Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

RESONATE HF ICD VR

Facility

$28,226.00

Service Code	HCPCS C1722
Hospital Revenue Code	275
Min. Negotiated Rate	$14,113.00
Max. Negotiated Rate	$27,379.22
Rate for Payer: AlohaCare Medicaid	$14,113.00
Rate for Payer: AlohaCare Medicare	$21,451.76
Rate for Payer: Cash Price	$16,935.60
Rate for Payer: Devoted Health Medicare	$23,709.84
Rate for Payer: Hawaii Medical Service Association Medicare	$21,451.76
Rate for Payer: Hawaii Western Management Group Commercial	$19,758.20
Rate for Payer: Health Management Network Commercial	$23,992.10
Rate for Payer: Humana Medicare	$21,451.76
Rate for Payer: Kaiser Permanente Commercial	$25,403.40
Rate for Payer: Kaiser Permanente Medicaid	$14,395.26
Rate for Payer: Kaiser Permanente Medicare	$21,451.76
Rate for Payer: MDX Hawaii PPO	$27,379.22
Rate for Payer: Ohana Health Plan Medicaid	$21,451.76
Rate for Payer: Ohana Health Plan Medicare	$21,451.76
Rate for Payer: UnitedHealthcare Medicare	$21,451.76
Rate for Payer: University Health Alliance Commercial	$15,806.56

RESONATE PACER HF CRT-D

Facility

$38,668.00

Service Code	HCPCS C1882
Hospital Revenue Code	275
Min. Negotiated Rate	$21,654.08
Max. Negotiated Rate	$37,507.96
Rate for Payer: Cash Price	$23,200.80
Rate for Payer: Hawaii Western Management Group Commercial	$27,067.60
Rate for Payer: Health Management Network Commercial	$32,867.80
Rate for Payer: Kaiser Permanente Commercial	$34,801.20
Rate for Payer: MDX Hawaii PPO	$37,507.96
Rate for Payer: University Health Alliance Commercial	$21,654.08

RESONATE PACER HF CRT-D

Facility

$38,668.00

Service Code	HCPCS C1882
Hospital Revenue Code	275
Min. Negotiated Rate	$19,334.00
Max. Negotiated Rate	$37,507.96
Rate for Payer: AlohaCare Medicaid	$19,334.00
Rate for Payer: AlohaCare Medicare	$29,387.68
Rate for Payer: Cash Price	$23,200.80
Rate for Payer: Devoted Health Medicare	$32,481.12
Rate for Payer: Hawaii Medical Service Association Medicare	$29,387.68
Rate for Payer: Hawaii Western Management Group Commercial	$27,067.60
Rate for Payer: Health Management Network Commercial	$32,867.80
Rate for Payer: Humana Medicare	$29,387.68
Rate for Payer: Kaiser Permanente Commercial	$34,801.20
Rate for Payer: Kaiser Permanente Medicaid	$19,720.68
Rate for Payer: Kaiser Permanente Medicare	$29,387.68
Rate for Payer: MDX Hawaii PPO	$37,507.96
Rate for Payer: Ohana Health Plan Medicaid	$29,387.68
Rate for Payer: Ohana Health Plan Medicare	$29,387.68
Rate for Payer: UnitedHealthcare Medicare	$29,387.68
Rate for Payer: University Health Alliance Commercial	$21,654.08

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$42,142.16

Service Code	MSDRG 178
Min. Negotiated Rate	$42,142.16
Max. Negotiated Rate	$42,142.16
Rate for Payer: Hawaii Medical Service Association Commercial	$42,142.16

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$42,142.16

Service Code	MSDRG 177
Min. Negotiated Rate	$42,142.16
Max. Negotiated Rate	$42,142.16
Rate for Payer: Hawaii Medical Service Association Commercial	$42,142.16

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$33,277.61

Service Code	MSDRG 179
Min. Negotiated Rate	$33,277.61
Max. Negotiated Rate	$33,277.61
Rate for Payer: Hawaii Medical Service Association Commercial	$33,277.61

RESPIRATORY NEOPLASMS WITH CC

Facility

$35,932.23

Service Code	MSDRG 181
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

RESPIRATORY NEOPLASMS WITH MCC

Facility

$35,932.23

Service Code	MSDRG 180
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$35,932.23

