Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CERVICAL SPINAL FUSION WITH MCC

Facility

$61,909.62

Service Code	MSDRG 471
Min. Negotiated Rate	$61,909.62
Max. Negotiated Rate	$61,909.62
Rate for Payer: Hawaii Medical Service Association Commercial	$61,909.62

CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$46,005.58

Service Code	MSDRG 473
Min. Negotiated Rate	$46,005.58
Max. Negotiated Rate	$46,005.58
Rate for Payer: Hawaii Medical Service Association Commercial	$46,005.58

CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility

$19,103.81

Service Code	MSDRG 787
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility

$19,103.81

Service Code	MSDRG 786
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility

$16,923.23

Service Code	MSDRG 788
Min. Negotiated Rate	$16,923.23
Max. Negotiated Rate	$16,923.23
Rate for Payer: Hawaii Medical Service Association Commercial	$16,923.23

CESAREAN SECTION WITH STERILIZATION WITH CC

Facility

$19,103.81

Service Code	MSDRG 784
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility

$19,103.81

Service Code	MSDRG 783
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility

$16,923.23

Service Code	MSDRG 785
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$16,923.23
Rate for Payer: Hawaii Medical Service Association Commercial	$16,923.23
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CETIRIZINE 10 MG TABLET [9506]

Facility

$1.00

Service Code	NDC 00904671761
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

CETIRIZINE 10 MG TABLET [9506]

Facility

$9.00

Service Code	NDC 51079059720
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

CETIRIZINE 10 MG TABLET [9506]

Facility

$9.00

Service Code	NDC 51079059720
Hospital Revenue Code	637
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$6.84
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$6.84
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$6.84
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$6.84
Rate for Payer: Ohana Health Plan Medicare	$6.84
Rate for Payer: UnitedHealthcare Medicare	$6.84
Rate for Payer: University Health Alliance Commercial	$6.56

CETIRIZINE 10 MG TABLET [9506]

Facility

$1.00

Service Code	NDC 00904671761
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

CETIRIZINE 1 MG/ML ORAL SOLUTION [124409]

Facility

$92.00

Service Code	NDC 51672407008
Hospital Revenue Code	250
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: MDX Hawaii PPO	$89.24

CETIRIZINE 1 MG/ML ORAL SOLUTION [124409]

Facility

$92.00

Service Code	NDC 51672407008
Hospital Revenue Code	637
Min. Negotiated Rate	$46.00
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$69.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Devoted Health Medicare	$77.28
Rate for Payer: Hawaii Medical Service Association Medicare	$69.92
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$69.92
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$69.92
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$69.92
Rate for Payer: Ohana Health Plan Medicare	$69.92
Rate for Payer: UnitedHealthcare Medicare	$69.92
Rate for Payer: University Health Alliance Commercial	$67.06

CETIRIZINE 1 MG/ML ORAL SOLUTION [124409]

Facility

$20.00

Service Code	NDC 00904676520
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

CETIRIZINE 1 MG/ML ORAL SOLUTION [124409]

Facility

$20.00

Service Code	NDC 00904676520
Hospital Revenue Code	637
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 Medicare	$15.20
Rate for Payer: University Health Alliance Commercial	$14.58

CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]

Facility

$2,510.00

Service Code	HCPCS J9055
Hospital Revenue Code	636
Min. Negotiated Rate	$78.47
Max. Negotiated Rate	$2,434.70
Rate for Payer: AlohaCare Medicaid	$1,255.00
Rate for Payer: AlohaCare Medicare	$1,907.60
Rate for Payer: Cash Price	$1,506.00
Rate for Payer: Cash Price	$1,506.00
Rate for Payer: Devoted Health Medicare	$2,108.40
Rate for Payer: Hawaii Medical Service Association ABD	$78.47
Rate for Payer: Hawaii Medical Service Association Commercial	$100.58
Rate for Payer: Hawaii Medical Service Association Medicare	$1,907.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$78.47
Rate for Payer: Hawaii Western Management Group Commercial	$2,384.50
Rate for Payer: Health Management Network Commercial	$2,133.50
Rate for Payer: Humana Medicare	$1,907.60
Rate for Payer: Kaiser Permanente Commercial	$2,259.00
Rate for Payer: Kaiser Permanente Medicaid	$1,280.10
Rate for Payer: Kaiser Permanente Medicare	$1,907.60
Rate for Payer: MDX Hawaii PPO	$2,434.70
Rate for Payer: Ohana Health Plan Medicaid	$1,907.60
Rate for Payer: Ohana Health Plan Medicare	$1,907.60
Rate for Payer: UnitedHealthcare Medicaid	$1,506.00
Rate for Payer: UnitedHealthcare Medicare	$1,907.60
Rate for Payer: University Health Alliance Commercial	$1,829.54

CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]

Facility

$2,510.00

Service Code	HCPCS J9055
Hospital Revenue Code	250
Min. Negotiated Rate	$2,133.50
Max. Negotiated Rate	$2,434.70
Rate for Payer: Cash Price	$1,506.00
Rate for Payer: Health Management Network Commercial	$2,133.50
Rate for Payer: Kaiser Permanente Commercial	$2,259.00
Rate for Payer: MDX Hawaii PPO	$2,434.70

CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]

Facility

$5,019.00

Service Code	HCPCS J9055
Hospital Revenue Code	636
Min. Negotiated Rate	$78.47
Max. Negotiated Rate	$4,868.43
Rate for Payer: AlohaCare Medicaid	$2,509.50
Rate for Payer: AlohaCare Medicare	$3,814.44
Rate for Payer: Cash Price	$3,011.40
Rate for Payer: Cash Price	$3,011.40
Rate for Payer: Devoted Health Medicare	$4,215.96
Rate for Payer: Hawaii Medical Service Association ABD	$78.47
Rate for Payer: Hawaii Medical Service Association Commercial	$100.58
Rate for Payer: Hawaii Medical Service Association Medicare	$3,814.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$78.47
Rate for Payer: Hawaii Western Management Group Commercial	$4,768.05
Rate for Payer: Health Management Network Commercial	$4,266.15
Rate for Payer: Humana Medicare	$3,814.44
Rate for Payer: Kaiser Permanente Commercial	$4,517.10
Rate for Payer: Kaiser Permanente Medicaid	$2,559.69
Rate for Payer: Kaiser Permanente Medicare	$3,814.44
Rate for Payer: MDX Hawaii PPO	$4,868.43
Rate for Payer: Ohana Health Plan Medicaid	$3,814.44
Rate for Payer: Ohana Health Plan Medicare	$3,814.44
Rate for Payer: UnitedHealthcare Medicaid	$3,011.40
Rate for Payer: UnitedHealthcare Medicare	$3,814.44
Rate for Payer: University Health Alliance Commercial	$3,658.35

CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]

Facility

$5,019.00

Service Code	HCPCS J9055
Hospital Revenue Code	250
Min. Negotiated Rate	$4,266.15
Max. Negotiated Rate	$4,868.43
Rate for Payer: Cash Price	$3,011.40
Rate for Payer: Health Management Network Commercial	$4,266.15
Rate for Payer: Kaiser Permanente Commercial	$4,517.10
Rate for Payer: MDX Hawaii PPO	$4,868.43

CHAMBER ILIVIA NEO DUAL 429529

Facility

$38,500.00

Service Code	HCPCS C1721
Hospital Revenue Code	275
Min. Negotiated Rate	$21,560.00
Max. Negotiated Rate	$37,345.00
Rate for Payer: Cash Price	$23,100.00
Rate for Payer: Hawaii Western Management Group Commercial	$26,950.00
Rate for Payer: Health Management Network Commercial	$32,725.00
Rate for Payer: Kaiser Permanente Commercial	$34,650.00
Rate for Payer: MDX Hawaii PPO	$37,345.00
Rate for Payer: University Health Alliance Commercial	$21,560.00

CHAMBER ILIVIA NEO DUAL 429529

Facility

$38,500.00

Service Code	HCPCS C1721
Hospital Revenue Code	275
Min. Negotiated Rate	$19,250.00
Max. Negotiated Rate	$37,345.00
Rate for Payer: AlohaCare Medicaid	$19,250.00
Rate for Payer: AlohaCare Medicare	$29,260.00
Rate for Payer: Cash Price	$23,100.00
Rate for Payer: Devoted Health Medicare	$32,340.00
Rate for Payer: Hawaii Medical Service Association Medicare	$29,260.00
Rate for Payer: Hawaii Western Management Group Commercial	$26,950.00
Rate for Payer: Health Management Network Commercial	$32,725.00
Rate for Payer: Humana Medicare	$29,260.00
Rate for Payer: Kaiser Permanente Commercial	$34,650.00
Rate for Payer: Kaiser Permanente Medicaid	$19,635.00
Rate for Payer: Kaiser Permanente Medicare	$29,260.00
Rate for Payer: MDX Hawaii PPO	$37,345.00
Rate for Payer: Ohana Health Plan Medicaid	$29,260.00
Rate for Payer: Ohana Health Plan Medicare	$29,260.00
Rate for Payer: UnitedHealthcare Medicare	$29,260.00
Rate for Payer: University Health Alliance Commercial	$21,560.00

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$57,975.09

Service Code	MSDRG 837
Min. Negotiated Rate	$57,975.09
Max. Negotiated Rate	$57,975.09
Rate for Payer: Hawaii Medical Service Association Commercial	$57,975.09

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$57,975.09

Service Code	MSDRG 838
Min. Negotiated Rate	$57,975.09
Max. Negotiated Rate	$57,975.09
Rate for Payer: Hawaii Medical Service Association Commercial	$57,975.09

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$57,975.09

Service Code	MSDRG 839
Min. Negotiated Rate	$57,975.09
Max. Negotiated Rate	$57,975.09
Rate for Payer: Hawaii Medical Service Association Commercial	$57,975.09

Know your out-of-pocket cost for care.

All Charges