Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MULTITASC SIZE 6 #4500-04

Facility

$5,358.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,679.00
Max. Negotiated Rate	$5,197.26
Rate for Payer: AlohaCare Medicaid	$2,679.00
Rate for Payer: AlohaCare Medicare	$4,072.08
Rate for Payer: Cash Price	$3,214.80
Rate for Payer: Devoted Health Medicare	$4,500.72
Rate for Payer: Hawaii Medical Service Association Medicare	$4,072.08
Rate for Payer: Hawaii Western Management Group Commercial	$5,090.10
Rate for Payer: Health Management Network Commercial	$4,554.30
Rate for Payer: Humana Medicare	$4,072.08
Rate for Payer: Kaiser Permanente Commercial	$4,822.20
Rate for Payer: Kaiser Permanente Medicaid	$2,732.58
Rate for Payer: Kaiser Permanente Medicare	$4,072.08
Rate for Payer: MDX Hawaii PPO	$5,197.26
Rate for Payer: Ohana Health Plan Medicaid	$4,072.08
Rate for Payer: Ohana Health Plan Medicare	$4,072.08
Rate for Payer: UnitedHealthcare Medicare	$4,072.08
Rate for Payer: University Health Alliance Commercial	$3,905.45

MULTITASC SIZE 6 #4500-04

Facility

$5,358.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,554.30
Max. Negotiated Rate	$5,197.26
Rate for Payer: Cash Price	$3,214.80
Rate for Payer: Health Management Network Commercial	$4,554.30
Rate for Payer: Kaiser Permanente Commercial	$4,822.20
Rate for Payer: MDX Hawaii PPO	$5,197.26

MULTITASC SIZE 7 #4500-05

Facility

$5,358.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,554.30
Max. Negotiated Rate	$5,197.26
Rate for Payer: Cash Price	$3,214.80
Rate for Payer: Health Management Network Commercial	$4,554.30
Rate for Payer: Kaiser Permanente Commercial	$4,822.20
Rate for Payer: MDX Hawaii PPO	$5,197.26

MULTITASC SIZE 7 #4500-05

Facility

$5,358.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,679.00
Max. Negotiated Rate	$5,197.26
Rate for Payer: AlohaCare Medicaid	$2,679.00
Rate for Payer: AlohaCare Medicare	$4,072.08
Rate for Payer: Cash Price	$3,214.80
Rate for Payer: Devoted Health Medicare	$4,500.72
Rate for Payer: Hawaii Medical Service Association Medicare	$4,072.08
Rate for Payer: Hawaii Western Management Group Commercial	$5,090.10
Rate for Payer: Health Management Network Commercial	$4,554.30
Rate for Payer: Humana Medicare	$4,072.08
Rate for Payer: Kaiser Permanente Commercial	$4,822.20
Rate for Payer: Kaiser Permanente Medicaid	$2,732.58
Rate for Payer: Kaiser Permanente Medicare	$4,072.08
Rate for Payer: MDX Hawaii PPO	$5,197.26
Rate for Payer: Ohana Health Plan Medicaid	$4,072.08
Rate for Payer: Ohana Health Plan Medicare	$4,072.08
Rate for Payer: UnitedHealthcare Medicare	$4,072.08
Rate for Payer: University Health Alliance Commercial	$3,905.45

MULTI VAC 50 XL HIP

Facility

$1,586.00

Hospital Revenue Code	272
Min. Negotiated Rate	$793.00
Max. Negotiated Rate	$1,538.42
Rate for Payer: AlohaCare Medicaid	$793.00
Rate for Payer: AlohaCare Medicare	$1,205.36
Rate for Payer: Cash Price	$951.60
Rate for Payer: Devoted Health Medicare	$1,332.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,205.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,506.70
Rate for Payer: Health Management Network Commercial	$1,348.10
Rate for Payer: Humana Medicare	$1,205.36
Rate for Payer: Kaiser Permanente Commercial	$1,427.40
Rate for Payer: Kaiser Permanente Medicaid	$808.86
Rate for Payer: Kaiser Permanente Medicare	$1,205.36
Rate for Payer: MDX Hawaii PPO	$1,538.42
Rate for Payer: Ohana Health Plan Medicaid	$1,205.36
Rate for Payer: Ohana Health Plan Medicare	$1,205.36
Rate for Payer: UnitedHealthcare Medicare	$1,205.36
Rate for Payer: University Health Alliance Commercial	$1,156.04

MULTI VAC 50 XL HIP

Facility

$1,586.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,348.10
Max. Negotiated Rate	$1,538.42
Rate for Payer: Cash Price	$951.60
Rate for Payer: Health Management Network Commercial	$1,348.10
Rate for Payer: Kaiser Permanente Commercial	$1,427.40
Rate for Payer: MDX Hawaii PPO	$1,538.42

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET [37053]

Facility

$1.00

Service Code	NDC 22368000000
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

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET [37053]

Facility

$1.00

Service Code	NDC 43233000000
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

