Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$90,375.73

Service Code	MSDRG 236
Min. Negotiated Rate	$90,375.73
Max. Negotiated Rate	$90,375.73
Rate for Payer: Hawaii Medical Service Association Commercial	$90,375.73

CORONARY BYPASS WITH PTCA WITH MCC

Facility

$140,505.46

Service Code	MSDRG 231
Min. Negotiated Rate	$140,505.46
Max. Negotiated Rate	$140,505.46
Rate for Payer: Hawaii Medical Service Association Commercial	$140,505.46

CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$140,505.46

Service Code	MSDRG 232
Min. Negotiated Rate	$140,505.46
Max. Negotiated Rate	$140,505.46
Rate for Payer: Hawaii Medical Service Association Commercial	$140,505.46

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$40,483.02

Service Code	MSDRG 323
Min. Negotiated Rate	$40,483.02
Max. Negotiated Rate	$40,483.02
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$40,483.02

Service Code	MSDRG 324
Min. Negotiated Rate	$40,483.02
Max. Negotiated Rate	$40,483.02
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02

CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE

Facility

$38,112.82

Service Code	MSDRG 325
Min. Negotiated Rate	$38,112.82
Max. Negotiated Rate	$38,112.82
Rate for Payer: Hawaii Medical Service Association Commercial	$38,112.82

CORONOID PLATE, RT 131218500

Facility

$2,660.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,330.00
Max. Negotiated Rate	$2,580.20
Rate for Payer: AlohaCare Medicaid	$1,330.00
Rate for Payer: AlohaCare Medicare	$2,021.60
Rate for Payer: Cash Price	$1,596.00
Rate for Payer: Devoted Health Medicare	$2,234.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,862.00
Rate for Payer: Health Management Network Commercial	$2,261.00
Rate for Payer: Humana Medicare	$2,021.60
Rate for Payer: Kaiser Permanente Commercial	$2,394.00
Rate for Payer: Kaiser Permanente Medicaid	$1,356.60
Rate for Payer: Kaiser Permanente Medicare	$2,021.60
Rate for Payer: MDX Hawaii PPO	$2,580.20
Rate for Payer: Ohana Health Plan Medicaid	$2,021.60
Rate for Payer: Ohana Health Plan Medicare	$2,021.60
Rate for Payer: UnitedHealthcare Medicare	$2,021.60
Rate for Payer: University Health Alliance Commercial	$1,489.60

CORONOID PLATE, RT 131218500

Facility

$2,660.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,489.60
Max. Negotiated Rate	$2,580.20
Rate for Payer: Cash Price	$1,596.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,862.00
Rate for Payer: Health Management Network Commercial	$2,261.00
Rate for Payer: Kaiser Permanente Commercial	$2,394.00
Rate for Payer: MDX Hawaii PPO	$2,580.20
Rate for Payer: University Health Alliance Commercial	$1,489.60

CORTILOC GLENOID DWK405LA25S

Facility

$9,960.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,980.00
Max. Negotiated Rate	$9,661.20
Rate for Payer: AlohaCare Medicaid	$4,980.00
Rate for Payer: AlohaCare Medicare	$7,569.60
Rate for Payer: Cash Price	$5,976.00
Rate for Payer: Devoted Health Medicare	$8,366.40
Rate for Payer: Hawaii Medical Service Association Medicare	$7,569.60
Rate for Payer: Hawaii Western Management Group Commercial	$6,972.00
Rate for Payer: Health Management Network Commercial	$8,466.00
Rate for Payer: Humana Medicare	$7,569.60
Rate for Payer: Kaiser Permanente Commercial	$8,964.00
Rate for Payer: Kaiser Permanente Medicaid	$5,079.60
Rate for Payer: Kaiser Permanente Medicare	$7,569.60
Rate for Payer: MDX Hawaii PPO	$9,661.20
Rate for Payer: Ohana Health Plan Medicaid	$7,569.60
Rate for Payer: Ohana Health Plan Medicare	$7,569.60
Rate for Payer: UnitedHealthcare Medicare	$7,569.60
Rate for Payer: University Health Alliance Commercial	$5,577.60

CORTILOC GLENOID DWK405LA25S

Facility

$9,960.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,577.60
Max. Negotiated Rate	$9,661.20
Rate for Payer: Cash Price	$5,976.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,972.00
Rate for Payer: Health Management Network Commercial	$8,466.00
Rate for Payer: Kaiser Permanente Commercial	$8,964.00
Rate for Payer: MDX Hawaii PPO	$9,661.20
Rate for Payer: University Health Alliance Commercial	$5,577.60

CORTILOC PEGGED GLENOID DWE421

Facility

$6,906.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,867.36
Max. Negotiated Rate	$6,698.82
Rate for Payer: Cash Price	$4,143.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,834.20
Rate for Payer: Health Management Network Commercial	$5,870.10
Rate for Payer: Kaiser Permanente Commercial	$6,215.40
Rate for Payer: MDX Hawaii PPO	$6,698.82
Rate for Payer: University Health Alliance Commercial	$3,867.36

