Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]

Facility

$45.00

Service Code	HCPCS J0895
Hospital Revenue Code	636
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$43.65
Rate for Payer: AlohaCare Medicaid	$22.50
Rate for Payer: AlohaCare Medicare	$34.20
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Devoted Health Medicare	$37.80
Rate for Payer: Hawaii Medical Service Association ABD	$9.02
Rate for Payer: Hawaii Medical Service Association Medicare	$34.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.02
Rate for Payer: Hawaii Western Management Group Commercial	$42.75
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Humana Medicare	$34.20
Rate for Payer: Kaiser Permanente Commercial	$40.50
Rate for Payer: Kaiser Permanente Medicaid	$22.95
Rate for Payer: Kaiser Permanente Medicare	$34.20
Rate for Payer: MDX Hawaii PPO	$43.65
Rate for Payer: Ohana Health Plan Medicaid	$34.20
Rate for Payer: Ohana Health Plan Medicare	$34.20
Rate for Payer: UnitedHealthcare Medicaid	$27.00
Rate for Payer: UnitedHealthcare Medicare	$34.20
Rate for Payer: University Health Alliance Commercial	$32.80

DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]

Facility

$45.00

Service Code	HCPCS J0895
Hospital Revenue Code	250
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Kaiser Permanente Commercial	$40.50
Rate for Payer: MDX Hawaii PPO	$43.65

DEGARELIX 120 MG SUBCUTANEOUS SOLUTION [171653]

Facility

$1,372.00

Service Code	HCPCS J9155
Hospital Revenue Code	250
Min. Negotiated Rate	$1,166.20
Max. Negotiated Rate	$1,330.84
Rate for Payer: Cash Price	$823.20
Rate for Payer: Health Management Network Commercial	$1,166.20
Rate for Payer: Kaiser Permanente Commercial	$1,234.80
Rate for Payer: MDX Hawaii PPO	$1,330.84

DEGARELIX 120 MG SUBCUTANEOUS SOLUTION [171653]

Facility

$1,372.00

Service Code	HCPCS J9155
Hospital Revenue Code	636
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$1,330.84
Rate for Payer: AlohaCare Medicaid	$686.00
Rate for Payer: AlohaCare Medicare	$1,042.72
Rate for Payer: Cash Price	$823.20
Rate for Payer: Cash Price	$823.20
Rate for Payer: Devoted Health Medicare	$1,152.48
Rate for Payer: Hawaii Medical Service Association ABD	$4.36
Rate for Payer: Hawaii Medical Service Association Commercial	$5.58
Rate for Payer: Hawaii Medical Service Association Medicare	$1,042.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,303.40
Rate for Payer: Health Management Network Commercial	$1,166.20
Rate for Payer: Humana Medicare	$1,042.72
Rate for Payer: Kaiser Permanente Commercial	$1,234.80
Rate for Payer: Kaiser Permanente Medicaid	$699.72
Rate for Payer: Kaiser Permanente Medicare	$1,042.72
Rate for Payer: MDX Hawaii PPO	$1,330.84
Rate for Payer: Ohana Health Plan Medicaid	$1,042.72
Rate for Payer: Ohana Health Plan Medicare	$1,042.72
Rate for Payer: UnitedHealthcare Medicaid	$823.20
Rate for Payer: UnitedHealthcare Medicare	$1,042.72
Rate for Payer: University Health Alliance Commercial	$1,000.05

DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]

