Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]

Facility

$155.00

Service Code	NDC 00338032401
Hospital Revenue Code	250
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]

Facility

$155.00

Service Code	NDC 00338032201
Hospital Revenue Code	250
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$21,047.38

Service Code	MSDRG 626
Min. Negotiated Rate	$21,047.38
Max. Negotiated Rate	$21,047.38
Rate for Payer: Hawaii Medical Service Association Commercial	$21,047.38

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$21,047.38

Service Code	MSDRG 625
Min. Negotiated Rate	$21,047.38
Max. Negotiated Rate	$21,047.38
Rate for Payer: Hawaii Medical Service Association Commercial	$21,047.38

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$21,047.38

Service Code	MSDRG 627
Min. Negotiated Rate	$21,047.38
Max. Negotiated Rate	$21,047.38
Rate for Payer: Hawaii Medical Service Association Commercial	$21,047.38

THYROID (PORK) 60 MG TABLET [150728]

Facility

$5.00

Service Code	NDC 42192033001
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

THYROID (PORK) 60 MG TABLET [150728]

Facility

$5.00

Service Code	NDC 42192033001
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION [180696]

Facility

$2,927.00

Service Code	HCPCS J3240
Hospital Revenue Code	636
Min. Negotiated Rate	$1,463.50
Max. Negotiated Rate	$2,839.19
Rate for Payer: AlohaCare Medicaid	$1,463.50
Rate for Payer: AlohaCare Medicare	$2,224.52
Rate for Payer: Cash Price	$1,756.20
Rate for Payer: Cash Price	$1,756.20
Rate for Payer: Devoted Health Medicare	$2,458.68
Rate for Payer: Hawaii Medical Service Association ABD	$2,113.24
Rate for Payer: Hawaii Medical Service Association Commercial	$2,656.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,224.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,113.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,780.65
Rate for Payer: Health Management Network Commercial	$2,487.95
Rate for Payer: Humana Medicare	$2,224.52
Rate for Payer: Kaiser Permanente Commercial	$2,634.30
Rate for Payer: Kaiser Permanente Medicaid	$1,492.77
Rate for Payer: Kaiser Permanente Medicare	$2,224.52
Rate for Payer: MDX Hawaii PPO	$2,839.19
Rate for Payer: Ohana Health Plan Medicaid	$2,224.52
Rate for Payer: Ohana Health Plan Medicare	$2,224.52
Rate for Payer: UnitedHealthcare Medicaid	$1,756.20
Rate for Payer: UnitedHealthcare Medicare	$2,224.52
Rate for Payer: University Health Alliance Commercial	$2,133.49

THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION [180696]

Facility

$2,927.00

Service Code	HCPCS J3240
Hospital Revenue Code	250
Min. Negotiated Rate	$2,487.95
Max. Negotiated Rate	$2,839.19
Rate for Payer: Cash Price	$1,756.20
Rate for Payer: Health Management Network Commercial	$2,487.95
Rate for Payer: Kaiser Permanente Commercial	$2,634.30
Rate for Payer: MDX Hawaii PPO	$2,839.19

TI ANCHOR 5.5MM 3910-400-050

Facility

$1,306.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$731.36
Max. Negotiated Rate	$1,266.82
Rate for Payer: Cash Price	$783.60
Rate for Payer: Hawaii Western Management Group Commercial	$914.20
Rate for Payer: Health Management Network Commercial	$1,110.10
Rate for Payer: Kaiser Permanente Commercial	$1,175.40
Rate for Payer: MDX Hawaii PPO	$1,266.82
Rate for Payer: University Health Alliance Commercial	$731.36

