Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HEAD HUMERAL X38-13

Facility

$4,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,300.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: AlohaCare Medicaid	$2,300.00
Rate for Payer: AlohaCare Medicare	$3,496.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Devoted Health Medicare	$3,864.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,496.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,220.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Humana Medicare	$3,496.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: Kaiser Permanente Medicaid	$2,346.00
Rate for Payer: Kaiser Permanente Medicare	$3,496.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: Ohana Health Plan Medicaid	$3,496.00
Rate for Payer: Ohana Health Plan Medicare	$3,496.00
Rate for Payer: UnitedHealthcare Medicare	$3,496.00
Rate for Payer: University Health Alliance Commercial	$2,576.00

HEAD PROLINE EVOLVE 496H018

Facility

$3,846.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,153.76
Max. Negotiated Rate	$3,730.62
Rate for Payer: Cash Price	$2,307.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,692.20
Rate for Payer: Health Management Network Commercial	$3,269.10
Rate for Payer: Kaiser Permanente Commercial	$3,461.40
Rate for Payer: MDX Hawaii PPO	$3,730.62
Rate for Payer: University Health Alliance Commercial	$2,153.76

HEAD PROLINE EVOLVE 496H018

Facility

$3,846.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,923.00
Max. Negotiated Rate	$3,730.62
Rate for Payer: AlohaCare Medicaid	$1,923.00
Rate for Payer: AlohaCare Medicare	$2,922.96
Rate for Payer: Cash Price	$2,307.60
Rate for Payer: Devoted Health Medicare	$3,230.64
Rate for Payer: Hawaii Medical Service Association Medicare	$2,922.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,692.20
Rate for Payer: Health Management Network Commercial	$3,269.10
Rate for Payer: Humana Medicare	$2,922.96
Rate for Payer: Kaiser Permanente Commercial	$3,461.40
Rate for Payer: Kaiser Permanente Medicaid	$1,961.46
Rate for Payer: Kaiser Permanente Medicare	$2,922.96
Rate for Payer: MDX Hawaii PPO	$3,730.62
Rate for Payer: Ohana Health Plan Medicaid	$2,922.96
Rate for Payer: Ohana Health Plan Medicare	$2,922.96
Rate for Payer: UnitedHealthcare Medicare	$2,922.96
Rate for Payer: University Health Alliance Commercial	$2,153.76

HEAD RADIAL 09.405.580S

Facility

$8,625.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,830.00
Max. Negotiated Rate	$8,366.25
Rate for Payer: Cash Price	$5,175.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,037.50
Rate for Payer: Health Management Network Commercial	$7,331.25
Rate for Payer: Kaiser Permanente Commercial	$7,762.50
Rate for Payer: MDX Hawaii PPO	$8,366.25
Rate for Payer: University Health Alliance Commercial	$4,830.00

HEAD RADIAL 09.405.580S

Facility

$8,625.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,312.50
Max. Negotiated Rate	$8,366.25
Rate for Payer: AlohaCare Medicaid	$4,312.50
Rate for Payer: AlohaCare Medicare	$6,555.00
Rate for Payer: Cash Price	$5,175.00
Rate for Payer: Devoted Health Medicare	$7,245.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,555.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,037.50
Rate for Payer: Health Management Network Commercial	$7,331.25
Rate for Payer: Humana Medicare	$6,555.00
Rate for Payer: Kaiser Permanente Commercial	$7,762.50
Rate for Payer: Kaiser Permanente Medicaid	$4,398.75
Rate for Payer: Kaiser Permanente Medicare	$6,555.00
Rate for Payer: MDX Hawaii PPO	$8,366.25
Rate for Payer: Ohana Health Plan Medicaid	$6,555.00
Rate for Payer: Ohana Health Plan Medicare	$6,555.00
Rate for Payer: UnitedHealthcare Medicare	$6,555.00
Rate for Payer: University Health Alliance Commercial	$4,830.00

HEALICOIL RG DILATOR 72203951

Facility

$875.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$665.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$735.00
Rate for Payer: Hawaii Medical Service Association Medicare	$665.00
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$665.00
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$665.00
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$665.00
Rate for Payer: Ohana Health Plan Medicare	$665.00
Rate for Payer: UnitedHealthcare Medicare	$665.00
Rate for Payer: University Health Alliance Commercial	$490.00

