Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$15,216.68

Service Code	MSDRG 087
Min. Negotiated Rate	$15,216.68
Max. Negotiated Rate	$15,216.68
Rate for Payer: Hawaii Medical Service Association Commercial	$15,216.68

TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$37,757.29

Service Code	MSDRG 084
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$17,918.71

Service Code	MSDRG 604
Min. Negotiated Rate	$17,918.71
Max. Negotiated Rate	$17,918.71
Rate for Payer: Hawaii Medical Service Association Commercial	$17,918.71

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$14,718.94

Service Code	MSDRG 605
Min. Negotiated Rate	$14,718.94
Max. Negotiated Rate	$14,718.94
Rate for Payer: Hawaii Medical Service Association Commercial	$14,718.94

TRAY CATHETER UMBILICAL

Facility

$203.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$172.55
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$121.80
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: MDX Hawaii PPO	$196.91

TRAY CATHETER UMBILICAL

Facility

$203.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$196.91
Rate for Payer: AlohaCare Medicaid	$101.50
Rate for Payer: AlohaCare Medicare	$154.28
Rate for Payer: Cash Price	$121.80
Rate for Payer: Devoted Health Medicare	$170.52
Rate for Payer: Hawaii Medical Service Association Medicare	$154.28
Rate for Payer: Hawaii Western Management Group Commercial	$192.85
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Humana Medicare	$154.28
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: Kaiser Permanente Medicaid	$103.53
Rate for Payer: Kaiser Permanente Medicare	$154.28
Rate for Payer: MDX Hawaii PPO	$196.91
Rate for Payer: Ohana Health Plan Medicaid	$154.28
Rate for Payer: Ohana Health Plan Medicare	$154.28
Rate for Payer: UnitedHealthcare Medicare	$154.28
Rate for Payer: University Health Alliance Commercial	$147.97

TRAY CATH TEMPERATURE SENSING

Facility

$166.00

Hospital Revenue Code	272
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$161.02
Rate for Payer: AlohaCare Medicaid	$83.00
Rate for Payer: AlohaCare Medicare	$126.16
Rate for Payer: Cash Price	$99.60
Rate for Payer: Devoted Health Medicare	$139.44
Rate for Payer: Hawaii Medical Service Association Medicare	$126.16
Rate for Payer: Hawaii Western Management Group Commercial	$157.70
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Humana Medicare	$126.16
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: Kaiser Permanente Medicare	$126.16
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: Ohana Health Plan Medicaid	$126.16
Rate for Payer: Ohana Health Plan Medicare	$126.16
Rate for Payer: UnitedHealthcare Medicare	$126.16
Rate for Payer: University Health Alliance Commercial	$121.00

TRAY CATH TEMPERATURE SENSING

Facility

$166.00

Hospital Revenue Code	272
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$99.60
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: MDX Hawaii PPO	$161.02

TRAY CHEST TUBE THALQUIK 18F

Facility

$678.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$339.00
Max. Negotiated Rate	$657.66
Rate for Payer: AlohaCare Medicaid	$339.00
Rate for Payer: AlohaCare Medicare	$515.28
Rate for Payer: Cash Price	$406.80
Rate for Payer: Devoted Health Medicare	$569.52
Rate for Payer: Hawaii Medical Service Association Medicare	$515.28
Rate for Payer: Hawaii Western Management Group Commercial	$644.10
Rate for Payer: Health Management Network Commercial	$576.30
Rate for Payer: Humana Medicare	$515.28
Rate for Payer: Kaiser Permanente Commercial	$610.20
Rate for Payer: Kaiser Permanente Medicaid	$345.78
Rate for Payer: Kaiser Permanente Medicare	$515.28
Rate for Payer: MDX Hawaii PPO	$657.66
Rate for Payer: Ohana Health Plan Medicaid	$515.28
Rate for Payer: Ohana Health Plan Medicare	$515.28
Rate for Payer: UnitedHealthcare Medicare	$515.28
Rate for Payer: University Health Alliance Commercial	$494.19

TRAY CHEST TUBE THALQUIK 18F

Facility

$678.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$576.30
Max. Negotiated Rate	$657.66
Rate for Payer: Cash Price	$406.80
Rate for Payer: Health Management Network Commercial	$576.30
Rate for Payer: Kaiser Permanente Commercial	$610.20
Rate for Payer: MDX Hawaii PPO	$657.66

TRAY CHEST TUBE THALQUIK 28F

Facility

$682.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$341.00
Max. Negotiated Rate	$661.54
Rate for Payer: AlohaCare Medicaid	$341.00
Rate for Payer: AlohaCare Medicare	$518.32
Rate for Payer: Cash Price	$409.20
Rate for Payer: Devoted Health Medicare	$572.88
Rate for Payer: Hawaii Medical Service Association Medicare	$518.32
Rate for Payer: Hawaii Western Management Group Commercial	$647.90
Rate for Payer: Health Management Network Commercial	$579.70
Rate for Payer: Humana Medicare	$518.32
Rate for Payer: Kaiser Permanente Commercial	$613.80
Rate for Payer: Kaiser Permanente Medicaid	$347.82
Rate for Payer: Kaiser Permanente Medicare	$518.32
Rate for Payer: MDX Hawaii PPO	$661.54
Rate for Payer: Ohana Health Plan Medicaid	$518.32
Rate for Payer: Ohana Health Plan Medicare	$518.32
Rate for Payer: UnitedHealthcare Medicare	$518.32
Rate for Payer: University Health Alliance Commercial	$497.11

TRAY CHEST TUBE THALQUIK 28F

Facility

$682.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$579.70
Max. Negotiated Rate	$661.54
Rate for Payer: Cash Price	$409.20
Rate for Payer: Health Management Network Commercial	$579.70
Rate for Payer: Kaiser Permanente Commercial	$613.80
Rate for Payer: MDX Hawaii PPO	$661.54

