Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

TUBE TRACH BIVONA 9.0M

Facility

$457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$233.07
Max. Negotiated Rate	$443.29
Rate for Payer: Cash Price	$274.20
Rate for Payer: Hawaii Western Management Group Commercial	$434.15
Rate for Payer: Health Management Network Commercial	$388.45
Rate for Payer: Kaiser Permanente Commercial	$287.91
Rate for Payer: Kaiser Permanente Medicaid	$233.07
Rate for Payer: MDX Hawaii PPO	$443.29
Rate for Payer: University Health Alliance Commercial	$333.11

TUBING INSUF HIFLOW

Facility

$217.00

Hospital Revenue Code	272
Min. Negotiated Rate	$110.67
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$130.20
Rate for Payer: Hawaii Western Management Group Commercial	$206.15
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$136.71
Rate for Payer: Kaiser Permanente Medicaid	$110.67
Rate for Payer: MDX Hawaii PPO	$210.49
Rate for Payer: University Health Alliance Commercial	$158.17

TUBING INSUF HIFLOW

Facility

$217.00

Hospital Revenue Code	272
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$130.20
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: MDX Hawaii PPO	$210.49

TUBING MYOSURE INFLOW

Facility

$473.00

Hospital Revenue Code	272
Min. Negotiated Rate	$241.23
Max. Negotiated Rate	$458.81
Rate for Payer: Cash Price	$283.80
Rate for Payer: Hawaii Western Management Group Commercial	$449.35
Rate for Payer: Health Management Network Commercial	$402.05
Rate for Payer: Kaiser Permanente Commercial	$297.99
Rate for Payer: Kaiser Permanente Medicaid	$241.23
Rate for Payer: MDX Hawaii PPO	$458.81
Rate for Payer: University Health Alliance Commercial	$344.77

TUBING MYOSURE INFLOW

Facility

$473.00

Hospital Revenue Code	272
Min. Negotiated Rate	$402.05
Max. Negotiated Rate	$458.81
Rate for Payer: Cash Price	$283.80
Rate for Payer: Health Management Network Commercial	$402.05
Rate for Payer: MDX Hawaii PPO	$458.81

TUBING MYOSURE OUTFLOW

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

TUBING MYOSURE OUTFLOW

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

TUBING SUCTN-IRR 12FT

Facility

$128.00

Hospital Revenue Code	272
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$76.80
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: MDX Hawaii PPO	$124.16

TUBING SUCTN-IRR 12FT

Facility

$128.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.28
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$76.80
Rate for Payer: Hawaii Western Management Group Commercial	$121.60
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Kaiser Permanente Commercial	$80.64
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: University Health Alliance Commercial	$93.30

TUBING SWIVEL HANDLE

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$60.48
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: University Health Alliance Commercial	$69.97

TUBING SWIVEL HANDLE

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: MDX Hawaii PPO	$93.12

TUBULAR LCK SS 12H AR-8943T-12

Facility

$1,502.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$766.02
Max. Negotiated Rate	$1,456.94
Rate for Payer: Cash Price	$901.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,051.40
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Kaiser Permanente Commercial	$946.26
Rate for Payer: Kaiser Permanente Medicaid	$766.02
Rate for Payer: MDX Hawaii PPO	$1,456.94
Rate for Payer: University Health Alliance Commercial	$841.12

TUBULAR LCK SS 12H AR-8943T-12

Facility

$1,502.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$841.12
Max. Negotiated Rate	$1,456.94
Rate for Payer: Cash Price	$901.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,051.40
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: MDX Hawaii PPO	$1,456.94
Rate for Payer: University Health Alliance Commercial	$841.12

TUBULAR PLATE 1/3 4H 241.34

Facility

$422.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$215.22
Max. Negotiated Rate	$409.34
Rate for Payer: Cash Price	$253.20
Rate for Payer: Hawaii Western Management Group Commercial	$295.40
Rate for Payer: Health Management Network Commercial	$358.70
Rate for Payer: Kaiser Permanente Commercial	$265.86
Rate for Payer: Kaiser Permanente Medicaid	$215.22
Rate for Payer: MDX Hawaii PPO	$409.34
Rate for Payer: University Health Alliance Commercial	$236.32

TUBULAR PLATE 1/3 4H 241.34

Facility

$422.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$236.32
Max. Negotiated Rate	$409.34
Rate for Payer: Cash Price	$253.20
Rate for Payer: Hawaii Western Management Group Commercial	$295.40
Rate for Payer: Health Management Network Commercial	$358.70
Rate for Payer: MDX Hawaii PPO	$409.34
Rate for Payer: University Health Alliance Commercial	$236.32

TUNNELER SHEATH LG BLU 9009-16

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$131.07
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: Hawaii Western Management Group Commercial	$244.15
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$161.91
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: University Health Alliance Commercial	$187.33

TUNNELER SHEATH LG BLU 9009-16

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: MDX Hawaii PPO	$249.29

TUNNELER SHEATH LG ORG 9009-20

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: MDX Hawaii PPO	$249.29

TUNNELER SHEATH LG ORG 9009-20

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$131.07
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: Hawaii Western Management Group Commercial	$244.15
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$161.91
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: University Health Alliance Commercial	$187.33

TUNNELER SHEATH SM YEL 9009-22

Facility

$211.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$126.60
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: MDX Hawaii PPO	$204.67

TUNNELER SHEATH SM YEL 9009-22

Facility

$211.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$107.61
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$126.60
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$132.93
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: University Health Alliance Commercial	$153.80

TURBOVAC 90 XL ASC1336-01

Facility

$1,642.00

Hospital Revenue Code	272
Min. Negotiated Rate	$837.42
Max. Negotiated Rate	$1,592.74
Rate for Payer: Cash Price	$985.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,559.90
Rate for Payer: Health Management Network Commercial	$1,395.70
Rate for Payer: Kaiser Permanente Commercial	$1,034.46
Rate for Payer: Kaiser Permanente Medicaid	$837.42
Rate for Payer: MDX Hawaii PPO	$1,592.74
Rate for Payer: University Health Alliance Commercial	$1,196.85

TURBOVAC 90 XL ASC1336-01

Facility

$1,642.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,395.70
Max. Negotiated Rate	$1,592.74
Rate for Payer: Cash Price	$985.20
Rate for Payer: Health Management Network Commercial	$1,395.70
Rate for Payer: MDX Hawaii PPO	$1,592.74

TVT OBTURATOR SYSTEM 810081L

Facility

$4,486.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.16
Max. Negotiated Rate	$4,351.42
Rate for Payer: Cash Price	$2,691.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,140.20
Rate for Payer: Health Management Network Commercial	$3,813.10
Rate for Payer: MDX Hawaii PPO	$4,351.42
Rate for Payer: University Health Alliance Commercial	$2,512.16

TVT OBTURATOR SYSTEM 810081L

Facility

$4,486.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$2,287.86
Max. Negotiated Rate	$4,351.42
Rate for Payer: Cash Price	$2,691.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,140.20
Rate for Payer: Health Management Network Commercial	$3,813.10
Rate for Payer: Kaiser Permanente Commercial	$2,826.18
Rate for Payer: Kaiser Permanente Medicaid	$2,287.86
Rate for Payer: MDX Hawaii PPO	$4,351.42
Rate for Payer: University Health Alliance Commercial	$2,512.16

Know your out-of-pocket cost for care.

All Charges