Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

TROCAR 28F CHEST TUBE THORACIC

Facility

$113.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$57.63
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$67.80
Rate for Payer: Hawaii Western Management Group Commercial	$107.35
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Kaiser Permanente Commercial	$71.19
Rate for Payer: Kaiser Permanente Medicaid	$57.63
Rate for Payer: MDX Hawaii PPO	$109.61
Rate for Payer: University Health Alliance Commercial	$82.37

TROCAR 28F CHEST TUBE THORACIC

Facility

$113.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$67.80
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: MDX Hawaii PPO	$109.61

TROCAR 32F CHEST TUBE THORACIC

Facility

$106.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$54.06
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$66.78
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: University Health Alliance Commercial	$77.26

TROCAR 32F CHEST TUBE THORACIC

Facility

$106.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: MDX Hawaii PPO	$102.82

TROCAR 5-11MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$233.77
Rate for Payer: Cash Price	$144.60
Rate for Payer: Hawaii Western Management Group Commercial	$228.95
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Kaiser Permanente Commercial	$151.83
Rate for Payer: Kaiser Permanente Medicaid	$122.91
Rate for Payer: MDX Hawaii PPO	$233.77
Rate for Payer: University Health Alliance Commercial	$175.66

TROCAR 5-11MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$233.77
Rate for Payer: Cash Price	$144.60
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: MDX Hawaii PPO	$233.77

TROCAR 5-12MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$233.77
Rate for Payer: Cash Price	$144.60
Rate for Payer: Hawaii Western Management Group Commercial	$228.95
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Kaiser Permanente Commercial	$151.83
Rate for Payer: Kaiser Permanente Medicaid	$122.91
Rate for Payer: MDX Hawaii PPO	$233.77
Rate for Payer: University Health Alliance Commercial	$175.66

TROCAR 5-12MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$233.77
Rate for Payer: Cash Price	$144.60
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: MDX Hawaii PPO	$233.77

TROCAR 5MM STEP

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$104.04
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$128.52
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: University Health Alliance Commercial	$148.70

TROCAR 5MM STEP

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: MDX Hawaii PPO	$197.88

TROCAR BALLOON 12X100MM CFF73

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

TROCAR BALLOON 12X100MM CFF73

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

TROCAR BALLOON 12X150MM CFF71

Facility

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$225.00
Rate for Payer: Hawaii Western Management Group Commercial	$356.25
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Kaiser Permanente Commercial	$236.25
Rate for Payer: Kaiser Permanente Medicaid	$191.25
Rate for Payer: MDX Hawaii PPO	$363.75
Rate for Payer: University Health Alliance Commercial	$273.34

TROCAR BALLOON 12X150MM CFF71

Facility

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: MDX Hawaii PPO	$363.75

TROCAR BALLOON OVAL

Facility

$3,258.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,769.30
Max. Negotiated Rate	$3,160.26
Rate for Payer: Cash Price	$1,954.80
Rate for Payer: Health Management Network Commercial	$2,769.30
Rate for Payer: MDX Hawaii PPO	$3,160.26

TROCAR BALLOON OVAL

Facility

$3,258.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,661.58
Max. Negotiated Rate	$3,160.26
Rate for Payer: Cash Price	$1,954.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,095.10
Rate for Payer: Health Management Network Commercial	$2,769.30
Rate for Payer: Kaiser Permanente Commercial	$2,052.54
Rate for Payer: Kaiser Permanente Medicaid	$1,661.58
Rate for Payer: MDX Hawaii PPO	$3,160.26
Rate for Payer: University Health Alliance Commercial	$2,374.76

TROCAR BALLOON ROUND

Facility

$2,457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,088.45
Max. Negotiated Rate	$2,383.29
Rate for Payer: Cash Price	$1,474.20
Rate for Payer: Health Management Network Commercial	$2,088.45
Rate for Payer: MDX Hawaii PPO	$2,383.29

TROCAR BALLOON ROUND

Facility

$2,457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,253.07
Max. Negotiated Rate	$2,383.29
Rate for Payer: Cash Price	$1,474.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,334.15
Rate for Payer: Health Management Network Commercial	$2,088.45
Rate for Payer: Kaiser Permanente Commercial	$1,547.91
Rate for Payer: Kaiser Permanente Medicaid	$1,253.07
Rate for Payer: MDX Hawaii PPO	$2,383.29
Rate for Payer: University Health Alliance Commercial	$1,790.91

TROCAR CLOSURE ENDOCLOSE

Facility

$141.00

Hospital Revenue Code	272
Min. Negotiated Rate	$71.91
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$88.83
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: University Health Alliance Commercial	$102.77

TROCAR CLOSURE ENDOCLOSE

Facility

$141.00

Hospital Revenue Code	272
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: MDX Hawaii PPO	$136.77

TROCAR EXPAND SLV

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$104.04
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$128.52
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: University Health Alliance Commercial	$148.70

TROCAR EXPAND SLV

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: MDX Hawaii PPO	$197.88

TROCAR LAPAROSCOPIC 5MM CFF03

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$342.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: University Health Alliance Commercial	$262.40

TROCAR LAPAROSCOPIC 5MM CFF03

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$349.20

TROCAR REP 5MM

Facility

$193.00

Hospital Revenue Code	272
Min. Negotiated Rate	$98.43
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$115.80
Rate for Payer: Hawaii Western Management Group Commercial	$183.35
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$121.59
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$140.68

Know your out-of-pocket cost for care.

All Charges