Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE ANCHOR #AR-1662BC

Facility

$1,435.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$731.85
Max. Negotiated Rate	$1,391.95
Rate for Payer: Cash Price	$861.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,004.50
Rate for Payer: Health Management Network Commercial	$1,219.75
Rate for Payer: Kaiser Permanente Commercial	$904.05
Rate for Payer: Kaiser Permanente Medicaid	$731.85
Rate for Payer: MDX Hawaii PPO	$1,391.95
Rate for Payer: University Health Alliance Commercial	$803.60

SUTURE ANCHOR #AR-1662BC

Facility

$1,435.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$803.60
Max. Negotiated Rate	$1,391.95
Rate for Payer: Cash Price	$861.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,004.50
Rate for Payer: Health Management Network Commercial	$1,219.75
Rate for Payer: MDX Hawaii PPO	$1,391.95
Rate for Payer: University Health Alliance Commercial	$803.60

SUTURE ANCHOR #AR-1927BCFT-45

Facility

$1,208.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$676.48
Max. Negotiated Rate	$1,171.76
Rate for Payer: Cash Price	$724.80
Rate for Payer: Hawaii Western Management Group Commercial	$845.60
Rate for Payer: Health Management Network Commercial	$1,026.80
Rate for Payer: MDX Hawaii PPO	$1,171.76
Rate for Payer: University Health Alliance Commercial	$676.48

SUTURE ANCHOR #AR-1927BCFT-45

Facility

$1,208.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$616.08
Max. Negotiated Rate	$1,171.76
Rate for Payer: Cash Price	$724.80
Rate for Payer: Hawaii Western Management Group Commercial	$845.60
Rate for Payer: Health Management Network Commercial	$1,026.80
Rate for Payer: Kaiser Permanente Commercial	$761.04
Rate for Payer: Kaiser Permanente Medicaid	$616.08
Rate for Payer: MDX Hawaii PPO	$1,171.76
Rate for Payer: University Health Alliance Commercial	$676.48

SUTURE ANCHOR #AR-1928SF-45

Facility

$1,152.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$645.12
Max. Negotiated Rate	$1,117.44
Rate for Payer: Cash Price	$691.20
Rate for Payer: Hawaii Western Management Group Commercial	$806.40
Rate for Payer: Health Management Network Commercial	$979.20
Rate for Payer: MDX Hawaii PPO	$1,117.44
Rate for Payer: University Health Alliance Commercial	$645.12

SUTURE ANCHOR #AR-1928SF-45

Facility

$1,152.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$587.52
Max. Negotiated Rate	$1,117.44
Rate for Payer: Cash Price	$691.20
Rate for Payer: Hawaii Western Management Group Commercial	$806.40
Rate for Payer: Health Management Network Commercial	$979.20
Rate for Payer: Kaiser Permanente Commercial	$725.76
Rate for Payer: Kaiser Permanente Medicaid	$587.52
Rate for Payer: MDX Hawaii PPO	$1,117.44
Rate for Payer: University Health Alliance Commercial	$645.12

SUTURE ANCHOR #AR-1929SF-3

Facility

$919.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$514.64
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Hawaii Western Management Group Commercial	$643.30
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: University Health Alliance Commercial	$514.64

SUTURE ANCHOR #AR-1929SF-3

Facility

$919.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$468.69
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Hawaii Western Management Group Commercial	$643.30
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$578.97
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: University Health Alliance Commercial	$514.64

SUTURE ANCHOR #AR-1938BC

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 #AR-1938BC

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 #AR-2324BCC-2

Facility

$1,788.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$911.88
Max. Negotiated Rate	$1,734.36
Rate for Payer: Cash Price	$1,072.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,251.60
Rate for Payer: Health Management Network Commercial	$1,519.80
Rate for Payer: Kaiser Permanente Commercial	$1,126.44
Rate for Payer: Kaiser Permanente Medicaid	$911.88
Rate for Payer: MDX Hawaii PPO	$1,734.36
Rate for Payer: University Health Alliance Commercial	$1,001.28

SUTURE ANCHOR #AR-2324BCC-2

Facility

$1,788.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,001.28
Max. Negotiated Rate	$1,734.36
Rate for Payer: Cash Price	$1,072.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,251.60
Rate for Payer: Health Management Network Commercial	$1,519.80
Rate for Payer: MDX Hawaii PPO	$1,734.36
Rate for Payer: University Health Alliance Commercial	$1,001.28

SUTURE ANCHOR #AR-2325PSLC

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$853.44
Max. Negotiated Rate	$1,478.28
Rate for Payer: Cash Price	$914.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,066.80
Rate for Payer: Health Management Network Commercial	$1,295.40
Rate for Payer: MDX Hawaii PPO	$1,478.28
Rate for Payer: University Health Alliance Commercial	$853.44

