Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

TUBE DISTAL ATTACHMENT

Facility

$634.00

Hospital Revenue Code	272
Min. Negotiated Rate	$538.90
Max. Negotiated Rate	$614.98
Rate for Payer: Cash Price	$380.40
Rate for Payer: Health Management Network Commercial	$538.90
Rate for Payer: MDX Hawaii PPO	$614.98

TUBE DISTAL ATTACHMENT

Facility

$634.00

Hospital Revenue Code	272
Min. Negotiated Rate	$323.34
Max. Negotiated Rate	$614.98
Rate for Payer: Cash Price	$380.40
Rate for Payer: Hawaii Western Management Group Commercial	$602.30
Rate for Payer: Health Management Network Commercial	$538.90
Rate for Payer: Kaiser Permanente Commercial	$399.42
Rate for Payer: Kaiser Permanente Medicaid	$323.34
Rate for Payer: MDX Hawaii PPO	$614.98
Rate for Payer: University Health Alliance Commercial	$462.12

TUBE EMG

Facility

$1,068.00

Hospital Revenue Code	272
Min. Negotiated Rate	$544.68
Max. Negotiated Rate	$1,035.96
Rate for Payer: Cash Price	$640.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,014.60
Rate for Payer: Health Management Network Commercial	$907.80
Rate for Payer: Kaiser Permanente Commercial	$672.84
Rate for Payer: Kaiser Permanente Medicaid	$544.68
Rate for Payer: MDX Hawaii PPO	$1,035.96
Rate for Payer: University Health Alliance Commercial	$778.47

TUBE EMG

Facility

$1,068.00

Hospital Revenue Code	272
Min. Negotiated Rate	$907.80
Max. Negotiated Rate	$1,035.96
Rate for Payer: Cash Price	$640.80
Rate for Payer: Health Management Network Commercial	$907.80
Rate for Payer: MDX Hawaii PPO	$1,035.96

TUBE EMG ENDOTRACH SZ6

Facility

$1,495.00

Hospital Revenue Code	270
Min. Negotiated Rate	$1,270.75
Max. Negotiated Rate	$1,450.15
Rate for Payer: Cash Price	$897.00
Rate for Payer: Health Management Network Commercial	$1,270.75
Rate for Payer: MDX Hawaii PPO	$1,450.15

TUBE EMG ENDOTRACH SZ6

Facility

$1,495.00

Hospital Revenue Code	270
Min. Negotiated Rate	$762.45
Max. Negotiated Rate	$1,450.15
Rate for Payer: Cash Price	$897.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,420.25
Rate for Payer: Health Management Network Commercial	$1,270.75
Rate for Payer: Kaiser Permanente Commercial	$941.85
Rate for Payer: Kaiser Permanente Medicaid	$762.45
Rate for Payer: MDX Hawaii PPO	$1,450.15
Rate for Payer: University Health Alliance Commercial	$1,089.71

TUBE EMG ENDOTRACH SZ7

Facility

$1,540.00

Hospital Revenue Code	270
Min. Negotiated Rate	$785.40
Max. Negotiated Rate	$1,493.80
Rate for Payer: Cash Price	$924.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.00
Rate for Payer: Health Management Network Commercial	$1,309.00
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: Kaiser Permanente Medicaid	$785.40
Rate for Payer: MDX Hawaii PPO	$1,493.80
Rate for Payer: University Health Alliance Commercial	$1,122.51

TUBE EMG ENDOTRACH SZ7

Facility

$1,540.00

Hospital Revenue Code	270
Min. Negotiated Rate	$1,309.00
Max. Negotiated Rate	$1,493.80
Rate for Payer: Cash Price	$924.00
Rate for Payer: Health Management Network Commercial	$1,309.00
Rate for Payer: MDX Hawaii PPO	$1,493.80

TUBE FEEDING KANGA 24F

Facility

$125.00

Service Code	HCPCS B4087
Hospital Revenue Code	272
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

TUBE FEEDING KANGA 24F

Facility

$125.00

Service Code	HCPCS B4087
Hospital Revenue Code	272
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
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: UnitedHealthcare Medicaid	$38.22
Rate for Payer: University Health Alliance Commercial	$91.11

TUBE IRRIG CYSTO Y-TUBE

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$104.76

TUBE IRRIG CYSTO Y-TUBE

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Hawaii Western Management Group Commercial	$102.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$68.04
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: University Health Alliance Commercial	$78.72

