Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$23,678.30

Service Code	MSDRG 055
Min. Negotiated Rate	$23,678.30
Max. Negotiated Rate	$23,678.30
Rate for Payer: Hawaii Medical Service Association Commercial	$23,678.30

NEUROLOGICAL EYE DISORDERS

Facility

$16,638.80

Service Code	MSDRG 123
Min. Negotiated Rate	$16,638.80
Max. Negotiated Rate	$16,638.80
Rate for Payer: Hawaii Medical Service Association Commercial	$16,638.80

NEUROSES EXCEPT DEPRESSIVE

Facility

$9,528.20

Service Code	MSDRG 882
Min. Negotiated Rate	$9,528.20
Max. Negotiated Rate	$9,528.20
Rate for Payer: Hawaii Medical Service Association Commercial	$9,528.20

NEUROSTIMULATOR EXTERNL 353101

Facility

$1,470.00

Service Code	HCPCS C1787
Hospital Revenue Code	272
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Kaiser Permanente Commercial	$1,323.00
Rate for Payer: MDX Hawaii PPO	$1,425.90

NEUROSTIMULATOR EXTERNL 353101

Facility

$1,470.00

Service Code	HCPCS C1787
Hospital Revenue Code	272
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,425.90
Rate for Payer: AlohaCare Medicaid	$735.00
Rate for Payer: AlohaCare Medicare	$1,117.20
Rate for Payer: Cash Price	$882.00
Rate for Payer: Devoted Health Medicare	$1,234.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,117.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Humana Medicare	$1,117.20
Rate for Payer: Kaiser Permanente Commercial	$1,323.00
Rate for Payer: Kaiser Permanente Medicaid	$749.70
Rate for Payer: Kaiser Permanente Medicare	$1,117.20
Rate for Payer: MDX Hawaii PPO	$1,425.90
Rate for Payer: Ohana Health Plan Medicaid	$1,117.20
Rate for Payer: Ohana Health Plan Medicare	$1,117.20
Rate for Payer: UnitedHealthcare Medicare	$1,117.20
Rate for Payer: University Health Alliance Commercial	$1,071.48

NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION [24119]

Facility

$285.00

Service Code	NDC 65862005724
Hospital Revenue Code	637
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$276.45
Rate for Payer: AlohaCare Medicaid	$142.50
Rate for Payer: AlohaCare Medicare	$216.60
Rate for Payer: Cash Price	$171.00
Rate for Payer: Devoted Health Medicare	$239.40
Rate for Payer: Hawaii Medical Service Association Medicare	$216.60
Rate for Payer: Hawaii Western Management Group Commercial	$270.75
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Humana Medicare	$216.60
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: Kaiser Permanente Medicaid	$145.35
Rate for Payer: Kaiser Permanente Medicare	$216.60
Rate for Payer: MDX Hawaii PPO	$276.45
Rate for Payer: Ohana Health Plan Medicaid	$216.60
Rate for Payer: Ohana Health Plan Medicare	$216.60
Rate for Payer: UnitedHealthcare Medicare	$216.60
Rate for Payer: University Health Alliance Commercial	$207.74

NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION [24119]

Facility

$285.00

Service Code	NDC 65862005724
Hospital Revenue Code	250
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$171.00
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: MDX Hawaii PPO	$276.45

NEXGEN 12X155MM STR 5988-11-12

Facility

$2,239.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,119.50
Max. Negotiated Rate	$2,171.83
Rate for Payer: AlohaCare Medicaid	$1,119.50
Rate for Payer: AlohaCare Medicare	$1,701.64
Rate for Payer: Cash Price	$1,343.40
Rate for Payer: Devoted Health Medicare	$1,880.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,701.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,567.30
Rate for Payer: Health Management Network Commercial	$1,903.15
Rate for Payer: Humana Medicare	$1,701.64
Rate for Payer: Kaiser Permanente Commercial	$2,015.10
Rate for Payer: Kaiser Permanente Medicaid	$1,141.89
Rate for Payer: Kaiser Permanente Medicare	$1,701.64
Rate for Payer: MDX Hawaii PPO	$2,171.83
Rate for Payer: Ohana Health Plan Medicaid	$1,701.64
Rate for Payer: Ohana Health Plan Medicare	$1,701.64
Rate for Payer: UnitedHealthcare Medicare	$1,701.64
Rate for Payer: University Health Alliance Commercial	$1,253.84

NEXGEN 12X155MM STR 5988-11-12

Facility

$2,239.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,253.84
Max. Negotiated Rate	$2,171.83
Rate for Payer: Cash Price	$1,343.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,567.30
Rate for Payer: Health Management Network Commercial	$1,903.15
Rate for Payer: Kaiser Permanente Commercial	$2,015.10
Rate for Payer: MDX Hawaii PPO	$2,171.83
Rate for Payer: University Health Alliance Commercial	$1,253.84

