Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]

Facility

$1,829.00

Service Code	HCPCS J2783
Hospital Revenue Code	250
Min. Negotiated Rate	$1,554.65
Max. Negotiated Rate	$1,774.13
Rate for Payer: Cash Price	$1,097.40
Rate for Payer: Health Management Network Commercial	$1,554.65
Rate for Payer: Kaiser Permanente Commercial	$1,646.10
Rate for Payer: MDX Hawaii PPO	$1,774.13

RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]

Facility

$1,829.00

Service Code	HCPCS J2783
Hospital Revenue Code	636
Min. Negotiated Rate	$376.48
Max. Negotiated Rate	$1,774.13
Rate for Payer: AlohaCare Medicaid	$914.50
Rate for Payer: AlohaCare Medicare	$1,390.04
Rate for Payer: Cash Price	$1,097.40
Rate for Payer: Cash Price	$1,097.40
Rate for Payer: Devoted Health Medicare	$1,536.36
Rate for Payer: Hawaii Medical Service Association ABD	$376.48
Rate for Payer: Hawaii Medical Service Association Commercial	$477.74
Rate for Payer: Hawaii Medical Service Association Medicare	$1,390.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$376.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,737.55
Rate for Payer: Health Management Network Commercial	$1,554.65
Rate for Payer: Humana Medicare	$1,390.04
Rate for Payer: Kaiser Permanente Commercial	$1,646.10
Rate for Payer: Kaiser Permanente Medicaid	$932.79
Rate for Payer: Kaiser Permanente Medicare	$1,390.04
Rate for Payer: MDX Hawaii PPO	$1,774.13
Rate for Payer: Ohana Health Plan Medicaid	$1,390.04
Rate for Payer: Ohana Health Plan Medicare	$1,390.04
Rate for Payer: UnitedHealthcare Medicaid	$1,097.40
Rate for Payer: UnitedHealthcare Medicare	$1,390.04
Rate for Payer: University Health Alliance Commercial	$1,333.16

RASBURICASE 7.5 MG/5ML IV (WET SOLR VIAL) [43076868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	250
Min. Negotiated Rate	$6,070.70
Max. Negotiated Rate	$6,927.74
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: Kaiser Permanente Commercial	$6,427.80
Rate for Payer: MDX Hawaii PPO	$6,927.74

RASBURICASE 7.5 MG/5ML IV (WET SOLR VIAL) [43076868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	636
Min. Negotiated Rate	$376.48
Max. Negotiated Rate	$6,927.74
Rate for Payer: AlohaCare Medicaid	$3,571.00
Rate for Payer: AlohaCare Medicare	$5,427.92
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Devoted Health Medicare	$5,999.28
Rate for Payer: Hawaii Medical Service Association ABD	$376.48
Rate for Payer: Hawaii Medical Service Association Commercial	$477.74
Rate for Payer: Hawaii Medical Service Association Medicare	$5,427.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$376.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,784.90
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: Humana Medicare	$5,427.92
Rate for Payer: Kaiser Permanente Commercial	$6,427.80
Rate for Payer: Kaiser Permanente Medicaid	$3,642.42
Rate for Payer: Kaiser Permanente Medicare	$5,427.92
Rate for Payer: MDX Hawaii PPO	$6,927.74
Rate for Payer: Ohana Health Plan Medicaid	$5,427.92
Rate for Payer: Ohana Health Plan Medicare	$5,427.92
Rate for Payer: UnitedHealthcare Medicaid	$4,285.20
Rate for Payer: UnitedHealthcare Medicare	$5,427.92
Rate for Payer: University Health Alliance Commercial	$5,205.80

RASBURICASE 7.5 MG INTRAVENOUS SOLUTION [76868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	250
Min. Negotiated Rate	$6,070.70
Max. Negotiated Rate	$6,927.74
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: Kaiser Permanente Commercial	$6,427.80
Rate for Payer: MDX Hawaii PPO	$6,927.74

