Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SPLINT EXTERNAL NASAL

Facility

$246.00

Hospital Revenue Code	272
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$238.62
Rate for Payer: AlohaCare Medicaid	$123.00
Rate for Payer: AlohaCare Medicare	$186.96
Rate for Payer: Cash Price	$147.60
Rate for Payer: Devoted Health Medicare	$206.64
Rate for Payer: Hawaii Medical Service Association Medicare	$186.96
Rate for Payer: Hawaii Western Management Group Commercial	$233.70
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Humana Medicare	$186.96
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: Kaiser Permanente Medicare	$186.96
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: Ohana Health Plan Medicaid	$186.96
Rate for Payer: Ohana Health Plan Medicare	$186.96
Rate for Payer: UnitedHealthcare Medicare	$186.96
Rate for Payer: University Health Alliance Commercial	$179.31

SPLINT EXTERNAL NASAL

Facility

$246.00

Hospital Revenue Code	272
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$147.60
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: MDX Hawaii PPO	$238.62

SPLINT INTRANASAL

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$329.80

SPLINT INTRANASAL

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$329.80
Rate for Payer: AlohaCare Medicaid	$170.00
Rate for Payer: AlohaCare Medicare	$258.40
Rate for Payer: Cash Price	$204.00
Rate for Payer: Devoted Health Medicare	$285.60
Rate for Payer: Hawaii Medical Service Association Medicare	$258.40
Rate for Payer: Hawaii Western Management Group Commercial	$323.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Humana Medicare	$258.40
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: Kaiser Permanente Medicare	$258.40
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: Ohana Health Plan Medicaid	$258.40
Rate for Payer: Ohana Health Plan Medicare	$258.40
Rate for Payer: UnitedHealthcare Medicare	$258.40
Rate for Payer: University Health Alliance Commercial	$247.83

SPLINT NASAL FIRM 4CM

Facility

$562.00

Hospital Revenue Code	272
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$545.14
Rate for Payer: AlohaCare Medicaid	$281.00
Rate for Payer: AlohaCare Medicare	$427.12
Rate for Payer: Cash Price	$337.20
Rate for Payer: Devoted Health Medicare	$472.08
Rate for Payer: Hawaii Medical Service Association Medicare	$427.12
Rate for Payer: Hawaii Western Management Group Commercial	$533.90
Rate for Payer: Health Management Network Commercial	$477.70
Rate for Payer: Humana Medicare	$427.12
Rate for Payer: Kaiser Permanente Commercial	$505.80
Rate for Payer: Kaiser Permanente Medicaid	$286.62
Rate for Payer: Kaiser Permanente Medicare	$427.12
Rate for Payer: MDX Hawaii PPO	$545.14
Rate for Payer: Ohana Health Plan Medicaid	$427.12
Rate for Payer: Ohana Health Plan Medicare	$427.12
Rate for Payer: UnitedHealthcare Medicare	$427.12
Rate for Payer: University Health Alliance Commercial	$409.64

SPLINT NASAL FIRM 4CM

Facility

$562.00

Hospital Revenue Code	272
Min. Negotiated Rate	$477.70
Max. Negotiated Rate	$545.14
Rate for Payer: Cash Price	$337.20
Rate for Payer: Health Management Network Commercial	$477.70
Rate for Payer: Kaiser Permanente Commercial	$505.80
Rate for Payer: MDX Hawaii PPO	$545.14

SPLINT NASAL MED

Facility

$184.00

Hospital Revenue Code	272
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$139.84
Rate for Payer: Cash Price	$110.40
Rate for Payer: Devoted Health Medicare	$154.56
Rate for Payer: Hawaii Medical Service Association Medicare	$139.84
Rate for Payer: Hawaii Western Management Group Commercial	$174.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$139.84
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$139.84
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$139.84
Rate for Payer: Ohana Health Plan Medicare	$139.84
Rate for Payer: UnitedHealthcare Medicare	$139.84
Rate for Payer: University Health Alliance Commercial	$134.12

SPLINT NASAL MED

Facility

$184.00

Hospital Revenue Code	272
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$110.40
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48

