Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MIC G-24 LAP INTRODUCER KIT

Facility

$930.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$465.00
Max. Negotiated Rate	$902.10
Rate for Payer: AlohaCare Medicaid	$465.00
Rate for Payer: AlohaCare Medicare	$706.80
Rate for Payer: Cash Price	$558.00
Rate for Payer: Devoted Health Medicare	$781.20
Rate for Payer: Hawaii Medical Service Association Medicare	$706.80
Rate for Payer: Hawaii Western Management Group Commercial	$883.50
Rate for Payer: Health Management Network Commercial	$790.50
Rate for Payer: Humana Medicare	$706.80
Rate for Payer: Kaiser Permanente Commercial	$837.00
Rate for Payer: Kaiser Permanente Medicaid	$474.30
Rate for Payer: Kaiser Permanente Medicare	$706.80
Rate for Payer: MDX Hawaii PPO	$902.10
Rate for Payer: Ohana Health Plan Medicaid	$706.80
Rate for Payer: Ohana Health Plan Medicare	$706.80
Rate for Payer: UnitedHealthcare Medicare	$706.80
Rate for Payer: University Health Alliance Commercial	$677.88

MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]

Facility

$26.00

Service Code	NDC 51672200102
Hospital Revenue Code	250
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: MDX Hawaii PPO	$25.22

MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]

Facility

$10.00

Service Code	NDC 68001048145
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]

Facility

$26.00

Service Code	NDC 51672200102
Hospital Revenue Code	637
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$25.22
Rate for Payer: AlohaCare Medicaid	$13.00
Rate for Payer: AlohaCare Medicare	$19.76
Rate for Payer: Cash Price	$15.60
Rate for Payer: Devoted Health Medicare	$21.84
Rate for Payer: Hawaii Medical Service Association Medicare	$19.76
Rate for Payer: Hawaii Western Management Group Commercial	$24.70
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Humana Medicare	$19.76
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: Kaiser Permanente Medicare	$19.76
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: Ohana Health Plan Medicaid	$19.76
Rate for Payer: Ohana Health Plan Medicare	$19.76
Rate for Payer: UnitedHealthcare Medicare	$19.76
Rate for Payer: University Health Alliance Commercial	$18.95

MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]

Facility

$10.00

Service Code	NDC 68001048145
Hospital Revenue Code	637
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$9.70
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$7.60
Rate for Payer: Cash Price	$6.00
Rate for Payer: Devoted Health Medicare	$8.40
Rate for Payer: Hawaii Medical Service Association Medicare	$7.60
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Humana Medicare	$7.60
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: Kaiser Permanente Medicare	$7.60
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: Ohana Health Plan Medicaid	$7.60
Rate for Payer: Ohana Health Plan Medicare	$7.60
Rate for Payer: UnitedHealthcare Medicare	$7.60
Rate for Payer: University Health Alliance Commercial	$7.29

MICONAZOLE NITRATE 2 % TOPICAL OINTMENT [13651]

Facility

$15.00

Service Code	NDC 13551000000
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

MICONAZOLE NITRATE 2 % TOPICAL OINTMENT [13651]

Facility

$15.00

Service Code	NDC 13551000000
Hospital Revenue Code	637
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

MICRA AV2 US

Facility

$2,844.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$1,592.64
Max. Negotiated Rate	$2,758.68
Rate for Payer: Cash Price	$1,706.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,990.80
Rate for Payer: Health Management Network Commercial	$2,417.40
Rate for Payer: Kaiser Permanente Commercial	$2,559.60
Rate for Payer: MDX Hawaii PPO	$2,758.68
Rate for Payer: University Health Alliance Commercial	$1,592.64

MICRA AV2 US

Facility

$2,844.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$1,422.00
Max. Negotiated Rate	$2,758.68
Rate for Payer: AlohaCare Medicaid	$1,422.00
Rate for Payer: AlohaCare Medicare	$2,161.44
Rate for Payer: Cash Price	$1,706.40
Rate for Payer: Devoted Health Medicare	$2,388.96
Rate for Payer: Hawaii Medical Service Association Medicare	$2,161.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,990.80
Rate for Payer: Health Management Network Commercial	$2,417.40
Rate for Payer: Humana Medicare	$2,161.44
Rate for Payer: Kaiser Permanente Commercial	$2,559.60
Rate for Payer: Kaiser Permanente Medicaid	$1,450.44
Rate for Payer: Kaiser Permanente Medicare	$2,161.44
Rate for Payer: MDX Hawaii PPO	$2,758.68
Rate for Payer: Ohana Health Plan Medicaid	$2,161.44
Rate for Payer: Ohana Health Plan Medicare	$2,161.44
Rate for Payer: UnitedHealthcare Medicare	$2,161.44
Rate for Payer: University Health Alliance Commercial	$1,592.64

