Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CARBON FBR ROD 8.0X200 395.782

Facility

$727.00

Service Code	HCPCS L5785
Hospital Revenue Code	274
Min. Negotiated Rate	$285.22
Max. Negotiated Rate	$705.19
Rate for Payer: AlohaCare Medicaid	$363.50
Rate for Payer: AlohaCare Medicare	$552.52
Rate for Payer: Cash Price	$436.20
Rate for Payer: Cash Price	$436.20
Rate for Payer: Devoted Health Medicare	$610.68
Rate for Payer: Hawaii Medical Service Association Medicare	$552.52
Rate for Payer: Hawaii Western Management Group Commercial	$508.90
Rate for Payer: Health Management Network Commercial	$617.95
Rate for Payer: Humana Medicare	$552.52
Rate for Payer: Kaiser Permanente Commercial	$654.30
Rate for Payer: Kaiser Permanente Medicaid	$370.77
Rate for Payer: Kaiser Permanente Medicare	$552.52
Rate for Payer: MDX Hawaii PPO	$705.19
Rate for Payer: Ohana Health Plan Medicaid	$552.52
Rate for Payer: Ohana Health Plan Medicare	$552.52
Rate for Payer: UnitedHealthcare Medicaid	$285.22
Rate for Payer: UnitedHealthcare Medicare	$552.52
Rate for Payer: University Health Alliance Commercial	$407.12

CARBON FBR ROD 8.0X220 395.784

Facility

$907.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$770.95
Max. Negotiated Rate	$879.79
Rate for Payer: Cash Price	$544.20
Rate for Payer: Health Management Network Commercial	$770.95
Rate for Payer: Kaiser Permanente Commercial	$816.30
Rate for Payer: MDX Hawaii PPO	$879.79

CARBON FBR ROD 8.0X220 395.784

Facility

$907.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$453.50
Max. Negotiated Rate	$879.79
Rate for Payer: AlohaCare Medicaid	$453.50
Rate for Payer: AlohaCare Medicare	$689.32
Rate for Payer: Cash Price	$544.20
Rate for Payer: Devoted Health Medicare	$761.88
Rate for Payer: Hawaii Medical Service Association Medicare	$689.32
Rate for Payer: Hawaii Western Management Group Commercial	$861.65
Rate for Payer: Health Management Network Commercial	$770.95
Rate for Payer: Humana Medicare	$689.32
Rate for Payer: Kaiser Permanente Commercial	$816.30
Rate for Payer: Kaiser Permanente Medicaid	$462.57
Rate for Payer: Kaiser Permanente Medicare	$689.32
Rate for Payer: MDX Hawaii PPO	$879.79
Rate for Payer: Ohana Health Plan Medicaid	$689.32
Rate for Payer: Ohana Health Plan Medicare	$689.32
Rate for Payer: UnitedHealthcare Medicare	$689.32
Rate for Payer: University Health Alliance Commercial	$661.11

CARBON FBR ROD 8.0X240 395.786

Facility

$727.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$617.95
Max. Negotiated Rate	$705.19
Rate for Payer: Cash Price	$436.20
Rate for Payer: Health Management Network Commercial	$617.95
Rate for Payer: Kaiser Permanente Commercial	$654.30
Rate for Payer: MDX Hawaii PPO	$705.19

CARBON FBR ROD 8.0X240 395.786

Facility

$727.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$363.50
Max. Negotiated Rate	$705.19
Rate for Payer: AlohaCare Medicaid	$363.50
Rate for Payer: AlohaCare Medicare	$552.52
Rate for Payer: Cash Price	$436.20
Rate for Payer: Devoted Health Medicare	$610.68
Rate for Payer: Hawaii Medical Service Association Medicare	$552.52
Rate for Payer: Hawaii Western Management Group Commercial	$690.65
Rate for Payer: Health Management Network Commercial	$617.95
Rate for Payer: Humana Medicare	$552.52
Rate for Payer: Kaiser Permanente Commercial	$654.30
Rate for Payer: Kaiser Permanente Medicaid	$370.77
Rate for Payer: Kaiser Permanente Medicare	$552.52
Rate for Payer: MDX Hawaii PPO	$705.19
Rate for Payer: Ohana Health Plan Medicaid	$552.52
Rate for Payer: Ohana Health Plan Medicare	$552.52
Rate for Payer: UnitedHealthcare Medicare	$552.52
Rate for Payer: University Health Alliance Commercial	$529.91