TI ANCHOR 5.5MM 3910-400-050

Facility

$1,306.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$653.00
Max. Negotiated Rate	$1,266.82
Rate for Payer: AlohaCare Medicaid	$653.00
Rate for Payer: AlohaCare Medicare	$992.56
Rate for Payer: Cash Price	$783.60
Rate for Payer: Devoted Health Medicare	$1,097.04
Rate for Payer: Hawaii Medical Service Association Medicare	$992.56
Rate for Payer: Hawaii Western Management Group Commercial	$914.20
Rate for Payer: Health Management Network Commercial	$1,110.10
Rate for Payer: Humana Medicare	$992.56
Rate for Payer: Kaiser Permanente Commercial	$1,175.40
Rate for Payer: Kaiser Permanente Medicaid	$666.06
Rate for Payer: Kaiser Permanente Medicare	$992.56
Rate for Payer: MDX Hawaii PPO	$1,266.82
Rate for Payer: Ohana Health Plan Medicaid	$992.56
Rate for Payer: Ohana Health Plan Medicare	$992.56
Rate for Payer: UnitedHealthcare Medicare	$992.56
Rate for Payer: University Health Alliance Commercial	$731.36

TIB BEARING SZ 7 #5532-G-709

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.00
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$2,033.76
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$2,247.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,033.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$2,033.76
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$2,033.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$2,033.76
Rate for Payer: Ohana Health Plan Medicare	$2,033.76
Rate for Payer: UnitedHealthcare Medicare	$2,033.76
Rate for Payer: University Health Alliance Commercial	$1,498.56

TIB BEARING SZ 7 #5532-G-709

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

TIBIA CAP 11.5 10MM 2341-0010S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$1,038.87
Rate for Payer: AlohaCare Medicaid	$535.50
Rate for Payer: AlohaCare Medicare	$813.96
Rate for Payer: Cash Price	$642.60
Rate for Payer: Devoted Health Medicare	$899.64
Rate for Payer: Hawaii Medical Service Association Medicare	$813.96
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Humana Medicare	$813.96
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: Kaiser Permanente Medicaid	$546.21
Rate for Payer: Kaiser Permanente Medicare	$813.96
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: Ohana Health Plan Medicaid	$813.96
Rate for Payer: Ohana Health Plan Medicare	$813.96
Rate for Payer: UnitedHealthcare Medicare	$813.96
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIA CAP 11.5 10MM 2341-0010S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$599.76
Max. Negotiated Rate	$1,038.87
Rate for Payer: Cash Price	$642.60
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIA CAP 11.5 20MM 2341-0020S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$1,038.87
Rate for Payer: AlohaCare Medicaid	$535.50
Rate for Payer: AlohaCare Medicare	$813.96
Rate for Payer: Cash Price	$642.60
Rate for Payer: Devoted Health Medicare	$899.64
Rate for Payer: Hawaii Medical Service Association Medicare	$813.96
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Humana Medicare	$813.96
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: Kaiser Permanente Medicaid	$546.21
Rate for Payer: Kaiser Permanente Medicare	$813.96
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: Ohana Health Plan Medicaid	$813.96
Rate for Payer: Ohana Health Plan Medicare	$813.96
Rate for Payer: UnitedHealthcare Medicare	$813.96
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIA CAP 11.5 20MM 2341-0020S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$599.76
Max. Negotiated Rate	$1,038.87
Rate for Payer: Cash Price	$642.60
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIA END CAP 11.5 2341-0015S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$599.76
Max. Negotiated Rate	$1,038.87
Rate for Payer: Cash Price	$642.60
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIA END CAP 11.5 2341-0015S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$1,038.87
Rate for Payer: AlohaCare Medicaid	$535.50
Rate for Payer: AlohaCare Medicare	$813.96
Rate for Payer: Cash Price	$642.60
Rate for Payer: Devoted Health Medicare	$899.64
Rate for Payer: Hawaii Medical Service Association Medicare	$813.96
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Humana Medicare	$813.96
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: Kaiser Permanente Medicaid	$546.21
Rate for Payer: Kaiser Permanente Medicare	$813.96
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: Ohana Health Plan Medicaid	$813.96
Rate for Payer: Ohana Health Plan Medicare	$813.96
Rate for Payer: UnitedHealthcare Medicare	$813.96
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIAL 4X9MM BRNG 5531-G-409-E

