Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [187009]

Facility

$1,383.00

Service Code	NDC 00046087221
Hospital Revenue Code	250
Min. Negotiated Rate	$1,175.55
Max. Negotiated Rate	$1,341.51
Rate for Payer: Cash Price	$829.80
Rate for Payer: Health Management Network Commercial	$1,175.55
Rate for Payer: Kaiser Permanente Commercial	$1,244.70
Rate for Payer: MDX Hawaii PPO	$1,341.51

CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [187009]

Facility

$1,383.00

Service Code	NDC 00046087221
Hospital Revenue Code	637
Min. Negotiated Rate	$691.50
Max. Negotiated Rate	$1,341.51
Rate for Payer: AlohaCare Medicaid	$691.50
Rate for Payer: AlohaCare Medicare	$1,051.08
Rate for Payer: Cash Price	$829.80
Rate for Payer: Devoted Health Medicare	$1,161.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,051.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,313.85
Rate for Payer: Health Management Network Commercial	$1,175.55
Rate for Payer: Humana Medicare	$1,051.08
Rate for Payer: Kaiser Permanente Commercial	$1,244.70
Rate for Payer: Kaiser Permanente Medicaid	$705.33
Rate for Payer: Kaiser Permanente Medicare	$1,051.08
Rate for Payer: MDX Hawaii PPO	$1,341.51
Rate for Payer: Ohana Health Plan Medicaid	$1,051.08
Rate for Payer: Ohana Health Plan Medicare	$1,051.08
Rate for Payer: UnitedHealthcare Medicare	$1,051.08
Rate for Payer: University Health Alliance Commercial	$1,008.07

CONJUGATED ESTROGENS 0.625 MG TABLET [9974]

Facility

$26.00

Service Code	NDC 00046110281
Hospital Revenue Code	637
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$25.22
Rate for Payer: AlohaCare Medicaid	$13.00
Rate for Payer: AlohaCare Medicare	$19.76
Rate for Payer: Cash Price	$15.60
Rate for Payer: Devoted Health Medicare	$21.84
Rate for Payer: Hawaii Medical Service Association Medicare	$19.76
Rate for Payer: Hawaii Western Management Group Commercial	$24.70
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Humana Medicare	$19.76
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: Kaiser Permanente Medicare	$19.76
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: Ohana Health Plan Medicaid	$19.76
Rate for Payer: Ohana Health Plan Medicare	$19.76
Rate for Payer: UnitedHealthcare Medicare	$19.76
Rate for Payer: University Health Alliance Commercial	$18.95

CONJUGATED ESTROGENS 0.625 MG TABLET [9974]

Facility

$26.00

Service Code	NDC 00046110281
Hospital Revenue Code	250
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: MDX Hawaii PPO	$25.22

CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]

Facility

$679.00

Service Code	HCPCS J1410
Hospital Revenue Code	636
Min. Negotiated Rate	$339.50
Max. Negotiated Rate	$658.63
Rate for Payer: AlohaCare Medicaid	$339.50
Rate for Payer: AlohaCare Medicare	$516.04
Rate for Payer: Cash Price	$407.40
Rate for Payer: Cash Price	$407.40
Rate for Payer: Devoted Health Medicare	$570.36
Rate for Payer: Hawaii Medical Service Association ABD	$390.74
Rate for Payer: Hawaii Medical Service Association Commercial	$489.65
Rate for Payer: Hawaii Medical Service Association Medicare	$516.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$390.74
Rate for Payer: Hawaii Western Management Group Commercial	$645.05
Rate for Payer: Health Management Network Commercial	$577.15
Rate for Payer: Humana Medicare	$516.04
Rate for Payer: Kaiser Permanente Commercial	$611.10
Rate for Payer: Kaiser Permanente Medicaid	$346.29
Rate for Payer: Kaiser Permanente Medicare	$516.04
Rate for Payer: MDX Hawaii PPO	$658.63
Rate for Payer: Ohana Health Plan Medicaid	$516.04
Rate for Payer: Ohana Health Plan Medicare	$516.04
Rate for Payer: UnitedHealthcare Medicaid	$407.40
Rate for Payer: UnitedHealthcare Medicare	$516.04
Rate for Payer: University Health Alliance Commercial	$494.92

CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]

Facility

$679.00

Service Code	HCPCS J1410
Hospital Revenue Code	250
Min. Negotiated Rate	$577.15
Max. Negotiated Rate	$658.63
Rate for Payer: Cash Price	$407.40
Rate for Payer: Health Management Network Commercial	$577.15
Rate for Payer: Kaiser Permanente Commercial	$611.10
Rate for Payer: MDX Hawaii PPO	$658.63

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$34,652.32

Service Code	MSDRG 546
Min. Negotiated Rate	$34,652.32
Max. Negotiated Rate	$34,652.32
Rate for Payer: Hawaii Medical Service Association Commercial	$34,652.32

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$40,032.68

Service Code	MSDRG 545
Min. Negotiated Rate	$40,032.68
Max. Negotiated Rate	$40,032.68
Rate for Payer: Hawaii Medical Service Association Commercial	$40,032.68

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$29,295.67

Service Code	MSDRG 547
Min. Negotiated Rate	$29,295.67
Max. Negotiated Rate	$29,295.67
Rate for Payer: Hawaii Medical Service Association Commercial	$29,295.67

