Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$34,391.60

Service Code	MSDRG 196
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$34,391.60

Service Code	MSDRG 198
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$34,415.30

Service Code	MSDRG 065
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$34,415.30

Service Code	MSDRG 064
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$34,415.30

Service Code	MSDRG 066
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$245,292.00

Service Code	MSDRG 021
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

$245,292.00

Service Code	MSDRG 020
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

$245,292.00

Service Code	MSDRG 022
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$18,511.26

Service Code	MSDRG 116
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,511.26
Rate for Payer: Hawaii Medical Service Association Commercial	$18,511.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$18,345.35

Service Code	MSDRG 117
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,345.35
Rate for Payer: Hawaii Medical Service Association Commercial	$18,345.35
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAUTERINE PRESSURE CATHETER

Facility

$232.00

Hospital Revenue Code	272
Min. Negotiated Rate	$116.00
Max. Negotiated Rate	$225.04
Rate for Payer: AlohaCare Medicaid	$116.00
Rate for Payer: AlohaCare Medicare	$176.32
Rate for Payer: Cash Price	$139.20
Rate for Payer: Devoted Health Medicare	$194.88
Rate for Payer: Hawaii Medical Service Association Medicare	$176.32
Rate for Payer: Hawaii Western Management Group Commercial	$220.40
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Humana Medicare	$176.32
Rate for Payer: Kaiser Permanente Commercial	$208.80
Rate for Payer: Kaiser Permanente Medicaid	$118.32
Rate for Payer: Kaiser Permanente Medicare	$176.32
Rate for Payer: MDX Hawaii PPO	$225.04
Rate for Payer: Ohana Health Plan Medicaid	$176.32
Rate for Payer: Ohana Health Plan Medicare	$176.32
Rate for Payer: UnitedHealthcare Medicare	$176.32
Rate for Payer: University Health Alliance Commercial	$169.10

INTRAUTERINE PRESSURE CATHETER

Facility

$232.00

Hospital Revenue Code	272
Min. Negotiated Rate	$197.20
Max. Negotiated Rate	$225.04
Rate for Payer: Cash Price	$139.20
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Kaiser Permanente Commercial	$208.80
Rate for Payer: MDX Hawaii PPO	$225.04

INTRO 10FR SAFESHEATH

Facility

$260.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: MDX Hawaii PPO	$252.20

INTRO 10FR SAFESHEATH

Facility

$260.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$252.20
Rate for Payer: AlohaCare Medicaid	$130.00
Rate for Payer: AlohaCare Medicare	$197.60
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$218.40
Rate for Payer: Hawaii Medical Service Association Medicare	$197.60
Rate for Payer: Hawaii Western Management Group Commercial	$247.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Humana Medicare	$197.60
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: Kaiser Permanente Medicaid	$132.60
Rate for Payer: Kaiser Permanente Medicare	$197.60
Rate for Payer: MDX Hawaii PPO	$252.20
Rate for Payer: Ohana Health Plan Medicaid	$197.60
Rate for Payer: Ohana Health Plan Medicare	$197.60
Rate for Payer: UnitedHealthcare Medicare	$197.60
Rate for Payer: University Health Alliance Commercial	$189.51

INTRO 9FR SAFESHEATH

Facility

$260.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: MDX Hawaii PPO	$252.20

INTRO 9FR SAFESHEATH

Facility

$260.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$252.20
Rate for Payer: AlohaCare Medicaid	$130.00
Rate for Payer: AlohaCare Medicare	$197.60
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$218.40
Rate for Payer: Hawaii Medical Service Association Medicare	$197.60
Rate for Payer: Hawaii Western Management Group Commercial	$247.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Humana Medicare	$197.60
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: Kaiser Permanente Medicaid	$132.60
Rate for Payer: Kaiser Permanente Medicare	$197.60
Rate for Payer: MDX Hawaii PPO	$252.20
Rate for Payer: Ohana Health Plan Medicaid	$197.60
Rate for Payer: Ohana Health Plan Medicare	$197.60
Rate for Payer: UnitedHealthcare Medicare	$197.60
Rate for Payer: University Health Alliance Commercial	$189.51

INTROD 4FR MICRO SET STIFF

Facility

$259.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$155.40
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: MDX Hawaii PPO	$251.23

INTROD 4FR MICRO SET STIFF

Facility

$259.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$251.23
Rate for Payer: AlohaCare Medicaid	$129.50
Rate for Payer: AlohaCare Medicare	$196.84
Rate for Payer: Cash Price	$155.40
Rate for Payer: Devoted Health Medicare	$217.56
Rate for Payer: Hawaii Medical Service Association Medicare	$196.84
Rate for Payer: Hawaii Western Management Group Commercial	$246.05
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Humana Medicare	$196.84
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: Kaiser Permanente Medicare	$196.84
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: Ohana Health Plan Medicaid	$196.84
Rate for Payer: Ohana Health Plan Medicare	$196.84
Rate for Payer: UnitedHealthcare Medicare	$196.84
Rate for Payer: University Health Alliance Commercial	$188.79

