Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

COLLAR CERVICAL INF PED1

Facility

$134.00

Service Code	HCPCS L0172
Hospital Revenue Code	274
Min. Negotiated Rate	$67.00
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$67.00
Rate for Payer: AlohaCare Medicare	$101.84
Rate for Payer: Cash Price	$80.40
Rate for Payer: Cash Price	$80.40
Rate for Payer: Devoted Health Medicare	$112.56
Rate for Payer: Hawaii Medical Service Association Medicare	$101.84
Rate for Payer: Hawaii Western Management Group Commercial	$93.80
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$101.84
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$101.84
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$101.84
Rate for Payer: Ohana Health Plan Medicare	$101.84
Rate for Payer: UnitedHealthcare Medicaid	$78.38
Rate for Payer: UnitedHealthcare Medicare	$101.84
Rate for Payer: University Health Alliance Commercial	$75.04

COLLAR CERVICAL INF REG PED2

Facility

$136.00

Service Code	HCPCS L0172
Hospital Revenue Code	274
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$103.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Devoted Health Medicare	$114.24
Rate for Payer: Hawaii Medical Service Association Medicare	$103.36
Rate for Payer: Hawaii Western Management Group Commercial	$95.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$103.36
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$103.36
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$103.36
Rate for Payer: Ohana Health Plan Medicare	$103.36
Rate for Payer: UnitedHealthcare Medicaid	$78.38
Rate for Payer: UnitedHealthcare Medicare	$103.36
Rate for Payer: University Health Alliance Commercial	$76.16

COLLAR CERVICAL INF REG PED2

Facility

$136.00

Service Code	HCPCS L0172
Hospital Revenue Code	274
Min. Negotiated Rate	$76.16
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Hawaii Western Management Group Commercial	$95.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: University Health Alliance Commercial	$76.16

COLLAR MIAMI J PEDS

Facility

$188.00

Service Code	HCPCS L0174
Hospital Revenue Code	274
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$211.18
Rate for Payer: AlohaCare Medicaid	$94.00
Rate for Payer: AlohaCare Medicare	$142.88
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Devoted Health Medicare	$157.92
Rate for Payer: Hawaii Medical Service Association Medicare	$142.88
Rate for Payer: Hawaii Western Management Group Commercial	$131.60
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Humana Medicare	$142.88
Rate for Payer: Kaiser Permanente Commercial	$169.20
Rate for Payer: Kaiser Permanente Medicaid	$95.88
Rate for Payer: Kaiser Permanente Medicare	$142.88
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: Ohana Health Plan Medicaid	$142.88
Rate for Payer: Ohana Health Plan Medicare	$142.88
Rate for Payer: UnitedHealthcare Medicaid	$211.18
Rate for Payer: UnitedHealthcare Medicare	$142.88
Rate for Payer: University Health Alliance Commercial	$105.28

COLLAR MIAMI J PEDS

Facility

$188.00

Service Code	HCPCS L0174
Hospital Revenue Code	274
Min. Negotiated Rate	$105.28
Max. Negotiated Rate	$182.36
Rate for Payer: Cash Price	$112.80
Rate for Payer: Hawaii Western Management Group Commercial	$131.60
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Kaiser Permanente Commercial	$169.20
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: University Health Alliance Commercial	$105.28

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$115,594.65

Service Code	MSDRG 429
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC

Facility

$115,594.65

Service Code	MSDRG 430
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

COMPACT VAC MIX SYSTEM

Facility

$998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$848.30
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$598.80
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: Kaiser Permanente Commercial	$898.20
Rate for Payer: MDX Hawaii PPO	$968.06

