Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95811]

Facility

$16.00

Service Code	NDC 00409318910
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95811]

Facility

$34.00

Service Code	NDC 71288071811
Hospital Revenue Code	250
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98

ROD 11MM X 500MM

Facility

$1,713.00

Hospital Revenue Code	278
Min. Negotiated Rate	$959.28
Max. Negotiated Rate	$1,661.61
Rate for Payer: Cash Price	$1,027.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,199.10
Rate for Payer: Health Management Network Commercial	$1,456.05
Rate for Payer: Kaiser Permanente Commercial	$1,541.70
Rate for Payer: MDX Hawaii PPO	$1,661.61
Rate for Payer: University Health Alliance Commercial	$959.28

ROD 11MM X 500MM

Facility

$1,713.00

Hospital Revenue Code	278
Min. Negotiated Rate	$856.50
Max. Negotiated Rate	$1,661.61
Rate for Payer: AlohaCare Medicaid	$856.50
Rate for Payer: AlohaCare Medicare	$1,301.88
Rate for Payer: Cash Price	$1,027.80
Rate for Payer: Devoted Health Medicare	$1,438.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,301.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,199.10
Rate for Payer: Health Management Network Commercial	$1,456.05
Rate for Payer: Humana Medicare	$1,301.88
Rate for Payer: Kaiser Permanente Commercial	$1,541.70
Rate for Payer: Kaiser Permanente Medicaid	$873.63
Rate for Payer: Kaiser Permanente Medicare	$1,301.88
Rate for Payer: MDX Hawaii PPO	$1,661.61
Rate for Payer: Ohana Health Plan Medicaid	$1,301.88
Rate for Payer: Ohana Health Plan Medicare	$1,301.88
Rate for Payer: UnitedHealthcare Medicare	$1,301.88
Rate for Payer: University Health Alliance Commercial	$959.28

ROD 11X450MM 4922-8-450

Facility

$1,502.00

Hospital Revenue Code	272
Min. Negotiated Rate	$751.00
Max. Negotiated Rate	$1,456.94
Rate for Payer: AlohaCare Medicaid	$751.00
Rate for Payer: AlohaCare Medicare	$1,141.52
Rate for Payer: Cash Price	$901.20
Rate for Payer: Devoted Health Medicare	$1,261.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,141.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,426.90
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Humana Medicare	$1,141.52
Rate for Payer: Kaiser Permanente Commercial	$1,351.80
Rate for Payer: Kaiser Permanente Medicaid	$766.02
Rate for Payer: Kaiser Permanente Medicare	$1,141.52
Rate for Payer: MDX Hawaii PPO	$1,456.94
Rate for Payer: Ohana Health Plan Medicaid	$1,141.52
Rate for Payer: Ohana Health Plan Medicare	$1,141.52
Rate for Payer: UnitedHealthcare Medicare	$1,141.52
Rate for Payer: University Health Alliance Commercial	$1,094.81

ROD 11X450MM 4922-8-450

Facility

$1,502.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,276.70
Max. Negotiated Rate	$1,456.94
Rate for Payer: Cash Price	$901.20
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Kaiser Permanente Commercial	$1,351.80
Rate for Payer: MDX Hawaii PPO	$1,456.94

ROD ATTCHMT MULTI PIN 390.003

Facility

$1,617.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$808.50
Max. Negotiated Rate	$1,568.49
Rate for Payer: AlohaCare Medicaid	$808.50
Rate for Payer: AlohaCare Medicare	$1,228.92
Rate for Payer: Cash Price	$970.20
Rate for Payer: Devoted Health Medicare	$1,358.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,228.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.90
Rate for Payer: Health Management Network Commercial	$1,374.45
Rate for Payer: Humana Medicare	$1,228.92
Rate for Payer: Kaiser Permanente Commercial	$1,455.30
Rate for Payer: Kaiser Permanente Medicaid	$824.67
Rate for Payer: Kaiser Permanente Medicare	$1,228.92
Rate for Payer: MDX Hawaii PPO	$1,568.49
Rate for Payer: Ohana Health Plan Medicaid	$1,228.92
Rate for Payer: Ohana Health Plan Medicare	$1,228.92
Rate for Payer: UnitedHealthcare Medicare	$1,228.92
Rate for Payer: University Health Alliance Commercial	$905.52

ROD ATTCHMT MULTI PIN 390.003

Facility

$1,617.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$905.52
Max. Negotiated Rate	$1,568.49
Rate for Payer: Cash Price	$970.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.90
Rate for Payer: Health Management Network Commercial	$1,374.45
Rate for Payer: Kaiser Permanente Commercial	$1,455.30
Rate for Payer: MDX Hawaii PPO	$1,568.49
Rate for Payer: University Health Alliance Commercial	$905.52

