Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$16,638.80

Service Code	MSDRG 812
Min. Negotiated Rate	$16,638.80
Max. Negotiated Rate	$16,638.80
Rate for Payer: Hawaii Medical Service Association Commercial	$16,638.80

REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]

Facility

$451.00

Service Code	HCPCS J2785
Hospital Revenue Code	250
Min. Negotiated Rate	$383.35
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$270.60
Rate for Payer: Cash Price	$278.40
Rate for Payer: Health Management Network Commercial	$394.40
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: Kaiser Permanente Commercial	$417.60
Rate for Payer: MDX Hawaii PPO	$437.47
Rate for Payer: MDX Hawaii PPO	$450.08

REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]

Facility

$464.00

Service Code	HCPCS J2785
Hospital Revenue Code	636
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$450.08
Rate for Payer: AlohaCare Medicaid	$232.00
Rate for Payer: AlohaCare Medicaid	$225.50
Rate for Payer: AlohaCare Medicare	$342.76
Rate for Payer: AlohaCare Medicare	$352.64
Rate for Payer: Cash Price	$270.60
Rate for Payer: Cash Price	$270.60
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cash Price	$278.40
Rate for Payer: Devoted Health Medicare	$378.84
Rate for Payer: Devoted Health Medicare	$389.76
Rate for Payer: Hawaii Medical Service Association ABD	$2.89
Rate for Payer: Hawaii Medical Service Association ABD	$2.89
Rate for Payer: Hawaii Medical Service Association Medicare	$342.76
Rate for Payer: Hawaii Medical Service Association Medicare	$352.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.89
Rate for Payer: Hawaii Western Management Group Commercial	$428.45
Rate for Payer: Hawaii Western Management Group Commercial	$440.80
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Health Management Network Commercial	$394.40
Rate for Payer: Humana Medicare	$342.76
Rate for Payer: Humana Medicare	$352.64
Rate for Payer: Kaiser Permanente Commercial	$417.60
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: Kaiser Permanente Medicaid	$230.01
Rate for Payer: Kaiser Permanente Medicaid	$236.64
Rate for Payer: Kaiser Permanente Medicare	$342.76
Rate for Payer: Kaiser Permanente Medicare	$352.64
Rate for Payer: MDX Hawaii PPO	$437.47
Rate for Payer: MDX Hawaii PPO	$450.08
Rate for Payer: Ohana Health Plan Medicaid	$352.64
Rate for Payer: Ohana Health Plan Medicaid	$342.76
Rate for Payer: Ohana Health Plan Medicare	$342.76
Rate for Payer: Ohana Health Plan Medicare	$352.64
Rate for Payer: UnitedHealthcare Medicaid	$270.60
Rate for Payer: UnitedHealthcare Medicaid	$278.40
Rate for Payer: UnitedHealthcare Medicare	$352.64
Rate for Payer: UnitedHealthcare Medicare	$342.76
Rate for Payer: University Health Alliance Commercial	$328.73
Rate for Payer: University Health Alliance Commercial	$338.21

REHABILITATION WITH CC/MCC

Facility

$9,765.22

Service Code	MSDRG 945
Min. Negotiated Rate	$9,765.22
Max. Negotiated Rate	$9,765.22
Rate for Payer: Hawaii Medical Service Association Commercial	$9,765.22

REHABILITATION WITHOUT CC/MCC

Facility

$9,765.22

Service Code	MSDRG 946
Min. Negotiated Rate	$9,765.22
Max. Negotiated Rate	$9,765.22
Rate for Payer: Hawaii Medical Service Association Commercial	$9,765.22

RELIANCE 4 FRONT COIL 64CM

Facility

$6,208.00

Service Code	HCPCS C1895
Hospital Revenue Code	278
Min. Negotiated Rate	$3,476.48
Max. Negotiated Rate	$6,021.76
Rate for Payer: Cash Price	$3,724.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,345.60
Rate for Payer: Health Management Network Commercial	$5,276.80
Rate for Payer: Kaiser Permanente Commercial	$5,587.20
Rate for Payer: MDX Hawaii PPO	$6,021.76
Rate for Payer: University Health Alliance Commercial	$3,476.48