HEALICOIL RG DILATOR 72203951

Facility

$875.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

HEALICOIL RSB SA 4.75 72203697

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

HEALICOIL RSB SA 4.75 72203697

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$831.50
Max. Negotiated Rate	$1,613.11
Rate for Payer: AlohaCare Medicaid	$831.50
Rate for Payer: AlohaCare Medicare	$1,263.88
Rate for Payer: Cash Price	$997.80
Rate for Payer: Devoted Health Medicare	$1,396.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,263.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Humana Medicare	$1,263.88
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: Kaiser Permanente Medicare	$1,263.88
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: Ohana Health Plan Medicaid	$1,263.88
Rate for Payer: Ohana Health Plan Medicare	$1,263.88
Rate for Payer: UnitedHealthcare Medicare	$1,263.88
Rate for Payer: University Health Alliance Commercial	$931.28

HEART FAILURE AND SHOCK WITH CC

Facility

$28,513.51

Service Code	MSDRG 292
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART FAILURE AND SHOCK WITH MCC

Facility

$28,513.51

Service Code	MSDRG 291
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART FAILURE AND SHOCK WITHOUT CC/MCC

Facility

$28,513.51

Service Code	MSDRG 293
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility

$270,036.89

Service Code	MSDRG 001
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$270,036.89
Rate for Payer: Hawaii Medical Service Association Commercial	$270,036.89
Rate for Payer: University Health Alliance Commercial	$10,400.00

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility

$270,036.89

Service Code	MSDRG 002
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$270,036.89
Rate for Payer: Hawaii Medical Service Association Commercial	$270,036.89
Rate for Payer: University Health Alliance Commercial	$10,400.00

HEMAGARD KNITTED 12X6 #HGK1206

Facility

$1,844.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,032.64
Max. Negotiated Rate	$1,788.68
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,290.80
Rate for Payer: Health Management Network Commercial	$1,567.40
Rate for Payer: Kaiser Permanente Commercial	$1,659.60
Rate for Payer: MDX Hawaii PPO	$1,788.68
Rate for Payer: University Health Alliance Commercial	$1,032.64

HEMAGARD KNITTED 12X6 #HGK1206

Facility

$1,844.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$922.00
Max. Negotiated Rate	$1,788.68
Rate for Payer: AlohaCare Medicaid	$922.00
Rate for Payer: AlohaCare Medicare	$1,401.44
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Devoted Health Medicare	$1,548.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,401.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,290.80
Rate for Payer: Health Management Network Commercial	$1,567.40
Rate for Payer: Humana Medicare	$1,401.44
Rate for Payer: Kaiser Permanente Commercial	$1,659.60
Rate for Payer: Kaiser Permanente Medicaid	$940.44
Rate for Payer: Kaiser Permanente Medicare	$1,401.44
Rate for Payer: MDX Hawaii PPO	$1,788.68
Rate for Payer: Ohana Health Plan Medicaid	$1,401.44
Rate for Payer: Ohana Health Plan Medicare	$1,401.44
Rate for Payer: UnitedHealthcare Medicare	$1,401.44
Rate for Payer: University Health Alliance Commercial	$1,032.64

HEMOCLIP RESOLUTION M00522611

Facility

$591.00

Hospital Revenue Code	272
Min. Negotiated Rate	$502.35
Max. Negotiated Rate	$573.27
Rate for Payer: Cash Price	$354.60
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Kaiser Permanente Commercial	$531.90
Rate for Payer: MDX Hawaii PPO	$573.27

HEMOCLIP RESOLUTION M00522611

Facility

$591.00

Hospital Revenue Code	272
Min. Negotiated Rate	$295.50
Max. Negotiated Rate	$573.27
Rate for Payer: AlohaCare Medicaid	$295.50
Rate for Payer: AlohaCare Medicare	$449.16
Rate for Payer: Cash Price	$354.60
Rate for Payer: Devoted Health Medicare	$496.44
Rate for Payer: Hawaii Medical Service Association Medicare	$449.16
Rate for Payer: Hawaii Western Management Group Commercial	$561.45
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Humana Medicare	$449.16
Rate for Payer: Kaiser Permanente Commercial	$531.90
Rate for Payer: Kaiser Permanente Medicaid	$301.41
Rate for Payer: Kaiser Permanente Medicare	$449.16
Rate for Payer: MDX Hawaii PPO	$573.27
Rate for Payer: Ohana Health Plan Medicaid	$449.16
Rate for Payer: Ohana Health Plan Medicare	$449.16
Rate for Payer: UnitedHealthcare Medicare	$449.16
Rate for Payer: University Health Alliance Commercial	$430.78