COMPACT VAC MIX SYSTEM

Facility

$998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$499.00
Max. Negotiated Rate	$968.06
Rate for Payer: AlohaCare Medicaid	$499.00
Rate for Payer: AlohaCare Medicare	$758.48
Rate for Payer: Cash Price	$598.80
Rate for Payer: Devoted Health Medicare	$838.32
Rate for Payer: Hawaii Medical Service Association Medicare	$758.48
Rate for Payer: Hawaii Western Management Group Commercial	$948.10
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: Humana Medicare	$758.48
Rate for Payer: Kaiser Permanente Commercial	$898.20
Rate for Payer: Kaiser Permanente Medicaid	$508.98
Rate for Payer: Kaiser Permanente Medicare	$758.48
Rate for Payer: MDX Hawaii PPO	$968.06
Rate for Payer: Ohana Health Plan Medicaid	$758.48
Rate for Payer: Ohana Health Plan Medicare	$758.48
Rate for Payer: UnitedHealthcare Medicare	$758.48
Rate for Payer: University Health Alliance Commercial	$727.44

COMPLEX AORTIC ARCH PROCEDURES

Facility

$193,360.92

Service Code	MSDRG 209
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

COMPLICATED PEPTIC ULCER WITH CC

Facility

$23,796.81

Service Code	MSDRG 381
Min. Negotiated Rate	$23,796.81
Max. Negotiated Rate	$23,796.81
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81

COMPLICATED PEPTIC ULCER WITH MCC

Facility

$23,796.81

Service Code	MSDRG 380
Min. Negotiated Rate	$23,796.81
Max. Negotiated Rate	$23,796.81
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81

COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$23,796.81

Service Code	MSDRG 382
Min. Negotiated Rate	$23,796.81
Max. Negotiated Rate	$23,796.81
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81

COMPLICATIONS OF TREATMENT WITH CC

Facility

$27,826.15

Service Code	MSDRG 920
Min. Negotiated Rate	$27,826.15
Max. Negotiated Rate	$27,826.15
Rate for Payer: Hawaii Medical Service Association Commercial	$27,826.15

COMPLICATIONS OF TREATMENT WITH MCC

Facility

$27,826.15

Service Code	MSDRG 919
Min. Negotiated Rate	$27,826.15
Max. Negotiated Rate	$27,826.15
Rate for Payer: Hawaii Medical Service Association Commercial	$27,826.15

COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$15,761.83

Service Code	MSDRG 921
Min. Negotiated Rate	$15,761.83
Max. Negotiated Rate	$15,761.83
Rate for Payer: Hawaii Medical Service Association Commercial	$15,761.83

COMPNENT KIT ACCESSRY HERO1003

Facility

$1,120.00

Hospital Revenue Code	272
Min. Negotiated Rate	$952.00
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Kaiser Permanente Commercial	$1,008.00
Rate for Payer: MDX Hawaii PPO	$1,086.40

COMPNENT KIT ACCESSRY HERO1003

Facility

$1,120.00

Hospital Revenue Code	272
Min. Negotiated Rate	$560.00
Max. Negotiated Rate	$1,086.40
Rate for Payer: AlohaCare Medicaid	$560.00
Rate for Payer: AlohaCare Medicare	$851.20
Rate for Payer: Cash Price	$672.00
Rate for Payer: Devoted Health Medicare	$940.80
Rate for Payer: Hawaii Medical Service Association Medicare	$851.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,064.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Humana Medicare	$851.20
Rate for Payer: Kaiser Permanente Commercial	$1,008.00
Rate for Payer: Kaiser Permanente Medicaid	$571.20
Rate for Payer: Kaiser Permanente Medicare	$851.20
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: Ohana Health Plan Medicaid	$851.20
Rate for Payer: Ohana Health Plan Medicare	$851.20
Rate for Payer: UnitedHealthcare Medicare	$851.20
Rate for Payer: University Health Alliance Commercial	$816.37

COMPONENT FEMORAL SIZE 8

Facility

$8,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,704.00
Max. Negotiated Rate	$8,148.00
Rate for Payer: Cash Price	$5,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,880.00
Rate for Payer: Health Management Network Commercial	$7,140.00
Rate for Payer: Kaiser Permanente Commercial	$7,560.00
Rate for Payer: MDX Hawaii PPO	$8,148.00
Rate for Payer: University Health Alliance Commercial	$4,704.00

