Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$57,643.26

Service Code	MSDRG 975
Min. Negotiated Rate	$57,643.26
Max. Negotiated Rate	$57,643.26
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$57,643.26

Service Code	MSDRG 974
Min. Negotiated Rate	$57,643.26
Max. Negotiated Rate	$57,643.26
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$57,643.26

Service Code	MSDRG 976
Min. Negotiated Rate	$57,643.26
Max. Negotiated Rate	$57,643.26
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26

HIV WITH OR WITHOUT OTHER RELATED CONDITION

Facility

$41,431.10

Service Code	MSDRG 977
Min. Negotiated Rate	$41,431.10
Max. Negotiated Rate	$41,431.10
Rate for Payer: Hawaii Medical Service Association Commercial	$41,431.10

HMRL RADIUS 52X17MM 5552-S-521

Facility

$6,838.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,419.00
Max. Negotiated Rate	$6,632.86
Rate for Payer: AlohaCare Medicaid	$3,419.00
Rate for Payer: AlohaCare Medicare	$5,196.88
Rate for Payer: Cash Price	$4,102.80
Rate for Payer: Devoted Health Medicare	$5,743.92
Rate for Payer: Hawaii Medical Service Association Medicare	$5,196.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,786.60
Rate for Payer: Health Management Network Commercial	$5,812.30
Rate for Payer: Humana Medicare	$5,196.88
Rate for Payer: Kaiser Permanente Commercial	$6,154.20
Rate for Payer: Kaiser Permanente Medicaid	$3,487.38
Rate for Payer: Kaiser Permanente Medicare	$5,196.88
Rate for Payer: MDX Hawaii PPO	$6,632.86
Rate for Payer: Ohana Health Plan Medicaid	$5,196.88
Rate for Payer: Ohana Health Plan Medicare	$5,196.88
Rate for Payer: UnitedHealthcare Medicare	$5,196.88
Rate for Payer: University Health Alliance Commercial	$3,829.28

HMRL RADIUS 52X17MM 5552-S-521

Facility

$6,838.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,829.28
Max. Negotiated Rate	$6,632.86
Rate for Payer: Cash Price	$4,102.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,786.60
Rate for Payer: Health Management Network Commercial	$5,812.30
Rate for Payer: Kaiser Permanente Commercial	$6,154.20
Rate for Payer: MDX Hawaii PPO	$6,632.86
Rate for Payer: University Health Alliance Commercial	$3,829.28

HOOPLATE LCP PROXI FEM 4.5MM

Facility

$4,572.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,560.32
Max. Negotiated Rate	$4,434.84
Rate for Payer: Cash Price	$2,743.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,200.40
Rate for Payer: Health Management Network Commercial	$3,886.20
Rate for Payer: Kaiser Permanente Commercial	$4,114.80
Rate for Payer: MDX Hawaii PPO	$4,434.84
Rate for Payer: University Health Alliance Commercial	$2,560.32

HOOPLATE LCP PROXI FEM 4.5MM

Facility

$4,572.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,286.00
Max. Negotiated Rate	$4,434.84
Rate for Payer: AlohaCare Medicaid	$2,286.00
Rate for Payer: AlohaCare Medicare	$3,474.72
Rate for Payer: Cash Price	$2,743.20
Rate for Payer: Devoted Health Medicare	$3,840.48
Rate for Payer: Hawaii Medical Service Association Medicare	$3,474.72
Rate for Payer: Hawaii Western Management Group Commercial	$3,200.40
Rate for Payer: Health Management Network Commercial	$3,886.20
Rate for Payer: Humana Medicare	$3,474.72
Rate for Payer: Kaiser Permanente Commercial	$4,114.80
Rate for Payer: Kaiser Permanente Medicaid	$2,331.72
Rate for Payer: Kaiser Permanente Medicare	$3,474.72
Rate for Payer: MDX Hawaii PPO	$4,434.84
Rate for Payer: Ohana Health Plan Medicaid	$3,474.72
Rate for Payer: Ohana Health Plan Medicare	$3,474.72
Rate for Payer: UnitedHealthcare Medicare	$3,474.72
Rate for Payer: University Health Alliance Commercial	$2,560.32

HSC+ 285CC 10721-285MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ 285CC 10721-285MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$2,166.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$2,394.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$2,166.00
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$2,166.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$2,166.00
Rate for Payer: Ohana Health Plan Medicare	$2,166.00
Rate for Payer: UnitedHealthcare Medicare	$2,166.00
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC GEL BREAST 440 10621-440HP

Facility

$2,085.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.60
Max. Negotiated Rate	$2,022.45
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.50
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: University Health Alliance Commercial	$1,167.60

HSC GEL BREAST 440 10621-440HP

Facility

$2,085.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.50
Max. Negotiated Rate	$2,022.45
Rate for Payer: AlohaCare Medicaid	$1,042.50
Rate for Payer: AlohaCare Medicare	$1,584.60
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Devoted Health Medicare	$1,751.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,584.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.50
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Humana Medicare	$1,584.60
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: Kaiser Permanente Medicaid	$1,063.35
Rate for Payer: Kaiser Permanente Medicare	$1,584.60
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: Ohana Health Plan Medicaid	$1,584.60
Rate for Payer: Ohana Health Plan Medicare	$1,584.60
Rate for Payer: UnitedHealthcare Medicare	$1,584.60
Rate for Payer: University Health Alliance Commercial	$1,167.60

HSC GEL BREAST LF 10621-470HP

Facility

$2,250.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,575.00
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
Rate for Payer: University Health Alliance Commercial	$1,260.00

HSC GEL BREAST LF 10621-470HP

Facility

$2,250.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
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	$1,575.00
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	$1,260.00

HSC+ RND HI RT 10721-565HP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ RND HI RT 10721-565HP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$2,166.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$2,394.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$2,166.00
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$2,166.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$2,166.00
Rate for Payer: Ohana Health Plan Medicare	$2,166.00
Rate for Payer: UnitedHealthcare Medicare	$2,166.00
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-325MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-325MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$2,166.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$2,394.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$2,166.00
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$2,166.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$2,166.00
Rate for Payer: Ohana Health Plan Medicare	$2,166.00
Rate for Payer: UnitedHealthcare Medicare	$2,166.00
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-385MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$2,166.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$2,394.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$2,166.00
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$2,166.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$2,166.00
Rate for Payer: Ohana Health Plan Medicare	$2,166.00
Rate for Payer: UnitedHealthcare Medicare	$2,166.00
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-385MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-435MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$2,166.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$2,394.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$2,166.00
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$2,166.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$2,166.00
Rate for Payer: Ohana Health Plan Medicare	$2,166.00
Rate for Payer: UnitedHealthcare Medicare	$2,166.00
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-435MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC SMOOTH RND 10721-455MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$2,166.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$2,394.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$2,166.00
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$2,166.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$2,166.00
Rate for Payer: Ohana Health Plan Medicare	$2,166.00
Rate for Payer: UnitedHealthcare Medicare	$2,166.00
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC SMOOTH RND 10721-455MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-535HP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

Know your out-of-pocket cost for care.

All Charges