Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

AO DRIVER SHAFT

Facility

$578.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$560.66
Rate for Payer: AlohaCare Medicaid	$289.00
Rate for Payer: AlohaCare Medicare	$439.28
Rate for Payer: Cash Price	$346.80
Rate for Payer: Devoted Health Medicare	$485.52
Rate for Payer: Hawaii Medical Service Association Medicare	$439.28
Rate for Payer: Hawaii Western Management Group Commercial	$549.10
Rate for Payer: Health Management Network Commercial	$491.30
Rate for Payer: Humana Medicare	$439.28
Rate for Payer: Kaiser Permanente Commercial	$520.20
Rate for Payer: Kaiser Permanente Medicaid	$294.78
Rate for Payer: Kaiser Permanente Medicare	$439.28
Rate for Payer: MDX Hawaii PPO	$560.66
Rate for Payer: Ohana Health Plan Medicaid	$439.28
Rate for Payer: Ohana Health Plan Medicare	$439.28
Rate for Payer: UnitedHealthcare Medicare	$439.28
Rate for Payer: University Health Alliance Commercial	$421.30

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$111,280.89

Service Code	MSDRG 268
Min. Negotiated Rate	$111,280.89
Max. Negotiated Rate	$111,280.89
Rate for Payer: Hawaii Medical Service Association Commercial	$111,280.89

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$96,040.50

Service Code	MSDRG 269
Min. Negotiated Rate	$96,040.50
Max. Negotiated Rate	$96,040.50
Rate for Payer: Hawaii Medical Service Association Commercial	$96,040.50

AORTIC EXTEN ENDO 23MMX3.3CM

Facility

$7,754.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,877.00
Max. Negotiated Rate	$7,521.38
Rate for Payer: AlohaCare Medicaid	$3,877.00
Rate for Payer: AlohaCare Medicare	$5,893.04
Rate for Payer: Cash Price	$4,652.40
Rate for Payer: Devoted Health Medicare	$6,513.36
Rate for Payer: Hawaii Medical Service Association Medicare	$5,893.04
Rate for Payer: Hawaii Western Management Group Commercial	$5,427.80
Rate for Payer: Health Management Network Commercial	$6,590.90
Rate for Payer: Humana Medicare	$5,893.04
Rate for Payer: Kaiser Permanente Commercial	$6,978.60
Rate for Payer: Kaiser Permanente Medicaid	$3,954.54
Rate for Payer: Kaiser Permanente Medicare	$5,893.04
Rate for Payer: MDX Hawaii PPO	$7,521.38
Rate for Payer: Ohana Health Plan Medicaid	$5,893.04
Rate for Payer: Ohana Health Plan Medicare	$5,893.04
Rate for Payer: UnitedHealthcare Medicare	$5,893.04
Rate for Payer: University Health Alliance Commercial	$4,342.24

AORTIC EXTEN ENDO 23MMX3.3CM

Facility

$7,754.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$4,342.24
Max. Negotiated Rate	$7,521.38
Rate for Payer: Cash Price	$4,652.40
Rate for Payer: Hawaii Western Management Group Commercial	$5,427.80
Rate for Payer: Health Management Network Commercial	$6,590.90
Rate for Payer: Kaiser Permanente Commercial	$6,978.60
Rate for Payer: MDX Hawaii PPO	$7,521.38
Rate for Payer: University Health Alliance Commercial	$4,342.24

AORTIC EXTEN ENDO 26MMX3.3CM

Facility

$6,350.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,556.00
Max. Negotiated Rate	$6,159.50
Rate for Payer: Cash Price	$3,810.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,445.00
Rate for Payer: Health Management Network Commercial	$5,397.50
Rate for Payer: Kaiser Permanente Commercial	$5,715.00
Rate for Payer: MDX Hawaii PPO	$6,159.50
Rate for Payer: University Health Alliance Commercial	$3,556.00

AORTIC EXTEN ENDO 26MMX3.3CM

Facility

$6,350.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,175.00
Max. Negotiated Rate	$6,159.50
Rate for Payer: AlohaCare Medicaid	$3,175.00
Rate for Payer: AlohaCare Medicare	$4,826.00
Rate for Payer: Cash Price	$3,810.00
Rate for Payer: Devoted Health Medicare	$5,334.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,826.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,445.00
Rate for Payer: Health Management Network Commercial	$5,397.50
Rate for Payer: Humana Medicare	$4,826.00
Rate for Payer: Kaiser Permanente Commercial	$5,715.00
Rate for Payer: Kaiser Permanente Medicaid	$3,238.50
Rate for Payer: Kaiser Permanente Medicare	$4,826.00
Rate for Payer: MDX Hawaii PPO	$6,159.50
Rate for Payer: Ohana Health Plan Medicaid	$4,826.00
Rate for Payer: Ohana Health Plan Medicare	$4,826.00
Rate for Payer: UnitedHealthcare Medicare	$4,826.00
Rate for Payer: University Health Alliance Commercial	$3,556.00

