Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TUBE EMG ENDOTRACH SZ7

Facility

$1,540.00

Hospital Revenue Code	270
Min. Negotiated Rate	$1,309.00
Max. Negotiated Rate	$1,493.80
Rate for Payer: Cash Price	$924.00
Rate for Payer: Health Management Network Commercial	$1,309.00
Rate for Payer: Kaiser Permanente Commercial	$1,386.00
Rate for Payer: MDX Hawaii PPO	$1,493.80

TUBE FEEDING KANGA 24F

Facility

$125.00

Service Code	HCPCS B4087
Hospital Revenue Code	272
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$95.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Devoted Health Medicare	$105.00
Rate for Payer: Hawaii Medical Service Association Medicare	$95.00
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$95.00
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$95.00
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$95.00
Rate for Payer: Ohana Health Plan Medicare	$95.00
Rate for Payer: UnitedHealthcare Medicaid	$38.22
Rate for Payer: UnitedHealthcare Medicare	$95.00
Rate for Payer: University Health Alliance Commercial	$91.11

TUBE FEEDING KANGA 24F

Facility

$125.00

Service Code	HCPCS B4087
Hospital Revenue Code	272
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

TUBE IRRIG CYSTO Y-TUBE

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$104.76
Rate for Payer: AlohaCare Medicaid	$54.00
Rate for Payer: AlohaCare Medicare	$82.08
Rate for Payer: Cash Price	$64.80
Rate for Payer: Devoted Health Medicare	$90.72
Rate for Payer: Hawaii Medical Service Association Medicare	$82.08
Rate for Payer: Hawaii Western Management Group Commercial	$102.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Humana Medicare	$82.08
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: Kaiser Permanente Medicare	$82.08
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: Ohana Health Plan Medicaid	$82.08
Rate for Payer: Ohana Health Plan Medicare	$82.08
Rate for Payer: UnitedHealthcare Medicare	$82.08
Rate for Payer: University Health Alliance Commercial	$78.72

TUBE IRRIG CYSTO Y-TUBE

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: MDX Hawaii PPO	$104.76

TUBE LASER ENDO 6MM DUAL CUFF

Facility

$367.00

Hospital Revenue Code	272
Min. Negotiated Rate	$311.95
Max. Negotiated Rate	$355.99
Rate for Payer: Cash Price	$220.20
Rate for Payer: Health Management Network Commercial	$311.95
Rate for Payer: Kaiser Permanente Commercial	$330.30
Rate for Payer: MDX Hawaii PPO	$355.99

TUBE LASER ENDO 6MM DUAL CUFF

Facility

$367.00

Hospital Revenue Code	272
Min. Negotiated Rate	$183.50
Max. Negotiated Rate	$355.99
Rate for Payer: AlohaCare Medicaid	$183.50
Rate for Payer: AlohaCare Medicare	$278.92
Rate for Payer: Cash Price	$220.20
Rate for Payer: Devoted Health Medicare	$308.28
Rate for Payer: Hawaii Medical Service Association Medicare	$278.92
Rate for Payer: Hawaii Western Management Group Commercial	$348.65
Rate for Payer: Health Management Network Commercial	$311.95
Rate for Payer: Humana Medicare	$278.92
Rate for Payer: Kaiser Permanente Commercial	$330.30
Rate for Payer: Kaiser Permanente Medicaid	$187.17
Rate for Payer: Kaiser Permanente Medicare	$278.92
Rate for Payer: MDX Hawaii PPO	$355.99
Rate for Payer: Ohana Health Plan Medicaid	$278.92
Rate for Payer: Ohana Health Plan Medicare	$278.92
Rate for Payer: UnitedHealthcare Medicare	$278.92
Rate for Payer: University Health Alliance Commercial	$267.51

TUBE NERVEAN EMG

Facility

$1,068.00

Hospital Revenue Code	272
Min. Negotiated Rate	$907.80
Max. Negotiated Rate	$1,035.96
Rate for Payer: Cash Price	$640.80
Rate for Payer: Health Management Network Commercial	$907.80
Rate for Payer: Kaiser Permanente Commercial	$961.20
Rate for Payer: MDX Hawaii PPO	$1,035.96

TUBE NERVEAN EMG

Facility

$1,068.00

Hospital Revenue Code	272
Min. Negotiated Rate	$534.00
Max. Negotiated Rate	$1,035.96
Rate for Payer: AlohaCare Medicaid	$534.00
Rate for Payer: AlohaCare Medicare	$811.68
Rate for Payer: Cash Price	$640.80
Rate for Payer: Devoted Health Medicare	$897.12
Rate for Payer: Hawaii Medical Service Association Medicare	$811.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,014.60
Rate for Payer: Health Management Network Commercial	$907.80
Rate for Payer: Humana Medicare	$811.68
Rate for Payer: Kaiser Permanente Commercial	$961.20
Rate for Payer: Kaiser Permanente Medicaid	$544.68
Rate for Payer: Kaiser Permanente Medicare	$811.68
Rate for Payer: MDX Hawaii PPO	$1,035.96
Rate for Payer: Ohana Health Plan Medicaid	$811.68
Rate for Payer: Ohana Health Plan Medicare	$811.68
Rate for Payer: UnitedHealthcare Medicare	$811.68
Rate for Payer: University Health Alliance Commercial	$778.47

