Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$22,990.94

Service Code	MSDRG 909
Min. Negotiated Rate	$22,990.94
Max. Negotiated Rate	$22,990.94
Rate for Payer: Hawaii Medical Service Association Commercial	$22,990.94

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$152,759.39

Service Code	MSDRG 958
Min. Negotiated Rate	$152,759.39
Max. Negotiated Rate	$152,759.39
Rate for Payer: Hawaii Medical Service Association Commercial	$152,759.39

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$152,759.39

Service Code	MSDRG 957
Min. Negotiated Rate	$152,759.39
Max. Negotiated Rate	$152,759.39
Rate for Payer: Hawaii Medical Service Association Commercial	$152,759.39

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$152,759.39

Service Code	MSDRG 959
Min. Negotiated Rate	$152,759.39
Max. Negotiated Rate	$152,759.39
Rate for Payer: Hawaii Medical Service Association Commercial	$152,759.39

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$42,260.67

Service Code	MSDRG 803
Min. Negotiated Rate	$42,260.67
Max. Negotiated Rate	$42,260.67
Rate for Payer: Hawaii Medical Service Association Commercial	$42,260.67

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$42,260.67

Service Code	MSDRG 802
Min. Negotiated Rate	$42,260.67
Max. Negotiated Rate	$42,260.67
Rate for Payer: Hawaii Medical Service Association Commercial	$42,260.67

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$42,260.67

Service Code	MSDRG 804
Min. Negotiated Rate	$42,260.67
Max. Negotiated Rate	$42,260.67
Rate for Payer: Hawaii Medical Service Association Commercial	$42,260.67

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$20,454.83

Service Code	MSDRG 205
Min. Negotiated Rate	$20,454.83
Max. Negotiated Rate	$20,454.83
Rate for Payer: Hawaii Medical Service Association Commercial	$20,454.83

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$17,634.29

Service Code	MSDRG 206
Min. Negotiated Rate	$17,634.29
Max. Negotiated Rate	$17,634.29
Rate for Payer: Hawaii Medical Service Association Commercial	$17,634.29

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$60,511.21

Service Code	MSDRG 167
Min. Negotiated Rate	$60,511.21
Max. Negotiated Rate	$60,511.21
Rate for Payer: Hawaii Medical Service Association Commercial	$60,511.21

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$63,497.66

Service Code	MSDRG 166
Min. Negotiated Rate	$63,497.66
Max. Negotiated Rate	$63,497.66
Rate for Payer: Hawaii Medical Service Association Commercial	$63,497.66

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$43,232.45

Service Code	MSDRG 168
Min. Negotiated Rate	$43,232.45
Max. Negotiated Rate	$43,232.45
Rate for Payer: Hawaii Medical Service Association Commercial	$43,232.45

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$29,295.67

Service Code	MSDRG 580
Min. Negotiated Rate	$29,295.67
Max. Negotiated Rate	$29,295.67
Rate for Payer: Hawaii Medical Service Association Commercial	$29,295.67

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$46,811.45

Service Code	MSDRG 579
Min. Negotiated Rate	$46,811.45
Max. Negotiated Rate	$46,811.45
Rate for Payer: Hawaii Medical Service Association Commercial	$46,811.45

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$24,057.53

Service Code	MSDRG 581
Min. Negotiated Rate	$24,057.53
Max. Negotiated Rate	$24,057.53
Rate for Payer: Hawaii Medical Service Association Commercial	$24,057.53

OTHER VASCULAR PROCEDURES WITH CC

Facility

$67,550.70

Service Code	MSDRG 253
Min. Negotiated Rate	$67,550.70
Max. Negotiated Rate	$67,550.70
Rate for Payer: Hawaii Medical Service Association Commercial	$67,550.70

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$71,911.87

Service Code	MSDRG 252
Min. Negotiated Rate	$71,911.87
Max. Negotiated Rate	$71,911.87
Rate for Payer: Hawaii Medical Service Association Commercial	$71,911.87

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$48,826.12

Service Code	MSDRG 254
Min. Negotiated Rate	$48,826.12
Max. Negotiated Rate	$48,826.12
Rate for Payer: Hawaii Medical Service Association Commercial	$48,826.12

