Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

G WIRE W/BDL AR-8950-06

Facility

$168.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$100.80
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: Kaiser Permanente Commercial	$151.20
Rate for Payer: MDX Hawaii PPO	$162.96

G WIRE W/BDL AR-8950-06

Facility

$168.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$162.96
Rate for Payer: AlohaCare Medicaid	$84.00
Rate for Payer: AlohaCare Medicare	$127.68
Rate for Payer: Cash Price	$100.80
Rate for Payer: Devoted Health Medicare	$141.12
Rate for Payer: Hawaii Medical Service Association Medicare	$127.68
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: Humana Medicare	$127.68
Rate for Payer: Kaiser Permanente Commercial	$151.20
Rate for Payer: Kaiser Permanente Medicaid	$85.68
Rate for Payer: Kaiser Permanente Medicare	$127.68
Rate for Payer: MDX Hawaii PPO	$162.96
Rate for Payer: Ohana Health Plan Medicaid	$127.68
Rate for Payer: Ohana Health Plan Medicare	$127.68
Rate for Payer: UnitedHealthcare Medicare	$127.68
Rate for Payer: University Health Alliance Commercial	$122.46

G-WIRE W/ TROCAR TIP AR-8941KT

Facility

$158.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$134.30
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$94.80
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26

G-WIRE W/ TROCAR TIP AR-8941KT

Facility

$158.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$120.08
Rate for Payer: Cash Price	$94.80
Rate for Payer: Devoted Health Medicare	$132.72
Rate for Payer: Hawaii Medical Service Association Medicare	$120.08
Rate for Payer: Hawaii Western Management Group Commercial	$150.10
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$120.08
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$120.08
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$120.08
Rate for Payer: Ohana Health Plan Medicare	$120.08
Rate for Payer: UnitedHealthcare Medicare	$120.08
Rate for Payer: University Health Alliance Commercial	$115.17

GYNECARE TVT TVTRL

Facility

$4,117.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$2,305.52
Max. Negotiated Rate	$3,993.49
Rate for Payer: Cash Price	$2,470.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,881.90
Rate for Payer: Health Management Network Commercial	$3,499.45
Rate for Payer: Kaiser Permanente Commercial	$3,705.30
Rate for Payer: MDX Hawaii PPO	$3,993.49
Rate for Payer: University Health Alliance Commercial	$2,305.52

GYNECARE TVT TVTRL

Facility

$4,117.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$2,058.50
Max. Negotiated Rate	$3,993.49
Rate for Payer: AlohaCare Medicaid	$2,058.50
Rate for Payer: AlohaCare Medicare	$3,128.92
Rate for Payer: Cash Price	$2,470.20
Rate for Payer: Devoted Health Medicare	$3,458.28
Rate for Payer: Hawaii Medical Service Association Medicare	$3,128.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,881.90
Rate for Payer: Health Management Network Commercial	$3,499.45
Rate for Payer: Humana Medicare	$3,128.92
Rate for Payer: Kaiser Permanente Commercial	$3,705.30
Rate for Payer: Kaiser Permanente Medicaid	$2,099.67
Rate for Payer: Kaiser Permanente Medicare	$3,128.92
Rate for Payer: MDX Hawaii PPO	$3,993.49
Rate for Payer: Ohana Health Plan Medicaid	$3,128.92
Rate for Payer: Ohana Health Plan Medicare	$3,128.92
Rate for Payer: UnitedHealthcare Medicare	$3,128.92
Rate for Payer: University Health Alliance Commercial	$2,305.52

GYN ESG PLASMLOOPE M WA47706S

Facility

$1,569.00

Hospital Revenue Code	272
Min. Negotiated Rate	$784.50
Max. Negotiated Rate	$1,521.93
Rate for Payer: AlohaCare Medicaid	$784.50
Rate for Payer: AlohaCare Medicare	$1,192.44
Rate for Payer: Cash Price	$941.40
Rate for Payer: Devoted Health Medicare	$1,317.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,192.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,490.55
Rate for Payer: Health Management Network Commercial	$1,333.65
Rate for Payer: Humana Medicare	$1,192.44
Rate for Payer: Kaiser Permanente Commercial	$1,412.10
Rate for Payer: Kaiser Permanente Medicaid	$800.19
Rate for Payer: Kaiser Permanente Medicare	$1,192.44
Rate for Payer: MDX Hawaii PPO	$1,521.93
Rate for Payer: Ohana Health Plan Medicaid	$1,192.44
Rate for Payer: Ohana Health Plan Medicare	$1,192.44
Rate for Payer: UnitedHealthcare Medicare	$1,192.44
Rate for Payer: University Health Alliance Commercial	$1,143.64

