Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$36.00

Service Code	NDC 68180067511
Hospital Revenue Code	637
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: AlohaCare Medicare	$27.36
Rate for Payer: Cash Price	$21.60
Rate for Payer: Devoted Health Medicare	$30.24
Rate for Payer: Hawaii Medical Service Association Medicare	$27.36
Rate for Payer: Hawaii Western Management Group Commercial	$34.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$27.36
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$27.36
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$27.36
Rate for Payer: Ohana Health Plan Medicare	$27.36
Rate for Payer: UnitedHealthcare Medicare	$27.36
Rate for Payer: University Health Alliance Commercial	$26.24

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$36.00

Service Code	NDC 68180067511
Hospital Revenue Code	250
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 70710116506
Hospital Revenue Code	250
Min. Negotiated Rate	$209.95
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: MDX Hawaii PPO	$239.59

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 27241013909
Hospital Revenue Code	250
Min. Negotiated Rate	$209.95
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: MDX Hawaii PPO	$239.59

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 27241013909
Hospital Revenue Code	637
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$239.59
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$187.72
Rate for Payer: Cash Price	$148.20
Rate for Payer: Devoted Health Medicare	$207.48
Rate for Payer: Hawaii Medical Service Association Medicare	$187.72
Rate for Payer: Hawaii Western Management Group Commercial	$234.65
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Humana Medicare	$187.72
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: Kaiser Permanente Medicaid	$125.97
Rate for Payer: Kaiser Permanente Medicare	$187.72
Rate for Payer: MDX Hawaii PPO	$239.59
Rate for Payer: Ohana Health Plan Medicaid	$187.72
Rate for Payer: Ohana Health Plan Medicare	$187.72
Rate for Payer: UnitedHealthcare Medicare	$187.72
Rate for Payer: University Health Alliance Commercial	$180.04

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 70710116506
Hospital Revenue Code	637
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$239.59
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$187.72
Rate for Payer: Cash Price	$148.20
Rate for Payer: Devoted Health Medicare	$207.48
Rate for Payer: Hawaii Medical Service Association Medicare	$187.72
Rate for Payer: Hawaii Western Management Group Commercial	$234.65
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Humana Medicare	$187.72
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: Kaiser Permanente Medicaid	$125.97
Rate for Payer: Kaiser Permanente Medicare	$187.72
Rate for Payer: MDX Hawaii PPO	$239.59
Rate for Payer: Ohana Health Plan Medicaid	$187.72
Rate for Payer: Ohana Health Plan Medicare	$187.72
Rate for Payer: UnitedHealthcare Medicare	$187.72
Rate for Payer: University Health Alliance Commercial	$180.04

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 68180067711
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 64380079901
Hospital Revenue Code	637
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$29.64
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$32.76
Rate for Payer: Hawaii Medical Service Association Medicare	$29.64
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$29.64
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$29.64
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$29.64
Rate for Payer: Ohana Health Plan Medicare	$29.64
Rate for Payer: UnitedHealthcare Medicare	$29.64
Rate for Payer: University Health Alliance Commercial	$28.43

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 68180067711
Hospital Revenue Code	637
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$29.64
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$32.76
Rate for Payer: Hawaii Medical Service Association Medicare	$29.64
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$29.64
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$29.64
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$29.64
Rate for Payer: Ohana Health Plan Medicare	$29.64
Rate for Payer: UnitedHealthcare Medicare	$29.64
Rate for Payer: University Health Alliance Commercial	$28.43

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 64380079901
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

OSELTAMIVIR CAPSULES (TAMIFLU) 75 MG (TAKE HOME) [4080396]

Facility

$15.00

Service Code	NDC 00004080184
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

OSELTAMIVIR CAPSULES (TAMIFLU) 75 MG (TAKE HOME) [4080396]

Facility

$15.00

Service Code	NDC 00004080184
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

OSTEOMYELITIS WITH CC

Facility

$39,013.49

Service Code	MSDRG 540
Min. Negotiated Rate	$39,013.49
Max. Negotiated Rate	$39,013.49
Rate for Payer: Hawaii Medical Service Association Commercial	$39,013.49

OSTEOMYELITIS WITH MCC

Facility

$39,013.49

Service Code	MSDRG 539
Min. Negotiated Rate	$39,013.49
Max. Negotiated Rate	$39,013.49
Rate for Payer: Hawaii Medical Service Association Commercial	$39,013.49