TRAY FIXED T3-I4 L 02.12.T314L

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,016.00
Max. Negotiated Rate	$3,492.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,520.00
Rate for Payer: Health Management Network Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Commercial	$3,240.00
Rate for Payer: MDX Hawaii PPO	$3,492.00
Rate for Payer: University Health Alliance Commercial	$2,016.00

TRAY FIXED T3-I4 L 02.12.T314L

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$3,492.00
Rate for Payer: AlohaCare Medicaid	$1,800.00
Rate for Payer: AlohaCare Medicare	$2,736.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Devoted Health Medicare	$3,024.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,736.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,520.00
Rate for Payer: Health Management Network Commercial	$3,060.00
Rate for Payer: Humana Medicare	$2,736.00
Rate for Payer: Kaiser Permanente Commercial	$3,240.00
Rate for Payer: Kaiser Permanente Medicaid	$1,836.00
Rate for Payer: Kaiser Permanente Medicare	$2,736.00
Rate for Payer: MDX Hawaii PPO	$3,492.00
Rate for Payer: Ohana Health Plan Medicaid	$2,736.00
Rate for Payer: Ohana Health Plan Medicare	$2,736.00
Rate for Payer: UnitedHealthcare Medicare	$2,736.00
Rate for Payer: University Health Alliance Commercial	$2,016.00

TRAY FOLEY W/UROMETER 14FR

Facility

$119.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$59.50
Rate for Payer: AlohaCare Medicare	$90.44
Rate for Payer: Cash Price	$71.40
Rate for Payer: Devoted Health Medicare	$99.96
Rate for Payer: Hawaii Medical Service Association Medicare	$90.44
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$90.44
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$90.44
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$90.44
Rate for Payer: Ohana Health Plan Medicare	$90.44
Rate for Payer: UnitedHealthcare Medicare	$90.44
Rate for Payer: University Health Alliance Commercial	$86.74

TRAY FOLEY W/UROMETER 14FR

Facility

$119.00

Hospital Revenue Code	272
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$115.43

TRAY FOLEY W/UROMETER 16FR

Facility

$119.00

Hospital Revenue Code	272
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$115.43

TRAY FOLEY W/UROMETER 16FR

Facility

$119.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$59.50
Rate for Payer: AlohaCare Medicare	$90.44
Rate for Payer: Cash Price	$71.40
Rate for Payer: Devoted Health Medicare	$99.96
Rate for Payer: Hawaii Medical Service Association Medicare	$90.44
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$90.44
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$90.44
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$90.44
Rate for Payer: Ohana Health Plan Medicare	$90.44
Rate for Payer: UnitedHealthcare Medicare	$90.44
Rate for Payer: University Health Alliance Commercial	$86.74

TRAY INTRODUCER PERCUT TRACH

Facility

$1,431.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,216.35
Max. Negotiated Rate	$1,388.07
Rate for Payer: Cash Price	$858.60
Rate for Payer: Health Management Network Commercial	$1,216.35
Rate for Payer: Kaiser Permanente Commercial	$1,287.90
Rate for Payer: MDX Hawaii PPO	$1,388.07

TRAY INTRODUCER PERCUT TRACH

Facility

$1,431.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$1,388.07
Rate for Payer: AlohaCare Medicaid	$715.50
Rate for Payer: AlohaCare Medicare	$1,087.56
Rate for Payer: Cash Price	$858.60
Rate for Payer: Devoted Health Medicare	$1,202.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,087.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,359.45
Rate for Payer: Health Management Network Commercial	$1,216.35
Rate for Payer: Humana Medicare	$1,087.56
Rate for Payer: Kaiser Permanente Commercial	$1,287.90
Rate for Payer: Kaiser Permanente Medicaid	$729.81
Rate for Payer: Kaiser Permanente Medicare	$1,087.56
Rate for Payer: MDX Hawaii PPO	$1,388.07
Rate for Payer: Ohana Health Plan Medicaid	$1,087.56
Rate for Payer: Ohana Health Plan Medicare	$1,087.56
Rate for Payer: UnitedHealthcare Medicare	$1,087.56
Rate for Payer: University Health Alliance Commercial	$1,043.06

TRAY LF MEDIAL TIB SZ F 154775

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$2,508.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$2,772.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,508.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$2,508.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$2,508.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$2,508.00
Rate for Payer: Ohana Health Plan Medicare	$2,508.00
Rate for Payer: UnitedHealthcare Medicare	$2,508.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

TRAY LF MEDIAL TIB SZ F 154775

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

TRAY REVERSED TI6AI4V DWF510

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: AlohaCare Medicaid	$1,000.00
Rate for Payer: AlohaCare Medicare	$1,520.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Devoted Health Medicare	$1,680.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Humana Medicare	$1,520.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: Kaiser Permanente Medicaid	$1,020.00
Rate for Payer: Kaiser Permanente Medicare	$1,520.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: Ohana Health Plan Medicaid	$1,520.00
Rate for Payer: Ohana Health Plan Medicare	$1,520.00
Rate for Payer: UnitedHealthcare Medicare	$1,520.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

TRAY REVERSED TI6AI4V DWF510

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

TRAY REVERSED TI6AI4V DWF520

Facility

$5,506.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,083.36
Max. Negotiated Rate	$5,340.82
Rate for Payer: Cash Price	$3,303.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,854.20
Rate for Payer: Health Management Network Commercial	$4,680.10
Rate for Payer: Kaiser Permanente Commercial	$4,955.40
Rate for Payer: MDX Hawaii PPO	$5,340.82
Rate for Payer: University Health Alliance Commercial	$3,083.36

Know your out-of-pocket cost for care.

All Charges