RASBURICASE 7.5 MG INTRAVENOUS SOLUTION [76868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	636
Min. Negotiated Rate	$376.48
Max. Negotiated Rate	$6,927.74
Rate for Payer: AlohaCare Medicaid	$3,571.00
Rate for Payer: AlohaCare Medicare	$5,427.92
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Devoted Health Medicare	$5,999.28
Rate for Payer: Hawaii Medical Service Association ABD	$376.48
Rate for Payer: Hawaii Medical Service Association Commercial	$477.74
Rate for Payer: Hawaii Medical Service Association Medicare	$5,427.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$376.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,784.90
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: Humana Medicare	$5,427.92
Rate for Payer: Kaiser Permanente Commercial	$6,427.80
Rate for Payer: Kaiser Permanente Medicaid	$3,642.42
Rate for Payer: Kaiser Permanente Medicare	$5,427.92
Rate for Payer: MDX Hawaii PPO	$6,927.74
Rate for Payer: Ohana Health Plan Medicaid	$5,427.92
Rate for Payer: Ohana Health Plan Medicare	$5,427.92
Rate for Payer: UnitedHealthcare Medicaid	$4,285.20
Rate for Payer: UnitedHealthcare Medicare	$5,427.92
Rate for Payer: University Health Alliance Commercial	$5,205.80

RASP PROXIMAL OSFT-1P

Facility

$1,147.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$573.50
Max. Negotiated Rate	$1,112.59
Rate for Payer: AlohaCare Medicaid	$573.50
Rate for Payer: AlohaCare Medicare	$871.72
Rate for Payer: Cash Price	$688.20
Rate for Payer: Devoted Health Medicare	$963.48
Rate for Payer: Hawaii Medical Service Association Medicare	$871.72
Rate for Payer: Hawaii Western Management Group Commercial	$802.90
Rate for Payer: Health Management Network Commercial	$974.95
Rate for Payer: Humana Medicare	$871.72
Rate for Payer: Kaiser Permanente Commercial	$1,032.30
Rate for Payer: Kaiser Permanente Medicaid	$584.97
Rate for Payer: Kaiser Permanente Medicare	$871.72
Rate for Payer: MDX Hawaii PPO	$1,112.59
Rate for Payer: Ohana Health Plan Medicaid	$871.72
Rate for Payer: Ohana Health Plan Medicare	$871.72
Rate for Payer: UnitedHealthcare Medicare	$871.72
Rate for Payer: University Health Alliance Commercial	$642.32

RASP PROXIMAL OSFT-1P

Facility

$1,147.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$642.32
Max. Negotiated Rate	$1,112.59
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$802.90
Rate for Payer: Health Management Network Commercial	$974.95
Rate for Payer: Kaiser Permanente Commercial	$1,032.30
Rate for Payer: MDX Hawaii PPO	$1,112.59
Rate for Payer: University Health Alliance Commercial	$642.32

REAMER 16MM METATARSL 323-1416

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.00
Max. Negotiated Rate	$2,518.12
Rate for Payer: AlohaCare Medicaid	$1,298.00
Rate for Payer: AlohaCare Medicare	$1,972.96
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Devoted Health Medicare	$2,180.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Humana Medicare	$1,972.96
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: Kaiser Permanente Medicare	$1,972.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: Ohana Health Plan Medicaid	$1,972.96
Rate for Payer: Ohana Health Plan Medicare	$1,972.96
Rate for Payer: UnitedHealthcare Medicare	$1,972.96
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 16MM METATARSL 323-1416

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 16MM PHALANX 323-1516

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 16MM PHALANX 323-1516

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.00
Max. Negotiated Rate	$2,518.12
Rate for Payer: AlohaCare Medicaid	$1,298.00
Rate for Payer: AlohaCare Medicare	$1,972.96
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Devoted Health Medicare	$2,180.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Humana Medicare	$1,972.96
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: Kaiser Permanente Medicare	$1,972.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: Ohana Health Plan Medicaid	$1,972.96
Rate for Payer: Ohana Health Plan Medicare	$1,972.96
Rate for Payer: UnitedHealthcare Medicare	$1,972.96
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 18MM METATARSL 323-1418

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 18MM METATARSL 323-1418

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.00
Max. Negotiated Rate	$2,518.12
Rate for Payer: AlohaCare Medicaid	$1,298.00
Rate for Payer: AlohaCare Medicare	$1,972.96
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Devoted Health Medicare	$2,180.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Humana Medicare	$1,972.96
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: Kaiser Permanente Medicare	$1,972.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: Ohana Health Plan Medicaid	$1,972.96
Rate for Payer: Ohana Health Plan Medicare	$1,972.96
Rate for Payer: UnitedHealthcare Medicare	$1,972.96
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 18MM PHALANX 323-1518

