Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$73,452.50

Service Code	MSDRG 827
Min. Negotiated Rate	$73,452.50
Max. Negotiated Rate	$73,452.50
Rate for Payer: Hawaii Medical Service Association Commercial	$73,452.50

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$73,452.50

Service Code	MSDRG 826
Min. Negotiated Rate	$73,452.50
Max. Negotiated Rate	$73,452.50
Rate for Payer: Hawaii Medical Service Association Commercial	$73,452.50

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$37,069.93

Service Code	MSDRG 828
Min. Negotiated Rate	$37,069.93
Max. Negotiated Rate	$37,069.93
Rate for Payer: Hawaii Medical Service Association Commercial	$37,069.93

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$46,811.45

Service Code	MSDRG 829
Min. Negotiated Rate	$46,811.45
Max. Negotiated Rate	$46,811.45
Rate for Payer: Hawaii Medical Service Association Commercial	$46,811.45

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$46,811.45

Service Code	MSDRG 830
Min. Negotiated Rate	$46,811.45
Max. Negotiated Rate	$46,811.45
Rate for Payer: Hawaii Medical Service Association Commercial	$46,811.45

MYNX CONTROL VENOUS 6F-12F

Facility

$945.00

Service Code	HCPCS C1760
Hospital Revenue Code	272
Min. Negotiated Rate	$803.25
Max. Negotiated Rate	$916.65
Rate for Payer: Cash Price	$567.00
Rate for Payer: Health Management Network Commercial	$803.25
Rate for Payer: Kaiser Permanente Commercial	$850.50
Rate for Payer: MDX Hawaii PPO	$916.65

MYNX CONTROL VENOUS 6F-12F

Facility

$945.00

Service Code	HCPCS C1760
Hospital Revenue Code	272
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$916.65
Rate for Payer: AlohaCare Medicaid	$472.50
Rate for Payer: AlohaCare Medicare	$718.20
Rate for Payer: Cash Price	$567.00
Rate for Payer: Devoted Health Medicare	$793.80
Rate for Payer: Hawaii Medical Service Association Medicare	$718.20
Rate for Payer: Hawaii Western Management Group Commercial	$897.75
Rate for Payer: Health Management Network Commercial	$803.25
Rate for Payer: Humana Medicare	$718.20
Rate for Payer: Kaiser Permanente Commercial	$850.50
Rate for Payer: Kaiser Permanente Medicaid	$481.95
Rate for Payer: Kaiser Permanente Medicare	$718.20
Rate for Payer: MDX Hawaii PPO	$916.65
Rate for Payer: Ohana Health Plan Medicaid	$718.20
Rate for Payer: Ohana Health Plan Medicare	$718.20
Rate for Payer: UnitedHealthcare Medicare	$718.20
Rate for Payer: University Health Alliance Commercial	$688.81

MYOCARDIAL BIOPSY FORCEPS

Facility

$2,299.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,149.50
Max. Negotiated Rate	$2,230.03
Rate for Payer: AlohaCare Medicaid	$1,149.50
Rate for Payer: AlohaCare Medicare	$1,747.24
Rate for Payer: Cash Price	$1,379.40
Rate for Payer: Devoted Health Medicare	$1,931.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,747.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,184.05
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Humana Medicare	$1,747.24
Rate for Payer: Kaiser Permanente Commercial	$2,069.10
Rate for Payer: Kaiser Permanente Medicaid	$1,172.49
Rate for Payer: Kaiser Permanente Medicare	$1,747.24
Rate for Payer: MDX Hawaii PPO	$2,230.03
Rate for Payer: Ohana Health Plan Medicaid	$1,747.24
Rate for Payer: Ohana Health Plan Medicare	$1,747.24
Rate for Payer: UnitedHealthcare Medicare	$1,747.24
Rate for Payer: University Health Alliance Commercial	$1,675.74

