Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

IMPLANT SYS LNT AR-1665KBCSL

Facility

$2,458.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,229.00
Max. Negotiated Rate	$2,384.26
Rate for Payer: AlohaCare Medicaid	$1,229.00
Rate for Payer: AlohaCare Medicare	$1,868.08
Rate for Payer: Cash Price	$1,474.80
Rate for Payer: Devoted Health Medicare	$2,064.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,868.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,720.60
Rate for Payer: Health Management Network Commercial	$2,089.30
Rate for Payer: Humana Medicare	$1,868.08
Rate for Payer: Kaiser Permanente Commercial	$2,212.20
Rate for Payer: Kaiser Permanente Medicaid	$1,253.58
Rate for Payer: Kaiser Permanente Medicare	$1,868.08
Rate for Payer: MDX Hawaii PPO	$2,384.26
Rate for Payer: Ohana Health Plan Medicaid	$1,868.08
Rate for Payer: Ohana Health Plan Medicare	$1,868.08
Rate for Payer: UnitedHealthcare Medicare	$1,868.08
Rate for Payer: University Health Alliance Commercial	$1,376.48

IMPLANT SYS LNT AR-1665KBCSL

Facility

$2,458.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.48
Max. Negotiated Rate	$2,384.26
Rate for Payer: Cash Price	$1,474.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,720.60
Rate for Payer: Health Management Network Commercial	$2,089.30
Rate for Payer: Kaiser Permanente Commercial	$2,212.20
Rate for Payer: MDX Hawaii PPO	$2,384.26
Rate for Payer: University Health Alliance Commercial	$1,376.48

IMPLANT SYS MPFL AR-1360CST-CP

Facility

$3,543.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.08
Max. Negotiated Rate	$3,436.71
Rate for Payer: Cash Price	$2,125.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,480.10
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: Kaiser Permanente Commercial	$3,188.70
Rate for Payer: MDX Hawaii PPO	$3,436.71
Rate for Payer: University Health Alliance Commercial	$1,984.08

IMPLANT SYS MPFL AR-1360CST-CP

Facility

$3,543.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,771.50
Max. Negotiated Rate	$3,436.71
Rate for Payer: AlohaCare Medicaid	$1,771.50
Rate for Payer: AlohaCare Medicare	$2,692.68
Rate for Payer: Cash Price	$2,125.80
Rate for Payer: Devoted Health Medicare	$2,976.12
Rate for Payer: Hawaii Medical Service Association Medicare	$2,692.68
Rate for Payer: Hawaii Western Management Group Commercial	$2,480.10
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: Humana Medicare	$2,692.68
Rate for Payer: Kaiser Permanente Commercial	$3,188.70
Rate for Payer: Kaiser Permanente Medicaid	$1,806.93
Rate for Payer: Kaiser Permanente Medicare	$2,692.68
Rate for Payer: MDX Hawaii PPO	$3,436.71
Rate for Payer: Ohana Health Plan Medicaid	$2,692.68
Rate for Payer: Ohana Health Plan Medicare	$2,692.68
Rate for Payer: UnitedHealthcare Medicare	$2,692.68
Rate for Payer: University Health Alliance Commercial	$1,984.08

IMPLANT SYSTEM AR-8978-CP

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.40
Max. Negotiated Rate	$3,045.80
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: Kaiser Permanente Commercial	$2,826.00
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: University Health Alliance Commercial	$1,758.40

IMPLANT SYSTEM AR-8978-CP

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,570.00
Max. Negotiated Rate	$3,045.80
Rate for Payer: AlohaCare Medicaid	$1,570.00
Rate for Payer: AlohaCare Medicare	$2,386.40
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Devoted Health Medicare	$2,637.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,386.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: Humana Medicare	$2,386.40
Rate for Payer: Kaiser Permanente Commercial	$2,826.00
Rate for Payer: Kaiser Permanente Medicaid	$1,601.40
Rate for Payer: Kaiser Permanente Medicare	$2,386.40
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: Ohana Health Plan Medicaid	$2,386.40
Rate for Payer: Ohana Health Plan Medicare	$2,386.40
Rate for Payer: UnitedHealthcare Medicare	$2,386.40
Rate for Payer: University Health Alliance Commercial	$1,758.40