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.00
Max. Negotiated Rate	$2,518.12
Rate for Payer: AlohaCare Medicaid	$1,298.00
Rate for Payer: AlohaCare Medicare	$1,972.96
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Devoted Health Medicare	$2,180.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Humana Medicare	$1,972.96
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: Kaiser Permanente Medicare	$1,972.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: Ohana Health Plan Medicaid	$1,972.96
Rate for Payer: Ohana Health Plan Medicare	$1,972.96
Rate for Payer: UnitedHealthcare Medicare	$1,972.96
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 18MM PHALANX 323-1518

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 20MM METATARSL 323-1420

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.00
Max. Negotiated Rate	$2,518.12
Rate for Payer: AlohaCare Medicaid	$1,298.00
Rate for Payer: AlohaCare Medicare	$1,972.96
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Devoted Health Medicare	$2,180.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Humana Medicare	$1,972.96
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: Kaiser Permanente Medicare	$1,972.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: Ohana Health Plan Medicaid	$1,972.96
Rate for Payer: Ohana Health Plan Medicare	$1,972.96
Rate for Payer: UnitedHealthcare Medicare	$1,972.96
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 20MM METATARSL 323-1420

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 20MM PHALANX 323-1520

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 20MM PHALANX 323-1520

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.00
Max. Negotiated Rate	$2,518.12
Rate for Payer: AlohaCare Medicaid	$1,298.00
Rate for Payer: AlohaCare Medicare	$1,972.96
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Devoted Health Medicare	$2,180.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Humana Medicare	$1,972.96
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: Kaiser Permanente Medicare	$1,972.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: Ohana Health Plan Medicaid	$1,972.96
Rate for Payer: Ohana Health Plan Medicare	$1,972.96
Rate for Payer: UnitedHealthcare Medicare	$1,972.96
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 22MM METATARSL 323-1422

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.00
Max. Negotiated Rate	$2,518.12
Rate for Payer: AlohaCare Medicaid	$1,298.00
Rate for Payer: AlohaCare Medicare	$1,972.96
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Devoted Health Medicare	$2,180.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Humana Medicare	$1,972.96
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: Kaiser Permanente Medicare	$1,972.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: Ohana Health Plan Medicaid	$1,972.96
Rate for Payer: Ohana Health Plan Medicare	$1,972.96
Rate for Payer: UnitedHealthcare Medicare	$1,972.96
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 22MM METATARSL 323-1422

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER 22MM PHALANX 323-1522

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.00
Max. Negotiated Rate	$2,518.12
Rate for Payer: AlohaCare Medicaid	$1,298.00
Rate for Payer: AlohaCare Medicare	$1,972.96
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Devoted Health Medicare	$2,180.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Humana Medicare	$1,972.96
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: Kaiser Permanente Medicare	$1,972.96
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: Ohana Health Plan Medicaid	$1,972.96
Rate for Payer: Ohana Health Plan Medicare	$1,972.96
Rate for Payer: UnitedHealthcare Medicare	$1,972.96
Rate for Payer: University Health Alliance Commercial	$1,892.22

REAMER 22MM PHALANX 323-1522

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.60
Max. Negotiated Rate	$2,518.12
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: MDX Hawaii PPO	$2,518.12

REAMER CANNULATED 2.7MM 117066

Facility

$3,240.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,620.00
Max. Negotiated Rate	$3,142.80
Rate for Payer: AlohaCare Medicaid	$1,620.00
Rate for Payer: AlohaCare Medicare	$2,462.40
Rate for Payer: Cash Price	$1,944.00
Rate for Payer: Devoted Health Medicare	$2,721.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,462.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,078.00
Rate for Payer: Health Management Network Commercial	$2,754.00
Rate for Payer: Humana Medicare	$2,462.40
Rate for Payer: Kaiser Permanente Commercial	$2,916.00
Rate for Payer: Kaiser Permanente Medicaid	$1,652.40
Rate for Payer: Kaiser Permanente Medicare	$2,462.40
Rate for Payer: MDX Hawaii PPO	$3,142.80
Rate for Payer: Ohana Health Plan Medicaid	$2,462.40
Rate for Payer: Ohana Health Plan Medicare	$2,462.40
Rate for Payer: UnitedHealthcare Medicare	$2,462.40
Rate for Payer: University Health Alliance Commercial	$2,361.64

Know your out-of-pocket cost for care.

All Charges