TUBE OVERTUBE GASTRIC

Facility

$844.00

Hospital Revenue Code	272
Min. Negotiated Rate	$717.40
Max. Negotiated Rate	$818.68
Rate for Payer: Cash Price	$506.40
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: MDX Hawaii PPO	$818.68

TUBE OVERTUBE GASTRIC

Facility

$844.00

Hospital Revenue Code	272
Min. Negotiated Rate	$422.00
Max. Negotiated Rate	$818.68
Rate for Payer: AlohaCare Medicaid	$422.00
Rate for Payer: AlohaCare Medicare	$641.44
Rate for Payer: Cash Price	$506.40
Rate for Payer: Devoted Health Medicare	$708.96
Rate for Payer: Hawaii Medical Service Association Medicare	$641.44
Rate for Payer: Hawaii Western Management Group Commercial	$801.80
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Humana Medicare	$641.44
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: Kaiser Permanente Medicaid	$430.44
Rate for Payer: Kaiser Permanente Medicare	$641.44
Rate for Payer: MDX Hawaii PPO	$818.68
Rate for Payer: Ohana Health Plan Medicaid	$641.44
Rate for Payer: Ohana Health Plan Medicare	$641.44
Rate for Payer: UnitedHealthcare Medicare	$641.44
Rate for Payer: University Health Alliance Commercial	$615.19

TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]

Facility

$20.00

Service Code	NDC 00004080210
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

TUBERCULIN PPD 5 UNITS/0.1 ML SYRINGE [4080264]

Facility

$20.00

Service Code	NDC 00004080210
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

TUBE RIA 520MM 314.746S

Facility

$1,589.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,350.65
Max. Negotiated Rate	$1,541.33
Rate for Payer: Cash Price	$953.40
Rate for Payer: Health Management Network Commercial	$1,350.65
Rate for Payer: Kaiser Permanente Commercial	$1,430.10
Rate for Payer: MDX Hawaii PPO	$1,541.33

TUBE RIA 520MM 314.746S

Facility

$1,589.00

Hospital Revenue Code	272
Min. Negotiated Rate	$794.50
Max. Negotiated Rate	$1,541.33
Rate for Payer: AlohaCare Medicaid	$794.50
Rate for Payer: AlohaCare Medicare	$1,207.64
Rate for Payer: Cash Price	$953.40
Rate for Payer: Devoted Health Medicare	$1,334.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,207.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.55
Rate for Payer: Health Management Network Commercial	$1,350.65
Rate for Payer: Humana Medicare	$1,207.64
Rate for Payer: Kaiser Permanente Commercial	$1,430.10
Rate for Payer: Kaiser Permanente Medicaid	$810.39
Rate for Payer: Kaiser Permanente Medicare	$1,207.64
Rate for Payer: MDX Hawaii PPO	$1,541.33
Rate for Payer: Ohana Health Plan Medicaid	$1,207.64
Rate for Payer: Ohana Health Plan Medicare	$1,207.64
Rate for Payer: UnitedHealthcare Medicare	$1,207.64
Rate for Payer: University Health Alliance Commercial	$1,158.22

TUBE SILICONE MOD 1.32MM

Facility

$146.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$87.60
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: MDX Hawaii PPO	$141.62

TUBE SILICONE MOD 1.32MM

Facility

$146.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$141.62
Rate for Payer: AlohaCare Medicaid	$73.00
Rate for Payer: AlohaCare Medicare	$110.96
Rate for Payer: Cash Price	$87.60
Rate for Payer: Devoted Health Medicare	$122.64
Rate for Payer: Hawaii Medical Service Association Medicare	$110.96
Rate for Payer: Hawaii Western Management Group Commercial	$138.70
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Humana Medicare	$110.96
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: Kaiser Permanente Medicare	$110.96
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: Ohana Health Plan Medicaid	$110.96
Rate for Payer: Ohana Health Plan Medicare	$110.96
Rate for Payer: UnitedHealthcare Medicare	$110.96
Rate for Payer: University Health Alliance Commercial	$106.42

