Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$14,007.88

Service Code	MSDRG 714
Min. Negotiated Rate	$14,007.88
Max. Negotiated Rate	$14,007.88
Rate for Payer: Hawaii Medical Service Association Commercial	$14,007.88

TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [167781]

Facility

$6,111.00

Service Code	HCPCS J9356
Hospital Revenue Code	250
Min. Negotiated Rate	$5,194.35
Max. Negotiated Rate	$5,927.67
Rate for Payer: Cash Price	$3,666.60
Rate for Payer: Health Management Network Commercial	$5,194.35
Rate for Payer: Kaiser Permanente Commercial	$5,499.90
Rate for Payer: MDX Hawaii PPO	$5,927.67

TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [167781]

Facility

$6,111.00

Service Code	HCPCS J9356
Hospital Revenue Code	636
Min. Negotiated Rate	$62.97
Max. Negotiated Rate	$5,927.67
Rate for Payer: AlohaCare Medicaid	$3,055.50
Rate for Payer: AlohaCare Medicare	$4,644.36
Rate for Payer: Cash Price	$3,666.60
Rate for Payer: Cash Price	$3,666.60
Rate for Payer: Devoted Health Medicare	$5,133.24
Rate for Payer: Hawaii Medical Service Association ABD	$62.97
Rate for Payer: Hawaii Medical Service Association Commercial	$74.89
Rate for Payer: Hawaii Medical Service Association Medicare	$4,644.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$62.97
Rate for Payer: Hawaii Western Management Group Commercial	$5,805.45
Rate for Payer: Health Management Network Commercial	$5,194.35
Rate for Payer: Humana Medicare	$4,644.36
Rate for Payer: Kaiser Permanente Commercial	$5,499.90
Rate for Payer: Kaiser Permanente Medicaid	$3,116.61
Rate for Payer: Kaiser Permanente Medicare	$4,644.36
Rate for Payer: MDX Hawaii PPO	$5,927.67
Rate for Payer: Ohana Health Plan Medicaid	$4,644.36
Rate for Payer: Ohana Health Plan Medicare	$4,644.36
Rate for Payer: UnitedHealthcare Medicaid	$3,666.60
Rate for Payer: UnitedHealthcare Medicare	$4,644.36
Rate for Payer: University Health Alliance Commercial	$4,454.31

TRASTUZUMAB-ANNS 150 MG/7.15ML IV (WET SOLR VIAL) [430170301]

Facility

$2,133.00

Service Code	HCPCS Q5117
Hospital Revenue Code	636
Min. Negotiated Rate	$43.28
Max. Negotiated Rate	$2,069.01
Rate for Payer: AlohaCare Medicaid	$1,066.50
Rate for Payer: AlohaCare Medicare	$1,621.08
Rate for Payer: Cash Price	$1,279.80
Rate for Payer: Cash Price	$1,279.80
Rate for Payer: Devoted Health Medicare	$1,791.72
Rate for Payer: Hawaii Medical Service Association ABD	$43.28
Rate for Payer: Hawaii Medical Service Association Commercial	$70.47
Rate for Payer: Hawaii Medical Service Association Medicare	$1,621.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.35
Rate for Payer: Health Management Network Commercial	$1,813.05
Rate for Payer: Humana Medicare	$1,621.08
Rate for Payer: Kaiser Permanente Commercial	$1,919.70
Rate for Payer: Kaiser Permanente Medicaid	$1,087.83
Rate for Payer: Kaiser Permanente Medicare	$1,621.08
Rate for Payer: MDX Hawaii PPO	$2,069.01
Rate for Payer: Ohana Health Plan Medicaid	$1,621.08
Rate for Payer: Ohana Health Plan Medicare	$1,621.08
Rate for Payer: UnitedHealthcare Medicaid	$1,279.80
Rate for Payer: UnitedHealthcare Medicare	$1,621.08
Rate for Payer: University Health Alliance Commercial	$1,554.74

TRASTUZUMAB-ANNS 150 MG/7.15ML IV (WET SOLR VIAL) [430170301]

