Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

REMEDY STEM EXT SZ 100 RSK100

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 FEMORAL SZL RSKFLG

Facility

$8,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,400.00
Max. Negotiated Rate	$8,536.00
Rate for Payer: AlohaCare Medicaid	$4,400.00
Rate for Payer: AlohaCare Medicare	$6,688.00
Rate for Payer: Cash Price	$5,280.00
Rate for Payer: Devoted Health Medicare	$7,392.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,688.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,160.00
Rate for Payer: Health Management Network Commercial	$7,480.00
Rate for Payer: Humana Medicare	$6,688.00
Rate for Payer: Kaiser Permanente Commercial	$7,920.00
Rate for Payer: Kaiser Permanente Medicaid	$4,488.00
Rate for Payer: Kaiser Permanente Medicare	$6,688.00
Rate for Payer: MDX Hawaii PPO	$8,536.00
Rate for Payer: Ohana Health Plan Medicaid	$6,688.00
Rate for Payer: Ohana Health Plan Medicare	$6,688.00
Rate for Payer: UnitedHealthcare Medicare	$6,688.00
Rate for Payer: University Health Alliance Commercial	$4,928.00

REMEDY STEM FEMORAL SZL RSKFLG

Facility

$8,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,928.00
Max. Negotiated Rate	$8,536.00
Rate for Payer: Cash Price	$5,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,160.00
Rate for Payer: Health Management Network Commercial	$7,480.00
Rate for Payer: Kaiser Permanente Commercial	$7,920.00
Rate for Payer: MDX Hawaii PPO	$8,536.00
Rate for Payer: University Health Alliance Commercial	$4,928.00

REMEDY STEM TIBIAL SZ L RSKTLG

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,760.00
Max. Negotiated Rate	$8,245.00
Rate for Payer: Cash Price	$5,100.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,950.00
Rate for Payer: Health Management Network Commercial	$7,225.00
Rate for Payer: Kaiser Permanente Commercial	$7,650.00
Rate for Payer: MDX Hawaii PPO	$8,245.00
Rate for Payer: University Health Alliance Commercial	$4,760.00

REMEDY STEM TIBIAL SZ L RSKTLG

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,250.00
Max. Negotiated Rate	$8,245.00
Rate for Payer: AlohaCare Medicaid	$4,250.00
Rate for Payer: AlohaCare Medicare	$6,460.00
Rate for Payer: Cash Price	$5,100.00
Rate for Payer: Devoted Health Medicare	$7,140.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,460.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,950.00
Rate for Payer: Health Management Network Commercial	$7,225.00
Rate for Payer: Humana Medicare	$6,460.00
Rate for Payer: Kaiser Permanente Commercial	$7,650.00
Rate for Payer: Kaiser Permanente Medicaid	$4,335.00
Rate for Payer: Kaiser Permanente Medicare	$6,460.00
Rate for Payer: MDX Hawaii PPO	$8,245.00
Rate for Payer: Ohana Health Plan Medicaid	$6,460.00
Rate for Payer: Ohana Health Plan Medicare	$6,460.00
Rate for Payer: UnitedHealthcare Medicare	$6,460.00
Rate for Payer: University Health Alliance Commercial	$4,760.00

REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]

Facility

$243.00

Service Code	NDC 72078003500
Hospital Revenue Code	250
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: MDX Hawaii PPO	$235.71

REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]

Facility

$221.00

Service Code	NDC 00143939201
Hospital Revenue Code	250
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$214.37

REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]

Facility

$243.00

Service Code	NDC 72078003502
Hospital Revenue Code	250
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: MDX Hawaii PPO	$235.71

REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]

Facility

$221.00

Service Code	NDC 00143939210
Hospital Revenue Code	250
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$214.37

REMIFENTANIL HCL 2 MG/2ML IV (WET SOLR VIAL) [43018400]

Facility

$243.00

Service Code	NDC 72078003500
Hospital Revenue Code	250
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: MDX Hawaii PPO	$235.71