IMPLAN TYMPANOST 1.14MM

Facility

$194.00

Hospital Revenue Code	278
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$188.18
Rate for Payer: AlohaCare Medicaid	$97.00
Rate for Payer: AlohaCare Medicare	$147.44
Rate for Payer: Cash Price	$116.40
Rate for Payer: Devoted Health Medicare	$162.96
Rate for Payer: Hawaii Medical Service Association Medicare	$147.44
Rate for Payer: Hawaii Western Management Group Commercial	$135.80
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Humana Medicare	$147.44
Rate for Payer: Kaiser Permanente Commercial	$174.60
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: Kaiser Permanente Medicare	$147.44
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: Ohana Health Plan Medicaid	$147.44
Rate for Payer: Ohana Health Plan Medicare	$147.44
Rate for Payer: UnitedHealthcare Medicare	$147.44
Rate for Payer: University Health Alliance Commercial	$108.64

IMPLAN TYMPANOST 1.14MM

Facility

$194.00

Hospital Revenue Code	278
Min. Negotiated Rate	$108.64
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$116.40
Rate for Payer: Hawaii Western Management Group Commercial	$135.80
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Kaiser Permanente Commercial	$174.60
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: University Health Alliance Commercial	$108.64

IMPLAN TYMPANOST W/TAB 1.14

Facility

$126.00

Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$88.20
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$70.56

IMPLAN TYMPANOST W/TAB 1.14

Facility

$126.00

Hospital Revenue Code	278
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$88.20
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$70.56

IMPLAN WEIGHT EYELID 1.4G

Facility

$1,218.00

Service Code	HCPCS L8610
Hospital Revenue Code	278
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$1,181.46
Rate for Payer: AlohaCare Medicaid	$609.00
Rate for Payer: AlohaCare Medicare	$925.68
Rate for Payer: Cash Price	$730.80
Rate for Payer: Cash Price	$730.80
Rate for Payer: Devoted Health Medicare	$1,023.12
Rate for Payer: Hawaii Medical Service Association Medicare	$925.68
Rate for Payer: Hawaii Western Management Group Commercial	$852.60
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: Humana Medicare	$925.68
Rate for Payer: Kaiser Permanente Commercial	$1,096.20
Rate for Payer: Kaiser Permanente Medicaid	$621.18
Rate for Payer: Kaiser Permanente Medicare	$925.68
Rate for Payer: MDX Hawaii PPO	$1,181.46
Rate for Payer: Ohana Health Plan Medicaid	$925.68
Rate for Payer: Ohana Health Plan Medicare	$925.68
Rate for Payer: UnitedHealthcare Medicaid	$44.09
Rate for Payer: UnitedHealthcare Medicare	$925.68
Rate for Payer: University Health Alliance Commercial	$682.08

IMPLAN WEIGHT EYELID 1.4G

Facility

$1,218.00

Service Code	HCPCS L8610
Hospital Revenue Code	278
Min. Negotiated Rate	$682.08
Max. Negotiated Rate	$1,181.46
Rate for Payer: Cash Price	$730.80
Rate for Payer: Hawaii Western Management Group Commercial	$852.60
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: Kaiser Permanente Commercial	$1,096.20
Rate for Payer: MDX Hawaii PPO	$1,181.46
Rate for Payer: University Health Alliance Commercial	$682.08

IMPRESS BERENSTEIN 5FX125

Facility

$195.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: MDX Hawaii PPO	$189.15