HEMOST ABSORBALBLE 3X4

Facility

$552.00

Hospital Revenue Code	272
Min. Negotiated Rate	$276.00
Max. Negotiated Rate	$535.44
Rate for Payer: AlohaCare Medicaid	$276.00
Rate for Payer: AlohaCare Medicare	$419.52
Rate for Payer: Cash Price	$331.20
Rate for Payer: Devoted Health Medicare	$463.68
Rate for Payer: Hawaii Medical Service Association Medicare	$419.52
Rate for Payer: Hawaii Western Management Group Commercial	$524.40
Rate for Payer: Health Management Network Commercial	$469.20
Rate for Payer: Humana Medicare	$419.52
Rate for Payer: Kaiser Permanente Commercial	$496.80
Rate for Payer: Kaiser Permanente Medicaid	$281.52
Rate for Payer: Kaiser Permanente Medicare	$419.52
Rate for Payer: MDX Hawaii PPO	$535.44
Rate for Payer: Ohana Health Plan Medicaid	$419.52
Rate for Payer: Ohana Health Plan Medicare	$419.52
Rate for Payer: UnitedHealthcare Medicare	$419.52
Rate for Payer: University Health Alliance Commercial	$402.35

HEMOST ABSORBALBLE 3X4

Facility

$552.00

Hospital Revenue Code	272
Min. Negotiated Rate	$469.20
Max. Negotiated Rate	$535.44
Rate for Payer: Cash Price	$331.20
Rate for Payer: Health Management Network Commercial	$469.20
Rate for Payer: Kaiser Permanente Commercial	$496.80
Rate for Payer: MDX Hawaii PPO	$535.44

HEMOSTAT DSTAT DRY TOPIC 3001

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$161.50
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: MDX Hawaii PPO	$184.30

HEMOSTAT DSTAT DRY TOPIC 3001

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$184.30
Rate for Payer: AlohaCare Medicaid	$95.00
Rate for Payer: AlohaCare Medicare	$144.40
Rate for Payer: Cash Price	$114.00
Rate for Payer: Devoted Health Medicare	$159.60
Rate for Payer: Hawaii Medical Service Association Medicare	$144.40
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Humana Medicare	$144.40
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: Kaiser Permanente Medicare	$144.40
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: Ohana Health Plan Medicaid	$144.40
Rate for Payer: Ohana Health Plan Medicare	$144.40
Rate for Payer: UnitedHealthcare Medicare	$144.40
Rate for Payer: University Health Alliance Commercial	$138.49

HEMOST FLEXITIP APPLICATOR

Facility

$149.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.50
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$74.50
Rate for Payer: AlohaCare Medicare	$113.24
Rate for Payer: Cash Price	$89.40
Rate for Payer: Devoted Health Medicare	$125.16
Rate for Payer: Hawaii Medical Service Association Medicare	$113.24
Rate for Payer: Hawaii Western Management Group Commercial	$141.55
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$113.24
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$113.24
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$113.24
Rate for Payer: Ohana Health Plan Medicare	$113.24
Rate for Payer: UnitedHealthcare Medicare	$113.24
Rate for Payer: University Health Alliance Commercial	$108.61

HEMOST FLEXITIP APPLICATOR

Facility

$149.00

Hospital Revenue Code	272
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$89.40
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: MDX Hawaii PPO	$144.53

HEMOST PARTICLES 3G

Facility

$812.00

Hospital Revenue Code	272
Min. Negotiated Rate	$690.20
Max. Negotiated Rate	$787.64
Rate for Payer: Cash Price	$487.20
Rate for Payer: Health Management Network Commercial	$690.20
Rate for Payer: Kaiser Permanente Commercial	$730.80
Rate for Payer: MDX Hawaii PPO	$787.64

Know your out-of-pocket cost for care.

All Charges