Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$12.00

Service Code	NDC 00406833001
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$12.00

Service Code	NDC 00406833001
Hospital Revenue Code	637
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$9.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Hawaii Medical Service Association Medicare	$9.12
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$9.12
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$9.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$9.12
Rate for Payer: Ohana Health Plan Medicare	$9.12
Rate for Payer: UnitedHealthcare Medicare	$9.12
Rate for Payer: University Health Alliance Commercial	$8.75

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$13.00

Service Code	NDC 00406833062
Hospital Revenue Code	637
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$9.88
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$10.92
Rate for Payer: Hawaii Medical Service Association Medicare	$9.88
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$9.88
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$9.88
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$9.88
Rate for Payer: Ohana Health Plan Medicare	$9.88
Rate for Payer: UnitedHealthcare Medicare	$9.88
Rate for Payer: University Health Alliance Commercial	$9.48

MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]

Facility

$122.00

Service Code	HCPCS J2274
Hospital Revenue Code	636
Min. Negotiated Rate	$10.79
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$67.64
Rate for Payer: AlohaCare Medicare	$92.72
Rate for Payer: Cash Price	$53.40
Rate for Payer: Cash Price	$73.20
Rate for Payer: Cash Price	$73.20
Rate for Payer: Cash Price	$53.40
Rate for Payer: Devoted Health Medicare	$102.48
Rate for Payer: Devoted Health Medicare	$74.76
Rate for Payer: Hawaii Medical Service Association ABD	$10.79
Rate for Payer: Hawaii Medical Service Association ABD	$10.79
Rate for Payer: Hawaii Medical Service Association Medicare	$92.72
Rate for Payer: Hawaii Medical Service Association Medicare	$67.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.79
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$92.72
Rate for Payer: Humana Medicare	$67.64
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$67.64
Rate for Payer: Kaiser Permanente Medicare	$92.72
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$67.64
Rate for Payer: Ohana Health Plan Medicaid	$92.72
Rate for Payer: Ohana Health Plan Medicare	$92.72
Rate for Payer: Ohana Health Plan Medicare	$67.64
Rate for Payer: UnitedHealthcare Medicaid	$73.20
Rate for Payer: UnitedHealthcare Medicaid	$53.40
Rate for Payer: UnitedHealthcare Medicare	$92.72
Rate for Payer: UnitedHealthcare Medicare	$67.64
Rate for Payer: University Health Alliance Commercial	$88.93
Rate for Payer: University Health Alliance Commercial	$64.87

MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]

Facility

$122.00

Service Code	HCPCS J2274
Hospital Revenue Code	250
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$73.20
Rate for Payer: Cash Price	$53.40
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: MDX Hawaii PPO	$118.34

MOUTH PROCEDURES WITH CC/MCC

Facility

$59,776.44

Service Code	MSDRG 137
Min. Negotiated Rate	$59,776.44
Max. Negotiated Rate	$59,776.44
Rate for Payer: Hawaii Medical Service Association Commercial	$59,776.44

MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$31,760.68

Service Code	MSDRG 138
Min. Negotiated Rate	$31,760.68
Max. Negotiated Rate	$31,760.68
Rate for Payer: Hawaii Medical Service Association Commercial	$31,760.68

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$335.00

Service Code	NDC 68180042201
Hospital Revenue Code	250
Min. Negotiated Rate	$284.75
Max. Negotiated Rate	$324.95
Rate for Payer: Cash Price	$201.00
Rate for Payer: Health Management Network Commercial	$284.75
Rate for Payer: Kaiser Permanente Commercial	$301.50
Rate for Payer: MDX Hawaii PPO	$324.95

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$335.00

Service Code	NDC 68180042201
Hospital Revenue Code	637
Min. Negotiated Rate	$167.50
Max. Negotiated Rate	$324.95
Rate for Payer: AlohaCare Medicaid	$167.50
Rate for Payer: AlohaCare Medicare	$254.60
Rate for Payer: Cash Price	$201.00
Rate for Payer: Devoted Health Medicare	$281.40
Rate for Payer: Hawaii Medical Service Association Medicare	$254.60
Rate for Payer: Hawaii Western Management Group Commercial	$318.25
Rate for Payer: Health Management Network Commercial	$284.75
Rate for Payer: Humana Medicare	$254.60
Rate for Payer: Kaiser Permanente Commercial	$301.50
Rate for Payer: Kaiser Permanente Medicaid	$170.85
Rate for Payer: Kaiser Permanente Medicare	$254.60
Rate for Payer: MDX Hawaii PPO	$324.95
Rate for Payer: Ohana Health Plan Medicaid	$254.60
Rate for Payer: Ohana Health Plan Medicare	$254.60
Rate for Payer: UnitedHealthcare Medicare	$254.60
Rate for Payer: University Health Alliance Commercial	$244.18

