Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

RADIAL RELOAD MEDIUM THICK

Facility

$1,302.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$781.20
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94

RADIAL RELOAD MEDIUM THICK

Facility

$1,302.00

Hospital Revenue Code	272
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$989.52
Rate for Payer: Cash Price	$781.20
Rate for Payer: Devoted Health Medicare	$1,093.68
Rate for Payer: Hawaii Medical Service Association Medicare	$989.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,236.90
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$989.52
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$989.52
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$989.52
Rate for Payer: Ohana Health Plan Medicare	$989.52
Rate for Payer: UnitedHealthcare Medicare	$989.52
Rate for Payer: University Health Alliance Commercial	$949.03

RADIOGRAPHIC CHARMS 10MM

Facility

$122.00

Hospital Revenue Code	272
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$73.20
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

RADIOGRAPHIC CHARMS 10MM

Facility

$122.00

Hospital Revenue Code	272
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$92.72
Rate for Payer: Cash Price	$73.20
Rate for Payer: Devoted Health Medicare	$102.48
Rate for Payer: Hawaii Medical Service Association Medicare	$92.72
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$92.72
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$92.72
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$92.72
Rate for Payer: Ohana Health Plan Medicare	$92.72
Rate for Payer: UnitedHealthcare Medicare	$92.72
Rate for Payer: University Health Alliance Commercial	$88.93

RADIOTHERAPY

Facility

$17,373.57

Service Code	MSDRG 849
Min. Negotiated Rate	$17,373.57
Max. Negotiated Rate	$17,373.57
Rate for Payer: Hawaii Medical Service Association Commercial	$17,373.57

RALOXIFENE 60 MG TABLET [22143]

Facility

$22.00

Service Code	NDC 65862070930
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$21.34

RALOXIFENE 60 MG TABLET [22143]

Facility

$22.00

Service Code	NDC 65862070930
Hospital Revenue Code	637
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$21.34
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicare	$16.72
Rate for Payer: Cash Price	$13.20
Rate for Payer: Devoted Health Medicare	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$16.72
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$16.72
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$16.72
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: Ohana Health Plan Medicaid	$16.72
Rate for Payer: Ohana Health Plan Medicare	$16.72
Rate for Payer: UnitedHealthcare Medicare	$16.72
Rate for Payer: University Health Alliance Commercial	$16.04

RALOXIFENE 60 MG TABLET [22143]

Facility

$22.00

Service Code	NDC 43598050530
Hospital Revenue Code	637
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$21.34
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicare	$16.72
Rate for Payer: Cash Price	$13.20
Rate for Payer: Devoted Health Medicare	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$16.72
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$16.72
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$16.72
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: Ohana Health Plan Medicaid	$16.72
Rate for Payer: Ohana Health Plan Medicare	$16.72
Rate for Payer: UnitedHealthcare Medicare	$16.72
Rate for Payer: University Health Alliance Commercial	$16.04

RALOXIFENE 60 MG TABLET [22143]

Facility

$22.00

Service Code	NDC 43598050530
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$21.34

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [125686]

Facility

$13,508.00

Service Code	HCPCS J9308
Hospital Revenue Code	636
Min. Negotiated Rate	$74.45
Max. Negotiated Rate	$13,102.76
Rate for Payer: AlohaCare Medicaid	$6,754.00
Rate for Payer: AlohaCare Medicaid	$1,351.00
Rate for Payer: AlohaCare Medicare	$2,053.52
Rate for Payer: AlohaCare Medicare	$10,266.08
Rate for Payer: Cash Price	$1,621.20
Rate for Payer: Cash Price	$8,104.80
Rate for Payer: Cash Price	$8,104.80
Rate for Payer: Cash Price	$1,621.20
Rate for Payer: Devoted Health Medicare	$2,269.68
Rate for Payer: Devoted Health Medicare	$11,346.72
Rate for Payer: Hawaii Medical Service Association ABD	$74.45
Rate for Payer: Hawaii Medical Service Association ABD	$74.45
Rate for Payer: Hawaii Medical Service Association Commercial	$94.34
Rate for Payer: Hawaii Medical Service Association Commercial	$94.34
Rate for Payer: Hawaii Medical Service Association Medicare	$10,266.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,053.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$74.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$74.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,566.90
Rate for Payer: Hawaii Western Management Group Commercial	$12,832.60
Rate for Payer: Health Management Network Commercial	$2,296.70
Rate for Payer: Health Management Network Commercial	$11,481.80
Rate for Payer: Humana Medicare	$2,053.52
Rate for Payer: Humana Medicare	$10,266.08
Rate for Payer: Kaiser Permanente Commercial	$12,157.20
Rate for Payer: Kaiser Permanente Commercial	$2,431.80
Rate for Payer: Kaiser Permanente Medicaid	$1,378.02
Rate for Payer: Kaiser Permanente Medicaid	$6,889.08
Rate for Payer: Kaiser Permanente Medicare	$10,266.08
Rate for Payer: Kaiser Permanente Medicare	$2,053.52
Rate for Payer: MDX Hawaii PPO	$13,102.76
Rate for Payer: MDX Hawaii PPO	$2,620.94
Rate for Payer: Ohana Health Plan Medicaid	$10,266.08
Rate for Payer: Ohana Health Plan Medicaid	$2,053.52
Rate for Payer: Ohana Health Plan Medicare	$2,053.52
Rate for Payer: Ohana Health Plan Medicare	$10,266.08
Rate for Payer: UnitedHealthcare Medicaid	$1,621.20
Rate for Payer: UnitedHealthcare Medicaid	$8,104.80
Rate for Payer: UnitedHealthcare Medicare	$2,053.52
Rate for Payer: UnitedHealthcare Medicare	$10,266.08
Rate for Payer: University Health Alliance Commercial	$9,845.98
Rate for Payer: University Health Alliance Commercial	$1,969.49

