Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

RANGER DCB 7X200X150

Facility

$4,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$3,740.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: Kaiser Permanente Commercial	$3,960.00
Rate for Payer: MDX Hawaii PPO	$4,268.00

RANGER DCB 7X40X135

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 7X40X135

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 7X60X135

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 7X60X135

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 7X80X135

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 7X80X135

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 IRR FLUID WMG SET 24750

Facility

$209.00

Hospital Revenue Code	272
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$125.40
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: MDX Hawaii PPO	$202.73

RANGER IRR FLUID WMG SET 24750

Facility

$209.00

Hospital Revenue Code	272
Min. Negotiated Rate	$104.50
Max. Negotiated Rate	$202.73
Rate for Payer: AlohaCare Medicaid	$104.50
Rate for Payer: AlohaCare Medicare	$158.84
Rate for Payer: Cash Price	$125.40
Rate for Payer: Devoted Health Medicare	$175.56
Rate for Payer: Hawaii Medical Service Association Medicare	$158.84
Rate for Payer: Hawaii Western Management Group Commercial	$198.55
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Humana Medicare	$158.84
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: Kaiser Permanente Medicaid	$106.59
Rate for Payer: Kaiser Permanente Medicare	$158.84
Rate for Payer: MDX Hawaii PPO	$202.73
Rate for Payer: Ohana Health Plan Medicaid	$158.84
Rate for Payer: Ohana Health Plan Medicare	$158.84
Rate for Payer: UnitedHealthcare Medicare	$158.84
Rate for Payer: University Health Alliance Commercial	$152.34

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$6.00

Service Code	NDC 60687054921
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$21.00

Service Code	NDC 27241012502
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$20.00

Service Code	NDC 67877052560
Hospital Revenue Code	637
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$15.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Devoted Health Medicare	$16.80
Rate for Payer: Hawaii Medical Service Association Medicare	$15.20
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$15.20
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$15.20
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$15.20
Rate for Payer: Ohana Health Plan Medicare	$15.20
Rate for Payer: UnitedHealthcare Medicare	$15.20
Rate for Payer: University Health Alliance Commercial	$14.58

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$6.00

Service Code	NDC 60687054921
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$4.56
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Hawaii Medical Service Association Medicare	$4.56
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$4.56
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$4.56
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$4.56
Rate for Payer: Ohana Health Plan Medicare	$4.56
Rate for Payer: UnitedHealthcare Medicare	$4.56
Rate for Payer: University Health Alliance Commercial	$4.37

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$21.00

Service Code	NDC 27241012502
Hospital Revenue Code	637
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$15.96
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$17.64
Rate for Payer: Hawaii Medical Service Association Medicare	$15.96
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$15.96
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$15.96
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$15.96
Rate for Payer: Ohana Health Plan Medicare	$15.96
Rate for Payer: UnitedHealthcare Medicare	$15.96
Rate for Payer: University Health Alliance Commercial	$15.31

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$20.00

Service Code	NDC 67877052560
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

RAPID STRUT TL LONG 50-10190

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,316.50
Max. Negotiated Rate	$2,554.01
Rate for Payer: AlohaCare Medicaid	$1,316.50
Rate for Payer: AlohaCare Medicare	$2,001.08
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Devoted Health Medicare	$2,211.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2,001.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Humana Medicare	$2,001.08
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: Kaiser Permanente Medicare	$2,001.08
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: Ohana Health Plan Medicaid	$2,001.08
Rate for Payer: Ohana Health Plan Medicare	$2,001.08
Rate for Payer: UnitedHealthcare Medicare	$2,001.08
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL LONG 50-10190

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL LONG 50-10190CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL LONG 50-10190CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,316.50
Max. Negotiated Rate	$2,554.01
Rate for Payer: AlohaCare Medicaid	$1,316.50
Rate for Payer: AlohaCare Medicare	$2,001.08
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Devoted Health Medicare	$2,211.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2,001.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Humana Medicare	$2,001.08
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: Kaiser Permanente Medicare	$2,001.08
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: Ohana Health Plan Medicaid	$2,001.08
Rate for Payer: Ohana Health Plan Medicare	$2,001.08
Rate for Payer: UnitedHealthcare Medicare	$2,001.08
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL MED 50-10180

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,316.50
Max. Negotiated Rate	$2,554.01
Rate for Payer: AlohaCare Medicaid	$1,316.50
Rate for Payer: AlohaCare Medicare	$2,001.08
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Devoted Health Medicare	$2,211.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2,001.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Humana Medicare	$2,001.08
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: Kaiser Permanente Medicare	$2,001.08
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: Ohana Health Plan Medicaid	$2,001.08
Rate for Payer: Ohana Health Plan Medicare	$2,001.08
Rate for Payer: UnitedHealthcare Medicare	$2,001.08
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL MED 50-10180

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL SHORT 50-10170

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL SHORT 50-10170

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,316.50
Max. Negotiated Rate	$2,554.01
Rate for Payer: AlohaCare Medicaid	$1,316.50
Rate for Payer: AlohaCare Medicare	$2,001.08
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Devoted Health Medicare	$2,211.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2,001.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Humana Medicare	$2,001.08
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: Kaiser Permanente Medicare	$2,001.08
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: Ohana Health Plan Medicaid	$2,001.08
Rate for Payer: Ohana Health Plan Medicare	$2,001.08
Rate for Payer: UnitedHealthcare Medicare	$2,001.08
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL SHRT 50-10170CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,316.50
Max. Negotiated Rate	$2,554.01
Rate for Payer: AlohaCare Medicaid	$1,316.50
Rate for Payer: AlohaCare Medicare	$2,001.08
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Devoted Health Medicare	$2,211.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2,001.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Humana Medicare	$2,001.08
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: Kaiser Permanente Medicare	$2,001.08
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: Ohana Health Plan Medicaid	$2,001.08
Rate for Payer: Ohana Health Plan Medicare	$2,001.08
Rate for Payer: UnitedHealthcare Medicare	$2,001.08
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL SHRT 50-10170CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: MDX Hawaii PPO	$2,554.01

Know your out-of-pocket cost for care.

All Charges