Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CEFUROXIME SODIUM 750 MG/8.3 ML IJ (WET SOLR VIAL) [4301465]

Facility

$18.00

Service Code	HCPCS J0697
Hospital Revenue Code	636
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$19.00
Rate for Payer: AlohaCare Medicare	$9.88
Rate for Payer: AlohaCare Medicare	$13.68
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$15.00
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$15.00
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Devoted Health Medicare	$21.00
Rate for Payer: Devoted Health Medicare	$15.12
Rate for Payer: Devoted Health Medicare	$10.92
Rate for Payer: Hawaii Medical Service Association ABD	$2.29
Rate for Payer: Hawaii Medical Service Association ABD	$2.29
Rate for Payer: Hawaii Medical Service Association ABD	$2.29
Rate for Payer: Hawaii Medical Service Association Medicare	$13.68
Rate for Payer: Hawaii Medical Service Association Medicare	$19.00
Rate for Payer: Hawaii Medical Service Association Medicare	$9.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.29
Rate for Payer: Hawaii Western Management Group Commercial	$23.75
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$13.68
Rate for Payer: Humana Medicare	$9.88
Rate for Payer: Humana Medicare	$19.00
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$13.68
Rate for Payer: Kaiser Permanente Medicare	$9.88
Rate for Payer: Kaiser Permanente Medicare	$19.00
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$13.68
Rate for Payer: Ohana Health Plan Medicaid	$19.00
Rate for Payer: Ohana Health Plan Medicaid	$9.88
Rate for Payer: Ohana Health Plan Medicare	$19.00
Rate for Payer: Ohana Health Plan Medicare	$9.88
Rate for Payer: Ohana Health Plan Medicare	$13.68
Rate for Payer: UnitedHealthcare Medicaid	$7.80
Rate for Payer: UnitedHealthcare Medicaid	$10.80
Rate for Payer: UnitedHealthcare Medicaid	$15.00
Rate for Payer: UnitedHealthcare Medicare	$9.88
Rate for Payer: UnitedHealthcare Medicare	$19.00
Rate for Payer: UnitedHealthcare Medicare	$13.68
Rate for Payer: University Health Alliance Commercial	$18.22
Rate for Payer: University Health Alliance Commercial	$13.12
Rate for Payer: University Health Alliance Commercial	$9.48

CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]

Facility

$13.00

Service Code	HCPCS J0697
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]

Facility

$13.00

Service Code	HCPCS J0697
Hospital Revenue Code	636
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$9.88
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$10.92
Rate for Payer: Hawaii Medical Service Association ABD	$2.29
Rate for Payer: Hawaii Medical Service Association Medicare	$9.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.29
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$9.88
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$9.88
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$9.88
Rate for Payer: Ohana Health Plan Medicare	$9.88
Rate for Payer: UnitedHealthcare Medicaid	$7.80
Rate for Payer: UnitedHealthcare Medicare	$9.88
Rate for Payer: University Health Alliance Commercial	$9.48

CELECOXIB 100 MG CAPSULE [24500]

Facility

$17.00

Service Code	NDC 60687043601
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

CELECOXIB 100 MG CAPSULE [24500]

Facility

$17.00

Service Code	NDC 60687043601
Hospital Revenue Code	637
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$12.92
Rate for Payer: Cash Price	$10.20
Rate for Payer: Devoted Health Medicare	$14.28
Rate for Payer: Hawaii Medical Service Association Medicare	$12.92
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$12.92
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$12.92
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$12.92
Rate for Payer: Ohana Health Plan Medicare	$12.92
Rate for Payer: UnitedHealthcare Medicare	$12.92
Rate for Payer: University Health Alliance Commercial	$12.39

CELECOXIB 100 MG CAPSULE [24500]

Facility

$17.00

Service Code	NDC 60687043611
Hospital Revenue Code	637
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$12.92
Rate for Payer: Cash Price	$10.20
Rate for Payer: Devoted Health Medicare	$14.28
Rate for Payer: Hawaii Medical Service Association Medicare	$12.92
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$12.92
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$12.92
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$12.92
Rate for Payer: Ohana Health Plan Medicare	$12.92
Rate for Payer: UnitedHealthcare Medicare	$12.92
Rate for Payer: University Health Alliance Commercial	$12.39

CELECOXIB 100 MG CAPSULE [24500]

Facility

$17.00

Service Code	NDC 60687043611
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

CELECOXIB 200 MG CAPSULE [24501]

Facility

$9.00

Service Code	NDC 60687044701
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

CELECOXIB 200 MG CAPSULE [24501]

Facility

$9.00

Service Code	NDC 60687044701
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

CELECOXIB 200 MG CAPSULE [24501]

Facility

$9.00

Service Code	NDC 60687044711
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

CELECOXIB 200 MG CAPSULE [24501]

