Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CENTERPOINT DELIVERY CATH 6.5F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: MDX Hawaii PPO	$1,681.01

CENTERPOINT SSPC3 8F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: MDX Hawaii PPO	$1,681.01

CENTERPOINT SSPC3 8F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$866.50
Max. Negotiated Rate	$1,681.01
Rate for Payer: AlohaCare Medicaid	$866.50
Rate for Payer: AlohaCare Medicare	$1,317.08
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Devoted Health Medicare	$1,455.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,317.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,646.35
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Humana Medicare	$1,317.08
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: Kaiser Permanente Medicare	$1,317.08
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: Ohana Health Plan Medicaid	$1,317.08
Rate for Payer: Ohana Health Plan Medicare	$1,317.08
Rate for Payer: UnitedHealthcare Medicare	$1,317.08
Rate for Payer: University Health Alliance Commercial	$1,263.18

CENTERPOINT SSPC3 9F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: MDX Hawaii PPO	$1,681.01

CENTERPOINT SSPC3 9F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$866.50
Max. Negotiated Rate	$1,681.01
Rate for Payer: AlohaCare Medicaid	$866.50
Rate for Payer: AlohaCare Medicare	$1,317.08
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Devoted Health Medicare	$1,455.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,317.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,646.35
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Humana Medicare	$1,317.08
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: Kaiser Permanente Medicare	$1,317.08
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: Ohana Health Plan Medicaid	$1,317.08
Rate for Payer: Ohana Health Plan Medicare	$1,317.08
Rate for Payer: UnitedHealthcare Medicare	$1,317.08
Rate for Payer: University Health Alliance Commercial	$1,263.18

CENTRALIZER #00-7859-013-00

Facility

$750.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$727.50
Rate for Payer: AlohaCare Medicaid	$375.00
Rate for Payer: AlohaCare Medicare	$570.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Devoted Health Medicare	$630.00
Rate for Payer: Hawaii Medical Service Association Medicare	$570.00
Rate for Payer: Hawaii Western Management Group Commercial	$525.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Humana Medicare	$570.00
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: Kaiser Permanente Medicare	$570.00
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: Ohana Health Plan Medicaid	$570.00
Rate for Payer: Ohana Health Plan Medicare	$570.00
Rate for Payer: UnitedHealthcare Medicare	$570.00
Rate for Payer: University Health Alliance Commercial	$420.00

CENTRALIZER #00-7859-013-00

Facility

$750.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$525.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: University Health Alliance Commercial	$420.00

CENTRALIZER #00-7859-015-00

Facility

$470.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$455.90
Rate for Payer: AlohaCare Medicaid	$235.00
Rate for Payer: AlohaCare Medicare	$357.20
Rate for Payer: Cash Price	$282.00
Rate for Payer: Devoted Health Medicare	$394.80
Rate for Payer: Hawaii Medical Service Association Medicare	$357.20
Rate for Payer: Hawaii Western Management Group Commercial	$329.00
Rate for Payer: Health Management Network Commercial	$399.50
Rate for Payer: Humana Medicare	$357.20
Rate for Payer: Kaiser Permanente Commercial	$423.00
Rate for Payer: Kaiser Permanente Medicaid	$239.70
Rate for Payer: Kaiser Permanente Medicare	$357.20
Rate for Payer: MDX Hawaii PPO	$455.90
Rate for Payer: Ohana Health Plan Medicaid	$357.20
Rate for Payer: Ohana Health Plan Medicare	$357.20
Rate for Payer: UnitedHealthcare Medicare	$357.20
Rate for Payer: University Health Alliance Commercial	$263.20

CENTRALIZER #00-7859-015-00

Facility

$470.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$263.20
Max. Negotiated Rate	$455.90
Rate for Payer: Cash Price	$282.00
Rate for Payer: Hawaii Western Management Group Commercial	$329.00
Rate for Payer: Health Management Network Commercial	$399.50
Rate for Payer: Kaiser Permanente Commercial	$423.00
Rate for Payer: MDX Hawaii PPO	$455.90
Rate for Payer: University Health Alliance Commercial	$263.20

CENTRAL SCREW DRILL 3.2MM

Facility

$544.00

Hospital Revenue Code	272
Min. Negotiated Rate	$462.40
Max. Negotiated Rate	$527.68
Rate for Payer: Cash Price	$326.40
Rate for Payer: Health Management Network Commercial	$462.40
Rate for Payer: Kaiser Permanente Commercial	$489.60
Rate for Payer: MDX Hawaii PPO	$527.68