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$39,013.49

Service Code	MSDRG 541
Min. Negotiated Rate	$39,013.49
Max. Negotiated Rate	$39,013.49
Rate for Payer: Hawaii Medical Service Association Commercial	$39,013.49

OSTEOSET BEAD KT 5ML 8400-0611

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,223.00
Max. Negotiated Rate	$2,372.62
Rate for Payer: AlohaCare Medicaid	$1,223.00
Rate for Payer: AlohaCare Medicare	$1,858.96
Rate for Payer: Cash Price	$1,467.60
Rate for Payer: Devoted Health Medicare	$2,054.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,858.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,712.20
Rate for Payer: Health Management Network Commercial	$2,079.10
Rate for Payer: Humana Medicare	$1,858.96
Rate for Payer: Kaiser Permanente Commercial	$2,201.40
Rate for Payer: Kaiser Permanente Medicaid	$1,247.46
Rate for Payer: Kaiser Permanente Medicare	$1,858.96
Rate for Payer: MDX Hawaii PPO	$2,372.62
Rate for Payer: Ohana Health Plan Medicaid	$1,858.96
Rate for Payer: Ohana Health Plan Medicare	$1,858.96
Rate for Payer: UnitedHealthcare Medicare	$1,858.96
Rate for Payer: University Health Alliance Commercial	$1,369.76

OSTEOSET BEAD KT 5ML 8400-0611

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,369.76
Max. Negotiated Rate	$2,372.62
Rate for Payer: Cash Price	$1,467.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,712.20
Rate for Payer: Health Management Network Commercial	$2,079.10
Rate for Payer: Kaiser Permanente Commercial	$2,201.40
Rate for Payer: MDX Hawaii PPO	$2,372.62
Rate for Payer: University Health Alliance Commercial	$1,369.76

OSTEOVATION 5CC FRMLA 390-0005

Facility

$105.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$73.50
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: University Health Alliance Commercial	$58.80

OSTEOVATION 5CC FRMLA 390-0005

Facility

$105.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$101.85
Rate for Payer: AlohaCare Medicaid	$52.50
Rate for Payer: AlohaCare Medicare	$79.80
Rate for Payer: Cash Price	$63.00
Rate for Payer: Devoted Health Medicare	$88.20
Rate for Payer: Hawaii Medical Service Association Medicare	$79.80
Rate for Payer: Hawaii Western Management Group Commercial	$73.50
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Humana Medicare	$79.80
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: Kaiser Permanente Medicare	$79.80
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: Ohana Health Plan Medicaid	$79.80
Rate for Payer: Ohana Health Plan Medicare	$79.80
Rate for Payer: UnitedHealthcare Medicare	$79.80
Rate for Payer: University Health Alliance Commercial	$58.80

OSTOMY CONE IRRIGATOR

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$74.69
Rate for Payer: AlohaCare Medicaid	$38.50
Rate for Payer: AlohaCare Medicare	$58.52
Rate for Payer: Cash Price	$46.20
Rate for Payer: Devoted Health Medicare	$64.68
Rate for Payer: Hawaii Medical Service Association Medicare	$58.52
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Humana Medicare	$58.52
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: Kaiser Permanente Medicare	$58.52
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: Ohana Health Plan Medicaid	$58.52
Rate for Payer: Ohana Health Plan Medicare	$58.52
Rate for Payer: UnitedHealthcare Medicare	$58.52
Rate for Payer: University Health Alliance Commercial	$56.13

OSTOMY CONE IRRIGATOR

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$10,618.50

Service Code	MSDRG 818
Min. Negotiated Rate	$10,618.50
Max. Negotiated Rate	$10,618.50
Rate for Payer: Hawaii Medical Service Association Commercial	$10,618.50

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$10,618.50

Service Code	MSDRG 817
Min. Negotiated Rate	$10,618.50
Max. Negotiated Rate	$10,618.50
Rate for Payer: Hawaii Medical Service Association Commercial	$10,618.50

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$10,334.07

Service Code	MSDRG 819
Min. Negotiated Rate	$10,334.07
Max. Negotiated Rate	$10,334.07
Rate for Payer: Hawaii Medical Service Association Commercial	$10,334.07

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$9,314.89

Service Code	MSDRG 832
Min. Negotiated Rate	$9,314.89
Max. Negotiated Rate	$9,314.89
Rate for Payer: Hawaii Medical Service Association Commercial	$9,314.89

Know your out-of-pocket cost for care.

All Charges