Facility

$2,133.00

Service Code	HCPCS Q5117
Hospital Revenue Code	250
Min. Negotiated Rate	$1,813.05
Max. Negotiated Rate	$2,069.01
Rate for Payer: Cash Price	$1,279.80
Rate for Payer: Health Management Network Commercial	$1,813.05
Rate for Payer: Kaiser Permanente Commercial	$1,919.70
Rate for Payer: MDX Hawaii PPO	$2,069.01

TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION [168930]

Facility

$5,070.00

Service Code	HCPCS Q5117
Hospital Revenue Code	250
Min. Negotiated Rate	$4,309.50
Max. Negotiated Rate	$4,917.90
Rate for Payer: Cash Price	$3,042.00
Rate for Payer: Health Management Network Commercial	$4,309.50
Rate for Payer: Kaiser Permanente Commercial	$4,563.00
Rate for Payer: MDX Hawaii PPO	$4,917.90

TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION [168930]

Facility

$5,070.00

Service Code	HCPCS Q5117
Hospital Revenue Code	636
Min. Negotiated Rate	$43.28
Max. Negotiated Rate	$4,917.90
Rate for Payer: AlohaCare Medicaid	$2,535.00
Rate for Payer: AlohaCare Medicare	$3,853.20
Rate for Payer: Cash Price	$3,042.00
Rate for Payer: Cash Price	$3,042.00
Rate for Payer: Devoted Health Medicare	$4,258.80
Rate for Payer: Hawaii Medical Service Association ABD	$43.28
Rate for Payer: Hawaii Medical Service Association Commercial	$70.47
Rate for Payer: Hawaii Medical Service Association Medicare	$3,853.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43.28
Rate for Payer: Hawaii Western Management Group Commercial	$4,816.50
Rate for Payer: Health Management Network Commercial	$4,309.50
Rate for Payer: Humana Medicare	$3,853.20
Rate for Payer: Kaiser Permanente Commercial	$4,563.00
Rate for Payer: Kaiser Permanente Medicaid	$2,585.70
Rate for Payer: Kaiser Permanente Medicare	$3,853.20
Rate for Payer: MDX Hawaii PPO	$4,917.90
Rate for Payer: Ohana Health Plan Medicaid	$3,853.20
Rate for Payer: Ohana Health Plan Medicare	$3,853.20
Rate for Payer: UnitedHealthcare Medicaid	$3,042.00
Rate for Payer: UnitedHealthcare Medicare	$3,853.20
Rate for Payer: University Health Alliance Commercial	$3,695.52

TRASTUZUMAB-DKST 150 MG/7.15ML IV (WET SOLR VIAL) [430170123]

Facility

$1,148.00

Service Code	HCPCS Q5114
Hospital Revenue Code	250
Min. Negotiated Rate	$975.80
Max. Negotiated Rate	$1,113.56
Rate for Payer: Cash Price	$688.80
Rate for Payer: Cash Price	$977.40
Rate for Payer: Health Management Network Commercial	$975.80
Rate for Payer: Health Management Network Commercial	$1,384.65
Rate for Payer: Kaiser Permanente Commercial	$1,033.20
Rate for Payer: Kaiser Permanente Commercial	$1,466.10
Rate for Payer: MDX Hawaii PPO	$1,580.13
Rate for Payer: MDX Hawaii PPO	$1,113.56

TRASTUZUMAB-DKST 150 MG/7.15ML IV (WET SOLR VIAL) [430170123]

