Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

$385.00

Service Code	NDC 72485062513
Hospital Revenue Code	637
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$373.45
Rate for Payer: AlohaCare Medicaid	$192.50
Rate for Payer: AlohaCare Medicare	$292.60
Rate for Payer: Cash Price	$231.00
Rate for Payer: Devoted Health Medicare	$323.40
Rate for Payer: Hawaii Medical Service Association Medicare	$292.60
Rate for Payer: Hawaii Western Management Group Commercial	$365.75
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: Humana Medicare	$292.60
Rate for Payer: Kaiser Permanente Commercial	$346.50
Rate for Payer: Kaiser Permanente Medicaid	$196.35
Rate for Payer: Kaiser Permanente Medicare	$292.60
Rate for Payer: MDX Hawaii PPO	$373.45
Rate for Payer: Ohana Health Plan Medicaid	$292.60
Rate for Payer: Ohana Health Plan Medicare	$292.60
Rate for Payer: UnitedHealthcare Medicare	$292.60
Rate for Payer: University Health Alliance Commercial	$280.63

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

$673.00

Service Code	NDC 43598032675
Hospital Revenue Code	250
Min. Negotiated Rate	$572.05
Max. Negotiated Rate	$652.81
Rate for Payer: Cash Price	$403.80
Rate for Payer: Health Management Network Commercial	$572.05
Rate for Payer: Kaiser Permanente Commercial	$605.70
Rate for Payer: MDX Hawaii PPO	$652.81

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

$701.00

Service Code	NDC 00781618667
Hospital Revenue Code	250
Min. Negotiated Rate	$595.85
Max. Negotiated Rate	$679.97
Rate for Payer: Cash Price	$420.60
Rate for Payer: Health Management Network Commercial	$595.85
Rate for Payer: Kaiser Permanente Commercial	$630.90
Rate for Payer: MDX Hawaii PPO	$679.97

CIPROFLOXACIN 0.3 % EYE DROPS [9610]

Facility

$142.00

Service Code	NDC 61314065605
Hospital Revenue Code	637
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$107.92
Rate for Payer: Cash Price	$85.20
Rate for Payer: Devoted Health Medicare	$119.28
Rate for Payer: Hawaii Medical Service Association Medicare	$107.92
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$107.92
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$107.92
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$107.92
Rate for Payer: Ohana Health Plan Medicare	$107.92
Rate for Payer: UnitedHealthcare Medicare	$107.92
Rate for Payer: University Health Alliance Commercial	$103.50

CIPROFLOXACIN 0.3 % EYE DROPS [9610]

Facility

$142.00

Service Code	NDC 61314065605
Hospital Revenue Code	250
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$85.20
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

$16.00

Service Code	NDC 55111012601
Hospital Revenue Code	637
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$12.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Medicare	$12.16
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$12.16
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$12.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$12.16
Rate for Payer: Ohana Health Plan Medicare	$12.16
Rate for Payer: UnitedHealthcare Medicare	$12.16
Rate for Payer: University Health Alliance Commercial	$11.66

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

$17.00

Service Code	NDC 00143992701
Hospital Revenue Code	637
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$12.92
Rate for Payer: Cash Price	$10.20
Rate for Payer: Devoted Health Medicare	$14.28
Rate for Payer: Hawaii Medical Service Association Medicare	$12.92
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$12.92
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$12.92
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$12.92
Rate for Payer: Ohana Health Plan Medicare	$12.92
Rate for Payer: UnitedHealthcare Medicare	$12.92
Rate for Payer: University Health Alliance Commercial	$12.39

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

$17.00

Service Code	NDC 00143992701
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

$17.00

Service Code	NDC 65862007601
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

$17.00

Service Code	NDC 65862007601
Hospital Revenue Code	637
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$12.92
Rate for Payer: Cash Price	$10.20
Rate for Payer: Devoted Health Medicare	$14.28
Rate for Payer: Hawaii Medical Service Association Medicare	$12.92
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$12.92
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$12.92
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$12.92
Rate for Payer: Ohana Health Plan Medicare	$12.92
Rate for Payer: UnitedHealthcare Medicare	$12.92
Rate for Payer: University Health Alliance Commercial	$12.39

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

$16.00

Service Code	NDC 55111012601
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108132]

Facility

$30.00

Service Code	HCPCS J0744
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108132]

Facility

$30.00

Service Code	HCPCS J0744
Hospital Revenue Code	636
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicare	$22.80
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Devoted Health Medicare	$25.20
Rate for Payer: Hawaii Medical Service Association ABD	$2.32
Rate for Payer: Hawaii Medical Service Association Medicare	$22.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.32
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$22.80
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$22.80
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$22.80
Rate for Payer: Ohana Health Plan Medicare	$22.80
Rate for Payer: UnitedHealthcare Medicaid	$18.00
Rate for Payer: UnitedHealthcare Medicare	$22.80
Rate for Payer: University Health Alliance Commercial	$21.87

CIPROFLOXACIN 500 MG TABLET [25119]

Facility

$2.00

Service Code	NDC 00904708361
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

CIPROFLOXACIN 500 MG TABLET [25119]

Facility

$2.00

Service Code	NDC 00904724361
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

CIPROFLOXACIN 500 MG TABLET [25119]

Facility

$2.00

Service Code	NDC 00904724361
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

CIPROFLOXACIN 500 MG TABLET [25119]

Facility

$2.00

Service Code	NDC 00904708361
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

CIPROFLOXACIN TABLETS (CIPRO) 500 MG (TAKE HOME) [4080346]

Facility

$15.00

Service Code	NDC 00004080134
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

CIPROFLOXACIN TABLETS (CIPRO) 500 MG (TAKE HOME) [4080346]

Facility

$15.00

Service Code	NDC 00004080134
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

CIRCL STR PASSER AR-7821

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$563.50
Max. Negotiated Rate	$1,093.19
Rate for Payer: AlohaCare Medicaid	$563.50
Rate for Payer: AlohaCare Medicare	$856.52
Rate for Payer: Cash Price	$676.20
Rate for Payer: Devoted Health Medicare	$946.68
Rate for Payer: Hawaii Medical Service Association Medicare	$856.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,070.65
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Humana Medicare	$856.52
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: Kaiser Permanente Medicare	$856.52
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: Ohana Health Plan Medicaid	$856.52
Rate for Payer: Ohana Health Plan Medicare	$856.52
Rate for Payer: UnitedHealthcare Medicare	$856.52
Rate for Payer: University Health Alliance Commercial	$821.47

CIRCL STR PASSER AR-7821

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$957.95
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: MDX Hawaii PPO	$1,093.19

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$34,130.88

Service Code	MSDRG 286
Min. Negotiated Rate	$34,130.88
Max. Negotiated Rate	$34,130.88
Rate for Payer: Hawaii Medical Service Association Commercial	$34,130.88

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$30,054.14

Service Code	MSDRG 287
Min. Negotiated Rate	$30,054.14
Max. Negotiated Rate	$30,054.14
Rate for Payer: Hawaii Medical Service Association Commercial	$30,054.14

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility

$41,336.29

Service Code	MSDRG 433
Min. Negotiated Rate	$41,336.29
Max. Negotiated Rate	$41,336.29
Rate for Payer: Hawaii Medical Service Association Commercial	$41,336.29

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility

$41,336.29

Service Code	MSDRG 432
Min. Negotiated Rate	$41,336.29
Max. Negotiated Rate	$41,336.29
Rate for Payer: Hawaii Medical Service Association Commercial	$41,336.29

Know your out-of-pocket cost for care.

All Charges