Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$15.00

Service Code	NDC 68084029901
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

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: Kaiser Permanente Commercial	$13.50
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	$7.50
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

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: Kaiser Permanente Commercial	$1,521.00
Rate for Payer: MDX Hawaii PPO	$1,639.30

TAP AO 703899

Facility

$1,690.00

Hospital Revenue Code	272
Min. Negotiated Rate	$845.00
Max. Negotiated Rate	$1,639.30
Rate for Payer: AlohaCare Medicaid	$845.00
Rate for Payer: AlohaCare Medicare	$1,284.40
Rate for Payer: Cash Price	$1,014.00
Rate for Payer: Devoted Health Medicare	$1,419.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,284.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,605.50
Rate for Payer: Health Management Network Commercial	$1,436.50
Rate for Payer: Humana Medicare	$1,284.40
Rate for Payer: Kaiser Permanente Commercial	$1,521.00
Rate for Payer: Kaiser Permanente Medicaid	$861.90
Rate for Payer: Kaiser Permanente Medicare	$1,284.40
Rate for Payer: MDX Hawaii PPO	$1,639.30
Rate for Payer: Ohana Health Plan Medicaid	$1,284.40
Rate for Payer: Ohana Health Plan Medicare	$1,284.40
Rate for Payer: UnitedHealthcare Medicare	$1,284.40
Rate for Payer: University Health Alliance Commercial	$1,231.84

TAP CORTX SCREW 3.5/110 311.32

Facility

$529.00

Service Code	HCPCS C1713
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

TAP CORTX SCREW 3.5/110 311.32

Facility

$529.00

Service Code	HCPCS C1713
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

TAPER M/L 6 EXT

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,077.00
Max. Negotiated Rate	$9,849.38
Rate for Payer: AlohaCare Medicaid	$5,077.00
Rate for Payer: AlohaCare Medicare	$7,717.04
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Devoted Health Medicare	$8,529.36
Rate for Payer: Hawaii Medical Service Association Medicare	$7,717.04
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Humana Medicare	$7,717.04
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: Kaiser Permanente Medicaid	$5,178.54
Rate for Payer: Kaiser Permanente Medicare	$7,717.04
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: Ohana Health Plan Medicaid	$7,717.04
Rate for Payer: Ohana Health Plan Medicare	$7,717.04
Rate for Payer: UnitedHealthcare Medicare	$7,717.04
Rate for Payer: University Health Alliance Commercial	$5,686.24

TAPER M/L 6 EXT

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,686.24
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

TAPER POST SHLDR 8156-0032-A

Facility

$2,436.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,364.16
Max. Negotiated Rate	$2,362.92
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,705.20
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: Kaiser Permanente Commercial	$2,192.40
Rate for Payer: MDX Hawaii PPO	$2,362.92
Rate for Payer: University Health Alliance Commercial	$1,364.16

TAPER POST SHLDR 8156-0032-A

Facility

$2,436.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.00
Max. Negotiated Rate	$2,362.92
Rate for Payer: AlohaCare Medicaid	$1,218.00
Rate for Payer: AlohaCare Medicare	$1,851.36
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Devoted Health Medicare	$2,046.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,851.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,705.20
Rate for Payer: Health Management Network Commercial	$2,070.60
Rate for Payer: Humana Medicare	$1,851.36
Rate for Payer: Kaiser Permanente Commercial	$2,192.40
Rate for Payer: Kaiser Permanente Medicaid	$1,242.36
Rate for Payer: Kaiser Permanente Medicare	$1,851.36
Rate for Payer: MDX Hawaii PPO	$2,362.92
Rate for Payer: Ohana Health Plan Medicaid	$1,851.36
Rate for Payer: Ohana Health Plan Medicare	$1,851.36
Rate for Payer: UnitedHealthcare Medicare	$1,851.36
Rate for Payer: University Health Alliance Commercial	$1,364.16

TAP QC 2.7X100 4811-100-27

Facility

$600.00

Hospital Revenue Code	272
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: Kaiser Permanente Commercial	$540.00
Rate for Payer: MDX Hawaii PPO	$582.00

TAP QC 2.7X100 4811-100-27

Facility

$600.00

Hospital Revenue Code	272
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$582.00
Rate for Payer: AlohaCare Medicaid	$300.00
Rate for Payer: AlohaCare Medicare	$456.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Devoted Health Medicare	$504.00
Rate for Payer: Hawaii Medical Service Association Medicare	$456.00
Rate for Payer: Hawaii Western Management Group Commercial	$570.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: Humana Medicare	$456.00
Rate for Payer: Kaiser Permanente Commercial	$540.00
Rate for Payer: Kaiser Permanente Medicaid	$306.00
Rate for Payer: Kaiser Permanente Medicare	$456.00
Rate for Payer: MDX Hawaii PPO	$582.00
Rate for Payer: Ohana Health Plan Medicaid	$456.00
Rate for Payer: Ohana Health Plan Medicare	$456.00
Rate for Payer: UnitedHealthcare Medicare	$456.00
Rate for Payer: University Health Alliance Commercial	$437.34

