Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HIP STEM 7.5 00-7711-007-10

Facility

$7,220.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,610.00
Max. Negotiated Rate	$7,003.40
Rate for Payer: AlohaCare Medicaid	$3,610.00
Rate for Payer: AlohaCare Medicare	$5,487.20
Rate for Payer: Cash Price	$4,332.00
Rate for Payer: Devoted Health Medicare	$6,064.80
Rate for Payer: Hawaii Medical Service Association Medicare	$5,487.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,054.00
Rate for Payer: Health Management Network Commercial	$6,137.00
Rate for Payer: Humana Medicare	$5,487.20
Rate for Payer: Kaiser Permanente Commercial	$6,498.00
Rate for Payer: Kaiser Permanente Medicaid	$3,682.20
Rate for Payer: Kaiser Permanente Medicare	$5,487.20
Rate for Payer: MDX Hawaii PPO	$7,003.40
Rate for Payer: Ohana Health Plan Medicaid	$5,487.20
Rate for Payer: Ohana Health Plan Medicare	$5,487.20
Rate for Payer: UnitedHealthcare Medicare	$5,487.20
Rate for Payer: University Health Alliance Commercial	$4,043.20

HIP STEM 7.5 00-7711-007-40

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 7.5 00-7711-007-40

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,600.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: AlohaCare Medicaid	$2,600.00
Rate for Payer: AlohaCare Medicare	$3,952.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Devoted Health Medicare	$4,368.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Humana Medicare	$3,952.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: Kaiser Permanente Medicaid	$2,652.00
Rate for Payer: Kaiser Permanente Medicare	$3,952.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: Ohana Health Plan Medicaid	$3,952.00
Rate for Payer: Ohana Health Plan Medicare	$3,952.00
Rate for Payer: UnitedHealthcare Medicare	$3,952.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM ACCOLADE II 6720-0937

Facility

$5,839.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,269.84
Max. Negotiated Rate	$5,663.83
Rate for Payer: Cash Price	$3,503.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,087.30
Rate for Payer: Health Management Network Commercial	$4,963.15
Rate for Payer: Kaiser Permanente Commercial	$5,255.10
Rate for Payer: MDX Hawaii PPO	$5,663.83
Rate for Payer: University Health Alliance Commercial	$3,269.84

HIP STEM ACCOLADE II 6720-0937

Facility

$5,839.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,919.50
Max. Negotiated Rate	$5,663.83
Rate for Payer: AlohaCare Medicaid	$2,919.50
Rate for Payer: AlohaCare Medicare	$4,437.64
Rate for Payer: Cash Price	$3,503.40
Rate for Payer: Devoted Health Medicare	$4,904.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4,437.64
Rate for Payer: Hawaii Western Management Group Commercial	$4,087.30
Rate for Payer: Health Management Network Commercial	$4,963.15
Rate for Payer: Humana Medicare	$4,437.64
Rate for Payer: Kaiser Permanente Commercial	$5,255.10
Rate for Payer: Kaiser Permanente Medicaid	$2,977.89
Rate for Payer: Kaiser Permanente Medicare	$4,437.64
Rate for Payer: MDX Hawaii PPO	$5,663.83
Rate for Payer: Ohana Health Plan Medicaid	$4,437.64
Rate for Payer: Ohana Health Plan Medicare	$4,437.64
Rate for Payer: UnitedHealthcare Medicare	$4,437.64
Rate for Payer: University Health Alliance Commercial	$3,269.84

HIP STEM SZ#8 37X117 6721-0837

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM SZ#8 37X117 6721-0837

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$5,606.60
Rate for Payer: AlohaCare Medicaid	$2,890.00
Rate for Payer: AlohaCare Medicare	$4,392.80
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Devoted Health Medicare	$4,855.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4,392.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Humana Medicare	$4,392.80
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: Kaiser Permanente Medicare	$4,392.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: Ohana Health Plan Medicaid	$4,392.80
Rate for Payer: Ohana Health Plan Medicare	$4,392.80
Rate for Payer: UnitedHealthcare Medicare	$4,392.80
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP SYS RESTORATION 6276-1-021

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,439.50
Max. Negotiated Rate	$8,612.63
Rate for Payer: AlohaCare Medicaid	$4,439.50
Rate for Payer: AlohaCare Medicare	$6,748.04
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Devoted Health Medicare	$7,458.36
Rate for Payer: Hawaii Medical Service Association Medicare	$6,748.04
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Humana Medicare	$6,748.04
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: Kaiser Permanente Medicaid	$4,528.29
Rate for Payer: Kaiser Permanente Medicare	$6,748.04
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: Ohana Health Plan Medicaid	$6,748.04
Rate for Payer: Ohana Health Plan Medicare	$6,748.04
Rate for Payer: UnitedHealthcare Medicare	$6,748.04
Rate for Payer: University Health Alliance Commercial	$4,972.24

