Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MINERAL OIL, LIGHT STERILE [209376]

Facility

$69.00

Service Code	NDC 25410000000
Hospital Revenue Code	637
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$52.44
Rate for Payer: Cash Price	$41.40
Rate for Payer: Devoted Health Medicare	$57.96
Rate for Payer: Hawaii Medical Service Association Medicare	$52.44
Rate for Payer: Hawaii Western Management Group Commercial	$65.55
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$52.44
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$52.44
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$52.44
Rate for Payer: Ohana Health Plan Medicare	$52.44
Rate for Payer: UnitedHealthcare Medicare	$52.44
Rate for Payer: University Health Alliance Commercial	$50.29

MINI QA+ #2/O OCARD V-5 212035

Facility

$2,367.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,325.52
Max. Negotiated Rate	$2,295.99
Rate for Payer: Cash Price	$1,420.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,656.90
Rate for Payer: Health Management Network Commercial	$2,011.95
Rate for Payer: Kaiser Permanente Commercial	$2,130.30
Rate for Payer: MDX Hawaii PPO	$2,295.99
Rate for Payer: University Health Alliance Commercial	$1,325.52

MINI QA+ #2/O OCARD V-5 212035

Facility

$2,367.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,183.50
Max. Negotiated Rate	$2,295.99
Rate for Payer: AlohaCare Medicaid	$1,183.50
Rate for Payer: AlohaCare Medicare	$1,798.92
Rate for Payer: Cash Price	$1,420.20
Rate for Payer: Devoted Health Medicare	$1,988.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,798.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,656.90
Rate for Payer: Health Management Network Commercial	$2,011.95
Rate for Payer: Humana Medicare	$1,798.92
Rate for Payer: Kaiser Permanente Commercial	$2,130.30
Rate for Payer: Kaiser Permanente Medicaid	$1,207.17
Rate for Payer: Kaiser Permanente Medicare	$1,798.92
Rate for Payer: MDX Hawaii PPO	$2,295.99
Rate for Payer: Ohana Health Plan Medicaid	$1,798.92
Rate for Payer: Ohana Health Plan Medicare	$1,798.92
Rate for Payer: UnitedHealthcare Medicare	$1,798.92
Rate for Payer: University Health Alliance Commercial	$1,325.52

MINIRAIL HORIZ ARTIC M111

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: MDX Hawaii PPO	$2,409.48

MINIRAIL HORIZ ARTIC M111

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,242.00
Max. Negotiated Rate	$2,409.48
Rate for Payer: AlohaCare Medicaid	$1,242.00
Rate for Payer: AlohaCare Medicare	$1,887.84
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Devoted Health Medicare	$2,086.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Humana Medicare	$1,887.84
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: Kaiser Permanente Medicare	$1,887.84
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: Ohana Health Plan Medicaid	$1,887.84
Rate for Payer: Ohana Health Plan Medicare	$1,887.84
Rate for Payer: UnitedHealthcare Medicare	$1,887.84
Rate for Payer: University Health Alliance Commercial	$1,810.59

MINIRAIL LONG 135/5MM M102

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,242.00
Max. Negotiated Rate	$2,409.48
Rate for Payer: AlohaCare Medicaid	$1,242.00
Rate for Payer: AlohaCare Medicare	$1,887.84
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Devoted Health Medicare	$2,086.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Humana Medicare	$1,887.84
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: Kaiser Permanente Medicare	$1,887.84
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: Ohana Health Plan Medicaid	$1,887.84
Rate for Payer: Ohana Health Plan Medicare	$1,887.84
Rate for Payer: UnitedHealthcare Medicare	$1,887.84
Rate for Payer: University Health Alliance Commercial	$1,810.59

MINIRAIL LONG 135/5MM M102

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: MDX Hawaii PPO	$2,409.48

MINIRAIL SHORT 32/5MM M103

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: MDX Hawaii PPO	$2,409.48

MINIRAIL SHORT 32/5MM M103

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,242.00
Max. Negotiated Rate	$2,409.48
Rate for Payer: AlohaCare Medicaid	$1,242.00
Rate for Payer: AlohaCare Medicare	$1,887.84
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Devoted Health Medicare	$2,086.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Humana Medicare	$1,887.84
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: Kaiser Permanente Medicare	$1,887.84
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: Ohana Health Plan Medicaid	$1,887.84
Rate for Payer: Ohana Health Plan Medicare	$1,887.84
Rate for Payer: UnitedHealthcare Medicare	$1,887.84
Rate for Payer: University Health Alliance Commercial	$1,810.59

MINIRAIL SHORT SSM160

Facility

$2,835.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,409.75
Max. Negotiated Rate	$2,749.95
Rate for Payer: Cash Price	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,409.75
Rate for Payer: Kaiser Permanente Commercial	$2,551.50
Rate for Payer: MDX Hawaii PPO	$2,749.95

MINIRAIL SHORT SSM160

Facility

$2,835.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,749.95
Rate for Payer: AlohaCare Medicaid	$1,417.50
Rate for Payer: AlohaCare Medicare	$2,154.60
Rate for Payer: Cash Price	$1,701.00
Rate for Payer: Devoted Health Medicare	$2,381.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,154.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,693.25
Rate for Payer: Health Management Network Commercial	$2,409.75
Rate for Payer: Humana Medicare	$2,154.60
Rate for Payer: Kaiser Permanente Commercial	$2,551.50
Rate for Payer: Kaiser Permanente Medicaid	$1,445.85
Rate for Payer: Kaiser Permanente Medicare	$2,154.60
Rate for Payer: MDX Hawaii PPO	$2,749.95
Rate for Payer: Ohana Health Plan Medicaid	$2,154.60
Rate for Payer: Ohana Health Plan Medicare	$2,154.60
Rate for Payer: UnitedHealthcare Medicare	$2,154.60
Rate for Payer: University Health Alliance Commercial	$2,066.43

