Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TIGHTROPE BUTTON AR-1588TB-3

Facility

$882.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$493.92
Max. Negotiated Rate	$855.54
Rate for Payer: Cash Price	$529.20
Rate for Payer: Hawaii Western Management Group Commercial	$617.40
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: Kaiser Permanente Commercial	$793.80
Rate for Payer: MDX Hawaii PPO	$855.54
Rate for Payer: University Health Alliance Commercial	$493.92

TIGHTROPE BUTTON AR-1588TB-3

Facility

$882.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$855.54
Rate for Payer: AlohaCare Medicaid	$441.00
Rate for Payer: AlohaCare Medicare	$670.32
Rate for Payer: Cash Price	$529.20
Rate for Payer: Devoted Health Medicare	$740.88
Rate for Payer: Hawaii Medical Service Association Medicare	$670.32
Rate for Payer: Hawaii Western Management Group Commercial	$617.40
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: Humana Medicare	$670.32
Rate for Payer: Kaiser Permanente Commercial	$793.80
Rate for Payer: Kaiser Permanente Medicaid	$449.82
Rate for Payer: Kaiser Permanente Medicare	$670.32
Rate for Payer: MDX Hawaii PPO	$855.54
Rate for Payer: Ohana Health Plan Medicaid	$670.32
Rate for Payer: Ohana Health Plan Medicare	$670.32
Rate for Payer: UnitedHealthcare Medicare	$670.32
Rate for Payer: University Health Alliance Commercial	$493.92

TIGHTROPE II ABS AR-1588TN-21

Facility

$1,084.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$607.04
Max. Negotiated Rate	$1,051.48
Rate for Payer: Cash Price	$650.40
Rate for Payer: Hawaii Western Management Group Commercial	$758.80
Rate for Payer: Health Management Network Commercial	$921.40
Rate for Payer: Kaiser Permanente Commercial	$975.60
Rate for Payer: MDX Hawaii PPO	$1,051.48
Rate for Payer: University Health Alliance Commercial	$607.04

TIGHTROPE II ABS AR-1588TN-21

Facility

$1,084.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$542.00
Max. Negotiated Rate	$1,051.48
Rate for Payer: AlohaCare Medicaid	$542.00
Rate for Payer: AlohaCare Medicare	$823.84
Rate for Payer: Cash Price	$650.40
Rate for Payer: Devoted Health Medicare	$910.56
Rate for Payer: Hawaii Medical Service Association Medicare	$823.84
Rate for Payer: Hawaii Western Management Group Commercial	$758.80
Rate for Payer: Health Management Network Commercial	$921.40
Rate for Payer: Humana Medicare	$823.84
Rate for Payer: Kaiser Permanente Commercial	$975.60
Rate for Payer: Kaiser Permanente Medicaid	$552.84
Rate for Payer: Kaiser Permanente Medicare	$823.84
Rate for Payer: MDX Hawaii PPO	$1,051.48
Rate for Payer: Ohana Health Plan Medicaid	$823.84
Rate for Payer: Ohana Health Plan Medicare	$823.84
Rate for Payer: UnitedHealthcare Medicare	$823.84
Rate for Payer: University Health Alliance Commercial	$607.04

TIGHTROPE KNOTLESS AR-2371BL

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,125.00
Max. Negotiated Rate	$6,062.50
Rate for Payer: AlohaCare Medicaid	$3,125.00
Rate for Payer: AlohaCare Medicare	$4,750.00
Rate for Payer: Cash Price	$3,750.00
Rate for Payer: Devoted Health Medicare	$5,250.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,750.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,375.00
Rate for Payer: Health Management Network Commercial	$5,312.50
Rate for Payer: Humana Medicare	$4,750.00
Rate for Payer: Kaiser Permanente Commercial	$5,625.00
Rate for Payer: Kaiser Permanente Medicaid	$3,187.50
Rate for Payer: Kaiser Permanente Medicare	$4,750.00
Rate for Payer: MDX Hawaii PPO	$6,062.50
Rate for Payer: Ohana Health Plan Medicaid	$4,750.00
Rate for Payer: Ohana Health Plan Medicare	$4,750.00
Rate for Payer: UnitedHealthcare Medicare	$4,750.00
Rate for Payer: University Health Alliance Commercial	$3,500.00

TIGHTROPE KNOTLESS AR-2371BL

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,500.00
Max. Negotiated Rate	$6,062.50
Rate for Payer: Cash Price	$3,750.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,375.00
Rate for Payer: Health Management Network Commercial	$5,312.50
Rate for Payer: Kaiser Permanente Commercial	$5,625.00
Rate for Payer: MDX Hawaii PPO	$6,062.50
Rate for Payer: University Health Alliance Commercial	$3,500.00

