Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

DVR LOCK WIDE L 131823050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

DVR LOCK WIDE L 131823050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.50
Max. Negotiated Rate	$2,825.61
Rate for Payer: AlohaCare Medicaid	$1,456.50
Rate for Payer: AlohaCare Medicare	$2,213.88
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Devoted Health Medicare	$2,446.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,213.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Humana Medicare	$2,213.88
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: Kaiser Permanente Medicaid	$1,485.63
Rate for Payer: Kaiser Permanente Medicare	$2,213.88
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: Ohana Health Plan Medicaid	$2,213.88
Rate for Payer: Ohana Health Plan Medicare	$2,213.88
Rate for Payer: UnitedHealthcare Medicare	$2,213.88
Rate for Payer: University Health Alliance Commercial	$1,631.28

DYSEQUILIBRIUM

Facility

$12,727.97

Service Code	MSDRG 149
Min. Negotiated Rate	$12,727.97
Max. Negotiated Rate	$12,727.97
Rate for Payer: Hawaii Medical Service Association Commercial	$12,727.97

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$35,363.38

Service Code	MSDRG 147
Min. Negotiated Rate	$35,363.38
Max. Negotiated Rate	$35,363.38
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$35,363.38

Service Code	MSDRG 146
Min. Negotiated Rate	$35,363.38
Max. Negotiated Rate	$35,363.38
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$35,363.38

Service Code	MSDRG 148
Min. Negotiated Rate	$35,363.38
Max. Negotiated Rate	$35,363.38
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$466,787.19

Service Code	MSDRG 003
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$466,787.19
Rate for Payer: Hawaii Medical Service Association Commercial	$466,787.19
Rate for Payer: University Health Alliance Commercial	$10,400.00

ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]

Facility

$397.00

Service Code	NDC 45802046653
Hospital Revenue Code	250
Min. Negotiated Rate	$337.45
Max. Negotiated Rate	$385.09
Rate for Payer: Cash Price	$238.20
Rate for Payer: Health Management Network Commercial	$337.45
Rate for Payer: Kaiser Permanente Commercial	$357.30
Rate for Payer: MDX Hawaii PPO	$385.09

ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]

Facility

$106.00

Service Code	NDC 45802046635
Hospital Revenue Code	250
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: MDX Hawaii PPO	$102.82

ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]

Facility

$397.00

Service Code	NDC 45802046653
Hospital Revenue Code	637
Min. Negotiated Rate	$198.50
Max. Negotiated Rate	$385.09
Rate for Payer: AlohaCare Medicaid	$198.50
Rate for Payer: AlohaCare Medicare	$301.72
Rate for Payer: Cash Price	$238.20
Rate for Payer: Devoted Health Medicare	$333.48
Rate for Payer: Hawaii Medical Service Association Medicare	$301.72
Rate for Payer: Hawaii Western Management Group Commercial	$377.15
Rate for Payer: Health Management Network Commercial	$337.45
Rate for Payer: Humana Medicare	$301.72
Rate for Payer: Kaiser Permanente Commercial	$357.30
Rate for Payer: Kaiser Permanente Medicaid	$202.47
Rate for Payer: Kaiser Permanente Medicare	$301.72
Rate for Payer: MDX Hawaii PPO	$385.09
Rate for Payer: Ohana Health Plan Medicaid	$301.72
Rate for Payer: Ohana Health Plan Medicare	$301.72
Rate for Payer: UnitedHealthcare Medicare	$301.72
Rate for Payer: University Health Alliance Commercial	$289.37

ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]

Facility

$106.00

Service Code	NDC 45802046635
Hospital Revenue Code	637
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$102.82
Rate for Payer: AlohaCare Medicaid	$53.00
Rate for Payer: AlohaCare Medicare	$80.56
Rate for Payer: Cash Price	$63.60
Rate for Payer: Devoted Health Medicare	$89.04
Rate for Payer: Hawaii Medical Service Association Medicare	$80.56
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Humana Medicare	$80.56
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: Kaiser Permanente Medicare	$80.56
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: Ohana Health Plan Medicaid	$80.56
Rate for Payer: Ohana Health Plan Medicare	$80.56
Rate for Payer: UnitedHealthcare Medicare	$80.56
Rate for Payer: University Health Alliance Commercial	$77.26