Facility

$9.00

Service Code	NDC 60687044711
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

CELECT VENA CAVA FILTER SET

Facility

$2,790.00

Service Code	HCPCS C1880
Hospital Revenue Code	272
Min. Negotiated Rate	$2,371.50
Max. Negotiated Rate	$2,706.30
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Health Management Network Commercial	$2,371.50
Rate for Payer: Kaiser Permanente Commercial	$2,511.00
Rate for Payer: MDX Hawaii PPO	$2,706.30

CELECT VENA CAVA FILTER SET

Facility

$2,790.00

Service Code	HCPCS C1880
Hospital Revenue Code	272
Min. Negotiated Rate	$1,395.00
Max. Negotiated Rate	$2,706.30
Rate for Payer: AlohaCare Medicaid	$1,395.00
Rate for Payer: AlohaCare Medicare	$2,120.40
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Devoted Health Medicare	$2,343.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,120.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,650.50
Rate for Payer: Health Management Network Commercial	$2,371.50
Rate for Payer: Humana Medicare	$2,120.40
Rate for Payer: Kaiser Permanente Commercial	$2,511.00
Rate for Payer: Kaiser Permanente Medicaid	$1,422.90
Rate for Payer: Kaiser Permanente Medicare	$2,120.40
Rate for Payer: MDX Hawaii PPO	$2,706.30
Rate for Payer: Ohana Health Plan Medicaid	$2,120.40
Rate for Payer: Ohana Health Plan Medicare	$2,120.40
Rate for Payer: UnitedHealthcare Medicare	$2,120.40
Rate for Payer: University Health Alliance Commercial	$2,033.63

CELL SAVER PROCEDURE KIT 04362

Facility

$532.00

Hospital Revenue Code	272
Min. Negotiated Rate	$266.00
Max. Negotiated Rate	$516.04
Rate for Payer: AlohaCare Medicaid	$266.00
Rate for Payer: AlohaCare Medicare	$404.32
Rate for Payer: Cash Price	$319.20
Rate for Payer: Devoted Health Medicare	$446.88
Rate for Payer: Hawaii Medical Service Association Medicare	$404.32
Rate for Payer: Hawaii Western Management Group Commercial	$505.40
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: Humana Medicare	$404.32
Rate for Payer: Kaiser Permanente Commercial	$478.80
Rate for Payer: Kaiser Permanente Medicaid	$271.32
Rate for Payer: Kaiser Permanente Medicare	$404.32
Rate for Payer: MDX Hawaii PPO	$516.04
Rate for Payer: Ohana Health Plan Medicaid	$404.32
Rate for Payer: Ohana Health Plan Medicare	$404.32
Rate for Payer: UnitedHealthcare Medicare	$404.32
Rate for Payer: University Health Alliance Commercial	$387.77

CELL SAVER PROCEDURE KIT 04362

Facility

$532.00

Hospital Revenue Code	272
Min. Negotiated Rate	$452.20
Max. Negotiated Rate	$516.04
Rate for Payer: Cash Price	$319.20
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: Kaiser Permanente Commercial	$478.80
Rate for Payer: MDX Hawaii PPO	$516.04

CELLULITIS WITH MCC

Facility

$23,986.42

Service Code	MSDRG 602
Min. Negotiated Rate	$23,986.42
Max. Negotiated Rate	$23,986.42
Rate for Payer: Hawaii Medical Service Association Commercial	$23,986.42

CELLULITIS WITHOUT MCC

Facility

$16,141.06

Service Code	MSDRG 603
Min. Negotiated Rate	$16,141.06
Max. Negotiated Rate	$16,141.06
Rate for Payer: Hawaii Medical Service Association Commercial	$16,141.06

CEMENT AUTOMIX RELYX 7770454

Facility

$326.00

Service Code	HCPCS C1734
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$316.22
Rate for Payer: AlohaCare Medicaid	$163.00
Rate for Payer: AlohaCare Medicare	$247.76
Rate for Payer: Cash Price	$195.60
Rate for Payer: Devoted Health Medicare	$273.84
Rate for Payer: Hawaii Medical Service Association Medicare	$247.76
Rate for Payer: Hawaii Western Management Group Commercial	$228.20
Rate for Payer: Health Management Network Commercial	$277.10
Rate for Payer: Humana Medicare	$247.76
Rate for Payer: Kaiser Permanente Commercial	$293.40
Rate for Payer: Kaiser Permanente Medicaid	$166.26
Rate for Payer: Kaiser Permanente Medicare	$247.76
Rate for Payer: MDX Hawaii PPO	$316.22
Rate for Payer: Ohana Health Plan Medicaid	$247.76
Rate for Payer: Ohana Health Plan Medicare	$247.76
Rate for Payer: UnitedHealthcare Medicare	$247.76
Rate for Payer: University Health Alliance Commercial	$182.56

