Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$21,355.50

Service Code	MSDRG 377
Min. Negotiated Rate	$21,355.50
Max. Negotiated Rate	$21,355.50
Rate for Payer: Hawaii Medical Service Association Commercial	$21,355.50

GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$16,378.08

Service Code	MSDRG 379
Min. Negotiated Rate	$16,378.08
Max. Negotiated Rate	$16,378.08
Rate for Payer: Hawaii Medical Service Association Commercial	$16,378.08

GASTROINTESTINAL OBSTRUCTION WITH CC

Facility

$16,662.51

Service Code	MSDRG 389
Min. Negotiated Rate	$16,662.51
Max. Negotiated Rate	$16,662.51
Rate for Payer: Hawaii Medical Service Association Commercial	$16,662.51

GASTROINTESTINAL OBSTRUCTION WITH MCC

Facility

$18,771.98

Service Code	MSDRG 388
Min. Negotiated Rate	$18,771.98
Max. Negotiated Rate	$18,771.98
Rate for Payer: Hawaii Medical Service Association Commercial	$18,771.98

GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC

Facility

$13,273.12

Service Code	MSDRG 390
Min. Negotiated Rate	$13,273.12
Max. Negotiated Rate	$13,273.12
Rate for Payer: Hawaii Medical Service Association Commercial	$13,273.12

GAUGE MOLDED OTOLOGIC SIZER

Facility

$86.00

Hospital Revenue Code	272
Min. Negotiated Rate	$43.00
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$65.36
Rate for Payer: Cash Price	$51.60
Rate for Payer: Devoted Health Medicare	$72.24
Rate for Payer: Hawaii Medical Service Association Medicare	$65.36
Rate for Payer: Hawaii Western Management Group Commercial	$81.70
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$65.36
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$65.36
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$65.36
Rate for Payer: Ohana Health Plan Medicare	$65.36
Rate for Payer: UnitedHealthcare Medicare	$65.36
Rate for Payer: University Health Alliance Commercial	$62.69

GAUGE MOLDED OTOLOGIC SIZER

Facility

$86.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$51.60
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

GDNG CATH W/ SD HLS 7FR XB3.5

Facility

$240.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$232.80
Rate for Payer: AlohaCare Medicaid	$120.00
Rate for Payer: AlohaCare Medicare	$182.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Devoted Health Medicare	$201.60
Rate for Payer: Hawaii Medical Service Association Medicare	$182.40
Rate for Payer: Hawaii Western Management Group Commercial	$228.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Humana Medicare	$182.40
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: Kaiser Permanente Medicare	$182.40
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: Ohana Health Plan Medicaid	$182.40
Rate for Payer: Ohana Health Plan Medicare	$182.40
Rate for Payer: UnitedHealthcare Medicare	$182.40
Rate for Payer: University Health Alliance Commercial	$174.94

GDNG CATH W/ SD HLS 7FR XB3.5

Facility

$240.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: MDX Hawaii PPO	$232.80

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 CM TOPICAL SPONGE [28022]

Facility

$111.00

Service Code	NDC 00009035301
Hospital Revenue Code	250
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: MDX Hawaii PPO	$107.67

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE [28025]

Facility

$111.00

Service Code	NDC 00009034201
Hospital Revenue Code	250
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: MDX Hawaii PPO	$107.67

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE [28018]

Facility

$29.00

Service Code	NDC 00009031508
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

GELPOINT MINI CNGL3

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$1,710.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Devoted Health Medicare	$1,890.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$1,710.00
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$1,710.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$1,710.00
Rate for Payer: Ohana Health Plan Medicare	$1,710.00
Rate for Payer: UnitedHealthcare Medicare	$1,710.00
Rate for Payer: University Health Alliance Commercial	$1,640.03

GELPOINT MINI CNGL3

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50

GELPOINT TRANSANAL ACC CNO11

Facility

$2,625.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,231.25
Max. Negotiated Rate	$2,546.25
Rate for Payer: Cash Price	$1,575.00
Rate for Payer: Health Management Network Commercial	$2,231.25
Rate for Payer: Kaiser Permanente Commercial	$2,362.50
Rate for Payer: MDX Hawaii PPO	$2,546.25

GELPOINT TRANSANAL ACC CNO11

Facility

$2,625.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,546.25
Rate for Payer: AlohaCare Medicaid	$1,312.50
Rate for Payer: AlohaCare Medicare	$1,995.00
Rate for Payer: Cash Price	$1,575.00
Rate for Payer: Devoted Health Medicare	$2,205.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,995.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,493.75
Rate for Payer: Health Management Network Commercial	$2,231.25
Rate for Payer: Humana Medicare	$1,995.00
Rate for Payer: Kaiser Permanente Commercial	$2,362.50
Rate for Payer: Kaiser Permanente Medicaid	$1,338.75
Rate for Payer: Kaiser Permanente Medicare	$1,995.00
Rate for Payer: MDX Hawaii PPO	$2,546.25
Rate for Payer: Ohana Health Plan Medicaid	$1,995.00
Rate for Payer: Ohana Health Plan Medicare	$1,995.00
Rate for Payer: UnitedHealthcare Medicare	$1,995.00
Rate for Payer: University Health Alliance Commercial	$1,913.36

