Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

SUTURETAK 3X14.5 #AR-1934BCFT

Facility

$1,628.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$830.28
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: Kaiser Permanente Commercial	$1,025.64
Rate for Payer: Kaiser Permanente Medicaid	$830.28
Rate for Payer: MDX Hawaii PPO	$1,579.16
Rate for Payer: University Health Alliance Commercial	$911.68

SUTURETAK KIT 23MM AR-1938PK

Facility

$1,305.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,109.25
Max. Negotiated Rate	$1,265.85
Rate for Payer: Cash Price	$783.00
Rate for Payer: Health Management Network Commercial	$1,109.25
Rate for Payer: MDX Hawaii PPO	$1,265.85

SUTURETAK KIT 23MM AR-1938PK

Facility

$1,305.00

Hospital Revenue Code	272
Min. Negotiated Rate	$665.55
Max. Negotiated Rate	$1,265.85
Rate for Payer: Cash Price	$783.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,239.75
Rate for Payer: Health Management Network Commercial	$1,109.25
Rate for Payer: Kaiser Permanente Commercial	$822.15
Rate for Payer: Kaiser Permanente Medicaid	$665.55
Rate for Payer: MDX Hawaii PPO	$1,265.85
Rate for Payer: University Health Alliance Commercial	$951.21

SUTURE TAPE FIBERLOOP AR-7534

Facility

$294.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

SUTURE TAPE FIBERLOOP AR-7534

Facility

$294.00

Hospital Revenue Code	272
Min. Negotiated Rate	$149.94
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Hawaii Western Management Group Commercial	$279.30
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: University Health Alliance Commercial	$214.30

SUTURE TAPE TIGERLOOP AR-7534T

Facility

$280.00

Hospital Revenue Code	272
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$271.60
Rate for Payer: Cash Price	$168.00
Rate for Payer: Hawaii Western Management Group Commercial	$266.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Kaiser Permanente Commercial	$176.40
Rate for Payer: Kaiser Permanente Medicaid	$142.80
Rate for Payer: MDX Hawaii PPO	$271.60
Rate for Payer: University Health Alliance Commercial	$204.09

SUTURE TAPE TIGERLOOP AR-7534T

Facility

$280.00

Hospital Revenue Code	272
Min. Negotiated Rate	$238.00
Max. Negotiated Rate	$271.60
Rate for Payer: Cash Price	$168.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: MDX Hawaii PPO	$271.60

SUTURE TISSUE HELIX

Facility

$809.00

Hospital Revenue Code	272
Min. Negotiated Rate	$412.59
Max. Negotiated Rate	$784.73
Rate for Payer: Cash Price	$485.40
Rate for Payer: Hawaii Western Management Group Commercial	$768.55
Rate for Payer: Health Management Network Commercial	$687.65
Rate for Payer: Kaiser Permanente Commercial	$509.67
Rate for Payer: Kaiser Permanente Medicaid	$412.59
Rate for Payer: MDX Hawaii PPO	$784.73
Rate for Payer: University Health Alliance Commercial	$589.68

SUTURE TISSUE HELIX

Facility

$809.00

Hospital Revenue Code	272
Min. Negotiated Rate	$687.65
Max. Negotiated Rate	$784.73
Rate for Payer: Cash Price	$485.40
Rate for Payer: Health Management Network Commercial	$687.65
Rate for Payer: MDX Hawaii PPO	$784.73

SWIVELOCK AR-2600SBS-4

Facility

$3,654.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,046.24
Max. Negotiated Rate	$3,544.38
Rate for Payer: Cash Price	$2,192.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.80
Rate for Payer: Health Management Network Commercial	$3,105.90
Rate for Payer: MDX Hawaii PPO	$3,544.38
Rate for Payer: University Health Alliance Commercial	$2,046.24

