Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PRAVASTATIN 10 MG TABLET [11110]

Facility

$11.00

Service Code	NDC 50268066511
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: MDX Hawaii PPO	$10.67

PRAVASTATIN 10 MG TABLET [11110]

Facility

$12.00

Service Code	NDC 60687016901
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

PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1

Professional

Both

$211.19

Service Code	HCPCS 11730
Min. Negotiated Rate	$49.29
Max. Negotiated Rate	$179.51
Rate for Payer: AlohaCare Medicaid	$54.23
Rate for Payer: AlohaCare Medicare	$49.29
Rate for Payer: Cash Price	$126.71
Rate for Payer: Cash Price	$126.71
Rate for Payer: Devoted Health Medicare	$54.22
Rate for Payer: Hawaii Medical Service Association ABD	$54.23
Rate for Payer: Hawaii Medical Service Association Commercial	$83.72
Rate for Payer: Hawaii Medical Service Association Medicare	$49.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$54.23
Rate for Payer: Hawaii Western Management Group Commercial	$50.18
Rate for Payer: Health Management Network Commercial	$179.51
Rate for Payer: Kaiser Permanente Commercial	$59.15
Rate for Payer: Kaiser Permanente Medicaid	$59.15
Rate for Payer: Kaiser Permanente Medicare	$59.15
Rate for Payer: Ohana Health Plan Medicaid	$54.23
Rate for Payer: Ohana Health Plan Medicare	$49.29
Rate for Payer: UnitedHealthcare Medicaid	$54.23
Rate for Payer: UnitedHealthcare Medicare	$49.29
Rate for Payer: University Health Alliance Commercial	$59.12

PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL

Professional

Both

$60.53

Service Code	HCPCS 11732
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$51.45
Rate for Payer: AlohaCare Medicaid	$16.65
Rate for Payer: AlohaCare Medicare	$14.84
Rate for Payer: Cash Price	$36.32
Rate for Payer: Cash Price	$36.32
Rate for Payer: Devoted Health Medicare	$16.32
Rate for Payer: Hawaii Medical Service Association ABD	$16.65
Rate for Payer: Hawaii Medical Service Association Commercial	$38.70
Rate for Payer: Hawaii Medical Service Association Medicare	$14.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.65
Rate for Payer: Hawaii Western Management Group Commercial	$9.62
Rate for Payer: Health Management Network Commercial	$51.45
Rate for Payer: Kaiser Permanente Commercial	$17.81
Rate for Payer: Kaiser Permanente Medicaid	$17.81
Rate for Payer: Kaiser Permanente Medicare	$17.81
Rate for Payer: Ohana Health Plan Medicaid	$16.65
Rate for Payer: Ohana Health Plan Medicare	$14.84
Rate for Payer: UnitedHealthcare Medicaid	$16.65
Rate for Payer: UnitedHealthcare Medicare	$14.84
Rate for Payer: University Health Alliance Commercial	$17.96

PR AXILLARY LYMPHADENECTOMY COMPLETE

Professional

Both

$1,511.00

Service Code	HCPCS 38745
Min. Negotiated Rate	$670.80
Max. Negotiated Rate	$1,284.35
Rate for Payer: AlohaCare Medicaid	$881.24
Rate for Payer: AlohaCare Medicare	$829.70
Rate for Payer: Cash Price	$906.60
Rate for Payer: Cash Price	$906.60
Rate for Payer: Devoted Health Medicare	$912.67
Rate for Payer: Hawaii Medical Service Association Medicare	$829.70
Rate for Payer: Hawaii Western Management Group Commercial	$670.80
Rate for Payer: Health Management Network Commercial	$1,284.35
Rate for Payer: Kaiser Permanente Commercial	$995.64
Rate for Payer: Kaiser Permanente Medicaid	$995.64
Rate for Payer: Kaiser Permanente Medicare	$995.64
Rate for Payer: Ohana Health Plan Medicaid	$881.24
Rate for Payer: Ohana Health Plan Medicare	$829.70
Rate for Payer: UnitedHealthcare Medicaid	$881.24
Rate for Payer: UnitedHealthcare Medicare	$829.70