CARBON FBR ROD 8.0X280 395.788

Facility

$917.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$458.50
Max. Negotiated Rate	$889.49
Rate for Payer: AlohaCare Medicaid	$458.50
Rate for Payer: AlohaCare Medicare	$696.92
Rate for Payer: Cash Price	$550.20
Rate for Payer: Devoted Health Medicare	$770.28
Rate for Payer: Hawaii Medical Service Association Medicare	$696.92
Rate for Payer: Hawaii Western Management Group Commercial	$871.15
Rate for Payer: Health Management Network Commercial	$779.45
Rate for Payer: Humana Medicare	$696.92
Rate for Payer: Kaiser Permanente Commercial	$825.30
Rate for Payer: Kaiser Permanente Medicaid	$467.67
Rate for Payer: Kaiser Permanente Medicare	$696.92
Rate for Payer: MDX Hawaii PPO	$889.49
Rate for Payer: Ohana Health Plan Medicaid	$696.92
Rate for Payer: Ohana Health Plan Medicare	$696.92
Rate for Payer: UnitedHealthcare Medicare	$696.92
Rate for Payer: University Health Alliance Commercial	$668.40

CARBON FBR ROD 8.0X280 395.788

Facility

$917.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$779.45
Max. Negotiated Rate	$889.49
Rate for Payer: Cash Price	$550.20
Rate for Payer: Health Management Network Commercial	$779.45
Rate for Payer: Kaiser Permanente Commercial	$825.30
Rate for Payer: MDX Hawaii PPO	$889.49

CARBON FBR ROD 8.0X360 395.796

Facility

$795.00

Hospital Revenue Code	272
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$771.15
Rate for Payer: AlohaCare Medicaid	$397.50
Rate for Payer: AlohaCare Medicare	$604.20
Rate for Payer: Cash Price	$477.00
Rate for Payer: Devoted Health Medicare	$667.80
Rate for Payer: Hawaii Medical Service Association Medicare	$604.20
Rate for Payer: Hawaii Western Management Group Commercial	$755.25
Rate for Payer: Health Management Network Commercial	$675.75
Rate for Payer: Humana Medicare	$604.20
Rate for Payer: Kaiser Permanente Commercial	$715.50
Rate for Payer: Kaiser Permanente Medicaid	$405.45
Rate for Payer: Kaiser Permanente Medicare	$604.20
Rate for Payer: MDX Hawaii PPO	$771.15
Rate for Payer: Ohana Health Plan Medicaid	$604.20
Rate for Payer: Ohana Health Plan Medicare	$604.20
Rate for Payer: UnitedHealthcare Medicare	$604.20
Rate for Payer: University Health Alliance Commercial	$579.48

CARBON FBR ROD 8.0X360 395.796

Facility

$795.00

Hospital Revenue Code	272
Min. Negotiated Rate	$675.75
Max. Negotiated Rate	$771.15
Rate for Payer: Cash Price	$477.00
Rate for Payer: Health Management Network Commercial	$675.75
Rate for Payer: Kaiser Permanente Commercial	$715.50
Rate for Payer: MDX Hawaii PPO	$771.15

CARBON FBR ROD 8.0X400 395.797

Facility

$795.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$771.15
Rate for Payer: AlohaCare Medicaid	$397.50
Rate for Payer: AlohaCare Medicare	$604.20
Rate for Payer: Cash Price	$477.00
Rate for Payer: Devoted Health Medicare	$667.80
Rate for Payer: Hawaii Medical Service Association Medicare	$604.20
Rate for Payer: Hawaii Western Management Group Commercial	$755.25
Rate for Payer: Health Management Network Commercial	$675.75
Rate for Payer: Humana Medicare	$604.20
Rate for Payer: Kaiser Permanente Commercial	$715.50
Rate for Payer: Kaiser Permanente Medicaid	$405.45
Rate for Payer: Kaiser Permanente Medicare	$604.20
Rate for Payer: MDX Hawaii PPO	$771.15
Rate for Payer: Ohana Health Plan Medicaid	$604.20
Rate for Payer: Ohana Health Plan Medicare	$604.20
Rate for Payer: UnitedHealthcare Medicare	$604.20
Rate for Payer: University Health Alliance Commercial	$579.48

