Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

FOOT PROCEDURES WITH CC

Facility

$23,227.96

Service Code	MSDRG 504
Min. Negotiated Rate	$23,227.96
Max. Negotiated Rate	$23,227.96
Rate for Payer: Hawaii Medical Service Association Commercial	$23,227.96

FOOT PROCEDURES WITH MCC

Facility

$23,227.96

Service Code	MSDRG 503
Min. Negotiated Rate	$23,227.96
Max. Negotiated Rate	$23,227.96
Rate for Payer: Hawaii Medical Service Association Commercial	$23,227.96

FOOT PROCEDURES WITHOUT CC/MCC

Facility

$23,227.96

Service Code	MSDRG 505
Min. Negotiated Rate	$23,227.96
Max. Negotiated Rate	$23,227.96
Rate for Payer: Hawaii Medical Service Association Commercial	$23,227.96

FORCEPS JEWEL BIPOLAR 20-1060

Facility

$206.00

Hospital Revenue Code	272
Min. Negotiated Rate	$103.00
Max. Negotiated Rate	$199.82
Rate for Payer: AlohaCare Medicaid	$103.00
Rate for Payer: AlohaCare Medicare	$156.56
Rate for Payer: Cash Price	$123.60
Rate for Payer: Devoted Health Medicare	$173.04
Rate for Payer: Hawaii Medical Service Association Medicare	$156.56
Rate for Payer: Hawaii Western Management Group Commercial	$195.70
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Humana Medicare	$156.56
Rate for Payer: Kaiser Permanente Commercial	$185.40
Rate for Payer: Kaiser Permanente Medicaid	$105.06
Rate for Payer: Kaiser Permanente Medicare	$156.56
Rate for Payer: MDX Hawaii PPO	$199.82
Rate for Payer: Ohana Health Plan Medicaid	$156.56
Rate for Payer: Ohana Health Plan Medicare	$156.56
Rate for Payer: UnitedHealthcare Medicare	$156.56
Rate for Payer: University Health Alliance Commercial	$150.15

FORCEPS JEWEL BIPOLAR 20-1060

Facility

$206.00

Hospital Revenue Code	272
Min. Negotiated Rate	$175.10
Max. Negotiated Rate	$199.82
Rate for Payer: Cash Price	$123.60
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Kaiser Permanente Commercial	$185.40
Rate for Payer: MDX Hawaii PPO	$199.82

FOSAPREPITANT 150 MG IN 250 ML NS IVPB-CNR (SIMPLE) [4080025]

Facility

$1,127.00

Service Code	HCPCS J1453
Hospital Revenue Code	250
Min. Negotiated Rate	$957.95
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: MDX Hawaii PPO	$1,093.19

FOSAPREPITANT 150 MG IN 250 ML NS IVPB-CNR (SIMPLE) [4080025]

Facility

$1,127.00

Service Code	HCPCS J1453
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$1,093.19
Rate for Payer: AlohaCare Medicaid	$563.50
Rate for Payer: AlohaCare Medicare	$856.52
Rate for Payer: Cash Price	$676.20
Rate for Payer: Cash Price	$676.20
Rate for Payer: Devoted Health Medicare	$946.68
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Medicare	$856.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Western Management Group Commercial	$1,070.65
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Humana Medicare	$856.52
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: Kaiser Permanente Medicare	$856.52
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: Ohana Health Plan Medicaid	$856.52
Rate for Payer: Ohana Health Plan Medicare	$856.52
Rate for Payer: UnitedHealthcare Medicaid	$676.20
Rate for Payer: UnitedHealthcare Medicare	$856.52
Rate for Payer: University Health Alliance Commercial	$821.47

FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]

