Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

$15.00

Service Code	NDC 00574010603
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

BRONCHITIS AND ASTHMA WITH CC/MCC

Facility

$17,800.20

Service Code	MSDRG 202
Min. Negotiated Rate	$17,800.20
Max. Negotiated Rate	$17,800.20
Rate for Payer: Hawaii Medical Service Association Commercial	$17,800.20

BRONCHITIS AND ASTHMA WITHOUT CC/MCC

Facility

$13,533.84

Service Code	MSDRG 203
Min. Negotiated Rate	$13,533.84
Max. Negotiated Rate	$13,533.84
Rate for Payer: Hawaii Medical Service Association Commercial	$13,533.84

BRUSH CYSTOLOGY ENDO

Facility

$93.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$70.68
Rate for Payer: Cash Price	$55.80
Rate for Payer: Devoted Health Medicare	$78.12
Rate for Payer: Hawaii Medical Service Association Medicare	$70.68
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$70.68
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$70.68
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$70.68
Rate for Payer: Ohana Health Plan Medicare	$70.68
Rate for Payer: UnitedHealthcare Medicare	$70.68
Rate for Payer: University Health Alliance Commercial	$67.79

BRUSH CYSTOLOGY ENDO

Facility

$93.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21

BRUSH CYTOLOGY BILIARY

Facility

$429.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$364.65
Max. Negotiated Rate	$416.13
Rate for Payer: Cash Price	$257.40
Rate for Payer: Health Management Network Commercial	$364.65
Rate for Payer: Kaiser Permanente Commercial	$386.10
Rate for Payer: MDX Hawaii PPO	$416.13

BRUSH CYTOLOGY BILIARY

Facility

$429.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$416.13
Rate for Payer: AlohaCare Medicaid	$214.50
Rate for Payer: AlohaCare Medicare	$326.04
Rate for Payer: Cash Price	$257.40
Rate for Payer: Devoted Health Medicare	$360.36
Rate for Payer: Hawaii Medical Service Association Medicare	$326.04
Rate for Payer: Hawaii Western Management Group Commercial	$407.55
Rate for Payer: Health Management Network Commercial	$364.65
Rate for Payer: Humana Medicare	$326.04
Rate for Payer: Kaiser Permanente Commercial	$386.10
Rate for Payer: Kaiser Permanente Medicaid	$218.79
Rate for Payer: Kaiser Permanente Medicare	$326.04
Rate for Payer: MDX Hawaii PPO	$416.13
Rate for Payer: Ohana Health Plan Medicaid	$326.04
Rate for Payer: Ohana Health Plan Medicare	$326.04
Rate for Payer: UnitedHealthcare Medicare	$326.04
Rate for Payer: University Health Alliance Commercial	$312.70

BRUSH FEMERAL SIMPULSE

Facility

$78.00

Hospital Revenue Code	272
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

BRUSH FEMERAL SIMPULSE

Facility

$78.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: AlohaCare Medicare	$59.28
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$65.52
Rate for Payer: Hawaii Medical Service Association Medicare	$59.28
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$59.28
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$59.28
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$59.28
Rate for Payer: Ohana Health Plan Medicare	$59.28
Rate for Payer: UnitedHealthcare Medicare	$59.28
Rate for Payer: University Health Alliance Commercial	$56.85

BRUSH SINGLE USE SOFT

Facility

$71.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$53.96
Rate for Payer: Cash Price	$42.60
Rate for Payer: Devoted Health Medicare	$59.64
Rate for Payer: Hawaii Medical Service Association Medicare	$53.96
Rate for Payer: Hawaii Western Management Group Commercial	$67.45
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$53.96
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$53.96
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$53.96
Rate for Payer: Ohana Health Plan Medicare	$53.96
Rate for Payer: UnitedHealthcare Medicare	$53.96
Rate for Payer: University Health Alliance Commercial	$51.75

BRUSH SINGLE USE SOFT

Facility

$71.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

BTB TIGHTROPE II AR-1588BTB2J

Facility

$1,717.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$961.52
Max. Negotiated Rate	$1,665.49
Rate for Payer: Cash Price	$1,030.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.90
Rate for Payer: Health Management Network Commercial	$1,459.45
Rate for Payer: Kaiser Permanente Commercial	$1,545.30
Rate for Payer: MDX Hawaii PPO	$1,665.49
Rate for Payer: University Health Alliance Commercial	$961.52