Service Code	MSDRG 182
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$13,486.44

Service Code	MSDRG 204
Min. Negotiated Rate	$13,486.44
Max. Negotiated Rate	$13,486.44
Rate for Payer: Hawaii Medical Service Association Commercial	$13,486.44

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$70,205.32

Service Code	MSDRG 208
Min. Negotiated Rate	$70,205.32
Max. Negotiated Rate	$70,205.32
Rate for Payer: Hawaii Medical Service Association Commercial	$70,205.32

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$185,231.13

Service Code	MSDRG 207
Min. Negotiated Rate	$185,231.13
Max. Negotiated Rate	$185,231.13
Rate for Payer: Hawaii Medical Service Association Commercial	$185,231.13

RESTORATION MODULAR 6276-7-017

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,563.28
Max. Negotiated Rate	$6,172.11
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: University Health Alliance Commercial	$3,563.28

RESTORATION MODULAR 6276-7-017

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,181.50
Max. Negotiated Rate	$6,172.11
Rate for Payer: AlohaCare Medicaid	$3,181.50
Rate for Payer: AlohaCare Medicare	$4,835.88
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Devoted Health Medicare	$5,344.92
Rate for Payer: Hawaii Medical Service Association Medicare	$4,835.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Humana Medicare	$4,835.88
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: Kaiser Permanente Medicaid	$3,245.13
Rate for Payer: Kaiser Permanente Medicare	$4,835.88
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: Ohana Health Plan Medicaid	$4,835.88
Rate for Payer: Ohana Health Plan Medicare	$4,835.88
Rate for Payer: UnitedHealthcare Medicare	$4,835.88
Rate for Payer: University Health Alliance Commercial	$3,563.28

RESTORATION MODULAR 6276-7-018

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,181.50
Max. Negotiated Rate	$6,172.11
Rate for Payer: AlohaCare Medicaid	$3,181.50
Rate for Payer: AlohaCare Medicare	$4,835.88
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Devoted Health Medicare	$5,344.92
Rate for Payer: Hawaii Medical Service Association Medicare	$4,835.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Humana Medicare	$4,835.88
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: Kaiser Permanente Medicaid	$3,245.13
Rate for Payer: Kaiser Permanente Medicare	$4,835.88
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: Ohana Health Plan Medicaid	$4,835.88
Rate for Payer: Ohana Health Plan Medicare	$4,835.88
Rate for Payer: UnitedHealthcare Medicare	$4,835.88
Rate for Payer: University Health Alliance Commercial	$3,563.28

RESTORATION MODULAR 6276-7-018

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,563.28
Max. Negotiated Rate	$6,172.11
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: University Health Alliance Commercial	$3,563.28

RESTORATION MODULAR HIP SYSTEM

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,972.24
Max. Negotiated Rate	$8,612.63
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: University Health Alliance Commercial	$4,972.24

RESTORATION MODULAR HIP SYSTEM

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,439.50
Max. Negotiated Rate	$8,612.63
Rate for Payer: AlohaCare Medicaid	$4,439.50
Rate for Payer: AlohaCare Medicare	$6,748.04
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Devoted Health Medicare	$7,458.36
Rate for Payer: Hawaii Medical Service Association Medicare	$6,748.04
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Humana Medicare	$6,748.04
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: Kaiser Permanente Medicaid	$4,528.29
Rate for Payer: Kaiser Permanente Medicare	$6,748.04
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: Ohana Health Plan Medicaid	$6,748.04
Rate for Payer: Ohana Health Plan Medicare	$6,748.04
Rate for Payer: UnitedHealthcare Medicare	$6,748.04
Rate for Payer: University Health Alliance Commercial	$4,972.24