Facility

$482.00

Service Code	HCPCS J1453
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$467.54
Rate for Payer: AlohaCare Medicaid	$241.00
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: AlohaCare Medicare	$366.32
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$289.20
Rate for Payer: Cash Price	$289.20
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Devoted Health Medicare	$404.88
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Medical Service Association Medicare	$366.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Hawaii Western Management Group Commercial	$457.90
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Health Management Network Commercial	$409.70
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Humana Medicare	$366.32
Rate for Payer: Kaiser Permanente Commercial	$433.80
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicaid	$245.82
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: Kaiser Permanente Medicare	$366.32
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: MDX Hawaii PPO	$467.54
Rate for Payer: Ohana Health Plan Medicaid	$366.32
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: Ohana Health Plan Medicare	$366.32
Rate for Payer: UnitedHealthcare Medicaid	$75.60
Rate for Payer: UnitedHealthcare Medicaid	$289.20
Rate for Payer: UnitedHealthcare Medicare	$366.32
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$91.84
Rate for Payer: University Health Alliance Commercial	$351.33

FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]

Facility

$126.00

Service Code	HCPCS J1453
Hospital Revenue Code	250
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$289.20
Rate for Payer: Health Management Network Commercial	$409.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Commercial	$433.80
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: MDX Hawaii PPO	$467.54

FOSAPREPITANT DIMEGLUMINE 150 MG/5ML IV (WET SOLR VIAL) [430106783]

Facility

$126.00

Service Code	HCPCS J1453
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicaid	$241.00
Rate for Payer: AlohaCare Medicaid	$207.50
Rate for Payer: AlohaCare Medicare	$315.40
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: AlohaCare Medicare	$366.32
Rate for Payer: Cash Price	$249.00
Rate for Payer: Cash Price	$289.20
Rate for Payer: Cash Price	$249.00
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$289.20
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Devoted Health Medicare	$404.88
Rate for Payer: Devoted Health Medicare	$348.60
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Medical Service Association Medicare	$366.32
Rate for Payer: Hawaii Medical Service Association Medicare	$315.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Western Management Group Commercial	$394.25
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Hawaii Western Management Group Commercial	$457.90
Rate for Payer: Health Management Network Commercial	$409.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Health Management Network Commercial	$352.75
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Humana Medicare	$315.40
Rate for Payer: Humana Medicare	$366.32
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Commercial	$373.50
Rate for Payer: Kaiser Permanente Commercial	$433.80
Rate for Payer: Kaiser Permanente Medicaid	$245.82
Rate for Payer: Kaiser Permanente Medicaid	$211.65
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: Kaiser Permanente Medicare	$315.40
Rate for Payer: Kaiser Permanente Medicare	$366.32
Rate for Payer: MDX Hawaii PPO	$467.54
Rate for Payer: MDX Hawaii PPO	$402.55
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$315.40
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicaid	$366.32
Rate for Payer: Ohana Health Plan Medicare	$315.40
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: Ohana Health Plan Medicare	$366.32
Rate for Payer: UnitedHealthcare Medicaid	$249.00
Rate for Payer: UnitedHealthcare Medicaid	$75.60
Rate for Payer: UnitedHealthcare Medicaid	$289.20
Rate for Payer: UnitedHealthcare Medicare	$315.40
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$366.32
Rate for Payer: University Health Alliance Commercial	$91.84
Rate for Payer: University Health Alliance Commercial	$302.49
Rate for Payer: University Health Alliance Commercial	$351.33

FOSAPREPITANT DIMEGLUMINE 150 MG/5ML IV (WET SOLR VIAL) [430106783]

Facility

$482.00

Service Code	HCPCS J1453
Hospital Revenue Code	250
Min. Negotiated Rate	$409.70
Max. Negotiated Rate	$467.54
Rate for Payer: Cash Price	$289.20
Rate for Payer: Cash Price	$249.00
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Health Management Network Commercial	$409.70
Rate for Payer: Health Management Network Commercial	$352.75
Rate for Payer: Kaiser Permanente Commercial	$373.50
Rate for Payer: Kaiser Permanente Commercial	$433.80
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$402.55
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: MDX Hawaii PPO	$467.54

FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]

Facility

$201.00

Service Code	NDC 69097057967
Hospital Revenue Code	250
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]

Facility

$201.00

Service Code	NDC 70700026899
Hospital Revenue Code	250
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]

Facility

$201.00

Service Code	NDC 69097057967
Hospital Revenue Code	637
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$152.76
Rate for Payer: Cash Price	$120.60
Rate for Payer: Devoted Health Medicare	$168.84
Rate for Payer: Hawaii Medical Service Association Medicare	$152.76
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$152.76
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$152.76
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$152.76
Rate for Payer: Ohana Health Plan Medicare	$152.76
Rate for Payer: UnitedHealthcare Medicare	$152.76
Rate for Payer: University Health Alliance Commercial	$146.51

FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]

Facility

$201.00

Service Code	NDC 70700026899
Hospital Revenue Code	637
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$152.76
Rate for Payer: Cash Price	$120.60
Rate for Payer: Devoted Health Medicare	$168.84
Rate for Payer: Hawaii Medical Service Association Medicare	$152.76
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$152.76
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$152.76
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$152.76
Rate for Payer: Ohana Health Plan Medicare	$152.76
Rate for Payer: UnitedHealthcare Medicare	$152.76
Rate for Payer: University Health Alliance Commercial	$146.51

FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]

Facility

$201.00

Service Code	NDC 70700026894
Hospital Revenue Code	637
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$152.76
Rate for Payer: Cash Price	$120.60
Rate for Payer: Devoted Health Medicare	$168.84
Rate for Payer: Hawaii Medical Service Association Medicare	$152.76
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$152.76
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$152.76
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$152.76
Rate for Payer: Ohana Health Plan Medicare	$152.76
Rate for Payer: UnitedHealthcare Medicare	$152.76
Rate for Payer: University Health Alliance Commercial	$146.51

FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]

Facility

$201.00

Service Code	NDC 70700026894
Hospital Revenue Code	250
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]

Facility

$122.00

Service Code	NDC 00069600125
Hospital Revenue Code	250
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$73.20
Rate for Payer: Cash Price	$156.60
Rate for Payer: Health Management Network Commercial	$221.85
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Commercial	$234.90
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: MDX Hawaii PPO	$253.17

FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]

Facility

$23.00

Service Code	NDC 63323040302
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]

Facility

$200.00

Service Code	NDC 68462062210
Hospital Revenue Code	250
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]

Facility

$364.00

Service Code	NDC 00069600121
Hospital Revenue Code	250
Min. Negotiated Rate	$309.40
Max. Negotiated Rate	$353.08
Rate for Payer: Cash Price	$218.40
Rate for Payer: Health Management Network Commercial	$309.40
Rate for Payer: Kaiser Permanente Commercial	$327.60
Rate for Payer: MDX Hawaii PPO	$353.08

FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]

Facility

$200.00

Service Code	NDC 68462062264
Hospital Revenue Code	250
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

FRACTURES OF FEMUR WITH MCC

Facility

$12,182.83

Service Code	MSDRG 533
Min. Negotiated Rate	$12,182.83
Max. Negotiated Rate	$12,182.83
Rate for Payer: Hawaii Medical Service Association Commercial	$12,182.83

FRACTURES OF FEMUR WITHOUT MCC

Facility

$12,182.83

Service Code	MSDRG 534
Min. Negotiated Rate	$12,182.83
Max. Negotiated Rate	$12,182.83
Rate for Payer: Hawaii Medical Service Association Commercial	$12,182.83

FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$17,444.67

Service Code	MSDRG 535
Min. Negotiated Rate	$17,444.67
Max. Negotiated Rate	$17,444.67
Rate for Payer: Hawaii Medical Service Association Commercial	$17,444.67

Know your out-of-pocket cost for care.

All Charges