Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$20.00

Service Code	NDC 81284061100
Hospital Revenue Code	636
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$15.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Devoted Health Medicare	$16.80
Rate for Payer: Hawaii Medical Service Association Medicare	$15.20
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$15.20
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$15.20
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$15.20
Rate for Payer: Ohana Health Plan Medicare	$15.20
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: UnitedHealthcare Medicare	$15.20
Rate for Payer: University Health Alliance Commercial	$14.58

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$16.00

Service Code	HCPCS J3490
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$13.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: MDX Hawaii PPO	$22.31

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$20.00

Service Code	NDC 81284061100
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$63.00

Service Code	HCPCS J3490
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 Medicaid	$8.00
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$15.20
Rate for Payer: AlohaCare Medicare	$47.88
Rate for Payer: AlohaCare Medicare	$12.16
Rate for Payer: AlohaCare Medicare	$17.48
Rate for Payer: Cash Price	$13.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$12.00
Rate for Payer: Devoted Health Medicare	$19.32
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Devoted Health Medicare	$16.80
Rate for Payer: Devoted Health Medicare	$52.92
Rate for Payer: Hawaii Medical Service Association Medicare	$47.88
Rate for Payer: Hawaii Medical Service Association Medicare	$12.16
Rate for Payer: Hawaii Medical Service Association Medicare	$17.48
Rate for Payer: Hawaii Medical Service Association Medicare	$15.20
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$47.88
Rate for Payer: Humana Medicare	$15.20
Rate for Payer: Humana Medicare	$12.16
Rate for Payer: Humana Medicare	$17.48
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicare	$12.16
Rate for Payer: Kaiser Permanente Medicare	$17.48
Rate for Payer: Kaiser Permanente Medicare	$47.88
Rate for Payer: Kaiser Permanente Medicare	$15.20
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$12.16
Rate for Payer: Ohana Health Plan Medicaid	$47.88
Rate for Payer: Ohana Health Plan Medicaid	$17.48
Rate for Payer: Ohana Health Plan Medicaid	$15.20
Rate for Payer: Ohana Health Plan Medicare	$12.16
Rate for Payer: Ohana Health Plan Medicare	$17.48
Rate for Payer: Ohana Health Plan Medicare	$47.88
Rate for Payer: Ohana Health Plan Medicare	$15.20
Rate for Payer: UnitedHealthcare Medicaid	$13.80
Rate for Payer: UnitedHealthcare Medicaid	$37.80
Rate for Payer: UnitedHealthcare Medicaid	$9.60
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: UnitedHealthcare Medicare	$47.88
Rate for Payer: UnitedHealthcare Medicare	$17.48
Rate for Payer: UnitedHealthcare Medicare	$12.16
Rate for Payer: UnitedHealthcare Medicare	$15.20
Rate for Payer: University Health Alliance Commercial	$11.66
Rate for Payer: University Health Alliance Commercial	$45.92
Rate for Payer: University Health Alliance Commercial	$16.76
Rate for Payer: University Health Alliance Commercial	$14.58

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$8.00

Service Code	NDC 81284061200
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]

Facility

$8.00

Service Code	NDC 81284061200
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: UnitedHealthcare Medicaid	$4.80
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83

TRANSCAROTID 10X40 SR-1040-CS

Facility

$8,990.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$5,034.40
Max. Negotiated Rate	$8,720.30
Rate for Payer: Cash Price	$5,394.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,293.00
Rate for Payer: Health Management Network Commercial	$7,641.50
Rate for Payer: Kaiser Permanente Commercial	$8,091.00
Rate for Payer: MDX Hawaii PPO	$8,720.30
Rate for Payer: University Health Alliance Commercial	$5,034.40

