Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]

Facility

$2.00

Service Code	HCPCS J7613
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: MDX Hawaii PPO	$4.85

ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP [252]

Facility

$209.00

Service Code	NDC 70752010212
Hospital Revenue Code	250
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$125.40
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: MDX Hawaii PPO	$202.73

ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP [252]

Facility

$209.00

Service Code	NDC 70752010212
Hospital Revenue Code	637
Min. Negotiated Rate	$104.50
Max. Negotiated Rate	$202.73
Rate for Payer: AlohaCare Medicaid	$104.50
Rate for Payer: AlohaCare Medicare	$158.84
Rate for Payer: Cash Price	$125.40
Rate for Payer: Devoted Health Medicare	$175.56
Rate for Payer: Hawaii Medical Service Association Medicare	$158.84
Rate for Payer: Hawaii Western Management Group Commercial	$198.55
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Humana Medicare	$158.84
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: Kaiser Permanente Medicaid	$106.59
Rate for Payer: Kaiser Permanente Medicare	$158.84
Rate for Payer: MDX Hawaii PPO	$202.73
Rate for Payer: Ohana Health Plan Medicaid	$158.84
Rate for Payer: Ohana Health Plan Medicare	$158.84
Rate for Payer: UnitedHealthcare Medicare	$158.84
Rate for Payer: University Health Alliance Commercial	$152.34

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION [170439]

Facility

$4.00

Service Code	HCPCS J7611
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicaid	$2.40
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION [170439]

Facility

$4.00

Service Code	HCPCS J7611
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]

Facility

$18.00

Service Code	HCPCS J7611
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]

Facility

$18.00

Service Code	HCPCS J7611
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$13.68
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Devoted Health Medicare	$15.12
Rate for Payer: Hawaii Medical Service Association ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Medicare	$13.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$13.68
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$13.68
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$13.68
Rate for Payer: Ohana Health Plan Medicare	$13.68
Rate for Payer: UnitedHealthcare Medicaid	$10.80
Rate for Payer: UnitedHealthcare Medicare	$13.68
Rate for Payer: University Health Alliance Commercial	$13.12

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

$135.00

Service Code	NDC 00781729685
Hospital Revenue Code	250
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Kaiser Permanente Commercial	$121.50
Rate for Payer: MDX Hawaii PPO	$130.95

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

$135.00

Service Code	NDC 00781729685
Hospital Revenue Code	637
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$130.95
Rate for Payer: AlohaCare Medicaid	$67.50
Rate for Payer: AlohaCare Medicare	$102.60
Rate for Payer: Cash Price	$81.00
Rate for Payer: Devoted Health Medicare	$113.40
Rate for Payer: Hawaii Medical Service Association Medicare	$102.60
Rate for Payer: Hawaii Western Management Group Commercial	$128.25
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$102.60
Rate for Payer: Kaiser Permanente Commercial	$121.50
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$102.60
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$102.60
Rate for Payer: Ohana Health Plan Medicare	$102.60
Rate for Payer: UnitedHealthcare Medicare	$102.60
Rate for Payer: University Health Alliance Commercial	$98.40

ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$8,461.61

Service Code	MSDRG 894
Min. Negotiated Rate	$8,461.61
Max. Negotiated Rate	$8,461.61
Rate for Payer: Hawaii Medical Service Association Commercial	$8,461.61

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$22,588.01

Service Code	MSDRG 896
Min. Negotiated Rate	$22,588.01
Max. Negotiated Rate	$22,588.01
Rate for Payer: Hawaii Medical Service Association Commercial	$22,588.01

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$14,410.82

Service Code	MSDRG 897
Min. Negotiated Rate	$14,410.82
Max. Negotiated Rate	$14,410.82
Rate for Payer: Hawaii Medical Service Association Commercial	$14,410.82

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$22,588.01

Service Code	MSDRG 895
Min. Negotiated Rate	$22,588.01
Max. Negotiated Rate	$22,588.01
Rate for Payer: Hawaii Medical Service Association Commercial	$22,588.01

ALENDRONATE 70 MG TABLET [29048]

Facility

$52.00

Service Code	NDC 64980034214
Hospital Revenue Code	637
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$50.44
Rate for Payer: AlohaCare Medicaid	$26.00
Rate for Payer: AlohaCare Medicare	$39.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Devoted Health Medicare	$43.68
Rate for Payer: Hawaii Medical Service Association Medicare	$39.52
Rate for Payer: Hawaii Western Management Group Commercial	$49.40
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Humana Medicare	$39.52
Rate for Payer: Kaiser Permanente Commercial	$46.80
Rate for Payer: Kaiser Permanente Medicaid	$26.52
Rate for Payer: Kaiser Permanente Medicare	$39.52
Rate for Payer: MDX Hawaii PPO	$50.44
Rate for Payer: Ohana Health Plan Medicaid	$39.52
Rate for Payer: Ohana Health Plan Medicare	$39.52
Rate for Payer: UnitedHealthcare Medicare	$39.52
Rate for Payer: University Health Alliance Commercial	$37.90

ALENDRONATE 70 MG TABLET [29048]