ROD CARBON FIBER 8.0M #395.792

Facility

$735.00

Service Code	HCPCS C1713
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

ROD CARBON FIBER 8.0M #395.792

Facility

$735.00

Service Code	HCPCS C1713
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

ROD CONNECTING 4922-8-350

Facility

$1,312.00

Hospital Revenue Code	272
Min. Negotiated Rate	$656.00
Max. Negotiated Rate	$1,272.64
Rate for Payer: AlohaCare Medicaid	$656.00
Rate for Payer: AlohaCare Medicare	$997.12
Rate for Payer: Cash Price	$787.20
Rate for Payer: Devoted Health Medicare	$1,102.08
Rate for Payer: Hawaii Medical Service Association Medicare	$997.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,246.40
Rate for Payer: Health Management Network Commercial	$1,115.20
Rate for Payer: Humana Medicare	$997.12
Rate for Payer: Kaiser Permanente Commercial	$1,180.80
Rate for Payer: Kaiser Permanente Medicaid	$669.12
Rate for Payer: Kaiser Permanente Medicare	$997.12
Rate for Payer: MDX Hawaii PPO	$1,272.64
Rate for Payer: Ohana Health Plan Medicaid	$997.12
Rate for Payer: Ohana Health Plan Medicare	$997.12
Rate for Payer: UnitedHealthcare Medicare	$997.12
Rate for Payer: University Health Alliance Commercial	$956.32

ROD CONNECTING 4922-8-350

Facility

$1,312.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,115.20
Max. Negotiated Rate	$1,272.64
Rate for Payer: Cash Price	$787.20
Rate for Payer: Health Management Network Commercial	$1,115.20
Rate for Payer: Kaiser Permanente Commercial	$1,180.80
Rate for Payer: MDX Hawaii PPO	$1,272.64

ROD EX-FIX 11X150MM 394.82

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$506.00
Max. Negotiated Rate	$981.64
Rate for Payer: AlohaCare Medicaid	$506.00
Rate for Payer: AlohaCare Medicare	$769.12
Rate for Payer: Cash Price	$607.20
Rate for Payer: Devoted Health Medicare	$850.08
Rate for Payer: Hawaii Medical Service Association Medicare	$769.12
Rate for Payer: Hawaii Western Management Group Commercial	$961.40
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: Humana Medicare	$769.12
Rate for Payer: Kaiser Permanente Commercial	$910.80
Rate for Payer: Kaiser Permanente Medicaid	$516.12
Rate for Payer: Kaiser Permanente Medicare	$769.12
Rate for Payer: MDX Hawaii PPO	$981.64
Rate for Payer: Ohana Health Plan Medicaid	$769.12
Rate for Payer: Ohana Health Plan Medicare	$769.12
Rate for Payer: UnitedHealthcare Medicare	$769.12
Rate for Payer: University Health Alliance Commercial	$737.65

ROD EX-FIX 11X150MM 394.82

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$860.20
Max. Negotiated Rate	$981.64
Rate for Payer: Cash Price	$607.20
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: Kaiser Permanente Commercial	$910.80
Rate for Payer: MDX Hawaii PPO	$981.64

ROD EX-FIX 11X200MM 394.83

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$860.20
Max. Negotiated Rate	$981.64
Rate for Payer: Cash Price	$607.20
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: Kaiser Permanente Commercial	$910.80
Rate for Payer: MDX Hawaii PPO	$981.64

ROD EX-FIX 11X200MM 394.83

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$506.00
Max. Negotiated Rate	$981.64
Rate for Payer: AlohaCare Medicaid	$506.00
Rate for Payer: AlohaCare Medicare	$769.12
Rate for Payer: Cash Price	$607.20
Rate for Payer: Devoted Health Medicare	$850.08
Rate for Payer: Hawaii Medical Service Association Medicare	$769.12
Rate for Payer: Hawaii Western Management Group Commercial	$961.40
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: Humana Medicare	$769.12
Rate for Payer: Kaiser Permanente Commercial	$910.80
Rate for Payer: Kaiser Permanente Medicaid	$516.12
Rate for Payer: Kaiser Permanente Medicare	$769.12
Rate for Payer: MDX Hawaii PPO	$981.64
Rate for Payer: Ohana Health Plan Medicaid	$769.12
Rate for Payer: Ohana Health Plan Medicare	$769.12
Rate for Payer: UnitedHealthcare Medicare	$769.12
Rate for Payer: University Health Alliance Commercial	$737.65