BTB TIGHTROPE II AR-1588BTB2J

Facility

$1,717.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$858.50
Max. Negotiated Rate	$1,665.49
Rate for Payer: AlohaCare Medicaid	$858.50
Rate for Payer: AlohaCare Medicare	$1,304.92
Rate for Payer: Cash Price	$1,030.20
Rate for Payer: Devoted Health Medicare	$1,442.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,304.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.90
Rate for Payer: Health Management Network Commercial	$1,459.45
Rate for Payer: Humana Medicare	$1,304.92
Rate for Payer: Kaiser Permanente Commercial	$1,545.30
Rate for Payer: Kaiser Permanente Medicaid	$875.67
Rate for Payer: Kaiser Permanente Medicare	$1,304.92
Rate for Payer: MDX Hawaii PPO	$1,665.49
Rate for Payer: Ohana Health Plan Medicaid	$1,304.92
Rate for Payer: Ohana Health Plan Medicare	$1,304.92
Rate for Payer: UnitedHealthcare Medicare	$1,304.92
Rate for Payer: University Health Alliance Commercial	$961.52

BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]

Facility

$29.00

Service Code	HCPCS J7626
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]

Facility

$29.00

Service Code	HCPCS J7626
Hospital Revenue Code	636
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$14.50
Rate for Payer: AlohaCare Medicare	$22.04
Rate for Payer: Cash Price	$17.40
Rate for Payer: Cash Price	$17.40
Rate for Payer: Devoted Health Medicare	$24.36
Rate for Payer: Hawaii Medical Service Association ABD	$1.28
Rate for Payer: Hawaii Medical Service Association Medicare	$22.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.28
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$22.04
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$22.04
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$22.04
Rate for Payer: Ohana Health Plan Medicare	$22.04
Rate for Payer: UnitedHealthcare Medicaid	$17.40
Rate for Payer: UnitedHealthcare Medicare	$22.04
Rate for Payer: University Health Alliance Commercial	$21.14

BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]

Facility

$28.00

Service Code	HCPCS J7626
Hospital Revenue Code	636
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$21.28
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Devoted Health Medicare	$23.52
Rate for Payer: Hawaii Medical Service Association ABD	$1.28
Rate for Payer: Hawaii Medical Service Association Medicare	$21.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.28
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$21.28
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$21.28
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$21.28
Rate for Payer: Ohana Health Plan Medicare	$21.28
Rate for Payer: UnitedHealthcare Medicaid	$16.80
Rate for Payer: UnitedHealthcare Medicare	$21.28
Rate for Payer: University Health Alliance Commercial	$20.41

BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]

Facility

$28.00

Service Code	HCPCS J7626
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

BUDESONIDE/FORMOTEROL 160-4.5 MCG (SYMBICORT) (60 PUFF(S)) (TAKE HOME) [4080395]

Facility

$15.00

Service Code	NDC 00004080183
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

BUDESONIDE/FORMOTEROL 160-4.5 MCG (SYMBICORT) (60 PUFF(S)) (TAKE HOME) [4080395]

Facility

$15.00

Service Code	NDC 00004080183
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

BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81454]

Facility

$478.00

Service Code	NDC 00186037028
Hospital Revenue Code	250
Min. Negotiated Rate	$406.30
Max. Negotiated Rate	$463.66
Rate for Payer: Cash Price	$286.80
Rate for Payer: Health Management Network Commercial	$406.30
Rate for Payer: Kaiser Permanente Commercial	$430.20
Rate for Payer: MDX Hawaii PPO	$463.66

BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81454]