OTITIS MEDIA AND URI WITH MCC

Facility

$12,182.83

Service Code	MSDRG 152
Min. Negotiated Rate	$12,182.83
Max. Negotiated Rate	$12,182.83
Rate for Payer: Hawaii Medical Service Association Commercial	$12,182.83

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$10,547.39

Service Code	MSDRG 153
Min. Negotiated Rate	$10,547.39
Max. Negotiated Rate	$10,547.39
Rate for Payer: Hawaii Medical Service Association Commercial	$10,547.39

OUTBOARD TL ASSM 51-10440

Facility

$1,742.00

Hospital Revenue Code	272
Min. Negotiated Rate	$871.00
Max. Negotiated Rate	$1,689.74
Rate for Payer: AlohaCare Medicaid	$871.00
Rate for Payer: AlohaCare Medicare	$1,323.92
Rate for Payer: Cash Price	$1,045.20
Rate for Payer: Devoted Health Medicare	$1,463.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,323.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,654.90
Rate for Payer: Health Management Network Commercial	$1,480.70
Rate for Payer: Humana Medicare	$1,323.92
Rate for Payer: Kaiser Permanente Commercial	$1,567.80
Rate for Payer: Kaiser Permanente Medicaid	$888.42
Rate for Payer: Kaiser Permanente Medicare	$1,323.92
Rate for Payer: MDX Hawaii PPO	$1,689.74
Rate for Payer: Ohana Health Plan Medicaid	$1,323.92
Rate for Payer: Ohana Health Plan Medicare	$1,323.92
Rate for Payer: UnitedHealthcare Medicare	$1,323.92
Rate for Payer: University Health Alliance Commercial	$1,269.74

OUTBOARD TL ASSM 51-10440

Facility

$1,742.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,480.70
Max. Negotiated Rate	$1,689.74
Rate for Payer: Cash Price	$1,045.20
Rate for Payer: Health Management Network Commercial	$1,480.70
Rate for Payer: Kaiser Permanente Commercial	$1,567.80
Rate for Payer: MDX Hawaii PPO	$1,689.74

OVERDRILL 2.0 705137

Facility

$826.00

Hospital Revenue Code	272
Min. Negotiated Rate	$413.00
Max. Negotiated Rate	$801.22
Rate for Payer: AlohaCare Medicaid	$413.00
Rate for Payer: AlohaCare Medicare	$627.76
Rate for Payer: Cash Price	$495.60
Rate for Payer: Devoted Health Medicare	$693.84
Rate for Payer: Hawaii Medical Service Association Medicare	$627.76
Rate for Payer: Hawaii Western Management Group Commercial	$784.70
Rate for Payer: Health Management Network Commercial	$702.10
Rate for Payer: Humana Medicare	$627.76
Rate for Payer: Kaiser Permanente Commercial	$743.40
Rate for Payer: Kaiser Permanente Medicaid	$421.26
Rate for Payer: Kaiser Permanente Medicare	$627.76
Rate for Payer: MDX Hawaii PPO	$801.22
Rate for Payer: Ohana Health Plan Medicaid	$627.76
Rate for Payer: Ohana Health Plan Medicare	$627.76
Rate for Payer: UnitedHealthcare Medicare	$627.76
Rate for Payer: University Health Alliance Commercial	$602.07

OVERDRILL 2.0 705137

Facility

$826.00

Hospital Revenue Code	272
Min. Negotiated Rate	$702.10
Max. Negotiated Rate	$801.22
Rate for Payer: Cash Price	$495.60
Rate for Payer: Health Management Network Commercial	$702.10
Rate for Payer: Kaiser Permanente Commercial	$743.40
Rate for Payer: MDX Hawaii PPO	$801.22

OVERTUBE ENDOSCOPIC ACCESS

Facility

$798.00

Hospital Revenue Code	272
Min. Negotiated Rate	$678.30
Max. Negotiated Rate	$774.06
Rate for Payer: Cash Price	$478.80
Rate for Payer: Health Management Network Commercial	$678.30
Rate for Payer: Kaiser Permanente Commercial	$718.20
Rate for Payer: MDX Hawaii PPO	$774.06

Know your out-of-pocket cost for care.

All Charges