NEXGEN 35 POLY PAT 5972-65-35

Facility

$1,635.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$915.60
Max. Negotiated Rate	$1,585.95
Rate for Payer: Cash Price	$981.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: Kaiser Permanente Commercial	$1,471.50
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: University Health Alliance Commercial	$915.60

NEXGEN 35 POLY PAT 5972-65-35

Facility

$1,635.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$817.50
Max. Negotiated Rate	$1,585.95
Rate for Payer: AlohaCare Medicaid	$817.50
Rate for Payer: AlohaCare Medicare	$1,242.60
Rate for Payer: Cash Price	$981.00
Rate for Payer: Devoted Health Medicare	$1,373.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,242.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: Humana Medicare	$1,242.60
Rate for Payer: Kaiser Permanente Commercial	$1,471.50
Rate for Payer: Kaiser Permanente Medicaid	$833.85
Rate for Payer: Kaiser Permanente Medicare	$1,242.60
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: Ohana Health Plan Medicaid	$1,242.60
Rate for Payer: Ohana Health Plan Medicare	$1,242.60
Rate for Payer: UnitedHealthcare Medicare	$1,242.60
Rate for Payer: University Health Alliance Commercial	$915.60

NEXGEN AC 7-10M 00-5976-050-12

Facility

$2,227.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,113.50
Max. Negotiated Rate	$2,160.19
Rate for Payer: AlohaCare Medicaid	$1,113.50
Rate for Payer: AlohaCare Medicare	$1,692.52
Rate for Payer: Cash Price	$1,336.20
Rate for Payer: Devoted Health Medicare	$1,870.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,692.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,558.90
Rate for Payer: Health Management Network Commercial	$1,892.95
Rate for Payer: Humana Medicare	$1,692.52
Rate for Payer: Kaiser Permanente Commercial	$2,004.30
Rate for Payer: Kaiser Permanente Medicaid	$1,135.77
Rate for Payer: Kaiser Permanente Medicare	$1,692.52
Rate for Payer: MDX Hawaii PPO	$2,160.19
Rate for Payer: Ohana Health Plan Medicaid	$1,692.52
Rate for Payer: Ohana Health Plan Medicare	$1,692.52
Rate for Payer: UnitedHealthcare Medicare	$1,692.52
Rate for Payer: University Health Alliance Commercial	$1,247.12

NEXGEN AC 7-10M 00-5976-050-12

Facility

$2,227.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.12
Max. Negotiated Rate	$2,160.19
Rate for Payer: Cash Price	$1,336.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,558.90
Rate for Payer: Health Management Network Commercial	$1,892.95
Rate for Payer: Kaiser Permanente Commercial	$2,004.30
Rate for Payer: MDX Hawaii PPO	$2,160.19
Rate for Payer: University Health Alliance Commercial	$1,247.12

NEXGEN AC ART SUFT 5-6/GRN, 14

Facility

$2,227.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.12
Max. Negotiated Rate	$2,160.19
Rate for Payer: Cash Price	$1,336.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,558.90
Rate for Payer: Health Management Network Commercial	$1,892.95
Rate for Payer: Kaiser Permanente Commercial	$2,004.30
Rate for Payer: MDX Hawaii PPO	$2,160.19
Rate for Payer: University Health Alliance Commercial	$1,247.12

NEXGEN AC ART SUFT 5-6/GRN, 14

Facility

$2,227.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,113.50
Max. Negotiated Rate	$2,160.19
Rate for Payer: AlohaCare Medicaid	$1,113.50
Rate for Payer: AlohaCare Medicare	$1,692.52
Rate for Payer: Cash Price	$1,336.20
Rate for Payer: Devoted Health Medicare	$1,870.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,692.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,558.90
Rate for Payer: Health Management Network Commercial	$1,892.95
Rate for Payer: Humana Medicare	$1,692.52
Rate for Payer: Kaiser Permanente Commercial	$2,004.30
Rate for Payer: Kaiser Permanente Medicaid	$1,135.77
Rate for Payer: Kaiser Permanente Medicare	$1,692.52
Rate for Payer: MDX Hawaii PPO	$2,160.19
Rate for Payer: Ohana Health Plan Medicaid	$1,692.52
Rate for Payer: Ohana Health Plan Medicare	$1,692.52
Rate for Payer: UnitedHealthcare Medicare	$1,692.52
Rate for Payer: University Health Alliance Commercial	$1,247.12

NEX GEN ALL-POLY PATELLA, 26MM

Facility

$1,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$560.00
Max. Negotiated Rate	$970.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Hawaii Western Management Group Commercial	$700.00
Rate for Payer: Health Management Network Commercial	$850.00
Rate for Payer: Kaiser Permanente Commercial	$900.00
Rate for Payer: MDX Hawaii PPO	$970.00
Rate for Payer: University Health Alliance Commercial	$560.00

