Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

SYSTEM VEIN HARVEST VH-2004

Facility

$3,998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,398.30
Max. Negotiated Rate	$3,878.06
Rate for Payer: Cash Price	$2,398.80
Rate for Payer: Health Management Network Commercial	$3,398.30
Rate for Payer: MDX Hawaii PPO	$3,878.06

SYSTEM VEIN HARVEST VH-2004

Facility

$3,998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,038.98
Max. Negotiated Rate	$3,878.06
Rate for Payer: Cash Price	$2,398.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,798.10
Rate for Payer: Health Management Network Commercial	$3,398.30
Rate for Payer: Kaiser Permanente Commercial	$2,518.74
Rate for Payer: Kaiser Permanente Medicaid	$2,038.98
Rate for Payer: MDX Hawaii PPO	$3,878.06
Rate for Payer: University Health Alliance Commercial	$2,914.14

TA 30-3.5 RELOADING STAPLER

Facility

$297.00

Hospital Revenue Code	272
Min. Negotiated Rate	$151.47
Max. Negotiated Rate	$288.09
Rate for Payer: Cash Price	$178.20
Rate for Payer: Hawaii Western Management Group Commercial	$282.15
Rate for Payer: Health Management Network Commercial	$252.45
Rate for Payer: Kaiser Permanente Commercial	$187.11
Rate for Payer: Kaiser Permanente Medicaid	$151.47
Rate for Payer: MDX Hawaii PPO	$288.09
Rate for Payer: University Health Alliance Commercial	$216.48

TA 30-3.5 RELOADING STAPLER

Facility

$297.00

Hospital Revenue Code	272
Min. Negotiated Rate	$252.45
Max. Negotiated Rate	$288.09
Rate for Payer: Cash Price	$178.20
Rate for Payer: Health Management Network Commercial	$252.45
Rate for Payer: MDX Hawaii PPO	$288.09

TA 30 STAPLER 30MM-3.5MM

Facility

$184.00

Hospital Revenue Code	272
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$110.40
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: MDX Hawaii PPO	$178.48

TA 30 STAPLER 30MM-3.5MM

Facility

$184.00

Hospital Revenue Code	272
Min. Negotiated Rate	$93.84
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$110.40
Rate for Payer: Hawaii Western Management Group Commercial	$174.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$115.92
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: University Health Alliance Commercial	$134.12

TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]

Facility

$8.00

Service Code	HCPCS J7507
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

TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]

Facility

$8.00

Service Code	HCPCS J7507
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.15
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

TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]

Facility

$16.00

Service Code	HCPCS J7507
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Hawaii Medical Service Association ABD	$0.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.15
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$10.08
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: UnitedHealthcare Medicaid	$9.60
Rate for Payer: University Health Alliance Commercial	$11.66

TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]

Facility

$16.00

Service Code	HCPCS J7507
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: MDX Hawaii PPO	$15.52

TAKERU RX OTW 1.5X12

Facility

$529.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$269.79
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: University Health Alliance Commercial	$385.59

TAKERU RX OTW 1.5X12

Facility

$529.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

TAKERU RX OTW 2X12

Facility

$529.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$269.79
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: University Health Alliance Commercial	$385.59

TAKERU RX OTW 2X12

Facility

$529.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

TAMOXIFEN 10 MG TABLET [7711]

Facility

$7.00

Service Code	NDC 59651029960
Hospital Revenue Code	637
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$4.41
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: University Health Alliance Commercial	$5.10

TAMOXIFEN 10 MG TABLET [7711]

Facility

$7.00

Service Code	NDC 59651029960
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: MDX Hawaii PPO	$6.79

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$15.00

Service Code	NDC 68084029901
Hospital Revenue Code	637
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$15.00

Service Code	NDC 68084029901
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$15.00

Service Code	NDC 68084029911
Hospital Revenue Code	637
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$15.00

Service Code	NDC 68084029911
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

TAMSULOSIN CAPSULES (FLOMAX) 0.4 MG (TAKE HOME) [4080397]

Facility

$15.00

Service Code	NDC 00004080189
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

TAMSULOSIN CAPSULES (FLOMAX) 0.4 MG (TAKE HOME) [4080397]

Facility

$15.00

Service Code	NDC 00004080189
Hospital Revenue Code	253
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION

Facility

$2,837.00

Service Code	CPT 11102
Hospital Revenue Code	360
Min. Negotiated Rate	$38.19
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$38.19
Rate for Payer: UnitedHealthcare Medicare	$480.23

TAP AO 703899

Facility

$1,690.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,436.50
Max. Negotiated Rate	$1,639.30
Rate for Payer: Cash Price	$1,014.00
Rate for Payer: Health Management Network Commercial	$1,436.50
Rate for Payer: MDX Hawaii PPO	$1,639.30

TAP AO 703899

Facility

$1,690.00

Hospital Revenue Code	272
Min. Negotiated Rate	$861.90
Max. Negotiated Rate	$1,639.30
Rate for Payer: Cash Price	$1,014.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,605.50
Rate for Payer: Health Management Network Commercial	$1,436.50
Rate for Payer: Kaiser Permanente Commercial	$1,064.70
Rate for Payer: Kaiser Permanente Medicaid	$861.90
Rate for Payer: MDX Hawaii PPO	$1,639.30
Rate for Payer: University Health Alliance Commercial	$1,231.84

Know your out-of-pocket cost for care.

All Charges