TUBE LASER ENDO 6MM DUAL CUFF

Facility

$367.00

Hospital Revenue Code	272
Min. Negotiated Rate	$187.17
Max. Negotiated Rate	$355.99
Rate for Payer: Cash Price	$220.20
Rate for Payer: Hawaii Western Management Group Commercial	$348.65
Rate for Payer: Health Management Network Commercial	$311.95
Rate for Payer: Kaiser Permanente Commercial	$231.21
Rate for Payer: Kaiser Permanente Medicaid	$187.17
Rate for Payer: MDX Hawaii PPO	$355.99
Rate for Payer: University Health Alliance Commercial	$267.51

TUBE LASER ENDO 6MM DUAL CUFF

Facility

$367.00

Hospital Revenue Code	272
Min. Negotiated Rate	$311.95
Max. Negotiated Rate	$355.99
Rate for Payer: Cash Price	$220.20
Rate for Payer: Health Management Network Commercial	$311.95
Rate for Payer: MDX Hawaii PPO	$355.99

TUBE NERVEAN EMG

Facility

$1,068.00

Hospital Revenue Code	272
Min. Negotiated Rate	$907.80
Max. Negotiated Rate	$1,035.96
Rate for Payer: Cash Price	$640.80
Rate for Payer: Health Management Network Commercial	$907.80
Rate for Payer: MDX Hawaii PPO	$1,035.96

TUBE NERVEAN EMG

Facility

$1,068.00

Hospital Revenue Code	272
Min. Negotiated Rate	$544.68
Max. Negotiated Rate	$1,035.96
Rate for Payer: Cash Price	$640.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,014.60
Rate for Payer: Health Management Network Commercial	$907.80
Rate for Payer: Kaiser Permanente Commercial	$672.84
Rate for Payer: Kaiser Permanente Medicaid	$544.68
Rate for Payer: MDX Hawaii PPO	$1,035.96
Rate for Payer: University Health Alliance Commercial	$778.47

TUBE OVERTUBE GASTRIC

Facility

$844.00

Hospital Revenue Code	272
Min. Negotiated Rate	$717.40
Max. Negotiated Rate	$818.68
Rate for Payer: Cash Price	$506.40
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: MDX Hawaii PPO	$818.68

TUBE OVERTUBE GASTRIC

Facility

$844.00

Hospital Revenue Code	272
Min. Negotiated Rate	$430.44
Max. Negotiated Rate	$818.68
Rate for Payer: Cash Price	$506.40
Rate for Payer: Hawaii Western Management Group Commercial	$801.80
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Kaiser Permanente Commercial	$531.72
Rate for Payer: Kaiser Permanente Medicaid	$430.44
Rate for Payer: MDX Hawaii PPO	$818.68
Rate for Payer: University Health Alliance Commercial	$615.19

TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]

Facility

$20.00

Service Code	NDC 00004080210
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

TUBERCULIN PPD 5 UNITS/0.1 ML SYRINGE [4080264]

Facility

$20.00

Service Code	NDC 00004080210
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

TUBE RIA 520MM 314.746S

Facility

$1,589.00

Hospital Revenue Code	272
Min. Negotiated Rate	$810.39
Max. Negotiated Rate	$1,541.33
Rate for Payer: Cash Price	$953.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.55
Rate for Payer: Health Management Network Commercial	$1,350.65
Rate for Payer: Kaiser Permanente Commercial	$1,001.07
Rate for Payer: Kaiser Permanente Medicaid	$810.39
Rate for Payer: MDX Hawaii PPO	$1,541.33
Rate for Payer: University Health Alliance Commercial	$1,158.22

TUBE RIA 520MM 314.746S

Facility

$1,589.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,350.65
Max. Negotiated Rate	$1,541.33
Rate for Payer: Cash Price	$953.40
Rate for Payer: Health Management Network Commercial	$1,350.65
Rate for Payer: MDX Hawaii PPO	$1,541.33

TUBE SILICONE MOD 1.32MM

Facility

$146.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.46
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$87.60
Rate for Payer: Hawaii Western Management Group Commercial	$138.70
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$91.98
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: University Health Alliance Commercial	$106.42

TUBE SILICONE MOD 1.32MM

Facility

$146.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$87.60
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: MDX Hawaii PPO	$141.62

TUBE TRACH BIVONA 9.0M

Facility

$457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$388.45
Max. Negotiated Rate	$443.29
Rate for Payer: Cash Price	$274.20
Rate for Payer: Health Management Network Commercial	$388.45
Rate for Payer: MDX Hawaii PPO	$443.29

Know your out-of-pocket cost for care.

All Charges