Facility

$52.00

Service Code	NDC 65862032904
Hospital Revenue Code	637
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$50.44
Rate for Payer: AlohaCare Medicaid	$26.00
Rate for Payer: AlohaCare Medicare	$39.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Devoted Health Medicare	$43.68
Rate for Payer: Hawaii Medical Service Association Medicare	$39.52
Rate for Payer: Hawaii Western Management Group Commercial	$49.40
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Humana Medicare	$39.52
Rate for Payer: Kaiser Permanente Commercial	$46.80
Rate for Payer: Kaiser Permanente Medicaid	$26.52
Rate for Payer: Kaiser Permanente Medicare	$39.52
Rate for Payer: MDX Hawaii PPO	$50.44
Rate for Payer: Ohana Health Plan Medicaid	$39.52
Rate for Payer: Ohana Health Plan Medicare	$39.52
Rate for Payer: UnitedHealthcare Medicare	$39.52
Rate for Payer: University Health Alliance Commercial	$37.90

ALENDRONATE 70 MG TABLET [29048]

Facility

$52.00

Service Code	NDC 64980034214
Hospital Revenue Code	250
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$31.20
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Kaiser Permanente Commercial	$46.80
Rate for Payer: MDX Hawaii PPO	$50.44

ALENDRONATE 70 MG TABLET [29048]

Facility

$52.00

Service Code	NDC 65862032904
Hospital Revenue Code	250
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$31.20
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Kaiser Permanente Commercial	$46.80
Rate for Payer: MDX Hawaii PPO	$50.44

ALEXIS CONTAINED EXTRACT GTB17

Facility

$1,278.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,086.30
Max. Negotiated Rate	$1,239.66
Rate for Payer: Cash Price	$766.80
Rate for Payer: Health Management Network Commercial	$1,086.30
Rate for Payer: Kaiser Permanente Commercial	$1,150.20
Rate for Payer: MDX Hawaii PPO	$1,239.66

ALEXIS CONTAINED EXTRACT GTB17

Facility

$1,278.00

Hospital Revenue Code	272
Min. Negotiated Rate	$639.00
Max. Negotiated Rate	$1,239.66
Rate for Payer: AlohaCare Medicaid	$639.00
Rate for Payer: AlohaCare Medicare	$971.28
Rate for Payer: Cash Price	$766.80
Rate for Payer: Devoted Health Medicare	$1,073.52
Rate for Payer: Hawaii Medical Service Association Medicare	$971.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,214.10
Rate for Payer: Health Management Network Commercial	$1,086.30
Rate for Payer: Humana Medicare	$971.28
Rate for Payer: Kaiser Permanente Commercial	$1,150.20
Rate for Payer: Kaiser Permanente Medicaid	$651.78
Rate for Payer: Kaiser Permanente Medicare	$971.28
Rate for Payer: MDX Hawaii PPO	$1,239.66
Rate for Payer: Ohana Health Plan Medicaid	$971.28
Rate for Payer: Ohana Health Plan Medicare	$971.28
Rate for Payer: UnitedHealthcare Medicare	$971.28
Rate for Payer: University Health Alliance Commercial	$931.53

ALEXIS WOUND PROTECTOR C8322

Facility

$248.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$124.00
Rate for Payer: AlohaCare Medicare	$188.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Devoted Health Medicare	$208.32
Rate for Payer: Hawaii Medical Service Association Medicare	$188.48
Rate for Payer: Hawaii Western Management Group Commercial	$235.60
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$188.48
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$188.48
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$188.48
Rate for Payer: Ohana Health Plan Medicare	$188.48
Rate for Payer: UnitedHealthcare Medicare	$188.48
Rate for Payer: University Health Alliance Commercial	$180.77

ALEXIS WOUND PROTECTOR C8322

Facility

$248.00

Hospital Revenue Code	272
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$148.80
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: MDX Hawaii PPO	$240.56

ALLERGIC REACTIONS WITH MCC

Facility

$13,130.91

Service Code	MSDRG 915
Min. Negotiated Rate	$13,130.91
Max. Negotiated Rate	$13,130.91
Rate for Payer: Hawaii Medical Service Association Commercial	$13,130.91

ALLERGIC REACTIONS WITHOUT MCC

Facility

$13,130.91

Service Code	MSDRG 916
Min. Negotiated Rate	$13,130.91
Max. Negotiated Rate	$13,130.91
Rate for Payer: Hawaii Medical Service Association Commercial	$13,130.91

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$228,961.32

Service Code	MSDRG 014
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$228,961.32
Rate for Payer: Hawaii Medical Service Association Commercial	$228,961.32
Rate for Payer: University Health Alliance Commercial	$10,400.00

ALLOGRAFT 10.0X64 FGL10064

Facility

$7,040.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$3,942.40
Max. Negotiated Rate	$6,828.80
Rate for Payer: Cash Price	$4,224.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,928.00
Rate for Payer: Health Management Network Commercial	$5,984.00
Rate for Payer: Kaiser Permanente Commercial	$6,336.00
Rate for Payer: MDX Hawaii PPO	$6,828.80
Rate for Payer: University Health Alliance Commercial	$3,942.40

Know your out-of-pocket cost for care.

All Charges