Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

DIGOXIN 125 MCG (0.125 MG) TABLET [2444]

Facility

$6.00

Service Code	NDC 60687085811
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

DIGOXIN 250 MCG (0.25 MG) TABLET [2445]

Facility

$6.00

Service Code	NDC 00904592261
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$4.56
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Hawaii Medical Service Association Medicare	$4.56
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$4.56
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$4.56
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$4.56
Rate for Payer: Ohana Health Plan Medicare	$4.56
Rate for Payer: UnitedHealthcare Medicare	$4.56
Rate for Payer: University Health Alliance Commercial	$4.37

DIGOXIN 250 MCG (0.25 MG) TABLET [2445]

Facility

$9.00

Service Code	NDC 00143124101
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

DIGOXIN 250 MCG (0.25 MG) TABLET [2445]

Facility

$6.00

Service Code	NDC 00904592261
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

DIGOXIN 250 MCG (0.25 MG) TABLET [2445]

Facility

$9.00

Service Code	NDC 00143124101
Hospital Revenue Code	637
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$6.84
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$6.84
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$6.84
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$6.84
Rate for Payer: Ohana Health Plan Medicare	$6.84
Rate for Payer: UnitedHealthcare Medicare	$6.84
Rate for Payer: University Health Alliance Commercial	$6.56

DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [2442]

Facility

$24.00

Service Code	HCPCS J1160
Hospital Revenue Code	250
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: MDX Hawaii PPO	$23.28

DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [2442]

Facility

$24.00

Service Code	HCPCS J1160
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$23.28
Rate for Payer: AlohaCare Medicaid	$12.00
Rate for Payer: AlohaCare Medicare	$18.24
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Devoted Health Medicare	$20.16
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Medicare	$18.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.00
Rate for Payer: Hawaii Western Management Group Commercial	$22.80
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Humana Medicare	$18.24
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: Kaiser Permanente Medicare	$18.24
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: Ohana Health Plan Medicaid	$18.24
Rate for Payer: Ohana Health Plan Medicare	$18.24
Rate for Payer: UnitedHealthcare Medicaid	$14.40
Rate for Payer: UnitedHealthcare Medicare	$18.24
Rate for Payer: University Health Alliance Commercial	$17.49

DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]

Facility

$252.00

Service Code	NDC 00054005746
Hospital Revenue Code	250
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$244.44
Rate for Payer: Cash Price	$151.20
Rate for Payer: Health Management Network Commercial	$214.20
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: MDX Hawaii PPO	$244.44

DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]

Facility

$224.00

Service Code	NDC 66689032702
Hospital Revenue Code	250
Min. Negotiated Rate	$190.40
Max. Negotiated Rate	$217.28
Rate for Payer: Cash Price	$134.40
Rate for Payer: Health Management Network Commercial	$190.40
Rate for Payer: Kaiser Permanente Commercial	$201.60
Rate for Payer: MDX Hawaii PPO	$217.28

DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]

Facility

$224.00

Service Code	NDC 66689032702
Hospital Revenue Code	637
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$217.28
Rate for Payer: AlohaCare Medicaid	$112.00
Rate for Payer: AlohaCare Medicare	$170.24
Rate for Payer: Cash Price	$134.40
Rate for Payer: Devoted Health Medicare	$188.16
Rate for Payer: Hawaii Medical Service Association Medicare	$170.24
Rate for Payer: Hawaii Western Management Group Commercial	$212.80
Rate for Payer: Health Management Network Commercial	$190.40
Rate for Payer: Humana Medicare	$170.24
Rate for Payer: Kaiser Permanente Commercial	$201.60
Rate for Payer: Kaiser Permanente Medicaid	$114.24
Rate for Payer: Kaiser Permanente Medicare	$170.24
Rate for Payer: MDX Hawaii PPO	$217.28
Rate for Payer: Ohana Health Plan Medicaid	$170.24
Rate for Payer: Ohana Health Plan Medicare	$170.24
Rate for Payer: UnitedHealthcare Medicare	$170.24
Rate for Payer: University Health Alliance Commercial	$163.27

DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]

Facility

$252.00

Service Code	NDC 00054005746
Hospital Revenue Code	637
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$244.44
Rate for Payer: AlohaCare Medicaid	$126.00
Rate for Payer: AlohaCare Medicare	$191.52
Rate for Payer: Cash Price	$151.20
Rate for Payer: Devoted Health Medicare	$211.68
Rate for Payer: Hawaii Medical Service Association Medicare	$191.52
Rate for Payer: Hawaii Western Management Group Commercial	$239.40
Rate for Payer: Health Management Network Commercial	$214.20
Rate for Payer: Humana Medicare	$191.52
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: Kaiser Permanente Medicaid	$128.52
Rate for Payer: Kaiser Permanente Medicare	$191.52
Rate for Payer: MDX Hawaii PPO	$244.44
Rate for Payer: Ohana Health Plan Medicaid	$191.52
Rate for Payer: Ohana Health Plan Medicare	$191.52
Rate for Payer: UnitedHealthcare Medicare	$191.52
Rate for Payer: University Health Alliance Commercial	$183.68

DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]

Facility

$6,469.00

Service Code	HCPCS J1162
Hospital Revenue Code	250
Min. Negotiated Rate	$5,498.65
Max. Negotiated Rate	$6,274.93
Rate for Payer: Cash Price	$3,881.40
Rate for Payer: Health Management Network Commercial	$5,498.65
Rate for Payer: Kaiser Permanente Commercial	$5,822.10
Rate for Payer: MDX Hawaii PPO	$6,274.93

DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]

Facility

$6,469.00

Service Code	HCPCS J1162
Hospital Revenue Code	636
Min. Negotiated Rate	$3,234.50
Max. Negotiated Rate	$6,458.74
Rate for Payer: AlohaCare Medicaid	$3,234.50
Rate for Payer: AlohaCare Medicare	$4,916.44
Rate for Payer: Cash Price	$3,881.40
Rate for Payer: Cash Price	$3,881.40
Rate for Payer: Devoted Health Medicare	$5,433.96
Rate for Payer: Hawaii Medical Service Association ABD	$4,968.58
Rate for Payer: Hawaii Medical Service Association Commercial	$6,458.74
Rate for Payer: Hawaii Medical Service Association Medicare	$4,916.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,968.58
Rate for Payer: Hawaii Western Management Group Commercial	$6,145.55
Rate for Payer: Health Management Network Commercial	$5,498.65
Rate for Payer: Humana Medicare	$4,916.44
Rate for Payer: Kaiser Permanente Commercial	$5,822.10
Rate for Payer: Kaiser Permanente Medicaid	$3,299.19
Rate for Payer: Kaiser Permanente Medicare	$4,916.44
Rate for Payer: MDX Hawaii PPO	$6,274.93
Rate for Payer: Ohana Health Plan Medicaid	$4,916.44
Rate for Payer: Ohana Health Plan Medicare	$4,916.44
Rate for Payer: UnitedHealthcare Medicaid	$3,881.40
Rate for Payer: UnitedHealthcare Medicare	$4,916.44
Rate for Payer: University Health Alliance Commercial	$4,715.25

DILATOR 28FR AMPLATZ

Facility

$207.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$175.95
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$124.20
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: MDX Hawaii PPO	$200.79

DILATOR 28FR AMPLATZ

Facility

$207.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$200.79
Rate for Payer: AlohaCare Medicaid	$103.50
Rate for Payer: AlohaCare Medicare	$157.32
Rate for Payer: Cash Price	$124.20
Rate for Payer: Devoted Health Medicare	$173.88
Rate for Payer: Hawaii Medical Service Association Medicare	$157.32
Rate for Payer: Hawaii Western Management Group Commercial	$196.65
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Humana Medicare	$157.32
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: Kaiser Permanente Medicaid	$105.57
Rate for Payer: Kaiser Permanente Medicare	$157.32
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: Ohana Health Plan Medicaid	$157.32
Rate for Payer: Ohana Health Plan Medicare	$157.32
Rate for Payer: UnitedHealthcare Medicare	$157.32
Rate for Payer: University Health Alliance Commercial	$150.88

DILATOR 30FR AMPLATZ

Facility

$207.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$200.79
Rate for Payer: AlohaCare Medicaid	$103.50
Rate for Payer: AlohaCare Medicare	$157.32
Rate for Payer: Cash Price	$124.20
Rate for Payer: Devoted Health Medicare	$173.88
Rate for Payer: Hawaii Medical Service Association Medicare	$157.32
Rate for Payer: Hawaii Western Management Group Commercial	$196.65
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Humana Medicare	$157.32
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: Kaiser Permanente Medicaid	$105.57
Rate for Payer: Kaiser Permanente Medicare	$157.32
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: Ohana Health Plan Medicaid	$157.32
Rate for Payer: Ohana Health Plan Medicare	$157.32
Rate for Payer: UnitedHealthcare Medicare	$157.32
Rate for Payer: University Health Alliance Commercial	$150.88

DILATOR 30FR AMPLATZ

Facility

$207.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$175.95
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$124.20
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: MDX Hawaii PPO	$200.79

DILATOR 5.5 F.THREAD 72203952

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$665.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$735.00
Rate for Payer: Hawaii Medical Service Association Medicare	$665.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$665.00
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$665.00
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$665.00
Rate for Payer: Ohana Health Plan Medicare	$665.00
Rate for Payer: UnitedHealthcare Medicare	$665.00
Rate for Payer: University Health Alliance Commercial	$637.79