CENTRAL SCREW DRILL 3.2MM

Facility

$544.00

Hospital Revenue Code	272
Min. Negotiated Rate	$272.00
Max. Negotiated Rate	$527.68
Rate for Payer: AlohaCare Medicaid	$272.00
Rate for Payer: AlohaCare Medicare	$413.44
Rate for Payer: Cash Price	$326.40
Rate for Payer: Devoted Health Medicare	$456.96
Rate for Payer: Hawaii Medical Service Association Medicare	$413.44
Rate for Payer: Hawaii Western Management Group Commercial	$516.80
Rate for Payer: Health Management Network Commercial	$462.40
Rate for Payer: Humana Medicare	$413.44
Rate for Payer: Kaiser Permanente Commercial	$489.60
Rate for Payer: Kaiser Permanente Medicaid	$277.44
Rate for Payer: Kaiser Permanente Medicare	$413.44
Rate for Payer: MDX Hawaii PPO	$527.68
Rate for Payer: Ohana Health Plan Medicaid	$413.44
Rate for Payer: Ohana Health Plan Medicare	$413.44
Rate for Payer: UnitedHealthcare Medicare	$413.44
Rate for Payer: University Health Alliance Commercial	$396.52

CENTRAL THIRD LF AR-2652CL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.68
Max. Negotiated Rate	$2,597.66
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: University Health Alliance Commercial	$1,499.68

CENTRAL THIRD LF AR-2652CL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,339.00
Max. Negotiated Rate	$2,597.66
Rate for Payer: AlohaCare Medicaid	$1,339.00
Rate for Payer: AlohaCare Medicare	$2,035.28
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Devoted Health Medicare	$2,249.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,035.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Humana Medicare	$2,035.28
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: Kaiser Permanente Medicaid	$1,365.78
Rate for Payer: Kaiser Permanente Medicare	$2,035.28
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: Ohana Health Plan Medicaid	$2,035.28
Rate for Payer: Ohana Health Plan Medicare	$2,035.28
Rate for Payer: UnitedHealthcare Medicare	$2,035.28
Rate for Payer: University Health Alliance Commercial	$1,499.68

CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]

Facility

$72.00

Service Code	NDC 00093417773
Hospital Revenue Code	637
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$54.72
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$60.48
Rate for Payer: Hawaii Medical Service Association Medicare	$54.72
Rate for Payer: Hawaii Western Management Group Commercial	$68.40
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$54.72
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$54.72
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$54.72
Rate for Payer: Ohana Health Plan Medicare	$54.72
Rate for Payer: UnitedHealthcare Medicare	$54.72
Rate for Payer: University Health Alliance Commercial	$52.48

CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]

Facility

$72.00

Service Code	NDC 00093417773
Hospital Revenue Code	250
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

CEPHALEXIN 250 MG CAPSULE [9499]

Facility

$3.00

Service Code	NDC 60687015201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

CEPHALEXIN 250 MG CAPSULE [9499]

Facility

$3.00

Service Code	NDC 60687015211
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

CEPHALEXIN 250 MG CAPSULE [9499]

Facility

$3.00

Service Code	NDC 60687015211
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

CEPHALEXIN 250 MG CAPSULE [9499]

Facility

$3.00

Service Code	NDC 60687015201
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

CEPHALEXIN 500 MG CAPSULE [9500]

Facility

$5.00

Service Code	NDC 60687016311
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

CEPHALEXIN 500 MG CAPSULE [9500]

Facility

$5.00

Service Code	NDC 60687016311
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

CEPHALEXIN 500 MG CAPSULE [9500]

Facility

$5.00

Service Code	NDC 60687016301
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

CEPHALEXIN 500 MG CAPSULE [9500]

Facility

$5.00

Service Code	NDC 60687016301
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

CEPHALEXIN CAPSULES (KEFLEX) 500 MG (TAKE HOME) [4080344]

Facility

$15.00

Service Code	NDC 00004080132
Hospital Revenue Code	253
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

CEPHALEXIN CAPSULES (KEFLEX) 500 MG (TAKE HOME) [4080344]

Facility

$15.00

Service Code	NDC 00004080132
Hospital Revenue Code	253
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

Know your out-of-pocket cost for care.

All Charges