Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TRACH TUBE SHILEY 7X12 CUFFED

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$102.00
Rate for Payer: AlohaCare Medicare	$155.04
Rate for Payer: Cash Price	$122.40
Rate for Payer: Devoted Health Medicare	$171.36
Rate for Payer: Hawaii Medical Service Association Medicare	$155.04
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$155.04
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$155.04
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$155.04
Rate for Payer: Ohana Health Plan Medicare	$155.04
Rate for Payer: UnitedHealthcare Medicare	$155.04
Rate for Payer: University Health Alliance Commercial	$148.70

TRACH TUBE UNCUFF 6.5

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

TRACH TUBE UNCUFF 6.5

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.50
Max. Negotiated Rate	$208.55
Rate for Payer: AlohaCare Medicaid	$107.50
Rate for Payer: AlohaCare Medicare	$163.40
Rate for Payer: Cash Price	$129.00
Rate for Payer: Devoted Health Medicare	$180.60
Rate for Payer: Hawaii Medical Service Association Medicare	$163.40
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Humana Medicare	$163.40
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: Kaiser Permanente Medicare	$163.40
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: Ohana Health Plan Medicaid	$163.40
Rate for Payer: Ohana Health Plan Medicare	$163.40
Rate for Payer: UnitedHealthcare Medicare	$163.40
Rate for Payer: University Health Alliance Commercial	$156.71

TRACH TUBE UNCUFF 7.5

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

TRACH TUBE UNCUFF 7.5

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.00
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$162.64
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$179.76
Rate for Payer: Hawaii Medical Service Association Medicare	$162.64
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$162.64
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$162.64
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$162.64
Rate for Payer: Ohana Health Plan Medicare	$162.64
Rate for Payer: UnitedHealthcare Medicare	$162.64
Rate for Payer: University Health Alliance Commercial	$155.98

TRACH TUBE UNCUFF 8.5

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

TRACH TUBE UNCUFF 8.5

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.50
Max. Negotiated Rate	$208.55
Rate for Payer: AlohaCare Medicaid	$107.50
Rate for Payer: AlohaCare Medicare	$163.40
Rate for Payer: Cash Price	$129.00
Rate for Payer: Devoted Health Medicare	$180.60
Rate for Payer: Hawaii Medical Service Association Medicare	$163.40
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Humana Medicare	$163.40
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: Kaiser Permanente Medicare	$163.40
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: Ohana Health Plan Medicaid	$163.40
Rate for Payer: Ohana Health Plan Medicare	$163.40
Rate for Payer: UnitedHealthcare Medicare	$163.40
Rate for Payer: University Health Alliance Commercial	$156.71

TRACH VALVE AQUA SPEAKING

Facility

$268.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$150.08
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$160.80
Rate for Payer: Hawaii Western Management Group Commercial	$187.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: University Health Alliance Commercial	$150.08

TRACH VALVE AQUA SPEAKING

Facility

$268.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$69.71
Max. Negotiated Rate	$259.96
Rate for Payer: AlohaCare Medicaid	$134.00
Rate for Payer: AlohaCare Medicare	$203.68
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Devoted Health Medicare	$225.12
Rate for Payer: Hawaii Medical Service Association Medicare	$203.68
Rate for Payer: Hawaii Western Management Group Commercial	$187.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Humana Medicare	$203.68
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: Kaiser Permanente Medicaid	$136.68
Rate for Payer: Kaiser Permanente Medicare	$203.68
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: Ohana Health Plan Medicaid	$203.68
Rate for Payer: Ohana Health Plan Medicare	$203.68
Rate for Payer: UnitedHealthcare Medicaid	$69.71
Rate for Payer: UnitedHealthcare Medicare	$203.68
Rate for Payer: University Health Alliance Commercial	$150.08

TRACH VALVE PURPLE SPEAKING

Facility

$294.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Hawaii Western Management Group Commercial	$205.80
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: University Health Alliance Commercial	$164.64

TRACH VALVE PURPLE SPEAKING

Facility

$294.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$69.71
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$147.00
Rate for Payer: AlohaCare Medicare	$223.44
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$246.96
Rate for Payer: Hawaii Medical Service Association Medicare	$223.44
Rate for Payer: Hawaii Western Management Group Commercial	$205.80
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$223.44
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$223.44
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$223.44
Rate for Payer: Ohana Health Plan Medicare	$223.44
Rate for Payer: UnitedHealthcare Medicaid	$69.71
Rate for Payer: UnitedHealthcare Medicare	$223.44
Rate for Payer: University Health Alliance Commercial	$164.64

TRACH VALVE SPEAKING

Facility

$198.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$118.80
Rate for Payer: Hawaii Western Management Group Commercial	$138.60
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Kaiser Permanente Commercial	$178.20
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: University Health Alliance Commercial	$110.88

