Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE FIX ANCHOR #72203853

Facility

$1,188.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$605.88
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: Kaiser Permanente Commercial	$748.44
Rate for Payer: Kaiser Permanente Medicaid	$605.88
Rate for Payer: MDX Hawaii PPO	$1,152.36
Rate for Payer: University Health Alliance Commercial	$665.28

SUTURE KIT UNIV APEX AR-7298

Facility

$1,400.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: MDX Hawaii PPO	$1,358.00

SUTURE KIT UNIV APEX AR-7298

Facility

$1,400.00

Hospital Revenue Code	272
Min. Negotiated Rate	$714.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: Kaiser Permanente Commercial	$882.00
Rate for Payer: Kaiser Permanente Medicaid	$714.00
Rate for Payer: MDX Hawaii PPO	$1,358.00
Rate for Payer: University Health Alliance Commercial	$1,020.46

SUTURE LASSO #AR-4068-25TLF

Facility

$893.00

Hospital Revenue Code	272
Min. Negotiated Rate	$759.05
Max. Negotiated Rate	$866.21
Rate for Payer: Cash Price	$535.80
Rate for Payer: Health Management Network Commercial	$759.05
Rate for Payer: MDX Hawaii PPO	$866.21

SUTURE LASSO #AR-4068-25TLF

Facility

$893.00

Hospital Revenue Code	272
Min. Negotiated Rate	$455.43
Max. Negotiated Rate	$866.21
Rate for Payer: Cash Price	$535.80
Rate for Payer: Hawaii Western Management Group Commercial	$848.35
Rate for Payer: Health Management Network Commercial	$759.05
Rate for Payer: Kaiser Permanente Commercial	$562.59
Rate for Payer: Kaiser Permanente Medicaid	$455.43
Rate for Payer: MDX Hawaii PPO	$866.21
Rate for Payer: University Health Alliance Commercial	$650.91

SUTURE LASSO #AR-4068-45R

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$267.75
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$330.75
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: University Health Alliance Commercial	$382.67

SUTURE LASSO #AR-4068-45R

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: MDX Hawaii PPO	$509.25

SUTURE LASSO #AR-6069-90

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$396.90
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: University Health Alliance Commercial	$459.21

SUTURE LASSO #AR-6069-90

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: MDX Hawaii PPO	$611.10

SUTURE LASSO AR-8703

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

SUTURE LASSO AR-8703

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

SUTURELOC SYSTEM AR-4551

Facility

$4,201.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,142.51
Max. Negotiated Rate	$4,074.97
Rate for Payer: Cash Price	$2,520.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,940.70
Rate for Payer: Health Management Network Commercial	$3,570.85
Rate for Payer: Kaiser Permanente Commercial	$2,646.63
Rate for Payer: Kaiser Permanente Medicaid	$2,142.51
Rate for Payer: MDX Hawaii PPO	$4,074.97
Rate for Payer: University Health Alliance Commercial	$2,352.56

SUTURELOC SYSTEM AR-4551

Facility

$4,201.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,352.56
Max. Negotiated Rate	$4,074.97
Rate for Payer: Cash Price	$2,520.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,940.70
Rate for Payer: Health Management Network Commercial	$3,570.85
Rate for Payer: MDX Hawaii PPO	$4,074.97
Rate for Payer: University Health Alliance Commercial	$2,352.56

SUTURE OF 1 NERVE; ULNAR MOTOR

Facility

$8,270.00

Service Code	CPT 64836
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$8,270.00
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: AlohaCare Medicaid	$4,035.65
Rate for Payer: AlohaCare Medicare	$4,035.65
Rate for Payer: Devoted Health Medicare	$4,439.22
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,035.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$4,035.65
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,035.65
Rate for Payer: Ohana Health Plan Medicaid	$4,439.22
Rate for Payer: Ohana Health Plan Medicare	$4,035.65
Rate for Payer: UnitedHealthcare Medicare	$4,035.65
Rate for Payer: University Health Alliance Commercial	$6,743.44

SUTURE PASSER AR-1000

Facility

$273.00

Hospital Revenue Code	272
Min. Negotiated Rate	$139.23
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$163.80
Rate for Payer: Hawaii Western Management Group Commercial	$259.35
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: Kaiser Permanente Commercial	$171.99
Rate for Payer: Kaiser Permanente Medicaid	$139.23
Rate for Payer: MDX Hawaii PPO	$264.81
Rate for Payer: University Health Alliance Commercial	$198.99

SUTURE PASSER AR-1000

Facility

$273.00

Hospital Revenue Code	272
Min. Negotiated Rate	$232.05
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$163.80
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: MDX Hawaii PPO	$264.81

SUTURE PASSER COBRA 3910900097

Facility

$844.00

Hospital Revenue Code	272
Min. Negotiated Rate	$430.44
Max. Negotiated Rate	$818.68
Rate for Payer: Cash Price	$506.40
Rate for Payer: Hawaii Western Management Group Commercial	$801.80
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Kaiser Permanente Commercial	$531.72
Rate for Payer: Kaiser Permanente Medicaid	$430.44
Rate for Payer: MDX Hawaii PPO	$818.68
Rate for Payer: University Health Alliance Commercial	$615.19

SUTURE PASSER COBRA 3910900097

Facility

$844.00

Hospital Revenue Code	272
Min. Negotiated Rate	$717.40
Max. Negotiated Rate	$818.68
Rate for Payer: Cash Price	$506.40
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: MDX Hawaii PPO	$818.68

SUTURE PASSER NDL 3910900091

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$333.03
Max. Negotiated Rate	$633.41
Rate for Payer: Cash Price	$391.80
Rate for Payer: Hawaii Western Management Group Commercial	$620.35
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Kaiser Permanente Commercial	$411.39
Rate for Payer: Kaiser Permanente Medicaid	$333.03
Rate for Payer: MDX Hawaii PPO	$633.41
Rate for Payer: University Health Alliance Commercial	$475.97

SUTURE PASSER NDL 3910900091

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$555.05
Max. Negotiated Rate	$633.41
Rate for Payer: Cash Price	$391.80
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: MDX Hawaii PPO	$633.41

SUTURE PASSER ST 72290128

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: MDX Hawaii PPO	$848.75

SUTURE PASSER ST 72290128

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$551.25
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$637.79

SUTURETAK 3.0 #AR-1934BCFT-2

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$1,212.50
Rate for Payer: Cash Price	$750.00
Rate for Payer: Hawaii Western Management Group Commercial	$875.00
Rate for Payer: Health Management Network Commercial	$1,062.50
Rate for Payer: MDX Hawaii PPO	$1,212.50
Rate for Payer: University Health Alliance Commercial	$700.00

SUTURETAK 3.0 #AR-1934BCFT-2

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,212.50
Rate for Payer: Cash Price	$750.00
Rate for Payer: Hawaii Western Management Group Commercial	$875.00
Rate for Payer: Health Management Network Commercial	$1,062.50
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$637.50
Rate for Payer: MDX Hawaii PPO	$1,212.50
Rate for Payer: University Health Alliance Commercial	$700.00

SUTURETAK 3X14.5 #AR-1934BCFT

Facility

$1,628.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$911.68
Max. Negotiated Rate	$1,579.16
Rate for Payer: Cash Price	$976.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,139.60
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: MDX Hawaii PPO	$1,579.16
Rate for Payer: University Health Alliance Commercial	$911.68

Know your out-of-pocket cost for care.

All Charges