REMIFENTANIL HCL 2 MG/2ML IV (WET SOLR VIAL) [43018400]

Facility

$221.00

Service Code	NDC 00143939210
Hospital Revenue Code	250
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$214.37

REMIFENTANIL HCL 2 MG/2ML IV (WET SOLR VIAL) [43018400]

Facility

$243.00

Service Code	NDC 72078003502
Hospital Revenue Code	250
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: MDX Hawaii PPO	$235.71

REMIFENTANIL HCL 2 MG/2ML IV (WET SOLR VIAL) [43018400]

Facility

$221.00

Service Code	NDC 00143939201
Hospital Revenue Code	250
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$214.37

REMOVAL DEVICE POLYP

Facility

$324.00

Hospital Revenue Code	272
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$314.28
Rate for Payer: AlohaCare Medicaid	$162.00
Rate for Payer: AlohaCare Medicare	$246.24
Rate for Payer: Cash Price	$194.40
Rate for Payer: Devoted Health Medicare	$272.16
Rate for Payer: Hawaii Medical Service Association Medicare	$246.24
Rate for Payer: Hawaii Western Management Group Commercial	$307.80
Rate for Payer: Health Management Network Commercial	$275.40
Rate for Payer: Humana Medicare	$246.24
Rate for Payer: Kaiser Permanente Commercial	$291.60
Rate for Payer: Kaiser Permanente Medicaid	$165.24
Rate for Payer: Kaiser Permanente Medicare	$246.24
Rate for Payer: MDX Hawaii PPO	$314.28
Rate for Payer: Ohana Health Plan Medicaid	$246.24
Rate for Payer: Ohana Health Plan Medicare	$246.24
Rate for Payer: UnitedHealthcare Medicare	$246.24
Rate for Payer: University Health Alliance Commercial	$236.16

REMOVAL DEVICE POLYP

Facility

$324.00

Hospital Revenue Code	272
Min. Negotiated Rate	$275.40
Max. Negotiated Rate	$314.28
Rate for Payer: Cash Price	$194.40
Rate for Payer: Health Management Network Commercial	$275.40
Rate for Payer: Kaiser Permanente Commercial	$291.60
Rate for Payer: MDX Hawaii PPO	$314.28

RENAL FAILURE WITH CC

Facility

$30,006.73

Service Code	MSDRG 683
Min. Negotiated Rate	$30,006.73
Max. Negotiated Rate	$30,006.73
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73

RENAL FAILURE WITH MCC

Facility

$30,006.73

Service Code	MSDRG 682
Min. Negotiated Rate	$30,006.73
Max. Negotiated Rate	$30,006.73
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73

RENAL FAILURE WITHOUT CC/MCC

Facility

$30,006.73

Service Code	MSDRG 684
Min. Negotiated Rate	$30,006.73
Max. Negotiated Rate	$30,006.73
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73

RENEGADE HI-FLO 20X135

Facility

$1,009.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$857.65
Max. Negotiated Rate	$978.73
Rate for Payer: Cash Price	$605.40
Rate for Payer: Health Management Network Commercial	$857.65
Rate for Payer: Kaiser Permanente Commercial	$908.10
Rate for Payer: MDX Hawaii PPO	$978.73

RENEGADE HI-FLO 20X135

Facility

$1,009.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$504.50
Max. Negotiated Rate	$978.73
Rate for Payer: AlohaCare Medicaid	$504.50
Rate for Payer: AlohaCare Medicare	$766.84
Rate for Payer: Cash Price	$605.40
Rate for Payer: Devoted Health Medicare	$847.56
Rate for Payer: Hawaii Medical Service Association Medicare	$766.84
Rate for Payer: Hawaii Western Management Group Commercial	$958.55
Rate for Payer: Health Management Network Commercial	$857.65
Rate for Payer: Humana Medicare	$766.84
Rate for Payer: Kaiser Permanente Commercial	$908.10
Rate for Payer: Kaiser Permanente Medicaid	$514.59
Rate for Payer: Kaiser Permanente Medicare	$766.84
Rate for Payer: MDX Hawaii PPO	$978.73
Rate for Payer: Ohana Health Plan Medicaid	$766.84
Rate for Payer: Ohana Health Plan Medicare	$766.84
Rate for Payer: UnitedHealthcare Medicare	$766.84
Rate for Payer: University Health Alliance Commercial	$735.46

