Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

SUT CHROMIC ENDO LOOP #0

Facility

$91.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$86.45
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: University Health Alliance Commercial	$66.33

SUT CT CLOSURE SYSTEM

Facility

$590.00

Hospital Revenue Code	272
Min. Negotiated Rate	$300.90
Max. Negotiated Rate	$572.30
Rate for Payer: Cash Price	$354.00
Rate for Payer: Hawaii Western Management Group Commercial	$560.50
Rate for Payer: Health Management Network Commercial	$501.50
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: Kaiser Permanente Medicaid	$300.90
Rate for Payer: MDX Hawaii PPO	$572.30
Rate for Payer: University Health Alliance Commercial	$430.05

SUT CT CLOSURE SYSTEM

Facility

$590.00

Hospital Revenue Code	272
Min. Negotiated Rate	$501.50
Max. Negotiated Rate	$572.30
Rate for Payer: Cash Price	$354.00
Rate for Payer: Health Management Network Commercial	$501.50
Rate for Payer: MDX Hawaii PPO	$572.30

SUT ENDO 2-0 POLYSORB 48IN

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: MDX Hawaii PPO	$120.28

SUT ENDO 2-0 POLYSORB 48IN

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$78.12
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: University Health Alliance Commercial	$90.38

SUTLASSO CURVE LT AR-4068-25TL

Facility

$551.00

Hospital Revenue Code	272
Min. Negotiated Rate	$468.35
Max. Negotiated Rate	$534.47
Rate for Payer: Cash Price	$330.60
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: MDX Hawaii PPO	$534.47

SUTLASSO CURVE LT AR-4068-25TL

Facility

$551.00

Hospital Revenue Code	272
Min. Negotiated Rate	$281.01
Max. Negotiated Rate	$534.47
Rate for Payer: Cash Price	$330.60
Rate for Payer: Hawaii Western Management Group Commercial	$523.45
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Kaiser Permanente Commercial	$347.13
Rate for Payer: Kaiser Permanente Medicaid	$281.01
Rate for Payer: MDX Hawaii PPO	$534.47
Rate for Payer: University Health Alliance Commercial	$401.62

SUT LIGASURE PDS ENDOLOOP

Facility

$600.00

Hospital Revenue Code	272
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Hawaii Western Management Group Commercial	$570.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: Kaiser Permanente Commercial	$378.00
Rate for Payer: Kaiser Permanente Medicaid	$306.00
Rate for Payer: MDX Hawaii PPO	$582.00
Rate for Payer: University Health Alliance Commercial	$437.34

SUT LIGASURE PDS ENDOLOOP

Facility

$600.00

Hospital Revenue Code	272
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: MDX Hawaii PPO	$582.00

SUT POLYSORB ENDO LOOP #0

Facility

$136.00

Hospital Revenue Code	272
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: MDX Hawaii PPO	$131.92

SUT POLYSORB ENDO LOOP #0

Facility

$136.00

Hospital Revenue Code	272
Min. Negotiated Rate	$69.36
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$85.68
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: University Health Alliance Commercial	$99.13

SUTURE ANCHOR 2.4X8.5MM

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$796.62
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Kaiser Permanente Commercial	$984.06
Rate for Payer: Kaiser Permanente Medicaid	$796.62
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

SUTURE ANCHOR 2.4X8.5MM

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$874.72
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

SUTURE ANCHOR 4.75 72203704

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$848.13
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,047.69
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 4.75 72203704

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 4.75 72203705

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$848.13
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,047.69
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 4.75 72203705

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 4.75M 3910847021

Facility

$1,835.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$935.85
Max. Negotiated Rate	$1,779.95
Rate for Payer: Cash Price	$1,101.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,284.50
Rate for Payer: Health Management Network Commercial	$1,559.75
Rate for Payer: Kaiser Permanente Commercial	$1,156.05
Rate for Payer: Kaiser Permanente Medicaid	$935.85
Rate for Payer: MDX Hawaii PPO	$1,779.95
Rate for Payer: University Health Alliance Commercial	$1,027.60

SUTURE ANCHOR 4.75M 3910847021

Facility

$1,835.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.60
Max. Negotiated Rate	$1,779.95
Rate for Payer: Cash Price	$1,101.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,284.50
Rate for Payer: Health Management Network Commercial	$1,559.75
Rate for Payer: MDX Hawaii PPO	$1,779.95
Rate for Payer: University Health Alliance Commercial	$1,027.60

SUTURE ANCHOR 5.5 72203708

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72203708

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$848.13
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,047.69
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72203801

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$848.13
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,047.69
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72203801

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72205135

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72205135

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$848.13
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,047.69
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

Know your out-of-pocket cost for care.

All Charges