Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility

$13,178.31

Service Code	MSDRG 728
Min. Negotiated Rate	$13,178.31
Max. Negotiated Rate	$13,178.31
Rate for Payer: Hawaii Medical Service Association Commercial	$13,178.31

INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$19,435.64

Service Code	MSDRG 386
Min. Negotiated Rate	$19,435.64
Max. Negotiated Rate	$19,435.64
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64

INFLAMMATORY BOWEL DISEASE WITH MCC

Facility

$19,435.64

Service Code	MSDRG 385
Min. Negotiated Rate	$19,435.64
Max. Negotiated Rate	$19,435.64
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64

INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC

Facility

$19,435.64

Service Code	MSDRG 387
Min. Negotiated Rate	$19,435.64
Max. Negotiated Rate	$19,435.64
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64

INFLATION DEVICE COOK G34903

Facility

$235.00

Hospital Revenue Code	272
Min. Negotiated Rate	$117.50
Max. Negotiated Rate	$227.95
Rate for Payer: AlohaCare Medicaid	$117.50
Rate for Payer: AlohaCare Medicare	$178.60
Rate for Payer: Cash Price	$141.00
Rate for Payer: Devoted Health Medicare	$197.40
Rate for Payer: Hawaii Medical Service Association Medicare	$178.60
Rate for Payer: Hawaii Western Management Group Commercial	$223.25
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Humana Medicare	$178.60
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: Kaiser Permanente Medicaid	$119.85
Rate for Payer: Kaiser Permanente Medicare	$178.60
Rate for Payer: MDX Hawaii PPO	$227.95
Rate for Payer: Ohana Health Plan Medicaid	$178.60
Rate for Payer: Ohana Health Plan Medicare	$178.60
Rate for Payer: UnitedHealthcare Medicare	$178.60
Rate for Payer: University Health Alliance Commercial	$171.29

INFLATION DEVICE COOK G34903

Facility

$235.00

Hospital Revenue Code	272
Min. Negotiated Rate	$199.75
Max. Negotiated Rate	$227.95
Rate for Payer: Cash Price	$141.00
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: MDX Hawaii PPO	$227.95

INFLIXIMAB-DYYB 100 MG/10ML IV (WET SOLR VIAL) [430134057]

Facility

$1,636.00

Service Code	HCPCS Q5103
Hospital Revenue Code	636
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$1,586.92
Rate for Payer: AlohaCare Medicaid	$818.00
Rate for Payer: AlohaCare Medicare	$1,243.36
Rate for Payer: Cash Price	$981.60
Rate for Payer: Cash Price	$981.60
Rate for Payer: Devoted Health Medicare	$1,374.24
Rate for Payer: Hawaii Medical Service Association ABD	$19.68
Rate for Payer: Hawaii Medical Service Association Commercial	$32.55
Rate for Payer: Hawaii Medical Service Association Medicare	$1,243.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,554.20
Rate for Payer: Health Management Network Commercial	$1,390.60
Rate for Payer: Humana Medicare	$1,243.36
Rate for Payer: Kaiser Permanente Commercial	$1,472.40
Rate for Payer: Kaiser Permanente Medicaid	$834.36
Rate for Payer: Kaiser Permanente Medicare	$1,243.36
Rate for Payer: MDX Hawaii PPO	$1,586.92
Rate for Payer: Ohana Health Plan Medicaid	$1,243.36
Rate for Payer: Ohana Health Plan Medicare	$1,243.36
Rate for Payer: UnitedHealthcare Medicaid	$981.60
Rate for Payer: UnitedHealthcare Medicare	$1,243.36
Rate for Payer: University Health Alliance Commercial	$1,192.48

INFLIXIMAB-DYYB 100 MG/10ML IV (WET SOLR VIAL) [430134057]

Facility

$1,636.00

Service Code	HCPCS Q5103
Hospital Revenue Code	250
Min. Negotiated Rate	$1,390.60
Max. Negotiated Rate	$1,586.92
Rate for Payer: Cash Price	$981.60
Rate for Payer: Health Management Network Commercial	$1,390.60
Rate for Payer: Kaiser Permanente Commercial	$1,472.40
Rate for Payer: MDX Hawaii PPO	$1,586.92

INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [134057]