TIGHTROPE KNTLSS AC AR-2372BLO

Facility

$5,818.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,258.08
Max. Negotiated Rate	$5,643.46
Rate for Payer: Cash Price	$3,490.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,072.60
Rate for Payer: Health Management Network Commercial	$4,945.30
Rate for Payer: Kaiser Permanente Commercial	$5,236.20
Rate for Payer: MDX Hawaii PPO	$5,643.46
Rate for Payer: University Health Alliance Commercial	$3,258.08

TIGHTROPE KNTLSS AC AR-2372BLO

Facility

$5,818.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,909.00
Max. Negotiated Rate	$5,643.46
Rate for Payer: AlohaCare Medicaid	$2,909.00
Rate for Payer: AlohaCare Medicare	$4,421.68
Rate for Payer: Cash Price	$3,490.80
Rate for Payer: Devoted Health Medicare	$4,887.12
Rate for Payer: Hawaii Medical Service Association Medicare	$4,421.68
Rate for Payer: Hawaii Western Management Group Commercial	$4,072.60
Rate for Payer: Health Management Network Commercial	$4,945.30
Rate for Payer: Humana Medicare	$4,421.68
Rate for Payer: Kaiser Permanente Commercial	$5,236.20
Rate for Payer: Kaiser Permanente Medicaid	$2,967.18
Rate for Payer: Kaiser Permanente Medicare	$4,421.68
Rate for Payer: MDX Hawaii PPO	$5,643.46
Rate for Payer: Ohana Health Plan Medicaid	$4,421.68
Rate for Payer: Ohana Health Plan Medicare	$4,421.68
Rate for Payer: UnitedHealthcare Medicare	$4,421.68
Rate for Payer: University Health Alliance Commercial	$3,258.08

TIGHTROPE SUTURE AR-1588BTB-J

Facility

$1,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$915.60
Max. Negotiated Rate	$1,585.95
Rate for Payer: Cash Price	$981.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: Kaiser Permanente Commercial	$1,471.50
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: University Health Alliance Commercial	$915.60

TIGHTROPE SUTURE AR-1588BTB-J

Facility

$1,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$817.50
Max. Negotiated Rate	$1,585.95
Rate for Payer: AlohaCare Medicaid	$817.50
Rate for Payer: AlohaCare Medicare	$1,242.60
Rate for Payer: Cash Price	$981.00
Rate for Payer: Devoted Health Medicare	$1,373.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,242.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: Humana Medicare	$1,242.60
Rate for Payer: Kaiser Permanente Commercial	$1,471.50
Rate for Payer: Kaiser Permanente Medicaid	$833.85
Rate for Payer: Kaiser Permanente Medicare	$1,242.60
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: Ohana Health Plan Medicaid	$1,242.60
Rate for Payer: Ohana Health Plan Medicare	$1,242.60
Rate for Payer: UnitedHealthcare Medicare	$1,242.60
Rate for Payer: University Health Alliance Commercial	$915.60

TIGHTROPE SYS AR-1288BTBIB-FC3

Facility

$2,384.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.04
Max. Negotiated Rate	$2,312.48
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,668.80
Rate for Payer: Health Management Network Commercial	$2,026.40
Rate for Payer: Kaiser Permanente Commercial	$2,145.60
Rate for Payer: MDX Hawaii PPO	$2,312.48
Rate for Payer: University Health Alliance Commercial	$1,335.04

TIGHTROPE SYS AR-1288BTBIB-FC3

Facility

$2,384.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$2,312.48
Rate for Payer: AlohaCare Medicaid	$1,192.00
Rate for Payer: AlohaCare Medicare	$1,811.84
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Devoted Health Medicare	$2,002.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,811.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,668.80
Rate for Payer: Health Management Network Commercial	$2,026.40
Rate for Payer: Humana Medicare	$1,811.84
Rate for Payer: Kaiser Permanente Commercial	$2,145.60
Rate for Payer: Kaiser Permanente Medicaid	$1,215.84
Rate for Payer: Kaiser Permanente Medicare	$1,811.84
Rate for Payer: MDX Hawaii PPO	$2,312.48
Rate for Payer: Ohana Health Plan Medicaid	$1,811.84
Rate for Payer: Ohana Health Plan Medicare	$1,811.84
Rate for Payer: UnitedHealthcare Medicare	$1,811.84
Rate for Payer: University Health Alliance Commercial	$1,335.04

TIMOLOL MALEATE 0.25 % EYE DROPS [11561]