Facility

$1,148.00

Service Code	HCPCS Q5114
Hospital Revenue Code	636
Min. Negotiated Rate	$44.59
Max. Negotiated Rate	$1,113.56
Rate for Payer: AlohaCare Medicaid	$574.00
Rate for Payer: AlohaCare Medicaid	$814.50
Rate for Payer: AlohaCare Medicare	$1,238.04
Rate for Payer: AlohaCare Medicare	$872.48
Rate for Payer: Cash Price	$977.40
Rate for Payer: Cash Price	$688.80
Rate for Payer: Cash Price	$977.40
Rate for Payer: Cash Price	$688.80
Rate for Payer: Devoted Health Medicare	$964.32
Rate for Payer: Devoted Health Medicare	$1,368.36
Rate for Payer: Hawaii Medical Service Association ABD	$44.59
Rate for Payer: Hawaii Medical Service Association ABD	$44.59
Rate for Payer: Hawaii Medical Service Association Commercial	$44.73
Rate for Payer: Hawaii Medical Service Association Commercial	$44.73
Rate for Payer: Hawaii Medical Service Association Medicare	$1,238.04
Rate for Payer: Hawaii Medical Service Association Medicare	$872.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$44.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$44.59
Rate for Payer: Hawaii Western Management Group Commercial	$1,090.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,547.55
Rate for Payer: Health Management Network Commercial	$1,384.65
Rate for Payer: Health Management Network Commercial	$975.80
Rate for Payer: Humana Medicare	$872.48
Rate for Payer: Humana Medicare	$1,238.04
Rate for Payer: Kaiser Permanente Commercial	$1,033.20
Rate for Payer: Kaiser Permanente Commercial	$1,466.10
Rate for Payer: Kaiser Permanente Medicaid	$830.79
Rate for Payer: Kaiser Permanente Medicaid	$585.48
Rate for Payer: Kaiser Permanente Medicare	$872.48
Rate for Payer: Kaiser Permanente Medicare	$1,238.04
Rate for Payer: MDX Hawaii PPO	$1,113.56
Rate for Payer: MDX Hawaii PPO	$1,580.13
Rate for Payer: Ohana Health Plan Medicaid	$1,238.04
Rate for Payer: Ohana Health Plan Medicaid	$872.48
Rate for Payer: Ohana Health Plan Medicare	$872.48
Rate for Payer: Ohana Health Plan Medicare	$1,238.04
Rate for Payer: UnitedHealthcare Medicaid	$977.40
Rate for Payer: UnitedHealthcare Medicaid	$688.80
Rate for Payer: UnitedHealthcare Medicare	$872.48
Rate for Payer: UnitedHealthcare Medicare	$1,238.04
Rate for Payer: University Health Alliance Commercial	$836.78
Rate for Payer: University Health Alliance Commercial	$1,187.38

TRASTUZUMAB-DTTB 420 MG INTRAVENOUS SOLUTION [173239]

Facility

$4,951.00

Service Code	HCPCS Q5112
Hospital Revenue Code	636
Min. Negotiated Rate	$21.99
Max. Negotiated Rate	$4,802.47
Rate for Payer: AlohaCare Medicaid	$2,475.50
Rate for Payer: AlohaCare Medicare	$3,762.76
Rate for Payer: Cash Price	$2,970.60
Rate for Payer: Cash Price	$2,970.60
Rate for Payer: Devoted Health Medicare	$4,158.84
Rate for Payer: Hawaii Medical Service Association ABD	$21.99
Rate for Payer: Hawaii Medical Service Association Commercial	$37.26
Rate for Payer: Hawaii Medical Service Association Medicare	$3,762.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.99
Rate for Payer: Hawaii Western Management Group Commercial	$4,703.45
Rate for Payer: Health Management Network Commercial	$4,208.35
Rate for Payer: Humana Medicare	$3,762.76
Rate for Payer: Kaiser Permanente Commercial	$4,455.90
Rate for Payer: Kaiser Permanente Medicaid	$2,525.01
Rate for Payer: Kaiser Permanente Medicare	$3,762.76
Rate for Payer: MDX Hawaii PPO	$4,802.47
Rate for Payer: Ohana Health Plan Medicaid	$3,762.76
Rate for Payer: Ohana Health Plan Medicare	$3,762.76
Rate for Payer: UnitedHealthcare Medicaid	$2,970.60
Rate for Payer: UnitedHealthcare Medicare	$3,762.76
Rate for Payer: University Health Alliance Commercial	$3,608.78

TRASTUZUMAB-DTTB 420 MG INTRAVENOUS SOLUTION [173239]

Facility

$4,951.00

Service Code	HCPCS Q5112
Hospital Revenue Code	250
Min. Negotiated Rate	$4,208.35
Max. Negotiated Rate	$4,802.47
Rate for Payer: Cash Price	$2,970.60
Rate for Payer: Health Management Network Commercial	$4,208.35
Rate for Payer: Kaiser Permanente Commercial	$4,455.90
Rate for Payer: MDX Hawaii PPO	$4,802.47

