Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

LINER 42MM CMNTLESS 626-00-42E

Facility

$3,331.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,865.36
Max. Negotiated Rate	$3,231.07
Rate for Payer: Cash Price	$1,998.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,331.70
Rate for Payer: Health Management Network Commercial	$2,831.35
Rate for Payer: Kaiser Permanente Commercial	$2,997.90
Rate for Payer: MDX Hawaii PPO	$3,231.07
Rate for Payer: University Health Alliance Commercial	$1,865.36

LINER MDM 38MM 626-00-38D

Facility

$3,344.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,672.00
Max. Negotiated Rate	$3,243.68
Rate for Payer: AlohaCare Medicaid	$1,672.00
Rate for Payer: AlohaCare Medicare	$2,541.44
Rate for Payer: Cash Price	$2,006.40
Rate for Payer: Devoted Health Medicare	$2,808.96
Rate for Payer: Hawaii Medical Service Association Medicare	$2,541.44
Rate for Payer: Hawaii Western Management Group Commercial	$2,340.80
Rate for Payer: Health Management Network Commercial	$2,842.40
Rate for Payer: Humana Medicare	$2,541.44
Rate for Payer: Kaiser Permanente Commercial	$3,009.60
Rate for Payer: Kaiser Permanente Medicaid	$1,705.44
Rate for Payer: Kaiser Permanente Medicare	$2,541.44
Rate for Payer: MDX Hawaii PPO	$3,243.68
Rate for Payer: Ohana Health Plan Medicaid	$2,541.44
Rate for Payer: Ohana Health Plan Medicare	$2,541.44
Rate for Payer: UnitedHealthcare Medicare	$2,541.44
Rate for Payer: University Health Alliance Commercial	$1,872.64

LINER MDM 38MM 626-00-38D

Facility

$3,344.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,872.64
Max. Negotiated Rate	$3,243.68
Rate for Payer: Cash Price	$2,006.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,340.80
Rate for Payer: Health Management Network Commercial	$2,842.40
Rate for Payer: Kaiser Permanente Commercial	$3,009.60
Rate for Payer: MDX Hawaii PPO	$3,243.68
Rate for Payer: University Health Alliance Commercial	$1,872.64

LINER NEUTRAL #00-8751-013-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

LINER NEUTRAL #00-8751-013-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

LINER RIM JJ/36 00-8752-011-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

LINER RIM JJ/36 00-8752-011-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$1,436.00

Service Code	NDC 00054031950
Hospital Revenue Code	250
Min. Negotiated Rate	$1,220.60
Max. Negotiated Rate	$1,392.92
Rate for Payer: Cash Price	$861.60
Rate for Payer: Health Management Network Commercial	$1,220.60
Rate for Payer: Kaiser Permanente Commercial	$1,292.40
Rate for Payer: MDX Hawaii PPO	$1,392.92

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$1,436.00

Service Code	NDC 00054031950
Hospital Revenue Code	637
Min. Negotiated Rate	$718.00
Max. Negotiated Rate	$1,392.92
Rate for Payer: AlohaCare Medicaid	$718.00
Rate for Payer: AlohaCare Medicare	$1,091.36
Rate for Payer: Cash Price	$861.60
Rate for Payer: Devoted Health Medicare	$1,206.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,091.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,364.20
Rate for Payer: Health Management Network Commercial	$1,220.60
Rate for Payer: Humana Medicare	$1,091.36
Rate for Payer: Kaiser Permanente Commercial	$1,292.40
Rate for Payer: Kaiser Permanente Medicaid	$732.36
Rate for Payer: Kaiser Permanente Medicare	$1,091.36
Rate for Payer: MDX Hawaii PPO	$1,392.92
Rate for Payer: Ohana Health Plan Medicaid	$1,091.36
Rate for Payer: Ohana Health Plan Medicare	$1,091.36
Rate for Payer: UnitedHealthcare Medicare	$1,091.36
Rate for Payer: University Health Alliance Commercial	$1,046.70

