Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CEPHALEXIN SUSPENSION (KEFLEX) 250 MG/5 ML (100 ML) (TAKE HOME) [4080343]

Facility

$15.00

Service Code	NDC 00004080131
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

CEPHALEXIN SUSPENSION (KEFLEX) 250 MG/5 ML (100 ML) (TAKE HOME) [4080343]

Facility

$15.00

Service Code	NDC 00004080131
Hospital Revenue Code	253
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

CERAMENT G 10ML A0535-05

Facility

$14,874.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$7,437.00
Max. Negotiated Rate	$14,427.78
Rate for Payer: AlohaCare Medicaid	$7,437.00
Rate for Payer: AlohaCare Medicare	$11,304.24
Rate for Payer: Cash Price	$8,924.40
Rate for Payer: Devoted Health Medicare	$12,494.16
Rate for Payer: Hawaii Medical Service Association Medicare	$11,304.24
Rate for Payer: Hawaii Western Management Group Commercial	$10,411.80
Rate for Payer: Health Management Network Commercial	$12,642.90
Rate for Payer: Humana Medicare	$11,304.24
Rate for Payer: Kaiser Permanente Commercial	$13,386.60
Rate for Payer: Kaiser Permanente Medicaid	$7,585.74
Rate for Payer: Kaiser Permanente Medicare	$11,304.24
Rate for Payer: MDX Hawaii PPO	$14,427.78
Rate for Payer: Ohana Health Plan Medicaid	$11,304.24
Rate for Payer: Ohana Health Plan Medicare	$11,304.24
Rate for Payer: UnitedHealthcare Medicare	$11,304.24
Rate for Payer: University Health Alliance Commercial	$8,329.44

CERAMENT G 10ML A0535-05

Facility

$14,874.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$8,329.44
Max. Negotiated Rate	$14,427.78
Rate for Payer: Cash Price	$8,924.40
Rate for Payer: Hawaii Western Management Group Commercial	$10,411.80
Rate for Payer: Health Management Network Commercial	$12,642.90
Rate for Payer: Kaiser Permanente Commercial	$13,386.60
Rate for Payer: MDX Hawaii PPO	$14,427.78
Rate for Payer: University Health Alliance Commercial	$8,329.44

CERAMIC FEMORAL HEAD 18-36-3

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

CERAMIC FEMORAL HEAD 18-36-3

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.00
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$2,033.76
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$2,247.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,033.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$2,033.76
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$2,033.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$2,033.76
Rate for Payer: Ohana Health Plan Medicare	$2,033.76
Rate for Payer: UnitedHealthcare Medicare	$2,033.76
Rate for Payer: University Health Alliance Commercial	$1,498.56

CERAMIC HEAD 36/0 6570-0-136

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

CERAMIC HEAD 36/0 6570-0-136

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$2,054.28
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$2,270.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,054.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$2,054.28
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$2,054.28
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$2,054.28
Rate for Payer: Ohana Health Plan Medicare	$2,054.28
Rate for Payer: UnitedHealthcare Medicare	$2,054.28
Rate for Payer: University Health Alliance Commercial	$1,513.68

CERAMIC HEAD 36MM 6570-0-436

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.00
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$2,033.76
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$2,247.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,033.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$2,033.76
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$2,033.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$2,033.76
Rate for Payer: Ohana Health Plan Medicare	$2,033.76
Rate for Payer: UnitedHealthcare Medicare	$2,033.76
Rate for Payer: University Health Alliance Commercial	$1,498.56

