Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$57,738.07

Service Code	MSDRG 574
Min. Negotiated Rate	$57,738.07
Max. Negotiated Rate	$57,738.07
Rate for Payer: Hawaii Medical Service Association Commercial	$57,738.07

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$60,890.44

Service Code	MSDRG 573
Min. Negotiated Rate	$60,890.44
Max. Negotiated Rate	$60,890.44
Rate for Payer: Hawaii Medical Service Association Commercial	$60,890.44

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$34,984.15

Service Code	MSDRG 575
Min. Negotiated Rate	$34,984.15
Max. Negotiated Rate	$34,984.15
Rate for Payer: Hawaii Medical Service Association Commercial	$34,984.15

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$46,076.69

Service Code	MSDRG 623
Min. Negotiated Rate	$46,076.69
Max. Negotiated Rate	$46,076.69
Rate for Payer: Hawaii Medical Service Association Commercial	$46,076.69

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$46,076.69

Service Code	MSDRG 622
Min. Negotiated Rate	$46,076.69
Max. Negotiated Rate	$46,076.69
Rate for Payer: Hawaii Medical Service Association Commercial	$46,076.69

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$46,076.69

Service Code	MSDRG 624
Min. Negotiated Rate	$46,076.69
Max. Negotiated Rate	$46,076.69
Rate for Payer: Hawaii Medical Service Association Commercial	$46,076.69

SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$65,061.99

Service Code	MSDRG 904
Min. Negotiated Rate	$65,061.99
Max. Negotiated Rate	$65,061.99
Rate for Payer: Hawaii Medical Service Association Commercial	$65,061.99

SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$65,061.99

Service Code	MSDRG 905
Min. Negotiated Rate	$65,061.99
Max. Negotiated Rate	$65,061.99
Rate for Payer: Hawaii Medical Service Association Commercial	$65,061.99

SKIN ULCERS WITH CC

Facility

$23,038.34

Service Code	MSDRG 593
Min. Negotiated Rate	$23,038.34
Max. Negotiated Rate	$23,038.34
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34

SKIN ULCERS WITH MCC

Facility

$23,038.34

Service Code	MSDRG 592
Min. Negotiated Rate	$23,038.34
Max. Negotiated Rate	$23,038.34
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34

SKIN ULCERS WITHOUT CC/MCC

Facility

$23,038.34

Service Code	MSDRG 594
Min. Negotiated Rate	$23,038.34
Max. Negotiated Rate	$23,038.34
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34

SLED OLECRANON OSN-70

Facility

$2,775.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,554.00
Max. Negotiated Rate	$2,691.75
Rate for Payer: Cash Price	$1,665.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,942.50
Rate for Payer: Health Management Network Commercial	$2,358.75
Rate for Payer: Kaiser Permanente Commercial	$2,497.50
Rate for Payer: MDX Hawaii PPO	$2,691.75
Rate for Payer: University Health Alliance Commercial	$1,554.00

SLED OLECRANON OSN-70

Facility

$2,775.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,691.75
Rate for Payer: AlohaCare Medicaid	$1,387.50
Rate for Payer: AlohaCare Medicare	$2,109.00
Rate for Payer: Cash Price	$1,665.00
Rate for Payer: Devoted Health Medicare	$2,331.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,109.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,942.50
Rate for Payer: Health Management Network Commercial	$2,358.75
Rate for Payer: Humana Medicare	$2,109.00
Rate for Payer: Kaiser Permanente Commercial	$2,497.50
Rate for Payer: Kaiser Permanente Medicaid	$1,415.25
Rate for Payer: Kaiser Permanente Medicare	$2,109.00
Rate for Payer: MDX Hawaii PPO	$2,691.75
Rate for Payer: Ohana Health Plan Medicaid	$2,109.00
Rate for Payer: Ohana Health Plan Medicare	$2,109.00
Rate for Payer: UnitedHealthcare Medicare	$2,109.00
Rate for Payer: University Health Alliance Commercial	$1,554.00

