Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

WOUND DEBRIDEMENTS FOR INJURIES WITH CC

Facility

$28,086.87

Service Code	MSDRG 902
Min. Negotiated Rate	$28,086.87
Max. Negotiated Rate	$28,086.87
Rate for Payer: Hawaii Medical Service Association Commercial	$28,086.87

WOUND DEBRIDEMENTS FOR INJURIES WITH MCC

Facility

$28,086.87

Service Code	MSDRG 901
Min. Negotiated Rate	$28,086.87
Max. Negotiated Rate	$28,086.87
Rate for Payer: Hawaii Medical Service Association Commercial	$28,086.87

WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC

Facility

$28,086.87

Service Code	MSDRG 903
Min. Negotiated Rate	$28,086.87
Max. Negotiated Rate	$28,086.87
Rate for Payer: Hawaii Medical Service Association Commercial	$28,086.87

WOUND LAVAGE WW 00-8887-002-00

Facility

$2,363.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,181.50
Max. Negotiated Rate	$2,292.11
Rate for Payer: AlohaCare Medicaid	$1,181.50
Rate for Payer: AlohaCare Medicare	$1,795.88
Rate for Payer: Cash Price	$1,417.80
Rate for Payer: Devoted Health Medicare	$1,984.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,795.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,244.85
Rate for Payer: Health Management Network Commercial	$2,008.55
Rate for Payer: Humana Medicare	$1,795.88
Rate for Payer: Kaiser Permanente Commercial	$2,126.70
Rate for Payer: Kaiser Permanente Medicaid	$1,205.13
Rate for Payer: Kaiser Permanente Medicare	$1,795.88
Rate for Payer: MDX Hawaii PPO	$2,292.11
Rate for Payer: Ohana Health Plan Medicaid	$1,795.88
Rate for Payer: Ohana Health Plan Medicare	$1,795.88
Rate for Payer: UnitedHealthcare Medicare	$1,795.88
Rate for Payer: University Health Alliance Commercial	$1,722.39

WOUND LAVAGE WW 00-8887-002-00

Facility

$2,363.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,008.55
Max. Negotiated Rate	$2,292.11
Rate for Payer: Cash Price	$1,417.80
Rate for Payer: Health Management Network Commercial	$2,008.55
Rate for Payer: Kaiser Permanente Commercial	$2,126.70
Rate for Payer: MDX Hawaii PPO	$2,292.11

WOUNDVAC CANISTER

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$110.20
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$121.80
Rate for Payer: Hawaii Medical Service Association Medicare	$110.20
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$110.20
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$110.20
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$110.20
Rate for Payer: Ohana Health Plan Medicare	$110.20
Rate for Payer: UnitedHealthcare Medicare	$110.20
Rate for Payer: University Health Alliance Commercial	$105.69

WOUNDVAC CANISTER

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65

WOUNDVAC CANISTER VERAFLO 1000

Facility

$214.00

Hospital Revenue Code	271
Min. Negotiated Rate	$107.00
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$162.64
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$179.76
Rate for Payer: Hawaii Medical Service Association Medicare	$162.64
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$162.64
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$162.64
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$162.64
Rate for Payer: Ohana Health Plan Medicare	$162.64
Rate for Payer: UnitedHealthcare Medicare	$162.64
Rate for Payer: University Health Alliance Commercial	$155.98

WOUNDVAC CANISTER VERAFLO 1000

Facility

$214.00

Hospital Revenue Code	271
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

WRAP EAR FLENTS EAVEY

Facility

$98.00

Hospital Revenue Code	272
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$58.80
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: MDX Hawaii PPO	$95.06

WRAP EAR FLENTS EAVEY

Facility

$98.00

Hospital Revenue Code	272
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$95.06
Rate for Payer: AlohaCare Medicaid	$49.00
Rate for Payer: AlohaCare Medicare	$74.48
Rate for Payer: Cash Price	$58.80
Rate for Payer: Devoted Health Medicare	$82.32
Rate for Payer: Hawaii Medical Service Association Medicare	$74.48
Rate for Payer: Hawaii Western Management Group Commercial	$93.10
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Humana Medicare	$74.48
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$49.98
Rate for Payer: Kaiser Permanente Medicare	$74.48
Rate for Payer: MDX Hawaii PPO	$95.06
Rate for Payer: Ohana Health Plan Medicaid	$74.48
Rate for Payer: Ohana Health Plan Medicare	$74.48
Rate for Payer: UnitedHealthcare Medicare	$74.48
Rate for Payer: University Health Alliance Commercial	$71.43