CARBON FBR ROD 8.0X400 395.797

Facility

$795.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$675.75
Max. Negotiated Rate	$771.15
Rate for Payer: Cash Price	$477.00
Rate for Payer: Health Management Network Commercial	$675.75
Rate for Payer: Kaiser Permanente Commercial	$715.50
Rate for Payer: MDX Hawaii PPO	$771.15

CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]

Facility

$302.00

Service Code	HCPCS J9045
Hospital Revenue Code	636
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$292.94
Rate for Payer: AlohaCare Medicaid	$151.00
Rate for Payer: AlohaCare Medicaid	$124.50
Rate for Payer: AlohaCare Medicaid	$105.50
Rate for Payer: AlohaCare Medicaid	$28.50
Rate for Payer: AlohaCare Medicaid	$99.00
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$67.64
Rate for Payer: AlohaCare Medicare	$229.52
Rate for Payer: AlohaCare Medicare	$150.48
Rate for Payer: AlohaCare Medicare	$160.36
Rate for Payer: AlohaCare Medicare	$189.24
Rate for Payer: AlohaCare Medicare	$43.32
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cash Price	$126.60
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$181.20
Rate for Payer: Cash Price	$53.40
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$53.40
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$126.60
Rate for Payer: Cash Price	$181.20
Rate for Payer: Cash Price	$118.80
Rate for Payer: Devoted Health Medicare	$47.88
Rate for Payer: Devoted Health Medicare	$253.68
Rate for Payer: Devoted Health Medicare	$166.32
Rate for Payer: Devoted Health Medicare	$209.16
Rate for Payer: Devoted Health Medicare	$177.24
Rate for Payer: Devoted Health Medicare	$74.76
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Medicare	$160.36
Rate for Payer: Hawaii Medical Service Association Medicare	$67.64
Rate for Payer: Hawaii Medical Service Association Medicare	$229.52
Rate for Payer: Hawaii Medical Service Association Medicare	$189.24
Rate for Payer: Hawaii Medical Service Association Medicare	$150.48
Rate for Payer: Hawaii Medical Service Association Medicare	$43.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Western Management Group Commercial	$236.55
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Hawaii Western Management Group Commercial	$54.15
Rate for Payer: Hawaii Western Management Group Commercial	$286.90
Rate for Payer: Hawaii Western Management Group Commercial	$188.10
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Health Management Network Commercial	$256.70
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$160.36
Rate for Payer: Humana Medicare	$150.48
Rate for Payer: Humana Medicare	$189.24
Rate for Payer: Humana Medicare	$43.32
Rate for Payer: Humana Medicare	$229.52
Rate for Payer: Humana Medicare	$67.64
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Commercial	$271.80
Rate for Payer: Kaiser Permanente Commercial	$178.20
Rate for Payer: Kaiser Permanente Medicaid	$154.02
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: Kaiser Permanente Medicaid	$126.99
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicaid	$100.98
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$189.24
Rate for Payer: Kaiser Permanente Medicare	$43.32
Rate for Payer: Kaiser Permanente Medicare	$229.52
Rate for Payer: Kaiser Permanente Medicare	$67.64
Rate for Payer: Kaiser Permanente Medicare	$150.48
Rate for Payer: Kaiser Permanente Medicare	$160.36
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: MDX Hawaii PPO	$241.53
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: MDX Hawaii PPO	$292.94
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$189.24
Rate for Payer: Ohana Health Plan Medicaid	$229.52
Rate for Payer: Ohana Health Plan Medicaid	$150.48
Rate for Payer: Ohana Health Plan Medicaid	$160.36
Rate for Payer: Ohana Health Plan Medicaid	$43.32
Rate for Payer: Ohana Health Plan Medicaid	$67.64
Rate for Payer: Ohana Health Plan Medicare	$160.36
Rate for Payer: Ohana Health Plan Medicare	$43.32
Rate for Payer: Ohana Health Plan Medicare	$229.52
Rate for Payer: Ohana Health Plan Medicare	$67.64
Rate for Payer: Ohana Health Plan Medicare	$150.48
Rate for Payer: Ohana Health Plan Medicare	$189.24
Rate for Payer: UnitedHealthcare Medicaid	$126.60
Rate for Payer: UnitedHealthcare Medicaid	$34.20
Rate for Payer: UnitedHealthcare Medicaid	$181.20
Rate for Payer: UnitedHealthcare Medicaid	$118.80
Rate for Payer: UnitedHealthcare Medicaid	$149.40
Rate for Payer: UnitedHealthcare Medicaid	$53.40
Rate for Payer: UnitedHealthcare Medicare	$43.32
Rate for Payer: UnitedHealthcare Medicare	$160.36
Rate for Payer: UnitedHealthcare Medicare	$189.24
Rate for Payer: UnitedHealthcare Medicare	$150.48
Rate for Payer: UnitedHealthcare Medicare	$67.64
Rate for Payer: UnitedHealthcare Medicare	$229.52
Rate for Payer: University Health Alliance Commercial	$41.55
Rate for Payer: University Health Alliance Commercial	$64.87
Rate for Payer: University Health Alliance Commercial	$220.13
Rate for Payer: University Health Alliance Commercial	$144.32
Rate for Payer: University Health Alliance Commercial	$153.80
Rate for Payer: University Health Alliance Commercial	$181.50

CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]

Facility

$211.00

Service Code	HCPCS J9045
Hospital Revenue Code	250
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$126.60
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$181.20
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$53.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$256.70
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Commercial	$178.20
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: Kaiser Permanente Commercial	$271.80
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$241.53
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: MDX Hawaii PPO	$292.94

CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]

Facility

$144.00

Service Code	HCPCS J3490
Hospital Revenue Code	250
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: MDX Hawaii PPO	$139.68

CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]

Facility

$144.00

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$72.00
Rate for Payer: AlohaCare Medicare	$109.44
Rate for Payer: Cash Price	$86.40
Rate for Payer: Devoted Health Medicare	$120.96
Rate for Payer: Hawaii Medical Service Association Medicare	$109.44
Rate for Payer: Hawaii Western Management Group Commercial	$136.80
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$109.44
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$109.44
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$109.44
Rate for Payer: Ohana Health Plan Medicare	$109.44
Rate for Payer: UnitedHealthcare Medicaid	$86.40
Rate for Payer: UnitedHealthcare Medicare	$109.44
Rate for Payer: University Health Alliance Commercial	$104.96

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$44,678.27

Service Code	MSDRG 297
Min. Negotiated Rate	$44,678.27
Max. Negotiated Rate	$44,678.27
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$44,678.27

Service Code	MSDRG 296
Min. Negotiated Rate	$44,678.27
Max. Negotiated Rate	$44,678.27
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$44,678.27

Service Code	MSDRG 298
Min. Negotiated Rate	$44,678.27
Max. Negotiated Rate	$44,678.27
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$19,814.87

Service Code	MSDRG 309
Min. Negotiated Rate	$19,814.87
Max. Negotiated Rate	$19,814.87
Rate for Payer: Hawaii Medical Service Association Commercial	$19,814.87

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$21,118.48

Service Code	MSDRG 308
Min. Negotiated Rate	$21,118.48
Max. Negotiated Rate	$21,118.48
Rate for Payer: Hawaii Medical Service Association Commercial	$21,118.48

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$15,192.98

Service Code	MSDRG 310
Min. Negotiated Rate	$15,192.98
Max. Negotiated Rate	$15,192.98
Rate for Payer: Hawaii Medical Service Association Commercial	$15,192.98

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$13,960.48

Service Code	MSDRG 306
Min. Negotiated Rate	$13,960.48
Max. Negotiated Rate	$13,960.48
Rate for Payer: Hawaii Medical Service Association Commercial	$13,960.48

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$12,893.89

Service Code	MSDRG 307
Min. Negotiated Rate	$12,893.89
Max. Negotiated Rate	$12,893.89
Rate for Payer: Hawaii Medical Service Association Commercial	$12,893.89

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$160,035.90

Service Code	MSDRG 275
Min. Negotiated Rate	$160,035.90
Max. Negotiated Rate	$160,035.90
Rate for Payer: Hawaii Medical Service Association Commercial	$160,035.90

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$103,008.89

Service Code	MSDRG 276
Min. Negotiated Rate	$103,008.89
Max. Negotiated Rate	$103,008.89
Rate for Payer: Hawaii Medical Service Association Commercial	$103,008.89

Know your out-of-pocket cost for care.

All Charges