Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

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

DESFLURANE 100 % INHALATION LIQUID [9747]

Facility

$289.00

Service Code	NDC 10019064134
Hospital Revenue Code	250
Min. Negotiated Rate	$245.65
Max. Negotiated Rate	$280.33
Rate for Payer: Cash Price	$173.40
Rate for Payer: Health Management Network Commercial	$245.65
Rate for Payer: Kaiser Permanente Commercial	$260.10
Rate for Payer: MDX Hawaii PPO	$280.33

DESFLURANE 100 % INHALATION LIQUID [9747]

Facility

$271.00

Service Code	NDC 00781617286
Hospital Revenue Code	250
Min. Negotiated Rate	$230.35
Max. Negotiated Rate	$262.87
Rate for Payer: Cash Price	$162.60
Rate for Payer: Health Management Network Commercial	$230.35
Rate for Payer: Kaiser Permanente Commercial	$243.90
Rate for Payer: MDX Hawaii PPO	$262.87

DESFLURANE 100 % INHALATION LIQUID [9747]

Facility

$289.00

Service Code	NDC 10019064164
Hospital Revenue Code	250
Min. Negotiated Rate	$245.65
Max. Negotiated Rate	$280.33
Rate for Payer: Cash Price	$173.40
Rate for Payer: Health Management Network Commercial	$245.65
Rate for Payer: Kaiser Permanente Commercial	$260.10
Rate for Payer: MDX Hawaii PPO	$280.33

DESIPRAMINE 25 MG TABLET [2286]

Facility

$8.00

Service Code	NDC 69238105501
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

DESIPRAMINE 25 MG TABLET [2286]

Facility

$8.00

Service Code	NDC 69238105501
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83

DESIPRAMINE 25 MG TABLET [2286]

Facility

$8.00

Service Code	NDC 50742011301
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83

DESIPRAMINE 25 MG TABLET [2286]

Facility

$8.00

Service Code	NDC 50742011301
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

DESMOPRESSIN 0.1 MG TABLET [16052]

Facility

$11.00

Service Code	NDC 68001057400
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: MDX Hawaii PPO	$10.67

DESMOPRESSIN 0.1 MG TABLET [16052]

Facility

$11.00

Service Code	NDC 68001057400
Hospital Revenue Code	637
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$10.67
Rate for Payer: AlohaCare Medicaid	$5.50
Rate for Payer: AlohaCare Medicare	$8.36
Rate for Payer: Cash Price	$6.60
Rate for Payer: Devoted Health Medicare	$9.24
Rate for Payer: Hawaii Medical Service Association Medicare	$8.36
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Humana Medicare	$8.36
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: Kaiser Permanente Medicare	$8.36
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: Ohana Health Plan Medicaid	$8.36
Rate for Payer: Ohana Health Plan Medicare	$8.36
Rate for Payer: UnitedHealthcare Medicare	$8.36
Rate for Payer: University Health Alliance Commercial	$8.02

DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]

Facility

$616.00

Service Code	NDC 24208034205
Hospital Revenue Code	637
Min. Negotiated Rate	$308.00
Max. Negotiated Rate	$597.52
Rate for Payer: AlohaCare Medicaid	$308.00
Rate for Payer: AlohaCare Medicare	$468.16
Rate for Payer: Cash Price	$369.60
Rate for Payer: Devoted Health Medicare	$517.44
Rate for Payer: Hawaii Medical Service Association Medicare	$468.16
Rate for Payer: Hawaii Western Management Group Commercial	$585.20
Rate for Payer: Health Management Network Commercial	$523.60
Rate for Payer: Humana Medicare	$468.16
Rate for Payer: Kaiser Permanente Commercial	$554.40
Rate for Payer: Kaiser Permanente Medicaid	$314.16
Rate for Payer: Kaiser Permanente Medicare	$468.16
Rate for Payer: MDX Hawaii PPO	$597.52
Rate for Payer: Ohana Health Plan Medicaid	$468.16
Rate for Payer: Ohana Health Plan Medicare	$468.16
Rate for Payer: UnitedHealthcare Medicare	$468.16
Rate for Payer: University Health Alliance Commercial	$449.00

DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]

Facility

$616.00

Service Code	NDC 24208034205
Hospital Revenue Code	250
Min. Negotiated Rate	$523.60
Max. Negotiated Rate	$597.52
Rate for Payer: Cash Price	$369.60
Rate for Payer: Health Management Network Commercial	$523.60
Rate for Payer: Kaiser Permanente Commercial	$554.40
Rate for Payer: MDX Hawaii PPO	$597.52

DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]

