Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

RIVAROXABAN 15 MG TABLET [112834]

Facility

$60.00

Service Code	NDC 50458057810
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

RIVAROXABAN 15 MG TABLET [112834]

Facility

$60.00

Service Code	NDC 50458057810
Hospital Revenue Code	637
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$45.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$50.40
Rate for Payer: Hawaii Medical Service Association Medicare	$45.60
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$45.60
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$45.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$45.60
Rate for Payer: Ohana Health Plan Medicare	$45.60
Rate for Payer: UnitedHealthcare Medicare	$45.60
Rate for Payer: University Health Alliance Commercial	$43.73

RIVAROXABAN 15 MG TABLET [112834]

Facility

$60.00

Service Code	NDC 50458057801
Hospital Revenue Code	637
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$45.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$50.40
Rate for Payer: Hawaii Medical Service Association Medicare	$45.60
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$45.60
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$45.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$45.60
Rate for Payer: Ohana Health Plan Medicare	$45.60
Rate for Payer: UnitedHealthcare Medicare	$45.60
Rate for Payer: University Health Alliance Commercial	$43.73

RIVAROXABAN 15 MG TABLET [112834]

Facility

$60.00

Service Code	NDC 50458057801
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

RIVAROXABAN 20 MG TABLET [112835]

Facility

$60.00

Service Code	NDC 50458057990
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

RIVAROXABAN 20 MG TABLET [112835]

Facility

$60.00

Service Code	NDC 50458057901
Hospital Revenue Code	637
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$45.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$50.40
Rate for Payer: Hawaii Medical Service Association Medicare	$45.60
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$45.60
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$45.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$45.60
Rate for Payer: Ohana Health Plan Medicare	$45.60
Rate for Payer: UnitedHealthcare Medicare	$45.60
Rate for Payer: University Health Alliance Commercial	$43.73

RIVAROXABAN 20 MG TABLET [112835]

Facility

$60.00

Service Code	NDC 50458057910
Hospital Revenue Code	637
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$45.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$50.40
Rate for Payer: Hawaii Medical Service Association Medicare	$45.60
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$45.60
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$45.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$45.60
Rate for Payer: Ohana Health Plan Medicare	$45.60
Rate for Payer: UnitedHealthcare Medicare	$45.60
Rate for Payer: University Health Alliance Commercial	$43.73

RIVAROXABAN 20 MG TABLET [112835]

Facility

$60.00

Service Code	NDC 50458057990
Hospital Revenue Code	637
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$45.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$50.40
Rate for Payer: Hawaii Medical Service Association Medicare	$45.60
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$45.60
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$45.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$45.60
Rate for Payer: Ohana Health Plan Medicare	$45.60
Rate for Payer: UnitedHealthcare Medicare	$45.60
Rate for Payer: University Health Alliance Commercial	$43.73

RIVAROXABAN 20 MG TABLET [112835]

Facility

$60.00

Service Code	NDC 50458057901
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

RIVAROXABAN 20 MG TABLET [112835]

Facility

$60.00

Service Code	NDC 50458057910
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

RIVAROXABAN 2.5 MG TABLET [164486]

Facility

$30.00

Service Code	NDC 50458057710
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

RIVAROXABAN 2.5 MG TABLET [164486]

Facility

$30.00

Service Code	NDC 50458057760
Hospital Revenue Code	637
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicare	$22.80
Rate for Payer: Cash Price	$18.00
Rate for Payer: Devoted Health Medicare	$25.20
Rate for Payer: Hawaii Medical Service Association Medicare	$22.80
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$22.80
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$22.80
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$22.80
Rate for Payer: Ohana Health Plan Medicare	$22.80
Rate for Payer: UnitedHealthcare Medicare	$22.80
Rate for Payer: University Health Alliance Commercial	$21.87

RIVAROXABAN 2.5 MG TABLET [164486]