CORTILOC PEGGED GLENOID DWE421

Facility

$6,906.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,453.00
Max. Negotiated Rate	$6,698.82
Rate for Payer: AlohaCare Medicaid	$3,453.00
Rate for Payer: AlohaCare Medicare	$5,248.56
Rate for Payer: Cash Price	$4,143.60
Rate for Payer: Devoted Health Medicare	$5,801.04
Rate for Payer: Hawaii Medical Service Association Medicare	$5,248.56
Rate for Payer: Hawaii Western Management Group Commercial	$4,834.20
Rate for Payer: Health Management Network Commercial	$5,870.10
Rate for Payer: Humana Medicare	$5,248.56
Rate for Payer: Kaiser Permanente Commercial	$6,215.40
Rate for Payer: Kaiser Permanente Medicaid	$3,522.06
Rate for Payer: Kaiser Permanente Medicare	$5,248.56
Rate for Payer: MDX Hawaii PPO	$6,698.82
Rate for Payer: Ohana Health Plan Medicaid	$5,248.56
Rate for Payer: Ohana Health Plan Medicare	$5,248.56
Rate for Payer: UnitedHealthcare Medicare	$5,248.56
Rate for Payer: University Health Alliance Commercial	$3,867.36

CORTILOC PEG GLENOID DWE433

Facility

$6,394.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,580.64
Max. Negotiated Rate	$6,202.18
Rate for Payer: Cash Price	$3,836.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,475.80
Rate for Payer: Health Management Network Commercial	$5,434.90
Rate for Payer: Kaiser Permanente Commercial	$5,754.60
Rate for Payer: MDX Hawaii PPO	$6,202.18
Rate for Payer: University Health Alliance Commercial	$3,580.64

CORTILOC PEG GLENOID DWE433

Facility

$6,394.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,197.00
Max. Negotiated Rate	$6,202.18
Rate for Payer: AlohaCare Medicaid	$3,197.00
Rate for Payer: AlohaCare Medicare	$4,859.44
Rate for Payer: Cash Price	$3,836.40
Rate for Payer: Devoted Health Medicare	$5,370.96
Rate for Payer: Hawaii Medical Service Association Medicare	$4,859.44
Rate for Payer: Hawaii Western Management Group Commercial	$4,475.80
Rate for Payer: Health Management Network Commercial	$5,434.90
Rate for Payer: Humana Medicare	$4,859.44
Rate for Payer: Kaiser Permanente Commercial	$5,754.60
Rate for Payer: Kaiser Permanente Medicaid	$3,260.94
Rate for Payer: Kaiser Permanente Medicare	$4,859.44
Rate for Payer: MDX Hawaii PPO	$6,202.18
Rate for Payer: Ohana Health Plan Medicaid	$4,859.44
Rate for Payer: Ohana Health Plan Medicare	$4,859.44
Rate for Payer: UnitedHealthcare Medicare	$4,859.44
Rate for Payer: University Health Alliance Commercial	$3,580.64

COSTAL CARTILAGE SM 450030

Facility

$2,997.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.50
Max. Negotiated Rate	$2,907.09
Rate for Payer: AlohaCare Medicaid	$1,498.50
Rate for Payer: AlohaCare Medicare	$2,277.72
Rate for Payer: Cash Price	$1,798.20
Rate for Payer: Devoted Health Medicare	$2,517.48
Rate for Payer: Hawaii Medical Service Association Medicare	$2,277.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,097.90
Rate for Payer: Health Management Network Commercial	$2,547.45
Rate for Payer: Humana Medicare	$2,277.72
Rate for Payer: Kaiser Permanente Commercial	$2,697.30
Rate for Payer: Kaiser Permanente Medicaid	$1,528.47
Rate for Payer: Kaiser Permanente Medicare	$2,277.72
Rate for Payer: MDX Hawaii PPO	$2,907.09
Rate for Payer: Ohana Health Plan Medicaid	$2,277.72
Rate for Payer: Ohana Health Plan Medicare	$2,277.72
Rate for Payer: UnitedHealthcare Medicare	$2,277.72
Rate for Payer: University Health Alliance Commercial	$1,678.32

COSTAL CARTILAGE SM 450030

Facility

$2,997.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$1,678.32
Max. Negotiated Rate	$2,907.09
Rate for Payer: Cash Price	$1,798.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,097.90
Rate for Payer: Health Management Network Commercial	$2,547.45
Rate for Payer: Kaiser Permanente Commercial	$2,697.30
Rate for Payer: MDX Hawaii PPO	$2,907.09
Rate for Payer: University Health Alliance Commercial	$1,678.32

COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]

Facility

$192.00

Service Code	HCPCS J0834
Hospital Revenue Code	250
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.80
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: MDX Hawaii PPO	$186.24

COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]

