Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$89,095.82

Service Code	MSDRG 026
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$89,095.82
Rate for Payer: Hawaii Medical Service Association Commercial	$89,095.82
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$89,095.82

Service Code	MSDRG 025
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$89,095.82
Rate for Payer: Hawaii Medical Service Association Commercial	$89,095.82
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$76,652.27

Service Code	MSDRG 027
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$76,652.27
Rate for Payer: Hawaii Medical Service Association Commercial	$76,652.27
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$224,860.87

Service Code	MSDRG 955
Min. Negotiated Rate	$224,860.87
Max. Negotiated Rate	$224,860.87
Rate for Payer: Hawaii Medical Service Association Commercial	$224,860.87

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility

$104,857.65

Service Code	MSDRG 023
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$104,857.65
Rate for Payer: Hawaii Medical Service Association Commercial	$104,857.65
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility

$99,927.63

Service Code	MSDRG 024
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$99,927.63
Rate for Payer: Hawaii Medical Service Association Commercial	$99,927.63
Rate for Payer: University Health Alliance Commercial	$10,400.00

CR ARTCLR SURF 00-5964-040-12

Facility

$2,803.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.68
Max. Negotiated Rate	$2,718.91
Rate for Payer: Cash Price	$1,681.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,962.10
Rate for Payer: Health Management Network Commercial	$2,382.55
Rate for Payer: Kaiser Permanente Commercial	$2,522.70
Rate for Payer: MDX Hawaii PPO	$2,718.91
Rate for Payer: University Health Alliance Commercial	$1,569.68

CR ARTCLR SURF 00-5964-040-12

Facility

$2,803.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.50
Max. Negotiated Rate	$2,718.91
Rate for Payer: AlohaCare Medicaid	$1,401.50
Rate for Payer: AlohaCare Medicare	$2,130.28
Rate for Payer: Cash Price	$1,681.80
Rate for Payer: Devoted Health Medicare	$2,354.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,130.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,962.10
Rate for Payer: Health Management Network Commercial	$2,382.55
Rate for Payer: Humana Medicare	$2,130.28
Rate for Payer: Kaiser Permanente Commercial	$2,522.70
Rate for Payer: Kaiser Permanente Medicaid	$1,429.53
Rate for Payer: Kaiser Permanente Medicare	$2,130.28
Rate for Payer: MDX Hawaii PPO	$2,718.91
Rate for Payer: Ohana Health Plan Medicaid	$2,130.28
Rate for Payer: Ohana Health Plan Medicare	$2,130.28
Rate for Payer: UnitedHealthcare Medicare	$2,130.28
Rate for Payer: University Health Alliance Commercial	$1,569.68

CRCLG PASSER LF OFFST AR-7824L

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$957.95
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: MDX Hawaii PPO	$1,093.19

CRCLG PASSER LF OFFST AR-7824L

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$563.50
Max. Negotiated Rate	$1,093.19
Rate for Payer: AlohaCare Medicaid	$563.50
Rate for Payer: AlohaCare Medicare	$856.52
Rate for Payer: Cash Price	$676.20
Rate for Payer: Devoted Health Medicare	$946.68
Rate for Payer: Hawaii Medical Service Association Medicare	$856.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,070.65
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Humana Medicare	$856.52
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: Kaiser Permanente Medicare	$856.52
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: Ohana Health Plan Medicaid	$856.52
Rate for Payer: Ohana Health Plan Medicare	$856.52
Rate for Payer: UnitedHealthcare Medicare	$856.52
Rate for Payer: University Health Alliance Commercial	$821.47

CRCLG PASSER RT OFFST AR-7824R

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$957.95
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: MDX Hawaii PPO	$1,093.19

CRCLG PASSER RT OFFST AR-7824R

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$563.50
Max. Negotiated Rate	$1,093.19
Rate for Payer: AlohaCare Medicaid	$563.50
Rate for Payer: AlohaCare Medicare	$856.52
Rate for Payer: Cash Price	$676.20
Rate for Payer: Devoted Health Medicare	$946.68
Rate for Payer: Hawaii Medical Service Association Medicare	$856.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,070.65
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Humana Medicare	$856.52
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: Kaiser Permanente Medicare	$856.52
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: Ohana Health Plan Medicaid	$856.52
Rate for Payer: Ohana Health Plan Medicare	$856.52
Rate for Payer: UnitedHealthcare Medicare	$856.52
Rate for Payer: University Health Alliance Commercial	$821.47

CRCLG PASSER TROCH AR-7823

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$563.50
Max. Negotiated Rate	$1,093.19
Rate for Payer: AlohaCare Medicaid	$563.50
Rate for Payer: AlohaCare Medicare	$856.52
Rate for Payer: Cash Price	$676.20
Rate for Payer: Devoted Health Medicare	$946.68
Rate for Payer: Hawaii Medical Service Association Medicare	$856.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,070.65
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Humana Medicare	$856.52
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: Kaiser Permanente Medicare	$856.52
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: Ohana Health Plan Medicaid	$856.52
Rate for Payer: Ohana Health Plan Medicare	$856.52
Rate for Payer: UnitedHealthcare Medicare	$856.52
Rate for Payer: University Health Alliance Commercial	$821.47