TRACH VALVE SPEAKING

Facility

$198.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$69.71
Max. Negotiated Rate	$192.06
Rate for Payer: AlohaCare Medicaid	$99.00
Rate for Payer: AlohaCare Medicare	$150.48
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
Rate for Payer: Devoted Health Medicare	$166.32
Rate for Payer: Hawaii Medical Service Association Medicare	$150.48
Rate for Payer: Hawaii Western Management Group Commercial	$138.60
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Humana Medicare	$150.48
Rate for Payer: Kaiser Permanente Commercial	$178.20
Rate for Payer: Kaiser Permanente Medicaid	$100.98
Rate for Payer: Kaiser Permanente Medicare	$150.48
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: Ohana Health Plan Medicaid	$150.48
Rate for Payer: Ohana Health Plan Medicare	$150.48
Rate for Payer: UnitedHealthcare Medicaid	$69.71
Rate for Payer: UnitedHealthcare Medicare	$150.48
Rate for Payer: University Health Alliance Commercial	$110.88

TRACH VALVE SPEAKING SHILEY

Facility

$198.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$118.80
Rate for Payer: Hawaii Western Management Group Commercial	$138.60
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Kaiser Permanente Commercial	$178.20
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: University Health Alliance Commercial	$110.88

TRACH VALVE SPEAKING SHILEY

Facility

$198.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$69.71
Max. Negotiated Rate	$192.06
Rate for Payer: AlohaCare Medicaid	$99.00
Rate for Payer: AlohaCare Medicare	$150.48
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
Rate for Payer: Devoted Health Medicare	$166.32
Rate for Payer: Hawaii Medical Service Association Medicare	$150.48
Rate for Payer: Hawaii Western Management Group Commercial	$138.60
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Humana Medicare	$150.48
Rate for Payer: Kaiser Permanente Commercial	$178.20
Rate for Payer: Kaiser Permanente Medicaid	$100.98
Rate for Payer: Kaiser Permanente Medicare	$150.48
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: Ohana Health Plan Medicaid	$150.48
Rate for Payer: Ohana Health Plan Medicare	$150.48
Rate for Payer: UnitedHealthcare Medicaid	$69.71
Rate for Payer: UnitedHealthcare Medicare	$150.48
Rate for Payer: University Health Alliance Commercial	$110.88

TRAMADOL 50 MG TABLET [14632]

Facility

$1.00

Service Code	NDC 60687079501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

TRAMADOL 50 MG TABLET [14632]

Facility

$1.00

Service Code	NDC 60687079511
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

TRAMADOL 50 MG TABLET [14632]

Facility

$3.00

Service Code	NDC 60219234801
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

TRAMADOL 50 MG TABLET [14632]

Facility

$3.00

Service Code	NDC 60219234801
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

TRAMADOL 50 MG TABLET [14632]

Facility

$1.00

Service Code	NDC 60687079511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

TRAMADOL 50 MG TABLET [14632]

Facility

$1.00

Service Code	NDC 60687079501
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]

Facility

$62.00

Service Code	HCPCS J3490
Hospital Revenue Code	250
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$37.20
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: MDX Hawaii PPO	$60.14

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]

Facility

$63.00

Service Code	NDC 51754010801
Hospital Revenue Code	250
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: MDX Hawaii PPO	$61.11

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]

Facility

$63.00

Service Code	NDC 51754010801
Hospital Revenue Code	636
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$61.11
Rate for Payer: AlohaCare Medicaid	$31.50
Rate for Payer: AlohaCare Medicare	$47.88
Rate for Payer: Cash Price	$37.80
Rate for Payer: Devoted Health Medicare	$52.92
Rate for Payer: Hawaii Medical Service Association Medicare	$47.88
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$47.88
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicare	$47.88
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$47.88
Rate for Payer: Ohana Health Plan Medicare	$47.88
Rate for Payer: UnitedHealthcare Medicaid	$37.80
Rate for Payer: UnitedHealthcare Medicare	$47.88
Rate for Payer: University Health Alliance Commercial	$45.92

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]

Facility

$62.00

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$31.00
Max. Negotiated Rate	$60.14
Rate for Payer: AlohaCare Medicaid	$31.00
Rate for Payer: AlohaCare Medicare	$47.12
Rate for Payer: Cash Price	$37.20
Rate for Payer: Devoted Health Medicare	$52.08
Rate for Payer: Hawaii Medical Service Association Medicare	$47.12
Rate for Payer: Hawaii Western Management Group Commercial	$58.90
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Humana Medicare	$47.12
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: Kaiser Permanente Medicare	$47.12
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: Ohana Health Plan Medicaid	$47.12
Rate for Payer: Ohana Health Plan Medicare	$47.12
Rate for Payer: UnitedHealthcare Medicaid	$37.20
Rate for Payer: UnitedHealthcare Medicare	$47.12
Rate for Payer: University Health Alliance Commercial	$45.19

Know your out-of-pocket cost for care.

All Charges