Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

COMPOSITE SYRINGE 3GM 7211199

Facility

$217.00

Hospital Revenue Code	272
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$210.49
Rate for Payer: AlohaCare Medicaid	$108.50
Rate for Payer: AlohaCare Medicare	$164.92
Rate for Payer: Cash Price	$130.20
Rate for Payer: Devoted Health Medicare	$182.28
Rate for Payer: Hawaii Medical Service Association Medicare	$164.92
Rate for Payer: Hawaii Western Management Group Commercial	$206.15
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Humana Medicare	$164.92
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: Kaiser Permanente Medicaid	$110.67
Rate for Payer: Kaiser Permanente Medicare	$164.92
Rate for Payer: MDX Hawaii PPO	$210.49
Rate for Payer: Ohana Health Plan Medicaid	$164.92
Rate for Payer: Ohana Health Plan Medicare	$164.92
Rate for Payer: UnitedHealthcare Medicare	$164.92
Rate for Payer: University Health Alliance Commercial	$158.17

COMPOSITE SYRINGE 3GM 7211318

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

COMPOSITE SYRINGE 3GM 7211318

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$171.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$189.00
Rate for Payer: Hawaii Medical Service Association Medicare	$171.00
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$171.00
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$171.00
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$171.00
Rate for Payer: Ohana Health Plan Medicare	$171.00
Rate for Payer: UnitedHealthcare Medicare	$171.00
Rate for Payer: University Health Alliance Commercial	$164.00

COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL [5851]

Facility

$55.00

Service Code	NDC 30316000000
Hospital Revenue Code	637
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$53.35
Rate for Payer: AlohaCare Medicaid	$27.50
Rate for Payer: AlohaCare Medicare	$41.80
Rate for Payer: Cash Price	$33.00
Rate for Payer: Devoted Health Medicare	$46.20
Rate for Payer: Hawaii Medical Service Association Medicare	$41.80
Rate for Payer: Hawaii Western Management Group Commercial	$52.25
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Humana Medicare	$41.80
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: Kaiser Permanente Medicaid	$28.05
Rate for Payer: Kaiser Permanente Medicare	$41.80
Rate for Payer: MDX Hawaii PPO	$53.35
Rate for Payer: Ohana Health Plan Medicaid	$41.80
Rate for Payer: Ohana Health Plan Medicare	$41.80
Rate for Payer: UnitedHealthcare Medicare	$41.80
Rate for Payer: University Health Alliance Commercial	$40.09

COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL [5851]

Facility

$55.00

Service Code	NDC 30316000000
Hospital Revenue Code	250
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: MDX Hawaii PPO	$53.35

COMPOUNDING VEHICLE SYRUP NO.23 [5852]

Facility

$77.00

Service Code	NDC 30416000000
Hospital Revenue Code	250
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

COMPOUNDING VEHICLE SYRUP NO.23 [5852]

Facility

$77.00

Service Code	NDC 30416000000
Hospital Revenue Code	637
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$74.69
Rate for Payer: AlohaCare Medicaid	$38.50
Rate for Payer: AlohaCare Medicare	$58.52
Rate for Payer: Cash Price	$46.20
Rate for Payer: Devoted Health Medicare	$64.68
Rate for Payer: Hawaii Medical Service Association Medicare	$58.52
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Humana Medicare	$58.52
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: Kaiser Permanente Medicare	$58.52
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: Ohana Health Plan Medicaid	$58.52
Rate for Payer: Ohana Health Plan Medicare	$58.52
Rate for Payer: UnitedHealthcare Medicare	$58.52
Rate for Payer: University Health Alliance Commercial	$56.13

COMPR SCD FOOT CUFF LG

Facility

$90.00

Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$68.40
Rate for Payer: Cash Price	$54.00
Rate for Payer: Devoted Health Medicare	$75.60
Rate for Payer: Hawaii Medical Service Association Medicare	$68.40
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$68.40
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$68.40
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$68.40
Rate for Payer: Ohana Health Plan Medicare	$68.40
Rate for Payer: UnitedHealthcare Medicare	$68.40
Rate for Payer: University Health Alliance Commercial	$65.60

COMPR SCD FOOT CUFF LG

Facility

$90.00

Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

COMPR SCD FOOT CUFF REG

Facility

$94.00

Hospital Revenue Code	271
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$91.18
Rate for Payer: AlohaCare Medicaid	$47.00
Rate for Payer: AlohaCare Medicare	$71.44
Rate for Payer: Cash Price	$56.40
Rate for Payer: Devoted Health Medicare	$78.96
Rate for Payer: Hawaii Medical Service Association Medicare	$71.44
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Humana Medicare	$71.44
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: Kaiser Permanente Medicare	$71.44
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: Ohana Health Plan Medicaid	$71.44
Rate for Payer: Ohana Health Plan Medicare	$71.44
Rate for Payer: UnitedHealthcare Medicare	$71.44
Rate for Payer: University Health Alliance Commercial	$68.52