SPONGE ENDO PEANUT

Facility

$88.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: MDX Hawaii PPO	$85.36

SPONGE ENDO PEANUT

Facility

$88.00

Hospital Revenue Code	272
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$85.36
Rate for Payer: AlohaCare Medicaid	$44.00
Rate for Payer: AlohaCare Medicare	$66.88
Rate for Payer: Cash Price	$52.80
Rate for Payer: Devoted Health Medicare	$73.92
Rate for Payer: Hawaii Medical Service Association Medicare	$66.88
Rate for Payer: Hawaii Western Management Group Commercial	$83.60
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Humana Medicare	$66.88
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: Kaiser Permanente Medicare	$66.88
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: Ohana Health Plan Medicaid	$66.88
Rate for Payer: Ohana Health Plan Medicare	$66.88
Rate for Payer: UnitedHealthcare Medicare	$66.88
Rate for Payer: University Health Alliance Commercial	$64.14

SPONGE NEURO .25X.25

Facility

$67.00

Hospital Revenue Code	272
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$64.99
Rate for Payer: AlohaCare Medicaid	$33.50
Rate for Payer: AlohaCare Medicare	$50.92
Rate for Payer: Cash Price	$40.20
Rate for Payer: Devoted Health Medicare	$56.28
Rate for Payer: Hawaii Medical Service Association Medicare	$50.92
Rate for Payer: Hawaii Western Management Group Commercial	$63.65
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Humana Medicare	$50.92
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: Kaiser Permanente Medicaid	$34.17
Rate for Payer: Kaiser Permanente Medicare	$50.92
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: Ohana Health Plan Medicaid	$50.92
Rate for Payer: Ohana Health Plan Medicare	$50.92
Rate for Payer: UnitedHealthcare Medicare	$50.92
Rate for Payer: University Health Alliance Commercial	$48.84

SPONGE NEURO .25X.25

Facility

$67.00

Hospital Revenue Code	272
Min. Negotiated Rate	$56.95
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$40.20
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: MDX Hawaii PPO	$64.99

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$24,910.80

Service Code	MSDRG 537
Min. Negotiated Rate	$24,910.80
Max. Negotiated Rate	$24,910.80
Rate for Payer: Hawaii Medical Service Association Commercial	$24,910.80

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$24,910.80

Service Code	MSDRG 538
Min. Negotiated Rate	$24,910.80
Max. Negotiated Rate	$24,910.80
Rate for Payer: Hawaii Medical Service Association Commercial	$24,910.80

SPRAY SETS FOR TISSEEL/ARTISS

Facility

$259.00

Hospital Revenue Code	272
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$155.40
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: MDX Hawaii PPO	$251.23

SPRAY SETS FOR TISSEEL/ARTISS

Facility

$259.00

Hospital Revenue Code	272
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$251.23
Rate for Payer: AlohaCare Medicaid	$129.50
Rate for Payer: AlohaCare Medicare	$196.84
Rate for Payer: Cash Price	$155.40
Rate for Payer: Devoted Health Medicare	$217.56
Rate for Payer: Hawaii Medical Service Association Medicare	$196.84
Rate for Payer: Hawaii Western Management Group Commercial	$246.05
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Humana Medicare	$196.84
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: Kaiser Permanente Medicare	$196.84
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: Ohana Health Plan Medicaid	$196.84
Rate for Payer: Ohana Health Plan Medicare	$196.84
Rate for Payer: UnitedHealthcare Medicare	$196.84
Rate for Payer: University Health Alliance Commercial	$188.79

SROM MODULAR HIP SYS 55-0534

Facility

$4,310.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,413.60
Max. Negotiated Rate	$4,180.70
Rate for Payer: Cash Price	$2,586.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,017.00
Rate for Payer: Health Management Network Commercial	$3,663.50
Rate for Payer: Kaiser Permanente Commercial	$3,879.00
Rate for Payer: MDX Hawaii PPO	$4,180.70
Rate for Payer: University Health Alliance Commercial	$2,413.60