Facility

$30.00

Service Code	NDC 50458057710
Hospital Revenue Code	637
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicare	$22.80
Rate for Payer: Cash Price	$18.00
Rate for Payer: Devoted Health Medicare	$25.20
Rate for Payer: Hawaii Medical Service Association Medicare	$22.80
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$22.80
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$22.80
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$22.80
Rate for Payer: Ohana Health Plan Medicare	$22.80
Rate for Payer: UnitedHealthcare Medicare	$22.80
Rate for Payer: University Health Alliance Commercial	$21.87

RIVAROXABAN 2.5 MG TABLET [164486]

Facility

$30.00

Service Code	NDC 50458057760
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$43.00

Service Code	NDC 00781730431
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$43.00

Service Code	NDC 00781730431
Hospital Revenue Code	637
Min. Negotiated Rate	$21.50
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$32.68
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$36.12
Rate for Payer: Hawaii Medical Service Association Medicare	$32.68
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$32.68
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$32.68
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$32.68
Rate for Payer: Ohana Health Plan Medicare	$32.68
Rate for Payer: UnitedHealthcare Medicare	$32.68
Rate for Payer: University Health Alliance Commercial	$31.34

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$43.00

Service Code	NDC 00781730458
Hospital Revenue Code	637
Min. Negotiated Rate	$21.50
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$32.68
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$36.12
Rate for Payer: Hawaii Medical Service Association Medicare	$32.68
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$32.68
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$32.68
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$32.68
Rate for Payer: Ohana Health Plan Medicare	$32.68
Rate for Payer: UnitedHealthcare Medicare	$32.68
Rate for Payer: University Health Alliance Commercial	$31.34

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$43.00

Service Code	NDC 00781730458
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730931
Hospital Revenue Code	637
Min. Negotiated Rate	$21.50
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$32.68
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$36.12
Rate for Payer: Hawaii Medical Service Association Medicare	$32.68
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$32.68
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$32.68
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$32.68
Rate for Payer: Ohana Health Plan Medicare	$32.68
Rate for Payer: UnitedHealthcare Medicare	$32.68
Rate for Payer: University Health Alliance Commercial	$31.34

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730958
Hospital Revenue Code	637
Min. Negotiated Rate	$21.50
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$32.68
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$36.12
Rate for Payer: Hawaii Medical Service Association Medicare	$32.68
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$32.68
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$32.68
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$32.68
Rate for Payer: Ohana Health Plan Medicare	$32.68
Rate for Payer: UnitedHealthcare Medicare	$32.68
Rate for Payer: University Health Alliance Commercial	$31.34

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730958
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730931
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

R MEDIUM 3D MAX LIGHT MESH

Facility

$1,233.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$690.48
Max. Negotiated Rate	$1,196.01
Rate for Payer: Cash Price	$739.80
Rate for Payer: Hawaii Western Management Group Commercial	$863.10
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Kaiser Permanente Commercial	$1,109.70
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: University Health Alliance Commercial	$690.48

R MEDIUM 3D MAX LIGHT MESH

Facility

$1,233.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$616.50
Max. Negotiated Rate	$1,196.01
Rate for Payer: Kaiser Permanente Commercial	$1,109.70
Rate for Payer: AlohaCare Medicaid	$616.50
Rate for Payer: AlohaCare Medicare	$937.08
Rate for Payer: Cash Price	$739.80
Rate for Payer: Devoted Health Medicare	$1,035.72
Rate for Payer: Hawaii Medical Service Association Medicare	$937.08
Rate for Payer: Hawaii Western Management Group Commercial	$863.10
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Humana Medicare	$937.08
Rate for Payer: Kaiser Permanente Medicaid	$628.83
Rate for Payer: Kaiser Permanente Medicare	$937.08
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: Ohana Health Plan Medicaid	$937.08
Rate for Payer: Ohana Health Plan Medicare	$937.08
Rate for Payer: UnitedHealthcare Medicare	$937.08
Rate for Payer: University Health Alliance Commercial	$690.48

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95811]

Facility

$16.00

Service Code	NDC 00409318905
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

Know your out-of-pocket cost for care.

All Charges