MICRA VR2 SINGLE CHAMBER

Facility

$22,820.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$12,779.20
Max. Negotiated Rate	$22,135.40
Rate for Payer: Cash Price	$13,692.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,974.00
Rate for Payer: Health Management Network Commercial	$19,397.00
Rate for Payer: Kaiser Permanente Commercial	$20,538.00
Rate for Payer: MDX Hawaii PPO	$22,135.40
Rate for Payer: University Health Alliance Commercial	$12,779.20

MICRA VR2 SINGLE CHAMBER

Facility

$22,820.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$11,410.00
Max. Negotiated Rate	$22,135.40
Rate for Payer: AlohaCare Medicaid	$11,410.00
Rate for Payer: AlohaCare Medicare	$17,343.20
Rate for Payer: Cash Price	$13,692.00
Rate for Payer: Devoted Health Medicare	$19,168.80
Rate for Payer: Hawaii Medical Service Association Medicare	$17,343.20
Rate for Payer: Hawaii Western Management Group Commercial	$15,974.00
Rate for Payer: Health Management Network Commercial	$19,397.00
Rate for Payer: Humana Medicare	$17,343.20
Rate for Payer: Kaiser Permanente Commercial	$20,538.00
Rate for Payer: Kaiser Permanente Medicaid	$11,638.20
Rate for Payer: Kaiser Permanente Medicare	$17,343.20
Rate for Payer: MDX Hawaii PPO	$22,135.40
Rate for Payer: Ohana Health Plan Medicaid	$17,343.20
Rate for Payer: Ohana Health Plan Medicare	$17,343.20
Rate for Payer: UnitedHealthcare Medicare	$17,343.20
Rate for Payer: University Health Alliance Commercial	$12,779.20

MICROMATRIX MD 500MG MM0500

Facility

$2,419.00

Service Code	HCPCS Q4118
Hospital Revenue Code	636
Min. Negotiated Rate	$2,056.15
Max. Negotiated Rate	$2,346.43
Rate for Payer: Cash Price	$1,451.40
Rate for Payer: Health Management Network Commercial	$2,056.15
Rate for Payer: Kaiser Permanente Commercial	$2,177.10
Rate for Payer: MDX Hawaii PPO	$2,346.43

MICROMATRIX MD 500MG MM0500

Facility

$2,419.00

Service Code	HCPCS Q4118
Hospital Revenue Code	636
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$2,346.43
Rate for Payer: AlohaCare Medicaid	$1,209.50
Rate for Payer: AlohaCare Medicare	$1,838.44
Rate for Payer: Cash Price	$1,451.40
Rate for Payer: Cash Price	$1,451.40
Rate for Payer: Devoted Health Medicare	$2,031.96
Rate for Payer: Hawaii Medical Service Association ABD	$2.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,838.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,298.05
Rate for Payer: Health Management Network Commercial	$2,056.15
Rate for Payer: Humana Medicare	$1,838.44
Rate for Payer: Kaiser Permanente Commercial	$2,177.10
Rate for Payer: Kaiser Permanente Medicaid	$1,233.69
Rate for Payer: Kaiser Permanente Medicare	$1,838.44
Rate for Payer: MDX Hawaii PPO	$2,346.43
Rate for Payer: Ohana Health Plan Medicaid	$1,838.44
Rate for Payer: Ohana Health Plan Medicare	$1,838.44
Rate for Payer: UnitedHealthcare Medicaid	$1,451.40
Rate for Payer: UnitedHealthcare Medicare	$1,838.44
Rate for Payer: University Health Alliance Commercial	$1,763.21

MICRO OCD UNIVERSAL DRILL

Facility

$1,526.00

Hospital Revenue Code	272
Min. Negotiated Rate	$763.00
Max. Negotiated Rate	$1,480.22
Rate for Payer: AlohaCare Medicaid	$763.00
Rate for Payer: AlohaCare Medicare	$1,159.76
Rate for Payer: Cash Price	$915.60
Rate for Payer: Devoted Health Medicare	$1,281.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,159.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,449.70
Rate for Payer: Health Management Network Commercial	$1,297.10
Rate for Payer: Humana Medicare	$1,159.76
Rate for Payer: Kaiser Permanente Commercial	$1,373.40
Rate for Payer: Kaiser Permanente Medicaid	$778.26
Rate for Payer: Kaiser Permanente Medicare	$1,159.76
Rate for Payer: MDX Hawaii PPO	$1,480.22
Rate for Payer: Ohana Health Plan Medicaid	$1,159.76
Rate for Payer: Ohana Health Plan Medicare	$1,159.76
Rate for Payer: UnitedHealthcare Medicare	$1,159.76
Rate for Payer: University Health Alliance Commercial	$1,112.30

MICRO OCD UNIVERSAL DRILL

Facility

$1,526.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,297.10
Max. Negotiated Rate	$1,480.22
Rate for Payer: Cash Price	$915.60
Rate for Payer: Health Management Network Commercial	$1,297.10
Rate for Payer: Kaiser Permanente Commercial	$1,373.40
Rate for Payer: MDX Hawaii PPO	$1,480.22

