Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC

Facility

$37,591.37

Service Code	MSDRG 274
Min. Negotiated Rate	$37,591.37
Max. Negotiated Rate	$37,591.37
Rate for Payer: Hawaii Medical Service Association Commercial	$37,591.37

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES

Facility

$57,050.71

Service Code	MSDRG 321
Min. Negotiated Rate	$57,050.71
Max. Negotiated Rate	$57,050.71
Rate for Payer: Hawaii Medical Service Association Commercial	$57,050.71

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$40,483.02

Service Code	MSDRG 322
Min. Negotiated Rate	$40,483.02
Max. Negotiated Rate	$40,483.02
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC

Facility

$47,996.55

Service Code	MSDRG 250
Min. Negotiated Rate	$47,996.55
Max. Negotiated Rate	$47,996.55
Rate for Payer: Hawaii Medical Service Association Commercial	$47,996.55

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC

Facility

$35,742.62

Service Code	MSDRG 251
Min. Negotiated Rate	$35,742.62
Max. Negotiated Rate	$35,742.62
Rate for Payer: Hawaii Medical Service Association Commercial	$35,742.62

PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$57,050.71

Service Code	MSDRG 359
Min. Negotiated Rate	$57,050.71
Max. Negotiated Rate	$57,050.71
Rate for Payer: Hawaii Medical Service Association Commercial	$57,050.71

PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$40,483.02

Service Code	MSDRG 360
Min. Negotiated Rate	$40,483.02
Max. Negotiated Rate	$40,483.02
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02

PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE

Facility

$47,996.55

Service Code	MSDRG 318
Min. Negotiated Rate	$47,996.55
Max. Negotiated Rate	$47,996.55
Rate for Payer: Hawaii Medical Service Association Commercial	$47,996.55

PERCUTANEOUS INST AR-1934PI-30

Facility

$977.00

Hospital Revenue Code	272
Min. Negotiated Rate	$488.50
Max. Negotiated Rate	$947.69
Rate for Payer: AlohaCare Medicaid	$488.50
Rate for Payer: AlohaCare Medicare	$742.52
Rate for Payer: Cash Price	$586.20
Rate for Payer: Devoted Health Medicare	$820.68
Rate for Payer: Hawaii Medical Service Association Medicare	$742.52
Rate for Payer: Hawaii Western Management Group Commercial	$928.15
Rate for Payer: Health Management Network Commercial	$830.45
Rate for Payer: Humana Medicare	$742.52
Rate for Payer: Kaiser Permanente Commercial	$879.30
Rate for Payer: Kaiser Permanente Medicaid	$498.27
Rate for Payer: Kaiser Permanente Medicare	$742.52
Rate for Payer: MDX Hawaii PPO	$947.69
Rate for Payer: Ohana Health Plan Medicaid	$742.52
Rate for Payer: Ohana Health Plan Medicare	$742.52
Rate for Payer: UnitedHealthcare Medicare	$742.52
Rate for Payer: University Health Alliance Commercial	$712.14

PERCUTANEOUS INST AR-1934PI-30

Facility

$977.00

Hospital Revenue Code	272
Min. Negotiated Rate	$830.45
Max. Negotiated Rate	$947.69
Rate for Payer: Cash Price	$586.20
Rate for Payer: Health Management Network Commercial	$830.45
Rate for Payer: Kaiser Permanente Commercial	$879.30
Rate for Payer: MDX Hawaii PPO	$947.69

PERFIX PLUG SMALL 0112950

Facility

$1,057.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$591.92
Max. Negotiated Rate	$1,025.29
Rate for Payer: Cash Price	$634.20
Rate for Payer: Hawaii Western Management Group Commercial	$739.90
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: Kaiser Permanente Commercial	$951.30
Rate for Payer: MDX Hawaii PPO	$1,025.29
Rate for Payer: University Health Alliance Commercial	$591.92

PERFIX PLUG SMALL 0112950

Facility

$1,057.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$528.50
Max. Negotiated Rate	$1,025.29
Rate for Payer: AlohaCare Medicaid	$528.50
Rate for Payer: AlohaCare Medicare	$803.32
Rate for Payer: Cash Price	$634.20
Rate for Payer: Devoted Health Medicare	$887.88
Rate for Payer: Hawaii Medical Service Association Medicare	$803.32
Rate for Payer: Hawaii Western Management Group Commercial	$739.90
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: Humana Medicare	$803.32
Rate for Payer: Kaiser Permanente Commercial	$951.30
Rate for Payer: Kaiser Permanente Medicaid	$539.07
Rate for Payer: Kaiser Permanente Medicare	$803.32
Rate for Payer: MDX Hawaii PPO	$1,025.29
Rate for Payer: Ohana Health Plan Medicaid	$803.32
Rate for Payer: Ohana Health Plan Medicare	$803.32
Rate for Payer: UnitedHealthcare Medicare	$803.32
Rate for Payer: University Health Alliance Commercial	$591.92

