Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HEPATITIS B VIRUS VACCINE RECMB(PF) 5 MCG/0.5 ML INTRAMUSCULAR SYRINGE [187816]

Facility

$70.00

Service Code	NDC 00006409301
Hospital Revenue Code	250
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [203219]

Facility

$88.00

Service Code	HCPCS 90744
Hospital Revenue Code	636
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$85.36
Rate for Payer: AlohaCare Medicaid	$44.00
Rate for Payer: AlohaCare Medicare	$66.88
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Devoted Health Medicare	$73.92
Rate for Payer: Hawaii Medical Service Association ABD	$30.77
Rate for Payer: Hawaii Medical Service Association Medicare	$66.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.77
Rate for Payer: Hawaii Western Management Group Commercial	$83.60
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Humana Medicare	$66.88
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: Kaiser Permanente Medicare	$66.88
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: Ohana Health Plan Medicaid	$66.88
Rate for Payer: Ohana Health Plan Medicare	$66.88
Rate for Payer: UnitedHealthcare Medicaid	$52.80
Rate for Payer: UnitedHealthcare Medicare	$66.88
Rate for Payer: University Health Alliance Commercial	$64.14

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [203219]

Facility

$88.00

Service Code	HCPCS 90744
Hospital Revenue Code	250
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: MDX Hawaii PPO	$85.36

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90747
Hospital Revenue Code	250
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90740
Hospital Revenue Code	636
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$132.24
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Devoted Health Medicare	$146.16
Rate for Payer: Hawaii Medical Service Association ABD	$158.15
Rate for Payer: Hawaii Medical Service Association Medicare	$132.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$158.15
Rate for Payer: Hawaii Western Management Group Commercial	$165.30
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$132.24
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$132.24
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$132.24
Rate for Payer: Ohana Health Plan Medicare	$132.24
Rate for Payer: UnitedHealthcare Medicaid	$104.40
Rate for Payer: UnitedHealthcare Medicare	$132.24
Rate for Payer: University Health Alliance Commercial	$126.83

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90740
Hospital Revenue Code	250
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90747
Hospital Revenue Code	636
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$132.24
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Devoted Health Medicare	$146.16
Rate for Payer: Hawaii Medical Service Association ABD	$140.75
Rate for Payer: Hawaii Medical Service Association Medicare	$132.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$140.75
Rate for Payer: Hawaii Western Management Group Commercial	$165.30
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$132.24
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$132.24
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$132.24
Rate for Payer: Ohana Health Plan Medicare	$132.24
Rate for Payer: UnitedHealthcare Medicaid	$104.40
Rate for Payer: UnitedHealthcare Medicare	$132.24
Rate for Payer: University Health Alliance Commercial	$126.83

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$65,464.92

Service Code	MSDRG 421
Min. Negotiated Rate	$65,464.92
Max. Negotiated Rate	$65,464.92
Rate for Payer: Hawaii Medical Service Association Commercial	$65,464.92

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility

$65,464.92

Service Code	MSDRG 420
Min. Negotiated Rate	$65,464.92
Max. Negotiated Rate	$65,464.92
Rate for Payer: Hawaii Medical Service Association Commercial	$65,464.92

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC

Facility

$58,093.60

Service Code	MSDRG 422
Min. Negotiated Rate	$58,093.60
Max. Negotiated Rate	$58,093.60
Rate for Payer: Hawaii Medical Service Association Commercial	$58,093.60

HERNIA PATCH VENTRIO 5950040

Facility

$2,435.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,363.60
Max. Negotiated Rate	$2,361.95
Rate for Payer: Cash Price	$1,461.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,704.50
Rate for Payer: Health Management Network Commercial	$2,069.75
Rate for Payer: Kaiser Permanente Commercial	$2,191.50
Rate for Payer: MDX Hawaii PPO	$2,361.95
Rate for Payer: University Health Alliance Commercial	$1,363.60

HERNIA PATCH VENTRIO 5950040

Facility

$2,435.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,217.50
Max. Negotiated Rate	$2,361.95
Rate for Payer: AlohaCare Medicaid	$1,217.50
Rate for Payer: AlohaCare Medicare	$1,850.60
Rate for Payer: Cash Price	$1,461.00
Rate for Payer: Devoted Health Medicare	$2,045.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,850.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,704.50
Rate for Payer: Health Management Network Commercial	$2,069.75
Rate for Payer: Humana Medicare	$1,850.60
Rate for Payer: Kaiser Permanente Commercial	$2,191.50
Rate for Payer: Kaiser Permanente Medicaid	$1,241.85
Rate for Payer: Kaiser Permanente Medicare	$1,850.60
Rate for Payer: MDX Hawaii PPO	$2,361.95
Rate for Payer: Ohana Health Plan Medicaid	$1,850.60
Rate for Payer: Ohana Health Plan Medicare	$1,850.60
Rate for Payer: UnitedHealthcare Medicare	$1,850.60
Rate for Payer: University Health Alliance Commercial	$1,363.60