CEMENT AUTOMIX RELYX 7770454

Facility

$326.00

Service Code	HCPCS C1734
Hospital Revenue Code	278
Min. Negotiated Rate	$182.56
Max. Negotiated Rate	$316.22
Rate for Payer: Cash Price	$195.60
Rate for Payer: Hawaii Western Management Group Commercial	$228.20
Rate for Payer: Health Management Network Commercial	$277.10
Rate for Payer: Kaiser Permanente Commercial	$293.40
Rate for Payer: MDX Hawaii PPO	$316.22
Rate for Payer: University Health Alliance Commercial	$182.56

CEMENT BONE 0306-573-000

Facility

$392.00

Hospital Revenue Code	272
Min. Negotiated Rate	$196.00
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$297.92
Rate for Payer: Cash Price	$235.20
Rate for Payer: Devoted Health Medicare	$329.28
Rate for Payer: Hawaii Medical Service Association Medicare	$297.92
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$297.92
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$297.92
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$297.92
Rate for Payer: Ohana Health Plan Medicare	$297.92
Rate for Payer: UnitedHealthcare Medicare	$297.92
Rate for Payer: University Health Alliance Commercial	$285.73

CEMENT BONE 0306-573-000

Facility

$392.00

Hospital Revenue Code	272
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$235.20
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

CEMENT BONE 40GM 6197-9-010

Facility

$6,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,416.00
Max. Negotiated Rate	$5,917.00
Rate for Payer: Cash Price	$3,660.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,270.00
Rate for Payer: Health Management Network Commercial	$5,185.00
Rate for Payer: Kaiser Permanente Commercial	$5,490.00
Rate for Payer: MDX Hawaii PPO	$5,917.00
Rate for Payer: University Health Alliance Commercial	$3,416.00

CEMENT BONE 40GM 6197-9-010

Facility

$6,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,050.00
Max. Negotiated Rate	$5,917.00
Rate for Payer: AlohaCare Medicaid	$3,050.00
Rate for Payer: AlohaCare Medicare	$4,636.00
Rate for Payer: Cash Price	$3,660.00
Rate for Payer: Devoted Health Medicare	$5,124.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,636.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,270.00
Rate for Payer: Health Management Network Commercial	$5,185.00
Rate for Payer: Humana Medicare	$4,636.00
Rate for Payer: Kaiser Permanente Commercial	$5,490.00
Rate for Payer: Kaiser Permanente Medicaid	$3,111.00
Rate for Payer: Kaiser Permanente Medicare	$4,636.00
Rate for Payer: MDX Hawaii PPO	$5,917.00
Rate for Payer: Ohana Health Plan Medicaid	$4,636.00
Rate for Payer: Ohana Health Plan Medicare	$4,636.00
Rate for Payer: UnitedHealthcare Medicare	$4,636.00
Rate for Payer: University Health Alliance Commercial	$3,416.00

CEMENT BONE HYDROSET XT 897005

Facility

$5,939.00

Service Code	HCPCS C1734
Hospital Revenue Code	278
Min. Negotiated Rate	$2,969.50
Max. Negotiated Rate	$5,760.83
Rate for Payer: AlohaCare Medicaid	$2,969.50
Rate for Payer: AlohaCare Medicare	$4,513.64
Rate for Payer: Cash Price	$3,563.40
Rate for Payer: Devoted Health Medicare	$4,988.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4,513.64
Rate for Payer: Hawaii Western Management Group Commercial	$4,157.30
Rate for Payer: Health Management Network Commercial	$5,048.15
Rate for Payer: Humana Medicare	$4,513.64
Rate for Payer: Kaiser Permanente Commercial	$5,345.10
Rate for Payer: Kaiser Permanente Medicaid	$3,028.89
Rate for Payer: Kaiser Permanente Medicare	$4,513.64
Rate for Payer: MDX Hawaii PPO	$5,760.83
Rate for Payer: Ohana Health Plan Medicaid	$4,513.64
Rate for Payer: Ohana Health Plan Medicare	$4,513.64
Rate for Payer: UnitedHealthcare Medicare	$4,513.64
Rate for Payer: University Health Alliance Commercial	$3,325.84

CEMENT BONE HYDROSET XT 897005

Facility

$5,939.00

Service Code	HCPCS C1734
Hospital Revenue Code	278
Min. Negotiated Rate	$3,325.84
Max. Negotiated Rate	$5,760.83
Rate for Payer: Cash Price	$3,563.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,157.30
Rate for Payer: Health Management Network Commercial	$5,048.15
Rate for Payer: Kaiser Permanente Commercial	$5,345.10
Rate for Payer: MDX Hawaii PPO	$5,760.83
Rate for Payer: University Health Alliance Commercial	$3,325.84

Know your out-of-pocket cost for care.

All Charges