CRCLG PASSER TROCH AR-7823

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$957.95
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: MDX Hawaii PPO	$1,093.19

CRCLG STR PASSER LG AR-7822

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$563.50
Max. Negotiated Rate	$1,093.19
Rate for Payer: AlohaCare Medicaid	$563.50
Rate for Payer: AlohaCare Medicare	$856.52
Rate for Payer: Cash Price	$676.20
Rate for Payer: Devoted Health Medicare	$946.68
Rate for Payer: Hawaii Medical Service Association Medicare	$856.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,070.65
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Humana Medicare	$856.52
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: Kaiser Permanente Medicare	$856.52
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: Ohana Health Plan Medicaid	$856.52
Rate for Payer: Ohana Health Plan Medicare	$856.52
Rate for Payer: UnitedHealthcare Medicare	$856.52
Rate for Payer: University Health Alliance Commercial	$821.47

CRCLG STR PASSER LG AR-7822

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$957.95
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: MDX Hawaii PPO	$1,093.19

CRCLG STR PASSER SM AR-7825

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$563.50
Max. Negotiated Rate	$1,093.19
Rate for Payer: AlohaCare Medicaid	$563.50
Rate for Payer: AlohaCare Medicare	$856.52
Rate for Payer: Cash Price	$676.20
Rate for Payer: Devoted Health Medicare	$946.68
Rate for Payer: Hawaii Medical Service Association Medicare	$856.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,070.65
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Humana Medicare	$856.52
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: Kaiser Permanente Medicare	$856.52
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: Ohana Health Plan Medicaid	$856.52
Rate for Payer: Ohana Health Plan Medicare	$856.52
Rate for Payer: UnitedHealthcare Medicare	$856.52
Rate for Payer: University Health Alliance Commercial	$821.47

CRCLG STR PASSER SM AR-7825

Facility

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$957.95
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: MDX Hawaii PPO	$1,093.19

CRESCENT PLATE 2X2 04.503.711

Facility

$2,344.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,172.00
Max. Negotiated Rate	$2,273.68
Rate for Payer: AlohaCare Medicaid	$1,172.00
Rate for Payer: AlohaCare Medicare	$1,781.44
Rate for Payer: Cash Price	$1,406.40
Rate for Payer: Devoted Health Medicare	$1,968.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,781.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,640.80
Rate for Payer: Health Management Network Commercial	$1,992.40
Rate for Payer: Humana Medicare	$1,781.44
Rate for Payer: Kaiser Permanente Commercial	$2,109.60
Rate for Payer: Kaiser Permanente Medicaid	$1,195.44
Rate for Payer: Kaiser Permanente Medicare	$1,781.44
Rate for Payer: MDX Hawaii PPO	$2,273.68
Rate for Payer: Ohana Health Plan Medicaid	$1,781.44
Rate for Payer: Ohana Health Plan Medicare	$1,781.44
Rate for Payer: UnitedHealthcare Medicare	$1,781.44
Rate for Payer: University Health Alliance Commercial	$1,312.64

CRESCENT PLATE 2X2 04.503.711

Facility

$2,344.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.64
Max. Negotiated Rate	$2,273.68
Rate for Payer: Cash Price	$1,406.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,640.80
Rate for Payer: Health Management Network Commercial	$1,992.40
Rate for Payer: Kaiser Permanente Commercial	$2,109.60
Rate for Payer: MDX Hawaii PPO	$2,273.68
Rate for Payer: University Health Alliance Commercial	$1,312.64

CRESCENT PLATE 3X3 04.503.727

Facility

$2,852.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,426.00
Max. Negotiated Rate	$2,766.44
Rate for Payer: AlohaCare Medicaid	$1,426.00
Rate for Payer: AlohaCare Medicare	$2,167.52
Rate for Payer: Cash Price	$1,711.20
Rate for Payer: Devoted Health Medicare	$2,395.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,167.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,996.40
Rate for Payer: Health Management Network Commercial	$2,424.20
Rate for Payer: Humana Medicare	$2,167.52
Rate for Payer: Kaiser Permanente Commercial	$2,566.80
Rate for Payer: Kaiser Permanente Medicaid	$1,454.52
Rate for Payer: Kaiser Permanente Medicare	$2,167.52
Rate for Payer: MDX Hawaii PPO	$2,766.44
Rate for Payer: Ohana Health Plan Medicaid	$2,167.52
Rate for Payer: Ohana Health Plan Medicare	$2,167.52
Rate for Payer: UnitedHealthcare Medicare	$2,167.52
Rate for Payer: University Health Alliance Commercial	$1,597.12

CRESCENT PLATE 3X3 04.503.727

Facility

$2,852.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,597.12
Max. Negotiated Rate	$2,766.44
Rate for Payer: Cash Price	$1,711.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,996.40
Rate for Payer: Health Management Network Commercial	$2,424.20
Rate for Payer: Kaiser Permanente Commercial	$2,566.80
Rate for Payer: MDX Hawaii PPO	$2,766.44
Rate for Payer: University Health Alliance Commercial	$1,597.12

CR FEMORAL SZ 7 5510-F-702

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

CR FEMORAL SZ 7 5510-F-702

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

CR FLEX FEM G-RT 5956-017-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

Know your out-of-pocket cost for care.

All Charges