RESERVOIR PROCEDURE SET 04361

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$712.95
Rate for Payer: Cash Price	$441.00
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: MDX Hawaii PPO	$712.95

RESERVOIR PROCEDURE SET 04361

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$712.95
Rate for Payer: AlohaCare Medicaid	$367.50
Rate for Payer: AlohaCare Medicare	$558.60
Rate for Payer: Cash Price	$441.00
Rate for Payer: Devoted Health Medicare	$617.40
Rate for Payer: Hawaii Medical Service Association Medicare	$558.60
Rate for Payer: Hawaii Western Management Group Commercial	$698.25
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Humana Medicare	$558.60
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$374.85
Rate for Payer: Kaiser Permanente Medicare	$558.60
Rate for Payer: MDX Hawaii PPO	$712.95
Rate for Payer: Ohana Health Plan Medicaid	$558.60
Rate for Payer: Ohana Health Plan Medicare	$558.60
Rate for Payer: UnitedHealthcare Medicare	$558.60
Rate for Payer: University Health Alliance Commercial	$535.74

RESONATE HF ICD DR

Facility

$33,982.00

Service Code	HCPCS C1721
Hospital Revenue Code	275
Min. Negotiated Rate	$16,991.00
Max. Negotiated Rate	$32,962.54
Rate for Payer: AlohaCare Medicaid	$16,991.00
Rate for Payer: AlohaCare Medicare	$25,826.32
Rate for Payer: Cash Price	$20,389.20
Rate for Payer: Devoted Health Medicare	$28,544.88
Rate for Payer: Hawaii Medical Service Association Medicare	$25,826.32
Rate for Payer: Hawaii Western Management Group Commercial	$23,787.40
Rate for Payer: Health Management Network Commercial	$28,884.70
Rate for Payer: Humana Medicare	$25,826.32
Rate for Payer: Kaiser Permanente Commercial	$30,583.80
Rate for Payer: Kaiser Permanente Medicaid	$17,330.82
Rate for Payer: Kaiser Permanente Medicare	$25,826.32
Rate for Payer: MDX Hawaii PPO	$32,962.54
Rate for Payer: Ohana Health Plan Medicaid	$25,826.32
Rate for Payer: Ohana Health Plan Medicare	$25,826.32
Rate for Payer: UnitedHealthcare Medicare	$25,826.32
Rate for Payer: University Health Alliance Commercial	$19,029.92

RESONATE HF ICD DR

Facility

$33,982.00

Service Code	HCPCS C1721
Hospital Revenue Code	275
Min. Negotiated Rate	$19,029.92
Max. Negotiated Rate	$32,962.54
Rate for Payer: Cash Price	$20,389.20
Rate for Payer: Hawaii Western Management Group Commercial	$23,787.40
Rate for Payer: Health Management Network Commercial	$28,884.70
Rate for Payer: Kaiser Permanente Commercial	$30,583.80
Rate for Payer: MDX Hawaii PPO	$32,962.54
Rate for Payer: University Health Alliance Commercial	$19,029.92

RESONATE HF ICD VR

Facility

$28,226.00

Service Code	HCPCS C1722
Hospital Revenue Code	275
Min. Negotiated Rate	$15,806.56
Max. Negotiated Rate	$27,379.22
Rate for Payer: Cash Price	$16,935.60
Rate for Payer: Hawaii Western Management Group Commercial	$19,758.20
Rate for Payer: Health Management Network Commercial	$23,992.10
Rate for Payer: Kaiser Permanente Commercial	$25,403.40
Rate for Payer: MDX Hawaii PPO	$27,379.22
Rate for Payer: University Health Alliance Commercial	$15,806.56

Know your out-of-pocket cost for care.

All Charges