TRANSCAROTID 10X40 SR-1040-CS

Facility

$8,990.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$4,495.00
Max. Negotiated Rate	$8,720.30
Rate for Payer: AlohaCare Medicaid	$4,495.00
Rate for Payer: AlohaCare Medicare	$6,832.40
Rate for Payer: Cash Price	$5,394.00
Rate for Payer: Devoted Health Medicare	$7,551.60
Rate for Payer: Hawaii Medical Service Association Medicare	$6,832.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,293.00
Rate for Payer: Health Management Network Commercial	$7,641.50
Rate for Payer: Humana Medicare	$6,832.40
Rate for Payer: Kaiser Permanente Commercial	$8,091.00
Rate for Payer: Kaiser Permanente Medicaid	$4,584.90
Rate for Payer: Kaiser Permanente Medicare	$6,832.40
Rate for Payer: MDX Hawaii PPO	$8,720.30
Rate for Payer: Ohana Health Plan Medicaid	$6,832.40
Rate for Payer: Ohana Health Plan Medicare	$6,832.40
Rate for Payer: UnitedHealthcare Medicare	$6,832.40
Rate for Payer: University Health Alliance Commercial	$5,034.40

TRANSCAROTID 8X40 SR-0840-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

TRANSCAROTID 8X40 SR-0840-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

TRANSCAROTID 9X40 SR-0940-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

TRANSCAROTID 9X40 SR-0940-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

TRANSCAROTID SYS SR-200-NPS

Facility

$7,500.00

Service Code	HCPCS C1884
Hospital Revenue Code	272
Min. Negotiated Rate	$6,375.00
Max. Negotiated Rate	$7,275.00
Rate for Payer: Cash Price	$4,500.00
Rate for Payer: Health Management Network Commercial	$6,375.00
Rate for Payer: Kaiser Permanente Commercial	$6,750.00
Rate for Payer: MDX Hawaii PPO	$7,275.00

TRANSCAROTID SYS SR-200-NPS

Facility

$7,500.00

Service Code	HCPCS C1884
Hospital Revenue Code	272
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$7,275.00
Rate for Payer: AlohaCare Medicaid	$3,750.00
Rate for Payer: AlohaCare Medicare	$5,700.00
Rate for Payer: Cash Price	$4,500.00
Rate for Payer: Devoted Health Medicare	$6,300.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,700.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,125.00
Rate for Payer: Health Management Network Commercial	$6,375.00
Rate for Payer: Humana Medicare	$5,700.00
Rate for Payer: Kaiser Permanente Commercial	$6,750.00
Rate for Payer: Kaiser Permanente Medicaid	$3,825.00
Rate for Payer: Kaiser Permanente Medicare	$5,700.00
Rate for Payer: MDX Hawaii PPO	$7,275.00
Rate for Payer: Ohana Health Plan Medicaid	$5,700.00
Rate for Payer: Ohana Health Plan Medicare	$5,700.00
Rate for Payer: UnitedHealthcare Medicare	$5,700.00
Rate for Payer: University Health Alliance Commercial	$5,466.75

TRANSFIXATN PIN 6X225MM 294.50

Facility

$641.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$358.96
Max. Negotiated Rate	$621.77
Rate for Payer: Cash Price	$384.60
Rate for Payer: Hawaii Western Management Group Commercial	$448.70
Rate for Payer: Health Management Network Commercial	$544.85
Rate for Payer: Kaiser Permanente Commercial	$576.90
Rate for Payer: MDX Hawaii PPO	$621.77
Rate for Payer: University Health Alliance Commercial	$358.96

TRANSFIXATN PIN 6X225MM 294.50

Facility

$641.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$320.50
Max. Negotiated Rate	$621.77
Rate for Payer: AlohaCare Medicaid	$320.50
Rate for Payer: AlohaCare Medicare	$487.16
Rate for Payer: Cash Price	$384.60
Rate for Payer: Devoted Health Medicare	$538.44
Rate for Payer: Hawaii Medical Service Association Medicare	$487.16
Rate for Payer: Hawaii Western Management Group Commercial	$448.70
Rate for Payer: Health Management Network Commercial	$544.85
Rate for Payer: Humana Medicare	$487.16
Rate for Payer: Kaiser Permanente Commercial	$576.90
Rate for Payer: Kaiser Permanente Medicaid	$326.91
Rate for Payer: Kaiser Permanente Medicare	$487.16
Rate for Payer: MDX Hawaii PPO	$621.77
Rate for Payer: Ohana Health Plan Medicaid	$487.16
Rate for Payer: Ohana Health Plan Medicare	$487.16
Rate for Payer: UnitedHealthcare Medicare	$487.16
Rate for Payer: University Health Alliance Commercial	$358.96