IMPRESS BERENSTEIN 5FX125

Facility

$195.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$189.15
Rate for Payer: AlohaCare Medicaid	$97.50
Rate for Payer: AlohaCare Medicare	$148.20
Rate for Payer: Cash Price	$117.00
Rate for Payer: Devoted Health Medicare	$163.80
Rate for Payer: Hawaii Medical Service Association Medicare	$148.20
Rate for Payer: Hawaii Western Management Group Commercial	$185.25
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Humana Medicare	$148.20
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: Kaiser Permanente Medicare	$148.20
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: Ohana Health Plan Medicaid	$148.20
Rate for Payer: Ohana Health Plan Medicare	$148.20
Rate for Payer: UnitedHealthcare Medicare	$148.20
Rate for Payer: University Health Alliance Commercial	$142.14

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$85,327.20

Service Code	MSDRG 642
Min. Negotiated Rate	$85,327.20
Max. Negotiated Rate	$85,327.20
Rate for Payer: Hawaii Medical Service Association Commercial	$85,327.20

INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION [10265]

Facility

$960.00

Service Code	NDC 00517037505
Hospital Revenue Code	250
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: Kaiser Permanente Commercial	$864.00
Rate for Payer: MDX Hawaii PPO	$931.20

INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION [187932]

Facility

$720.00

Service Code	HCPCS C9300
Hospital Revenue Code	636
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$698.40
Rate for Payer: AlohaCare Medicaid	$360.00
Rate for Payer: AlohaCare Medicare	$547.20
Rate for Payer: Cash Price	$432.00
Rate for Payer: Devoted Health Medicare	$604.80
Rate for Payer: Hawaii Medical Service Association Medicare	$547.20
Rate for Payer: Hawaii Western Management Group Commercial	$684.00
Rate for Payer: Health Management Network Commercial	$612.00
Rate for Payer: Humana Medicare	$547.20
Rate for Payer: Kaiser Permanente Commercial	$648.00
Rate for Payer: Kaiser Permanente Medicaid	$367.20
Rate for Payer: Kaiser Permanente Medicare	$547.20
Rate for Payer: MDX Hawaii PPO	$698.40
Rate for Payer: Ohana Health Plan Medicaid	$547.20
Rate for Payer: Ohana Health Plan Medicare	$547.20
Rate for Payer: UnitedHealthcare Medicaid	$432.00
Rate for Payer: UnitedHealthcare Medicare	$547.20
Rate for Payer: University Health Alliance Commercial	$524.81

INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION [187932]

Facility

$720.00

Service Code	HCPCS C9300
Hospital Revenue Code	250
Min. Negotiated Rate	$612.00
Max. Negotiated Rate	$698.40
Rate for Payer: Cash Price	$432.00
Rate for Payer: Health Management Network Commercial	$612.00
Rate for Payer: Kaiser Permanente Commercial	$648.00
Rate for Payer: MDX Hawaii PPO	$698.40

INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION [10266]

Facility

$536.00

Service Code	NDC 70100082502
Hospital Revenue Code	250
Min. Negotiated Rate	$455.60
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: MDX Hawaii PPO	$519.92

INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION [10266]

Facility

$383.00

Service Code	NDC 70100042401
Hospital Revenue Code	250
Min. Negotiated Rate	$325.55
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$229.80
Rate for Payer: Health Management Network Commercial	$325.55
Rate for Payer: Kaiser Permanente Commercial	$344.70
Rate for Payer: MDX Hawaii PPO	$371.51

INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION [10266]

Facility

$383.00

Service Code	NDC 70100042402
Hospital Revenue Code	250
Min. Negotiated Rate	$325.55
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$229.80
Rate for Payer: Health Management Network Commercial	$325.55
Rate for Payer: Kaiser Permanente Commercial	$344.70
Rate for Payer: MDX Hawaii PPO	$371.51

INDOMETHACIN 25 MG CAPSULE [3897]

Facility

$2.00

Service Code	NDC 68462040601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

INDOMETHACIN 25 MG CAPSULE [3897]

Facility

$2.00

Service Code	NDC 50268043015
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

INDOMETHACIN 25 MG CAPSULE [3897]

Facility

$2.00

Service Code	NDC 50268043011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

INDOMETHACIN 25 MG CAPSULE [3897]

Facility

$2.00

Service Code	NDC 68462040601
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

Know your out-of-pocket cost for care.

All Charges