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [125686]

Facility

$2,702.00

Service Code	HCPCS J9308
Hospital Revenue Code	250
Min. Negotiated Rate	$2,296.70
Max. Negotiated Rate	$2,620.94
Rate for Payer: Cash Price	$1,621.20
Rate for Payer: Cash Price	$8,104.80
Rate for Payer: Health Management Network Commercial	$2,296.70
Rate for Payer: Health Management Network Commercial	$11,481.80
Rate for Payer: Kaiser Permanente Commercial	$12,157.20
Rate for Payer: Kaiser Permanente Commercial	$2,431.80
Rate for Payer: MDX Hawaii PPO	$13,102.76
Rate for Payer: MDX Hawaii PPO	$2,620.94

RANGER DCB 4X100X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 4X100X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$2,584.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$2,856.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,584.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$2,584.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$2,584.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$2,584.00
Rate for Payer: Ohana Health Plan Medicare	$2,584.00
Rate for Payer: UnitedHealthcare Medicare	$2,584.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 4X150X150

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 4X150X150

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$2,584.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$2,856.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,584.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$2,584.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$2,584.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$2,584.00
Rate for Payer: Ohana Health Plan Medicare	$2,584.00
Rate for Payer: UnitedHealthcare Medicare	$2,584.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 4X40X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 4X40X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$2,584.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$2,856.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,584.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$2,584.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$2,584.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$2,584.00
Rate for Payer: Ohana Health Plan Medicare	$2,584.00
Rate for Payer: UnitedHealthcare Medicare	$2,584.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 4X60X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 4X60X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$2,584.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$2,856.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,584.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$2,584.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$2,584.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$2,584.00
Rate for Payer: Ohana Health Plan Medicare	$2,584.00
Rate for Payer: UnitedHealthcare Medicare	$2,584.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 5X100X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 5X100X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$2,584.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$2,856.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,584.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$2,584.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$2,584.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$2,584.00
Rate for Payer: Ohana Health Plan Medicare	$2,584.00
Rate for Payer: UnitedHealthcare Medicare	$2,584.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 5X120X150

Facility

$3,590.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,795.00
Max. Negotiated Rate	$3,482.30
Rate for Payer: AlohaCare Medicaid	$1,795.00
Rate for Payer: AlohaCare Medicare	$2,728.40
Rate for Payer: Cash Price	$2,154.00
Rate for Payer: Devoted Health Medicare	$3,015.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,728.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,410.50
Rate for Payer: Health Management Network Commercial	$3,051.50
Rate for Payer: Humana Medicare	$2,728.40
Rate for Payer: Kaiser Permanente Commercial	$3,231.00
Rate for Payer: Kaiser Permanente Medicaid	$1,830.90
Rate for Payer: Kaiser Permanente Medicare	$2,728.40
Rate for Payer: MDX Hawaii PPO	$3,482.30
Rate for Payer: Ohana Health Plan Medicaid	$2,728.40
Rate for Payer: Ohana Health Plan Medicare	$2,728.40
Rate for Payer: UnitedHealthcare Medicare	$2,728.40
Rate for Payer: University Health Alliance Commercial	$2,616.75

RANGER DCB 5X120X150

Facility

$3,590.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$3,051.50
Max. Negotiated Rate	$3,482.30
Rate for Payer: Cash Price	$2,154.00
Rate for Payer: Health Management Network Commercial	$3,051.50
Rate for Payer: Kaiser Permanente Commercial	$3,231.00
Rate for Payer: MDX Hawaii PPO	$3,482.30

RANGER DCB 5X150X150

Facility

$3,700.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$3,589.00
Rate for Payer: Cash Price	$2,220.00
Rate for Payer: Health Management Network Commercial	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$3,330.00
Rate for Payer: MDX Hawaii PPO	$3,589.00

RANGER DCB 5X150X150

Facility

$3,700.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,850.00
Max. Negotiated Rate	$3,589.00
Rate for Payer: AlohaCare Medicaid	$1,850.00
Rate for Payer: AlohaCare Medicare	$2,812.00
Rate for Payer: Cash Price	$2,220.00
Rate for Payer: Devoted Health Medicare	$3,108.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,812.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,515.00
Rate for Payer: Health Management Network Commercial	$3,145.00
Rate for Payer: Humana Medicare	$2,812.00
Rate for Payer: Kaiser Permanente Commercial	$3,330.00
Rate for Payer: Kaiser Permanente Medicaid	$1,887.00
Rate for Payer: Kaiser Permanente Medicare	$2,812.00
Rate for Payer: MDX Hawaii PPO	$3,589.00
Rate for Payer: Ohana Health Plan Medicaid	$2,812.00
Rate for Payer: Ohana Health Plan Medicare	$2,812.00
Rate for Payer: UnitedHealthcare Medicare	$2,812.00
Rate for Payer: University Health Alliance Commercial	$2,696.93

Know your out-of-pocket cost for care.

All Charges