Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NEEDLE MARROW/ASP 13GX2

Facility

$123.00

Hospital Revenue Code	272
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$119.31
Rate for Payer: AlohaCare Medicaid	$61.50
Rate for Payer: AlohaCare Medicare	$93.48
Rate for Payer: Cash Price	$73.80
Rate for Payer: Devoted Health Medicare	$103.32
Rate for Payer: Hawaii Medical Service Association Medicare	$93.48
Rate for Payer: Hawaii Western Management Group Commercial	$116.85
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: Humana Medicare	$93.48
Rate for Payer: Kaiser Permanente Commercial	$110.70
Rate for Payer: Kaiser Permanente Medicaid	$62.73
Rate for Payer: Kaiser Permanente Medicare	$93.48
Rate for Payer: MDX Hawaii PPO	$119.31
Rate for Payer: Ohana Health Plan Medicaid	$93.48
Rate for Payer: Ohana Health Plan Medicare	$93.48
Rate for Payer: UnitedHealthcare Medicare	$93.48
Rate for Payer: University Health Alliance Commercial	$89.65

NEEDLE MARROW/ASP 13GX3.5

Facility

$92.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.00
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$69.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Devoted Health Medicare	$77.28
Rate for Payer: Hawaii Medical Service Association Medicare	$69.92
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$69.92
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$69.92
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$69.92
Rate for Payer: Ohana Health Plan Medicare	$69.92
Rate for Payer: UnitedHealthcare Medicare	$69.92
Rate for Payer: University Health Alliance Commercial	$67.06

NEEDLE MARROW/ASP 13GX3.5

Facility

$92.00

Hospital Revenue Code	272
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: MDX Hawaii PPO	$89.24

NEEDLE SCORPION

Facility

$669.00

Hospital Revenue Code	272
Min. Negotiated Rate	$334.50
Max. Negotiated Rate	$648.93
Rate for Payer: AlohaCare Medicaid	$334.50
Rate for Payer: AlohaCare Medicare	$508.44
Rate for Payer: Cash Price	$401.40
Rate for Payer: Devoted Health Medicare	$561.96
Rate for Payer: Hawaii Medical Service Association Medicare	$508.44
Rate for Payer: Hawaii Western Management Group Commercial	$635.55
Rate for Payer: Health Management Network Commercial	$568.65
Rate for Payer: Humana Medicare	$508.44
Rate for Payer: Kaiser Permanente Commercial	$602.10
Rate for Payer: Kaiser Permanente Medicaid	$341.19
Rate for Payer: Kaiser Permanente Medicare	$508.44
Rate for Payer: MDX Hawaii PPO	$648.93
Rate for Payer: Ohana Health Plan Medicaid	$508.44
Rate for Payer: Ohana Health Plan Medicare	$508.44
Rate for Payer: UnitedHealthcare Medicare	$508.44
Rate for Payer: University Health Alliance Commercial	$487.63

NEEDLE SCORPION

Facility

$669.00

Hospital Revenue Code	272
Min. Negotiated Rate	$568.65
Max. Negotiated Rate	$648.93
Rate for Payer: Cash Price	$401.40
Rate for Payer: Health Management Network Commercial	$568.65
Rate for Payer: Kaiser Permanente Commercial	$602.10
Rate for Payer: MDX Hawaii PPO	$648.93

NEEDLE SCORPION KNEE AR-12990N

Facility

$2,048.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,740.80
Max. Negotiated Rate	$1,986.56
Rate for Payer: Cash Price	$1,228.80
Rate for Payer: Health Management Network Commercial	$1,740.80
Rate for Payer: Kaiser Permanente Commercial	$1,843.20
Rate for Payer: MDX Hawaii PPO	$1,986.56

NEEDLE SCORPION KNEE AR-12990N

Facility

$2,048.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,024.00
Max. Negotiated Rate	$1,986.56
Rate for Payer: AlohaCare Medicaid	$1,024.00
Rate for Payer: AlohaCare Medicare	$1,556.48
Rate for Payer: Cash Price	$1,228.80
Rate for Payer: Devoted Health Medicare	$1,720.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,556.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,945.60
Rate for Payer: Health Management Network Commercial	$1,740.80
Rate for Payer: Humana Medicare	$1,556.48
Rate for Payer: Kaiser Permanente Commercial	$1,843.20
Rate for Payer: Kaiser Permanente Medicaid	$1,044.48
Rate for Payer: Kaiser Permanente Medicare	$1,556.48
Rate for Payer: MDX Hawaii PPO	$1,986.56
Rate for Payer: Ohana Health Plan Medicaid	$1,556.48
Rate for Payer: Ohana Health Plan Medicare	$1,556.48
Rate for Payer: UnitedHealthcare Medicare	$1,556.48
Rate for Payer: University Health Alliance Commercial	$1,492.79

NEEDLE SPINAL 22GX3.5

Facility

$66.00

Hospital Revenue Code	272
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02

NEEDLE SPINAL 22GX3.5

Facility

$66.00

Hospital Revenue Code	272
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$50.16
Rate for Payer: Cash Price	$39.60
Rate for Payer: Devoted Health Medicare	$55.44
Rate for Payer: Hawaii Medical Service Association Medicare	$50.16
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$50.16
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$50.16
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$50.16
Rate for Payer: Ohana Health Plan Medicare	$50.16
Rate for Payer: UnitedHealthcare Medicare	$50.16
Rate for Payer: University Health Alliance Commercial	$48.11