INTROD 6FX45CM FLEXOR CHECKFLO

Facility

$310.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$155.00
Max. Negotiated Rate	$300.70
Rate for Payer: AlohaCare Medicaid	$155.00
Rate for Payer: AlohaCare Medicare	$235.60
Rate for Payer: Cash Price	$186.00
Rate for Payer: Devoted Health Medicare	$260.40
Rate for Payer: Hawaii Medical Service Association Medicare	$235.60
Rate for Payer: Hawaii Western Management Group Commercial	$294.50
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Humana Medicare	$235.60
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: Kaiser Permanente Medicaid	$158.10
Rate for Payer: Kaiser Permanente Medicare	$235.60
Rate for Payer: MDX Hawaii PPO	$300.70
Rate for Payer: Ohana Health Plan Medicaid	$235.60
Rate for Payer: Ohana Health Plan Medicare	$235.60
Rate for Payer: UnitedHealthcare Medicare	$235.60
Rate for Payer: University Health Alliance Commercial	$225.96

INTROD 6FX45CM FLEXOR CHECKFLO

Facility

$310.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$263.50
Max. Negotiated Rate	$300.70
Rate for Payer: Cash Price	$186.00
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: MDX Hawaii PPO	$300.70

INTROD PERCUTANEOUS TRACH

Facility

$1,712.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$856.00
Max. Negotiated Rate	$1,660.64
Rate for Payer: AlohaCare Medicaid	$856.00
Rate for Payer: AlohaCare Medicare	$1,301.12
Rate for Payer: Cash Price	$1,027.20
Rate for Payer: Devoted Health Medicare	$1,438.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,301.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,626.40
Rate for Payer: Health Management Network Commercial	$1,455.20
Rate for Payer: Humana Medicare	$1,301.12
Rate for Payer: Kaiser Permanente Commercial	$1,540.80
Rate for Payer: Kaiser Permanente Medicaid	$873.12
Rate for Payer: Kaiser Permanente Medicare	$1,301.12
Rate for Payer: MDX Hawaii PPO	$1,660.64
Rate for Payer: Ohana Health Plan Medicaid	$1,301.12
Rate for Payer: Ohana Health Plan Medicare	$1,301.12
Rate for Payer: UnitedHealthcare Medicare	$1,301.12
Rate for Payer: University Health Alliance Commercial	$1,247.88

INTROD PERCUTANEOUS TRACH

Facility

$1,712.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,455.20
Max. Negotiated Rate	$1,660.64
Rate for Payer: Cash Price	$1,027.20
Rate for Payer: Health Management Network Commercial	$1,455.20
Rate for Payer: Kaiser Permanente Commercial	$1,540.80
Rate for Payer: MDX Hawaii PPO	$1,660.64

INTROD STENT INTRO SYSTEM

Facility

$332.00

Hospital Revenue Code	272
Min. Negotiated Rate	$282.20
Max. Negotiated Rate	$322.04
Rate for Payer: Cash Price	$199.20
Rate for Payer: Health Management Network Commercial	$282.20
Rate for Payer: Kaiser Permanente Commercial	$298.80
Rate for Payer: MDX Hawaii PPO	$322.04

INTROD STENT INTRO SYSTEM

Facility

$332.00

Hospital Revenue Code	272
Min. Negotiated Rate	$166.00
Max. Negotiated Rate	$322.04
Rate for Payer: AlohaCare Medicaid	$166.00
Rate for Payer: AlohaCare Medicare	$252.32
Rate for Payer: Cash Price	$199.20
Rate for Payer: Devoted Health Medicare	$278.88
Rate for Payer: Hawaii Medical Service Association Medicare	$252.32
Rate for Payer: Hawaii Western Management Group Commercial	$315.40
Rate for Payer: Health Management Network Commercial	$282.20
Rate for Payer: Humana Medicare	$252.32
Rate for Payer: Kaiser Permanente Commercial	$298.80
Rate for Payer: Kaiser Permanente Medicaid	$169.32
Rate for Payer: Kaiser Permanente Medicare	$252.32
Rate for Payer: MDX Hawaii PPO	$322.04
Rate for Payer: Ohana Health Plan Medicaid	$252.32
Rate for Payer: Ohana Health Plan Medicare	$252.32
Rate for Payer: UnitedHealthcare Medicare	$252.32
Rate for Payer: University Health Alliance Commercial	$241.99

INTRODUCER 12FRX30 PERFORMER

Facility

$240.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: MDX Hawaii PPO	$232.80

Know your out-of-pocket cost for care.

All Charges