Facility

$1,636.00

Service Code	HCPCS Q5103
Hospital Revenue Code	636
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$1,586.92
Rate for Payer: AlohaCare Medicaid	$818.00
Rate for Payer: AlohaCare Medicare	$1,243.36
Rate for Payer: Cash Price	$981.60
Rate for Payer: Cash Price	$981.60
Rate for Payer: Devoted Health Medicare	$1,374.24
Rate for Payer: Hawaii Medical Service Association ABD	$19.68
Rate for Payer: Hawaii Medical Service Association Commercial	$32.55
Rate for Payer: Hawaii Medical Service Association Medicare	$1,243.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,554.20
Rate for Payer: Health Management Network Commercial	$1,390.60
Rate for Payer: Humana Medicare	$1,243.36
Rate for Payer: Kaiser Permanente Commercial	$1,472.40
Rate for Payer: Kaiser Permanente Medicaid	$834.36
Rate for Payer: Kaiser Permanente Medicare	$1,243.36
Rate for Payer: MDX Hawaii PPO	$1,586.92
Rate for Payer: Ohana Health Plan Medicaid	$1,243.36
Rate for Payer: Ohana Health Plan Medicare	$1,243.36
Rate for Payer: UnitedHealthcare Medicaid	$981.60
Rate for Payer: UnitedHealthcare Medicare	$1,243.36
Rate for Payer: University Health Alliance Commercial	$1,192.48

INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [134057]

Facility

$1,636.00

Service Code	HCPCS Q5103
Hospital Revenue Code	250
Min. Negotiated Rate	$1,390.60
Max. Negotiated Rate	$1,586.92
Rate for Payer: Cash Price	$981.60
Rate for Payer: Health Management Network Commercial	$1,390.60
Rate for Payer: Kaiser Permanente Commercial	$1,472.40
Rate for Payer: MDX Hawaii PPO	$1,586.92

INGENIO DR IS-1 GENERATOR

Facility

$12,310.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$6,893.60
Max. Negotiated Rate	$11,940.70
Rate for Payer: MDX Hawaii PPO	$11,940.70
Rate for Payer: Cash Price	$7,386.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,617.00
Rate for Payer: Health Management Network Commercial	$10,463.50
Rate for Payer: Kaiser Permanente Commercial	$11,079.00
Rate for Payer: University Health Alliance Commercial	$6,893.60

INGENIO DR IS-1 GENERATOR

Facility

$12,310.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$6,155.00
Max. Negotiated Rate	$11,940.70
Rate for Payer: AlohaCare Medicaid	$6,155.00
Rate for Payer: AlohaCare Medicare	$9,355.60
Rate for Payer: Cash Price	$7,386.00
Rate for Payer: Devoted Health Medicare	$10,340.40
Rate for Payer: Hawaii Medical Service Association Medicare	$9,355.60
Rate for Payer: Hawaii Western Management Group Commercial	$8,617.00
Rate for Payer: Health Management Network Commercial	$10,463.50
Rate for Payer: Humana Medicare	$9,355.60
Rate for Payer: Kaiser Permanente Commercial	$11,079.00
Rate for Payer: Kaiser Permanente Medicaid	$6,278.10
Rate for Payer: Kaiser Permanente Medicare	$9,355.60
Rate for Payer: MDX Hawaii PPO	$11,940.70
Rate for Payer: Ohana Health Plan Medicaid	$9,355.60
Rate for Payer: Ohana Health Plan Medicare	$9,355.60
Rate for Payer: UnitedHealthcare Medicare	$9,355.60
Rate for Payer: University Health Alliance Commercial	$6,893.60

INGEVITY LEAD 45CM

Facility

$1,302.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$729.12
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$781.20
Rate for Payer: Hawaii Western Management Group Commercial	$911.40
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: University Health Alliance Commercial	$729.12

INGEVITY LEAD 45CM

Facility

$1,302.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$989.52
Rate for Payer: Cash Price	$781.20
Rate for Payer: Devoted Health Medicare	$1,093.68
Rate for Payer: Hawaii Medical Service Association Medicare	$989.52
Rate for Payer: Hawaii Western Management Group Commercial	$911.40
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$989.52
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$989.52
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$989.52
Rate for Payer: Ohana Health Plan Medicare	$989.52
Rate for Payer: UnitedHealthcare Medicare	$989.52
Rate for Payer: University Health Alliance Commercial	$729.12

INGEVITY LEAD 59CM

Facility

$1,302.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$729.12
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$781.20
Rate for Payer: Hawaii Western Management Group Commercial	$911.40
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: University Health Alliance Commercial	$729.12

INGEVITY LEAD 59CM

Facility

$1,302.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$989.52
Rate for Payer: Cash Price	$781.20
Rate for Payer: Devoted Health Medicare	$1,093.68
Rate for Payer: Hawaii Medical Service Association Medicare	$989.52
Rate for Payer: Hawaii Western Management Group Commercial	$911.40
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$989.52
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$989.52
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$989.52
Rate for Payer: Ohana Health Plan Medicare	$989.52
Rate for Payer: UnitedHealthcare Medicare	$989.52
Rate for Payer: University Health Alliance Commercial	$729.12