SUTURE ANCHOR #AR-2325PSLC

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$777.24
Max. Negotiated Rate	$1,478.28
Rate for Payer: Cash Price	$914.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,066.80
Rate for Payer: Health Management Network Commercial	$1,295.40
Rate for Payer: Kaiser Permanente Commercial	$960.12
Rate for Payer: Kaiser Permanente Medicaid	$777.24
Rate for Payer: MDX Hawaii PPO	$1,478.28
Rate for Payer: University Health Alliance Commercial	$853.44

SUTURE ANCHOR AR-8934BCST

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 AR-8934BCST

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 BIOCOMPOSITE

Facility

$1,288.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$721.28
Max. Negotiated Rate	$1,249.36
Rate for Payer: Cash Price	$772.80
Rate for Payer: Hawaii Western Management Group Commercial	$901.60
Rate for Payer: Health Management Network Commercial	$1,094.80
Rate for Payer: MDX Hawaii PPO	$1,249.36
Rate for Payer: University Health Alliance Commercial	$721.28

SUTURE ANCHOR BIOCOMPOSITE

Facility

$1,288.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$656.88
Max. Negotiated Rate	$1,249.36
Rate for Payer: Cash Price	$772.80
Rate for Payer: Hawaii Western Management Group Commercial	$901.60
Rate for Payer: Health Management Network Commercial	$1,094.80
Rate for Payer: Kaiser Permanente Commercial	$811.44
Rate for Payer: Kaiser Permanente Medicaid	$656.88
Rate for Payer: MDX Hawaii PPO	$1,249.36
Rate for Payer: University Health Alliance Commercial	$721.28

SUTURE ANCHOR BIO-PUSHLOCK

Facility

$1,701.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$867.51
Max. Negotiated Rate	$1,649.97
Rate for Payer: Cash Price	$1,020.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,190.70
Rate for Payer: Health Management Network Commercial	$1,445.85
Rate for Payer: Kaiser Permanente Commercial	$1,071.63
Rate for Payer: Kaiser Permanente Medicaid	$867.51
Rate for Payer: MDX Hawaii PPO	$1,649.97
Rate for Payer: University Health Alliance Commercial	$952.56

SUTURE ANCHOR BIO-PUSHLOCK

Facility

$1,701.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$952.56
Max. Negotiated Rate	$1,649.97
Rate for Payer: Cash Price	$1,020.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,190.70
Rate for Payer: Health Management Network Commercial	$1,445.85
Rate for Payer: MDX Hawaii PPO	$1,649.97
Rate for Payer: University Health Alliance Commercial	$952.56

SUTURE BUTTON 12MM #AR-8922

Facility

$536.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$300.16
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Hawaii Western Management Group Commercial	$375.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: University Health Alliance Commercial	$300.16

SUTURE BUTTON 12MM #AR-8922

Facility

$536.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$273.36
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Hawaii Western Management Group Commercial	$375.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$337.68
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: University Health Alliance Commercial	$300.16

SUTURE CINCH-LNG M00505550

Facility

$684.00

Hospital Revenue Code	272
Min. Negotiated Rate	$581.40
Max. Negotiated Rate	$663.48
Rate for Payer: Cash Price	$410.40
Rate for Payer: Health Management Network Commercial	$581.40
Rate for Payer: MDX Hawaii PPO	$663.48

SUTURE CINCH-LNG M00505550

Facility

$684.00

Hospital Revenue Code	272
Min. Negotiated Rate	$348.84
Max. Negotiated Rate	$663.48
Rate for Payer: Cash Price	$410.40
Rate for Payer: Hawaii Western Management Group Commercial	$649.80
Rate for Payer: Health Management Network Commercial	$581.40
Rate for Payer: Kaiser Permanente Commercial	$430.92
Rate for Payer: Kaiser Permanente Medicaid	$348.84
Rate for Payer: MDX Hawaii PPO	$663.48
Rate for Payer: University Health Alliance Commercial	$498.57

SUTURE FIX ANCHOR #72203853

Facility

$1,188.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$665.28
Max. Negotiated Rate	$1,152.36
Rate for Payer: Cash Price	$712.80
Rate for Payer: Hawaii Western Management Group Commercial	$831.60
Rate for Payer: Health Management Network Commercial	$1,009.80
Rate for Payer: MDX Hawaii PPO	$1,152.36
Rate for Payer: University Health Alliance Commercial	$665.28

Know your out-of-pocket cost for care.

All Charges