RESTORELLE Y SMARTMESH 501430

Facility

$3,762.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,881.00
Max. Negotiated Rate	$3,649.14
Rate for Payer: AlohaCare Medicaid	$1,881.00
Rate for Payer: AlohaCare Medicare	$2,859.12
Rate for Payer: Cash Price	$2,257.20
Rate for Payer: Devoted Health Medicare	$3,160.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,859.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,633.40
Rate for Payer: Health Management Network Commercial	$3,197.70
Rate for Payer: Humana Medicare	$2,859.12
Rate for Payer: Kaiser Permanente Commercial	$3,385.80
Rate for Payer: Kaiser Permanente Medicaid	$1,918.62
Rate for Payer: Kaiser Permanente Medicare	$2,859.12
Rate for Payer: MDX Hawaii PPO	$3,649.14
Rate for Payer: Ohana Health Plan Medicaid	$2,859.12
Rate for Payer: Ohana Health Plan Medicare	$2,859.12
Rate for Payer: UnitedHealthcare Medicare	$2,859.12
Rate for Payer: University Health Alliance Commercial	$2,106.72

RESTORELLE Y SMARTMESH 501430

Facility

$3,762.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.72
Max. Negotiated Rate	$3,649.14
Rate for Payer: Cash Price	$2,257.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,633.40
Rate for Payer: Health Management Network Commercial	$3,197.70
Rate for Payer: Kaiser Permanente Commercial	$3,385.80
Rate for Payer: MDX Hawaii PPO	$3,649.14
Rate for Payer: University Health Alliance Commercial	$2,106.72

RETAINER VISCERA CENTER SPINE

Facility

$221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$214.37

RETAINER VISCERA CENTER SPINE

Facility

$221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$214.37
Rate for Payer: AlohaCare Medicaid	$110.50
Rate for Payer: AlohaCare Medicare	$167.96
Rate for Payer: Cash Price	$132.60
Rate for Payer: Devoted Health Medicare	$185.64
Rate for Payer: Hawaii Medical Service Association Medicare	$167.96
Rate for Payer: Hawaii Western Management Group Commercial	$209.95
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Humana Medicare	$167.96
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: Kaiser Permanente Medicaid	$112.71
Rate for Payer: Kaiser Permanente Medicare	$167.96
Rate for Payer: MDX Hawaii PPO	$214.37
Rate for Payer: Ohana Health Plan Medicaid	$167.96
Rate for Payer: Ohana Health Plan Medicare	$167.96
Rate for Payer: UnitedHealthcare Medicare	$167.96
Rate for Payer: University Health Alliance Commercial	$161.09

RETAIN FEMORAL SZ.5 5517-F-501

Facility

$15,986.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,952.16
Max. Negotiated Rate	$15,506.42
Rate for Payer: Cash Price	$9,591.60
Rate for Payer: Hawaii Western Management Group Commercial	$11,190.20
Rate for Payer: Health Management Network Commercial	$13,588.10
Rate for Payer: Kaiser Permanente Commercial	$14,387.40
Rate for Payer: MDX Hawaii PPO	$15,506.42
Rate for Payer: University Health Alliance Commercial	$8,952.16

RETAIN FEMORAL SZ.5 5517-F-501

Facility

$15,986.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,993.00
Max. Negotiated Rate	$15,506.42
Rate for Payer: AlohaCare Medicaid	$7,993.00
Rate for Payer: AlohaCare Medicare	$12,149.36
Rate for Payer: Cash Price	$9,591.60
Rate for Payer: Devoted Health Medicare	$13,428.24
Rate for Payer: Hawaii Medical Service Association Medicare	$12,149.36
Rate for Payer: Hawaii Western Management Group Commercial	$11,190.20
Rate for Payer: Health Management Network Commercial	$13,588.10
Rate for Payer: Humana Medicare	$12,149.36
Rate for Payer: Kaiser Permanente Commercial	$14,387.40
Rate for Payer: Kaiser Permanente Medicaid	$8,152.86
Rate for Payer: Kaiser Permanente Medicare	$12,149.36
Rate for Payer: MDX Hawaii PPO	$15,506.42
Rate for Payer: Ohana Health Plan Medicaid	$12,149.36
Rate for Payer: Ohana Health Plan Medicare	$12,149.36
Rate for Payer: UnitedHealthcare Medicare	$12,149.36
Rate for Payer: University Health Alliance Commercial	$8,952.16

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$15,975.15

Service Code	MSDRG 815
Min. Negotiated Rate	$15,975.15
Max. Negotiated Rate	$15,975.15
Rate for Payer: Hawaii Medical Service Association Commercial	$15,975.15

Know your out-of-pocket cost for care.

All Charges