Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

UNIV HEAD 26X41 #UH1-41-26

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UNIV HEAD 26X42 #UH1-42-26

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UNIV HEAD 26X42 #UH1-42-26

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UNIV HEAD 26X43 #UH1-43-26

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UNIV HEAD 26X43 #UH1-43-26

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility

$36,643.29

Service Code	MSDRG 256
Min. Negotiated Rate	$36,643.29
Max. Negotiated Rate	$36,643.29
Rate for Payer: Hawaii Medical Service Association Commercial	$36,643.29

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility

$36,643.29

Service Code	MSDRG 255
Min. Negotiated Rate	$36,643.29
Max. Negotiated Rate	$36,643.29
Rate for Payer: Hawaii Medical Service Association Commercial	$36,643.29

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$36,643.29

Service Code	MSDRG 257
Min. Negotiated Rate	$36,643.29
Max. Negotiated Rate	$36,643.29
Rate for Payer: Hawaii Medical Service Association Commercial	$36,643.29

UREA 15 GRAM ORAL POWDER PACKET [137170]

Facility

$16.00

Service Code	NDC 00011000000
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

UREA 15 GRAM ORAL POWDER PACKET [137170]

Facility

$16.00

Service Code	NDC 00011000000
Hospital Revenue Code	637
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$12.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Medicare	$12.16
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$12.16
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$12.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$12.16
Rate for Payer: Ohana Health Plan Medicare	$12.16
Rate for Payer: UnitedHealthcare Medicare	$12.16
Rate for Payer: University Health Alliance Commercial	$11.66

URETHRAL PROCEDURES WITH CC/MCC

Facility

$35,505.60

Service Code	MSDRG 671
Min. Negotiated Rate	$35,505.60
Max. Negotiated Rate	$35,505.60
Rate for Payer: Hawaii Medical Service Association Commercial	$35,505.60

URETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$35,505.60

Service Code	MSDRG 672
Min. Negotiated Rate	$35,505.60
Max. Negotiated Rate	$35,505.60
Rate for Payer: Hawaii Medical Service Association Commercial	$35,505.60

URETHRAL STRICTURE

Facility

$5,190.74

Service Code	MSDRG 697
Min. Negotiated Rate	$5,190.74
Max. Negotiated Rate	$5,190.74
Rate for Payer: Hawaii Medical Service Association Commercial	$5,190.74

URINARY STONES WITH MCC

Facility

$12,538.36

Service Code	MSDRG 693
Min. Negotiated Rate	$12,538.36
Max. Negotiated Rate	$12,538.36
Rate for Payer: Hawaii Medical Service Association Commercial	$12,538.36

URINARY STONES WITHOUT MCC

Facility

$11,708.79

Service Code	MSDRG 694
Min. Negotiated Rate	$11,708.79
Max. Negotiated Rate	$11,708.79
Rate for Payer: Hawaii Medical Service Association Commercial	$11,708.79

UROMAX CATH KIT M0062251210

Facility

$938.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$469.00
Max. Negotiated Rate	$909.86
Rate for Payer: AlohaCare Medicaid	$469.00
Rate for Payer: AlohaCare Medicare	$712.88
Rate for Payer: Cash Price	$562.80
Rate for Payer: Devoted Health Medicare	$787.92
Rate for Payer: Hawaii Medical Service Association Medicare	$712.88
Rate for Payer: Hawaii Western Management Group Commercial	$891.10
Rate for Payer: Health Management Network Commercial	$797.30
Rate for Payer: Humana Medicare	$712.88
Rate for Payer: Kaiser Permanente Commercial	$844.20
Rate for Payer: Kaiser Permanente Medicaid	$478.38
Rate for Payer: Kaiser Permanente Medicare	$712.88
Rate for Payer: MDX Hawaii PPO	$909.86
Rate for Payer: Ohana Health Plan Medicaid	$712.88
Rate for Payer: Ohana Health Plan Medicare	$712.88
Rate for Payer: UnitedHealthcare Medicare	$712.88
Rate for Payer: University Health Alliance Commercial	$683.71