SROM MODULAR HIP SYS 55-0534

Facility

$4,310.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,155.00
Max. Negotiated Rate	$4,180.70
Rate for Payer: AlohaCare Medicaid	$2,155.00
Rate for Payer: AlohaCare Medicare	$3,275.60
Rate for Payer: Cash Price	$2,586.00
Rate for Payer: Devoted Health Medicare	$3,620.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3,275.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,017.00
Rate for Payer: Health Management Network Commercial	$3,663.50
Rate for Payer: Humana Medicare	$3,275.60
Rate for Payer: Kaiser Permanente Commercial	$3,879.00
Rate for Payer: Kaiser Permanente Medicaid	$2,198.10
Rate for Payer: Kaiser Permanente Medicare	$3,275.60
Rate for Payer: MDX Hawaii PPO	$4,180.70
Rate for Payer: Ohana Health Plan Medicaid	$3,275.60
Rate for Payer: Ohana Health Plan Medicare	$3,275.60
Rate for Payer: UnitedHealthcare Medicare	$3,275.60
Rate for Payer: University Health Alliance Commercial	$2,413.60

SROM TOTAL HIP SYS 52.3420

Facility

$8,873.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,436.50
Max. Negotiated Rate	$8,606.81
Rate for Payer: AlohaCare Medicaid	$4,436.50
Rate for Payer: AlohaCare Medicare	$6,743.48
Rate for Payer: Cash Price	$5,323.80
Rate for Payer: Devoted Health Medicare	$7,453.32
Rate for Payer: Hawaii Medical Service Association Medicare	$6,743.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,211.10
Rate for Payer: Health Management Network Commercial	$7,542.05
Rate for Payer: Humana Medicare	$6,743.48
Rate for Payer: Kaiser Permanente Commercial	$7,985.70
Rate for Payer: Kaiser Permanente Medicaid	$4,525.23
Rate for Payer: Kaiser Permanente Medicare	$6,743.48
Rate for Payer: MDX Hawaii PPO	$8,606.81
Rate for Payer: Ohana Health Plan Medicaid	$6,743.48
Rate for Payer: Ohana Health Plan Medicare	$6,743.48
Rate for Payer: UnitedHealthcare Medicare	$6,743.48
Rate for Payer: University Health Alliance Commercial	$4,968.88

SROM TOTAL HIP SYS 52.3420

Facility

$8,873.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,968.88
Max. Negotiated Rate	$8,606.81
Rate for Payer: Cash Price	$5,323.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,211.10
Rate for Payer: Health Management Network Commercial	$7,542.05
Rate for Payer: Kaiser Permanente Commercial	$7,985.70
Rate for Payer: MDX Hawaii PPO	$8,606.81
Rate for Payer: University Health Alliance Commercial	$4,968.88

SSPC NXT 2.5 DELIVERY CATH 9F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: MDX Hawaii PPO	$1,681.01

SSPC NXT 2.5 DELIVERY CATH 9F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$866.50
Max. Negotiated Rate	$1,681.01
Rate for Payer: AlohaCare Medicaid	$866.50
Rate for Payer: AlohaCare Medicare	$1,317.08
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Devoted Health Medicare	$1,455.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,317.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,646.35
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Humana Medicare	$1,317.08
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: Kaiser Permanente Medicare	$1,317.08
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: Ohana Health Plan Medicaid	$1,317.08
Rate for Payer: Ohana Health Plan Medicare	$1,317.08
Rate for Payer: UnitedHealthcare Medicare	$1,317.08
Rate for Payer: University Health Alliance Commercial	$1,263.18

SSPC NXT Y DELIVERY CATH

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$866.50
Max. Negotiated Rate	$1,681.01
Rate for Payer: AlohaCare Medicaid	$866.50
Rate for Payer: AlohaCare Medicare	$1,317.08
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Devoted Health Medicare	$1,455.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,317.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,646.35
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Humana Medicare	$1,317.08
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: Kaiser Permanente Medicare	$1,317.08
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: Ohana Health Plan Medicaid	$1,317.08
Rate for Payer: Ohana Health Plan Medicare	$1,317.08
Rate for Payer: UnitedHealthcare Medicare	$1,317.08
Rate for Payer: University Health Alliance Commercial	$1,263.18

SSPC NXT Y DELIVERY CATH

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: MDX Hawaii PPO	$1,681.01

STABILIZER FEMORAL 5512-F-201

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,878.48
Max. Negotiated Rate	$11,914.51
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Kaiser Permanente Commercial	$11,054.70
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: University Health Alliance Commercial	$6,878.48

Know your out-of-pocket cost for care.

All Charges