Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [82162]

Facility

$1.00

Service Code	NDC 45802014370
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

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [82162]

Facility

$1.00

Service Code	NDC 47682022335
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

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [82162]

Facility

$1.00

Service Code	NDC 00904880567
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

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [82162]

Facility

$1.00

Service Code	NDC 45802014300
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

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [82162]

Facility

$1.00

Service Code	NDC 45802014370
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

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [82162]

Facility

$1.00

Service Code	NDC 00904880567
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

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [82162]

Facility

$1.00

Service Code	NDC 45802014300
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

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [82162]

Facility

$1.00

Service Code	NDC 47682022335
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

NEOMYCIN/POLYMYXIN B/HC OTIC SUSPENSION (CORTISPORIN) (10 ML) (TAKE HOME) [4080351]

Facility

$15.00

Service Code	NDC 00004080139
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

NEOMYCIN/POLYMYXIN B/HC OTIC SUSPENSION (CORTISPORIN) (10 ML) (TAKE HOME) [4080351]

Facility

$15.00

Service Code	NDC 00004080139
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

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]

Facility

$132.00

Service Code	NDC 61314063006
Hospital Revenue Code	250
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$79.20
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: MDX Hawaii PPO	$128.04

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]

Facility

$70.00

Service Code	NDC 24208083060
Hospital Revenue Code	250
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]

Facility

$132.00

Service Code	NDC 61314063006
Hospital Revenue Code	637
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$128.04
Rate for Payer: AlohaCare Medicaid	$66.00
Rate for Payer: AlohaCare Medicare	$100.32
Rate for Payer: Cash Price	$79.20
Rate for Payer: Devoted Health Medicare	$110.88
Rate for Payer: Hawaii Medical Service Association Medicare	$100.32
Rate for Payer: Hawaii Western Management Group Commercial	$125.40
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Humana Medicare	$100.32
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: Kaiser Permanente Medicaid	$67.32
Rate for Payer: Kaiser Permanente Medicare	$100.32
Rate for Payer: MDX Hawaii PPO	$128.04
Rate for Payer: Ohana Health Plan Medicaid	$100.32
Rate for Payer: Ohana Health Plan Medicare	$100.32
Rate for Payer: UnitedHealthcare Medicare	$100.32
Rate for Payer: University Health Alliance Commercial	$96.21

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]

Facility

$70.00

Service Code	NDC 24208083060
Hospital Revenue Code	637
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$35.00
Rate for Payer: AlohaCare Medicare	$53.20
Rate for Payer: Cash Price	$42.00
Rate for Payer: Devoted Health Medicare	$58.80
Rate for Payer: Hawaii Medical Service Association Medicare	$53.20
Rate for Payer: Hawaii Western Management Group Commercial	$66.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Humana Medicare	$53.20
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: Kaiser Permanente Medicare	$53.20
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: Ohana Health Plan Medicaid	$53.20
Rate for Payer: Ohana Health Plan Medicare	$53.20
Rate for Payer: UnitedHealthcare Medicare	$53.20
Rate for Payer: University Health Alliance Commercial	$51.02

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]

Facility

$303.00

Service Code	NDC 24208063562
Hospital Revenue Code	250
Min. Negotiated Rate	$257.55
Max. Negotiated Rate	$293.91
Rate for Payer: Cash Price	$181.80
Rate for Payer: Health Management Network Commercial	$257.55
Rate for Payer: Kaiser Permanente Commercial	$272.70
Rate for Payer: MDX Hawaii PPO	$293.91

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]

Facility

$296.00

Service Code	NDC 64980044801
Hospital Revenue Code	637
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$287.12
Rate for Payer: AlohaCare Medicaid	$148.00
Rate for Payer: AlohaCare Medicare	$224.96
Rate for Payer: Cash Price	$177.60
Rate for Payer: Devoted Health Medicare	$248.64
Rate for Payer: Hawaii Medical Service Association Medicare	$224.96
Rate for Payer: Hawaii Western Management Group Commercial	$281.20
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: Humana Medicare	$224.96
Rate for Payer: Kaiser Permanente Commercial	$266.40
Rate for Payer: Kaiser Permanente Medicaid	$150.96
Rate for Payer: Kaiser Permanente Medicare	$224.96
Rate for Payer: MDX Hawaii PPO	$287.12
Rate for Payer: Ohana Health Plan Medicaid	$224.96
Rate for Payer: Ohana Health Plan Medicare	$224.96
Rate for Payer: UnitedHealthcare Medicare	$224.96
Rate for Payer: University Health Alliance Commercial	$215.75