SLEEVE 12.0MM ST 03.010.437S

Facility

$476.00

Hospital Revenue Code	272
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$285.60
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Kaiser Permanente Commercial	$428.40
Rate for Payer: MDX Hawaii PPO	$461.72

SLEEVE 12.0MM ST 03.010.437S

Facility

$476.00

Hospital Revenue Code	272
Min. Negotiated Rate	$238.00
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$238.00
Rate for Payer: AlohaCare Medicare	$361.76
Rate for Payer: Cash Price	$285.60
Rate for Payer: Devoted Health Medicare	$399.84
Rate for Payer: Hawaii Medical Service Association Medicare	$361.76
Rate for Payer: Hawaii Western Management Group Commercial	$452.20
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$361.76
Rate for Payer: Kaiser Permanente Commercial	$428.40
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$361.76
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$361.76
Rate for Payer: Ohana Health Plan Medicare	$361.76
Rate for Payer: UnitedHealthcare Medicare	$361.76
Rate for Payer: University Health Alliance Commercial	$346.96

SLEEVE LG SCD THIGH

Facility

$131.00

Hospital Revenue Code	271
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$78.60
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: MDX Hawaii PPO	$127.07

SLEEVE LG SCD THIGH

Facility

$131.00

Hospital Revenue Code	271
Min. Negotiated Rate	$65.50
Max. Negotiated Rate	$127.07
Rate for Payer: AlohaCare Medicaid	$65.50
Rate for Payer: AlohaCare Medicare	$99.56
Rate for Payer: Cash Price	$78.60
Rate for Payer: Devoted Health Medicare	$110.04
Rate for Payer: Hawaii Medical Service Association Medicare	$99.56
Rate for Payer: Hawaii Western Management Group Commercial	$124.45
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$99.56
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$99.56
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$99.56
Rate for Payer: Ohana Health Plan Medicare	$99.56
Rate for Payer: UnitedHealthcare Medicare	$99.56
Rate for Payer: University Health Alliance Commercial	$95.49

SLEEVE NAIL INSERT 1806-1406S

Facility

$538.00

Hospital Revenue Code	272
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$521.86
Rate for Payer: Cash Price	$322.80
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: Kaiser Permanente Commercial	$484.20
Rate for Payer: MDX Hawaii PPO	$521.86

SLEEVE NAIL INSERT 1806-1406S

Facility

$538.00

Hospital Revenue Code	272
Min. Negotiated Rate	$269.00
Max. Negotiated Rate	$521.86
Rate for Payer: AlohaCare Medicaid	$269.00
Rate for Payer: AlohaCare Medicare	$408.88
Rate for Payer: Cash Price	$322.80
Rate for Payer: Devoted Health Medicare	$451.92
Rate for Payer: Hawaii Medical Service Association Medicare	$408.88
Rate for Payer: Hawaii Western Management Group Commercial	$511.10
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: Humana Medicare	$408.88
Rate for Payer: Kaiser Permanente Commercial	$484.20
Rate for Payer: Kaiser Permanente Medicaid	$274.38
Rate for Payer: Kaiser Permanente Medicare	$408.88
Rate for Payer: MDX Hawaii PPO	$521.86
Rate for Payer: Ohana Health Plan Medicaid	$408.88
Rate for Payer: Ohana Health Plan Medicare	$408.88
Rate for Payer: UnitedHealthcare Medicare	$408.88
Rate for Payer: University Health Alliance Commercial	$392.15

SLEEVE PROTCTN 10MM 03.010.038

Facility

$1,674.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$1,422.90
Max. Negotiated Rate	$1,623.78
Rate for Payer: Cash Price	$1,004.40
Rate for Payer: Health Management Network Commercial	$1,422.90
Rate for Payer: Kaiser Permanente Commercial	$1,506.60
Rate for Payer: MDX Hawaii PPO	$1,623.78