TUBE TRACH BIVONA 9.0M

Facility

$457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$228.50
Max. Negotiated Rate	$443.29
Rate for Payer: AlohaCare Medicaid	$228.50
Rate for Payer: AlohaCare Medicare	$347.32
Rate for Payer: Cash Price	$274.20
Rate for Payer: Devoted Health Medicare	$383.88
Rate for Payer: Hawaii Medical Service Association Medicare	$347.32
Rate for Payer: Hawaii Western Management Group Commercial	$434.15
Rate for Payer: Health Management Network Commercial	$388.45
Rate for Payer: Humana Medicare	$347.32
Rate for Payer: Kaiser Permanente Commercial	$411.30
Rate for Payer: Kaiser Permanente Medicaid	$233.07
Rate for Payer: Kaiser Permanente Medicare	$347.32
Rate for Payer: MDX Hawaii PPO	$443.29
Rate for Payer: Ohana Health Plan Medicaid	$347.32
Rate for Payer: Ohana Health Plan Medicare	$347.32
Rate for Payer: UnitedHealthcare Medicare	$347.32
Rate for Payer: University Health Alliance Commercial	$333.11

TUBE TRACH BIVONA 9.0M

Facility

$457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$388.45
Max. Negotiated Rate	$443.29
Rate for Payer: Cash Price	$274.20
Rate for Payer: Health Management Network Commercial	$388.45
Rate for Payer: Kaiser Permanente Commercial	$411.30
Rate for Payer: MDX Hawaii PPO	$443.29

TUBING INSUF HIFLOW

Facility

$217.00

Hospital Revenue Code	272
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$130.20
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: MDX Hawaii PPO	$210.49

TUBING INSUF HIFLOW

Facility

$217.00

Hospital Revenue Code	272
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$210.49
Rate for Payer: AlohaCare Medicaid	$108.50
Rate for Payer: AlohaCare Medicare	$164.92
Rate for Payer: Cash Price	$130.20
Rate for Payer: Devoted Health Medicare	$182.28
Rate for Payer: Hawaii Medical Service Association Medicare	$164.92
Rate for Payer: Hawaii Western Management Group Commercial	$206.15
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Humana Medicare	$164.92
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: Kaiser Permanente Medicaid	$110.67
Rate for Payer: Kaiser Permanente Medicare	$164.92
Rate for Payer: MDX Hawaii PPO	$210.49
Rate for Payer: Ohana Health Plan Medicaid	$164.92
Rate for Payer: Ohana Health Plan Medicare	$164.92
Rate for Payer: UnitedHealthcare Medicare	$164.92
Rate for Payer: University Health Alliance Commercial	$158.17

TUBING MYOSURE INFLOW

Facility

$473.00

Hospital Revenue Code	272
Min. Negotiated Rate	$402.05
Max. Negotiated Rate	$458.81
Rate for Payer: Cash Price	$283.80
Rate for Payer: Health Management Network Commercial	$402.05
Rate for Payer: Kaiser Permanente Commercial	$425.70
Rate for Payer: MDX Hawaii PPO	$458.81

TUBING MYOSURE INFLOW

Facility

$473.00

Hospital Revenue Code	272
Min. Negotiated Rate	$236.50
Max. Negotiated Rate	$458.81
Rate for Payer: AlohaCare Medicaid	$236.50
Rate for Payer: AlohaCare Medicare	$359.48
Rate for Payer: Cash Price	$283.80
Rate for Payer: Devoted Health Medicare	$397.32
Rate for Payer: Hawaii Medical Service Association Medicare	$359.48
Rate for Payer: Hawaii Western Management Group Commercial	$449.35
Rate for Payer: Health Management Network Commercial	$402.05
Rate for Payer: Humana Medicare	$359.48
Rate for Payer: Kaiser Permanente Commercial	$425.70
Rate for Payer: Kaiser Permanente Medicaid	$241.23
Rate for Payer: Kaiser Permanente Medicare	$359.48
Rate for Payer: MDX Hawaii PPO	$458.81
Rate for Payer: Ohana Health Plan Medicaid	$359.48
Rate for Payer: Ohana Health Plan Medicare	$359.48
Rate for Payer: UnitedHealthcare Medicare	$359.48
Rate for Payer: University Health Alliance Commercial	$344.77

TUBING MYOSURE OUTFLOW

Facility

$139.00

Hospital Revenue Code	272
Min. Negotiated Rate	$69.50
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$105.64
Rate for Payer: Cash Price	$83.40
Rate for Payer: Devoted Health Medicare	$116.76
Rate for Payer: Hawaii Medical Service Association Medicare	$105.64
Rate for Payer: Hawaii Western Management Group Commercial	$132.05
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$105.64
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$105.64
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$105.64
Rate for Payer: Ohana Health Plan Medicare	$105.64
Rate for Payer: UnitedHealthcare Medicare	$105.64
Rate for Payer: University Health Alliance Commercial	$101.32

TUBING MYOSURE OUTFLOW

Facility

$139.00

Hospital Revenue Code	272
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$83.40
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

Know your out-of-pocket cost for care.

All Charges