CONTAINE CHEST TUBE ATRIUM RVR

Facility

$213.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$127.80
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Kaiser Permanente Commercial	$191.70
Rate for Payer: MDX Hawaii PPO	$206.61

CONTAINE CHEST TUBE ATRIUM RVR

Facility

$213.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$206.61
Rate for Payer: AlohaCare Medicaid	$106.50
Rate for Payer: AlohaCare Medicare	$161.88
Rate for Payer: Cash Price	$127.80
Rate for Payer: Devoted Health Medicare	$178.92
Rate for Payer: Hawaii Medical Service Association Medicare	$161.88
Rate for Payer: Hawaii Western Management Group Commercial	$202.35
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Humana Medicare	$161.88
Rate for Payer: Kaiser Permanente Commercial	$191.70
Rate for Payer: Kaiser Permanente Medicaid	$108.63
Rate for Payer: Kaiser Permanente Medicare	$161.88
Rate for Payer: MDX Hawaii PPO	$206.61
Rate for Payer: Ohana Health Plan Medicaid	$161.88
Rate for Payer: Ohana Health Plan Medicare	$161.88
Rate for Payer: UnitedHealthcare Medicare	$161.88
Rate for Payer: University Health Alliance Commercial	$155.26

CONTIN LONGEVITY NEUTRAL LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTIN LONGEVITY NEUTRAL LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTINUUM 36X56 00-8752-012-36

Facility

$5,696.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,848.00
Max. Negotiated Rate	$5,525.12
Rate for Payer: AlohaCare Medicaid	$2,848.00
Rate for Payer: AlohaCare Medicare	$4,328.96
Rate for Payer: Cash Price	$3,417.60
Rate for Payer: Devoted Health Medicare	$4,784.64
Rate for Payer: Hawaii Medical Service Association Medicare	$4,328.96
Rate for Payer: Hawaii Western Management Group Commercial	$3,987.20
Rate for Payer: Health Management Network Commercial	$4,841.60
Rate for Payer: Humana Medicare	$4,328.96
Rate for Payer: Kaiser Permanente Commercial	$5,126.40
Rate for Payer: Kaiser Permanente Medicaid	$2,904.96
Rate for Payer: Kaiser Permanente Medicare	$4,328.96
Rate for Payer: MDX Hawaii PPO	$5,525.12
Rate for Payer: Ohana Health Plan Medicaid	$4,328.96
Rate for Payer: Ohana Health Plan Medicare	$4,328.96
Rate for Payer: UnitedHealthcare Medicare	$4,328.96
Rate for Payer: University Health Alliance Commercial	$3,189.76

CONTINUUM 36X56 00-8752-012-36

Facility

$5,696.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,189.76
Max. Negotiated Rate	$5,525.12
Rate for Payer: Cash Price	$3,417.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,987.20
Rate for Payer: Health Management Network Commercial	$4,841.60
Rate for Payer: Kaiser Permanente Commercial	$5,126.40
Rate for Payer: MDX Hawaii PPO	$5,525.12
Rate for Payer: University Health Alliance Commercial	$3,189.76

CONTINUUM 36X58 00-8752-013-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTINUUM 36X58 00-8752-013-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTINUUM LINER 00-8752-015-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTINUUM LINER 00-8752-015-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTINUUM LONGEVITY LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	272
Min. Negotiated Rate	$2,380.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00

CONTINUUM LONGEVITY LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	272
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$2,040.92

CONT LONGEVITY ELEVATED LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONT LONGEVITY ELEVATED LINER

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONT LONGEVITY NEUT LINE HH

Facility

$2,642.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,321.00
Max. Negotiated Rate	$2,562.74
Rate for Payer: AlohaCare Medicaid	$1,321.00
Rate for Payer: AlohaCare Medicare	$2,007.92
Rate for Payer: Cash Price	$1,585.20
Rate for Payer: Devoted Health Medicare	$2,219.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,007.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,849.40
Rate for Payer: Health Management Network Commercial	$2,245.70
Rate for Payer: Humana Medicare	$2,007.92
Rate for Payer: Kaiser Permanente Commercial	$2,377.80
Rate for Payer: Kaiser Permanente Medicaid	$1,347.42
Rate for Payer: Kaiser Permanente Medicare	$2,007.92
Rate for Payer: MDX Hawaii PPO	$2,562.74
Rate for Payer: Ohana Health Plan Medicaid	$2,007.92
Rate for Payer: Ohana Health Plan Medicare	$2,007.92
Rate for Payer: UnitedHealthcare Medicare	$2,007.92
Rate for Payer: University Health Alliance Commercial	$1,479.52

CONT LONGEVITY NEUT LINE HH

Facility

$2,642.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.52
Max. Negotiated Rate	$2,562.74
Rate for Payer: Cash Price	$1,585.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,849.40
Rate for Payer: Health Management Network Commercial	$2,245.70
Rate for Payer: Kaiser Permanente Commercial	$2,377.80
Rate for Payer: MDX Hawaii PPO	$2,562.74
Rate for Payer: University Health Alliance Commercial	$1,479.52

Know your out-of-pocket cost for care.

All Charges