RELIANCE 4 FRONT COIL 64CM

Facility

$6,208.00

Service Code	HCPCS C1895
Hospital Revenue Code	278
Min. Negotiated Rate	$3,104.00
Max. Negotiated Rate	$6,021.76
Rate for Payer: AlohaCare Medicaid	$3,104.00
Rate for Payer: AlohaCare Medicare	$4,718.08
Rate for Payer: Cash Price	$3,724.80
Rate for Payer: Devoted Health Medicare	$5,214.72
Rate for Payer: Hawaii Medical Service Association Medicare	$4,718.08
Rate for Payer: Hawaii Western Management Group Commercial	$4,345.60
Rate for Payer: Health Management Network Commercial	$5,276.80
Rate for Payer: Humana Medicare	$4,718.08
Rate for Payer: Kaiser Permanente Commercial	$5,587.20
Rate for Payer: Kaiser Permanente Medicaid	$3,166.08
Rate for Payer: Kaiser Permanente Medicare	$4,718.08
Rate for Payer: MDX Hawaii PPO	$6,021.76
Rate for Payer: Ohana Health Plan Medicaid	$4,718.08
Rate for Payer: Ohana Health Plan Medicare	$4,718.08
Rate for Payer: UnitedHealthcare Medicare	$4,718.08
Rate for Payer: University Health Alliance Commercial	$3,476.48

RELIANCE LEAD 59CM

Facility

$6,208.00

Service Code	HCPCS C1777
Hospital Revenue Code	278
Min. Negotiated Rate	$3,104.00
Max. Negotiated Rate	$6,021.76
Rate for Payer: AlohaCare Medicaid	$3,104.00
Rate for Payer: AlohaCare Medicare	$4,718.08
Rate for Payer: Cash Price	$3,724.80
Rate for Payer: Devoted Health Medicare	$5,214.72
Rate for Payer: Hawaii Medical Service Association Medicare	$4,718.08
Rate for Payer: Hawaii Western Management Group Commercial	$4,345.60
Rate for Payer: Health Management Network Commercial	$5,276.80
Rate for Payer: Humana Medicare	$4,718.08
Rate for Payer: Kaiser Permanente Commercial	$5,587.20
Rate for Payer: Kaiser Permanente Medicaid	$3,166.08
Rate for Payer: Kaiser Permanente Medicare	$4,718.08
Rate for Payer: MDX Hawaii PPO	$6,021.76
Rate for Payer: Ohana Health Plan Medicaid	$4,718.08
Rate for Payer: Ohana Health Plan Medicare	$4,718.08
Rate for Payer: UnitedHealthcare Medicare	$4,718.08
Rate for Payer: University Health Alliance Commercial	$3,476.48

RELIANCE LEAD 59CM

Facility

$6,208.00

Service Code	HCPCS C1777
Hospital Revenue Code	278
Min. Negotiated Rate	$3,476.48
Max. Negotiated Rate	$6,021.76
Rate for Payer: Cash Price	$3,724.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,345.60
Rate for Payer: Health Management Network Commercial	$5,276.80
Rate for Payer: Kaiser Permanente Commercial	$5,587.20
Rate for Payer: MDX Hawaii PPO	$6,021.76
Rate for Payer: University Health Alliance Commercial	$3,476.48

RELIANCE LEAD 64CM

Facility

$6,208.00

Service Code	HCPCS C1777
Hospital Revenue Code	278
Min. Negotiated Rate	$3,104.00
Max. Negotiated Rate	$6,021.76
Rate for Payer: AlohaCare Medicaid	$3,104.00
Rate for Payer: AlohaCare Medicare	$4,718.08
Rate for Payer: Cash Price	$3,724.80
Rate for Payer: Devoted Health Medicare	$5,214.72
Rate for Payer: Hawaii Medical Service Association Medicare	$4,718.08
Rate for Payer: Hawaii Western Management Group Commercial	$4,345.60
Rate for Payer: Health Management Network Commercial	$5,276.80
Rate for Payer: Humana Medicare	$4,718.08
Rate for Payer: Kaiser Permanente Commercial	$5,587.20
Rate for Payer: Kaiser Permanente Medicaid	$3,166.08
Rate for Payer: Kaiser Permanente Medicare	$4,718.08
Rate for Payer: MDX Hawaii PPO	$6,021.76
Rate for Payer: Ohana Health Plan Medicaid	$4,718.08
Rate for Payer: Ohana Health Plan Medicare	$4,718.08
Rate for Payer: UnitedHealthcare Medicare	$4,718.08
Rate for Payer: University Health Alliance Commercial	$3,476.48