PERFORATOR DISP 14/11 200-241

Facility

$791.00

Hospital Revenue Code	272
Min. Negotiated Rate	$395.50
Max. Negotiated Rate	$767.27
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$601.16
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$664.44
Rate for Payer: Hawaii Medical Service Association Medicare	$601.16
Rate for Payer: Hawaii Western Management Group Commercial	$751.45
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$601.16
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$403.41
Rate for Payer: Kaiser Permanente Medicare	$601.16
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$601.16
Rate for Payer: Ohana Health Plan Medicare	$601.16
Rate for Payer: UnitedHealthcare Medicare	$601.16
Rate for Payer: University Health Alliance Commercial	$576.56

PERFORATOR DISP 14/11 200-241

Facility

$791.00

Hospital Revenue Code	272
Min. Negotiated Rate	$672.35
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: MDX Hawaii PPO	$767.27

PERFORM ANOTOM GLENOID DWE403

Facility

$4,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,591.68
Max. Negotiated Rate	$4,489.16
Rate for Payer: Cash Price	$2,776.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,239.60
Rate for Payer: Health Management Network Commercial	$3,933.80
Rate for Payer: Kaiser Permanente Commercial	$4,165.20
Rate for Payer: MDX Hawaii PPO	$4,489.16
Rate for Payer: University Health Alliance Commercial	$2,591.68

PERFORM ANOTOM GLENOID DWE403

Facility

$4,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,314.00
Max. Negotiated Rate	$4,489.16
Rate for Payer: AlohaCare Medicaid	$2,314.00
Rate for Payer: AlohaCare Medicare	$3,517.28
Rate for Payer: Cash Price	$2,776.80
Rate for Payer: Devoted Health Medicare	$3,887.52
Rate for Payer: Hawaii Medical Service Association Medicare	$3,517.28
Rate for Payer: Hawaii Western Management Group Commercial	$3,239.60
Rate for Payer: Health Management Network Commercial	$3,933.80
Rate for Payer: Humana Medicare	$3,517.28
Rate for Payer: Kaiser Permanente Commercial	$4,165.20
Rate for Payer: Kaiser Permanente Medicaid	$2,360.28
Rate for Payer: Kaiser Permanente Medicare	$3,517.28
Rate for Payer: MDX Hawaii PPO	$4,489.16
Rate for Payer: Ohana Health Plan Medicaid	$3,517.28
Rate for Payer: Ohana Health Plan Medicare	$3,517.28
Rate for Payer: UnitedHealthcare Medicare	$3,517.28
Rate for Payer: University Health Alliance Commercial	$2,591.68

PERFORM HUMERAL SYSTEM DWP2420

Facility

$2,768.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,384.00
Max. Negotiated Rate	$2,684.96
Rate for Payer: AlohaCare Medicaid	$1,384.00
Rate for Payer: AlohaCare Medicare	$2,103.68
Rate for Payer: Cash Price	$1,660.80
Rate for Payer: Devoted Health Medicare	$2,325.12
Rate for Payer: Hawaii Medical Service Association Medicare	$2,103.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,937.60
Rate for Payer: Health Management Network Commercial	$2,352.80
Rate for Payer: Humana Medicare	$2,103.68
Rate for Payer: Kaiser Permanente Commercial	$2,491.20
Rate for Payer: Kaiser Permanente Medicaid	$1,411.68
Rate for Payer: Kaiser Permanente Medicare	$2,103.68
Rate for Payer: MDX Hawaii PPO	$2,684.96
Rate for Payer: Ohana Health Plan Medicaid	$2,103.68
Rate for Payer: Ohana Health Plan Medicare	$2,103.68
Rate for Payer: UnitedHealthcare Medicare	$2,103.68
Rate for Payer: University Health Alliance Commercial	$1,550.08

PERFORM HUMERAL SYSTEM DWP2420

Facility

$2,768.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.08
Max. Negotiated Rate	$2,684.96
Rate for Payer: Cash Price	$1,660.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,937.60
Rate for Payer: Health Management Network Commercial	$2,352.80
Rate for Payer: Kaiser Permanente Commercial	$2,491.20
Rate for Payer: MDX Hawaii PPO	$2,684.96
Rate for Payer: University Health Alliance Commercial	$1,550.08