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$17,468.37

Service Code	MSDRG 069
Min. Negotiated Rate	$17,468.37
Max. Negotiated Rate	$17,468.37
Rate for Payer: Hawaii Medical Service Association Commercial	$17,468.37

TRANSPEC SPECIMEN DEVICE

Facility

$249.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$241.53
Rate for Payer: AlohaCare Medicaid	$124.50
Rate for Payer: AlohaCare Medicare	$189.24
Rate for Payer: Cash Price	$149.40
Rate for Payer: Devoted Health Medicare	$209.16
Rate for Payer: Hawaii Medical Service Association Medicare	$189.24
Rate for Payer: Hawaii Western Management Group Commercial	$236.55
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Humana Medicare	$189.24
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: Kaiser Permanente Medicaid	$126.99
Rate for Payer: Kaiser Permanente Medicare	$189.24
Rate for Payer: MDX Hawaii PPO	$241.53
Rate for Payer: Ohana Health Plan Medicaid	$189.24
Rate for Payer: Ohana Health Plan Medicare	$189.24
Rate for Payer: UnitedHealthcare Medicare	$189.24
Rate for Payer: University Health Alliance Commercial	$181.50

TRANSPEC SPECIMEN DEVICE

Facility

$249.00

Hospital Revenue Code	272
Min. Negotiated Rate	$211.65
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$149.40
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: MDX Hawaii PPO	$241.53

TRANSTIBIAL KIT #AR-1897S

Facility

$889.00

Hospital Revenue Code	272
Min. Negotiated Rate	$755.65
Max. Negotiated Rate	$862.33
Rate for Payer: Cash Price	$533.40
Rate for Payer: Health Management Network Commercial	$755.65
Rate for Payer: Kaiser Permanente Commercial	$800.10
Rate for Payer: MDX Hawaii PPO	$862.33

TRANSTIBIAL KIT #AR-1897S

Facility

$889.00

Hospital Revenue Code	272
Min. Negotiated Rate	$444.50
Max. Negotiated Rate	$862.33
Rate for Payer: AlohaCare Medicaid	$444.50
Rate for Payer: AlohaCare Medicare	$675.64
Rate for Payer: Cash Price	$533.40
Rate for Payer: Devoted Health Medicare	$746.76
Rate for Payer: Hawaii Medical Service Association Medicare	$675.64
Rate for Payer: Hawaii Western Management Group Commercial	$844.55
Rate for Payer: Health Management Network Commercial	$755.65
Rate for Payer: Humana Medicare	$675.64
Rate for Payer: Kaiser Permanente Commercial	$800.10
Rate for Payer: Kaiser Permanente Medicaid	$453.39
Rate for Payer: Kaiser Permanente Medicare	$675.64
Rate for Payer: MDX Hawaii PPO	$862.33
Rate for Payer: Ohana Health Plan Medicaid	$675.64
Rate for Payer: Ohana Health Plan Medicare	$675.64
Rate for Payer: UnitedHealthcare Medicare	$675.64
Rate for Payer: University Health Alliance Commercial	$647.99

TRANSURETHRAL PROCEDURES WITH CC

Facility

$21,165.89

Service Code	MSDRG 669
Min. Negotiated Rate	$21,165.89
Max. Negotiated Rate	$21,165.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21,165.89

TRANSURETHRAL PROCEDURES WITH MCC

Facility

$21,165.89

Service Code	MSDRG 668
Min. Negotiated Rate	$21,165.89
Max. Negotiated Rate	$21,165.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21,165.89

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$18,771.98

Service Code	MSDRG 670
Min. Negotiated Rate	$18,771.98
Max. Negotiated Rate	$18,771.98
Rate for Payer: Hawaii Medical Service Association Commercial	$18,771.98

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$17,681.69

Service Code	MSDRG 713
Min. Negotiated Rate	$17,681.69
Max. Negotiated Rate	$17,681.69
Rate for Payer: Hawaii Medical Service Association Commercial	$17,681.69

Know your out-of-pocket cost for care.

All Charges