Facility

$1,185.00

Service Code	HCPCS J2597
Hospital Revenue Code	636
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$1,149.45
Rate for Payer: AlohaCare Medicaid	$592.50
Rate for Payer: AlohaCare Medicaid	$184.00
Rate for Payer: AlohaCare Medicaid	$57.00
Rate for Payer: AlohaCare Medicaid	$225.00
Rate for Payer: AlohaCare Medicare	$342.00
Rate for Payer: AlohaCare Medicare	$86.64
Rate for Payer: AlohaCare Medicare	$900.60
Rate for Payer: AlohaCare Medicare	$279.68
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$711.00
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$711.00
Rate for Payer: Cash Price	$220.80
Rate for Payer: Devoted Health Medicare	$309.12
Rate for Payer: Devoted Health Medicare	$995.40
Rate for Payer: Devoted Health Medicare	$378.00
Rate for Payer: Devoted Health Medicare	$95.76
Rate for Payer: Hawaii Medical Service Association ABD	$3.89
Rate for Payer: Hawaii Medical Service Association ABD	$3.89
Rate for Payer: Hawaii Medical Service Association ABD	$3.89
Rate for Payer: Hawaii Medical Service Association ABD	$3.89
Rate for Payer: Hawaii Medical Service Association Medicare	$86.64
Rate for Payer: Hawaii Medical Service Association Medicare	$342.00
Rate for Payer: Hawaii Medical Service Association Medicare	$279.68
Rate for Payer: Hawaii Medical Service Association Medicare	$900.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.89
Rate for Payer: Hawaii Western Management Group Commercial	$427.50
Rate for Payer: Hawaii Western Management Group Commercial	$349.60
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,125.75
Rate for Payer: Health Management Network Commercial	$312.80
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$1,007.25
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Humana Medicare	$86.64
Rate for Payer: Humana Medicare	$279.68
Rate for Payer: Humana Medicare	$900.60
Rate for Payer: Humana Medicare	$342.00
Rate for Payer: Kaiser Permanente Commercial	$331.20
Rate for Payer: Kaiser Permanente Commercial	$1,066.50
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: Kaiser Permanente Medicaid	$604.35
Rate for Payer: Kaiser Permanente Medicaid	$187.68
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: Kaiser Permanente Medicare	$279.68
Rate for Payer: Kaiser Permanente Medicare	$86.64
Rate for Payer: Kaiser Permanente Medicare	$342.00
Rate for Payer: Kaiser Permanente Medicare	$900.60
Rate for Payer: MDX Hawaii PPO	$356.96
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: MDX Hawaii PPO	$1,149.45
Rate for Payer: Ohana Health Plan Medicaid	$900.60
Rate for Payer: Ohana Health Plan Medicaid	$279.68
Rate for Payer: Ohana Health Plan Medicaid	$86.64
Rate for Payer: Ohana Health Plan Medicaid	$342.00
Rate for Payer: Ohana Health Plan Medicare	$342.00
Rate for Payer: Ohana Health Plan Medicare	$279.68
Rate for Payer: Ohana Health Plan Medicare	$900.60
Rate for Payer: Ohana Health Plan Medicare	$86.64
Rate for Payer: UnitedHealthcare Medicaid	$711.00
Rate for Payer: UnitedHealthcare Medicaid	$220.80
Rate for Payer: UnitedHealthcare Medicaid	$68.40
Rate for Payer: UnitedHealthcare Medicaid	$270.00
Rate for Payer: UnitedHealthcare Medicare	$86.64
Rate for Payer: UnitedHealthcare Medicare	$279.68
Rate for Payer: UnitedHealthcare Medicare	$342.00
Rate for Payer: UnitedHealthcare Medicare	$900.60
Rate for Payer: University Health Alliance Commercial	$83.09
Rate for Payer: University Health Alliance Commercial	$863.75
Rate for Payer: University Health Alliance Commercial	$268.24
Rate for Payer: University Health Alliance Commercial	$328.00

DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]

Facility

$1,185.00

Service Code	HCPCS J2597
Hospital Revenue Code	250
Min. Negotiated Rate	$1,007.25
Max. Negotiated Rate	$1,149.45
Rate for Payer: Cash Price	$711.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$1,007.25
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$312.80
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: Kaiser Permanente Commercial	$1,066.50
Rate for Payer: Kaiser Permanente Commercial	$331.20
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: MDX Hawaii PPO	$1,149.45
Rate for Payer: MDX Hawaii PPO	$356.96

DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]

