Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SODIUM BICARBONATE 650 MG TABLET [7313]

Facility

$1.00

Service Code	NDC 69367025810
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

SODIUM BICARBONATE 650 MG TABLET [7313]

Facility

$1.00

Service Code	NDC 00904726161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

SODIUM BICARBONATE 650 MG TABLET [7313]

Facility

$1.00

Service Code	NDC 64980052810
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

SODIUM BICARBONATE 650 MG TABLET [7313]

Facility

$1.00

Service Code	NDC 69367025810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

SODIUM BICARBONATE 650 MG TABLET [7313]

Facility

$1.00

Service Code	NDC 64980052810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]

Facility

$18.00

Service Code	NDC 00264780200
Hospital Revenue Code	258
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]

Facility

$16.00

Service Code	NDC 00264780210
Hospital Revenue Code	258
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

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]

Facility

$18.00

Service Code	NDC 00264780200
Hospital Revenue Code	258
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$13.68
Rate for Payer: Cash Price	$10.80
Rate for Payer: Devoted Health Medicare	$15.12
Rate for Payer: Hawaii Medical Service Association Medicare	$13.68
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$13.68
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$13.68
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$13.68
Rate for Payer: Ohana Health Plan Medicare	$13.68
Rate for Payer: UnitedHealthcare Medicare	$13.68
Rate for Payer: University Health Alliance Commercial	$13.12

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]

Facility

$18.00

Service Code	NDC 00264580400
Hospital Revenue Code	258
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$13.68
Rate for Payer: Cash Price	$10.80
Rate for Payer: Devoted Health Medicare	$15.12
Rate for Payer: Hawaii Medical Service Association Medicare	$13.68
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$13.68
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$13.68
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$13.68
Rate for Payer: Ohana Health Plan Medicare	$13.68
Rate for Payer: UnitedHealthcare Medicare	$13.68
Rate for Payer: University Health Alliance Commercial	$13.12

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]

Facility

$16.00

Service Code	NDC 00264780210
Hospital Revenue Code	258
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

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]

Facility

$18.00

Service Code	NDC 00264580400
Hospital Revenue Code	258
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

SODIUM CHLORIDE 0.45 % IV BOLUS [400292]

Facility

$16.00

Service Code	NDC 00264780210
Hospital Revenue Code	258
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

SODIUM CHLORIDE 0.45 % IV BOLUS [400292]

Facility

$18.00

Service Code	NDC 00264580400
Hospital Revenue Code	258
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$13.68
Rate for Payer: Cash Price	$10.80
Rate for Payer: Devoted Health Medicare	$15.12
Rate for Payer: Hawaii Medical Service Association Medicare	$13.68
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$13.68
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$13.68
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$13.68
Rate for Payer: Ohana Health Plan Medicare	$13.68
Rate for Payer: UnitedHealthcare Medicare	$13.68
Rate for Payer: University Health Alliance Commercial	$13.12

SODIUM CHLORIDE 0.45 % IV BOLUS [400292]

Facility

$16.00

Service Code	NDC 00264780210
Hospital Revenue Code	258
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

SODIUM CHLORIDE 0.45 % IV BOLUS [400292]

Facility

$18.00

Service Code	NDC 00264780200
Hospital Revenue Code	258
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

SODIUM CHLORIDE 0.45 % IV BOLUS [400292]

Facility

$18.00

Service Code	NDC 00264780200
Hospital Revenue Code	258
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$13.68
Rate for Payer: Cash Price	$10.80
Rate for Payer: Devoted Health Medicare	$15.12
Rate for Payer: Hawaii Medical Service Association Medicare	$13.68
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$13.68
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$13.68
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$13.68
Rate for Payer: Ohana Health Plan Medicare	$13.68
Rate for Payer: UnitedHealthcare Medicare	$13.68
Rate for Payer: University Health Alliance Commercial	$13.12

SODIUM CHLORIDE 0.45 % IV BOLUS [400292]

Facility

$18.00

Service Code	NDC 00264580400
Hospital Revenue Code	258
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL [7030]

Facility

$5.00

Service Code	NDC 00904386575
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

SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION [7028]

Facility

$10.00

Service Code	NDC 00409196602
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION [7028]

Facility

$10.00

Service Code	NDC 00409196607
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION [7028]

Facility

$8.00

Service Code	NDC 63323092410
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

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

$9.00

Service Code	NDC 63323018603
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

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

$5.00

Service Code	NDC 63323018601
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

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

$5.00

Service Code	NDC 63323018610
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: MDX Hawaii PPO	$4.85

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

$4.00

Service Code	NDC 00409488810
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

Know your out-of-pocket cost for care.

All Charges