GELPORT LAPAROSCOPIC SYS C8XX2

Facility

$2,100.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,785.00
Max. Negotiated Rate	$2,037.00
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Health Management Network Commercial	$1,785.00
Rate for Payer: Kaiser Permanente Commercial	$1,890.00
Rate for Payer: MDX Hawaii PPO	$2,037.00

GELPORT LAPAROSCOPIC SYS C8XX2

Facility

$2,100.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$2,037.00
Rate for Payer: AlohaCare Medicaid	$1,050.00
Rate for Payer: AlohaCare Medicare	$1,596.00
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Devoted Health Medicare	$1,764.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,596.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$1,785.00
Rate for Payer: Humana Medicare	$1,596.00
Rate for Payer: Kaiser Permanente Commercial	$1,890.00
Rate for Payer: Kaiser Permanente Medicaid	$1,071.00
Rate for Payer: Kaiser Permanente Medicare	$1,596.00
Rate for Payer: MDX Hawaii PPO	$2,037.00
Rate for Payer: Ohana Health Plan Medicaid	$1,596.00
Rate for Payer: Ohana Health Plan Medicare	$1,596.00
Rate for Payer: UnitedHealthcare Medicare	$1,596.00
Rate for Payer: University Health Alliance Commercial	$1,530.69

GEL SILVER ANTIMICROBIAL WOUND

Facility

$94.00

Service Code	HCPCS A6261
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

GEL SILVER ANTIMICROBIAL WOUND

Facility

$94.00

Service Code	HCPCS A6261
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

GEL SIZER 305CC

Facility

$844.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$422.00
Max. Negotiated Rate	$818.68
Rate for Payer: AlohaCare Medicaid	$422.00
Rate for Payer: AlohaCare Medicare	$641.44
Rate for Payer: Cash Price	$506.40
Rate for Payer: Devoted Health Medicare	$708.96
Rate for Payer: Hawaii Medical Service Association Medicare	$641.44
Rate for Payer: Hawaii Western Management Group Commercial	$590.80
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Humana Medicare	$641.44
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: Kaiser Permanente Medicaid	$430.44
Rate for Payer: Kaiser Permanente Medicare	$641.44
Rate for Payer: MDX Hawaii PPO	$818.68
Rate for Payer: Ohana Health Plan Medicaid	$641.44
Rate for Payer: Ohana Health Plan Medicare	$641.44
Rate for Payer: UnitedHealthcare Medicare	$641.44
Rate for Payer: University Health Alliance Commercial	$472.64

GEL SIZER 305CC

Facility

$844.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$472.64
Max. Negotiated Rate	$818.68
Rate for Payer: Cash Price	$506.40
Rate for Payer: Hawaii Western Management Group Commercial	$590.80
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: MDX Hawaii PPO	$818.68
Rate for Payer: University Health Alliance Commercial	$472.64

GEL SIZER 350CC

Facility

$844.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$422.00
Max. Negotiated Rate	$818.68
Rate for Payer: AlohaCare Medicaid	$422.00
Rate for Payer: AlohaCare Medicare	$641.44
Rate for Payer: Cash Price	$506.40
Rate for Payer: Devoted Health Medicare	$708.96
Rate for Payer: Hawaii Medical Service Association Medicare	$641.44
Rate for Payer: Hawaii Western Management Group Commercial	$590.80
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Humana Medicare	$641.44
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: Kaiser Permanente Medicaid	$430.44
Rate for Payer: Kaiser Permanente Medicare	$641.44
Rate for Payer: MDX Hawaii PPO	$818.68
Rate for Payer: Ohana Health Plan Medicaid	$641.44
Rate for Payer: Ohana Health Plan Medicare	$641.44
Rate for Payer: UnitedHealthcare Medicare	$641.44
Rate for Payer: University Health Alliance Commercial	$472.64

GEL SIZER 350CC

Facility

$844.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$472.64
Max. Negotiated Rate	$818.68
Rate for Payer: Cash Price	$506.40
Rate for Payer: Hawaii Western Management Group Commercial	$590.80
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: MDX Hawaii PPO	$818.68
Rate for Payer: University Health Alliance Commercial	$472.64

GEL SIZER 350CC GS10512-350MP

Facility

$844.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$422.00
Max. Negotiated Rate	$818.68
Rate for Payer: AlohaCare Medicaid	$422.00
Rate for Payer: AlohaCare Medicare	$641.44
Rate for Payer: Cash Price	$506.40
Rate for Payer: Devoted Health Medicare	$708.96
Rate for Payer: Hawaii Medical Service Association Medicare	$641.44
Rate for Payer: Hawaii Western Management Group Commercial	$590.80
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Humana Medicare	$641.44
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: Kaiser Permanente Medicaid	$430.44
Rate for Payer: Kaiser Permanente Medicare	$641.44
Rate for Payer: MDX Hawaii PPO	$818.68
Rate for Payer: Ohana Health Plan Medicaid	$641.44
Rate for Payer: Ohana Health Plan Medicare	$641.44
Rate for Payer: UnitedHealthcare Medicare	$641.44
Rate for Payer: University Health Alliance Commercial	$472.64

Know your out-of-pocket cost for care.

All Charges