Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

WATER FOR INJECTION, STERILE INJECTION SOLUTION [7484]

Facility

$2.00

Service Code	NDC 00409488710
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$1.94

WATER FOR INJECTION, STERILE INJECTION SOLUTION [7484]

Facility

$42.00

Service Code	NDC 65219018701
Hospital Revenue Code	250
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$25.20
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: MDX Hawaii PPO	$40.74

WATER FOR INJECTION, STERILE INJECTION SOLUTION [7484]

Facility

$15.00

Service Code	NDC 00409488717
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

WATER FOR INJECTION, STERILE INJECTION SOLUTION [7484]

Facility

$21.00

Service Code	NDC 00409488720
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

WATER FOR INJECTION, STERILE INJECTION SOLUTION [7484]

Facility

$21.00

Service Code	NDC 00409488723
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [27834]

Facility

$18.00

Service Code	NDC 00264785020
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

WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [27834]

Facility

$42.00

Service Code	NDC 00338001304
Hospital Revenue Code	258
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$40.74
Rate for Payer: AlohaCare Medicaid	$21.00
Rate for Payer: AlohaCare Medicare	$31.92
Rate for Payer: Cash Price	$25.20
Rate for Payer: Devoted Health Medicare	$35.28
Rate for Payer: Hawaii Medical Service Association Medicare	$31.92
Rate for Payer: Hawaii Western Management Group Commercial	$39.90
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Humana Medicare	$31.92
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Medicaid	$21.42
Rate for Payer: Kaiser Permanente Medicare	$31.92
Rate for Payer: MDX Hawaii PPO	$40.74
Rate for Payer: Ohana Health Plan Medicaid	$31.92
Rate for Payer: Ohana Health Plan Medicare	$31.92
Rate for Payer: UnitedHealthcare Medicare	$31.92
Rate for Payer: University Health Alliance Commercial	$30.61

WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [27834]

Facility

$42.00

Service Code	NDC 00338001304
Hospital Revenue Code	258
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$25.20
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: MDX Hawaii PPO	$40.74

WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [27834]

Facility

$18.00

Service Code	NDC 00264785020
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

WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [27834]

Facility

$21.00

Service Code	NDC 00264785000
Hospital Revenue Code	258
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$15.96
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$17.64
Rate for Payer: Hawaii Medical Service Association Medicare	$15.96
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$15.96
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$15.96
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$15.96
Rate for Payer: Ohana Health Plan Medicare	$15.96
Rate for Payer: UnitedHealthcare Medicare	$15.96
Rate for Payer: University Health Alliance Commercial	$15.31

WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [27834]

Facility

$21.00

Service Code	NDC 00264785000
Hospital Revenue Code	258
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

WATER FOR IRRIGATION, STERILE SOLUTION [7485]

Facility

$14.00

Service Code	NDC 00264210110
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

WATER FOR IRRIGATION, STERILE SOLUTION [7485]

Facility

$7.00

Service Code	NDC 00264210100
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: MDX Hawaii PPO	$6.79

WAYNE PNEUMOTHORAX SET

Facility

$779.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$389.50
Max. Negotiated Rate	$755.63
Rate for Payer: AlohaCare Medicaid	$389.50
Rate for Payer: AlohaCare Medicare	$592.04
Rate for Payer: Cash Price	$467.40
Rate for Payer: Devoted Health Medicare	$654.36
Rate for Payer: Hawaii Medical Service Association Medicare	$592.04
Rate for Payer: Hawaii Western Management Group Commercial	$740.05
Rate for Payer: Health Management Network Commercial	$662.15
Rate for Payer: Humana Medicare	$592.04
Rate for Payer: Kaiser Permanente Commercial	$701.10
Rate for Payer: Kaiser Permanente Medicaid	$397.29
Rate for Payer: Kaiser Permanente Medicare	$592.04
Rate for Payer: MDX Hawaii PPO	$755.63
Rate for Payer: Ohana Health Plan Medicaid	$592.04
Rate for Payer: Ohana Health Plan Medicare	$592.04
Rate for Payer: UnitedHealthcare Medicare	$592.04
Rate for Payer: University Health Alliance Commercial	$567.81

WAYNE PNEUMOTHORAX SET

Facility

$779.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$662.15
Max. Negotiated Rate	$755.63
Rate for Payer: Cash Price	$467.40
Rate for Payer: Health Management Network Commercial	$662.15
Rate for Payer: Kaiser Permanente Commercial	$701.10
Rate for Payer: MDX Hawaii PPO	$755.63

WAYNE PNEUMOTHORAX TRAY G56537

Facility

$868.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$434.00
Max. Negotiated Rate	$841.96
Rate for Payer: AlohaCare Medicaid	$434.00
Rate for Payer: AlohaCare Medicare	$659.68
Rate for Payer: Cash Price	$520.80
Rate for Payer: Devoted Health Medicare	$729.12
Rate for Payer: Hawaii Medical Service Association Medicare	$659.68
Rate for Payer: Hawaii Western Management Group Commercial	$824.60
Rate for Payer: Health Management Network Commercial	$737.80
Rate for Payer: Humana Medicare	$659.68
Rate for Payer: Kaiser Permanente Commercial	$781.20
Rate for Payer: Kaiser Permanente Medicaid	$442.68
Rate for Payer: Kaiser Permanente Medicare	$659.68
Rate for Payer: MDX Hawaii PPO	$841.96
Rate for Payer: Ohana Health Plan Medicaid	$659.68
Rate for Payer: Ohana Health Plan Medicare	$659.68
Rate for Payer: UnitedHealthcare Medicare	$659.68
Rate for Payer: University Health Alliance Commercial	$632.69