DILATOR 5.5 F.THREAD 72203952

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75

DILATOR 8-24FR URETHRAL

Facility

$936.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$795.60
Max. Negotiated Rate	$907.92
Rate for Payer: Cash Price	$561.60
Rate for Payer: Health Management Network Commercial	$795.60
Rate for Payer: Kaiser Permanente Commercial	$842.40
Rate for Payer: MDX Hawaii PPO	$907.92

DILATOR 8-24FR URETHRAL

Facility

$936.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$468.00
Max. Negotiated Rate	$907.92
Rate for Payer: AlohaCare Medicaid	$468.00
Rate for Payer: AlohaCare Medicare	$711.36
Rate for Payer: Cash Price	$561.60
Rate for Payer: Devoted Health Medicare	$786.24
Rate for Payer: Hawaii Medical Service Association Medicare	$711.36
Rate for Payer: Hawaii Western Management Group Commercial	$889.20
Rate for Payer: Health Management Network Commercial	$795.60
Rate for Payer: Humana Medicare	$711.36
Rate for Payer: Kaiser Permanente Commercial	$842.40
Rate for Payer: Kaiser Permanente Medicaid	$477.36
Rate for Payer: Kaiser Permanente Medicare	$711.36
Rate for Payer: MDX Hawaii PPO	$907.92
Rate for Payer: Ohana Health Plan Medicaid	$711.36
Rate for Payer: Ohana Health Plan Medicare	$711.36
Rate for Payer: UnitedHealthcare Medicare	$711.36
Rate for Payer: University Health Alliance Commercial	$682.25

DILATOR 9-16MM SET

Facility

$1,324.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,125.40
Max. Negotiated Rate	$1,284.28
Rate for Payer: Cash Price	$794.40
Rate for Payer: Health Management Network Commercial	$1,125.40
Rate for Payer: Kaiser Permanente Commercial	$1,191.60
Rate for Payer: MDX Hawaii PPO	$1,284.28

DILATOR 9-16MM SET

Facility

$1,324.00

Hospital Revenue Code	272
Min. Negotiated Rate	$662.00
Max. Negotiated Rate	$1,284.28
Rate for Payer: AlohaCare Medicaid	$662.00
Rate for Payer: AlohaCare Medicare	$1,006.24
Rate for Payer: Cash Price	$794.40
Rate for Payer: Devoted Health Medicare	$1,112.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,006.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,257.80
Rate for Payer: Health Management Network Commercial	$1,125.40
Rate for Payer: Humana Medicare	$1,006.24
Rate for Payer: Kaiser Permanente Commercial	$1,191.60
Rate for Payer: Kaiser Permanente Medicaid	$675.24
Rate for Payer: Kaiser Permanente Medicare	$1,006.24
Rate for Payer: MDX Hawaii PPO	$1,284.28
Rate for Payer: Ohana Health Plan Medicaid	$1,006.24
Rate for Payer: Ohana Health Plan Medicare	$1,006.24
Rate for Payer: UnitedHealthcare Medicare	$1,006.24
Rate for Payer: University Health Alliance Commercial	$965.06

DILATOR AMPLATZ RENAL

Facility

$921.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$460.50
Max. Negotiated Rate	$893.37
Rate for Payer: AlohaCare Medicaid	$460.50
Rate for Payer: AlohaCare Medicare	$699.96
Rate for Payer: Cash Price	$552.60
Rate for Payer: Devoted Health Medicare	$773.64
Rate for Payer: Hawaii Medical Service Association Medicare	$699.96
Rate for Payer: Hawaii Western Management Group Commercial	$874.95
Rate for Payer: Health Management Network Commercial	$782.85
Rate for Payer: Humana Medicare	$699.96
Rate for Payer: Kaiser Permanente Commercial	$828.90
Rate for Payer: Kaiser Permanente Medicaid	$469.71
Rate for Payer: Kaiser Permanente Medicare	$699.96
Rate for Payer: MDX Hawaii PPO	$893.37
Rate for Payer: Ohana Health Plan Medicaid	$699.96
Rate for Payer: Ohana Health Plan Medicare	$699.96
Rate for Payer: UnitedHealthcare Medicare	$699.96
Rate for Payer: University Health Alliance Commercial	$671.32

DILATOR AMPLATZ RENAL

Facility

$921.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$782.85
Max. Negotiated Rate	$893.37
Rate for Payer: Cash Price	$552.60
Rate for Payer: Health Management Network Commercial	$782.85
Rate for Payer: Kaiser Permanente Commercial	$828.90
Rate for Payer: MDX Hawaii PPO	$893.37

Know your out-of-pocket cost for care.

All Charges