HIP SYS RESTORATION 6276-1-021

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,972.24
Max. Negotiated Rate	$8,612.63
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: University Health Alliance Commercial	$4,972.24

HIP SYS RESTORATION 6276-7-019

Facility

$6,428.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.00
Max. Negotiated Rate	$6,235.16
Rate for Payer: AlohaCare Medicaid	$3,214.00
Rate for Payer: AlohaCare Medicare	$4,885.28
Rate for Payer: Cash Price	$3,856.80
Rate for Payer: Devoted Health Medicare	$5,399.52
Rate for Payer: Hawaii Medical Service Association Medicare	$4,885.28
Rate for Payer: Hawaii Western Management Group Commercial	$4,499.60
Rate for Payer: Health Management Network Commercial	$5,463.80
Rate for Payer: Humana Medicare	$4,885.28
Rate for Payer: Kaiser Permanente Commercial	$5,785.20
Rate for Payer: Kaiser Permanente Medicaid	$3,278.28
Rate for Payer: Kaiser Permanente Medicare	$4,885.28
Rate for Payer: MDX Hawaii PPO	$6,235.16
Rate for Payer: Ohana Health Plan Medicaid	$4,885.28
Rate for Payer: Ohana Health Plan Medicare	$4,885.28
Rate for Payer: UnitedHealthcare Medicare	$4,885.28
Rate for Payer: University Health Alliance Commercial	$3,599.68

HIP SYS RESTORATION 6276-7-019

Facility

$6,428.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,599.68
Max. Negotiated Rate	$6,235.16
Rate for Payer: Cash Price	$3,856.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,499.60
Rate for Payer: Health Management Network Commercial	$5,463.80
Rate for Payer: Kaiser Permanente Commercial	$5,785.20
Rate for Payer: MDX Hawaii PPO	$6,235.16
Rate for Payer: University Health Alliance Commercial	$3,599.68

HIP SYS RESTORATION 6276-7-418

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,181.50
Max. Negotiated Rate	$6,172.11
Rate for Payer: AlohaCare Medicaid	$3,181.50
Rate for Payer: AlohaCare Medicare	$4,835.88
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Devoted Health Medicare	$5,344.92
Rate for Payer: Hawaii Medical Service Association Medicare	$4,835.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Humana Medicare	$4,835.88
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: Kaiser Permanente Medicaid	$3,245.13
Rate for Payer: Kaiser Permanente Medicare	$4,835.88
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: Ohana Health Plan Medicaid	$4,835.88
Rate for Payer: Ohana Health Plan Medicare	$4,835.88
Rate for Payer: UnitedHealthcare Medicare	$4,835.88
Rate for Payer: University Health Alliance Commercial	$3,563.28

HIP SYS RESTORATION 6276-7-418

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,563.28
Max. Negotiated Rate	$6,172.11
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: University Health Alliance Commercial	$3,563.28

HIP SYS SZE 23MM 62726-1-123

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,972.24
Max. Negotiated Rate	$8,612.63
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: University Health Alliance Commercial	$4,972.24

HIP SYS SZE 23MM 62726-1-123

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,439.50
Max. Negotiated Rate	$8,612.63
Rate for Payer: AlohaCare Medicaid	$4,439.50
Rate for Payer: AlohaCare Medicare	$6,748.04
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Devoted Health Medicare	$7,458.36
Rate for Payer: Hawaii Medical Service Association Medicare	$6,748.04
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Humana Medicare	$6,748.04
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: Kaiser Permanente Medicaid	$4,528.29
Rate for Payer: Kaiser Permanente Medicare	$6,748.04
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: Ohana Health Plan Medicaid	$6,748.04
Rate for Payer: Ohana Health Plan Medicare	$6,748.04
Rate for Payer: UnitedHealthcare Medicare	$6,748.04
Rate for Payer: University Health Alliance Commercial	$4,972.24

HIP SYSYTEM 6276-7-022

Facility

$6,428.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.00
Max. Negotiated Rate	$6,235.16
Rate for Payer: AlohaCare Medicaid	$3,214.00
Rate for Payer: AlohaCare Medicare	$4,885.28
Rate for Payer: Cash Price	$3,856.80
Rate for Payer: Devoted Health Medicare	$5,399.52
Rate for Payer: Hawaii Medical Service Association Medicare	$4,885.28
Rate for Payer: Hawaii Western Management Group Commercial	$4,499.60
Rate for Payer: Health Management Network Commercial	$5,463.80
Rate for Payer: Humana Medicare	$4,885.28
Rate for Payer: Kaiser Permanente Commercial	$5,785.20
Rate for Payer: Kaiser Permanente Medicaid	$3,278.28
Rate for Payer: Kaiser Permanente Medicare	$4,885.28
Rate for Payer: MDX Hawaii PPO	$6,235.16
Rate for Payer: Ohana Health Plan Medicaid	$4,885.28
Rate for Payer: Ohana Health Plan Medicare	$4,885.28
Rate for Payer: UnitedHealthcare Medicare	$4,885.28
Rate for Payer: University Health Alliance Commercial	$3,599.68