MINIRAIL STD 57/5MM M101

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,242.00
Max. Negotiated Rate	$2,409.48
Rate for Payer: AlohaCare Medicaid	$1,242.00
Rate for Payer: AlohaCare Medicare	$1,887.84
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Devoted Health Medicare	$2,086.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Humana Medicare	$1,887.84
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: Kaiser Permanente Medicare	$1,887.84
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: Ohana Health Plan Medicaid	$1,887.84
Rate for Payer: Ohana Health Plan Medicare	$1,887.84
Rate for Payer: UnitedHealthcare Medicare	$1,887.84
Rate for Payer: University Health Alliance Commercial	$1,810.59

MINIRAIL STD 57/5MM M101

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: MDX Hawaii PPO	$2,409.48

MINIRAIL VERT ARTIC M122

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,242.00
Max. Negotiated Rate	$2,409.48
Rate for Payer: AlohaCare Medicaid	$1,242.00
Rate for Payer: AlohaCare Medicare	$1,887.84
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Devoted Health Medicare	$2,086.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Humana Medicare	$1,887.84
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: Kaiser Permanente Medicare	$1,887.84
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: Ohana Health Plan Medicaid	$1,887.84
Rate for Payer: Ohana Health Plan Medicare	$1,887.84
Rate for Payer: UnitedHealthcare Medicare	$1,887.84
Rate for Payer: University Health Alliance Commercial	$1,810.59

MINIRAIL VERT ARTIC M122

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: MDX Hawaii PPO	$2,409.48

MINIRAIL W/ HINGE #SSM512

Facility

$3,626.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,082.10
Max. Negotiated Rate	$3,517.22
Rate for Payer: Cash Price	$2,175.60
Rate for Payer: Health Management Network Commercial	$3,082.10
Rate for Payer: Kaiser Permanente Commercial	$3,263.40
Rate for Payer: MDX Hawaii PPO	$3,517.22

MINIRAIL W/ HINGE #SSM512

Facility

$3,626.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,813.00
Max. Negotiated Rate	$3,517.22
Rate for Payer: AlohaCare Medicaid	$1,813.00
Rate for Payer: AlohaCare Medicare	$2,755.76
Rate for Payer: Cash Price	$2,175.60
Rate for Payer: Devoted Health Medicare	$3,045.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,755.76
Rate for Payer: Hawaii Western Management Group Commercial	$3,444.70
Rate for Payer: Health Management Network Commercial	$3,082.10
Rate for Payer: Humana Medicare	$2,755.76
Rate for Payer: Kaiser Permanente Commercial	$3,263.40
Rate for Payer: Kaiser Permanente Medicaid	$1,849.26
Rate for Payer: Kaiser Permanente Medicare	$2,755.76
Rate for Payer: MDX Hawaii PPO	$3,517.22
Rate for Payer: Ohana Health Plan Medicaid	$2,755.76
Rate for Payer: Ohana Health Plan Medicare	$2,755.76
Rate for Payer: UnitedHealthcare Medicare	$2,755.76
Rate for Payer: University Health Alliance Commercial	$2,642.99

MINOR BLADDER PROCEDURES WITH CC

Facility

$24,365.66

Service Code	MSDRG 663
Min. Negotiated Rate	$24,365.66
Max. Negotiated Rate	$24,365.66
Rate for Payer: Hawaii Medical Service Association Commercial	$24,365.66

MINOR BLADDER PROCEDURES WITH MCC

Facility

$32,827.27

Service Code	MSDRG 662
Min. Negotiated Rate	$32,827.27
Max. Negotiated Rate	$32,827.27
Rate for Payer: Hawaii Medical Service Association Commercial	$32,827.27

MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$19,151.22

Service Code	MSDRG 664
Min. Negotiated Rate	$19,151.22
Max. Negotiated Rate	$19,151.22
Rate for Payer: Hawaii Medical Service Association Commercial	$19,151.22

MINOR SKIN DISORDERS WITH MCC

Facility

$13,913.07

Service Code	MSDRG 606
Min. Negotiated Rate	$13,913.07
Max. Negotiated Rate	$13,913.07
Rate for Payer: Hawaii Medical Service Association Commercial	$13,913.07

MINOR SKIN DISORDERS WITHOUT MCC

Facility

$12,538.36

Service Code	MSDRG 607
Min. Negotiated Rate	$12,538.36
Max. Negotiated Rate	$12,538.36
Rate for Payer: Hawaii Medical Service Association Commercial	$12,538.36

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$32,448.04

Service Code	MSDRG 345
Min. Negotiated Rate	$32,448.04
Max. Negotiated Rate	$32,448.04
Rate for Payer: Hawaii Medical Service Association Commercial	$32,448.04

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$36,287.76

Service Code	MSDRG 344
Min. Negotiated Rate	$36,287.76
Max. Negotiated Rate	$36,287.76
Rate for Payer: Hawaii Medical Service Association Commercial	$36,287.76

MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$26,688.45

Service Code	MSDRG 346
Min. Negotiated Rate	$26,688.45
Max. Negotiated Rate	$26,688.45
Rate for Payer: Hawaii Medical Service Association Commercial	$26,688.45

Know your out-of-pocket cost for care.

All Charges