Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

LISINOPRIL 5 MG TABLET [10451]

Facility

$4.00

Service Code	NDC 60687066711
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

LITHIUM CARBONATE 150 MG CAPSULE [4528]

Facility

$1.00

Service Code	NDC 68462022001
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

LITHIUM CARBONATE 150 MG CAPSULE [4528]

Facility

$1.00

Service Code	NDC 68462022001
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

LITHIUM CARBONATE 300 MG CAPSULE [4529]

Facility

$2.00

Service Code	NDC 00054852725
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

LITHIUM CARBONATE 300 MG CAPSULE [4529]

Facility

$2.00

Service Code	NDC 00054852725
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

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE [10454]

Facility

$2.00

Service Code	NDC 68084064011
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

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE [10454]

Facility

$2.00

Service Code	NDC 68084064011
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

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE [10454]

Facility

$2.00

Service Code	NDC 68462022301
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

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE [10454]

Facility

$2.00

Service Code	NDC 68462022301
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

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE [10455]

Facility

$2.00

Service Code	NDC 68462022401
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

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE [10455]

Facility

$2.00

Service Code	NDC 68462022401
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

LITHIUM CITRATE 8 MEQ/5 ML ORAL SOLUTION [126234]

Facility

$486.00

Service Code	NDC 72888017246
Hospital Revenue Code	637
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$471.42
Rate for Payer: AlohaCare Medicaid	$243.00
Rate for Payer: AlohaCare Medicare	$369.36
Rate for Payer: Cash Price	$291.60
Rate for Payer: Devoted Health Medicare	$408.24
Rate for Payer: Hawaii Medical Service Association Medicare	$369.36
Rate for Payer: Hawaii Western Management Group Commercial	$461.70
Rate for Payer: Health Management Network Commercial	$413.10
Rate for Payer: Humana Medicare	$369.36
Rate for Payer: Kaiser Permanente Commercial	$437.40
Rate for Payer: Kaiser Permanente Medicaid	$247.86
Rate for Payer: Kaiser Permanente Medicare	$369.36
Rate for Payer: MDX Hawaii PPO	$471.42
Rate for Payer: Ohana Health Plan Medicaid	$369.36
Rate for Payer: Ohana Health Plan Medicare	$369.36
Rate for Payer: UnitedHealthcare Medicare	$369.36
Rate for Payer: University Health Alliance Commercial	$354.25

LITHIUM CITRATE 8 MEQ/5 ML ORAL SOLUTION [126234]

Facility

$486.00

Service Code	NDC 72888017246
Hospital Revenue Code	250
Min. Negotiated Rate	$413.10
Max. Negotiated Rate	$471.42
Rate for Payer: Cash Price	$291.60
Rate for Payer: Health Management Network Commercial	$413.10
Rate for Payer: Kaiser Permanente Commercial	$437.40
Rate for Payer: MDX Hawaii PPO	$471.42

LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

$358,611.26

Service Code	MSDRG 005
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$358,611.26
Rate for Payer: Hawaii Medical Service Association Commercial	$358,611.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

LIVER TRANSPLANT WITHOUT MCC

Facility

$358,611.26

Service Code	MSDRG 006
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$358,611.26
Rate for Payer: Hawaii Medical Service Association Commercial	$358,611.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC

Facility

$35,553.00

Service Code	MSDRG 496
Min. Negotiated Rate	$35,553.00
Max. Negotiated Rate	$35,553.00
Rate for Payer: Hawaii Medical Service Association Commercial	$35,553.00

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC

Facility

$38,278.73

Service Code	MSDRG 495
Min. Negotiated Rate	$38,278.73
Max. Negotiated Rate	$38,278.73
Rate for Payer: Hawaii Medical Service Association Commercial	$38,278.73

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

$24,673.78

Service Code	MSDRG 497
Min. Negotiated Rate	$24,673.78
Max. Negotiated Rate	$24,673.78
Rate for Payer: Hawaii Medical Service Association Commercial	$24,673.78