GYN ESG PLASMLOOPE M WA47706S

Facility

$1,569.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,333.65
Max. Negotiated Rate	$1,521.93
Rate for Payer: Cash Price	$941.40
Rate for Payer: Health Management Network Commercial	$1,333.65
Rate for Payer: Kaiser Permanente Commercial	$1,412.10
Rate for Payer: MDX Hawaii PPO	$1,521.93

HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]

Facility

$40.00

Service Code	NDC 49281054503
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]

Facility

$40.00

Service Code	NDC 49281054758
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

HALF BLOCK SZ 5 TIB 5546-A-501

Facility

$2,173.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,216.88
Max. Negotiated Rate	$2,107.81
Rate for Payer: Cash Price	$1,303.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,521.10
Rate for Payer: Health Management Network Commercial	$1,847.05
Rate for Payer: Kaiser Permanente Commercial	$1,955.70
Rate for Payer: MDX Hawaii PPO	$2,107.81
Rate for Payer: University Health Alliance Commercial	$1,216.88

HALF BLOCK SZ 5 TIB 5546-A-501

Facility

$2,173.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,086.50
Max. Negotiated Rate	$2,107.81
Rate for Payer: AlohaCare Medicaid	$1,086.50
Rate for Payer: AlohaCare Medicare	$1,651.48
Rate for Payer: Cash Price	$1,303.80
Rate for Payer: Devoted Health Medicare	$1,825.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,651.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,521.10
Rate for Payer: Health Management Network Commercial	$1,847.05
Rate for Payer: Humana Medicare	$1,651.48
Rate for Payer: Kaiser Permanente Commercial	$1,955.70
Rate for Payer: Kaiser Permanente Medicaid	$1,108.23
Rate for Payer: Kaiser Permanente Medicare	$1,651.48
Rate for Payer: MDX Hawaii PPO	$2,107.81
Rate for Payer: Ohana Health Plan Medicaid	$1,651.48
Rate for Payer: Ohana Health Plan Medicare	$1,651.48
Rate for Payer: UnitedHealthcare Medicare	$1,651.48
Rate for Payer: University Health Alliance Commercial	$1,216.88

HALOBETASOL PROPIONATE 0.05 % TOPICAL CREAM [10159]

Facility

$279.00

Service Code	NDC 00713064015
Hospital Revenue Code	637
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$270.63
Rate for Payer: AlohaCare Medicaid	$139.50
Rate for Payer: AlohaCare Medicare	$212.04
Rate for Payer: Cash Price	$167.40
Rate for Payer: Devoted Health Medicare	$234.36
Rate for Payer: Hawaii Medical Service Association Medicare	$212.04
Rate for Payer: Hawaii Western Management Group Commercial	$265.05
Rate for Payer: Health Management Network Commercial	$237.15
Rate for Payer: Humana Medicare	$212.04
Rate for Payer: Kaiser Permanente Commercial	$251.10
Rate for Payer: Kaiser Permanente Medicaid	$142.29
Rate for Payer: Kaiser Permanente Medicare	$212.04
Rate for Payer: MDX Hawaii PPO	$270.63
Rate for Payer: Ohana Health Plan Medicaid	$212.04
Rate for Payer: Ohana Health Plan Medicare	$212.04
Rate for Payer: UnitedHealthcare Medicare	$212.04
Rate for Payer: University Health Alliance Commercial	$203.36

HALOBETASOL PROPIONATE 0.05 % TOPICAL CREAM [10159]

Facility

$139.00

Service Code	NDC 45802012935
Hospital Revenue Code	250
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$83.40
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

HALOBETASOL PROPIONATE 0.05 % TOPICAL CREAM [10159]

Facility

$279.00

Service Code	NDC 00713064015
Hospital Revenue Code	250
Min. Negotiated Rate	$237.15
Max. Negotiated Rate	$270.63
Rate for Payer: Cash Price	$167.40
Rate for Payer: Health Management Network Commercial	$237.15
Rate for Payer: Kaiser Permanente Commercial	$251.10
Rate for Payer: MDX Hawaii PPO	$270.63