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET [37053]

Facility

$1.00

Service Code	NDC 43233000000
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

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET [37053]

Facility

$1.00

Service Code	NDC 22368000000
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

MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET [5821]

Facility

$1.00

Service Code	NDC 53061000000
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

MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET [5821]

Facility

$1.00

Service Code	NDC 53061000000
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

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID [1481]

Facility

$19.00

Service Code	NDC 00858000000
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

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID [1481]

Facility

$19.00

Service Code	NDC 00858000000
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

MUPIROCIN 2% OINTMENT (BACTROBAN) (22 GRAM) (TAKE HOME) [4080378]

Facility

$15.00

Service Code	NDC 00004080166
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

MUPIROCIN 2% OINTMENT (BACTROBAN) (22 GRAM) (TAKE HOME) [4080378]

Facility

$15.00

Service Code	NDC 00004080166
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

MUPIROCIN 2 % TOPICAL OINTMENT [10674]

Facility

$150.00

Service Code	NDC 68462018022
Hospital Revenue Code	637
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$114.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Devoted Health Medicare	$126.00
Rate for Payer: Hawaii Medical Service Association Medicare	$114.00
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$114.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$114.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$114.00
Rate for Payer: Ohana Health Plan Medicare	$114.00
Rate for Payer: UnitedHealthcare Medicare	$114.00
Rate for Payer: University Health Alliance Commercial	$109.33

MUPIROCIN 2 % TOPICAL OINTMENT [10674]

Facility

$150.00

Service Code	NDC 68462018022
Hospital Revenue Code	250
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

MUPIROCIN CALCIUM 2 % TOPICAL CREAM [22251]

Facility

$613.00

Service Code	NDC 68462056417
Hospital Revenue Code	250
Min. Negotiated Rate	$521.05
Max. Negotiated Rate	$594.61
Rate for Payer: Cash Price	$367.80
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: MDX Hawaii PPO	$594.61

MUPIROCIN CALCIUM 2 % TOPICAL CREAM [22251]

Facility

$613.00

Service Code	NDC 68462056417
Hospital Revenue Code	637
Min. Negotiated Rate	$306.50
Max. Negotiated Rate	$594.61
Rate for Payer: AlohaCare Medicaid	$306.50
Rate for Payer: AlohaCare Medicare	$465.88
Rate for Payer: Cash Price	$367.80
Rate for Payer: Devoted Health Medicare	$514.92
Rate for Payer: Hawaii Medical Service Association Medicare	$465.88
Rate for Payer: Hawaii Western Management Group Commercial	$582.35
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Humana Medicare	$465.88
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: Kaiser Permanente Medicaid	$312.63
Rate for Payer: Kaiser Permanente Medicare	$465.88
Rate for Payer: MDX Hawaii PPO	$594.61
Rate for Payer: Ohana Health Plan Medicaid	$465.88
Rate for Payer: Ohana Health Plan Medicare	$465.88
Rate for Payer: UnitedHealthcare Medicare	$465.88
Rate for Payer: University Health Alliance Commercial	$446.82

MUPIROCIN CALCIUM 2 % TOPICAL CREAM [22251]

Facility

$613.00

Service Code	NDC 51672137001
Hospital Revenue Code	250
Min. Negotiated Rate	$521.05
Max. Negotiated Rate	$594.61
Rate for Payer: Cash Price	$367.80
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: MDX Hawaii PPO	$594.61

MUPIROCIN CALCIUM 2 % TOPICAL CREAM [22251]

Facility

$613.00

Service Code	NDC 51672137001
Hospital Revenue Code	637
Min. Negotiated Rate	$306.50
Max. Negotiated Rate	$594.61
Rate for Payer: AlohaCare Medicaid	$306.50
Rate for Payer: AlohaCare Medicare	$465.88
Rate for Payer: Cash Price	$367.80
Rate for Payer: Devoted Health Medicare	$514.92
Rate for Payer: Hawaii Medical Service Association Medicare	$465.88
Rate for Payer: Hawaii Western Management Group Commercial	$582.35
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Humana Medicare	$465.88
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: Kaiser Permanente Medicaid	$312.63
Rate for Payer: Kaiser Permanente Medicare	$465.88
Rate for Payer: MDX Hawaii PPO	$594.61
Rate for Payer: Ohana Health Plan Medicaid	$465.88
Rate for Payer: Ohana Health Plan Medicare	$465.88
Rate for Payer: UnitedHealthcare Medicare	$465.88
Rate for Payer: University Health Alliance Commercial	$446.82

MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION [119571]

Facility

$33.00

Service Code	NDC 54643564901
Hospital Revenue Code	250
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: MDX Hawaii PPO	$32.01

MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]

Facility

$3.00

Service Code	HCPCS J7517
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]

Facility

$3.00

Service Code	HCPCS J7517
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$1.80
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 Medicare	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

Know your out-of-pocket cost for care.

All Charges