MYOCARDIAL BIOPSY FORCEPS

Facility

$2,299.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,954.15
Max. Negotiated Rate	$2,230.03
Rate for Payer: Cash Price	$1,379.40
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$2,069.10
Rate for Payer: MDX Hawaii PPO	$2,230.03

MYOSURE POLYP RMVL SIMPLIFIED

Facility

$2,085.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,772.25
Max. Negotiated Rate	$2,022.45
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: MDX Hawaii PPO	$2,022.45

MYOSURE POLYP RMVL SIMPLIFIED

Facility

$2,085.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,042.50
Max. Negotiated Rate	$2,022.45
Rate for Payer: AlohaCare Medicaid	$1,042.50
Rate for Payer: AlohaCare Medicare	$1,584.60
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Devoted Health Medicare	$1,751.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,584.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,980.75
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Humana Medicare	$1,584.60
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: Kaiser Permanente Medicaid	$1,063.35
Rate for Payer: Kaiser Permanente Medicare	$1,584.60
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: Ohana Health Plan Medicaid	$1,584.60
Rate for Payer: Ohana Health Plan Medicare	$1,584.60
Rate for Payer: UnitedHealthcare Medicare	$1,584.60
Rate for Payer: University Health Alliance Commercial	$1,519.76

MYOSURE TISSUE REMOVAL SIMPLIF

Facility

$2,590.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$2,201.50
Max. Negotiated Rate	$2,512.30
Rate for Payer: Cash Price	$1,554.00
Rate for Payer: Health Management Network Commercial	$2,201.50
Rate for Payer: Kaiser Permanente Commercial	$2,331.00
Rate for Payer: MDX Hawaii PPO	$2,512.30

MYOSURE TISSUE REMOVAL SIMPLIF

Facility

$2,590.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,295.00
Max. Negotiated Rate	$2,512.30
Rate for Payer: AlohaCare Medicaid	$1,295.00
Rate for Payer: AlohaCare Medicare	$1,968.40
Rate for Payer: Cash Price	$1,554.00
Rate for Payer: Devoted Health Medicare	$2,175.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,968.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,460.50
Rate for Payer: Health Management Network Commercial	$2,201.50
Rate for Payer: Humana Medicare	$1,968.40
Rate for Payer: Kaiser Permanente Commercial	$2,331.00
Rate for Payer: Kaiser Permanente Medicaid	$1,320.90
Rate for Payer: Kaiser Permanente Medicare	$1,968.40
Rate for Payer: MDX Hawaii PPO	$2,512.30
Rate for Payer: Ohana Health Plan Medicaid	$1,968.40
Rate for Payer: Ohana Health Plan Medicare	$1,968.40
Rate for Payer: UnitedHealthcare Medicare	$1,968.40
Rate for Payer: University Health Alliance Commercial	$1,887.85

MYRIAD MATRIX 5X5 SR02LG0505US

Facility

$861.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$731.85
Max. Negotiated Rate	$835.17
Rate for Payer: Cash Price	$516.60
Rate for Payer: Health Management Network Commercial	$731.85
Rate for Payer: Kaiser Permanente Commercial	$774.90
Rate for Payer: MDX Hawaii PPO	$835.17

MYRIAD MATRIX 5X5 SR02LG0505US

Facility

$861.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$430.50
Max. Negotiated Rate	$835.17
Rate for Payer: AlohaCare Medicaid	$430.50
Rate for Payer: AlohaCare Medicare	$654.36
Rate for Payer: Cash Price	$516.60
Rate for Payer: Devoted Health Medicare	$723.24
Rate for Payer: Hawaii Medical Service Association Medicare	$654.36
Rate for Payer: Hawaii Western Management Group Commercial	$817.95
Rate for Payer: Health Management Network Commercial	$731.85
Rate for Payer: Humana Medicare	$654.36
Rate for Payer: Kaiser Permanente Commercial	$774.90
Rate for Payer: Kaiser Permanente Medicaid	$439.11
Rate for Payer: Kaiser Permanente Medicare	$654.36
Rate for Payer: MDX Hawaii PPO	$835.17
Rate for Payer: Ohana Health Plan Medicaid	$654.36
Rate for Payer: Ohana Health Plan Medicare	$654.36
Rate for Payer: UnitedHealthcare Medicaid	$516.60
Rate for Payer: UnitedHealthcare Medicare	$654.36
Rate for Payer: University Health Alliance Commercial	$627.58