Facility

$192.00

Service Code	HCPCS J0834
Hospital Revenue Code	636
Min. Negotiated Rate	$28.02
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$146.68
Rate for Payer: AlohaCare Medicare	$145.92
Rate for Payer: Cash Price	$115.80
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.80
Rate for Payer: Devoted Health Medicare	$161.28
Rate for Payer: Devoted Health Medicare	$162.12
Rate for Payer: Hawaii Medical Service Association ABD	$28.02
Rate for Payer: Hawaii Medical Service Association ABD	$28.02
Rate for Payer: Hawaii Medical Service Association Medicare	$146.68
Rate for Payer: Hawaii Medical Service Association Medicare	$145.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.02
Rate for Payer: Hawaii Western Management Group Commercial	$183.35
Rate for Payer: Hawaii Western Management Group Commercial	$182.40
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$146.68
Rate for Payer: Humana Medicare	$145.92
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$146.68
Rate for Payer: Kaiser Permanente Medicare	$145.92
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$145.92
Rate for Payer: Ohana Health Plan Medicaid	$146.68
Rate for Payer: Ohana Health Plan Medicare	$145.92
Rate for Payer: Ohana Health Plan Medicare	$146.68
Rate for Payer: UnitedHealthcare Medicaid	$115.20
Rate for Payer: UnitedHealthcare Medicaid	$115.80
Rate for Payer: UnitedHealthcare Medicare	$146.68
Rate for Payer: UnitedHealthcare Medicare	$145.92
Rate for Payer: University Health Alliance Commercial	$139.95
Rate for Payer: University Health Alliance Commercial	$140.68

COUNTERSINK 1.7MM HSINK-1.7

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$611.10
Rate for Payer: AlohaCare Medicaid	$315.00
Rate for Payer: AlohaCare Medicare	$478.80
Rate for Payer: Cash Price	$378.00
Rate for Payer: Devoted Health Medicare	$529.20
Rate for Payer: Hawaii Medical Service Association Medicare	$478.80
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Humana Medicare	$478.80
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: Kaiser Permanente Medicare	$478.80
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: Ohana Health Plan Medicaid	$478.80
Rate for Payer: Ohana Health Plan Medicare	$478.80
Rate for Payer: UnitedHealthcare Medicare	$478.80
Rate for Payer: University Health Alliance Commercial	$459.21

COUNTERSINK 1.7MM HSINK-1.7

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: MDX Hawaii PPO	$611.10

COUNTERSINK 2.0/2.4MM 316-0101

Facility

$906.50

Hospital Revenue Code	272
Min. Negotiated Rate	$453.25
Max. Negotiated Rate	$879.30
Rate for Payer: AlohaCare Medicaid	$453.25
Rate for Payer: AlohaCare Medicare	$688.94
Rate for Payer: Cash Price	$543.90
Rate for Payer: Devoted Health Medicare	$761.46
Rate for Payer: Hawaii Medical Service Association Medicare	$688.94
Rate for Payer: Hawaii Western Management Group Commercial	$861.17
Rate for Payer: Health Management Network Commercial	$770.52
Rate for Payer: Humana Medicare	$688.94
Rate for Payer: Kaiser Permanente Commercial	$815.85
Rate for Payer: Kaiser Permanente Medicaid	$462.31
Rate for Payer: Kaiser Permanente Medicare	$688.94
Rate for Payer: MDX Hawaii PPO	$879.30
Rate for Payer: Ohana Health Plan Medicaid	$688.94
Rate for Payer: Ohana Health Plan Medicare	$688.94
Rate for Payer: UnitedHealthcare Medicare	$688.94
Rate for Payer: University Health Alliance Commercial	$660.75

COUNTERSINK 2.0/2.4MM 316-0101

Facility

$906.50

Hospital Revenue Code	272
Min. Negotiated Rate	$770.52
Max. Negotiated Rate	$879.30
Rate for Payer: Cash Price	$543.90
Rate for Payer: Health Management Network Commercial	$770.52
Rate for Payer: Kaiser Permanente Commercial	$815.85
Rate for Payer: MDX Hawaii PPO	$879.30

COUNTERSINK 2.3MM HSINK-2.3

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: MDX Hawaii PPO	$611.10

COUNTERSINK 2.3MM HSINK-2.3

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$611.10
Rate for Payer: AlohaCare Medicaid	$315.00
Rate for Payer: AlohaCare Medicare	$478.80
Rate for Payer: Cash Price	$378.00
Rate for Payer: Devoted Health Medicare	$529.20
Rate for Payer: Hawaii Medical Service Association Medicare	$478.80
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Humana Medicare	$478.80
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: Kaiser Permanente Medicare	$478.80
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: Ohana Health Plan Medicaid	$478.80
Rate for Payer: Ohana Health Plan Medicare	$478.80
Rate for Payer: UnitedHealthcare Medicare	$478.80
Rate for Payer: University Health Alliance Commercial	$459.21

COUNTERSINK 2.7MM QR 320-2727

Facility

$840.00

Hospital Revenue Code	272
Min. Negotiated Rate	$714.00
Max. Negotiated Rate	$814.80
Rate for Payer: Cash Price	$504.00
Rate for Payer: Health Management Network Commercial	$714.00
Rate for Payer: Kaiser Permanente Commercial	$756.00
Rate for Payer: MDX Hawaii PPO	$814.80

Know your out-of-pocket cost for care.

All Charges