PERFORM HUMERAL SYSTEM DWX3SS

Facility

$10,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,381.00
Max. Negotiated Rate	$10,439.14
Rate for Payer: AlohaCare Medicaid	$5,381.00
Rate for Payer: AlohaCare Medicare	$8,179.12
Rate for Payer: Cash Price	$6,457.20
Rate for Payer: Devoted Health Medicare	$9,040.08
Rate for Payer: Hawaii Medical Service Association Medicare	$8,179.12
Rate for Payer: Hawaii Western Management Group Commercial	$7,533.40
Rate for Payer: Health Management Network Commercial	$9,147.70
Rate for Payer: Humana Medicare	$8,179.12
Rate for Payer: Kaiser Permanente Commercial	$9,685.80
Rate for Payer: Kaiser Permanente Medicaid	$5,488.62
Rate for Payer: Kaiser Permanente Medicare	$8,179.12
Rate for Payer: MDX Hawaii PPO	$10,439.14
Rate for Payer: Ohana Health Plan Medicaid	$8,179.12
Rate for Payer: Ohana Health Plan Medicare	$8,179.12
Rate for Payer: UnitedHealthcare Medicare	$8,179.12
Rate for Payer: University Health Alliance Commercial	$6,026.72

PERFORM HUMERAL SYSTEM DWX3SS

Facility

$10,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,026.72
Max. Negotiated Rate	$10,439.14
Rate for Payer: Cash Price	$6,457.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,533.40
Rate for Payer: Health Management Network Commercial	$9,147.70
Rate for Payer: Kaiser Permanente Commercial	$9,685.80
Rate for Payer: MDX Hawaii PPO	$10,439.14
Rate for Payer: University Health Alliance Commercial	$6,026.72

PERFORM REVERSE GLENOID DWJ012

Facility

$6,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,014.00
Max. Negotiated Rate	$5,847.16
Rate for Payer: AlohaCare Medicaid	$3,014.00
Rate for Payer: AlohaCare Medicare	$4,581.28
Rate for Payer: Cash Price	$3,616.80
Rate for Payer: Devoted Health Medicare	$5,063.52
Rate for Payer: Hawaii Medical Service Association Medicare	$4,581.28
Rate for Payer: Hawaii Western Management Group Commercial	$4,219.60
Rate for Payer: Health Management Network Commercial	$5,123.80
Rate for Payer: Humana Medicare	$4,581.28
Rate for Payer: Kaiser Permanente Commercial	$5,425.20
Rate for Payer: Kaiser Permanente Medicaid	$3,074.28
Rate for Payer: Kaiser Permanente Medicare	$4,581.28
Rate for Payer: MDX Hawaii PPO	$5,847.16
Rate for Payer: Ohana Health Plan Medicaid	$4,581.28
Rate for Payer: Ohana Health Plan Medicare	$4,581.28
Rate for Payer: UnitedHealthcare Medicare	$4,581.28
Rate for Payer: University Health Alliance Commercial	$3,375.68

PERFORM REVERSE GLENOID DWJ012

Facility

$6,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,375.68
Max. Negotiated Rate	$5,847.16
Rate for Payer: Cash Price	$3,616.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,219.60
Rate for Payer: Health Management Network Commercial	$5,123.80
Rate for Payer: Kaiser Permanente Commercial	$5,425.20
Rate for Payer: MDX Hawaii PPO	$5,847.16
Rate for Payer: University Health Alliance Commercial	$3,375.68

PERINEAL PAD SUPINE 72200634

Facility

$354.00

Hospital Revenue Code	272
Min. Negotiated Rate	$300.90
Max. Negotiated Rate	$343.38
Rate for Payer: Cash Price	$212.40
Rate for Payer: Health Management Network Commercial	$300.90
Rate for Payer: Kaiser Permanente Commercial	$318.60
Rate for Payer: MDX Hawaii PPO	$343.38

PERINEAL PAD SUPINE 72200634

Facility

$354.00

Hospital Revenue Code	272
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$343.38
Rate for Payer: AlohaCare Medicaid	$177.00
Rate for Payer: AlohaCare Medicare	$269.04
Rate for Payer: Cash Price	$212.40
Rate for Payer: Devoted Health Medicare	$297.36
Rate for Payer: Hawaii Medical Service Association Medicare	$269.04
Rate for Payer: Hawaii Western Management Group Commercial	$336.30
Rate for Payer: Health Management Network Commercial	$300.90
Rate for Payer: Humana Medicare	$269.04
Rate for Payer: Kaiser Permanente Commercial	$318.60
Rate for Payer: Kaiser Permanente Medicaid	$180.54
Rate for Payer: Kaiser Permanente Medicare	$269.04
Rate for Payer: MDX Hawaii PPO	$343.38
Rate for Payer: Ohana Health Plan Medicaid	$269.04
Rate for Payer: Ohana Health Plan Medicare	$269.04
Rate for Payer: UnitedHealthcare Medicare	$269.04
Rate for Payer: University Health Alliance Commercial	$258.03

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$58,093.60

Service Code	MSDRG 041
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$58,093.60
Rate for Payer: Hawaii Medical Service Association Commercial	$58,093.60
Rate for Payer: University Health Alliance Commercial	$10,400.00

Know your out-of-pocket cost for care.

All Charges