NEX GEN ALL-POLY PATELLA, 26MM

Facility

$1,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$970.00
Rate for Payer: AlohaCare Medicaid	$500.00
Rate for Payer: AlohaCare Medicare	$760.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Devoted Health Medicare	$840.00
Rate for Payer: Hawaii Medical Service Association Medicare	$760.00
Rate for Payer: Hawaii Western Management Group Commercial	$700.00
Rate for Payer: Health Management Network Commercial	$850.00
Rate for Payer: Humana Medicare	$760.00
Rate for Payer: Kaiser Permanente Commercial	$900.00
Rate for Payer: Kaiser Permanente Medicaid	$510.00
Rate for Payer: Kaiser Permanente Medicare	$760.00
Rate for Payer: MDX Hawaii PPO	$970.00
Rate for Payer: Ohana Health Plan Medicaid	$760.00
Rate for Payer: Ohana Health Plan Medicare	$760.00
Rate for Payer: UnitedHealthcare Medicare	$760.00
Rate for Payer: University Health Alliance Commercial	$560.00

NEX GEN ALL-POLY PATELLA, 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: AlohaCare Medicaid	$750.00
Rate for Payer: AlohaCare Medicare	$1,140.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Devoted Health Medicare	$1,260.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,140.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Humana Medicare	$1,140.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: Kaiser Permanente Medicaid	$765.00
Rate for Payer: Kaiser Permanente Medicare	$1,140.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: Ohana Health Plan Medicaid	$1,140.00
Rate for Payer: Ohana Health Plan Medicare	$1,140.00
Rate for Payer: UnitedHealthcare Medicare	$1,140.00
Rate for Payer: University Health Alliance Commercial	$840.00

NEX GEN ALL-POLY PATELLA, 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

NEXGEN ALL-POLY PATELLA, 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

NEXGEN ALL-POLY PATELLA, 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: AlohaCare Medicaid	$750.00
Rate for Payer: AlohaCare Medicare	$1,140.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Devoted Health Medicare	$1,260.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,140.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Humana Medicare	$1,140.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: Kaiser Permanente Medicaid	$765.00
Rate for Payer: Kaiser Permanente Medicare	$1,140.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: Ohana Health Plan Medicaid	$1,140.00
Rate for Payer: Ohana Health Plan Medicare	$1,140.00
Rate for Payer: UnitedHealthcare Medicare	$1,140.00
Rate for Payer: University Health Alliance Commercial	$840.00

NEXGEN ART SURF 00-5976-030-14

Facility

$2,016.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,955.52
Rate for Payer: AlohaCare Medicaid	$1,008.00
Rate for Payer: AlohaCare Medicare	$1,532.16
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Devoted Health Medicare	$1,693.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,532.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Humana Medicare	$1,532.16
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: Kaiser Permanente Medicaid	$1,028.16
Rate for Payer: Kaiser Permanente Medicare	$1,532.16
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: Ohana Health Plan Medicaid	$1,532.16
Rate for Payer: Ohana Health Plan Medicare	$1,532.16
Rate for Payer: UnitedHealthcare Medicare	$1,532.16
Rate for Payer: University Health Alliance Commercial	$1,128.96

NEXGEN ART SURF 00-5976-030-14

Facility

$2,016.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

NEXGEN COMP KNEE SOL, CRUCIATE

Facility

$7,795.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,897.50
Max. Negotiated Rate	$7,561.15
Rate for Payer: AlohaCare Medicaid	$3,897.50
Rate for Payer: AlohaCare Medicare	$5,924.20
Rate for Payer: Cash Price	$4,677.00
Rate for Payer: Devoted Health Medicare	$6,547.80
Rate for Payer: Hawaii Medical Service Association Medicare	$5,924.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,456.50
Rate for Payer: Health Management Network Commercial	$6,625.75
Rate for Payer: Humana Medicare	$5,924.20
Rate for Payer: Kaiser Permanente Commercial	$7,015.50
Rate for Payer: Kaiser Permanente Medicaid	$3,975.45
Rate for Payer: Kaiser Permanente Medicare	$5,924.20
Rate for Payer: MDX Hawaii PPO	$7,561.15
Rate for Payer: Ohana Health Plan Medicaid	$5,924.20
Rate for Payer: Ohana Health Plan Medicare	$5,924.20
Rate for Payer: UnitedHealthcare Medicare	$5,924.20
Rate for Payer: University Health Alliance Commercial	$4,365.20

NEXGEN COMP KNEE SOL, CRUCIATE

Facility

$7,795.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,365.20
Max. Negotiated Rate	$7,561.15
Rate for Payer: Cash Price	$4,677.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,456.50
Rate for Payer: Health Management Network Commercial	$6,625.75
Rate for Payer: Kaiser Permanente Commercial	$7,015.50
Rate for Payer: MDX Hawaii PPO	$7,561.15
Rate for Payer: University Health Alliance Commercial	$4,365.20

Know your out-of-pocket cost for care.

All Charges