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$607.00

Service Code	NDC 60687075405
Hospital Revenue Code	637
Min. Negotiated Rate	$303.50
Max. Negotiated Rate	$588.79
Rate for Payer: AlohaCare Medicaid	$303.50
Rate for Payer: AlohaCare Medicare	$461.32
Rate for Payer: Cash Price	$364.20
Rate for Payer: Devoted Health Medicare	$509.88
Rate for Payer: Hawaii Medical Service Association Medicare	$461.32
Rate for Payer: Hawaii Western Management Group Commercial	$576.65
Rate for Payer: Health Management Network Commercial	$515.95
Rate for Payer: Humana Medicare	$461.32
Rate for Payer: Kaiser Permanente Commercial	$546.30
Rate for Payer: Kaiser Permanente Medicaid	$309.57
Rate for Payer: Kaiser Permanente Medicare	$461.32
Rate for Payer: MDX Hawaii PPO	$588.79
Rate for Payer: Ohana Health Plan Medicaid	$461.32
Rate for Payer: Ohana Health Plan Medicare	$461.32
Rate for Payer: UnitedHealthcare Medicare	$461.32
Rate for Payer: University Health Alliance Commercial	$442.44

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$607.00

Service Code	NDC 60687075405
Hospital Revenue Code	250
Min. Negotiated Rate	$515.95
Max. Negotiated Rate	$588.79
Rate for Payer: Cash Price	$364.20
Rate for Payer: Health Management Network Commercial	$515.95
Rate for Payer: Kaiser Permanente Commercial	$546.30
Rate for Payer: MDX Hawaii PPO	$588.79

LINEZOLID 600 MG TABLET [28224]

Facility

$190.00

Service Code	NDC 60687030921
Hospital Revenue Code	637
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$184.30
Rate for Payer: AlohaCare Medicaid	$95.00
Rate for Payer: AlohaCare Medicare	$144.40
Rate for Payer: Cash Price	$114.00
Rate for Payer: Devoted Health Medicare	$159.60
Rate for Payer: Hawaii Medical Service Association Medicare	$144.40
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Humana Medicare	$144.40
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: Kaiser Permanente Medicare	$144.40
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: Ohana Health Plan Medicaid	$144.40
Rate for Payer: Ohana Health Plan Medicare	$144.40
Rate for Payer: UnitedHealthcare Medicare	$144.40
Rate for Payer: University Health Alliance Commercial	$138.49

LINEZOLID 600 MG TABLET [28224]

Facility

$276.00

Service Code	NDC 67877041984
Hospital Revenue Code	637
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$267.72
Rate for Payer: AlohaCare Medicaid	$138.00
Rate for Payer: AlohaCare Medicare	$209.76
Rate for Payer: Cash Price	$165.60
Rate for Payer: Devoted Health Medicare	$231.84
Rate for Payer: Hawaii Medical Service Association Medicare	$209.76
Rate for Payer: Hawaii Western Management Group Commercial	$262.20
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Humana Medicare	$209.76
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: Kaiser Permanente Medicaid	$140.76
Rate for Payer: Kaiser Permanente Medicare	$209.76
Rate for Payer: MDX Hawaii PPO	$267.72
Rate for Payer: Ohana Health Plan Medicaid	$209.76
Rate for Payer: Ohana Health Plan Medicare	$209.76
Rate for Payer: UnitedHealthcare Medicare	$209.76
Rate for Payer: University Health Alliance Commercial	$201.18

LINEZOLID 600 MG TABLET [28224]

Facility

$276.00

Service Code	NDC 67877041933
Hospital Revenue Code	637
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$267.72
Rate for Payer: AlohaCare Medicaid	$138.00
Rate for Payer: AlohaCare Medicare	$209.76
Rate for Payer: Cash Price	$165.60
Rate for Payer: Devoted Health Medicare	$231.84
Rate for Payer: Hawaii Medical Service Association Medicare	$209.76
Rate for Payer: Hawaii Western Management Group Commercial	$262.20
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Humana Medicare	$209.76
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: Kaiser Permanente Medicaid	$140.76
Rate for Payer: Kaiser Permanente Medicare	$209.76
Rate for Payer: MDX Hawaii PPO	$267.72
Rate for Payer: Ohana Health Plan Medicaid	$209.76
Rate for Payer: Ohana Health Plan Medicare	$209.76
Rate for Payer: UnitedHealthcare Medicare	$209.76
Rate for Payer: University Health Alliance Commercial	$201.18