HALOBETASOL PROPIONATE 0.05 % TOPICAL CREAM [10159]

Facility

$139.00

Service Code	NDC 45802012935
Hospital Revenue Code	637
Min. Negotiated Rate	$69.50
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$105.64
Rate for Payer: Cash Price	$83.40
Rate for Payer: Devoted Health Medicare	$116.76
Rate for Payer: Hawaii Medical Service Association Medicare	$105.64
Rate for Payer: Hawaii Western Management Group Commercial	$132.05
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$105.64
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$105.64
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$105.64
Rate for Payer: Ohana Health Plan Medicare	$105.64
Rate for Payer: UnitedHealthcare Medicare	$105.64
Rate for Payer: University Health Alliance Commercial	$101.32

HALOBETASOL PROPIONATE 0.05 % TOPICAL OINTMENT [10160]

Facility

$758.00

Service Code	NDC 70752011904
Hospital Revenue Code	250
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$454.80
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: MDX Hawaii PPO	$735.26

HALOBETASOL PROPIONATE 0.05 % TOPICAL OINTMENT [10160]

Facility

$670.00

Service Code	NDC 45802013132
Hospital Revenue Code	637
Min. Negotiated Rate	$335.00
Max. Negotiated Rate	$649.90
Rate for Payer: AlohaCare Medicaid	$335.00
Rate for Payer: AlohaCare Medicare	$509.20
Rate for Payer: Cash Price	$402.00
Rate for Payer: Devoted Health Medicare	$562.80
Rate for Payer: Hawaii Medical Service Association Medicare	$509.20
Rate for Payer: Hawaii Western Management Group Commercial	$636.50
Rate for Payer: Health Management Network Commercial	$569.50
Rate for Payer: Humana Medicare	$509.20
Rate for Payer: Kaiser Permanente Commercial	$603.00
Rate for Payer: Kaiser Permanente Medicaid	$341.70
Rate for Payer: Kaiser Permanente Medicare	$509.20
Rate for Payer: MDX Hawaii PPO	$649.90
Rate for Payer: Ohana Health Plan Medicaid	$509.20
Rate for Payer: Ohana Health Plan Medicare	$509.20
Rate for Payer: UnitedHealthcare Medicare	$509.20
Rate for Payer: University Health Alliance Commercial	$488.36

HALOBETASOL PROPIONATE 0.05 % TOPICAL OINTMENT [10160]

Facility

$758.00

Service Code	NDC 70752011904
Hospital Revenue Code	637
Min. Negotiated Rate	$379.00
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$379.00
Rate for Payer: AlohaCare Medicare	$576.08
Rate for Payer: Cash Price	$454.80
Rate for Payer: Devoted Health Medicare	$636.72
Rate for Payer: Hawaii Medical Service Association Medicare	$576.08
Rate for Payer: Hawaii Western Management Group Commercial	$720.10
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$576.08
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$576.08
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$576.08
Rate for Payer: Ohana Health Plan Medicare	$576.08
Rate for Payer: UnitedHealthcare Medicare	$576.08
Rate for Payer: University Health Alliance Commercial	$552.51

HALOBETASOL PROPIONATE 0.05 % TOPICAL OINTMENT [10160]

Facility

$670.00

Service Code	NDC 45802013132
Hospital Revenue Code	250
Min. Negotiated Rate	$569.50
Max. Negotiated Rate	$649.90
Rate for Payer: Cash Price	$402.00
Rate for Payer: Health Management Network Commercial	$569.50
Rate for Payer: Kaiser Permanente Commercial	$603.00
Rate for Payer: MDX Hawaii PPO	$649.90

HALOPERIDOL 0.5 MG TABLET [3578]

Facility

$2.00

Service Code	NDC 51079073320
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

HALOPERIDOL 0.5 MG TABLET [3578]

Facility

$2.00

Service Code	NDC 51079073301
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

HALOPERIDOL 0.5 MG TABLET [3578]

Facility

$2.00

Service Code	NDC 51079073301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

HALOPERIDOL 0.5 MG TABLET [3578]

Facility

$2.00

Service Code	NDC 51079073320
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

HALOPERIDOL 1 MG TABLET [3579]

Facility

$3.00

Service Code	NDC 00904739061
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

Know your out-of-pocket cost for care.

All Charges