Facility

$53.00

Service Code	NDC 64980051305
Hospital Revenue Code	637
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$26.50
Rate for Payer: AlohaCare Medicare	$40.28
Rate for Payer: Cash Price	$31.80
Rate for Payer: Devoted Health Medicare	$44.52
Rate for Payer: Hawaii Medical Service Association Medicare	$40.28
Rate for Payer: Hawaii Western Management Group Commercial	$50.35
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Humana Medicare	$40.28
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: Kaiser Permanente Medicare	$40.28
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: Ohana Health Plan Medicaid	$40.28
Rate for Payer: Ohana Health Plan Medicare	$40.28
Rate for Payer: UnitedHealthcare Medicare	$40.28
Rate for Payer: University Health Alliance Commercial	$38.63

TIMOLOL MALEATE 0.25 % EYE DROPS [11561]

Facility

$53.00

Service Code	NDC 64980051305
Hospital Revenue Code	250
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$31.80
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: MDX Hawaii PPO	$51.41

TIMOLOL MALEATE 0.5 % EYE DROPS [11562]

Facility

$60.00

Service Code	NDC 61314022705
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

TIMOLOL MALEATE 0.5 % EYE DROPS [11562]

Facility

$60.00

Service Code	NDC 61314022705
Hospital Revenue Code	637
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$45.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$50.40
Rate for Payer: Hawaii Medical Service Association Medicare	$45.60
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$45.60
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$45.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$45.60
Rate for Payer: Ohana Health Plan Medicare	$45.60
Rate for Payer: UnitedHealthcare Medicare	$45.60
Rate for Payer: University Health Alliance Commercial	$43.73

TI NAIL 11X380/RT 04.003.456S

Facility

$3,806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,131.36
Max. Negotiated Rate	$3,691.82
Rate for Payer: Cash Price	$2,283.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,664.20
Rate for Payer: Health Management Network Commercial	$3,235.10
Rate for Payer: Kaiser Permanente Commercial	$3,425.40
Rate for Payer: MDX Hawaii PPO	$3,691.82
Rate for Payer: University Health Alliance Commercial	$2,131.36

TI NAIL 11X380/RT 04.003.456S

Facility

$3,806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,903.00
Max. Negotiated Rate	$3,691.82
Rate for Payer: AlohaCare Medicaid	$1,903.00
Rate for Payer: AlohaCare Medicare	$2,892.56
Rate for Payer: Cash Price	$2,283.60
Rate for Payer: Devoted Health Medicare	$3,197.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,892.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,664.20
Rate for Payer: Health Management Network Commercial	$3,235.10
Rate for Payer: Humana Medicare	$2,892.56
Rate for Payer: Kaiser Permanente Commercial	$3,425.40
Rate for Payer: Kaiser Permanente Medicaid	$1,941.06
Rate for Payer: Kaiser Permanente Medicare	$2,892.56
Rate for Payer: MDX Hawaii PPO	$3,691.82
Rate for Payer: Ohana Health Plan Medicaid	$2,892.56
Rate for Payer: Ohana Health Plan Medicare	$2,892.56
Rate for Payer: UnitedHealthcare Medicare	$2,892.56
Rate for Payer: University Health Alliance Commercial	$2,131.36

TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [127331]

Facility

$225.00

Service Code	NDC 00597010051
Hospital Revenue Code	250
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [127331]

Facility

$225.00

Service Code	NDC 00597010051
Hospital Revenue Code	637
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$171.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$189.00
Rate for Payer: Hawaii Medical Service Association Medicare	$171.00
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$171.00
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$171.00
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$171.00
Rate for Payer: Ohana Health Plan Medicare	$171.00
Rate for Payer: UnitedHealthcare Medicare	$171.00
Rate for Payer: University Health Alliance Commercial	$164.00

TIPS DISPOSABLE RENEW 3372

Facility

$226.00

Hospital Revenue Code	272
Min. Negotiated Rate	$192.10
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$135.60
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Kaiser Permanente Commercial	$203.40
Rate for Payer: MDX Hawaii PPO	$219.22

TIPS DISPOSABLE RENEW 3372

Facility

$226.00

Hospital Revenue Code	272
Min. Negotiated Rate	$113.00
Max. Negotiated Rate	$219.22
Rate for Payer: AlohaCare Medicaid	$113.00
Rate for Payer: AlohaCare Medicare	$171.76
Rate for Payer: Cash Price	$135.60
Rate for Payer: Devoted Health Medicare	$189.84
Rate for Payer: Hawaii Medical Service Association Medicare	$171.76
Rate for Payer: Hawaii Western Management Group Commercial	$214.70
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Humana Medicare	$171.76
Rate for Payer: Kaiser Permanente Commercial	$203.40
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: Kaiser Permanente Medicare	$171.76
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: Ohana Health Plan Medicaid	$171.76
Rate for Payer: Ohana Health Plan Medicare	$171.76
Rate for Payer: UnitedHealthcare Medicare	$171.76
Rate for Payer: University Health Alliance Commercial	$164.73