LINEZOLID 600 MG TABLET [28224]

Facility

$276.00

Service Code	NDC 67877041984
Hospital Revenue Code	250
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: MDX Hawaii PPO	$267.72

LINEZOLID 600 MG TABLET [28224]

Facility

$276.00

Service Code	NDC 67877041933
Hospital Revenue Code	250
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: MDX Hawaii PPO	$267.72

LINEZOLID 600 MG TABLET [28224]

Facility

$190.00

Service Code	NDC 60687030921
Hospital Revenue Code	250
Min. Negotiated Rate	$161.50
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: MDX Hawaii PPO	$184.30

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [131499]

Facility

$80.00

Service Code	HCPCS J2020
Hospital Revenue Code	250
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: MDX Hawaii PPO	$77.60

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [131499]

Facility

$80.00

Service Code	HCPCS J2020
Hospital Revenue Code	636
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$40.00
Rate for Payer: AlohaCare Medicare	$60.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Devoted Health Medicare	$67.20
Rate for Payer: Hawaii Medical Service Association ABD	$3.47
Rate for Payer: Hawaii Medical Service Association Medicare	$60.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.47
Rate for Payer: Hawaii Western Management Group Commercial	$76.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$60.80
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$60.80
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$60.80
Rate for Payer: Ohana Health Plan Medicare	$60.80
Rate for Payer: UnitedHealthcare Medicaid	$48.00
Rate for Payer: UnitedHealthcare Medicare	$60.80
Rate for Payer: University Health Alliance Commercial	$58.31

LIPASE-PROTEASE-AMYLASE (PORK) 15,000-47,000-63K UNIT CAPSULE,DEL REL [208816]

Facility

$22.00

Service Code	NDC 73562011101
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$21.34

LIPASE-PROTEASE-AMYLASE (PORK) 15,000-47,000-63K UNIT CAPSULE,DEL REL [208816]

Facility

$22.00

Service Code	NDC 73562011101
Hospital Revenue Code	637
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$21.34
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicare	$16.72
Rate for Payer: Cash Price	$13.20
Rate for Payer: Devoted Health Medicare	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$16.72
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$16.72
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$16.72
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: Ohana Health Plan Medicaid	$16.72
Rate for Payer: Ohana Health Plan Medicare	$16.72
Rate for Payer: UnitedHealthcare Medicare	$16.72
Rate for Payer: University Health Alliance Commercial	$16.04

LIPASE-PROTEASE-AMYLASE(PORK)5,000-17,000-24,000 UNIT CAPSULE, DEL REL [151365]

Facility

$9.00

Service Code	NDC 73562011501
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

LIPASE-PROTEASE-AMYLASE(PORK)5,000-17,000-24,000 UNIT CAPSULE, DEL REL [151365]

Facility

$9.00

Service Code	NDC 73562011501
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

LIPOASPIRATE WASH VIALITY-1400

Facility

$2,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,042.50
Max. Negotiated Rate	$2,022.45
Rate for Payer: AlohaCare Medicaid	$1,042.50
Rate for Payer: AlohaCare Medicare	$1,584.60
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Devoted Health Medicare	$1,751.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,584.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,980.75
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Humana Medicare	$1,584.60
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: Kaiser Permanente Medicaid	$1,063.35
Rate for Payer: Kaiser Permanente Medicare	$1,584.60
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: Ohana Health Plan Medicaid	$1,584.60
Rate for Payer: Ohana Health Plan Medicare	$1,584.60
Rate for Payer: UnitedHealthcare Medicare	$1,584.60
Rate for Payer: University Health Alliance Commercial	$1,519.76

LIPOASPIRATE WASH VIALITY-1400

Facility

$2,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,772.25
Max. Negotiated Rate	$2,022.45
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: MDX Hawaii PPO	$2,022.45

Know your out-of-pocket cost for care.

All Charges