Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

TROCAR REP 5MM

Facility

$193.00

Hospital Revenue Code	272
Min. Negotiated Rate	$164.05
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$115.80
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: MDX Hawaii PPO	$187.21

TROCAR SHIELDED BLADED 11X100

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 SHIELDED BLADED 11X100

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 STEP 12MM

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.14
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$134.82
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: University Health Alliance Commercial	$155.98

TROCAR STEP 12MM

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: MDX Hawaii PPO	$207.58

TROCAR STEP 5MM SHORT

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: MDX Hawaii PPO	$207.58

TROCAR STEP 5MM SHORT

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.14
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$134.82
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: University Health Alliance Commercial	$155.98

TROPICAMIDE 0.5 % EYE DROPS [8249]

Facility

$94.00

Service Code	NDC 61314035401
Hospital Revenue Code	637
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

TROPICAMIDE 0.5 % EYE DROPS [8249]

Facility

$94.00

Service Code	NDC 61314035401
Hospital Revenue Code	250
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

TROPICAMIDE 1 % EYE DROPS [8250]

Facility

$125.00

Service Code	NDC 70069012101
Hospital Revenue Code	250
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: MDX Hawaii PPO	$121.25

TROPICAMIDE 1 % EYE DROPS [8250]

Facility

$125.00

Service Code	NDC 70069012101
Hospital Revenue Code	637
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$78.75
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: University Health Alliance Commercial	$91.11

TRUSELECT STRAIGHT 021X130

Facility

$2,025.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,032.75
Max. Negotiated Rate	$1,964.25
Rate for Payer: Cash Price	$1,215.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.75
Rate for Payer: Health Management Network Commercial	$1,721.25
Rate for Payer: Kaiser Permanente Commercial	$1,275.75
Rate for Payer: Kaiser Permanente Medicaid	$1,032.75
Rate for Payer: MDX Hawaii PPO	$1,964.25
Rate for Payer: University Health Alliance Commercial	$1,476.02

TRUSELECT STRAIGHT 021X130

Facility

$2,025.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,964.25
Rate for Payer: Cash Price	$1,215.00
Rate for Payer: Health Management Network Commercial	$1,721.25
Rate for Payer: MDX Hawaii PPO	$1,964.25

TTKNIFE ELECTROSURGCAL KD-640L

Facility

$2,110.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,793.50
Max. Negotiated Rate	$2,046.70
Rate for Payer: Cash Price	$1,266.00
Rate for Payer: Health Management Network Commercial	$1,793.50
Rate for Payer: MDX Hawaii PPO	$2,046.70

TTKNIFE ELECTROSURGCAL KD-640L

Facility

$2,110.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,076.10
Max. Negotiated Rate	$2,046.70
Rate for Payer: Cash Price	$1,266.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,004.50
Rate for Payer: Health Management Network Commercial	$1,793.50
Rate for Payer: Kaiser Permanente Commercial	$1,329.30
Rate for Payer: Kaiser Permanente Medicaid	$1,076.10
Rate for Payer: MDX Hawaii PPO	$2,046.70
Rate for Payer: University Health Alliance Commercial	$1,537.98

TUBE 16F ENFIT GASTRO

Facility

$140.00

Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: University Health Alliance Commercial	$102.05

TUBE 16F ENFIT GASTRO

Facility

$140.00

Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: MDX Hawaii PPO	$135.80

TUBE 18FR ENFIT GASTRO

Facility

$140.00

Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: MDX Hawaii PPO	$135.80

TUBE 18FR ENFIT GASTRO

Facility

$140.00

Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: University Health Alliance Commercial	$102.05

TUBE 20FR ENFIT GASTRO

Facility

$140.00

Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: MDX Hawaii PPO	$135.80

TUBE 20FR ENFIT GASTRO

Facility

$140.00

Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: University Health Alliance Commercial	$102.05

TUBE CHEST THALQUIK 10F

Facility

$732.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$373.32
Max. Negotiated Rate	$710.04
Rate for Payer: Cash Price	$439.20
Rate for Payer: Hawaii Western Management Group Commercial	$695.40
Rate for Payer: Health Management Network Commercial	$622.20
Rate for Payer: Kaiser Permanente Commercial	$461.16
Rate for Payer: Kaiser Permanente Medicaid	$373.32
Rate for Payer: MDX Hawaii PPO	$710.04
Rate for Payer: University Health Alliance Commercial	$533.55

TUBE CHEST THALQUIK 10F

Facility

$732.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$622.20
Max. Negotiated Rate	$710.04
Rate for Payer: Cash Price	$439.20
Rate for Payer: Health Management Network Commercial	$622.20
Rate for Payer: MDX Hawaii PPO	$710.04

TUBE CHEST THALQUIK 8F

Facility

$678.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$345.78
Max. Negotiated Rate	$657.66
Rate for Payer: Cash Price	$406.80
Rate for Payer: Hawaii Western Management Group Commercial	$644.10
Rate for Payer: Health Management Network Commercial	$576.30
Rate for Payer: Kaiser Permanente Commercial	$427.14
Rate for Payer: Kaiser Permanente Medicaid	$345.78
Rate for Payer: MDX Hawaii PPO	$657.66
Rate for Payer: University Health Alliance Commercial	$494.19

TUBE CHEST THALQUIK 8F

Facility

$678.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$576.30
Max. Negotiated Rate	$657.66
Rate for Payer: Cash Price	$406.80
Rate for Payer: Health Management Network Commercial	$576.30
Rate for Payer: MDX Hawaii PPO	$657.66

Know your out-of-pocket cost for care.

All Charges