CERAMIC HEAD 36MM 6570-0-436

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

CERC CBL 1.8X635MM 2232-04-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,711.08
Rate for Payer: AlohaCare Medicaid	$882.00
Rate for Payer: AlohaCare Medicare	$1,340.64
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Devoted Health Medicare	$1,481.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,340.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Humana Medicare	$1,340.64
Rate for Payer: Kaiser Permanente Commercial	$1,587.60
Rate for Payer: Kaiser Permanente Medicaid	$899.64
Rate for Payer: Kaiser Permanente Medicare	$1,340.64
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: Ohana Health Plan Medicaid	$1,340.64
Rate for Payer: Ohana Health Plan Medicare	$1,340.64
Rate for Payer: UnitedHealthcare Medicare	$1,340.64
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL 1.8X635MM 2232-04-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$987.84
Max. Negotiated Rate	$1,711.08
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Commercial	$1,587.60
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL W/CRMP 22" 2232-01-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,711.08
Rate for Payer: AlohaCare Medicaid	$882.00
Rate for Payer: AlohaCare Medicare	$1,340.64
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Devoted Health Medicare	$1,481.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,340.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Humana Medicare	$1,340.64
Rate for Payer: Kaiser Permanente Commercial	$1,587.60
Rate for Payer: Kaiser Permanente Medicaid	$899.64
Rate for Payer: Kaiser Permanente Medicare	$1,340.64
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: Ohana Health Plan Medicaid	$1,340.64
Rate for Payer: Ohana Health Plan Medicare	$1,340.64
Rate for Payer: UnitedHealthcare Medicare	$1,340.64
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL W/CRMP 22" 2232-01-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$987.84
Max. Negotiated Rate	$1,711.08
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Commercial	$1,587.60
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL W/CRMP 36" 2232-01-28

Facility

$2,730.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.00
Max. Negotiated Rate	$2,648.10
Rate for Payer: AlohaCare Medicaid	$1,365.00
Rate for Payer: AlohaCare Medicare	$2,074.80
Rate for Payer: Cash Price	$1,638.00
Rate for Payer: Devoted Health Medicare	$2,293.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2,074.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,911.00
Rate for Payer: Health Management Network Commercial	$2,320.50
Rate for Payer: Humana Medicare	$2,074.80
Rate for Payer: Kaiser Permanente Commercial	$2,457.00
Rate for Payer: Kaiser Permanente Medicaid	$1,392.30
Rate for Payer: Kaiser Permanente Medicare	$2,074.80
Rate for Payer: MDX Hawaii PPO	$2,648.10
Rate for Payer: Ohana Health Plan Medicaid	$2,074.80
Rate for Payer: Ohana Health Plan Medicare	$2,074.80
Rate for Payer: UnitedHealthcare Medicare	$2,074.80
Rate for Payer: University Health Alliance Commercial	$1,528.80

CERC CBL W/CRMP 36" 2232-01-28

Facility

$2,730.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,528.80
Max. Negotiated Rate	$2,648.10
Rate for Payer: Cash Price	$1,638.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,911.00
Rate for Payer: Health Management Network Commercial	$2,320.50
Rate for Payer: Kaiser Permanente Commercial	$2,457.00
Rate for Payer: MDX Hawaii PPO	$2,648.10
Rate for Payer: University Health Alliance Commercial	$1,528.80

CERCLAGE PC 0.5X175 291.230.98

Facility

$121.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$117.37
Rate for Payer: AlohaCare Medicaid	$60.50
Rate for Payer: AlohaCare Medicare	$91.96
Rate for Payer: Cash Price	$72.60
Rate for Payer: Devoted Health Medicare	$101.64
Rate for Payer: Hawaii Medical Service Association Medicare	$91.96
Rate for Payer: Hawaii Western Management Group Commercial	$114.95
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Humana Medicare	$91.96
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: Kaiser Permanente Medicare	$91.96
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: Ohana Health Plan Medicaid	$91.96
Rate for Payer: Ohana Health Plan Medicare	$91.96
Rate for Payer: UnitedHealthcare Medicare	$91.96
Rate for Payer: University Health Alliance Commercial	$88.20

CERCLAGE PC 0.5X175 291.230.98

Facility

$121.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: MDX Hawaii PPO	$117.37