Facility

$880.00

Service Code	HCPCS J9155
Hospital Revenue Code	636
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$853.60
Rate for Payer: AlohaCare Medicaid	$440.00
Rate for Payer: AlohaCare Medicare	$668.80
Rate for Payer: Cash Price	$528.00
Rate for Payer: Cash Price	$528.00
Rate for Payer: Devoted Health Medicare	$739.20
Rate for Payer: Hawaii Medical Service Association ABD	$4.36
Rate for Payer: Hawaii Medical Service Association Commercial	$5.58
Rate for Payer: Hawaii Medical Service Association Medicare	$668.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.36
Rate for Payer: Hawaii Western Management Group Commercial	$836.00
Rate for Payer: Health Management Network Commercial	$748.00
Rate for Payer: Humana Medicare	$668.80
Rate for Payer: Kaiser Permanente Commercial	$792.00
Rate for Payer: Kaiser Permanente Medicaid	$448.80
Rate for Payer: Kaiser Permanente Medicare	$668.80
Rate for Payer: MDX Hawaii PPO	$853.60
Rate for Payer: Ohana Health Plan Medicaid	$668.80
Rate for Payer: Ohana Health Plan Medicare	$668.80
Rate for Payer: UnitedHealthcare Medicaid	$528.00
Rate for Payer: UnitedHealthcare Medicare	$668.80
Rate for Payer: University Health Alliance Commercial	$641.43

DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]

Facility

$880.00

Service Code	HCPCS J9155
Hospital Revenue Code	250
Min. Negotiated Rate	$748.00
Max. Negotiated Rate	$853.60
Rate for Payer: Cash Price	$528.00
Rate for Payer: Health Management Network Commercial	$748.00
Rate for Payer: Kaiser Permanente Commercial	$792.00
Rate for Payer: MDX Hawaii PPO	$853.60

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC

Facility

$25,835.18

Service Code	MSDRG 056
Min. Negotiated Rate	$25,835.18
Max. Negotiated Rate	$25,835.18
Rate for Payer: Hawaii Medical Service Association Commercial	$25,835.18

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC

Facility

$25,835.18

Service Code	MSDRG 057
Min. Negotiated Rate	$25,835.18
Max. Negotiated Rate	$25,835.18
Rate for Payer: Hawaii Medical Service Association Commercial	$25,835.18

DELIVERY NEEDLE 10GAX10CM

Facility

$282.00

Hospital Revenue Code	272
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$169.20
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Kaiser Permanente Commercial	$253.80
Rate for Payer: MDX Hawaii PPO	$273.54

DELIVERY NEEDLE 10GAX10CM

Facility

$282.00

Hospital Revenue Code	272
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$273.54
Rate for Payer: AlohaCare Medicaid	$141.00
Rate for Payer: AlohaCare Medicare	$214.32
Rate for Payer: Cash Price	$169.20
Rate for Payer: Devoted Health Medicare	$236.88
Rate for Payer: Hawaii Medical Service Association Medicare	$214.32
Rate for Payer: Hawaii Western Management Group Commercial	$267.90
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Humana Medicare	$214.32
Rate for Payer: Kaiser Permanente Commercial	$253.80
Rate for Payer: Kaiser Permanente Medicaid	$143.82
Rate for Payer: Kaiser Permanente Medicare	$214.32
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: Ohana Health Plan Medicaid	$214.32
Rate for Payer: Ohana Health Plan Medicare	$214.32
Rate for Payer: UnitedHealthcare Medicare	$214.32
Rate for Payer: University Health Alliance Commercial	$205.55

DEMECLOCYCLINE 150 MG TABLET [9726]

Facility

$29.00

Service Code	NDC 53746055401
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

DEMECLOCYCLINE 150 MG TABLET [9726]

Facility

$48.00

Service Code	NDC 42806014301
Hospital Revenue Code	637
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: AlohaCare Medicare	$36.48
Rate for Payer: Cash Price	$28.80
Rate for Payer: Devoted Health Medicare	$40.32
Rate for Payer: Hawaii Medical Service Association Medicare	$36.48
Rate for Payer: Hawaii Western Management Group Commercial	$45.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$36.48
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$36.48
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$36.48
Rate for Payer: Ohana Health Plan Medicare	$36.48
Rate for Payer: UnitedHealthcare Medicare	$36.48
Rate for Payer: University Health Alliance Commercial	$34.99

