Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

TRACH VALVE SPEAKING

Facility

$198.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$118.80
Rate for Payer: Hawaii Western Management Group Commercial	$138.60
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: University Health Alliance Commercial	$110.88

TRACH VALVE SPEAKING SHILEY

Facility

$198.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$118.80
Rate for Payer: Hawaii Western Management Group Commercial	$138.60
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: University Health Alliance Commercial	$110.88

TRACH VALVE SPEAKING SHILEY

Facility

$198.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$69.71
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
Rate for Payer: Hawaii Western Management Group Commercial	$138.60
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Kaiser Permanente Commercial	$124.74
Rate for Payer: Kaiser Permanente Medicaid	$100.98
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: UnitedHealthcare Medicaid	$69.71
Rate for Payer: University Health Alliance Commercial	$110.88

TRAMADOL 50 MG TABLET [14632]

Facility

$1.00

Service Code	NDC 60687079501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97

TRAMADOL 50 MG TABLET [14632]

Facility

$3.00

Service Code	NDC 60219234801
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: MDX Hawaii PPO	$2.91

TRAMADOL 50 MG TABLET [14632]

Facility

$1.00

Service Code	NDC 60687079501
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

TRAMADOL 50 MG TABLET [14632]

Facility

$1.00

Service Code	NDC 60687079511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97

TRAMADOL 50 MG TABLET [14632]

Facility

$1.00

Service Code	NDC 60687079511
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

TRAMADOL 50 MG TABLET [14632]

Facility

$3.00

Service Code	NDC 60219234801
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$1.89
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: University Health Alliance Commercial	$2.19

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]

Facility

$62.00

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$31.62
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$37.20
Rate for Payer: Hawaii Western Management Group Commercial	$58.90
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Kaiser Permanente Commercial	$39.06
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: UnitedHealthcare Medicaid	$37.20
Rate for Payer: University Health Alliance Commercial	$45.19

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]

Facility

$63.00

Service Code	NDC 51754010801
Hospital Revenue Code	250
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: MDX Hawaii PPO	$61.11

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]

Facility

$62.00

Service Code	HCPCS J3490
Hospital Revenue Code	250
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$37.20
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: MDX Hawaii PPO	$60.14

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]

Facility

$63.00

Service Code	NDC 51754010801
Hospital Revenue Code	636
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$37.80
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Kaiser Permanente Commercial	$39.69
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: UnitedHealthcare Medicaid	$37.80
Rate for Payer: University Health Alliance Commercial	$45.92

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$20.00

Service Code	NDC 81284061100
Hospital Revenue Code	636
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: University Health Alliance Commercial	$14.58

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$16.00

Service Code	HCPCS J3490
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: MDX Hawaii PPO	$22.31

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$20.00

Service Code	NDC 81284061100
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: MDX Hawaii PPO	$19.40

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$8.00

Service Code	NDC 81284061200
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: MDX Hawaii PPO	$7.76

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$23.00

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$12.00
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$14.49
Rate for Payer: Kaiser Permanente Commercial	$10.08
Rate for Payer: Kaiser Permanente Commercial	$39.69
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: UnitedHealthcare Medicaid	$13.80
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: UnitedHealthcare Medicaid	$9.60
Rate for Payer: UnitedHealthcare Medicaid	$37.80
Rate for Payer: University Health Alliance Commercial	$16.76
Rate for Payer: University Health Alliance Commercial	$14.58
Rate for Payer: University Health Alliance Commercial	$45.92
Rate for Payer: University Health Alliance Commercial	$11.66

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$8.00

Service Code	NDC 81284061200
Hospital Revenue Code	636
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$5.04
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: UnitedHealthcare Medicaid	$4.80
Rate for Payer: University Health Alliance Commercial	$5.83

TRANSCAROTID 10X40 SR-1040-CS

Facility

$8,990.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$5,034.40
Max. Negotiated Rate	$8,720.30
Rate for Payer: Cash Price	$5,394.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,293.00
Rate for Payer: Health Management Network Commercial	$7,641.50
Rate for Payer: MDX Hawaii PPO	$8,720.30
Rate for Payer: University Health Alliance Commercial	$5,034.40

TRANSCAROTID 10X40 SR-1040-CS

Facility

$8,990.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$4,584.90
Max. Negotiated Rate	$8,720.30
Rate for Payer: Cash Price	$5,394.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,293.00
Rate for Payer: Health Management Network Commercial	$7,641.50
Rate for Payer: Kaiser Permanente Commercial	$5,663.70
Rate for Payer: Kaiser Permanente Medicaid	$4,584.90
Rate for Payer: MDX Hawaii PPO	$8,720.30
Rate for Payer: University Health Alliance Commercial	$5,034.40

TRANSCAROTID 8X40 SR-0840-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

TRANSCAROTID 8X40 SR-0840-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,754.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$3,402.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

TRANSCAROTID 9X40 SR-0940-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

TRANSCAROTID 9X40 SR-0940-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,754.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$3,402.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

Know your out-of-pocket cost for care.

All Charges