SWIVELOCK AR-2600SBS-4

Facility

$3,654.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,863.54
Max. Negotiated Rate	$3,544.38
Rate for Payer: Cash Price	$2,192.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.80
Rate for Payer: Health Management Network Commercial	$3,105.90
Rate for Payer: Kaiser Permanente Commercial	$2,302.02
Rate for Payer: Kaiser Permanente Medicaid	$1,863.54
Rate for Payer: MDX Hawaii PPO	$3,544.38
Rate for Payer: University Health Alliance Commercial	$2,046.24

SWIVELOCK C 3.5 #AR-2325BCC

Facility

$1,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
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	$980.00
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	$784.00

SWIVELOCK C 3.5 #AR-2325BCC

Facility

$1,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$784.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Hawaii Western Management Group Commercial	$980.00
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: MDX Hawaii PPO	$1,358.00
Rate for Payer: University Health Alliance Commercial	$784.00

SWIVELOCK C 4.75 #AR-2324BCC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$960.96
Max. Negotiated Rate	$1,664.52
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: University Health Alliance Commercial	$960.96

SWIVELOCK C 4.75 #AR-2324BCC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$875.16
Max. Negotiated Rate	$1,664.52
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Kaiser Permanente Commercial	$1,081.08
Rate for Payer: Kaiser Permanente Medicaid	$875.16
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: University Health Alliance Commercial	$960.96

SWIVELOCK C 5.5 #AR-2323BCC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$875.16
Max. Negotiated Rate	$1,664.52
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Kaiser Permanente Commercial	$1,081.08
Rate for Payer: Kaiser Permanente Medicaid	$875.16
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: University Health Alliance Commercial	$960.96

SWIVELOCK C 5.5 #AR-2323BCC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$960.96
Max. Negotiated Rate	$1,664.52
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: University Health Alliance Commercial	$960.96

SWIVELOCK SP PUNCH #AR-2324BCM

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$901.60
Max. Negotiated Rate	$1,561.70
Rate for Payer: Cash Price	$966.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.00
Rate for Payer: Health Management Network Commercial	$1,368.50
Rate for Payer: MDX Hawaii PPO	$1,561.70
Rate for Payer: University Health Alliance Commercial	$901.60

SWIVELOCK SP PUNCH #AR-2324BCM

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$821.10
Max. Negotiated Rate	$1,561.70
Rate for Payer: Cash Price	$966.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.00
Rate for Payer: Health Management Network Commercial	$1,368.50
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: Kaiser Permanente Medicaid	$821.10
Rate for Payer: MDX Hawaii PPO	$1,561.70
Rate for Payer: University Health Alliance Commercial	$901.60

SWIVELOCK W/FIBER #AR-2324BCCT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.16
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Commercial	$1,270.08
Rate for Payer: Kaiser Permanente Medicaid	$1,028.16
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

SWIVELOCK W/FIBER #AR-2324BCCT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

SWIVELOCK W/TIGER#AR2324BCCTT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.16
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Commercial	$1,270.08
Rate for Payer: Kaiser Permanente Medicaid	$1,028.16
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

SWIVELOCK W/TIGER#AR2324BCCTT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

SW JAVELIN FLX IVL 1.5X25

Facility

$9,400.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$7,990.00
Max. Negotiated Rate	$9,118.00
Rate for Payer: Cash Price	$5,640.00
Rate for Payer: Health Management Network Commercial	$7,990.00
Rate for Payer: MDX Hawaii PPO	$9,118.00

SW JAVELIN FLX IVL 1.5X25

Facility

$9,400.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$4,794.00
Max. Negotiated Rate	$9,118.00
Rate for Payer: Cash Price	$5,640.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,930.00
Rate for Payer: Health Management Network Commercial	$7,990.00
Rate for Payer: Kaiser Permanente Commercial	$5,922.00
Rate for Payer: Kaiser Permanente Medicaid	$4,794.00
Rate for Payer: MDX Hawaii PPO	$9,118.00
Rate for Payer: University Health Alliance Commercial	$6,851.66

Know your out-of-pocket cost for care.

All Charges