Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SYRINGE INFLATOR ALLIANCE

Facility

$152.00

Hospital Revenue Code	272
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

SYRINGE INFLATOR ALLIANCE

Facility

$152.00

Hospital Revenue Code	272
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: AlohaCare Medicare	$115.52
Rate for Payer: Cash Price	$91.20
Rate for Payer: Devoted Health Medicare	$127.68
Rate for Payer: Hawaii Medical Service Association Medicare	$115.52
Rate for Payer: Hawaii Western Management Group Commercial	$144.40
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Humana Medicare	$115.52
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: Kaiser Permanente Medicare	$115.52
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: Ohana Health Plan Medicaid	$115.52
Rate for Payer: Ohana Health Plan Medicare	$115.52
Rate for Payer: UnitedHealthcare Medicare	$115.52
Rate for Payer: University Health Alliance Commercial	$110.79

SYRINGE THERACAL PT H-34110P

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

SYRINGE THERACAL PT H-34110P

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$228.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Devoted Health Medicare	$252.00
Rate for Payer: Hawaii Medical Service Association Medicare	$228.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$228.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$228.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$228.00
Rate for Payer: Ohana Health Plan Medicare	$228.00
Rate for Payer: UnitedHealthcare Medicare	$228.00
Rate for Payer: University Health Alliance Commercial	$218.67

SYSTEM IMPLANT AR-1360FT-BC

Facility

$6,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,325.00
Max. Negotiated Rate	$6,450.50
Rate for Payer: AlohaCare Medicaid	$3,325.00
Rate for Payer: AlohaCare Medicare	$5,054.00
Rate for Payer: Cash Price	$3,990.00
Rate for Payer: Devoted Health Medicare	$5,586.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,655.00
Rate for Payer: Health Management Network Commercial	$5,652.50
Rate for Payer: Humana Medicare	$5,054.00
Rate for Payer: Kaiser Permanente Commercial	$5,985.00
Rate for Payer: Kaiser Permanente Medicaid	$3,391.50
Rate for Payer: Kaiser Permanente Medicare	$5,054.00
Rate for Payer: MDX Hawaii PPO	$6,450.50
Rate for Payer: Ohana Health Plan Medicaid	$5,054.00
Rate for Payer: Ohana Health Plan Medicare	$5,054.00
Rate for Payer: UnitedHealthcare Medicare	$5,054.00
Rate for Payer: University Health Alliance Commercial	$3,724.00

SYSTEM IMPLANT AR-1360FT-BC

Facility

$6,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,724.00
Max. Negotiated Rate	$6,450.50
Rate for Payer: Cash Price	$3,990.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,655.00
Rate for Payer: Health Management Network Commercial	$5,652.50
Rate for Payer: Kaiser Permanente Commercial	$5,985.00
Rate for Payer: MDX Hawaii PPO	$6,450.50
Rate for Payer: University Health Alliance Commercial	$3,724.00

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: Kaiser Permanente Commercial	$3,598.20
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	$1,999.00
Max. Negotiated Rate	$3,878.06
Rate for Payer: AlohaCare Medicaid	$1,999.00
Rate for Payer: AlohaCare Medicare	$3,038.48
Rate for Payer: Cash Price	$2,398.80
Rate for Payer: Devoted Health Medicare	$3,358.32
Rate for Payer: Hawaii Medical Service Association Medicare	$3,038.48
Rate for Payer: Hawaii Western Management Group Commercial	$3,798.10
Rate for Payer: Health Management Network Commercial	$3,398.30
Rate for Payer: Humana Medicare	$3,038.48
Rate for Payer: Kaiser Permanente Commercial	$3,598.20
Rate for Payer: Kaiser Permanente Medicaid	$2,038.98
Rate for Payer: Kaiser Permanente Medicare	$3,038.48
Rate for Payer: MDX Hawaii PPO	$3,878.06
Rate for Payer: Ohana Health Plan Medicaid	$3,038.48
Rate for Payer: Ohana Health Plan Medicare	$3,038.48
Rate for Payer: UnitedHealthcare Medicare	$3,038.48
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	$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: Kaiser Permanente Commercial	$267.30
Rate for Payer: MDX Hawaii PPO	$288.09