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$335.00

Service Code	NDC 60505058204
Hospital Revenue Code	637
Min. Negotiated Rate	$167.50
Max. Negotiated Rate	$324.95
Rate for Payer: AlohaCare Medicaid	$167.50
Rate for Payer: AlohaCare Medicare	$254.60
Rate for Payer: Cash Price	$201.00
Rate for Payer: Devoted Health Medicare	$281.40
Rate for Payer: Hawaii Medical Service Association Medicare	$254.60
Rate for Payer: Hawaii Western Management Group Commercial	$318.25
Rate for Payer: Health Management Network Commercial	$284.75
Rate for Payer: Humana Medicare	$254.60
Rate for Payer: Kaiser Permanente Commercial	$301.50
Rate for Payer: Kaiser Permanente Medicaid	$170.85
Rate for Payer: Kaiser Permanente Medicare	$254.60
Rate for Payer: MDX Hawaii PPO	$324.95
Rate for Payer: Ohana Health Plan Medicaid	$254.60
Rate for Payer: Ohana Health Plan Medicare	$254.60
Rate for Payer: UnitedHealthcare Medicare	$254.60
Rate for Payer: University Health Alliance Commercial	$244.18

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$335.00

Service Code	NDC 60505058204
Hospital Revenue Code	250
Min. Negotiated Rate	$284.75
Max. Negotiated Rate	$324.95
Rate for Payer: Cash Price	$201.00
Rate for Payer: Health Management Network Commercial	$284.75
Rate for Payer: Kaiser Permanente Commercial	$301.50
Rate for Payer: MDX Hawaii PPO	$324.95

MOXIFLOXACIN 0.5% OPHTH SOLUTION (VIGAMOX) (3 ML) (TAKE HOME) [4080377]

Facility

$15.00

Service Code	NDC 00004080165
Hospital Revenue Code	253
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

MOXIFLOXACIN 0.5% OPHTH SOLUTION (VIGAMOX) (3 ML) (TAKE HOME) [4080377]

Facility

$15.00

Service Code	NDC 00004080165
Hospital Revenue Code	253
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

MP CATH 14FR DRAINAGE APD

Facility

$400.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: MDX Hawaii PPO	$388.00

MP CATH 14FR DRAINAGE APD

Facility

$400.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$388.00
Rate for Payer: AlohaCare Medicaid	$200.00
Rate for Payer: AlohaCare Medicare	$304.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Devoted Health Medicare	$336.00
Rate for Payer: Hawaii Medical Service Association Medicare	$304.00
Rate for Payer: Hawaii Western Management Group Commercial	$380.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Humana Medicare	$304.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: Kaiser Permanente Medicaid	$204.00
Rate for Payer: Kaiser Permanente Medicare	$304.00
Rate for Payer: MDX Hawaii PPO	$388.00
Rate for Payer: Ohana Health Plan Medicaid	$304.00
Rate for Payer: Ohana Health Plan Medicare	$304.00
Rate for Payer: UnitedHealthcare Medicare	$304.00
Rate for Payer: University Health Alliance Commercial	$291.56

MP DRAIN CATH 14X45 6SH

Facility

$381.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$323.85
Max. Negotiated Rate	$369.57
Rate for Payer: Cash Price	$228.60
Rate for Payer: Health Management Network Commercial	$323.85
Rate for Payer: Kaiser Permanente Commercial	$342.90
Rate for Payer: MDX Hawaii PPO	$369.57

MP DRAIN CATH 14X45 6SH

Facility

$381.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$190.50
Max. Negotiated Rate	$369.57
Rate for Payer: AlohaCare Medicaid	$190.50
Rate for Payer: AlohaCare Medicare	$289.56
Rate for Payer: Cash Price	$228.60
Rate for Payer: Devoted Health Medicare	$320.04
Rate for Payer: Hawaii Medical Service Association Medicare	$289.56
Rate for Payer: Hawaii Western Management Group Commercial	$361.95
Rate for Payer: Health Management Network Commercial	$323.85
Rate for Payer: Humana Medicare	$289.56
Rate for Payer: Kaiser Permanente Commercial	$342.90
Rate for Payer: Kaiser Permanente Medicaid	$194.31
Rate for Payer: Kaiser Permanente Medicare	$289.56
Rate for Payer: MDX Hawaii PPO	$369.57
Rate for Payer: Ohana Health Plan Medicaid	$289.56
Rate for Payer: Ohana Health Plan Medicare	$289.56
Rate for Payer: UnitedHealthcare Medicare	$289.56
Rate for Payer: University Health Alliance Commercial	$277.71

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC

Facility

$115,594.65

Service Code	MSDRG 427
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$115,594.65

Service Code	MSDRG 426
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC

Facility

$115,594.65

Service Code	MSDRG 428
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$84,260.61

Service Code	MSDRG 447
Min. Negotiated Rate	$84,260.61
Max. Negotiated Rate	$84,260.61
Rate for Payer: Hawaii Medical Service Association Commercial	$84,260.61

MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$79,283.19

Service Code	MSDRG 448
Min. Negotiated Rate	$79,283.19
Max. Negotiated Rate	$79,283.19
Rate for Payer: Hawaii Medical Service Association Commercial	$79,283.19

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC

Facility

$20,170.40

Service Code	MSDRG 059
Min. Negotiated Rate	$20,170.40
Max. Negotiated Rate	$20,170.40
Rate for Payer: Hawaii Medical Service Association Commercial	$20,170.40

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC

Facility

$20,170.40

Service Code	MSDRG 058
Min. Negotiated Rate	$20,170.40
Max. Negotiated Rate	$20,170.40
Rate for Payer: Hawaii Medical Service Association Commercial	$20,170.40

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC

Facility

$20,170.40

Service Code	MSDRG 060
Min. Negotiated Rate	$20,170.40
Max. Negotiated Rate	$20,170.40
Rate for Payer: Hawaii Medical Service Association Commercial	$20,170.40

Know your out-of-pocket cost for care.

All Charges