WRENCH ALLEN 3MM 10.012

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

WRENCH ALLEN 3MM 10.012

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

WRENCH TORQUE 108984

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$152.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$168.00
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$152.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$152.00
Rate for Payer: Ohana Health Plan Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: University Health Alliance Commercial	$145.78

WRENCH TORQUE 108984

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

XEN AB 19CMx35CM 1151935

Facility

$40,520.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$22,691.20
Max. Negotiated Rate	$39,304.40
Rate for Payer: Cash Price	$24,312.00
Rate for Payer: Hawaii Western Management Group Commercial	$28,364.00
Rate for Payer: Health Management Network Commercial	$34,442.00
Rate for Payer: Kaiser Permanente Commercial	$36,468.00
Rate for Payer: MDX Hawaii PPO	$39,304.40
Rate for Payer: University Health Alliance Commercial	$22,691.20

XEN AB 19CMx35CM 1151935

Facility

$40,520.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$20,260.00
Max. Negotiated Rate	$39,304.40
Rate for Payer: AlohaCare Medicaid	$20,260.00
Rate for Payer: AlohaCare Medicare	$30,795.20
Rate for Payer: Cash Price	$24,312.00
Rate for Payer: Devoted Health Medicare	$34,036.80
Rate for Payer: Hawaii Medical Service Association Medicare	$30,795.20
Rate for Payer: Hawaii Western Management Group Commercial	$28,364.00
Rate for Payer: Health Management Network Commercial	$34,442.00
Rate for Payer: Humana Medicare	$30,795.20
Rate for Payer: Kaiser Permanente Commercial	$36,468.00
Rate for Payer: Kaiser Permanente Medicaid	$20,665.20
Rate for Payer: Kaiser Permanente Medicare	$30,795.20
Rate for Payer: MDX Hawaii PPO	$39,304.40
Rate for Payer: Ohana Health Plan Medicaid	$30,795.20
Rate for Payer: Ohana Health Plan Medicare	$30,795.20
Rate for Payer: UnitedHealthcare Medicare	$30,795.20
Rate for Payer: University Health Alliance Commercial	$22,691.20

XENMATRIX 10X15 BIOLOGY GRAFT

Facility

$8,620.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$4,827.20
Max. Negotiated Rate	$8,361.40
Rate for Payer: Cash Price	$5,172.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,034.00
Rate for Payer: Health Management Network Commercial	$7,327.00
Rate for Payer: Kaiser Permanente Commercial	$7,758.00
Rate for Payer: MDX Hawaii PPO	$8,361.40
Rate for Payer: University Health Alliance Commercial	$4,827.20

XENMATRIX 10X15 BIOLOGY GRAFT

Facility

$8,620.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$4,310.00
Max. Negotiated Rate	$8,361.40
Rate for Payer: AlohaCare Medicaid	$4,310.00
Rate for Payer: AlohaCare Medicare	$6,551.20
Rate for Payer: Cash Price	$5,172.00
Rate for Payer: Devoted Health Medicare	$7,240.80
Rate for Payer: Hawaii Medical Service Association Medicare	$6,551.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,034.00
Rate for Payer: Health Management Network Commercial	$7,327.00
Rate for Payer: Humana Medicare	$6,551.20
Rate for Payer: Kaiser Permanente Commercial	$7,758.00
Rate for Payer: Kaiser Permanente Medicaid	$4,396.20
Rate for Payer: Kaiser Permanente Medicare	$6,551.20
Rate for Payer: MDX Hawaii PPO	$8,361.40
Rate for Payer: Ohana Health Plan Medicaid	$6,551.20
Rate for Payer: Ohana Health Plan Medicare	$6,551.20
Rate for Payer: UnitedHealthcare Medicare	$6,551.20
Rate for Payer: University Health Alliance Commercial	$4,827.20

XENMATRIX 19X35 BIOLOGIC GRAFT

Facility

$38,529.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$21,576.24
Max. Negotiated Rate	$37,373.13
Rate for Payer: Cash Price	$23,117.40
Rate for Payer: Hawaii Western Management Group Commercial	$26,970.30
Rate for Payer: Health Management Network Commercial	$32,749.65
Rate for Payer: Kaiser Permanente Commercial	$34,676.10
Rate for Payer: MDX Hawaii PPO	$37,373.13
Rate for Payer: University Health Alliance Commercial	$21,576.24

