Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA [3128]

Facility

$9.00

Service Code	NDC 00132020220
Hospital Revenue Code	637
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$6.84
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$6.84
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$6.84
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$6.84
Rate for Payer: Ohana Health Plan Medicare	$6.84
Rate for Payer: UnitedHealthcare Medicare	$6.84
Rate for Payer: University Health Alliance Commercial	$6.56

SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA [3128]

Facility

$9.00

Service Code	NDC 00132020220
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 POLYSTYRENE SULFONATE POWDER [7356]

Facility

$56.00

Service Code	NDC 11534016616
Hospital Revenue Code	250
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$33.60
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: MDX Hawaii PPO	$54.32

SODIUM POLYSTYRENE SULFONATE POWDER [7356]

Facility

$56.00

Service Code	NDC 11534016616
Hospital Revenue Code	637
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$54.32
Rate for Payer: AlohaCare Medicaid	$28.00
Rate for Payer: AlohaCare Medicare	$42.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Devoted Health Medicare	$47.04
Rate for Payer: Hawaii Medical Service Association Medicare	$42.56
Rate for Payer: Hawaii Western Management Group Commercial	$53.20
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Humana Medicare	$42.56
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: Kaiser Permanente Medicare	$42.56
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: Ohana Health Plan Medicaid	$42.56
Rate for Payer: Ohana Health Plan Medicare	$42.56
Rate for Payer: UnitedHealthcare Medicare	$42.56
Rate for Payer: University Health Alliance Commercial	$40.82

SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]

Facility

$231.00

Service Code	NDC 24201020105
Hospital Revenue Code	250
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$138.60
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]

Facility

$231.00

Service Code	NDC 24201020101
Hospital Revenue Code	250
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$138.60
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INJECTION SOLUTION [181343]

Facility

$406.00

Service Code	NDC 60267070550
Hospital Revenue Code	250
Min. Negotiated Rate	$345.10
Max. Negotiated Rate	$393.82
Rate for Payer: Cash Price	$243.60
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Health Management Network Commercial	$345.10
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Commercial	$365.40
Rate for Payer: MDX Hawaii PPO	$393.82
Rate for Payer: MDX Hawaii PPO	$12.61

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [162642]

Facility

$87.00

Service Code	NDC 00310111030
Hospital Revenue Code	250
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [162642]

Facility

$87.00

Service Code	NDC 00310111001
Hospital Revenue Code	637
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$66.12
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$73.08
Rate for Payer: Hawaii Medical Service Association Medicare	$66.12
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$66.12
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$66.12
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$66.12
Rate for Payer: Ohana Health Plan Medicare	$66.12
Rate for Payer: UnitedHealthcare Medicare	$66.12
Rate for Payer: University Health Alliance Commercial	$63.41

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [162642]

Facility

$87.00

Service Code	NDC 00310111001
Hospital Revenue Code	250
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [162642]

Facility

$87.00

Service Code	NDC 00310111030
Hospital Revenue Code	637
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$66.12
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$73.08
Rate for Payer: Hawaii Medical Service Association Medicare	$66.12
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$66.12
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$66.12
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$66.12
Rate for Payer: Ohana Health Plan Medicare	$66.12
Rate for Payer: UnitedHealthcare Medicare	$66.12
Rate for Payer: University Health Alliance Commercial	$63.41

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [162641]

Facility

$87.00

Service Code	NDC 00310110501
Hospital Revenue Code	637
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$66.12
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$73.08
Rate for Payer: Hawaii Medical Service Association Medicare	$66.12
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$66.12
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$66.12
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$66.12
Rate for Payer: Ohana Health Plan Medicare	$66.12
Rate for Payer: UnitedHealthcare Medicare	$66.12
Rate for Payer: University Health Alliance Commercial	$63.41

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [162641]