TA 30-3.5 RELOADING STAPLER

Facility

$297.00

Hospital Revenue Code	272
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$288.09
Rate for Payer: AlohaCare Medicaid	$148.50
Rate for Payer: AlohaCare Medicare	$225.72
Rate for Payer: Cash Price	$178.20
Rate for Payer: Devoted Health Medicare	$249.48
Rate for Payer: Hawaii Medical Service Association Medicare	$225.72
Rate for Payer: Hawaii Western Management Group Commercial	$282.15
Rate for Payer: Health Management Network Commercial	$252.45
Rate for Payer: Humana Medicare	$225.72
Rate for Payer: Kaiser Permanente Commercial	$267.30
Rate for Payer: Kaiser Permanente Medicaid	$151.47
Rate for Payer: Kaiser Permanente Medicare	$225.72
Rate for Payer: MDX Hawaii PPO	$288.09
Rate for Payer: Ohana Health Plan Medicaid	$225.72
Rate for Payer: Ohana Health Plan Medicare	$225.72
Rate for Payer: UnitedHealthcare Medicare	$225.72
Rate for Payer: University Health Alliance Commercial	$216.48

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: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48

TA 30 STAPLER 30MM-3.5MM

Facility

$184.00

Hospital Revenue Code	272
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$139.84
Rate for Payer: Cash Price	$110.40
Rate for Payer: Devoted Health Medicare	$154.56
Rate for Payer: Hawaii Medical Service Association Medicare	$139.84
Rate for Payer: Hawaii Western Management Group Commercial	$174.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$139.84
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$139.84
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$139.84
Rate for Payer: Ohana Health Plan Medicare	$139.84
Rate for Payer: UnitedHealthcare Medicare	$139.84
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	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association ABD	$0.15
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
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: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: UnitedHealthcare Medicaid	$4.80
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83

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: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

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: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

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: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$12.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association ABD	$0.15
Rate for Payer: Hawaii Medical Service Association Medicare	$12.16
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: Humana Medicare	$12.16
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$12.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$12.16
Rate for Payer: Ohana Health Plan Medicare	$12.16
Rate for Payer: UnitedHealthcare Medicaid	$9.60
Rate for Payer: UnitedHealthcare Medicare	$12.16
Rate for Payer: University Health Alliance Commercial	$11.66

TAKERU RX OTW 1.5X12

Facility

$529.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$402.04
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$444.36
Rate for Payer: Hawaii Medical Service Association Medicare	$402.04
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$402.04
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$402.04
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$402.04
Rate for Payer: Ohana Health Plan Medicare	$402.04
Rate for Payer: UnitedHealthcare Medicare	$402.04
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: Kaiser Permanente Commercial	$476.10
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	$264.50
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$402.04
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$444.36
Rate for Payer: Hawaii Medical Service Association Medicare	$402.04
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$402.04
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$402.04
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$402.04
Rate for Payer: Ohana Health Plan Medicare	$402.04
Rate for Payer: UnitedHealthcare Medicare	$402.04
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: Kaiser Permanente Commercial	$476.10
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	$3.50
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$5.32
Rate for Payer: Cash Price	$4.20
Rate for Payer: Devoted Health Medicare	$5.88
Rate for Payer: Hawaii Medical Service Association Medicare	$5.32
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$5.32
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$5.32
Rate for Payer: Ohana Health Plan Medicare	$5.32
Rate for Payer: UnitedHealthcare Medicare	$5.32
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: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

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: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

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: Kaiser Permanente Commercial	$13.50
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	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

Know your out-of-pocket cost for care.

All Charges