MYRIAD MATRIX SR02LG1010US

Facility

$2,756.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$1,378.00
Max. Negotiated Rate	$2,673.32
Rate for Payer: AlohaCare Medicaid	$1,378.00
Rate for Payer: AlohaCare Medicare	$2,094.56
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$2,315.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,094.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,618.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$2,094.56
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: Kaiser Permanente Medicaid	$1,405.56
Rate for Payer: Kaiser Permanente Medicare	$2,094.56
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$2,094.56
Rate for Payer: Ohana Health Plan Medicare	$2,094.56
Rate for Payer: UnitedHealthcare Medicaid	$1,653.60
Rate for Payer: UnitedHealthcare Medicare	$2,094.56
Rate for Payer: University Health Alliance Commercial	$2,008.85

MYRIAD MATRIX SR02LG1010US

Facility

$2,756.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: MDX Hawaii PPO	$2,673.32

MYRIAD MATRIX SR02LG2020US

Facility

$7,350.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$3,675.00
Max. Negotiated Rate	$7,129.50
Rate for Payer: AlohaCare Medicaid	$3,675.00
Rate for Payer: AlohaCare Medicare	$5,586.00
Rate for Payer: Cash Price	$4,410.00
Rate for Payer: Devoted Health Medicare	$6,174.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,586.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,982.50
Rate for Payer: Health Management Network Commercial	$6,247.50
Rate for Payer: Humana Medicare	$5,586.00
Rate for Payer: Kaiser Permanente Commercial	$6,615.00
Rate for Payer: Kaiser Permanente Medicaid	$3,748.50
Rate for Payer: Kaiser Permanente Medicare	$5,586.00
Rate for Payer: MDX Hawaii PPO	$7,129.50
Rate for Payer: Ohana Health Plan Medicaid	$5,586.00
Rate for Payer: Ohana Health Plan Medicare	$5,586.00
Rate for Payer: UnitedHealthcare Medicaid	$4,410.00
Rate for Payer: UnitedHealthcare Medicare	$5,586.00
Rate for Payer: University Health Alliance Commercial	$5,357.41

MYRIAD MATRIX SR02LG2020US

Facility

$7,350.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$6,247.50
Max. Negotiated Rate	$7,129.50
Rate for Payer: Cash Price	$4,410.00
Rate for Payer: Health Management Network Commercial	$6,247.50
Rate for Payer: Kaiser Permanente Commercial	$6,615.00
Rate for Payer: MDX Hawaii PPO	$7,129.50

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 60687030295
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

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 00904707007
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

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 60687030225
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

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 00904707007
Hospital Revenue Code	637
Min. Negotiated Rate	$6.50
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: Devoted Health Medicare	$10.92
Rate for Payer: Hawaii Medical Service Association Medicare	$9.88
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 Medicare	$9.88
Rate for Payer: University Health Alliance Commercial	$9.48

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 60687030225
Hospital Revenue Code	637
Min. Negotiated Rate	$6.50
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: Devoted Health Medicare	$10.92
Rate for Payer: Hawaii Medical Service Association Medicare	$9.88
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 Medicare	$9.88
Rate for Payer: University Health Alliance Commercial	$9.48

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 60687030295
Hospital Revenue Code	637
Min. Negotiated Rate	$6.50
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: Devoted Health Medicare	$10.92
Rate for Payer: Hawaii Medical Service Association Medicare	$9.88
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 Medicare	$9.88
Rate for Payer: University Health Alliance Commercial	$9.48

Know your out-of-pocket cost for care.

All Charges