Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY

Facility

$20,300.00

Service Code	CPT 60220
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$20,300.00
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,395.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85
Rate for Payer: University Health Alliance Commercial	$20,300.00

TOURN CUFF STERILE 12X3 15-110

Facility

$170.00

Hospital Revenue Code	272
Min. Negotiated Rate	$144.50
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$102.00
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: MDX Hawaii PPO	$164.90

TOURN CUFF STERILE 12X3 15-110

Facility

$170.00

Hospital Revenue Code	272
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$102.00
Rate for Payer: Hawaii Western Management Group Commercial	$161.50
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: Kaiser Permanente Medicaid	$86.70
Rate for Payer: MDX Hawaii PPO	$164.90
Rate for Payer: University Health Alliance Commercial	$123.91

TOURN CUFF STERILE 18X4 15-130

Facility

$187.00

Hospital Revenue Code	272
Min. Negotiated Rate	$158.95
Max. Negotiated Rate	$181.39
Rate for Payer: Cash Price	$112.20
Rate for Payer: Health Management Network Commercial	$158.95
Rate for Payer: MDX Hawaii PPO	$181.39

TOURN CUFF STERILE 18X4 15-130

Facility

$187.00

Hospital Revenue Code	272
Min. Negotiated Rate	$95.37
Max. Negotiated Rate	$181.39
Rate for Payer: Cash Price	$112.20
Rate for Payer: Hawaii Western Management Group Commercial	$177.65
Rate for Payer: Health Management Network Commercial	$158.95
Rate for Payer: Kaiser Permanente Commercial	$117.81
Rate for Payer: Kaiser Permanente Medicaid	$95.37
Rate for Payer: MDX Hawaii PPO	$181.39
Rate for Payer: University Health Alliance Commercial	$136.30

TOURN CUFF STERILE 24X4 15-140

Facility

$195.00

Hospital Revenue Code	272
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: MDX Hawaii PPO	$189.15

TOURN CUFF STERILE 24X4 15-140

Facility

$195.00

Hospital Revenue Code	272
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$117.00
Rate for Payer: Hawaii Western Management Group Commercial	$185.25
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$122.85
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: University Health Alliance Commercial	$142.14

TOURN CUFF STERILE 30X5 15-150

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25

TOURN CUFF STERILE 30X5 15-150

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: University Health Alliance Commercial	$164.00

TOURN CUFF STERILE 34X5 15-160

Facility

$238.00

Hospital Revenue Code	272
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$142.80
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: MDX Hawaii PPO	$230.86

TOURN CUFF STERILE 34X5 15-160

Facility

$238.00

Hospital Revenue Code	272
Min. Negotiated Rate	$121.38
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$142.80
Rate for Payer: Hawaii Western Management Group Commercial	$226.10
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Kaiser Permanente Commercial	$149.94
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: University Health Alliance Commercial	$173.48

TOURNIQUET 12IN

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$47.94
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$59.22
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: University Health Alliance Commercial	$68.52

TOURNIQUET 12IN

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: MDX Hawaii PPO	$91.18

TOURNIQUET 18" 5921-218-135

Facility

$107.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: MDX Hawaii PPO	$103.79

TOURNIQUET 18" 5921-218-135

Facility

$107.00

Hospital Revenue Code	272
Min. Negotiated Rate	$54.57
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Hawaii Western Management Group Commercial	$101.65
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$67.41
Rate for Payer: Kaiser Permanente Medicaid	$54.57
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: University Health Alliance Commercial	$77.99

TOURNIQUET 30" 5921-030-135

Facility

$55.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: MDX Hawaii PPO	$53.35

TOURNIQUET 30" 5921-030-135

Facility

$55.00

Hospital Revenue Code	272
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$33.00
Rate for Payer: Hawaii Western Management Group Commercial	$52.25
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Kaiser Permanente Commercial	$34.65
Rate for Payer: Kaiser Permanente Medicaid	$28.05
Rate for Payer: MDX Hawaii PPO	$53.35
Rate for Payer: University Health Alliance Commercial	$40.09

TOURNIQUET 34" 5921-034-135

Facility

$139.00

Hospital Revenue Code	272
Min. Negotiated Rate	$70.89
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$83.40
Rate for Payer: Hawaii Western Management Group Commercial	$132.05
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$87.57
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: University Health Alliance Commercial	$101.32

TOURNIQUET 34" 5921-034-135

Facility

$139.00

Hospital Revenue Code	272
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$83.40
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: MDX Hawaii PPO	$134.83

TOURNIQUET 44IN

Facility

$127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.77
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$80.01
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: University Health Alliance Commercial	$92.57

TOURNIQUET 44IN

Facility

$127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: MDX Hawaii PPO	$123.19

TOURNIQUET CUFF

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$47.94
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$59.22
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: University Health Alliance Commercial	$68.52

TOURNIQUET CUFF

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: MDX Hawaii PPO	$91.18

TOURNQ NS 18X4 5921-218-135NS

Facility

$107.00

Hospital Revenue Code	272
Min. Negotiated Rate	$54.57
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Hawaii Western Management Group Commercial	$101.65
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$67.41
Rate for Payer: Kaiser Permanente Medicaid	$54.57
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: University Health Alliance Commercial	$77.99

TOURNQ NS 18X4 5921-218-135NS

Facility

$107.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: MDX Hawaii PPO	$103.79

Know your out-of-pocket cost for care.

All Charges