Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

BRITE TIP INTRODUCER 6X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88

BRITE TIP INTRODUCER 6X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$302.00
Max. Negotiated Rate	$585.88
Rate for Payer: AlohaCare Medicaid	$302.00
Rate for Payer: AlohaCare Medicare	$459.04
Rate for Payer: Cash Price	$362.40
Rate for Payer: Devoted Health Medicare	$507.36
Rate for Payer: Hawaii Medical Service Association Medicare	$459.04
Rate for Payer: Hawaii Western Management Group Commercial	$573.80
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Humana Medicare	$459.04
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: Kaiser Permanente Medicare	$459.04
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: Ohana Health Plan Medicaid	$459.04
Rate for Payer: Ohana Health Plan Medicare	$459.04
Rate for Payer: UnitedHealthcare Medicare	$459.04
Rate for Payer: University Health Alliance Commercial	$440.26

BRITE TIP INTRODUCER 6X5.5

Facility

$439.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$373.15
Max. Negotiated Rate	$425.83
Rate for Payer: Cash Price	$263.40
Rate for Payer: Health Management Network Commercial	$373.15
Rate for Payer: Kaiser Permanente Commercial	$395.10
Rate for Payer: MDX Hawaii PPO	$425.83

BRITE TIP INTRODUCER 6X5.5

Facility

$439.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$219.50
Max. Negotiated Rate	$425.83
Rate for Payer: AlohaCare Medicaid	$219.50
Rate for Payer: AlohaCare Medicare	$333.64
Rate for Payer: Cash Price	$263.40
Rate for Payer: Devoted Health Medicare	$368.76
Rate for Payer: Hawaii Medical Service Association Medicare	$333.64
Rate for Payer: Hawaii Western Management Group Commercial	$417.05
Rate for Payer: Health Management Network Commercial	$373.15
Rate for Payer: Humana Medicare	$333.64
Rate for Payer: Kaiser Permanente Commercial	$395.10
Rate for Payer: Kaiser Permanente Medicaid	$223.89
Rate for Payer: Kaiser Permanente Medicare	$333.64
Rate for Payer: MDX Hawaii PPO	$425.83
Rate for Payer: Ohana Health Plan Medicaid	$333.64
Rate for Payer: Ohana Health Plan Medicare	$333.64
Rate for Payer: UnitedHealthcare Medicare	$333.64
Rate for Payer: University Health Alliance Commercial	$319.99

BRITE TIP INTRODUCER 7FX11

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80

BRITE TIP INTRODUCER 7FX11

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$135.80
Rate for Payer: AlohaCare Medicaid	$70.00
Rate for Payer: AlohaCare Medicare	$106.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Devoted Health Medicare	$117.60
Rate for Payer: Hawaii Medical Service Association Medicare	$106.40
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Humana Medicare	$106.40
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicare	$106.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: Ohana Health Plan Medicaid	$106.40
Rate for Payer: Ohana Health Plan Medicare	$106.40
Rate for Payer: UnitedHealthcare Medicare	$106.40
Rate for Payer: University Health Alliance Commercial	$102.05

BRITE TIP INTRODUCER 7X23

Facility

$528.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$448.80
Max. Negotiated Rate	$512.16
Rate for Payer: Cash Price	$316.80
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Kaiser Permanente Commercial	$475.20
Rate for Payer: MDX Hawaii PPO	$512.16

BRITE TIP INTRODUCER 7X23

Facility

$528.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$512.16
Rate for Payer: AlohaCare Medicaid	$264.00
Rate for Payer: AlohaCare Medicare	$401.28
Rate for Payer: Cash Price	$316.80
Rate for Payer: Devoted Health Medicare	$443.52
Rate for Payer: Hawaii Medical Service Association Medicare	$401.28
Rate for Payer: Hawaii Western Management Group Commercial	$501.60
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Humana Medicare	$401.28
Rate for Payer: Kaiser Permanente Commercial	$475.20
Rate for Payer: Kaiser Permanente Medicaid	$269.28
Rate for Payer: Kaiser Permanente Medicare	$401.28
Rate for Payer: MDX Hawaii PPO	$512.16
Rate for Payer: Ohana Health Plan Medicaid	$401.28
Rate for Payer: Ohana Health Plan Medicare	$401.28
Rate for Payer: UnitedHealthcare Medicare	$401.28
Rate for Payer: University Health Alliance Commercial	$384.86

