Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

RIFAMPIN 300 MG CAPSULE [11293]

Facility

$8.00

Service Code	NDC 60687058611
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83

RIFAMPIN 300 MG CAPSULE [11293]

Facility

$8.00

Service Code	NDC 60687058601
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83

RIFAMPIN 300 MG CAPSULE [11293]

Facility

$8.00

Service Code	NDC 60687058611
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

RIFAMPIN 600 MG/10ML IV (WET SOLR VIAL) [43011291]

Facility

$161.00

Service Code	NDC 00068059701
Hospital Revenue Code	250
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$96.60
Rate for Payer: Cash Price	$193.20
Rate for Payer: Health Management Network Commercial	$273.70
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: Kaiser Permanente Commercial	$289.80
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: MDX Hawaii PPO	$312.34

RIFAMPIN 600 MG/10ML IV (WET SOLR VIAL) [43011291]

Facility

$276.00

Service Code	NDC 63323035120
Hospital Revenue Code	250
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: MDX Hawaii PPO	$267.72

RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]

Facility

$322.00

Service Code	HCPCS J2804
Hospital Revenue Code	250
Min. Negotiated Rate	$273.70
Max. Negotiated Rate	$312.34
Rate for Payer: Cash Price	$193.20
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$273.70
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: Kaiser Permanente Commercial	$289.80
Rate for Payer: MDX Hawaii PPO	$312.34
Rate for Payer: MDX Hawaii PPO	$267.72

RIFAXIMIN 550 MG TABLET [104604]

Facility

$139.00

Service Code	NDC 65649030303
Hospital Revenue Code	637
Min. Negotiated Rate	$69.50
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$105.64
Rate for Payer: Cash Price	$83.40
Rate for Payer: Devoted Health Medicare	$116.76
Rate for Payer: Hawaii Medical Service Association Medicare	$105.64
Rate for Payer: Hawaii Western Management Group Commercial	$132.05
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$105.64
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$105.64
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$105.64
Rate for Payer: Ohana Health Plan Medicare	$105.64
Rate for Payer: UnitedHealthcare Medicare	$105.64
Rate for Payer: University Health Alliance Commercial	$101.32

RIFAXIMIN 550 MG TABLET [104604]

Facility

$139.00

Service Code	NDC 65649030303
Hospital Revenue Code	250
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$83.40
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

RIGIFLEX 35/10 BLN M00554510

Facility

$1,854.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$1,798.38
Rate for Payer: AlohaCare Medicaid	$927.00
Rate for Payer: AlohaCare Medicare	$1,409.04
Rate for Payer: Cash Price	$1,112.40
Rate for Payer: Devoted Health Medicare	$1,557.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1,409.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.30
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: Humana Medicare	$1,409.04
Rate for Payer: Kaiser Permanente Commercial	$1,668.60
Rate for Payer: Kaiser Permanente Medicaid	$945.54
Rate for Payer: Kaiser Permanente Medicare	$1,409.04
Rate for Payer: MDX Hawaii PPO	$1,798.38
Rate for Payer: Ohana Health Plan Medicaid	$1,409.04
Rate for Payer: Ohana Health Plan Medicare	$1,409.04
Rate for Payer: UnitedHealthcare Medicare	$1,409.04
Rate for Payer: University Health Alliance Commercial	$1,351.38

RIGIFLEX 35/10 BLN M00554510

Facility

$1,854.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$1,575.90
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,112.40
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: Kaiser Permanente Commercial	$1,668.60
Rate for Payer: MDX Hawaii PPO	$1,798.38

RIM PLATE 12H 0.5MM 04.503.343

Facility

$2,229.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.50
Max. Negotiated Rate	$2,162.13
Rate for Payer: AlohaCare Medicaid	$1,114.50
Rate for Payer: AlohaCare Medicare	$1,694.04
Rate for Payer: Cash Price	$1,337.40
Rate for Payer: Devoted Health Medicare	$1,872.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1,694.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,560.30
Rate for Payer: Health Management Network Commercial	$1,894.65
Rate for Payer: Humana Medicare	$1,694.04
Rate for Payer: Kaiser Permanente Commercial	$2,006.10
Rate for Payer: Kaiser Permanente Medicaid	$1,136.79
Rate for Payer: Kaiser Permanente Medicare	$1,694.04
Rate for Payer: MDX Hawaii PPO	$2,162.13
Rate for Payer: Ohana Health Plan Medicaid	$1,694.04
Rate for Payer: Ohana Health Plan Medicare	$1,694.04
Rate for Payer: UnitedHealthcare Medicare	$1,694.04
Rate for Payer: University Health Alliance Commercial	$1,248.24

