Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MEDL MALLE SLED 35MM MMSLED-35

Facility

$2,895.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.50
Max. Negotiated Rate	$2,808.15
Rate for Payer: AlohaCare Medicaid	$1,447.50
Rate for Payer: AlohaCare Medicare	$2,200.20
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Devoted Health Medicare	$2,431.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,200.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Humana Medicare	$2,200.20
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: Kaiser Permanente Medicaid	$1,476.45
Rate for Payer: Kaiser Permanente Medicare	$2,200.20
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: Ohana Health Plan Medicaid	$2,200.20
Rate for Payer: Ohana Health Plan Medicare	$2,200.20
Rate for Payer: UnitedHealthcare Medicare	$2,200.20
Rate for Payer: University Health Alliance Commercial	$1,621.20

MEDL MALLE SLED 35MM MMSLED-35

Facility

$2,895.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,808.15
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: University Health Alliance Commercial	$1,621.20

MEDL MALLE SLED 42MM MMSLED-42

Facility

$2,895.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.50
Max. Negotiated Rate	$2,808.15
Rate for Payer: AlohaCare Medicaid	$1,447.50
Rate for Payer: AlohaCare Medicare	$2,200.20
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Devoted Health Medicare	$2,431.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,200.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Humana Medicare	$2,200.20
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: Kaiser Permanente Medicaid	$1,476.45
Rate for Payer: Kaiser Permanente Medicare	$2,200.20
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: Ohana Health Plan Medicaid	$2,200.20
Rate for Payer: Ohana Health Plan Medicare	$2,200.20
Rate for Payer: UnitedHealthcare Medicare	$2,200.20
Rate for Payer: University Health Alliance Commercial	$1,621.20

MEDL MALLE SLED 42MM MMSLED-42

Facility

$2,895.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,808.15
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: University Health Alliance Commercial	$1,621.20

MEDL MALLE SLED WASHER MMSLEDW

Facility

$788.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$394.00
Max. Negotiated Rate	$764.36
Rate for Payer: AlohaCare Medicaid	$394.00
Rate for Payer: AlohaCare Medicare	$598.88
Rate for Payer: Cash Price	$472.80
Rate for Payer: Devoted Health Medicare	$661.92
Rate for Payer: Hawaii Medical Service Association Medicare	$598.88
Rate for Payer: Hawaii Western Management Group Commercial	$551.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Humana Medicare	$598.88
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: Kaiser Permanente Medicaid	$401.88
Rate for Payer: Kaiser Permanente Medicare	$598.88
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: Ohana Health Plan Medicaid	$598.88
Rate for Payer: Ohana Health Plan Medicare	$598.88
Rate for Payer: UnitedHealthcare Medicare	$598.88
Rate for Payer: University Health Alliance Commercial	$441.28

MEDL MALLE SLED WASHER MMSLEDW

Facility

$788.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$441.28
Max. Negotiated Rate	$764.36
Rate for Payer: Cash Price	$472.80
Rate for Payer: Hawaii Western Management Group Commercial	$551.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: University Health Alliance Commercial	$441.28

MEDROXYPROGESTERONE 10 MG TABLET [4854]

Facility

$2.00

Service Code	NDC 00555077902
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

MEDROXYPROGESTERONE 10 MG TABLET [4854]

Facility

$2.00

Service Code	NDC 00555077902
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

MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION [19736]

Facility

$196.00

Service Code	HCPCS J1050
Hospital Revenue Code	250
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$190.12
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$166.60
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Kaiser Permanente Commercial	$93.60
Rate for Payer: Kaiser Permanente Commercial	$176.40
Rate for Payer: MDX Hawaii PPO	$190.12
Rate for Payer: MDX Hawaii PPO	$100.88

MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE [134069]