ROD EX-FIX 11X250MM 394.84

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$542.50
Max. Negotiated Rate	$1,052.45
Rate for Payer: AlohaCare Medicaid	$542.50
Rate for Payer: AlohaCare Medicare	$824.60
Rate for Payer: Cash Price	$651.00
Rate for Payer: Devoted Health Medicare	$911.40
Rate for Payer: Hawaii Medical Service Association Medicare	$824.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,030.75
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Humana Medicare	$824.60
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: Kaiser Permanente Medicare	$824.60
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: Ohana Health Plan Medicaid	$824.60
Rate for Payer: Ohana Health Plan Medicare	$824.60
Rate for Payer: UnitedHealthcare Medicare	$824.60
Rate for Payer: University Health Alliance Commercial	$790.86

ROD EX-FIX 11X250MM 394.84

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$922.25
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: MDX Hawaii PPO	$1,052.45

ROD EX-FIX 11X300MM 394.85

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$922.25
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: MDX Hawaii PPO	$1,052.45

ROD EX-FIX 11X300MM 394.85

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$542.50
Max. Negotiated Rate	$1,052.45
Rate for Payer: AlohaCare Medicaid	$542.50
Rate for Payer: AlohaCare Medicare	$824.60
Rate for Payer: Cash Price	$651.00
Rate for Payer: Devoted Health Medicare	$911.40
Rate for Payer: Hawaii Medical Service Association Medicare	$824.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,030.75
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Humana Medicare	$824.60
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: Kaiser Permanente Medicare	$824.60
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: Ohana Health Plan Medicaid	$824.60
Rate for Payer: Ohana Health Plan Medicare	$824.60
Rate for Payer: UnitedHealthcare Medicare	$824.60
Rate for Payer: University Health Alliance Commercial	$790.86

ROD EX-FIX 11X350MM 394.86

Facility

$1,085.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$542.50
Max. Negotiated Rate	$1,052.45
Rate for Payer: AlohaCare Medicaid	$542.50
Rate for Payer: AlohaCare Medicare	$824.60
Rate for Payer: Cash Price	$651.00
Rate for Payer: Devoted Health Medicare	$911.40
Rate for Payer: Hawaii Medical Service Association Medicare	$824.60
Rate for Payer: Hawaii Western Management Group Commercial	$759.50
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Humana Medicare	$824.60
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: Kaiser Permanente Medicare	$824.60
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: Ohana Health Plan Medicaid	$824.60
Rate for Payer: Ohana Health Plan Medicare	$824.60
Rate for Payer: UnitedHealthcare Medicare	$824.60
Rate for Payer: University Health Alliance Commercial	$607.60

ROD EX-FIX 11X350MM 394.86

Facility

$1,085.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$607.60
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Hawaii Western Management Group Commercial	$759.50
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: University Health Alliance Commercial	$607.60

ROD EX-FIX 11X400MM 394.87

Facility

$1,191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,012.35
Max. Negotiated Rate	$1,155.27
Rate for Payer: Cash Price	$714.60
Rate for Payer: Health Management Network Commercial	$1,012.35
Rate for Payer: Kaiser Permanente Commercial	$1,071.90
Rate for Payer: MDX Hawaii PPO	$1,155.27

ROD EX-FIX 11X400MM 394.87

Facility

$1,191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$595.50
Max. Negotiated Rate	$1,155.27
Rate for Payer: AlohaCare Medicaid	$595.50
Rate for Payer: AlohaCare Medicare	$905.16
Rate for Payer: Cash Price	$714.60
Rate for Payer: Devoted Health Medicare	$1,000.44
Rate for Payer: Hawaii Medical Service Association Medicare	$905.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.45
Rate for Payer: Health Management Network Commercial	$1,012.35
Rate for Payer: Humana Medicare	$905.16
Rate for Payer: Kaiser Permanente Commercial	$1,071.90
Rate for Payer: Kaiser Permanente Medicaid	$607.41
Rate for Payer: Kaiser Permanente Medicare	$905.16
Rate for Payer: MDX Hawaii PPO	$1,155.27
Rate for Payer: Ohana Health Plan Medicaid	$905.16
Rate for Payer: Ohana Health Plan Medicare	$905.16
Rate for Payer: UnitedHealthcare Medicare	$905.16
Rate for Payer: University Health Alliance Commercial	$868.12

ROD EXTERN FIX CONNECT 200MM

Facility

$1,279.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$716.24
Max. Negotiated Rate	$1,240.63
Rate for Payer: Cash Price	$767.40
Rate for Payer: Hawaii Western Management Group Commercial	$895.30
Rate for Payer: Health Management Network Commercial	$1,087.15
Rate for Payer: Kaiser Permanente Commercial	$1,151.10
Rate for Payer: MDX Hawaii PPO	$1,240.63
Rate for Payer: University Health Alliance Commercial	$716.24

Know your out-of-pocket cost for care.

All Charges