Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TOURNQ NS 18X4 5921-218-135NS

Facility

$107.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$96.30
Rate for Payer: MDX Hawaii PPO	$103.79

TOURNQ NS 30X4 5921-030-135NS

Facility

$129.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$77.40
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: MDX Hawaii PPO	$125.13

TOURNQ NS 30X4 5921-030-135NS

Facility

$129.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$64.50
Rate for Payer: AlohaCare Medicare	$98.04
Rate for Payer: Cash Price	$77.40
Rate for Payer: Devoted Health Medicare	$108.36
Rate for Payer: Hawaii Medical Service Association Medicare	$98.04
Rate for Payer: Hawaii Western Management Group Commercial	$122.55
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$98.04
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$98.04
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$98.04
Rate for Payer: Ohana Health Plan Medicare	$98.04
Rate for Payer: UnitedHealthcare Medicare	$98.04
Rate for Payer: University Health Alliance Commercial	$94.03

TOURNQ NS 34X4 5921-034-135NS

Facility

$137.00

Hospital Revenue Code	272
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$68.50
Rate for Payer: AlohaCare Medicare	$104.12
Rate for Payer: Cash Price	$82.20
Rate for Payer: Devoted Health Medicare	$115.08
Rate for Payer: Hawaii Medical Service Association Medicare	$104.12
Rate for Payer: Hawaii Western Management Group Commercial	$130.15
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$104.12
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$104.12
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$104.12
Rate for Payer: Ohana Health Plan Medicare	$104.12
Rate for Payer: UnitedHealthcare Medicare	$104.12
Rate for Payer: University Health Alliance Commercial	$99.86

TOURNQ NS 34X4 5921-034-135NS

Facility

$137.00

Hospital Revenue Code	272
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$82.20
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: MDX Hawaii PPO	$132.89

T-PLATE 2.0 6 HOLE MCT-6N

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$831.50
Max. Negotiated Rate	$1,613.11
Rate for Payer: AlohaCare Medicaid	$831.50
Rate for Payer: AlohaCare Medicare	$1,263.88
Rate for Payer: Cash Price	$997.80
Rate for Payer: Devoted Health Medicare	$1,396.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,263.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Humana Medicare	$1,263.88
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: Kaiser Permanente Medicare	$1,263.88
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: Ohana Health Plan Medicaid	$1,263.88
Rate for Payer: Ohana Health Plan Medicare	$1,263.88
Rate for Payer: UnitedHealthcare Medicare	$1,263.88
Rate for Payer: University Health Alliance Commercial	$931.28

T-PLATE 2.0 6 HOLE MCT-6N

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

T-PLATE 2.4 LCP 249.615

Facility

$2,525.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,414.00
Max. Negotiated Rate	$2,449.25
Rate for Payer: Cash Price	$1,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,767.50
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: MDX Hawaii PPO	$2,449.25
Rate for Payer: University Health Alliance Commercial	$1,414.00

T-PLATE 2.4 LCP 249.615

Facility

$2,525.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,262.50
Max. Negotiated Rate	$2,449.25
Rate for Payer: AlohaCare Medicaid	$1,262.50
Rate for Payer: AlohaCare Medicare	$1,919.00
Rate for Payer: Cash Price	$1,515.00
Rate for Payer: Devoted Health Medicare	$2,121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,919.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,767.50
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Humana Medicare	$1,919.00
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: Kaiser Permanente Medicaid	$1,287.75
Rate for Payer: Kaiser Permanente Medicare	$1,919.00
Rate for Payer: MDX Hawaii PPO	$2,449.25
Rate for Payer: Ohana Health Plan Medicaid	$1,919.00
Rate for Payer: Ohana Health Plan Medicare	$1,919.00
Rate for Payer: UnitedHealthcare Medicare	$1,919.00
Rate for Payer: University Health Alliance Commercial	$1,414.00

TRABECTEDIN 1 MG/20ML IV (WET SOLR VIAL) [430129413]

Facility

$4,928.00

Service Code	HCPCS J9352
Hospital Revenue Code	250
Min. Negotiated Rate	$4,188.80
Max. Negotiated Rate	$4,780.16
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Kaiser Permanente Commercial	$4,435.20
Rate for Payer: MDX Hawaii PPO	$4,780.16

TRABECTEDIN 1 MG/20ML IV (WET SOLR VIAL) [430129413]

