Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]

Facility

$21.00

Service Code	HCPCS J1885
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: MDX Hawaii PPO	$14.55

KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]

Facility

$8.00

Service Code	HCPCS J1885
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: AlohaCare Medicare	$15.96
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$17.64
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association ABD	$0.35
Rate for Payer: Hawaii Medical Service Association ABD	$0.35
Rate for Payer: Hawaii Medical Service Association ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Commercial	$0.43
Rate for Payer: Hawaii Medical Service Association Commercial	$0.43
Rate for Payer: Hawaii Medical Service Association Commercial	$0.43
Rate for Payer: Hawaii Medical Service Association Medicare	$15.96
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.35
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$15.96
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: Kaiser Permanente Medicare	$15.96
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$15.96
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: Ohana Health Plan Medicare	$15.96
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicaid	$9.00
Rate for Payer: UnitedHealthcare Medicaid	$12.60
Rate for Payer: UnitedHealthcare Medicaid	$4.80
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$15.96
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83
Rate for Payer: University Health Alliance Commercial	$10.93
Rate for Payer: University Health Alliance Commercial	$15.31

KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [97716]

Facility

$4.00

Service Code	HCPCS J1885
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: MDX Hawaii PPO	$3.88

KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [97716]

Facility

$4.00

Service Code	HCPCS J1885
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$6.84
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association ABD	$0.35
Rate for Payer: Hawaii Medical Service Association ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Commercial	$0.43
Rate for Payer: Hawaii Medical Service Association Commercial	$0.43
Rate for Payer: Hawaii Medical Service Association Medicare	$6.84
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.35
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Humana Medicare	$6.84
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: Kaiser Permanente Medicare	$6.84
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$6.84
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: Ohana Health Plan Medicare	$6.84
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: UnitedHealthcare Medicaid	$2.40
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$6.84
Rate for Payer: University Health Alliance Commercial	$2.92
Rate for Payer: University Health Alliance Commercial	$6.56

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

$43,279.85

Service Code	MSDRG 657
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

$43,279.85

Service Code	MSDRG 656
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility

$43,279.85

Service Code	MSDRG 658
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC

Facility

$46,052.99

Service Code	MSDRG 660
Min. Negotiated Rate	$46,052.99
Max. Negotiated Rate	$46,052.99
Rate for Payer: Hawaii Medical Service Association Commercial	$46,052.99

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC

Facility

$47,759.53

Service Code	MSDRG 659
Min. Negotiated Rate	$47,759.53
Max. Negotiated Rate	$47,759.53
Rate for Payer: Hawaii Medical Service Association Commercial	$47,759.53

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC

Facility

$31,144.43

Service Code	MSDRG 661
Min. Negotiated Rate	$31,144.43
Max. Negotiated Rate	$31,144.43
Rate for Payer: Hawaii Medical Service Association Commercial	$31,144.43

KIDNEY AND URINARY TRACT INFECTIONS WITH MCC

Facility

$17,539.48

Service Code	MSDRG 689
Min. Negotiated Rate	$17,539.48
Max. Negotiated Rate	$17,539.48
Rate for Payer: Hawaii Medical Service Association Commercial	$17,539.48

KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC

Facility

$14,979.66

Service Code	MSDRG 690
Min. Negotiated Rate	$14,979.66
Max. Negotiated Rate	$14,979.66
Rate for Payer: Hawaii Medical Service Association Commercial	$14,979.66

KIDNEY AND URINARY TRACT NEOPLASMS WITH CC

Facility

$30,931.11

Service Code	MSDRG 687
Min. Negotiated Rate	$30,931.11
Max. Negotiated Rate	$30,931.11
Rate for Payer: Hawaii Medical Service Association Commercial	$30,931.11

KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC

Facility

$30,931.11

Service Code	MSDRG 686
Min. Negotiated Rate	$30,931.11
Max. Negotiated Rate	$30,931.11
Rate for Payer: Hawaii Medical Service Association Commercial	$30,931.11

KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC

Facility

$30,931.11

Service Code	MSDRG 688
Min. Negotiated Rate	$30,931.11
Max. Negotiated Rate	$30,931.11
Rate for Payer: Hawaii Medical Service Association Commercial	$30,931.11

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility

$20,525.93

Service Code	MSDRG 695
Min. Negotiated Rate	$20,525.93
Max. Negotiated Rate	$20,525.93
Rate for Payer: Hawaii Medical Service Association Commercial	$20,525.93

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$20,525.93

Service Code	MSDRG 696
Min. Negotiated Rate	$20,525.93
Max. Negotiated Rate	$20,525.93
Rate for Payer: Hawaii Medical Service Association Commercial	$20,525.93

KIDNEY TRANSPLANT

Facility

$154,726.66

Service Code	MSDRG 652
Min. Negotiated Rate	$154,726.66
Max. Negotiated Rate	$154,726.66
Rate for Payer: Hawaii Medical Service Association Commercial	$154,726.66

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$154,726.66

Service Code	MSDRG 650
Min. Negotiated Rate	$154,726.66
Max. Negotiated Rate	$154,726.66
Rate for Payer: Hawaii Medical Service Association Commercial	$154,726.66

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$154,726.66

Service Code	MSDRG 651
Min. Negotiated Rate	$154,726.66
Max. Negotiated Rate	$154,726.66
Rate for Payer: Hawaii Medical Service Association Commercial	$154,726.66

KII FIOS OBTURATOR 5X100 CTF03

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$349.20
Rate for Payer: AlohaCare Medicaid	$180.00
Rate for Payer: AlohaCare Medicare	$273.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Devoted Health Medicare	$302.40
Rate for Payer: Hawaii Medical Service Association Medicare	$273.60
Rate for Payer: Hawaii Western Management Group Commercial	$342.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Humana Medicare	$273.60
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: Kaiser Permanente Medicare	$273.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: Ohana Health Plan Medicaid	$273.60
Rate for Payer: Ohana Health Plan Medicare	$273.60
Rate for Payer: UnitedHealthcare Medicare	$273.60
Rate for Payer: University Health Alliance Commercial	$262.40

KII FIOS OBTURATOR 5X100 CTF03

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: MDX Hawaii PPO	$349.20

KII SLEEVE 5X100 CFS02

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

KII SLEEVE 5X100 CFS02

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$171.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$189.00
Rate for Payer: Hawaii Medical Service Association Medicare	$171.00
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$171.00
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$171.00
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$171.00
Rate for Payer: Ohana Health Plan Medicare	$171.00
Rate for Payer: UnitedHealthcare Medicare	$171.00
Rate for Payer: University Health Alliance Commercial	$164.00

KIRSCHNER WIRE 47-186-78

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

Know your out-of-pocket cost for care.

All Charges