ECO SUCTIONER MAT USA-XG8

Facility

$276.00

Hospital Revenue Code	271
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$267.72
Rate for Payer: AlohaCare Medicaid	$138.00
Rate for Payer: AlohaCare Medicare	$209.76
Rate for Payer: Cash Price	$165.60
Rate for Payer: Devoted Health Medicare	$231.84
Rate for Payer: Hawaii Medical Service Association Medicare	$209.76
Rate for Payer: Hawaii Western Management Group Commercial	$262.20
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Humana Medicare	$209.76
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: Kaiser Permanente Medicaid	$140.76
Rate for Payer: Kaiser Permanente Medicare	$209.76
Rate for Payer: MDX Hawaii PPO	$267.72
Rate for Payer: Ohana Health Plan Medicaid	$209.76
Rate for Payer: Ohana Health Plan Medicare	$209.76
Rate for Payer: UnitedHealthcare Medicare	$209.76
Rate for Payer: University Health Alliance Commercial	$201.18

ECO SUCTIONER MAT USA-XG8

Facility

$276.00

Hospital Revenue Code	271
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: MDX Hawaii PPO	$267.72

EDORA SR-T PROMRI W/HM 431749

Facility

$10,500.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$10,185.00
Rate for Payer: AlohaCare Medicaid	$5,250.00
Rate for Payer: AlohaCare Medicare	$7,980.00
Rate for Payer: Cash Price	$6,300.00
Rate for Payer: Devoted Health Medicare	$8,820.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,350.00
Rate for Payer: Health Management Network Commercial	$8,925.00
Rate for Payer: Humana Medicare	$7,980.00
Rate for Payer: Kaiser Permanente Commercial	$9,450.00
Rate for Payer: Kaiser Permanente Medicaid	$5,355.00
Rate for Payer: Kaiser Permanente Medicare	$7,980.00
Rate for Payer: MDX Hawaii PPO	$10,185.00
Rate for Payer: Ohana Health Plan Medicaid	$7,980.00
Rate for Payer: Ohana Health Plan Medicare	$7,980.00
Rate for Payer: UnitedHealthcare Medicare	$7,980.00
Rate for Payer: University Health Alliance Commercial	$5,880.00

EDORA SR-T PROMRI W/HM 431749

Facility

$10,500.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,880.00
Max. Negotiated Rate	$10,185.00
Rate for Payer: Cash Price	$6,300.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,350.00
Rate for Payer: Health Management Network Commercial	$8,925.00
Rate for Payer: Kaiser Permanente Commercial	$9,450.00
Rate for Payer: MDX Hawaii PPO	$10,185.00
Rate for Payer: University Health Alliance Commercial	$5,880.00

EGG BURR 4.0MM #1607-002-035

Facility

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$139.80
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: MDX Hawaii PPO	$226.01

EGG BURR 4.0MM #1607-002-035

Facility

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$116.50
Max. Negotiated Rate	$226.01
Rate for Payer: AlohaCare Medicaid	$116.50
Rate for Payer: AlohaCare Medicare	$177.08
Rate for Payer: Cash Price	$139.80
Rate for Payer: Devoted Health Medicare	$195.72
Rate for Payer: Hawaii Medical Service Association Medicare	$177.08
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Humana Medicare	$177.08
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: Kaiser Permanente Medicaid	$118.83
Rate for Payer: Kaiser Permanente Medicare	$177.08
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: Ohana Health Plan Medicaid	$177.08
Rate for Payer: Ohana Health Plan Medicare	$177.08
Rate for Payer: UnitedHealthcare Medicare	$177.08
Rate for Payer: University Health Alliance Commercial	$169.83

ELECTROCATHETER S 53-J 107237

Facility

$200.00

Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: University Health Alliance Commercial	$112.00

ELECTROCATHETER S 53-J 107237

Facility

$200.00

Hospital Revenue Code	278
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$152.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$168.00
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$152.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$152.00
Rate for Payer: Ohana Health Plan Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: University Health Alliance Commercial	$112.00

ELECTROCATHETER S 53-K 107235

Facility

$200.00

Hospital Revenue Code	278
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$152.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$168.00
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$152.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$152.00
Rate for Payer: Ohana Health Plan Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: University Health Alliance Commercial	$112.00

ELECTROCATHETER S 53-K 107235

Facility

$200.00

Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: University Health Alliance Commercial	$112.00

ELECTRODE BALL

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

ELECTRODE BALL

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

ELECTRODE BALL 3X11CM

Facility

$94.00

Hospital Revenue Code	272
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

ELECTRODE BALL 3X11CM

Facility

$94.00

Hospital Revenue Code	272
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

Know your out-of-pocket cost for care.

All Charges