RIM PLATE 12H 0.5MM 04.503.343

Facility

$2,229.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,248.24
Max. Negotiated Rate	$2,162.13
Rate for Payer: Cash Price	$1,337.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,560.30
Rate for Payer: Health Management Network Commercial	$1,894.65
Rate for Payer: Kaiser Permanente Commercial	$2,006.10
Rate for Payer: MDX Hawaii PPO	$2,162.13
Rate for Payer: University Health Alliance Commercial	$1,248.24

RING FULL 220MM 99-56-20080

Facility

$3,506.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,753.00
Max. Negotiated Rate	$3,400.82
Rate for Payer: AlohaCare Medicaid	$1,753.00
Rate for Payer: AlohaCare Medicare	$2,664.56
Rate for Payer: Cash Price	$2,103.60
Rate for Payer: Devoted Health Medicare	$2,945.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,664.56
Rate for Payer: Hawaii Western Management Group Commercial	$3,330.70
Rate for Payer: Health Management Network Commercial	$2,980.10
Rate for Payer: Humana Medicare	$2,664.56
Rate for Payer: Kaiser Permanente Commercial	$3,155.40
Rate for Payer: Kaiser Permanente Medicaid	$1,788.06
Rate for Payer: Kaiser Permanente Medicare	$2,664.56
Rate for Payer: MDX Hawaii PPO	$3,400.82
Rate for Payer: Ohana Health Plan Medicaid	$2,664.56
Rate for Payer: Ohana Health Plan Medicare	$2,664.56
Rate for Payer: UnitedHealthcare Medicare	$2,664.56
Rate for Payer: University Health Alliance Commercial	$2,555.52

RING FULL 220MM 99-56-20080

Facility

$3,506.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,980.10
Max. Negotiated Rate	$3,400.82
Rate for Payer: Cash Price	$2,103.60
Rate for Payer: Health Management Network Commercial	$2,980.10
Rate for Payer: Kaiser Permanente Commercial	$3,155.40
Rate for Payer: MDX Hawaii PPO	$3,400.82

RING HALF 220MM 56-11670

Facility

$2,313.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,966.05
Max. Negotiated Rate	$2,243.61
Rate for Payer: Cash Price	$1,387.80
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Kaiser Permanente Commercial	$2,081.70
Rate for Payer: MDX Hawaii PPO	$2,243.61

RING HALF 220MM 56-11670

Facility

$2,313.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,156.50
Max. Negotiated Rate	$2,243.61
Rate for Payer: AlohaCare Medicaid	$1,156.50
Rate for Payer: AlohaCare Medicare	$1,757.88
Rate for Payer: Cash Price	$1,387.80
Rate for Payer: Devoted Health Medicare	$1,942.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,757.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,197.35
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Humana Medicare	$1,757.88
Rate for Payer: Kaiser Permanente Commercial	$2,081.70
Rate for Payer: Kaiser Permanente Medicaid	$1,179.63
Rate for Payer: Kaiser Permanente Medicare	$1,757.88
Rate for Payer: MDX Hawaii PPO	$2,243.61
Rate for Payer: Ohana Health Plan Medicaid	$1,757.88
Rate for Payer: Ohana Health Plan Medicare	$1,757.88
Rate for Payer: UnitedHealthcare Medicare	$1,757.88
Rate for Payer: University Health Alliance Commercial	$1,685.95

RISPERIDONE 0.5 MG TABLET [25520]

Facility

$15.00

Service Code	NDC 68084027111
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

RISPERIDONE 0.5 MG TABLET [25520]

Facility

$15.00

Service Code	NDC 68084027111
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

RISPERIDONE 1 MG TABLET [18313]

Facility

$16.00

Service Code	NDC 68084027201
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

RISPERIDONE 1 MG TABLET [18313]

Facility

$16.00

Service Code	NDC 68084027211
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

RISPERIDONE 1 MG TABLET [18313]

Facility

$16.00

Service Code	NDC 68084027201
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

RISPERIDONE 1 MG TABLET [18313]

Facility

$16.00

Service Code	NDC 68382011414
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

RISPERIDONE 1 MG TABLET [18313]

Facility

$16.00

Service Code	NDC 68084027211
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

RISPERIDONE 1 MG TABLET [18313]

Facility

$16.00

Service Code	NDC 68382011414
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

RISPERIDONE 2 MG TABLET [18311]

Facility

$23.00

Service Code	NDC 68084027301
Hospital Revenue Code	637
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$17.48
Rate for Payer: Cash Price	$13.80
Rate for Payer: Devoted Health Medicare	$19.32
Rate for Payer: Hawaii Medical Service Association Medicare	$17.48
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$17.48
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$17.48
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$17.48
Rate for Payer: Ohana Health Plan Medicare	$17.48
Rate for Payer: UnitedHealthcare Medicare	$17.48
Rate for Payer: University Health Alliance Commercial	$16.76

Know your out-of-pocket cost for care.

All Charges