HIP SYSYTEM 6276-7-022

Facility

$6,428.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,599.68
Max. Negotiated Rate	$6,235.16
Rate for Payer: Cash Price	$3,856.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,499.60
Rate for Payer: Health Management Network Commercial	$5,463.80
Rate for Payer: Kaiser Permanente Commercial	$5,785.20
Rate for Payer: MDX Hawaii PPO	$6,235.16
Rate for Payer: University Health Alliance Commercial	$3,599.68

HI-TORQUE BALANCE 014X190

Facility

$1,488.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,264.80
Max. Negotiated Rate	$1,443.36
Rate for Payer: Cash Price	$892.80
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: MDX Hawaii PPO	$1,443.36

HI-TORQUE BALANCE 014X190

Facility

$1,488.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$1,443.36
Rate for Payer: AlohaCare Medicaid	$744.00
Rate for Payer: AlohaCare Medicare	$1,130.88
Rate for Payer: Cash Price	$892.80
Rate for Payer: Devoted Health Medicare	$1,249.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,130.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,413.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Humana Medicare	$1,130.88
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: Kaiser Permanente Medicaid	$758.88
Rate for Payer: Kaiser Permanente Medicare	$1,130.88
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: Ohana Health Plan Medicaid	$1,130.88
Rate for Payer: Ohana Health Plan Medicare	$1,130.88
Rate for Payer: UnitedHealthcare Medicare	$1,130.88
Rate for Payer: University Health Alliance Commercial	$1,084.60

HI-TORQUE PILOT 50 STRT 300

Facility

$360.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: MDX Hawaii PPO	$349.20

HI-TORQUE PILOT 50 STRT 300

Facility

$360.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$349.20
Rate for Payer: AlohaCare Medicaid	$180.00
Rate for Payer: AlohaCare Medicare	$273.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Devoted Health Medicare	$302.40
Rate for Payer: Hawaii Medical Service Association Medicare	$273.60
Rate for Payer: Hawaii Western Management Group Commercial	$342.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Humana Medicare	$273.60
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: Kaiser Permanente Medicare	$273.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: Ohana Health Plan Medicaid	$273.60
Rate for Payer: Ohana Health Plan Medicare	$273.60
Rate for Payer: UnitedHealthcare Medicare	$273.60
Rate for Payer: University Health Alliance Commercial	$262.40

HI VIS HIP BURR 4.0 #7220312

Facility

$426.00

Hospital Revenue Code	272
Min. Negotiated Rate	$362.10
Max. Negotiated Rate	$413.22
Rate for Payer: Cash Price	$255.60
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: Kaiser Permanente Commercial	$383.40
Rate for Payer: MDX Hawaii PPO	$413.22

HI VIS HIP BURR 4.0 #7220312

Facility

$426.00

Hospital Revenue Code	272
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$413.22
Rate for Payer: AlohaCare Medicaid	$213.00
Rate for Payer: AlohaCare Medicare	$323.76
Rate for Payer: Cash Price	$255.60
Rate for Payer: Devoted Health Medicare	$357.84
Rate for Payer: Hawaii Medical Service Association Medicare	$323.76
Rate for Payer: Hawaii Western Management Group Commercial	$404.70
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: Humana Medicare	$323.76
Rate for Payer: Kaiser Permanente Commercial	$383.40
Rate for Payer: Kaiser Permanente Medicaid	$217.26
Rate for Payer: Kaiser Permanente Medicare	$323.76
Rate for Payer: MDX Hawaii PPO	$413.22
Rate for Payer: Ohana Health Plan Medicaid	$323.76
Rate for Payer: Ohana Health Plan Medicare	$323.76
Rate for Payer: UnitedHealthcare Medicare	$323.76
Rate for Payer: University Health Alliance Commercial	$310.51

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$99,074.36

Service Code	MSDRG 969
Min. Negotiated Rate	$99,074.36
Max. Negotiated Rate	$99,074.36
Rate for Payer: Hawaii Medical Service Association Commercial	$99,074.36

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$99,074.36

Service Code	MSDRG 970
Min. Negotiated Rate	$99,074.36
Max. Negotiated Rate	$99,074.36
Rate for Payer: Hawaii Medical Service Association Commercial	$99,074.36

Know your out-of-pocket cost for care.

All Charges