TISOTUMAB VEDOTIN-TFTV 40 MG/4ML IV (WET SOLR VIAL) [430181289]

Facility

$9,381.00

Service Code	NDC 51144000301
Hospital Revenue Code	250
Min. Negotiated Rate	$7,973.85
Max. Negotiated Rate	$9,099.57
Rate for Payer: Cash Price	$5,628.60
Rate for Payer: Health Management Network Commercial	$7,973.85
Rate for Payer: Kaiser Permanente Commercial	$8,442.90
Rate for Payer: MDX Hawaii PPO	$9,099.57

TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [181289]

Facility

$9,381.00

Service Code	HCPCS J9273
Hospital Revenue Code	250
Min. Negotiated Rate	$7,973.85
Max. Negotiated Rate	$9,099.57
Rate for Payer: Cash Price	$5,628.60
Rate for Payer: Cash Price	$11,757.00
Rate for Payer: Health Management Network Commercial	$7,973.85
Rate for Payer: Health Management Network Commercial	$16,655.75
Rate for Payer: Kaiser Permanente Commercial	$17,635.50
Rate for Payer: Kaiser Permanente Commercial	$8,442.90
Rate for Payer: MDX Hawaii PPO	$9,099.57
Rate for Payer: MDX Hawaii PPO	$19,007.15

TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [181289]

Facility

$19,595.00

Service Code	HCPCS J9273
Hospital Revenue Code	636
Min. Negotiated Rate	$188.65
Max. Negotiated Rate	$19,007.15
Rate for Payer: AlohaCare Medicaid	$9,797.50
Rate for Payer: AlohaCare Medicaid	$4,690.50
Rate for Payer: AlohaCare Medicare	$14,892.20
Rate for Payer: AlohaCare Medicare	$7,129.56
Rate for Payer: Cash Price	$11,757.00
Rate for Payer: Cash Price	$5,628.60
Rate for Payer: Cash Price	$5,628.60
Rate for Payer: Cash Price	$11,757.00
Rate for Payer: Devoted Health Medicare	$16,459.80
Rate for Payer: Devoted Health Medicare	$7,880.04
Rate for Payer: Hawaii Medical Service Association ABD	$188.65
Rate for Payer: Hawaii Medical Service Association ABD	$188.65
Rate for Payer: Hawaii Medical Service Association Commercial	$245.15
Rate for Payer: Hawaii Medical Service Association Commercial	$245.15
Rate for Payer: Hawaii Medical Service Association Medicare	$7,129.56
Rate for Payer: Hawaii Medical Service Association Medicare	$14,892.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$188.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$188.65
Rate for Payer: Hawaii Western Management Group Commercial	$18,615.25
Rate for Payer: Hawaii Western Management Group Commercial	$8,911.95
Rate for Payer: Health Management Network Commercial	$16,655.75
Rate for Payer: Health Management Network Commercial	$7,973.85
Rate for Payer: Humana Medicare	$7,129.56
Rate for Payer: Humana Medicare	$14,892.20
Rate for Payer: Kaiser Permanente Commercial	$17,635.50
Rate for Payer: Kaiser Permanente Commercial	$8,442.90
Rate for Payer: Kaiser Permanente Medicaid	$4,784.31
Rate for Payer: Kaiser Permanente Medicaid	$9,993.45
Rate for Payer: Kaiser Permanente Medicare	$14,892.20
Rate for Payer: Kaiser Permanente Medicare	$7,129.56
Rate for Payer: MDX Hawaii PPO	$9,099.57
Rate for Payer: MDX Hawaii PPO	$19,007.15
Rate for Payer: Ohana Health Plan Medicaid	$7,129.56
Rate for Payer: Ohana Health Plan Medicaid	$14,892.20
Rate for Payer: Ohana Health Plan Medicare	$14,892.20
Rate for Payer: Ohana Health Plan Medicare	$7,129.56
Rate for Payer: UnitedHealthcare Medicaid	$5,628.60
Rate for Payer: UnitedHealthcare Medicaid	$11,757.00
Rate for Payer: UnitedHealthcare Medicare	$14,892.20
Rate for Payer: UnitedHealthcare Medicare	$7,129.56
Rate for Payer: University Health Alliance Commercial	$14,282.80
Rate for Payer: University Health Alliance Commercial	$6,837.81

Know your out-of-pocket cost for care.

All Charges