WAYNE PNEUMOTHORAX TRAY G56537

Facility

$868.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$737.80
Max. Negotiated Rate	$841.96
Rate for Payer: Cash Price	$520.80
Rate for Payer: Health Management Network Commercial	$737.80
Rate for Payer: Kaiser Permanente Commercial	$781.20
Rate for Payer: MDX Hawaii PPO	$841.96

WEDGE FULL BASE PLATE DWJ515

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

WEDGE FULL BASE PLATE DWJ515

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: Kaiser Permanente Medicaid	$1,530.00
Rate for Payer: AlohaCare Medicaid	$1,500.00
Rate for Payer: AlohaCare Medicare	$2,280.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Devoted Health Medicare	$2,520.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Humana Medicare	$2,280.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: Kaiser Permanente Medicare	$2,280.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: Ohana Health Plan Medicaid	$2,280.00
Rate for Payer: Ohana Health Plan Medicare	$2,280.00
Rate for Payer: UnitedHealthcare Medicare	$2,280.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

WEDGE SUBTALAR 12MM PSBT-1206

Facility

$5,588.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,794.00
Max. Negotiated Rate	$5,420.36
Rate for Payer: AlohaCare Medicaid	$2,794.00
Rate for Payer: AlohaCare Medicare	$4,246.88
Rate for Payer: Cash Price	$3,352.80
Rate for Payer: Devoted Health Medicare	$4,693.92
Rate for Payer: Hawaii Medical Service Association Medicare	$4,246.88
Rate for Payer: Hawaii Western Management Group Commercial	$3,911.60
Rate for Payer: Health Management Network Commercial	$4,749.80
Rate for Payer: Humana Medicare	$4,246.88
Rate for Payer: Kaiser Permanente Commercial	$5,029.20
Rate for Payer: Kaiser Permanente Medicaid	$2,849.88
Rate for Payer: Kaiser Permanente Medicare	$4,246.88
Rate for Payer: MDX Hawaii PPO	$5,420.36
Rate for Payer: Ohana Health Plan Medicaid	$4,246.88
Rate for Payer: Ohana Health Plan Medicare	$4,246.88
Rate for Payer: UnitedHealthcare Medicare	$4,246.88
Rate for Payer: University Health Alliance Commercial	$3,129.28

WEDGE SUBTALAR 12MM PSBT-1206

Facility

$5,588.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,129.28
Max. Negotiated Rate	$5,420.36
Rate for Payer: Cash Price	$3,352.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,911.60
Rate for Payer: Health Management Network Commercial	$4,749.80
Rate for Payer: Kaiser Permanente Commercial	$5,029.20
Rate for Payer: MDX Hawaii PPO	$5,420.36
Rate for Payer: University Health Alliance Commercial	$3,129.28

WEDGE SUBTALAR 18MM PSBT-1818

Facility

$5,476.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,738.00
Max. Negotiated Rate	$5,311.72
Rate for Payer: AlohaCare Medicaid	$2,738.00
Rate for Payer: AlohaCare Medicare	$4,161.76
Rate for Payer: Cash Price	$3,285.60
Rate for Payer: Devoted Health Medicare	$4,599.84
Rate for Payer: Hawaii Medical Service Association Medicare	$4,161.76
Rate for Payer: Hawaii Western Management Group Commercial	$3,833.20
Rate for Payer: Health Management Network Commercial	$4,654.60
Rate for Payer: Humana Medicare	$4,161.76
Rate for Payer: Kaiser Permanente Commercial	$4,928.40
Rate for Payer: Kaiser Permanente Medicaid	$2,792.76
Rate for Payer: Kaiser Permanente Medicare	$4,161.76
Rate for Payer: MDX Hawaii PPO	$5,311.72
Rate for Payer: Ohana Health Plan Medicaid	$4,161.76
Rate for Payer: Ohana Health Plan Medicare	$4,161.76
Rate for Payer: UnitedHealthcare Medicare	$4,161.76
Rate for Payer: University Health Alliance Commercial	$3,066.56

WEDGE SUBTALAR 18MM PSBT-1818

Facility

$5,476.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,066.56
Max. Negotiated Rate	$5,311.72
Rate for Payer: Cash Price	$3,285.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,833.20
Rate for Payer: Health Management Network Commercial	$4,654.60
Rate for Payer: Kaiser Permanente Commercial	$4,928.40
Rate for Payer: MDX Hawaii PPO	$5,311.72
Rate for Payer: University Health Alliance Commercial	$3,066.56

WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT [139325]

Facility

$27.00

Service Code	NDC 00065051801
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT [139325]

Facility

$27.00

Service Code	NDC 00065051801
Hospital Revenue Code	637
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$26.19
Rate for Payer: AlohaCare Medicaid	$13.50
Rate for Payer: AlohaCare Medicare	$20.52
Rate for Payer: Cash Price	$16.20
Rate for Payer: Devoted Health Medicare	$22.68
Rate for Payer: Hawaii Medical Service Association Medicare	$20.52
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Humana Medicare	$20.52
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: Kaiser Permanente Medicare	$20.52
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: Ohana Health Plan Medicaid	$20.52
Rate for Payer: Ohana Health Plan Medicare	$20.52
Rate for Payer: UnitedHealthcare Medicare	$20.52
Rate for Payer: University Health Alliance Commercial	$19.68

Know your out-of-pocket cost for care.

All Charges