Facility

$87.00

Service Code	NDC 00310110530
Hospital Revenue Code	637
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$66.12
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$73.08
Rate for Payer: Hawaii Medical Service Association Medicare	$66.12
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$66.12
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$66.12
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$66.12
Rate for Payer: Ohana Health Plan Medicare	$66.12
Rate for Payer: UnitedHealthcare Medicare	$66.12
Rate for Payer: University Health Alliance Commercial	$63.41

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [162641]

Facility

$87.00

Service Code	NDC 00310110501
Hospital Revenue Code	250
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [162641]

Facility

$87.00

Service Code	NDC 00310110530
Hospital Revenue Code	250
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

SOFT TISSUE PROCEDURES WITH CC

Facility

$46,408.52

Service Code	MSDRG 501
Min. Negotiated Rate	$46,408.52
Max. Negotiated Rate	$46,408.52
Rate for Payer: Hawaii Medical Service Association Commercial	$46,408.52

SOFT TISSUE PROCEDURES WITH MCC

Facility

$46,408.52

Service Code	MSDRG 500
Min. Negotiated Rate	$46,408.52
Max. Negotiated Rate	$46,408.52
Rate for Payer: Hawaii Medical Service Association Commercial	$46,408.52

SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$22,896.13

Service Code	MSDRG 502
Min. Negotiated Rate	$22,896.13
Max. Negotiated Rate	$22,896.13
Rate for Payer: Hawaii Medical Service Association Commercial	$22,896.13

SOFT-VU MPA 5FX65

Facility

$145.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65

SOFT-VU MPA 5FX65

Facility

$145.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$110.20
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$121.80
Rate for Payer: Hawaii Medical Service Association Medicare	$110.20
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$110.20
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$110.20
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$110.20
Rate for Payer: Ohana Health Plan Medicare	$110.20
Rate for Payer: UnitedHealthcare Medicare	$110.20
Rate for Payer: University Health Alliance Commercial	$105.69

SOLN LIFT AGENT 5ML

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

SOLN LIFT AGENT 5ML

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$152.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$168.00
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$152.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$152.00
Rate for Payer: Ohana Health Plan Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: University Health Alliance Commercial	$145.78

SOLUTION 1.5% 2L PD

Facility

$163.00

Hospital Revenue Code	272
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$97.80
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: MDX Hawaii PPO	$158.11

SOLUTION 1.5% 2L PD

Facility

$163.00

Hospital Revenue Code	272
Min. Negotiated Rate	$81.50
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$81.50
Rate for Payer: AlohaCare Medicare	$123.88
Rate for Payer: Cash Price	$97.80
Rate for Payer: Devoted Health Medicare	$136.92
Rate for Payer: Hawaii Medical Service Association Medicare	$123.88
Rate for Payer: Hawaii Western Management Group Commercial	$154.85
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$123.88
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$123.88
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$123.88
Rate for Payer: Ohana Health Plan Medicare	$123.88
Rate for Payer: UnitedHealthcare Medicare	$123.88
Rate for Payer: University Health Alliance Commercial	$118.81

SOLUTION 2.5% 2L PD

Facility

$188.00

Hospital Revenue Code	272
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$182.36
Rate for Payer: AlohaCare Medicaid	$94.00
Rate for Payer: AlohaCare Medicare	$142.88
Rate for Payer: Cash Price	$112.80
Rate for Payer: Devoted Health Medicare	$157.92
Rate for Payer: Hawaii Medical Service Association Medicare	$142.88
Rate for Payer: Hawaii Western Management Group Commercial	$178.60
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Humana Medicare	$142.88
Rate for Payer: Kaiser Permanente Commercial	$169.20
Rate for Payer: Kaiser Permanente Medicaid	$95.88
Rate for Payer: Kaiser Permanente Medicare	$142.88
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: Ohana Health Plan Medicaid	$142.88
Rate for Payer: Ohana Health Plan Medicare	$142.88
Rate for Payer: UnitedHealthcare Medicare	$142.88
Rate for Payer: University Health Alliance Commercial	$137.03

Know your out-of-pocket cost for care.

All Charges