AORTIC EXTEN ENDO 28.5MMX3.3CM

Facility

$6,350.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,175.00
Max. Negotiated Rate	$6,159.50
Rate for Payer: AlohaCare Medicaid	$3,175.00
Rate for Payer: AlohaCare Medicare	$4,826.00
Rate for Payer: Cash Price	$3,810.00
Rate for Payer: Devoted Health Medicare	$5,334.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,826.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,445.00
Rate for Payer: Health Management Network Commercial	$5,397.50
Rate for Payer: Humana Medicare	$4,826.00
Rate for Payer: Kaiser Permanente Commercial	$5,715.00
Rate for Payer: Kaiser Permanente Medicaid	$3,238.50
Rate for Payer: Kaiser Permanente Medicare	$4,826.00
Rate for Payer: MDX Hawaii PPO	$6,159.50
Rate for Payer: Ohana Health Plan Medicaid	$4,826.00
Rate for Payer: Ohana Health Plan Medicare	$4,826.00
Rate for Payer: UnitedHealthcare Medicare	$4,826.00
Rate for Payer: University Health Alliance Commercial	$3,556.00

AORTIC EXTEN ENDO 28.5MMX3.3CM

Facility

$6,350.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,556.00
Max. Negotiated Rate	$6,159.50
Rate for Payer: Cash Price	$3,810.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,445.00
Rate for Payer: Health Management Network Commercial	$5,397.50
Rate for Payer: Kaiser Permanente Commercial	$5,715.00
Rate for Payer: MDX Hawaii PPO	$6,159.50
Rate for Payer: University Health Alliance Commercial	$3,556.00

AORTIC EXTEN ENDO 32MMX4.5CM

Facility

$6,350.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,175.00
Max. Negotiated Rate	$6,159.50
Rate for Payer: AlohaCare Medicaid	$3,175.00
Rate for Payer: AlohaCare Medicare	$4,826.00
Rate for Payer: Cash Price	$3,810.00
Rate for Payer: Devoted Health Medicare	$5,334.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,826.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,445.00
Rate for Payer: Health Management Network Commercial	$5,397.50
Rate for Payer: Humana Medicare	$4,826.00
Rate for Payer: Kaiser Permanente Commercial	$5,715.00
Rate for Payer: Kaiser Permanente Medicaid	$3,238.50
Rate for Payer: Kaiser Permanente Medicare	$4,826.00
Rate for Payer: MDX Hawaii PPO	$6,159.50
Rate for Payer: Ohana Health Plan Medicaid	$4,826.00
Rate for Payer: Ohana Health Plan Medicare	$4,826.00
Rate for Payer: UnitedHealthcare Medicare	$4,826.00
Rate for Payer: University Health Alliance Commercial	$3,556.00

AORTIC EXTEN ENDO 32MMX4.5CM

Facility

$6,350.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,556.00
Max. Negotiated Rate	$6,159.50
Rate for Payer: Cash Price	$3,810.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,445.00
Rate for Payer: Health Management Network Commercial	$5,397.50
Rate for Payer: Kaiser Permanente Commercial	$5,715.00
Rate for Payer: MDX Hawaii PPO	$6,159.50
Rate for Payer: University Health Alliance Commercial	$3,556.00

AORTIC EXTEN ENDO 36MMX4.5CM

Facility

$6,350.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,175.00
Max. Negotiated Rate	$6,159.50
Rate for Payer: AlohaCare Medicaid	$3,175.00
Rate for Payer: AlohaCare Medicare	$4,826.00
Rate for Payer: Cash Price	$3,810.00
Rate for Payer: Devoted Health Medicare	$5,334.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,826.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,445.00
Rate for Payer: Health Management Network Commercial	$5,397.50
Rate for Payer: Humana Medicare	$4,826.00
Rate for Payer: Kaiser Permanente Commercial	$5,715.00
Rate for Payer: Kaiser Permanente Medicaid	$3,238.50
Rate for Payer: Kaiser Permanente Medicare	$4,826.00
Rate for Payer: MDX Hawaii PPO	$6,159.50
Rate for Payer: Ohana Health Plan Medicaid	$4,826.00
Rate for Payer: Ohana Health Plan Medicare	$4,826.00
Rate for Payer: UnitedHealthcare Medicare	$4,826.00
Rate for Payer: University Health Alliance Commercial	$3,556.00

AORTIC EXTEN ENDO 36MMX4.5CM

Facility

$6,350.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,556.00
Max. Negotiated Rate	$6,159.50
Rate for Payer: Cash Price	$3,810.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,445.00
Rate for Payer: Health Management Network Commercial	$5,397.50
Rate for Payer: Kaiser Permanente Commercial	$5,715.00
Rate for Payer: MDX Hawaii PPO	$6,159.50
Rate for Payer: University Health Alliance Commercial	$3,556.00

APIXABAN 2.5 MG TABLET [119040]

Facility

$31.00

Service Code	NDC 00003089331
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