TAP QC 3.5X110MM 4811-110-35

Facility

$563.00

Hospital Revenue Code	272
Min. Negotiated Rate	$281.50
Max. Negotiated Rate	$546.11
Rate for Payer: AlohaCare Medicaid	$281.50
Rate for Payer: AlohaCare Medicare	$427.88
Rate for Payer: Cash Price	$337.80
Rate for Payer: Devoted Health Medicare	$472.92
Rate for Payer: Hawaii Medical Service Association Medicare	$427.88
Rate for Payer: Hawaii Western Management Group Commercial	$534.85
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Humana Medicare	$427.88
Rate for Payer: Kaiser Permanente Commercial	$506.70
Rate for Payer: Kaiser Permanente Medicaid	$287.13
Rate for Payer: Kaiser Permanente Medicare	$427.88
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: Ohana Health Plan Medicaid	$427.88
Rate for Payer: Ohana Health Plan Medicare	$427.88
Rate for Payer: UnitedHealthcare Medicare	$427.88
Rate for Payer: University Health Alliance Commercial	$410.37

TAP QC 3.5X110MM 4811-110-35

Facility

$563.00

Hospital Revenue Code	272
Min. Negotiated Rate	$478.55
Max. Negotiated Rate	$546.11
Rate for Payer: Cash Price	$337.80
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Kaiser Permanente Commercial	$506.70
Rate for Payer: MDX Hawaii PPO	$546.11

TAP QC 4.0X110MM 4811-110-40

Facility

$675.00

Hospital Revenue Code	272
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$654.75
Rate for Payer: AlohaCare Medicaid	$337.50
Rate for Payer: AlohaCare Medicare	$513.00
Rate for Payer: Cash Price	$405.00
Rate for Payer: Devoted Health Medicare	$567.00
Rate for Payer: Hawaii Medical Service Association Medicare	$513.00
Rate for Payer: Hawaii Western Management Group Commercial	$641.25
Rate for Payer: Health Management Network Commercial	$573.75
Rate for Payer: Humana Medicare	$513.00
Rate for Payer: Kaiser Permanente Commercial	$607.50
Rate for Payer: Kaiser Permanente Medicaid	$344.25
Rate for Payer: Kaiser Permanente Medicare	$513.00
Rate for Payer: MDX Hawaii PPO	$654.75
Rate for Payer: Ohana Health Plan Medicaid	$513.00
Rate for Payer: Ohana Health Plan Medicare	$513.00
Rate for Payer: UnitedHealthcare Medicare	$513.00
Rate for Payer: University Health Alliance Commercial	$492.01

TAP QC 4.0X110MM 4811-110-40

Facility

$675.00

Hospital Revenue Code	272
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$654.75
Rate for Payer: Cash Price	$405.00
Rate for Payer: Health Management Network Commercial	$573.75
Rate for Payer: Kaiser Permanente Commercial	$607.50
Rate for Payer: MDX Hawaii PPO	$654.75

TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION [198533]

Facility

$18,500.00

Service Code	HCPCS J9026
Hospital Revenue Code	250
Min. Negotiated Rate	$15,725.00
Max. Negotiated Rate	$17,945.00
Rate for Payer: Cash Price	$11,100.00
Rate for Payer: Health Management Network Commercial	$15,725.00
Rate for Payer: Kaiser Permanente Commercial	$16,650.00
Rate for Payer: MDX Hawaii PPO	$17,945.00

T-CLAMP FOR 2/3MM PINS M104

Facility

$608.00

Hospital Revenue Code	272
Min. Negotiated Rate	$516.80
Max. Negotiated Rate	$589.76
Rate for Payer: Cash Price	$364.80
Rate for Payer: Health Management Network Commercial	$516.80
Rate for Payer: Kaiser Permanente Commercial	$547.20
Rate for Payer: MDX Hawaii PPO	$589.76

T-CLAMP FOR 2/3MM PINS M104

Facility

$608.00

Hospital Revenue Code	272
Min. Negotiated Rate	$304.00
Max. Negotiated Rate	$589.76
Rate for Payer: AlohaCare Medicaid	$304.00
Rate for Payer: AlohaCare Medicare	$462.08
Rate for Payer: Cash Price	$364.80
Rate for Payer: Devoted Health Medicare	$510.72
Rate for Payer: Hawaii Medical Service Association Medicare	$462.08
Rate for Payer: Hawaii Western Management Group Commercial	$577.60
Rate for Payer: Health Management Network Commercial	$516.80
Rate for Payer: Humana Medicare	$462.08
Rate for Payer: Kaiser Permanente Commercial	$547.20
Rate for Payer: Kaiser Permanente Medicaid	$310.08
Rate for Payer: Kaiser Permanente Medicare	$462.08
Rate for Payer: MDX Hawaii PPO	$589.76
Rate for Payer: Ohana Health Plan Medicaid	$462.08
Rate for Payer: Ohana Health Plan Medicare	$462.08
Rate for Payer: UnitedHealthcare Medicare	$462.08
Rate for Payer: University Health Alliance Commercial	$443.17

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$4.00

Service Code	NDC 50268077911
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$4.00

Service Code	NDC 50268077915
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$3.00

Service Code	NDC 67877014601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$4.00

Service Code	NDC 50268077911
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

TEMAZEPAM 15 MG CAPSULE [7753]

Facility

$3.00

Service Code	NDC 67877014601
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

Know your out-of-pocket cost for care.

All Charges