DEMECLOCYCLINE 150 MG TABLET [9726]

Facility

$29.00

Service Code	NDC 53746055401
Hospital Revenue Code	637
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$14.50
Rate for Payer: AlohaCare Medicare	$22.04
Rate for Payer: Cash Price	$17.40
Rate for Payer: Devoted Health Medicare	$24.36
Rate for Payer: Hawaii Medical Service Association Medicare	$22.04
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$22.04
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$22.04
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$22.04
Rate for Payer: Ohana Health Plan Medicare	$22.04
Rate for Payer: UnitedHealthcare Medicare	$22.04
Rate for Payer: University Health Alliance Commercial	$21.14

DEMECLOCYCLINE 150 MG TABLET [9726]

Facility

$48.00

Service Code	NDC 42806014301
Hospital Revenue Code	250
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56

DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]

Facility

$4,640.00

Service Code	HCPCS J0897
Hospital Revenue Code	250
Min. Negotiated Rate	$3,944.00
Max. Negotiated Rate	$4,500.80
Rate for Payer: Cash Price	$2,784.00
Rate for Payer: Health Management Network Commercial	$3,944.00
Rate for Payer: Kaiser Permanente Commercial	$4,176.00
Rate for Payer: MDX Hawaii PPO	$4,500.80

DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]

Facility

$4,640.00

Service Code	HCPCS J0897
Hospital Revenue Code	636
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$4,500.80
Rate for Payer: AlohaCare Medicaid	$2,320.00
Rate for Payer: AlohaCare Medicare	$3,526.40
Rate for Payer: Cash Price	$2,784.00
Rate for Payer: Cash Price	$2,784.00
Rate for Payer: Devoted Health Medicare	$3,897.60
Rate for Payer: Hawaii Medical Service Association ABD	$29.24
Rate for Payer: Hawaii Medical Service Association Commercial	$36.89
Rate for Payer: Hawaii Medical Service Association Medicare	$3,526.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.24
Rate for Payer: Hawaii Western Management Group Commercial	$4,408.00
Rate for Payer: Health Management Network Commercial	$3,944.00
Rate for Payer: Humana Medicare	$3,526.40
Rate for Payer: Kaiser Permanente Commercial	$4,176.00
Rate for Payer: Kaiser Permanente Medicaid	$2,366.40
Rate for Payer: Kaiser Permanente Medicare	$3,526.40
Rate for Payer: MDX Hawaii PPO	$4,500.80
Rate for Payer: Ohana Health Plan Medicaid	$3,526.40
Rate for Payer: Ohana Health Plan Medicare	$3,526.40
Rate for Payer: UnitedHealthcare Medicaid	$2,784.00
Rate for Payer: UnitedHealthcare Medicare	$3,526.40
Rate for Payer: University Health Alliance Commercial	$3,382.10

DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [166256]

Facility

$2,751.00

Service Code	HCPCS J0897
Hospital Revenue Code	250
Min. Negotiated Rate	$2,338.35
Max. Negotiated Rate	$2,668.47
Rate for Payer: Cash Price	$1,650.60
Rate for Payer: Health Management Network Commercial	$2,338.35
Rate for Payer: Kaiser Permanente Commercial	$2,475.90
Rate for Payer: MDX Hawaii PPO	$2,668.47

DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [166256]