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

TIBIAL 4X9MM BRNG 5531-G-409-E

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$2,054.28
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$2,270.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,054.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$2,054.28
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$2,054.28
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$2,054.28
Rate for Payer: Ohana Health Plan Medicare	$2,054.28
Rate for Payer: UnitedHealthcare Medicare	$2,054.28
Rate for Payer: University Health Alliance Commercial	$1,513.68

TIBIAL ASYMMETRICE 5549-A-241

Facility

$11,136.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,568.00
Max. Negotiated Rate	$10,801.92
Rate for Payer: AlohaCare Medicaid	$5,568.00
Rate for Payer: AlohaCare Medicare	$8,463.36
Rate for Payer: Cash Price	$6,681.60
Rate for Payer: Devoted Health Medicare	$9,354.24
Rate for Payer: Hawaii Medical Service Association Medicare	$8,463.36
Rate for Payer: Hawaii Western Management Group Commercial	$7,795.20
Rate for Payer: Health Management Network Commercial	$9,465.60
Rate for Payer: Humana Medicare	$8,463.36
Rate for Payer: Kaiser Permanente Commercial	$10,022.40
Rate for Payer: Kaiser Permanente Medicaid	$5,679.36
Rate for Payer: Kaiser Permanente Medicare	$8,463.36
Rate for Payer: MDX Hawaii PPO	$10,801.92
Rate for Payer: Ohana Health Plan Medicaid	$8,463.36
Rate for Payer: Ohana Health Plan Medicare	$8,463.36
Rate for Payer: UnitedHealthcare Medicare	$8,463.36
Rate for Payer: University Health Alliance Commercial	$6,236.16

TIBIAL ASYMMETRICE 5549-A-241

Facility

$11,136.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,236.16
Max. Negotiated Rate	$10,801.92
Rate for Payer: Cash Price	$6,681.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,795.20
Rate for Payer: Health Management Network Commercial	$9,465.60
Rate for Payer: Kaiser Permanente Commercial	$10,022.40
Rate for Payer: MDX Hawaii PPO	$10,801.92
Rate for Payer: University Health Alliance Commercial	$6,236.16

TIBIAL AUGMENT 5545-A-401

Facility

$2,123.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,061.50
Max. Negotiated Rate	$2,059.31
Rate for Payer: AlohaCare Medicaid	$1,061.50
Rate for Payer: AlohaCare Medicare	$1,613.48
Rate for Payer: Cash Price	$1,273.80
Rate for Payer: Devoted Health Medicare	$1,783.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,613.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.10
Rate for Payer: Health Management Network Commercial	$1,804.55
Rate for Payer: Humana Medicare	$1,613.48
Rate for Payer: Kaiser Permanente Commercial	$1,910.70
Rate for Payer: Kaiser Permanente Medicaid	$1,082.73
Rate for Payer: Kaiser Permanente Medicare	$1,613.48
Rate for Payer: MDX Hawaii PPO	$2,059.31
Rate for Payer: Ohana Health Plan Medicaid	$1,613.48
Rate for Payer: Ohana Health Plan Medicare	$1,613.48
Rate for Payer: UnitedHealthcare Medicare	$1,613.48
Rate for Payer: University Health Alliance Commercial	$1,188.88

TIBIAL AUGMENT 5545-A-401

Facility

$2,123.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.88
Max. Negotiated Rate	$2,059.31
Rate for Payer: Cash Price	$1,273.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.10
Rate for Payer: Health Management Network Commercial	$1,804.55
Rate for Payer: Kaiser Permanente Commercial	$1,910.70
Rate for Payer: MDX Hawaii PPO	$2,059.31
Rate for Payer: University Health Alliance Commercial	$1,188.88

Know your out-of-pocket cost for care.

All Charges