APIXABAN 2.5 MG TABLET [119040]

Facility

$31.00

Service Code	NDC 00003089331
Hospital Revenue Code	637
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$30.07
Rate for Payer: AlohaCare Medicaid	$15.50
Rate for Payer: AlohaCare Medicare	$23.56
Rate for Payer: Cash Price	$18.60
Rate for Payer: Devoted Health Medicare	$26.04
Rate for Payer: Hawaii Medical Service Association Medicare	$23.56
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Humana Medicare	$23.56
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: Kaiser Permanente Medicare	$23.56
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: Ohana Health Plan Medicaid	$23.56
Rate for Payer: Ohana Health Plan Medicare	$23.56
Rate for Payer: UnitedHealthcare Medicare	$23.56
Rate for Payer: University Health Alliance Commercial	$22.60

APIXABAN 5 MG TABLET [119614]

Facility

$31.00

Service Code	NDC 00003089431
Hospital Revenue Code	637
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$30.07
Rate for Payer: AlohaCare Medicaid	$15.50
Rate for Payer: AlohaCare Medicare	$23.56
Rate for Payer: Cash Price	$18.60
Rate for Payer: Devoted Health Medicare	$26.04
Rate for Payer: Hawaii Medical Service Association Medicare	$23.56
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Humana Medicare	$23.56
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: Kaiser Permanente Medicare	$23.56
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: Ohana Health Plan Medicaid	$23.56
Rate for Payer: Ohana Health Plan Medicare	$23.56
Rate for Payer: UnitedHealthcare Medicare	$23.56
Rate for Payer: University Health Alliance Commercial	$22.60

APIXABAN 5 MG TABLET [119614]

Facility

$31.00

Service Code	NDC 00003089431
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

APPENDIX PROCEDURES WITH CC

Facility

$31,689.57

Service Code	MSDRG 398
Min. Negotiated Rate	$31,689.57
Max. Negotiated Rate	$31,689.57
Rate for Payer: Hawaii Medical Service Association Commercial	$31,689.57

APPENDIX PROCEDURES WITH MCC

Facility

$34,320.50

Service Code	MSDRG 397
Min. Negotiated Rate	$34,320.50
Max. Negotiated Rate	$34,320.50
Rate for Payer: Hawaii Medical Service Association Commercial	$34,320.50

APPENDIX PROCEDURES WITHOUT CC/MCC

Facility

$23,654.60

Service Code	MSDRG 399
Min. Negotiated Rate	$23,654.60
Max. Negotiated Rate	$23,654.60
Rate for Payer: Hawaii Medical Service Association Commercial	$23,654.60

APPLICATOR ENDOSCOPIC

Facility

$316.00

Hospital Revenue Code	272
Min. Negotiated Rate	$158.00
Max. Negotiated Rate	$306.52
Rate for Payer: AlohaCare Medicaid	$158.00
Rate for Payer: AlohaCare Medicare	$240.16
Rate for Payer: Cash Price	$189.60
Rate for Payer: Devoted Health Medicare	$265.44
Rate for Payer: Hawaii Medical Service Association Medicare	$240.16
Rate for Payer: Hawaii Western Management Group Commercial	$300.20
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Humana Medicare	$240.16
Rate for Payer: Kaiser Permanente Commercial	$284.40
Rate for Payer: Kaiser Permanente Medicaid	$161.16
Rate for Payer: Kaiser Permanente Medicare	$240.16
Rate for Payer: MDX Hawaii PPO	$306.52
Rate for Payer: Ohana Health Plan Medicaid	$240.16
Rate for Payer: Ohana Health Plan Medicare	$240.16
Rate for Payer: UnitedHealthcare Medicare	$240.16
Rate for Payer: University Health Alliance Commercial	$230.33

APPLICATOR ENDOSCOPIC

Facility

$316.00

Hospital Revenue Code	272
Min. Negotiated Rate	$268.60
Max. Negotiated Rate	$306.52
Rate for Payer: Cash Price	$189.60
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Kaiser Permanente Commercial	$284.40
Rate for Payer: MDX Hawaii PPO	$306.52

APRACLONIDINE 0.5 % EYE DROPS [9119]

Facility

$217.00

Service Code	NDC 61314066505
Hospital Revenue Code	637
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

APRACLONIDINE 0.5 % EYE DROPS [9119]

Facility

$217.00

Service Code	NDC 61314066505
Hospital Revenue Code	250
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$130.20
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: MDX Hawaii PPO	$210.49

AQUAMANTYS MALLEABLE BIPOLAR

Facility

$1,885.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,602.25
Max. Negotiated Rate	$1,828.45
Rate for Payer: Cash Price	$1,131.00
Rate for Payer: Health Management Network Commercial	$1,602.25
Rate for Payer: Kaiser Permanente Commercial	$1,696.50
Rate for Payer: MDX Hawaii PPO	$1,828.45

Know your out-of-pocket cost for care.

All Charges