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]

Facility

$296.00

Service Code	NDC 64980044801
Hospital Revenue Code	250
Min. Negotiated Rate	$251.60
Max. Negotiated Rate	$287.12
Rate for Payer: Cash Price	$177.60
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: Kaiser Permanente Commercial	$266.40
Rate for Payer: MDX Hawaii PPO	$287.12

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]

Facility

$303.00

Service Code	NDC 24208063562
Hospital Revenue Code	637
Min. Negotiated Rate	$151.50
Max. Negotiated Rate	$293.91
Rate for Payer: AlohaCare Medicaid	$151.50
Rate for Payer: AlohaCare Medicare	$230.28
Rate for Payer: Cash Price	$181.80
Rate for Payer: Devoted Health Medicare	$254.52
Rate for Payer: Hawaii Medical Service Association Medicare	$230.28
Rate for Payer: Hawaii Western Management Group Commercial	$287.85
Rate for Payer: Health Management Network Commercial	$257.55
Rate for Payer: Humana Medicare	$230.28
Rate for Payer: Kaiser Permanente Commercial	$272.70
Rate for Payer: Kaiser Permanente Medicaid	$154.53
Rate for Payer: Kaiser Permanente Medicare	$230.28
Rate for Payer: MDX Hawaii PPO	$293.91
Rate for Payer: Ohana Health Plan Medicaid	$230.28
Rate for Payer: Ohana Health Plan Medicare	$230.28
Rate for Payer: UnitedHealthcare Medicare	$230.28
Rate for Payer: University Health Alliance Commercial	$220.86

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]

Facility

$303.00

Service Code	NDC 24208063110
Hospital Revenue Code	637
Min. Negotiated Rate	$151.50
Max. Negotiated Rate	$293.91
Rate for Payer: AlohaCare Medicaid	$151.50
Rate for Payer: AlohaCare Medicare	$230.28
Rate for Payer: Cash Price	$181.80
Rate for Payer: Devoted Health Medicare	$254.52
Rate for Payer: Hawaii Medical Service Association Medicare	$230.28
Rate for Payer: Hawaii Western Management Group Commercial	$287.85
Rate for Payer: Health Management Network Commercial	$257.55
Rate for Payer: Humana Medicare	$230.28
Rate for Payer: Kaiser Permanente Commercial	$272.70
Rate for Payer: Kaiser Permanente Medicaid	$154.53
Rate for Payer: Kaiser Permanente Medicare	$230.28
Rate for Payer: MDX Hawaii PPO	$293.91
Rate for Payer: Ohana Health Plan Medicaid	$230.28
Rate for Payer: Ohana Health Plan Medicare	$230.28
Rate for Payer: UnitedHealthcare Medicare	$230.28
Rate for Payer: University Health Alliance Commercial	$220.86

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]

Facility

$303.00

Service Code	NDC 24208063110
Hospital Revenue Code	250
Min. Negotiated Rate	$257.55
Max. Negotiated Rate	$293.91
Rate for Payer: Cash Price	$181.80
Rate for Payer: Health Management Network Commercial	$257.55
Rate for Payer: Kaiser Permanente Commercial	$272.70
Rate for Payer: MDX Hawaii PPO	$293.91

NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$64,422.04

Service Code	MSDRG 789
Min. Negotiated Rate	$64,422.04
Max. Negotiated Rate	$64,422.04
Rate for Payer: Hawaii Medical Service Association Commercial	$64,422.04

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$4,029.34

Service Code	MSDRG 794
Min. Negotiated Rate	$4,029.34
Max. Negotiated Rate	$4,029.34
Rate for Payer: Hawaii Medical Service Association Commercial	$4,029.34

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]

Facility

$38.00

Service Code	NDC 00641614901
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: MDX Hawaii PPO	$36.86

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]

Facility

$78.00

Service Code	NDC 51754122003
Hospital Revenue Code	250
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]

Facility

$38.00

Service Code	NDC 00641614910
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: MDX Hawaii PPO	$36.86

Know your out-of-pocket cost for care.

All Charges