COMPR SCD FOOT CUFF REG

Facility

$94.00

Hospital Revenue Code	271
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: MDX Hawaii PPO	$91.18

COMP RVS TRAY CO 44MM #115370

Facility

$1,845.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$922.50
Max. Negotiated Rate	$1,789.65
Rate for Payer: AlohaCare Medicaid	$922.50
Rate for Payer: AlohaCare Medicare	$1,402.20
Rate for Payer: Cash Price	$1,107.00
Rate for Payer: Devoted Health Medicare	$1,549.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,402.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,291.50
Rate for Payer: Health Management Network Commercial	$1,568.25
Rate for Payer: Humana Medicare	$1,402.20
Rate for Payer: Kaiser Permanente Commercial	$1,660.50
Rate for Payer: Kaiser Permanente Medicaid	$940.95
Rate for Payer: Kaiser Permanente Medicare	$1,402.20
Rate for Payer: MDX Hawaii PPO	$1,789.65
Rate for Payer: Ohana Health Plan Medicaid	$1,402.20
Rate for Payer: Ohana Health Plan Medicare	$1,402.20
Rate for Payer: UnitedHealthcare Medicare	$1,402.20
Rate for Payer: University Health Alliance Commercial	$1,033.20

COMP RVS TRAY CO 44MM #115370

Facility

$1,845.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,033.20
Max. Negotiated Rate	$1,789.65
Rate for Payer: Cash Price	$1,107.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,291.50
Rate for Payer: Health Management Network Commercial	$1,568.25
Rate for Payer: Kaiser Permanente Commercial	$1,660.50
Rate for Payer: MDX Hawaii PPO	$1,789.65
Rate for Payer: University Health Alliance Commercial	$1,033.20

COMP WIRE MEDIUM 824299104

Facility

$280.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$271.60
Rate for Payer: AlohaCare Medicaid	$140.00
Rate for Payer: AlohaCare Medicare	$212.80
Rate for Payer: Cash Price	$168.00
Rate for Payer: Devoted Health Medicare	$235.20
Rate for Payer: Hawaii Medical Service Association Medicare	$212.80
Rate for Payer: Hawaii Western Management Group Commercial	$266.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Humana Medicare	$212.80
Rate for Payer: Kaiser Permanente Commercial	$252.00
Rate for Payer: Kaiser Permanente Medicaid	$142.80
Rate for Payer: Kaiser Permanente Medicare	$212.80
Rate for Payer: MDX Hawaii PPO	$271.60
Rate for Payer: Ohana Health Plan Medicaid	$212.80
Rate for Payer: Ohana Health Plan Medicare	$212.80
Rate for Payer: UnitedHealthcare Medicare	$212.80
Rate for Payer: University Health Alliance Commercial	$204.09

COMP WIRE MEDIUM 824299104

Facility

$280.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$238.00
Max. Negotiated Rate	$271.60
Rate for Payer: Cash Price	$168.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Kaiser Permanente Commercial	$252.00
Rate for Payer: MDX Hawaii PPO	$271.60

CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES

Facility

$127,540.46

Service Code	MSDRG 212
Min. Negotiated Rate	$127,540.46
Max. Negotiated Rate	$127,540.46
Rate for Payer: Hawaii Medical Service Association Commercial	$127,540.46

CONCUSSION WITH CC

Facility

$22,493.20

Service Code	MSDRG 089
Min. Negotiated Rate	$22,493.20
Max. Negotiated Rate	$22,493.20
Rate for Payer: Hawaii Medical Service Association Commercial	$22,493.20

CONCUSSION WITH MCC

Facility

$22,493.20

Service Code	MSDRG 088
Min. Negotiated Rate	$22,493.20
Max. Negotiated Rate	$22,493.20
Rate for Payer: Hawaii Medical Service Association Commercial	$22,493.20

CONCUSSION WITHOUT CC/MCC

Facility

$16,781.02

Service Code	MSDRG 090
Min. Negotiated Rate	$16,781.02
Max. Negotiated Rate	$16,781.02
Rate for Payer: Hawaii Medical Service Association Commercial	$16,781.02