RELIANCE LEAD 64CM

Facility

$6,208.00

Service Code	HCPCS C1777
Hospital Revenue Code	278
Min. Negotiated Rate	$3,476.48
Max. Negotiated Rate	$6,021.76
Rate for Payer: Cash Price	$3,724.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,345.60
Rate for Payer: Health Management Network Commercial	$5,276.80
Rate for Payer: Kaiser Permanente Commercial	$5,587.20
Rate for Payer: MDX Hawaii PPO	$6,021.76
Rate for Payer: University Health Alliance Commercial	$3,476.48

RELIANT STENT GRAFT BLN CATH

Facility

$1,558.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$1,324.30
Max. Negotiated Rate	$1,511.26
Rate for Payer: Cash Price	$934.80
Rate for Payer: Health Management Network Commercial	$1,324.30
Rate for Payer: Kaiser Permanente Commercial	$1,402.20
Rate for Payer: MDX Hawaii PPO	$1,511.26

RELIANT STENT GRAFT BLN CATH

Facility

$1,558.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$779.00
Max. Negotiated Rate	$1,511.26
Rate for Payer: AlohaCare Medicaid	$779.00
Rate for Payer: AlohaCare Medicare	$1,184.08
Rate for Payer: Cash Price	$934.80
Rate for Payer: Devoted Health Medicare	$1,308.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,184.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,480.10
Rate for Payer: Health Management Network Commercial	$1,324.30
Rate for Payer: Humana Medicare	$1,184.08
Rate for Payer: Kaiser Permanente Commercial	$1,402.20
Rate for Payer: Kaiser Permanente Medicaid	$794.58
Rate for Payer: Kaiser Permanente Medicare	$1,184.08
Rate for Payer: MDX Hawaii PPO	$1,511.26
Rate for Payer: Ohana Health Plan Medicaid	$1,184.08
Rate for Payer: Ohana Health Plan Medicare	$1,184.08
Rate for Payer: UnitedHealthcare Medicare	$1,184.08
Rate for Payer: University Health Alliance Commercial	$1,135.63

RELOAD 5MM JR-REL25-2.0-12

Facility

$1,278.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,086.30
Max. Negotiated Rate	$1,239.66
Rate for Payer: Cash Price	$766.80
Rate for Payer: Health Management Network Commercial	$1,086.30
Rate for Payer: Kaiser Permanente Commercial	$1,150.20
Rate for Payer: MDX Hawaii PPO	$1,239.66

RELOAD 5MM JR-REL25-2.0-12

Facility

$1,278.00

Hospital Revenue Code	272
Min. Negotiated Rate	$639.00
Max. Negotiated Rate	$1,239.66
Rate for Payer: AlohaCare Medicaid	$639.00
Rate for Payer: AlohaCare Medicare	$971.28
Rate for Payer: Cash Price	$766.80
Rate for Payer: Devoted Health Medicare	$1,073.52
Rate for Payer: Hawaii Medical Service Association Medicare	$971.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,214.10
Rate for Payer: Health Management Network Commercial	$1,086.30
Rate for Payer: Humana Medicare	$971.28
Rate for Payer: Kaiser Permanente Commercial	$1,150.20
Rate for Payer: Kaiser Permanente Medicaid	$651.78
Rate for Payer: Kaiser Permanente Medicare	$971.28
Rate for Payer: MDX Hawaii PPO	$1,239.66
Rate for Payer: Ohana Health Plan Medicaid	$971.28
Rate for Payer: Ohana Health Plan Medicare	$971.28
Rate for Payer: UnitedHealthcare Medicare	$971.28
Rate for Payer: University Health Alliance Commercial	$931.53

RELOAD SUREFORM 8MM BLU 48230B

Facility

$788.00

Hospital Revenue Code	278
Min. Negotiated Rate	$441.28
Max. Negotiated Rate	$764.36
Rate for Payer: Cash Price	$472.80
Rate for Payer: Hawaii Western Management Group Commercial	$551.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: University Health Alliance Commercial	$441.28

RELOAD SUREFORM 8MM BLU 48230B

Facility

$788.00

Hospital Revenue Code	278
Min. Negotiated Rate	$394.00
Max. Negotiated Rate	$764.36
Rate for Payer: AlohaCare Medicaid	$394.00
Rate for Payer: AlohaCare Medicare	$598.88
Rate for Payer: Cash Price	$472.80
Rate for Payer: Devoted Health Medicare	$661.92
Rate for Payer: Hawaii Medical Service Association Medicare	$598.88
Rate for Payer: Hawaii Western Management Group Commercial	$551.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Humana Medicare	$598.88
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: Kaiser Permanente Medicaid	$401.88
Rate for Payer: Kaiser Permanente Medicare	$598.88
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: Ohana Health Plan Medicaid	$598.88
Rate for Payer: Ohana Health Plan Medicare	$598.88
Rate for Payer: UnitedHealthcare Medicare	$598.88
Rate for Payer: University Health Alliance Commercial	$441.28