XENMATRIX 19X35 BIOLOGIC GRAFT

Facility

$38,529.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$19,264.50
Max. Negotiated Rate	$37,373.13
Rate for Payer: AlohaCare Medicaid	$19,264.50
Rate for Payer: AlohaCare Medicare	$29,282.04
Rate for Payer: Cash Price	$23,117.40
Rate for Payer: Devoted Health Medicare	$32,364.36
Rate for Payer: Hawaii Medical Service Association Medicare	$29,282.04
Rate for Payer: Hawaii Western Management Group Commercial	$26,970.30
Rate for Payer: Health Management Network Commercial	$32,749.65
Rate for Payer: Humana Medicare	$29,282.04
Rate for Payer: Kaiser Permanente Commercial	$34,676.10
Rate for Payer: Kaiser Permanente Medicaid	$19,649.79
Rate for Payer: Kaiser Permanente Medicare	$29,282.04
Rate for Payer: MDX Hawaii PPO	$37,373.13
Rate for Payer: Ohana Health Plan Medicaid	$29,282.04
Rate for Payer: Ohana Health Plan Medicare	$29,282.04
Rate for Payer: UnitedHealthcare Medicare	$29,282.04
Rate for Payer: University Health Alliance Commercial	$21,576.24

XENMATRIX XEN AB 10X15 1151015

Facility

$9,480.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$5,308.80
Max. Negotiated Rate	$9,195.60
Rate for Payer: Cash Price	$5,688.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,636.00
Rate for Payer: Health Management Network Commercial	$8,058.00
Rate for Payer: Kaiser Permanente Commercial	$8,532.00
Rate for Payer: MDX Hawaii PPO	$9,195.60
Rate for Payer: University Health Alliance Commercial	$5,308.80

XENMATRIX XEN AB 10X15 1151015

Facility

$9,480.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$4,740.00
Max. Negotiated Rate	$9,195.60
Rate for Payer: AlohaCare Medicaid	$4,740.00
Rate for Payer: AlohaCare Medicare	$7,204.80
Rate for Payer: Cash Price	$5,688.00
Rate for Payer: Devoted Health Medicare	$7,963.20
Rate for Payer: Hawaii Medical Service Association Medicare	$7,204.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,636.00
Rate for Payer: Health Management Network Commercial	$8,058.00
Rate for Payer: Humana Medicare	$7,204.80
Rate for Payer: Kaiser Permanente Commercial	$8,532.00
Rate for Payer: Kaiser Permanente Medicaid	$4,834.80
Rate for Payer: Kaiser Permanente Medicare	$7,204.80
Rate for Payer: MDX Hawaii PPO	$9,195.60
Rate for Payer: Ohana Health Plan Medicaid	$7,204.80
Rate for Payer: Ohana Health Plan Medicare	$7,204.80
Rate for Payer: UnitedHealthcare Medicare	$7,204.80
Rate for Payer: University Health Alliance Commercial	$5,308.80

XENOSURE BIOLOGIC PATCH 1.5X10

Facility

$1,047.00

Hospital Revenue Code	278
Min. Negotiated Rate	$586.32
Max. Negotiated Rate	$1,015.59
Rate for Payer: Cash Price	$628.20
Rate for Payer: Hawaii Western Management Group Commercial	$732.90
Rate for Payer: Health Management Network Commercial	$889.95
Rate for Payer: Kaiser Permanente Commercial	$942.30
Rate for Payer: MDX Hawaii PPO	$1,015.59
Rate for Payer: University Health Alliance Commercial	$586.32

XENOSURE BIOLOGIC PATCH 1.5X10

Facility

$1,047.00

Hospital Revenue Code	278
Min. Negotiated Rate	$523.50
Max. Negotiated Rate	$1,015.59
Rate for Payer: AlohaCare Medicaid	$523.50
Rate for Payer: AlohaCare Medicare	$795.72
Rate for Payer: Cash Price	$628.20
Rate for Payer: Devoted Health Medicare	$879.48
Rate for Payer: Hawaii Medical Service Association Medicare	$795.72
Rate for Payer: Hawaii Western Management Group Commercial	$732.90
Rate for Payer: Health Management Network Commercial	$889.95
Rate for Payer: Humana Medicare	$795.72
Rate for Payer: Kaiser Permanente Commercial	$942.30
Rate for Payer: Kaiser Permanente Medicaid	$533.97
Rate for Payer: Kaiser Permanente Medicare	$795.72
Rate for Payer: MDX Hawaii PPO	$1,015.59
Rate for Payer: Ohana Health Plan Medicaid	$795.72
Rate for Payer: Ohana Health Plan Medicare	$795.72
Rate for Payer: UnitedHealthcare Medicare	$795.72
Rate for Payer: University Health Alliance Commercial	$586.32

Know your out-of-pocket cost for care.

All Charges