CONDITIONER CAVITY 6GM 3337058

Facility

$251.00

Hospital Revenue Code	272
Min. Negotiated Rate	$125.50
Max. Negotiated Rate	$243.47
Rate for Payer: AlohaCare Medicaid	$125.50
Rate for Payer: AlohaCare Medicare	$190.76
Rate for Payer: Cash Price	$150.60
Rate for Payer: Devoted Health Medicare	$210.84
Rate for Payer: Hawaii Medical Service Association Medicare	$190.76
Rate for Payer: Hawaii Western Management Group Commercial	$238.45
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Humana Medicare	$190.76
Rate for Payer: Kaiser Permanente Commercial	$225.90
Rate for Payer: Kaiser Permanente Medicaid	$128.01
Rate for Payer: Kaiser Permanente Medicare	$190.76
Rate for Payer: MDX Hawaii PPO	$243.47
Rate for Payer: Ohana Health Plan Medicaid	$190.76
Rate for Payer: Ohana Health Plan Medicare	$190.76
Rate for Payer: UnitedHealthcare Medicare	$190.76
Rate for Payer: University Health Alliance Commercial	$182.95

CONDITIONER CAVITY 6GM 3337058

Facility

$251.00

Hospital Revenue Code	272
Min. Negotiated Rate	$213.35
Max. Negotiated Rate	$243.47
Rate for Payer: Cash Price	$150.60
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Kaiser Permanente Commercial	$225.90
Rate for Payer: MDX Hawaii PPO	$243.47

CONE AUGMENT 5549-A-110

Facility

$10,933.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,122.48
Max. Negotiated Rate	$10,605.01
Rate for Payer: Cash Price	$6,559.80
Rate for Payer: Hawaii Western Management Group Commercial	$7,653.10
Rate for Payer: Health Management Network Commercial	$9,293.05
Rate for Payer: Kaiser Permanente Commercial	$9,839.70
Rate for Payer: MDX Hawaii PPO	$10,605.01
Rate for Payer: University Health Alliance Commercial	$6,122.48

CONE AUGMENT 5549-A-110

Facility

$10,933.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,466.50
Max. Negotiated Rate	$10,605.01
Rate for Payer: AlohaCare Medicaid	$5,466.50
Rate for Payer: AlohaCare Medicare	$8,309.08
Rate for Payer: Cash Price	$6,559.80
Rate for Payer: Devoted Health Medicare	$9,183.72
Rate for Payer: Hawaii Medical Service Association Medicare	$8,309.08
Rate for Payer: Hawaii Western Management Group Commercial	$7,653.10
Rate for Payer: Health Management Network Commercial	$9,293.05
Rate for Payer: Humana Medicare	$8,309.08
Rate for Payer: Kaiser Permanente Commercial	$9,839.70
Rate for Payer: Kaiser Permanente Medicaid	$5,575.83
Rate for Payer: Kaiser Permanente Medicare	$8,309.08
Rate for Payer: MDX Hawaii PPO	$10,605.01
Rate for Payer: Ohana Health Plan Medicaid	$8,309.08
Rate for Payer: Ohana Health Plan Medicare	$8,309.08
Rate for Payer: UnitedHealthcare Medicare	$8,309.08
Rate for Payer: University Health Alliance Commercial	$6,122.48

CONICAL BURR 9.5MM #358.682

Facility

$1,628.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,383.80
Max. Negotiated Rate	$1,579.16
Rate for Payer: Cash Price	$976.80
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: Kaiser Permanente Commercial	$1,465.20
Rate for Payer: MDX Hawaii PPO	$1,579.16

CONICAL BURR 9.5MM #358.682

Facility

$1,628.00

Hospital Revenue Code	272
Min. Negotiated Rate	$814.00
Max. Negotiated Rate	$1,579.16
Rate for Payer: AlohaCare Medicaid	$814.00
Rate for Payer: AlohaCare Medicare	$1,237.28
Rate for Payer: Cash Price	$976.80
Rate for Payer: Devoted Health Medicare	$1,367.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,237.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,546.60
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: Humana Medicare	$1,237.28
Rate for Payer: Kaiser Permanente Commercial	$1,465.20
Rate for Payer: Kaiser Permanente Medicaid	$830.28
Rate for Payer: Kaiser Permanente Medicare	$1,237.28
Rate for Payer: MDX Hawaii PPO	$1,579.16
Rate for Payer: Ohana Health Plan Medicaid	$1,237.28
Rate for Payer: Ohana Health Plan Medicare	$1,237.28
Rate for Payer: UnitedHealthcare Medicare	$1,237.28
Rate for Payer: University Health Alliance Commercial	$1,186.65

Know your out-of-pocket cost for care.

All Charges