Facility

$478.00

Service Code	NDC 00186037028
Hospital Revenue Code	637
Min. Negotiated Rate	$239.00
Max. Negotiated Rate	$463.66
Rate for Payer: AlohaCare Medicaid	$239.00
Rate for Payer: AlohaCare Medicare	$363.28
Rate for Payer: Cash Price	$286.80
Rate for Payer: Devoted Health Medicare	$401.52
Rate for Payer: Hawaii Medical Service Association Medicare	$363.28
Rate for Payer: Hawaii Western Management Group Commercial	$454.10
Rate for Payer: Health Management Network Commercial	$406.30
Rate for Payer: Humana Medicare	$363.28
Rate for Payer: Kaiser Permanente Commercial	$430.20
Rate for Payer: Kaiser Permanente Medicaid	$243.78
Rate for Payer: Kaiser Permanente Medicare	$363.28
Rate for Payer: MDX Hawaii PPO	$463.66
Rate for Payer: Ohana Health Plan Medicaid	$363.28
Rate for Payer: Ohana Health Plan Medicare	$363.28
Rate for Payer: UnitedHealthcare Medicare	$363.28
Rate for Payer: University Health Alliance Commercial	$348.41

BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]

Facility

$416.00

Service Code	NDC 00186037228
Hospital Revenue Code	637
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$403.52
Rate for Payer: AlohaCare Medicaid	$208.00
Rate for Payer: AlohaCare Medicare	$316.16
Rate for Payer: Cash Price	$249.60
Rate for Payer: Devoted Health Medicare	$349.44
Rate for Payer: Hawaii Medical Service Association Medicare	$316.16
Rate for Payer: Hawaii Western Management Group Commercial	$395.20
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Humana Medicare	$316.16
Rate for Payer: Kaiser Permanente Commercial	$374.40
Rate for Payer: Kaiser Permanente Medicaid	$212.16
Rate for Payer: Kaiser Permanente Medicare	$316.16
Rate for Payer: MDX Hawaii PPO	$403.52
Rate for Payer: Ohana Health Plan Medicaid	$316.16
Rate for Payer: Ohana Health Plan Medicare	$316.16
Rate for Payer: UnitedHealthcare Medicare	$316.16
Rate for Payer: University Health Alliance Commercial	$303.22

BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]

Facility

$416.00

Service Code	NDC 00186037228
Hospital Revenue Code	250
Min. Negotiated Rate	$353.60
Max. Negotiated Rate	$403.52
Rate for Payer: Cash Price	$249.60
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Kaiser Permanente Commercial	$374.40
Rate for Payer: MDX Hawaii PPO	$403.52

BULKAMID URETHRAL SYSTEM 50050

Facility

$2,300.00

Service Code	HCPCS L8606
Hospital Revenue Code	278
Min. Negotiated Rate	$1,150.00
Max. Negotiated Rate	$2,231.00
Rate for Payer: AlohaCare Medicaid	$1,150.00
Rate for Payer: AlohaCare Medicare	$1,748.00
Rate for Payer: Cash Price	$1,380.00
Rate for Payer: Devoted Health Medicare	$1,932.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,748.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,610.00
Rate for Payer: Health Management Network Commercial	$1,955.00
Rate for Payer: Humana Medicare	$1,748.00
Rate for Payer: Kaiser Permanente Commercial	$2,070.00
Rate for Payer: Kaiser Permanente Medicaid	$1,173.00
Rate for Payer: Kaiser Permanente Medicare	$1,748.00
Rate for Payer: MDX Hawaii PPO	$2,231.00
Rate for Payer: Ohana Health Plan Medicaid	$1,748.00
Rate for Payer: Ohana Health Plan Medicare	$1,748.00
Rate for Payer: UnitedHealthcare Medicare	$1,748.00
Rate for Payer: University Health Alliance Commercial	$1,288.00

BULKAMID URETHRAL SYSTEM 50050

Facility

$2,300.00

Service Code	HCPCS L8606
Hospital Revenue Code	278
Min. Negotiated Rate	$1,288.00
Max. Negotiated Rate	$2,231.00
Rate for Payer: Cash Price	$1,380.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,610.00
Rate for Payer: Health Management Network Commercial	$1,955.00
Rate for Payer: Kaiser Permanente Commercial	$2,070.00
Rate for Payer: MDX Hawaii PPO	$2,231.00
Rate for Payer: University Health Alliance Commercial	$1,288.00

Know your out-of-pocket cost for care.

All Charges