TRASTUZUMAB-PKRB 150 MG/7.15ML IV (WET SOLR VIAL) [430171650]

Facility

$1,809.00

Service Code	HCPCS Q5113
Hospital Revenue Code	250
Min. Negotiated Rate	$1,537.65
Max. Negotiated Rate	$1,754.73
Rate for Payer: Cash Price	$1,085.40
Rate for Payer: Health Management Network Commercial	$1,537.65
Rate for Payer: Kaiser Permanente Commercial	$1,628.10
Rate for Payer: MDX Hawaii PPO	$1,754.73

TRASTUZUMAB-PKRB 150 MG/7.15ML IV (WET SOLR VIAL) [430171650]

Facility

$1,809.00

Service Code	HCPCS Q5113
Hospital Revenue Code	636
Min. Negotiated Rate	$70.03
Max. Negotiated Rate	$1,754.73
Rate for Payer: AlohaCare Medicaid	$904.50
Rate for Payer: AlohaCare Medicare	$1,374.84
Rate for Payer: Cash Price	$1,085.40
Rate for Payer: Cash Price	$1,085.40
Rate for Payer: Devoted Health Medicare	$1,519.56
Rate for Payer: Hawaii Medical Service Association ABD	$77.49
Rate for Payer: Hawaii Medical Service Association Commercial	$70.03
Rate for Payer: Hawaii Medical Service Association Medicare	$1,374.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$77.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,718.55
Rate for Payer: Health Management Network Commercial	$1,537.65
Rate for Payer: Humana Medicare	$1,374.84
Rate for Payer: Kaiser Permanente Commercial	$1,628.10
Rate for Payer: Kaiser Permanente Medicaid	$922.59
Rate for Payer: Kaiser Permanente Medicare	$1,374.84
Rate for Payer: MDX Hawaii PPO	$1,754.73
Rate for Payer: Ohana Health Plan Medicaid	$1,374.84
Rate for Payer: Ohana Health Plan Medicare	$1,374.84
Rate for Payer: UnitedHealthcare Medicaid	$1,085.40
Rate for Payer: UnitedHealthcare Medicare	$1,374.84
Rate for Payer: University Health Alliance Commercial	$1,318.58

TRAUMACEM V CEMENT 07.702.040S

Facility

$1,598.00

Hospital Revenue Code	278
Min. Negotiated Rate	$894.88
Max. Negotiated Rate	$1,550.06
Rate for Payer: Cash Price	$958.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,118.60
Rate for Payer: Health Management Network Commercial	$1,358.30
Rate for Payer: Kaiser Permanente Commercial	$1,438.20
Rate for Payer: MDX Hawaii PPO	$1,550.06
Rate for Payer: University Health Alliance Commercial	$894.88

TRAUMACEM V CEMENT 07.702.040S

Facility

$1,598.00

Hospital Revenue Code	278
Min. Negotiated Rate	$799.00
Max. Negotiated Rate	$1,550.06
Rate for Payer: AlohaCare Medicaid	$799.00
Rate for Payer: AlohaCare Medicare	$1,214.48
Rate for Payer: Cash Price	$958.80
Rate for Payer: Devoted Health Medicare	$1,342.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,214.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,118.60
Rate for Payer: Health Management Network Commercial	$1,358.30
Rate for Payer: Humana Medicare	$1,214.48
Rate for Payer: Kaiser Permanente Commercial	$1,438.20
Rate for Payer: Kaiser Permanente Medicaid	$814.98
Rate for Payer: Kaiser Permanente Medicare	$1,214.48
Rate for Payer: MDX Hawaii PPO	$1,550.06
Rate for Payer: Ohana Health Plan Medicaid	$1,214.48
Rate for Payer: Ohana Health Plan Medicare	$1,214.48
Rate for Payer: UnitedHealthcare Medicare	$1,214.48
Rate for Payer: University Health Alliance Commercial	$894.88