RELOAD SUREFORM 8MM WHT 48230W

Facility

$788.00

Hospital Revenue Code	278
Min. Negotiated Rate	$394.00
Max. Negotiated Rate	$764.36
Rate for Payer: AlohaCare Medicaid	$394.00
Rate for Payer: AlohaCare Medicare	$598.88
Rate for Payer: Cash Price	$472.80
Rate for Payer: Devoted Health Medicare	$661.92
Rate for Payer: Hawaii Medical Service Association Medicare	$598.88
Rate for Payer: Hawaii Western Management Group Commercial	$551.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Humana Medicare	$598.88
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: Kaiser Permanente Medicaid	$401.88
Rate for Payer: Kaiser Permanente Medicare	$598.88
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: Ohana Health Plan Medicaid	$598.88
Rate for Payer: Ohana Health Plan Medicare	$598.88
Rate for Payer: UnitedHealthcare Medicare	$598.88
Rate for Payer: University Health Alliance Commercial	$441.28

RELOAD SUREFORM 8MM WHT 48230W

Facility

$788.00

Hospital Revenue Code	278
Min. Negotiated Rate	$441.28
Max. Negotiated Rate	$764.36
Rate for Payer: Cash Price	$472.80
Rate for Payer: Hawaii Western Management Group Commercial	$551.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: University Health Alliance Commercial	$441.28

REMDESIVIR 100 MG/20ML IV (WET SOLR VIAL) [430400829]

Facility

$1,260.00

Service Code	NDC 61958290102
Hospital Revenue Code	250
Min. Negotiated Rate	$1,071.00
Max. Negotiated Rate	$1,222.20
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cash Price	$703.20
Rate for Payer: Health Management Network Commercial	$996.20
Rate for Payer: Health Management Network Commercial	$1,071.00
Rate for Payer: Kaiser Permanente Commercial	$1,134.00
Rate for Payer: Kaiser Permanente Commercial	$1,054.80
Rate for Payer: MDX Hawaii PPO	$1,222.20
Rate for Payer: MDX Hawaii PPO	$1,136.84

REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [400829]

Facility

$1,172.00

Service Code	HCPCS J0248
Hospital Revenue Code	636
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$1,136.84
Rate for Payer: AlohaCare Medicaid	$586.00
Rate for Payer: AlohaCare Medicare	$890.72
Rate for Payer: Cash Price	$703.20
Rate for Payer: Cash Price	$703.20
Rate for Payer: Devoted Health Medicare	$984.48
Rate for Payer: Hawaii Medical Service Association ABD	$6.73
Rate for Payer: Hawaii Medical Service Association Commercial	$8.62
Rate for Payer: Hawaii Medical Service Association Medicare	$890.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.73
Rate for Payer: Hawaii Western Management Group Commercial	$1,113.40
Rate for Payer: Health Management Network Commercial	$996.20
Rate for Payer: Humana Medicare	$890.72
Rate for Payer: Kaiser Permanente Commercial	$1,054.80
Rate for Payer: Kaiser Permanente Medicaid	$597.72
Rate for Payer: Kaiser Permanente Medicare	$890.72
Rate for Payer: MDX Hawaii PPO	$1,136.84
Rate for Payer: Ohana Health Plan Medicaid	$890.72
Rate for Payer: Ohana Health Plan Medicare	$890.72
Rate for Payer: UnitedHealthcare Medicaid	$703.20
Rate for Payer: UnitedHealthcare Medicare	$890.72
Rate for Payer: University Health Alliance Commercial	$854.27

REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [400829]

Facility

$1,172.00

Service Code	HCPCS J0248
Hospital Revenue Code	250
Min. Negotiated Rate	$996.20
Max. Negotiated Rate	$1,136.84
Rate for Payer: Cash Price	$703.20
Rate for Payer: Health Management Network Commercial	$996.20
Rate for Payer: Kaiser Permanente Commercial	$1,054.80
Rate for Payer: MDX Hawaii PPO	$1,136.84

REMEDY STEM EST SZ 175 RSK175

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

REMEDY STEM EST SZ 175 RSK175

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

REMEDY STEM EXT SZ 100 RSK100

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

Know your out-of-pocket cost for care.

All Charges