Facility

$2,751.00

Service Code	HCPCS J0897
Hospital Revenue Code	636
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$2,668.47
Rate for Payer: AlohaCare Medicaid	$1,375.50
Rate for Payer: AlohaCare Medicare	$2,090.76
Rate for Payer: Cash Price	$1,650.60
Rate for Payer: Cash Price	$1,650.60
Rate for Payer: Devoted Health Medicare	$2,310.84
Rate for Payer: Hawaii Medical Service Association ABD	$29.24
Rate for Payer: Hawaii Medical Service Association Commercial	$36.89
Rate for Payer: Hawaii Medical Service Association Medicare	$2,090.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,613.45
Rate for Payer: Health Management Network Commercial	$2,338.35
Rate for Payer: Humana Medicare	$2,090.76
Rate for Payer: Kaiser Permanente Commercial	$2,475.90
Rate for Payer: Kaiser Permanente Medicaid	$1,403.01
Rate for Payer: Kaiser Permanente Medicare	$2,090.76
Rate for Payer: MDX Hawaii PPO	$2,668.47
Rate for Payer: Ohana Health Plan Medicaid	$2,090.76
Rate for Payer: Ohana Health Plan Medicare	$2,090.76
Rate for Payer: UnitedHealthcare Medicaid	$1,650.60
Rate for Payer: UnitedHealthcare Medicare	$2,090.76
Rate for Payer: University Health Alliance Commercial	$2,005.20

DENTAL AND ORAL DISEASES WITH CC

Facility

$19,933.38

Service Code	MSDRG 158
Min. Negotiated Rate	$19,933.38
Max. Negotiated Rate	$19,933.38
Rate for Payer: Hawaii Medical Service Association Commercial	$19,933.38

DENTAL AND ORAL DISEASES WITH MCC

Facility

$19,933.38

Service Code	MSDRG 157
Min. Negotiated Rate	$19,933.38
Max. Negotiated Rate	$19,933.38
Rate for Payer: Hawaii Medical Service Association Commercial	$19,933.38

DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$19,933.38

Service Code	MSDRG 159
Min. Negotiated Rate	$19,933.38
Max. Negotiated Rate	$19,933.38
Rate for Payer: Hawaii Medical Service Association Commercial	$19,933.38

DEPRESSIVE NEUROSES

Facility

$10,002.24

Service Code	MSDRG 881
Min. Negotiated Rate	$10,002.24
Max. Negotiated Rate	$10,002.24
Rate for Payer: Hawaii Medical Service Association Commercial	$10,002.24

DERMACLOSE RC KIT 204010-K

Facility

$2,997.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,498.50
Max. Negotiated Rate	$2,907.09
Rate for Payer: AlohaCare Medicaid	$1,498.50
Rate for Payer: AlohaCare Medicare	$2,277.72
Rate for Payer: Cash Price	$1,798.20
Rate for Payer: Devoted Health Medicare	$2,517.48
Rate for Payer: Hawaii Medical Service Association Medicare	$2,277.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,847.15
Rate for Payer: Health Management Network Commercial	$2,547.45
Rate for Payer: Humana Medicare	$2,277.72
Rate for Payer: Kaiser Permanente Commercial	$2,697.30
Rate for Payer: Kaiser Permanente Medicaid	$1,528.47
Rate for Payer: Kaiser Permanente Medicare	$2,277.72
Rate for Payer: MDX Hawaii PPO	$2,907.09
Rate for Payer: Ohana Health Plan Medicaid	$2,277.72
Rate for Payer: Ohana Health Plan Medicare	$2,277.72
Rate for Payer: UnitedHealthcare Medicare	$2,277.72
Rate for Payer: University Health Alliance Commercial	$2,184.51

DERMACLOSE RC KIT 204010-K

Facility

$2,997.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,547.45
Max. Negotiated Rate	$2,907.09
Rate for Payer: Cash Price	$1,798.20
Rate for Payer: Health Management Network Commercial	$2,547.45
Rate for Payer: Kaiser Permanente Commercial	$2,697.30
Rate for Payer: MDX Hawaii PPO	$2,907.09

DERMATOME BLADE 00-8800-000-10

Facility

$244.00

Hospital Revenue Code	272
Min. Negotiated Rate	$207.40
Max. Negotiated Rate	$236.68
Rate for Payer: Cash Price	$146.40
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Kaiser Permanente Commercial	$219.60
Rate for Payer: MDX Hawaii PPO	$236.68

Know your out-of-pocket cost for care.

All Charges