PR AXILLARY LYMPHADENECTOMY SUPERFICIAL

Professional

Both

$1,209.00

Service Code	HCPCS 38740
Min. Negotiated Rate	$341.38
Max. Negotiated Rate	$1,027.65
Rate for Payer: AlohaCare Medicaid	$705.32
Rate for Payer: AlohaCare Medicare	$668.32
Rate for Payer: Cash Price	$725.40
Rate for Payer: Cash Price	$725.40
Rate for Payer: Devoted Health Medicare	$735.15
Rate for Payer: Hawaii Medical Service Association Medicare	$668.32
Rate for Payer: Hawaii Western Management Group Commercial	$341.38
Rate for Payer: Health Management Network Commercial	$1,027.65
Rate for Payer: Kaiser Permanente Commercial	$801.98
Rate for Payer: Kaiser Permanente Medicaid	$801.98
Rate for Payer: Kaiser Permanente Medicare	$801.98
Rate for Payer: Ohana Health Plan Medicaid	$705.32
Rate for Payer: Ohana Health Plan Medicare	$668.32
Rate for Payer: UnitedHealthcare Medicaid	$705.32
Rate for Payer: UnitedHealthcare Medicare	$668.32

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$7.00

Service Code	NDC 68084099611
Hospital Revenue Code	637
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$5.32
Rate for Payer: Cash Price	$4.20
Rate for Payer: Devoted Health Medicare	$5.88
Rate for Payer: Hawaii Medical Service Association Medicare	$5.32
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$5.32
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$5.32
Rate for Payer: Ohana Health Plan Medicare	$5.32
Rate for Payer: UnitedHealthcare Medicare	$5.32
Rate for Payer: University Health Alliance Commercial	$5.10

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$4.00

Service Code	NDC 00093406701
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$7.00

Service Code	NDC 68084099611
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

PRAZOSIN 1 MG CAPSULE [6468]

Facility

$4.00

Service Code	NDC 00093406701
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

PRAZOSIN 2 MG CAPSULE [6469]

Facility

$9.00

Service Code	NDC 68084099701
Hospital Revenue Code	637
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$6.84
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$6.84
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$6.84
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$6.84
Rate for Payer: Ohana Health Plan Medicare	$6.84
Rate for Payer: UnitedHealthcare Medicare	$6.84
Rate for Payer: University Health Alliance Commercial	$6.56

PRAZOSIN 2 MG CAPSULE [6469]

Facility

$9.00

Service Code	NDC 51079063101
Hospital Revenue Code	637
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$6.84
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$6.84
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$6.84
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$6.84
Rate for Payer: Ohana Health Plan Medicare	$6.84
Rate for Payer: UnitedHealthcare Medicare	$6.84
Rate for Payer: University Health Alliance Commercial	$6.56

PRAZOSIN 2 MG CAPSULE [6469]

Facility

$9.00

Service Code	NDC 51079063101
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

PRAZOSIN 2 MG CAPSULE [6469]

Facility

$5.00

Service Code	NDC 00093406801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

PRAZOSIN 2 MG CAPSULE [6469]

Facility

$9.00

Service Code	NDC 68084099701
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

PRAZOSIN 2 MG CAPSULE [6469]

Facility

$5.00

Service Code	NDC 00093406801
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$16.00

Service Code	NDC 51079063201
Hospital Revenue Code	637
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$12.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Medicare	$12.16
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$12.16
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$12.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$12.16
Rate for Payer: Ohana Health Plan Medicare	$12.16
Rate for Payer: UnitedHealthcare Medicare	$12.16
Rate for Payer: University Health Alliance Commercial	$11.66

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$16.00

Service Code	NDC 51079063220
Hospital Revenue Code	637
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$12.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Medicare	$12.16
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$12.16
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$12.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$12.16
Rate for Payer: Ohana Health Plan Medicare	$12.16
Rate for Payer: UnitedHealthcare Medicare	$12.16
Rate for Payer: University Health Alliance Commercial	$11.66

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$16.00

Service Code	NDC 51079063220
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

PRAZOSIN 5 MG CAPSULE [6470]

Facility

$16.00

Service Code	NDC 51079063201
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL

Professional

Both

$262.00

Service Code	HCPCS 90586
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$222.70
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$157.20
Rate for Payer: Cash Price	$157.20
Rate for Payer: Health Management Network Commercial	$222.70
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT

Professional

Both

$914.69

Service Code	HCPCS 47542
Min. Negotiated Rate	$114.43
Max. Negotiated Rate	$777.49
Rate for Payer: AlohaCare Medicaid	$130.30
Rate for Payer: AlohaCare Medicare	$114.43
Rate for Payer: Cash Price	$548.81
Rate for Payer: Cash Price	$548.81
Rate for Payer: Devoted Health Medicare	$125.87
Rate for Payer: Hawaii Medical Service Association ABD	$130.30
Rate for Payer: Hawaii Medical Service Association Commercial	$206.24
Rate for Payer: Hawaii Medical Service Association Medicare	$114.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$130.30
Rate for Payer: Hawaii Western Management Group Commercial	$585.78
Rate for Payer: Health Management Network Commercial	$777.49
Rate for Payer: Kaiser Permanente Commercial	$137.32
Rate for Payer: Kaiser Permanente Medicaid	$137.32
Rate for Payer: Kaiser Permanente Medicare	$137.32
Rate for Payer: Ohana Health Plan Medicaid	$130.30
Rate for Payer: Ohana Health Plan Medicare	$114.43
Rate for Payer: UnitedHealthcare Medicaid	$130.30
Rate for Payer: UnitedHealthcare Medicare	$114.43

PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I

Professional

Both

$1,535.33

Service Code	HCPCS 50706
Min. Negotiated Rate	$151.97
Max. Negotiated Rate	$1,305.03
Rate for Payer: AlohaCare Medicaid	$174.12
Rate for Payer: AlohaCare Medicare	$151.97
Rate for Payer: Cash Price	$921.20
Rate for Payer: Cash Price	$921.20
Rate for Payer: Devoted Health Medicare	$167.17
Rate for Payer: Hawaii Medical Service Association ABD	$174.12
Rate for Payer: Hawaii Medical Service Association Commercial	$275.82
Rate for Payer: Hawaii Medical Service Association Medicare	$151.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$174.12
Rate for Payer: Health Management Network Commercial	$1,305.03
Rate for Payer: Kaiser Permanente Commercial	$182.36
Rate for Payer: Kaiser Permanente Medicaid	$182.36
Rate for Payer: Kaiser Permanente Medicare	$182.36
Rate for Payer: Ohana Health Plan Medicaid	$174.12
Rate for Payer: Ohana Health Plan Medicare	$151.97
Rate for Payer: UnitedHealthcare Medicaid	$174.12
Rate for Payer: UnitedHealthcare Medicare	$151.97
Rate for Payer: University Health Alliance Commercial	$233.53

PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT

Professional

Both

$9.64

Service Code	HCPCS 96127
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$8.19
Rate for Payer: AlohaCare Medicaid	$5.16
Rate for Payer: AlohaCare Medicare	$5.51
Rate for Payer: Cash Price	$5.78
Rate for Payer: Cash Price	$5.78
Rate for Payer: Devoted Health Medicare	$6.06
Rate for Payer: Hawaii Medical Service Association Medicare	$5.51
Rate for Payer: Hawaii Western Management Group Commercial	$6.04
Rate for Payer: Health Management Network Commercial	$8.19
Rate for Payer: Kaiser Permanente Commercial	$6.61
Rate for Payer: Kaiser Permanente Medicaid	$6.61
Rate for Payer: Kaiser Permanente Medicare	$6.61
Rate for Payer: Ohana Health Plan Medicaid	$5.16
Rate for Payer: Ohana Health Plan Medicare	$5.51
Rate for Payer: UnitedHealthcare Medicaid	$5.16
Rate for Payer: UnitedHealthcare Medicare	$5.51

PR BEHAVIOR COUNSEL OBESITY 15M

Professional

Both

$61.69

Service Code	HCPCS G0447
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$52.44
Rate for Payer: AlohaCare Medicaid	$22.81
Rate for Payer: AlohaCare Medicare	$26.51
Rate for Payer: Cash Price	$37.01
Rate for Payer: Cash Price	$37.01
Rate for Payer: Devoted Health Medicare	$29.16
Rate for Payer: Hawaii Medical Service Association ABD	$22.81
Rate for Payer: Hawaii Medical Service Association Medicare	$26.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.81
Rate for Payer: Health Management Network Commercial	$52.44
Rate for Payer: Kaiser Permanente Commercial	$31.81
Rate for Payer: Kaiser Permanente Medicaid	$31.81
Rate for Payer: Kaiser Permanente Medicare	$31.81
Rate for Payer: Ohana Health Plan Medicaid	$22.81
Rate for Payer: Ohana Health Plan Medicare	$26.51
Rate for Payer: UnitedHealthcare Medicaid	$22.81
Rate for Payer: UnitedHealthcare Medicare	$26.51

Know your out-of-pocket cost for care.

All Charges