MICROWAVE ABILATION APP 14CM

Facility

$7,000.00

Hospital Revenue Code	272
Min. Negotiated Rate	$5,950.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: MDX Hawaii PPO	$6,790.00

MICROWAVE ABILATION APP 14CM

Facility

$7,000.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,500.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$5,320.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$5,880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,320.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,650.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Humana Medicare	$5,320.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$5,320.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$5,320.00
Rate for Payer: Ohana Health Plan Medicare	$5,320.00
Rate for Payer: UnitedHealthcare Medicare	$5,320.00
Rate for Payer: University Health Alliance Commercial	$5,102.30

MICROWAVE ABILATION APP 19CM

Facility

$7,000.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,500.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$5,320.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$5,880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,320.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,650.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Humana Medicare	$5,320.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$5,320.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$5,320.00
Rate for Payer: Ohana Health Plan Medicare	$5,320.00
Rate for Payer: UnitedHealthcare Medicare	$5,320.00
Rate for Payer: University Health Alliance Commercial	$5,102.30

MICROWAVE ABILATION APP 19CM

Facility

$7,000.00

Hospital Revenue Code	272
Min. Negotiated Rate	$5,950.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: MDX Hawaii PPO	$6,790.00

MIDAZOLAM 1 MG/ML INJECTION SOLUTION [93519]

Facility

$14.00

Service Code	HCPCS J2250
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$13.58
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: AlohaCare Medicare	$10.64
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$8.40
Rate for Payer: Cash Price	$8.40
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$11.76
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association ABD	$0.16
Rate for Payer: Hawaii Medical Service Association ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Medical Service Association Medicare	$10.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$10.64
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$10.64
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicaid	$10.64
Rate for Payer: Ohana Health Plan Medicare	$10.64
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicaid	$8.40
Rate for Payer: UnitedHealthcare Medicare	$10.64
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$10.20
Rate for Payer: University Health Alliance Commercial	$2.19

MIDAZOLAM 1 MG/ML INJECTION SOLUTION [93519]

Facility

$14.00

Service Code	HCPCS J2250
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: MDX Hawaii PPO	$13.58

MIDAZOLAM 2 MG/ML ORAL SYRUP [24176]

Facility

$376.00

Service Code	NDC 00054356699
Hospital Revenue Code	637
Min. Negotiated Rate	$188.00
Max. Negotiated Rate	$364.72
Rate for Payer: AlohaCare Medicaid	$188.00
Rate for Payer: AlohaCare Medicare	$285.76
Rate for Payer: Cash Price	$225.60
Rate for Payer: Devoted Health Medicare	$315.84
Rate for Payer: Hawaii Medical Service Association Medicare	$285.76
Rate for Payer: Hawaii Western Management Group Commercial	$357.20
Rate for Payer: Health Management Network Commercial	$319.60
Rate for Payer: Humana Medicare	$285.76
Rate for Payer: Kaiser Permanente Commercial	$338.40
Rate for Payer: Kaiser Permanente Medicaid	$191.76
Rate for Payer: Kaiser Permanente Medicare	$285.76
Rate for Payer: MDX Hawaii PPO	$364.72
Rate for Payer: Ohana Health Plan Medicaid	$285.76
Rate for Payer: Ohana Health Plan Medicare	$285.76
Rate for Payer: UnitedHealthcare Medicare	$285.76
Rate for Payer: University Health Alliance Commercial	$274.07

MIDAZOLAM 2 MG/ML ORAL SYRUP [24176]

Facility

$376.00

Service Code	NDC 00054356699
Hospital Revenue Code	250
Min. Negotiated Rate	$319.60
Max. Negotiated Rate	$364.72
Rate for Payer: Cash Price	$225.60
Rate for Payer: Health Management Network Commercial	$319.60
Rate for Payer: Kaiser Permanente Commercial	$338.40
Rate for Payer: MDX Hawaii PPO	$364.72

MIDAZOLAM 2 MG/ML ORAL SYRUP [24176]

Facility

$19.00

Service Code	NDC 68094076262
Hospital Revenue Code	637
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$18.43
Rate for Payer: AlohaCare Medicaid	$9.50
Rate for Payer: AlohaCare Medicare	$14.44
Rate for Payer: Cash Price	$11.40
Rate for Payer: Devoted Health Medicare	$15.96
Rate for Payer: Hawaii Medical Service Association Medicare	$14.44
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Humana Medicare	$14.44
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: Kaiser Permanente Medicare	$14.44
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: Ohana Health Plan Medicaid	$14.44
Rate for Payer: Ohana Health Plan Medicare	$14.44
Rate for Payer: UnitedHealthcare Medicare	$14.44
Rate for Payer: University Health Alliance Commercial	$13.85

MIDAZOLAM 2 MG/ML ORAL SYRUP [24176]

Facility

$19.00

Service Code	NDC 68094076259
Hospital Revenue Code	250
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: MDX Hawaii PPO	$18.43

Know your out-of-pocket cost for care.

All Charges