

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 42MM #462.642

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 42MM #462.642

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 44MM #462.644

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 44MM #462.644

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 46MM #462.646

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 46MM #462.646

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 48MM #462.648

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 48MM #462.648

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 50MM #462.650

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 50MM #462.650

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 52MM #462.652

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.48
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: Kaiser Permanente Commercial	$1,731.24
Rate for Payer: Kaiser Permanente Medicaid	$1,401.48
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 52MM #462.652

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

BLADE TI SPIRAL 54MM

Facility

$2,748.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.88
Max. Negotiated Rate	$2,665.56
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.60
Rate for Payer: Health Management Network Commercial	$2,335.80
Rate for Payer: MDX Hawaii PPO	$2,665.56
Rate for Payer: University Health Alliance Commercial	$1,538.88

Know your out-of-pocket cost for care.

All Charges