CERCLAGE TENSIONER AR-7820

Facility

$1,011.00

Hospital Revenue Code	272
Min. Negotiated Rate	$505.50
Max. Negotiated Rate	$980.67
Rate for Payer: AlohaCare Medicaid	$505.50
Rate for Payer: AlohaCare Medicare	$768.36
Rate for Payer: Cash Price	$606.60
Rate for Payer: Devoted Health Medicare	$849.24
Rate for Payer: Hawaii Medical Service Association Medicare	$768.36
Rate for Payer: Hawaii Western Management Group Commercial	$960.45
Rate for Payer: Health Management Network Commercial	$859.35
Rate for Payer: Humana Medicare	$768.36
Rate for Payer: Kaiser Permanente Commercial	$909.90
Rate for Payer: Kaiser Permanente Medicaid	$515.61
Rate for Payer: Kaiser Permanente Medicare	$768.36
Rate for Payer: MDX Hawaii PPO	$980.67
Rate for Payer: Ohana Health Plan Medicaid	$768.36
Rate for Payer: Ohana Health Plan Medicare	$768.36
Rate for Payer: UnitedHealthcare Medicare	$768.36
Rate for Payer: University Health Alliance Commercial	$736.92

CERCLAGE TENSIONER AR-7820

Facility

$1,011.00

Hospital Revenue Code	272
Min. Negotiated Rate	$859.35
Max. Negotiated Rate	$980.67
Rate for Payer: Cash Price	$606.60
Rate for Payer: Health Management Network Commercial	$859.35
Rate for Payer: Kaiser Permanente Commercial	$909.90
Rate for Payer: MDX Hawaii PPO	$980.67

CERMENT BONE VOID A0210-08

Facility

$5,390.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,018.40
Max. Negotiated Rate	$5,228.30
Rate for Payer: Cash Price	$3,234.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,773.00
Rate for Payer: Health Management Network Commercial	$4,581.50
Rate for Payer: Kaiser Permanente Commercial	$4,851.00
Rate for Payer: MDX Hawaii PPO	$5,228.30
Rate for Payer: University Health Alliance Commercial	$3,018.40

CERMENT BONE VOID A0210-08

Facility

$5,390.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,695.00
Max. Negotiated Rate	$5,228.30
Rate for Payer: AlohaCare Medicaid	$2,695.00
Rate for Payer: AlohaCare Medicare	$4,096.40
Rate for Payer: Cash Price	$3,234.00
Rate for Payer: Devoted Health Medicare	$4,527.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4,096.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,773.00
Rate for Payer: Health Management Network Commercial	$4,581.50
Rate for Payer: Humana Medicare	$4,096.40
Rate for Payer: Kaiser Permanente Commercial	$4,851.00
Rate for Payer: Kaiser Permanente Medicaid	$2,748.90
Rate for Payer: Kaiser Permanente Medicare	$4,096.40
Rate for Payer: MDX Hawaii PPO	$5,228.30
Rate for Payer: Ohana Health Plan Medicaid	$4,096.40
Rate for Payer: Ohana Health Plan Medicare	$4,096.40
Rate for Payer: UnitedHealthcare Medicare	$4,096.40
Rate for Payer: University Health Alliance Commercial	$3,018.40

CERVICAL RIPENING BALLOON 18FR

Facility

$288.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: MDX Hawaii PPO	$279.36

CERVICAL RIPENING BALLOON 18FR

Facility

$288.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$279.36
Rate for Payer: AlohaCare Medicaid	$144.00
Rate for Payer: AlohaCare Medicare	$218.88
Rate for Payer: Cash Price	$172.80
Rate for Payer: Devoted Health Medicare	$241.92
Rate for Payer: Hawaii Medical Service Association Medicare	$218.88
Rate for Payer: Hawaii Western Management Group Commercial	$273.60
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Humana Medicare	$218.88
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: Kaiser Permanente Medicaid	$146.88
Rate for Payer: Kaiser Permanente Medicare	$218.88
Rate for Payer: MDX Hawaii PPO	$279.36
Rate for Payer: Ohana Health Plan Medicaid	$218.88
Rate for Payer: Ohana Health Plan Medicare	$218.88
Rate for Payer: UnitedHealthcare Medicare	$218.88
Rate for Payer: University Health Alliance Commercial	$209.92

CERVICAL SPINAL FUSION WITH CC

Facility

$50,129.73

Service Code	MSDRG 472
Min. Negotiated Rate	$50,129.73
Max. Negotiated Rate	$50,129.73
Rate for Payer: Hawaii Medical Service Association Commercial	$50,129.73

Know your out-of-pocket cost for care.

All Charges