HERNIA PATCH VENTRIOST 5950030

Facility

$2,423.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,211.50
Max. Negotiated Rate	$2,350.31
Rate for Payer: AlohaCare Medicaid	$1,211.50
Rate for Payer: AlohaCare Medicare	$1,841.48
Rate for Payer: Cash Price	$1,453.80
Rate for Payer: Devoted Health Medicare	$2,035.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,841.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,696.10
Rate for Payer: Health Management Network Commercial	$2,059.55
Rate for Payer: Humana Medicare	$1,841.48
Rate for Payer: Kaiser Permanente Commercial	$2,180.70
Rate for Payer: Kaiser Permanente Medicaid	$1,235.73
Rate for Payer: Kaiser Permanente Medicare	$1,841.48
Rate for Payer: MDX Hawaii PPO	$2,350.31
Rate for Payer: Ohana Health Plan Medicaid	$1,841.48
Rate for Payer: Ohana Health Plan Medicare	$1,841.48
Rate for Payer: UnitedHealthcare Medicare	$1,841.48
Rate for Payer: University Health Alliance Commercial	$1,356.88

HERNIA PATCH VENTRIOST 5950030

Facility

$2,423.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.88
Max. Negotiated Rate	$2,350.31
Rate for Payer: Cash Price	$1,453.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,696.10
Rate for Payer: Health Management Network Commercial	$2,059.55
Rate for Payer: Kaiser Permanente Commercial	$2,180.70
Rate for Payer: MDX Hawaii PPO	$2,350.31
Rate for Payer: University Health Alliance Commercial	$1,356.88

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC

Facility

$31,950.30

Service Code	MSDRG 354
Min. Negotiated Rate	$31,950.30
Max. Negotiated Rate	$31,950.30
Rate for Payer: Hawaii Medical Service Association Commercial	$31,950.30

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC

Facility

$41,407.39

Service Code	MSDRG 353
Min. Negotiated Rate	$41,407.39
Max. Negotiated Rate	$41,407.39
Rate for Payer: Hawaii Medical Service Association Commercial	$41,407.39

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$23,607.19

Service Code	MSDRG 355
Min. Negotiated Rate	$23,607.19
Max. Negotiated Rate	$23,607.19
Rate for Payer: Hawaii Medical Service Association Commercial	$23,607.19

HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]

Facility

$179.00

Service Code	NDC 00409724803
Hospital Revenue Code	250
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$107.40
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]

Facility

$179.00

Service Code	NDC 00409724813
Hospital Revenue Code	250
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$107.40
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

HEX DRIVE CANNULATE AR-7000-13

Facility

$1,213.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,031.05
Max. Negotiated Rate	$1,176.61
Rate for Payer: Cash Price	$727.80
Rate for Payer: Health Management Network Commercial	$1,031.05
Rate for Payer: Kaiser Permanente Commercial	$1,091.70
Rate for Payer: MDX Hawaii PPO	$1,176.61

HEX DRIVE CANNULATE AR-7000-13

Facility

$1,213.00

Hospital Revenue Code	272
Min. Negotiated Rate	$606.50
Max. Negotiated Rate	$1,176.61
Rate for Payer: AlohaCare Medicaid	$606.50
Rate for Payer: AlohaCare Medicare	$921.88
Rate for Payer: Cash Price	$727.80
Rate for Payer: Devoted Health Medicare	$1,018.92
Rate for Payer: Hawaii Medical Service Association Medicare	$921.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,152.35
Rate for Payer: Health Management Network Commercial	$1,031.05
Rate for Payer: Humana Medicare	$921.88
Rate for Payer: Kaiser Permanente Commercial	$1,091.70
Rate for Payer: Kaiser Permanente Medicaid	$618.63
Rate for Payer: Kaiser Permanente Medicare	$921.88
Rate for Payer: MDX Hawaii PPO	$1,176.61
Rate for Payer: Ohana Health Plan Medicaid	$921.88
Rate for Payer: Ohana Health Plan Medicare	$921.88
Rate for Payer: UnitedHealthcare Medicare	$921.88
Rate for Payer: University Health Alliance Commercial	$884.16

HEX WRENCH 442-2

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$90.00
Rate for Payer: AlohaCare Medicare	$136.80
Rate for Payer: Cash Price	$108.00
Rate for Payer: Devoted Health Medicare	$151.20
Rate for Payer: Hawaii Medical Service Association Medicare	$136.80
Rate for Payer: Hawaii Western Management Group Commercial	$171.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$136.80
Rate for Payer: Kaiser Permanente Commercial	$162.00
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$136.80
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$136.80
Rate for Payer: Ohana Health Plan Medicare	$136.80
Rate for Payer: UnitedHealthcare Medicare	$136.80
Rate for Payer: University Health Alliance Commercial	$131.20

HEX WRENCH 442-2

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Kaiser Permanente Commercial	$162.00
Rate for Payer: MDX Hawaii PPO	$174.60

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$48,517.99

Service Code	MSDRG 481
Min. Negotiated Rate	$48,517.99
Max. Negotiated Rate	$48,517.99
Rate for Payer: Hawaii Medical Service Association Commercial	$48,517.99

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$49,750.50

Service Code	MSDRG 480
Min. Negotiated Rate	$49,750.50
Max. Negotiated Rate	$49,750.50
Rate for Payer: Hawaii Medical Service Association Commercial	$49,750.50

Know your out-of-pocket cost for care.

All Charges