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC

Facility

$42,971.73

Service Code	MSDRG 498
Min. Negotiated Rate	$42,971.73
Max. Negotiated Rate	$42,971.73
Rate for Payer: Hawaii Medical Service Association Commercial	$42,971.73

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC

Facility

$42,971.73

Service Code	MSDRG 499
Min. Negotiated Rate	$42,971.73
Max. Negotiated Rate	$42,971.73
Rate for Payer: Hawaii Medical Service Association Commercial	$42,971.73

LOCKING PLATE 2.3MM 57-15340

Facility

$1,729.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$864.50
Max. Negotiated Rate	$1,677.13
Rate for Payer: AlohaCare Medicaid	$864.50
Rate for Payer: AlohaCare Medicare	$1,314.04
Rate for Payer: Cash Price	$1,037.40
Rate for Payer: Devoted Health Medicare	$1,452.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1,314.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,210.30
Rate for Payer: Health Management Network Commercial	$1,469.65
Rate for Payer: Humana Medicare	$1,314.04
Rate for Payer: Kaiser Permanente Commercial	$1,556.10
Rate for Payer: Kaiser Permanente Medicaid	$881.79
Rate for Payer: Kaiser Permanente Medicare	$1,314.04
Rate for Payer: MDX Hawaii PPO	$1,677.13
Rate for Payer: Ohana Health Plan Medicaid	$1,314.04
Rate for Payer: Ohana Health Plan Medicare	$1,314.04
Rate for Payer: UnitedHealthcare Medicare	$1,314.04
Rate for Payer: University Health Alliance Commercial	$968.24

LOCKING PLATE 2.3MM 57-15340

Facility

$1,729.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$968.24
Max. Negotiated Rate	$1,677.13
Rate for Payer: Cash Price	$1,037.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,210.30
Rate for Payer: Health Management Network Commercial	$1,469.65
Rate for Payer: Kaiser Permanente Commercial	$1,556.10
Rate for Payer: MDX Hawaii PPO	$1,677.13
Rate for Payer: University Health Alliance Commercial	$968.24

LONG ARMED GUIDE ACCUCUT 19510

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$398.65
Max. Negotiated Rate	$454.93
Rate for Payer: Cash Price	$281.40
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: MDX Hawaii PPO	$454.93

LONG ARMED GUIDE ACCUCUT 19510

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$234.50
Max. Negotiated Rate	$454.93
Rate for Payer: AlohaCare Medicaid	$234.50
Rate for Payer: AlohaCare Medicare	$356.44
Rate for Payer: Cash Price	$281.40
Rate for Payer: Devoted Health Medicare	$393.96
Rate for Payer: Hawaii Medical Service Association Medicare	$356.44
Rate for Payer: Hawaii Western Management Group Commercial	$445.55
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Humana Medicare	$356.44
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: Kaiser Permanente Medicaid	$239.19
Rate for Payer: Kaiser Permanente Medicare	$356.44
Rate for Payer: MDX Hawaii PPO	$454.93
Rate for Payer: Ohana Health Plan Medicaid	$356.44
Rate for Payer: Ohana Health Plan Medicare	$356.44
Rate for Payer: UnitedHealthcare Medicare	$356.44
Rate for Payer: University Health Alliance Commercial	$341.85

LOOP ELECTRODE 20MMX12MM

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$91.18
Rate for Payer: AlohaCare Medicaid	$47.00
Rate for Payer: AlohaCare Medicare	$71.44
Rate for Payer: Cash Price	$56.40
Rate for Payer: Devoted Health Medicare	$78.96
Rate for Payer: Hawaii Medical Service Association Medicare	$71.44
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Humana Medicare	$71.44
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: Kaiser Permanente Medicare	$71.44
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: Ohana Health Plan Medicaid	$71.44
Rate for Payer: Ohana Health Plan Medicare	$71.44
Rate for Payer: UnitedHealthcare Medicare	$71.44
Rate for Payer: University Health Alliance Commercial	$68.52

Know your out-of-pocket cost for care.

All Charges