BRITE TIP INTRODUCER 8X11

Facility

$554.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$277.00
Max. Negotiated Rate	$537.38
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$421.04
Rate for Payer: Cash Price	$332.40
Rate for Payer: Devoted Health Medicare	$465.36
Rate for Payer: Hawaii Medical Service Association Medicare	$421.04
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$421.04
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: Kaiser Permanente Medicare	$421.04
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$421.04
Rate for Payer: Ohana Health Plan Medicare	$421.04
Rate for Payer: UnitedHealthcare Medicare	$421.04
Rate for Payer: University Health Alliance Commercial	$403.81

BRITE TIP INTRODUCER 8X11

Facility

$554.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$332.40
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

BRITE TIP INTRODUCER 8X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$362.40
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88

BRITE TIP INTRODUCER 8X23

Facility

$604.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$302.00
Max. Negotiated Rate	$585.88
Rate for Payer: AlohaCare Medicaid	$302.00
Rate for Payer: AlohaCare Medicare	$459.04
Rate for Payer: Cash Price	$362.40
Rate for Payer: Devoted Health Medicare	$507.36
Rate for Payer: Hawaii Medical Service Association Medicare	$459.04
Rate for Payer: Hawaii Western Management Group Commercial	$573.80
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Humana Medicare	$459.04
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: Kaiser Permanente Medicare	$459.04
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: Ohana Health Plan Medicaid	$459.04
Rate for Payer: Ohana Health Plan Medicare	$459.04
Rate for Payer: UnitedHealthcare Medicare	$459.04
Rate for Payer: University Health Alliance Commercial	$440.26

BRITE TIP INTRODUCER 9X11

Facility

$554.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$277.00
Max. Negotiated Rate	$537.38
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$421.04
Rate for Payer: Cash Price	$332.40
Rate for Payer: Devoted Health Medicare	$465.36
Rate for Payer: Hawaii Medical Service Association Medicare	$421.04
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$421.04
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: Kaiser Permanente Medicare	$421.04
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$421.04
Rate for Payer: Ohana Health Plan Medicare	$421.04
Rate for Payer: UnitedHealthcare Medicare	$421.04
Rate for Payer: University Health Alliance Commercial	$403.81

BRITE TIP INTRODUCER 9X11

Facility

$554.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$332.40
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

BRITE TIP INTRODUCER 9X23

Facility

$150.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
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

BRITE TIP INTRODUCER 9X23

Facility

$150.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
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

BRIVARACETAM 50 MG/5 ML INTRAVENOUS SOLUTION [131987]

Facility

$152.00

Service Code	NDC 50474097063
Hospital Revenue Code	250
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

BRIVARACETAM 50 MG/5 ML INTRAVENOUS SOLUTION [131987]

Facility

$152.00

Service Code	NDC 50474097075
Hospital Revenue Code	250
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

BRIVARACETAM 50 MG TABLET [131983]

Facility

$74.00

Service Code	NDC 50474057066
Hospital Revenue Code	250
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$44.40
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: Kaiser Permanente Commercial	$66.60
Rate for Payer: MDX Hawaii PPO	$71.78

BRIVARACETAM 50 MG TABLET [131983]

Facility

$74.00

Service Code	NDC 50474057066
Hospital Revenue Code	637
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$71.78
Rate for Payer: AlohaCare Medicaid	$37.00
Rate for Payer: AlohaCare Medicare	$56.24
Rate for Payer: Cash Price	$44.40
Rate for Payer: Devoted Health Medicare	$62.16
Rate for Payer: Hawaii Medical Service Association Medicare	$56.24
Rate for Payer: Hawaii Western Management Group Commercial	$70.30
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: Humana Medicare	$56.24
Rate for Payer: Kaiser Permanente Commercial	$66.60
Rate for Payer: Kaiser Permanente Medicaid	$37.74
Rate for Payer: Kaiser Permanente Medicare	$56.24
Rate for Payer: MDX Hawaii PPO	$71.78
Rate for Payer: Ohana Health Plan Medicaid	$56.24
Rate for Payer: Ohana Health Plan Medicare	$56.24
Rate for Payer: UnitedHealthcare Medicare	$56.24
Rate for Payer: University Health Alliance Commercial	$53.94

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

$15.00

Service Code	NDC 00574010603
Hospital Revenue Code	637
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: MDX Hawaii PPO	$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: 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

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

$15.00

Service Code	NDC 70954097810
Hospital Revenue Code	250
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

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

$15.00

Service Code	NDC 70954097810
Hospital Revenue Code	637
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

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

$19.00

Service Code	NDC 00781532531
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

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

$19.00

Service Code	NDC 00781532531
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

Know your out-of-pocket cost for care.

All Charges