Facility

$204.00

Service Code	NDC 45802049535
Hospital Revenue Code	637
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$102.00
Rate for Payer: AlohaCare Medicare	$155.04
Rate for Payer: Cash Price	$122.40
Rate for Payer: Devoted Health Medicare	$171.36
Rate for Payer: Hawaii Medical Service Association Medicare	$155.04
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$155.04
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$155.04
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$155.04
Rate for Payer: Ohana Health Plan Medicare	$155.04
Rate for Payer: UnitedHealthcare Medicare	$155.04
Rate for Payer: University Health Alliance Commercial	$148.70

DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]

Facility

$204.00

Service Code	NDC 45802049535
Hospital Revenue Code	250
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$197.88

DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]

Facility

$304.00

Service Code	NDC 51672127001
Hospital Revenue Code	250
Min. Negotiated Rate	$258.40
Max. Negotiated Rate	$294.88
Rate for Payer: Cash Price	$182.40
Rate for Payer: Health Management Network Commercial	$258.40
Rate for Payer: Kaiser Permanente Commercial	$273.60
Rate for Payer: MDX Hawaii PPO	$294.88

DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]

Facility

$304.00

Service Code	NDC 51672127001
Hospital Revenue Code	637
Min. Negotiated Rate	$152.00
Max. Negotiated Rate	$294.88
Rate for Payer: AlohaCare Medicaid	$152.00
Rate for Payer: AlohaCare Medicare	$231.04
Rate for Payer: Cash Price	$182.40
Rate for Payer: Devoted Health Medicare	$255.36
Rate for Payer: Hawaii Medical Service Association Medicare	$231.04
Rate for Payer: Hawaii Western Management Group Commercial	$288.80
Rate for Payer: Health Management Network Commercial	$258.40
Rate for Payer: Humana Medicare	$231.04
Rate for Payer: Kaiser Permanente Commercial	$273.60
Rate for Payer: Kaiser Permanente Medicaid	$155.04
Rate for Payer: Kaiser Permanente Medicare	$231.04
Rate for Payer: MDX Hawaii PPO	$294.88
Rate for Payer: Ohana Health Plan Medicaid	$231.04
Rate for Payer: Ohana Health Plan Medicare	$231.04
Rate for Payer: UnitedHealthcare Medicare	$231.04
Rate for Payer: University Health Alliance Commercial	$221.59

DESOXIMETASONE 0.25 % TOPICAL OINTMENT [9753]

Facility

$210.00

Service Code	NDC 45802049696
Hospital Revenue Code	250
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$203.70
Rate for Payer: Cash Price	$126.00
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Kaiser Permanente Commercial	$189.00
Rate for Payer: MDX Hawaii PPO	$203.70

DESOXIMETASONE 0.25 % TOPICAL OINTMENT [9753]

Facility

$210.00

Service Code	NDC 45802049696
Hospital Revenue Code	637
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$203.70
Rate for Payer: AlohaCare Medicaid	$105.00
Rate for Payer: AlohaCare Medicare	$159.60
Rate for Payer: Cash Price	$126.00
Rate for Payer: Devoted Health Medicare	$176.40
Rate for Payer: Hawaii Medical Service Association Medicare	$159.60
Rate for Payer: Hawaii Western Management Group Commercial	$199.50
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Humana Medicare	$159.60
Rate for Payer: Kaiser Permanente Commercial	$189.00
Rate for Payer: Kaiser Permanente Medicaid	$107.10
Rate for Payer: Kaiser Permanente Medicare	$159.60
Rate for Payer: MDX Hawaii PPO	$203.70
Rate for Payer: Ohana Health Plan Medicaid	$159.60
Rate for Payer: Ohana Health Plan Medicare	$159.60
Rate for Payer: UnitedHealthcare Medicare	$159.60
Rate for Payer: University Health Alliance Commercial	$153.07

DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR [2319]

Facility

$126.00

Service Code	HCPCS J8540
Hospital Revenue Code	250
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR [2319]

Facility

$126.00

Service Code	HCPCS J8540
Hospital Revenue Code	637
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Hawaii Medical Service Association ABD	$0.02
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.02
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicaid	$0.02
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$91.84

DEXAMETHASONE 0.5 MG TABLET [2322]

Facility

$1.00

Service Code	NDC 60505624901
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

DEXAMETHASONE 0.5 MG TABLET [2322]

Facility

$1.00

Service Code	NDC 00054817925
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

DEXAMETHASONE 40 MG IN 50 ML NS IVPB (SIMPLE) [4080503]

Facility

$36.00

Service Code	HCPCS J1100
Hospital Revenue Code	250
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92

Know your out-of-pocket cost for care.

All Charges