SLEEVE PROTCTN 10MM 03.010.038

Facility

$1,674.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$837.00
Max. Negotiated Rate	$1,623.78
Rate for Payer: AlohaCare Medicaid	$837.00
Rate for Payer: AlohaCare Medicare	$1,272.24
Rate for Payer: Cash Price	$1,004.40
Rate for Payer: Devoted Health Medicare	$1,406.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,272.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,590.30
Rate for Payer: Health Management Network Commercial	$1,422.90
Rate for Payer: Humana Medicare	$1,272.24
Rate for Payer: Kaiser Permanente Commercial	$1,506.60
Rate for Payer: Kaiser Permanente Medicaid	$853.74
Rate for Payer: Kaiser Permanente Medicare	$1,272.24
Rate for Payer: MDX Hawaii PPO	$1,623.78
Rate for Payer: Ohana Health Plan Medicaid	$1,272.24
Rate for Payer: Ohana Health Plan Medicare	$1,272.24
Rate for Payer: UnitedHealthcare Medicare	$1,272.24
Rate for Payer: University Health Alliance Commercial	$1,220.18

SLEEVE SCD KNEE XLG EXPRESS

Facility

$249.00

Hospital Revenue Code	271
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$241.53
Rate for Payer: AlohaCare Medicaid	$124.50
Rate for Payer: AlohaCare Medicare	$189.24
Rate for Payer: Cash Price	$149.40
Rate for Payer: Devoted Health Medicare	$209.16
Rate for Payer: Hawaii Medical Service Association Medicare	$189.24
Rate for Payer: Hawaii Western Management Group Commercial	$236.55
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Humana Medicare	$189.24
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: Kaiser Permanente Medicaid	$126.99
Rate for Payer: Kaiser Permanente Medicare	$189.24
Rate for Payer: MDX Hawaii PPO	$241.53
Rate for Payer: Ohana Health Plan Medicaid	$189.24
Rate for Payer: Ohana Health Plan Medicare	$189.24
Rate for Payer: UnitedHealthcare Medicare	$189.24
Rate for Payer: University Health Alliance Commercial	$181.50

SLEEVE SCD KNEE XLG EXPRESS

Facility

$249.00

Hospital Revenue Code	271
Min. Negotiated Rate	$211.65
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$149.40
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: MDX Hawaii PPO	$241.53

SLING ABBREVO URETHRAL

Facility

$3,439.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$1,719.50
Max. Negotiated Rate	$3,335.83
Rate for Payer: AlohaCare Medicaid	$1,719.50
Rate for Payer: AlohaCare Medicare	$2,613.64
Rate for Payer: Cash Price	$2,063.40
Rate for Payer: Devoted Health Medicare	$2,888.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,613.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,407.30
Rate for Payer: Health Management Network Commercial	$2,923.15
Rate for Payer: Humana Medicare	$2,613.64
Rate for Payer: Kaiser Permanente Commercial	$3,095.10
Rate for Payer: Kaiser Permanente Medicaid	$1,753.89
Rate for Payer: Kaiser Permanente Medicare	$2,613.64
Rate for Payer: MDX Hawaii PPO	$3,335.83
Rate for Payer: Ohana Health Plan Medicaid	$2,613.64
Rate for Payer: Ohana Health Plan Medicare	$2,613.64
Rate for Payer: UnitedHealthcare Medicare	$2,613.64
Rate for Payer: University Health Alliance Commercial	$1,925.84

SLING ABBREVO URETHRAL

Facility

$3,439.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$1,925.84
Max. Negotiated Rate	$3,335.83
Rate for Payer: Cash Price	$2,063.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,407.30
Rate for Payer: Health Management Network Commercial	$2,923.15
Rate for Payer: Kaiser Permanente Commercial	$3,095.10
Rate for Payer: MDX Hawaii PPO	$3,335.83
Rate for Payer: University Health Alliance Commercial	$1,925.84

Know your out-of-pocket cost for care.

All Charges