INGEVITY MRI 59CM 7742

Facility

$1,875.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,818.75
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,312.50
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: MDX Hawaii PPO	$1,818.75
Rate for Payer: University Health Alliance Commercial	$1,050.00

INGEVITY MRI 59CM 7742

Facility

$1,875.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,818.75
Rate for Payer: AlohaCare Medicaid	$937.50
Rate for Payer: AlohaCare Medicare	$1,425.00
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Devoted Health Medicare	$1,575.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,425.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,312.50
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Humana Medicare	$1,425.00
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: Kaiser Permanente Medicaid	$956.25
Rate for Payer: Kaiser Permanente Medicare	$1,425.00
Rate for Payer: MDX Hawaii PPO	$1,818.75
Rate for Payer: Ohana Health Plan Medicaid	$1,425.00
Rate for Payer: Ohana Health Plan Medicare	$1,425.00
Rate for Payer: UnitedHealthcare Medicare	$1,425.00
Rate for Payer: University Health Alliance Commercial	$1,050.00

INGEVITY MRI FIX 52CM 7741

Facility

$1,875.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,818.75
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,312.50
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: MDX Hawaii PPO	$1,818.75
Rate for Payer: University Health Alliance Commercial	$1,050.00

INGEVITY MRI FIX 52CM 7741

Facility

$1,875.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,818.75
Rate for Payer: AlohaCare Medicaid	$937.50
Rate for Payer: AlohaCare Medicare	$1,425.00
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Devoted Health Medicare	$1,575.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,425.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,312.50
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Humana Medicare	$1,425.00
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: Kaiser Permanente Medicaid	$956.25
Rate for Payer: Kaiser Permanente Medicare	$1,425.00
Rate for Payer: MDX Hawaii PPO	$1,818.75
Rate for Payer: Ohana Health Plan Medicaid	$1,425.00
Rate for Payer: Ohana Health Plan Medicare	$1,425.00
Rate for Payer: UnitedHealthcare Medicare	$1,425.00
Rate for Payer: University Health Alliance Commercial	$1,050.00

INGEVITY + PACING LEAD 52CM

Facility

$1,414.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$791.84
Max. Negotiated Rate	$1,371.58
Rate for Payer: Cash Price	$848.40
Rate for Payer: Hawaii Western Management Group Commercial	$989.80
Rate for Payer: Health Management Network Commercial	$1,201.90
Rate for Payer: Kaiser Permanente Commercial	$1,272.60
Rate for Payer: MDX Hawaii PPO	$1,371.58
Rate for Payer: University Health Alliance Commercial	$791.84

INGEVITY + PACING LEAD 52CM

Facility

$1,414.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$707.00
Max. Negotiated Rate	$1,371.58
Rate for Payer: AlohaCare Medicaid	$707.00
Rate for Payer: AlohaCare Medicare	$1,074.64
Rate for Payer: Cash Price	$848.40
Rate for Payer: Devoted Health Medicare	$1,187.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,074.64
Rate for Payer: Hawaii Western Management Group Commercial	$989.80
Rate for Payer: Health Management Network Commercial	$1,201.90
Rate for Payer: Humana Medicare	$1,074.64
Rate for Payer: Kaiser Permanente Commercial	$1,272.60
Rate for Payer: Kaiser Permanente Medicaid	$721.14
Rate for Payer: Kaiser Permanente Medicare	$1,074.64
Rate for Payer: MDX Hawaii PPO	$1,371.58
Rate for Payer: Ohana Health Plan Medicaid	$1,074.64
Rate for Payer: Ohana Health Plan Medicare	$1,074.64
Rate for Payer: UnitedHealthcare Medicare	$1,074.64
Rate for Payer: University Health Alliance Commercial	$791.84

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC

Facility

$29,888.22

Service Code	MSDRG 351
Min. Negotiated Rate	$29,888.22
Max. Negotiated Rate	$29,888.22
Rate for Payer: Hawaii Medical Service Association Commercial	$29,888.22

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC

Facility

$37,117.33

Service Code	MSDRG 350
Min. Negotiated Rate	$37,117.33
Max. Negotiated Rate	$37,117.33
Rate for Payer: Hawaii Medical Service Association Commercial	$37,117.33

INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC

Facility

$15,453.70

Service Code	MSDRG 352
Min. Negotiated Rate	$15,453.70
Max. Negotiated Rate	$15,453.70
Rate for Payer: Hawaii Medical Service Association Commercial	$15,453.70

Know your out-of-pocket cost for care.

All Charges