NEEDLE SPINAL 25GX3.5 WHITACRE

Facility

$68.00

Hospital Revenue Code	272
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

NEEDLE SPINAL 25GX3.5 WHITACRE

Facility

$68.00

Hospital Revenue Code	272
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$34.00
Rate for Payer: AlohaCare Medicare	$51.68
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$57.12
Rate for Payer: Hawaii Medical Service Association Medicare	$51.68
Rate for Payer: Hawaii Western Management Group Commercial	$64.60
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$51.68
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$51.68
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$51.68
Rate for Payer: Ohana Health Plan Medicare	$51.68
Rate for Payer: UnitedHealthcare Medicare	$51.68
Rate for Payer: University Health Alliance Commercial	$49.57

NEEDLE SPINAL 27GX3.5 WHITACRE

Facility

$76.00

Hospital Revenue Code	272
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$57.76
Rate for Payer: Cash Price	$45.60
Rate for Payer: Devoted Health Medicare	$63.84
Rate for Payer: Hawaii Medical Service Association Medicare	$57.76
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$57.76
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$57.76
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$57.76
Rate for Payer: Ohana Health Plan Medicare	$57.76
Rate for Payer: UnitedHealthcare Medicare	$57.76
Rate for Payer: University Health Alliance Commercial	$55.40

NEEDLE SPINAL 27GX3.5 WHITACRE

Facility

$76.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]

Facility

$184.00

Service Code	NDC 24208079062
Hospital Revenue Code	637
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$139.84
Rate for Payer: Cash Price	$110.40
Rate for Payer: Devoted Health Medicare	$154.56
Rate for Payer: Hawaii Medical Service Association Medicare	$139.84
Rate for Payer: Hawaii Western Management Group Commercial	$174.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$139.84
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$139.84
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$139.84
Rate for Payer: Ohana Health Plan Medicare	$139.84
Rate for Payer: UnitedHealthcare Medicare	$139.84
Rate for Payer: University Health Alliance Commercial	$134.12

NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]

Facility

$184.00

Service Code	NDC 24208079062
Hospital Revenue Code	250
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$110.40
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48

NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]

Facility

$61.00

Service Code	NDC 24208079535
Hospital Revenue Code	637
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$30.50
Rate for Payer: AlohaCare Medicare	$46.36
Rate for Payer: Cash Price	$36.60
Rate for Payer: Devoted Health Medicare	$51.24
Rate for Payer: Hawaii Medical Service Association Medicare	$46.36
Rate for Payer: Hawaii Western Management Group Commercial	$57.95
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$46.36
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$46.36
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$46.36
Rate for Payer: Ohana Health Plan Medicare	$46.36
Rate for Payer: UnitedHealthcare Medicare	$46.36
Rate for Payer: University Health Alliance Commercial	$44.46

NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]

Facility

$61.00

Service Code	NDC 24208079535
Hospital Revenue Code	250
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$36.60
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17

NEOMYCIN 500 MG TABLET [5472]

Facility

$6.00

Service Code	NDC 00093117701
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

NEOMYCIN 500 MG TABLET [5472]

Facility

$6.00

Service Code	NDC 00093117701
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

NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT [38701]

Facility

$125.00

Service Code	NDC 24208078055
Hospital Revenue Code	250
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT [38701]

Facility

$125.00

Service Code	NDC 24208078055
Hospital Revenue Code	637
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$95.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Devoted Health Medicare	$105.00
Rate for Payer: Hawaii Medical Service Association Medicare	$95.00
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$95.00
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$95.00
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$95.00
Rate for Payer: Ohana Health Plan Medicare	$95.00
Rate for Payer: UnitedHealthcare Medicare	$95.00
Rate for Payer: University Health Alliance Commercial	$91.11

NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [16839]

Facility

$18.00

Service Code	NDC 68001048346
Hospital Revenue Code	637
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$13.68
Rate for Payer: Cash Price	$10.80
Rate for Payer: Devoted Health Medicare	$15.12
Rate for Payer: Hawaii Medical Service Association Medicare	$13.68
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$13.68
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$13.68
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$13.68
Rate for Payer: Ohana Health Plan Medicare	$13.68
Rate for Payer: UnitedHealthcare Medicare	$13.68
Rate for Payer: University Health Alliance Commercial	$13.12

NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [16839]

Facility

$14.00

Service Code	NDC 45802014301
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [16839]

Facility

$14.00

Service Code	NDC 45802014301
Hospital Revenue Code	637
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$13.58
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$10.64
Rate for Payer: Cash Price	$8.40
Rate for Payer: Devoted Health Medicare	$11.76
Rate for Payer: Hawaii Medical Service Association Medicare	$10.64
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$10.64
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$10.64
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: Ohana Health Plan Medicaid	$10.64
Rate for Payer: Ohana Health Plan Medicare	$10.64
Rate for Payer: UnitedHealthcare Medicare	$10.64
Rate for Payer: University Health Alliance Commercial	$10.20

NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [16839]

Facility

$18.00

Service Code	NDC 68001048346
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

Know your out-of-pocket cost for care.

All Charges