COMPONENT FEMORAL SIZE 8

Facility

$8,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$8,148.00
Rate for Payer: AlohaCare Medicaid	$4,200.00
Rate for Payer: AlohaCare Medicare	$6,384.00
Rate for Payer: Cash Price	$5,040.00
Rate for Payer: Devoted Health Medicare	$7,056.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,384.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,880.00
Rate for Payer: Health Management Network Commercial	$7,140.00
Rate for Payer: Humana Medicare	$6,384.00
Rate for Payer: Kaiser Permanente Commercial	$7,560.00
Rate for Payer: Kaiser Permanente Medicaid	$4,284.00
Rate for Payer: Kaiser Permanente Medicare	$6,384.00
Rate for Payer: MDX Hawaii PPO	$8,148.00
Rate for Payer: Ohana Health Plan Medicaid	$6,384.00
Rate for Payer: Ohana Health Plan Medicare	$6,384.00
Rate for Payer: UnitedHealthcare Medicare	$6,384.00
Rate for Payer: University Health Alliance Commercial	$4,704.00

COMPONENT TIBIAL SIZE C RT

Facility

$3,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,128.00
Max. Negotiated Rate	$3,686.00
Rate for Payer: Cash Price	$2,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$3,230.00
Rate for Payer: Kaiser Permanente Commercial	$3,420.00
Rate for Payer: MDX Hawaii PPO	$3,686.00
Rate for Payer: University Health Alliance Commercial	$2,128.00

COMPONENT TIBIAL SIZE C RT

Facility

$3,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$3,686.00
Rate for Payer: AlohaCare Medicaid	$1,900.00
Rate for Payer: AlohaCare Medicare	$2,888.00
Rate for Payer: Cash Price	$2,280.00
Rate for Payer: Devoted Health Medicare	$3,192.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,888.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$3,230.00
Rate for Payer: Humana Medicare	$2,888.00
Rate for Payer: Kaiser Permanente Commercial	$3,420.00
Rate for Payer: Kaiser Permanente Medicaid	$1,938.00
Rate for Payer: Kaiser Permanente Medicare	$2,888.00
Rate for Payer: MDX Hawaii PPO	$3,686.00
Rate for Payer: Ohana Health Plan Medicaid	$2,888.00
Rate for Payer: Ohana Health Plan Medicare	$2,888.00
Rate for Payer: UnitedHealthcare Medicare	$2,888.00
Rate for Payer: University Health Alliance Commercial	$2,128.00

COMPOSITE SYRINGE

Facility

$352.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.00
Max. Negotiated Rate	$341.44
Rate for Payer: AlohaCare Medicaid	$176.00
Rate for Payer: AlohaCare Medicare	$267.52
Rate for Payer: Cash Price	$211.20
Rate for Payer: Devoted Health Medicare	$295.68
Rate for Payer: Hawaii Medical Service Association Medicare	$267.52
Rate for Payer: Hawaii Western Management Group Commercial	$334.40
Rate for Payer: Health Management Network Commercial	$299.20
Rate for Payer: Humana Medicare	$267.52
Rate for Payer: Kaiser Permanente Commercial	$316.80
Rate for Payer: Kaiser Permanente Medicaid	$179.52
Rate for Payer: Kaiser Permanente Medicare	$267.52
Rate for Payer: MDX Hawaii PPO	$341.44
Rate for Payer: Ohana Health Plan Medicaid	$267.52
Rate for Payer: Ohana Health Plan Medicare	$267.52
Rate for Payer: UnitedHealthcare Medicare	$267.52
Rate for Payer: University Health Alliance Commercial	$256.57

COMPOSITE SYRINGE

Facility

$352.00

Hospital Revenue Code	272
Min. Negotiated Rate	$299.20
Max. Negotiated Rate	$341.44
Rate for Payer: Cash Price	$211.20
Rate for Payer: Health Management Network Commercial	$299.20
Rate for Payer: Kaiser Permanente Commercial	$316.80
Rate for Payer: MDX Hawaii PPO	$341.44

COMPOSITE SYRINGE 3GM 7211199

Facility

$217.00

Hospital Revenue Code	272
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$130.20
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: MDX Hawaii PPO	$210.49

Know your out-of-pocket cost for care.

All Charges