UROMAX CATH KIT M0062251210

Facility

$938.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$797.30
Max. Negotiated Rate	$909.86
Rate for Payer: Cash Price	$562.80
Rate for Payer: Health Management Network Commercial	$797.30
Rate for Payer: Kaiser Permanente Commercial	$844.20
Rate for Payer: MDX Hawaii PPO	$909.86

UROMAX ULTRA BALLOON KIT

Facility

$883.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$441.50
Max. Negotiated Rate	$856.51
Rate for Payer: AlohaCare Medicaid	$441.50
Rate for Payer: AlohaCare Medicare	$671.08
Rate for Payer: Cash Price	$529.80
Rate for Payer: Devoted Health Medicare	$741.72
Rate for Payer: Hawaii Medical Service Association Medicare	$671.08
Rate for Payer: Hawaii Western Management Group Commercial	$838.85
Rate for Payer: Health Management Network Commercial	$750.55
Rate for Payer: Humana Medicare	$671.08
Rate for Payer: Kaiser Permanente Commercial	$794.70
Rate for Payer: Kaiser Permanente Medicaid	$450.33
Rate for Payer: Kaiser Permanente Medicare	$671.08
Rate for Payer: MDX Hawaii PPO	$856.51
Rate for Payer: Ohana Health Plan Medicaid	$671.08
Rate for Payer: Ohana Health Plan Medicare	$671.08
Rate for Payer: UnitedHealthcare Medicare	$671.08
Rate for Payer: University Health Alliance Commercial	$643.62

UROMAX ULTRA BALLOON KIT

Facility

$883.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$750.55
Max. Negotiated Rate	$856.51
Rate for Payer: Cash Price	$529.80
Rate for Payer: Health Management Network Commercial	$750.55
Rate for Payer: Kaiser Permanente Commercial	$794.70
Rate for Payer: MDX Hawaii PPO	$856.51

URSODIOL 300 MG CAPSULE [11624]

Facility

$23.00

Service Code	NDC 60687010011
Hospital Revenue Code	637
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$17.48
Rate for Payer: Cash Price	$13.80
Rate for Payer: Devoted Health Medicare	$19.32
Rate for Payer: Hawaii Medical Service Association Medicare	$17.48
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$17.48
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$17.48
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$17.48
Rate for Payer: Ohana Health Plan Medicare	$17.48
Rate for Payer: UnitedHealthcare Medicare	$17.48
Rate for Payer: University Health Alliance Commercial	$16.76

URSODIOL 300 MG CAPSULE [11624]

Facility

$23.00

Service Code	NDC 60687010001
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

URSODIOL 300 MG CAPSULE [11624]

Facility

$23.00

Service Code	NDC 60687010011
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

URSODIOL 300 MG CAPSULE [11624]

Facility

$23.00

Service Code	NDC 60687010001
Hospital Revenue Code	637
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$17.48
Rate for Payer: Cash Price	$13.80
Rate for Payer: Devoted Health Medicare	$19.32
Rate for Payer: Hawaii Medical Service Association Medicare	$17.48
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$17.48
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$17.48
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$17.48
Rate for Payer: Ohana Health Plan Medicare	$17.48
Rate for Payer: UnitedHealthcare Medicare	$17.48
Rate for Payer: University Health Alliance Commercial	$16.76

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$22,279.88

Service Code	MSDRG 742
Min. Negotiated Rate	$22,279.88
Max. Negotiated Rate	$22,279.88
Rate for Payer: Hawaii Medical Service Association Commercial	$22,279.88

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$20,028.19

Service Code	MSDRG 743
Min. Negotiated Rate	$20,028.19
Max. Negotiated Rate	$20,028.19
Rate for Payer: Hawaii Medical Service Association Commercial	$20,028.19

Know your out-of-pocket cost for care.

All Charges