Facility

$173.00

Service Code	HCPCS J1050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$167.81
Rate for Payer: AlohaCare Medicaid	$86.50
Rate for Payer: AlohaCare Medicaid	$84.00
Rate for Payer: AlohaCare Medicare	$127.68
Rate for Payer: AlohaCare Medicare	$131.48
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$103.80
Rate for Payer: Cash Price	$103.80
Rate for Payer: Devoted Health Medicare	$141.12
Rate for Payer: Devoted Health Medicare	$145.32
Rate for Payer: Hawaii Medical Service Association ABD	$0.57
Rate for Payer: Hawaii Medical Service Association ABD	$0.57
Rate for Payer: Hawaii Medical Service Association Medicare	$127.68
Rate for Payer: Hawaii Medical Service Association Medicare	$131.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.57
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Hawaii Western Management Group Commercial	$164.35
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Humana Medicare	$127.68
Rate for Payer: Humana Medicare	$131.48
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: Kaiser Permanente Commercial	$151.20
Rate for Payer: Kaiser Permanente Medicaid	$85.68
Rate for Payer: Kaiser Permanente Medicaid	$88.23
Rate for Payer: Kaiser Permanente Medicare	$127.68
Rate for Payer: Kaiser Permanente Medicare	$131.48
Rate for Payer: MDX Hawaii PPO	$162.96
Rate for Payer: MDX Hawaii PPO	$167.81
Rate for Payer: Ohana Health Plan Medicaid	$131.48
Rate for Payer: Ohana Health Plan Medicaid	$127.68
Rate for Payer: Ohana Health Plan Medicare	$127.68
Rate for Payer: Ohana Health Plan Medicare	$131.48
Rate for Payer: UnitedHealthcare Medicaid	$100.80
Rate for Payer: UnitedHealthcare Medicaid	$103.80
Rate for Payer: UnitedHealthcare Medicare	$131.48
Rate for Payer: UnitedHealthcare Medicare	$127.68
Rate for Payer: University Health Alliance Commercial	$122.46
Rate for Payer: University Health Alliance Commercial	$126.10

MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE [134069]

Facility

$168.00

Service Code	HCPCS J1050
Hospital Revenue Code	250
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$103.80
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: Kaiser Permanente Commercial	$151.20
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: MDX Hawaii PPO	$162.96
Rate for Payer: MDX Hawaii PPO	$167.81

MEDROXYPROGESTERONE 2.5 MG TABLET [4855]

Facility

$2.00

Service Code	NDC 00555087202
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

MEDROXYPROGESTERONE 2.5 MG TABLET [4855]

Facility

$2.00

Service Code	NDC 00555087202
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

MEDULLARY XCHANGE TUBE 355.006

Facility

$356.00

Hospital Revenue Code	272
Min. Negotiated Rate	$302.60
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$213.60
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Kaiser Permanente Commercial	$320.40
Rate for Payer: MDX Hawaii PPO	$345.32

MEDULLARY XCHANGE TUBE 355.006

Facility

$356.00

Hospital Revenue Code	272
Min. Negotiated Rate	$178.00
Max. Negotiated Rate	$345.32
Rate for Payer: AlohaCare Medicaid	$178.00
Rate for Payer: AlohaCare Medicare	$270.56
Rate for Payer: Cash Price	$213.60
Rate for Payer: Devoted Health Medicare	$299.04
Rate for Payer: Hawaii Medical Service Association Medicare	$270.56
Rate for Payer: Hawaii Western Management Group Commercial	$338.20
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Humana Medicare	$270.56
Rate for Payer: Kaiser Permanente Commercial	$320.40
Rate for Payer: Kaiser Permanente Medicaid	$181.56
Rate for Payer: Kaiser Permanente Medicare	$270.56
Rate for Payer: MDX Hawaii PPO	$345.32
Rate for Payer: Ohana Health Plan Medicaid	$270.56
Rate for Payer: Ohana Health Plan Medicare	$270.56
Rate for Payer: UnitedHealthcare Medicare	$270.56
Rate for Payer: University Health Alliance Commercial	$259.49

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]

Facility

$22.00

Service Code	NDC 69339016016
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

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]

Facility

$22.00

Service Code	NDC 69339016016
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

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]

Facility

$20.00

Service Code	NDC 68094006359
Hospital Revenue Code	637
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$15.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Devoted Health Medicare	$16.80
Rate for Payer: Hawaii Medical Service Association Medicare	$15.20
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$15.20
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$15.20
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$15.20
Rate for Payer: Ohana Health Plan Medicare	$15.20
Rate for Payer: UnitedHealthcare Medicare	$15.20
Rate for Payer: University Health Alliance Commercial	$14.58

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]

Facility

$20.00

Service Code	NDC 68094006359
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

MEGESTROL 40 MG TABLET [4871]

Facility

$6.00

Service Code	NDC 00555060702
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

MEGESTROL 40 MG TABLET [4871]

Facility

$6.00

Service Code	NDC 00555060702
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

MELATONIN 3 MG TABLET [16830]

Facility

$1.00

Service Code	NDC 61502000000
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

MELATONIN 3 MG TABLET [16830]

Facility

$2.00

Service Code	NDC 52411000000
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

MELATONIN 3 MG TABLET [16830]

Facility

$2.00

Service Code	NDC 52411000000
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

MELATONIN 3 MG TABLET [16830]

Facility

$2.00

Service Code	NDC 52415000000
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

Know your out-of-pocket cost for care.

All Charges