TRAUMACEM V INJECT 03.702.121S

Facility

$1,684.00

Hospital Revenue Code	272
Min. Negotiated Rate	$842.00
Max. Negotiated Rate	$1,633.48
Rate for Payer: AlohaCare Medicaid	$842.00
Rate for Payer: AlohaCare Medicare	$1,279.84
Rate for Payer: Cash Price	$1,010.40
Rate for Payer: Devoted Health Medicare	$1,414.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,279.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,599.80
Rate for Payer: Health Management Network Commercial	$1,431.40
Rate for Payer: Humana Medicare	$1,279.84
Rate for Payer: Kaiser Permanente Commercial	$1,515.60
Rate for Payer: Kaiser Permanente Medicaid	$858.84
Rate for Payer: Kaiser Permanente Medicare	$1,279.84
Rate for Payer: MDX Hawaii PPO	$1,633.48
Rate for Payer: Ohana Health Plan Medicaid	$1,279.84
Rate for Payer: Ohana Health Plan Medicare	$1,279.84
Rate for Payer: UnitedHealthcare Medicare	$1,279.84
Rate for Payer: University Health Alliance Commercial	$1,227.47

TRAUMACEM V INJECT 03.702.121S

Facility

$1,684.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,431.40
Max. Negotiated Rate	$1,633.48
Rate for Payer: Cash Price	$1,010.40
Rate for Payer: Health Management Network Commercial	$1,431.40
Rate for Payer: Kaiser Permanente Commercial	$1,515.60
Rate for Payer: MDX Hawaii PPO	$1,633.48

TRAUMACEM V SYRING 03.702.150S

Facility

$666.00

Hospital Revenue Code	272
Min. Negotiated Rate	$566.10
Max. Negotiated Rate	$646.02
Rate for Payer: Cash Price	$399.60
Rate for Payer: Health Management Network Commercial	$566.10
Rate for Payer: Kaiser Permanente Commercial	$599.40
Rate for Payer: MDX Hawaii PPO	$646.02

TRAUMACEM V SYRING 03.702.150S

Facility

$666.00

Hospital Revenue Code	272
Min. Negotiated Rate	$333.00
Max. Negotiated Rate	$646.02
Rate for Payer: AlohaCare Medicaid	$333.00
Rate for Payer: AlohaCare Medicare	$506.16
Rate for Payer: Cash Price	$399.60
Rate for Payer: Devoted Health Medicare	$559.44
Rate for Payer: Hawaii Medical Service Association Medicare	$506.16
Rate for Payer: Hawaii Western Management Group Commercial	$632.70
Rate for Payer: Health Management Network Commercial	$566.10
Rate for Payer: Humana Medicare	$506.16
Rate for Payer: Kaiser Permanente Commercial	$599.40
Rate for Payer: Kaiser Permanente Medicaid	$339.66
Rate for Payer: Kaiser Permanente Medicare	$506.16
Rate for Payer: MDX Hawaii PPO	$646.02
Rate for Payer: Ohana Health Plan Medicaid	$506.16
Rate for Payer: Ohana Health Plan Medicare	$506.16
Rate for Payer: UnitedHealthcare Medicare	$506.16
Rate for Payer: University Health Alliance Commercial	$485.45

TRAUMATIC INJURY WITH MCC

Facility

$14,861.15

Service Code	MSDRG 913
Min. Negotiated Rate	$14,861.15
Max. Negotiated Rate	$14,861.15
Rate for Payer: Hawaii Medical Service Association Commercial	$14,861.15

TRAUMATIC INJURY WITHOUT MCC

Facility

$14,861.15

Service Code	MSDRG 914
Min. Negotiated Rate	$14,861.15
Max. Negotiated Rate	$14,861.15
Rate for Payer: Hawaii Medical Service Association Commercial	$14,861.15

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$16,709.91

Service Code	MSDRG 086
Min. Negotiated Rate	$16,709.91
Max. Negotiated Rate	$16,709.91
Rate for Payer: Hawaii Medical Service Association Commercial	$16,709.91

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$37,757.29

Service Code	MSDRG 083
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$58,235.81

Service Code	MSDRG 085
Min. Negotiated Rate	$58,235.81
Max. Negotiated Rate	$58,235.81
Rate for Payer: Hawaii Medical Service Association Commercial	$58,235.81

TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$37,757.29

Service Code	MSDRG 082
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

Know your out-of-pocket cost for care.

All Charges