Facility

$4,928.00

Service Code	HCPCS J9352
Hospital Revenue Code	636
Min. Negotiated Rate	$383.07
Max. Negotiated Rate	$4,780.16
Rate for Payer: AlohaCare Medicaid	$2,464.00
Rate for Payer: AlohaCare Medicare	$3,745.28
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Devoted Health Medicare	$4,139.52
Rate for Payer: Hawaii Medical Service Association ABD	$383.07
Rate for Payer: Hawaii Medical Service Association Commercial	$488.84
Rate for Payer: Hawaii Medical Service Association Medicare	$3,745.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$383.07
Rate for Payer: Hawaii Western Management Group Commercial	$4,681.60
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Humana Medicare	$3,745.28
Rate for Payer: Kaiser Permanente Commercial	$4,435.20
Rate for Payer: Kaiser Permanente Medicaid	$2,513.28
Rate for Payer: Kaiser Permanente Medicare	$3,745.28
Rate for Payer: MDX Hawaii PPO	$4,780.16
Rate for Payer: Ohana Health Plan Medicaid	$3,745.28
Rate for Payer: Ohana Health Plan Medicare	$3,745.28
Rate for Payer: UnitedHealthcare Medicaid	$2,956.80
Rate for Payer: UnitedHealthcare Medicare	$3,745.28
Rate for Payer: University Health Alliance Commercial	$3,592.02

TRABECTEDIN 1 MG INTRAVENOUS SOLUTION [129413]

Facility

$4,928.00

Service Code	HCPCS J9352
Hospital Revenue Code	250
Min. Negotiated Rate	$4,188.80
Max. Negotiated Rate	$4,780.16
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Cash Price	$4,624.80
Rate for Payer: Health Management Network Commercial	$6,551.80
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Kaiser Permanente Commercial	$4,435.20
Rate for Payer: Kaiser Permanente Commercial	$6,937.20
Rate for Payer: MDX Hawaii PPO	$4,780.16
Rate for Payer: MDX Hawaii PPO	$7,476.76

TRABECTEDIN 1 MG INTRAVENOUS SOLUTION [129413]

Facility

$4,928.00

Service Code	HCPCS J9352
Hospital Revenue Code	636
Min. Negotiated Rate	$383.07
Max. Negotiated Rate	$4,780.16
Rate for Payer: AlohaCare Medicaid	$2,464.00
Rate for Payer: AlohaCare Medicaid	$3,854.00
Rate for Payer: AlohaCare Medicare	$5,858.08
Rate for Payer: AlohaCare Medicare	$3,745.28
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Cash Price	$4,624.80
Rate for Payer: Cash Price	$4,624.80
Rate for Payer: Devoted Health Medicare	$4,139.52
Rate for Payer: Devoted Health Medicare	$6,474.72
Rate for Payer: Hawaii Medical Service Association ABD	$383.07
Rate for Payer: Hawaii Medical Service Association ABD	$383.07
Rate for Payer: Hawaii Medical Service Association Commercial	$488.84
Rate for Payer: Hawaii Medical Service Association Commercial	$488.84
Rate for Payer: Hawaii Medical Service Association Medicare	$3,745.28
Rate for Payer: Hawaii Medical Service Association Medicare	$5,858.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$383.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$383.07
Rate for Payer: Hawaii Western Management Group Commercial	$4,681.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,322.60
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Health Management Network Commercial	$6,551.80
Rate for Payer: Humana Medicare	$3,745.28
Rate for Payer: Humana Medicare	$5,858.08
Rate for Payer: Kaiser Permanente Commercial	$4,435.20
Rate for Payer: Kaiser Permanente Commercial	$6,937.20
Rate for Payer: Kaiser Permanente Medicaid	$2,513.28
Rate for Payer: Kaiser Permanente Medicaid	$3,931.08
Rate for Payer: Kaiser Permanente Medicare	$3,745.28
Rate for Payer: Kaiser Permanente Medicare	$5,858.08
Rate for Payer: MDX Hawaii PPO	$4,780.16
Rate for Payer: MDX Hawaii PPO	$7,476.76
Rate for Payer: Ohana Health Plan Medicaid	$5,858.08
Rate for Payer: Ohana Health Plan Medicaid	$3,745.28
Rate for Payer: Ohana Health Plan Medicare	$3,745.28
Rate for Payer: Ohana Health Plan Medicare	$5,858.08
Rate for Payer: UnitedHealthcare Medicaid	$2,956.80
Rate for Payer: UnitedHealthcare Medicaid	$4,624.80
Rate for Payer: UnitedHealthcare Medicare	$5,858.08
Rate for Payer: UnitedHealthcare Medicare	$3,745.28
Rate for Payer: University Health Alliance Commercial	$3,592.02
Rate for Payer: University Health Alliance Commercial	$5,618.36

TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION [174502]

Facility

$85.00

Service Code	NDC 00517930501
Hospital Revenue Code	250
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Kaiser Permanente Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$82.45

TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION [174502]

Facility

$85.00

Service Code	NDC 00517930525
Hospital Revenue Code	250
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Kaiser Permanente Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$82.45

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC

Facility

$83,122.91

Service Code	MSDRG 012
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC

Facility

$83,122.91

Service Code	MSDRG 011
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC

Facility

$83,122.91

Service Code	MSDRG 013
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

Facility

$404,593.14

Service Code	MSDRG 004
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$404,593.14
Rate for Payer: Hawaii Medical Service Association Commercial	$404,593.14
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACH PERC INTROD 8.0MM

Facility

$1,560.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$1,513.20
Rate for Payer: AlohaCare Medicaid	$780.00
Rate for Payer: AlohaCare Medicare	$1,185.60
Rate for Payer: Cash Price	$936.00
Rate for Payer: Devoted Health Medicare	$1,310.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,185.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,482.00
Rate for Payer: Health Management Network Commercial	$1,326.00
Rate for Payer: Humana Medicare	$1,185.60
Rate for Payer: Kaiser Permanente Commercial	$1,404.00
Rate for Payer: Kaiser Permanente Medicaid	$795.60
Rate for Payer: Kaiser Permanente Medicare	$1,185.60
Rate for Payer: MDX Hawaii PPO	$1,513.20
Rate for Payer: Ohana Health Plan Medicaid	$1,185.60
Rate for Payer: Ohana Health Plan Medicare	$1,185.60
Rate for Payer: UnitedHealthcare Medicare	$1,185.60
Rate for Payer: University Health Alliance Commercial	$1,137.08

TRACH PERC INTROD 8.0MM

Facility

$1,560.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$1,513.20
Rate for Payer: Cash Price	$936.00
Rate for Payer: Health Management Network Commercial	$1,326.00
Rate for Payer: Kaiser Permanente Commercial	$1,404.00
Rate for Payer: MDX Hawaii PPO	$1,513.20

TRACH SHILEY 8XLT CUFF

Facility

$259.00

Hospital Revenue Code	272
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$251.23
Rate for Payer: AlohaCare Medicaid	$129.50
Rate for Payer: AlohaCare Medicare	$196.84
Rate for Payer: Cash Price	$155.40
Rate for Payer: Devoted Health Medicare	$217.56
Rate for Payer: Hawaii Medical Service Association Medicare	$196.84
Rate for Payer: Hawaii Western Management Group Commercial	$246.05
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Humana Medicare	$196.84
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: Kaiser Permanente Medicare	$196.84
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: Ohana Health Plan Medicaid	$196.84
Rate for Payer: Ohana Health Plan Medicare	$196.84
Rate for Payer: UnitedHealthcare Medicare	$196.84
Rate for Payer: University Health Alliance Commercial	$188.79

TRACH SHILEY 8XLT CUFF

Facility

$259.00

Hospital Revenue Code	272
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$155.40
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: MDX Hawaii PPO	$251.23

TRACH TUBE 6.0MM BIVONA

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$712.95
Rate for Payer: Cash Price	$441.00
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: MDX Hawaii PPO	$712.95

TRACH TUBE 6.0MM BIVONA

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$712.95
Rate for Payer: AlohaCare Medicaid	$367.50
Rate for Payer: AlohaCare Medicare	$558.60
Rate for Payer: Cash Price	$441.00
Rate for Payer: Devoted Health Medicare	$617.40
Rate for Payer: Hawaii Medical Service Association Medicare	$558.60
Rate for Payer: Hawaii Western Management Group Commercial	$698.25
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Humana Medicare	$558.60
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$374.85
Rate for Payer: Kaiser Permanente Medicare	$558.60
Rate for Payer: MDX Hawaii PPO	$712.95
Rate for Payer: Ohana Health Plan Medicaid	$558.60
Rate for Payer: Ohana Health Plan Medicare	$558.60
Rate for Payer: UnitedHealthcare Medicare	$558.60
Rate for Payer: University Health Alliance Commercial	$535.74

Know your out-of-pocket cost for care.

All Charges