Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CLAMP MULTI-PIN 6 POS 390.002

Facility

$2,885.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.60
Max. Negotiated Rate	$2,798.45
Rate for Payer: Cash Price	$1,731.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,019.50
Rate for Payer: Health Management Network Commercial	$2,452.25
Rate for Payer: Kaiser Permanente Commercial	$2,596.50
Rate for Payer: MDX Hawaii PPO	$2,798.45
Rate for Payer: University Health Alliance Commercial	$1,615.60

CLAMP MULTI-PIN 6 POS 390.002

Facility

$2,885.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,442.50
Max. Negotiated Rate	$2,798.45
Rate for Payer: AlohaCare Medicaid	$1,442.50
Rate for Payer: AlohaCare Medicare	$2,192.60
Rate for Payer: Cash Price	$1,731.00
Rate for Payer: Devoted Health Medicare	$2,423.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,192.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,019.50
Rate for Payer: Health Management Network Commercial	$2,452.25
Rate for Payer: Humana Medicare	$2,192.60
Rate for Payer: Kaiser Permanente Commercial	$2,596.50
Rate for Payer: Kaiser Permanente Medicaid	$1,471.35
Rate for Payer: Kaiser Permanente Medicare	$2,192.60
Rate for Payer: MDX Hawaii PPO	$2,798.45
Rate for Payer: Ohana Health Plan Medicaid	$2,192.60
Rate for Payer: Ohana Health Plan Medicare	$2,192.60
Rate for Payer: UnitedHealthcare Medicare	$2,192.60
Rate for Payer: University Health Alliance Commercial	$1,615.60

CLAMP OPEN ADJ 390.008

Facility

$2,090.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.40
Max. Negotiated Rate	$2,027.30
Rate for Payer: Cash Price	$1,254.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.00
Rate for Payer: Health Management Network Commercial	$1,776.50
Rate for Payer: Kaiser Permanente Commercial	$1,881.00
Rate for Payer: MDX Hawaii PPO	$2,027.30
Rate for Payer: University Health Alliance Commercial	$1,170.40

CLAMP OPEN ADJ 390.008

Facility

$2,090.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.00
Max. Negotiated Rate	$2,027.30
Rate for Payer: AlohaCare Medicaid	$1,045.00
Rate for Payer: AlohaCare Medicare	$1,588.40
Rate for Payer: Cash Price	$1,254.00
Rate for Payer: Devoted Health Medicare	$1,755.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,588.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.00
Rate for Payer: Health Management Network Commercial	$1,776.50
Rate for Payer: Humana Medicare	$1,588.40
Rate for Payer: Kaiser Permanente Commercial	$1,881.00
Rate for Payer: Kaiser Permanente Medicaid	$1,065.90
Rate for Payer: Kaiser Permanente Medicare	$1,588.40
Rate for Payer: MDX Hawaii PPO	$2,027.30
Rate for Payer: Ohana Health Plan Medicaid	$1,588.40
Rate for Payer: Ohana Health Plan Medicare	$1,588.40
Rate for Payer: UnitedHealthcare Medicare	$1,588.40
Rate for Payer: University Health Alliance Commercial	$1,170.40

CLAMP PIN 4 POSITION #390.033

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: MDX Hawaii PPO	$2,409.48

CLAMP PIN 4 POSITION #390.033

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,242.00
Max. Negotiated Rate	$2,409.48
Rate for Payer: AlohaCare Medicaid	$1,242.00
Rate for Payer: AlohaCare Medicare	$1,887.84
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Devoted Health Medicare	$2,086.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Humana Medicare	$1,887.84
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: Kaiser Permanente Medicare	$1,887.84
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: Ohana Health Plan Medicaid	$1,887.84
Rate for Payer: Ohana Health Plan Medicare	$1,887.84
Rate for Payer: UnitedHealthcare Medicare	$1,887.84
Rate for Payer: University Health Alliance Commercial	$1,810.59

CLAMP PIN 5 HOLE 4922-2-020

Facility

$2,221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,110.50
Max. Negotiated Rate	$2,154.37
Rate for Payer: AlohaCare Medicaid	$1,110.50
Rate for Payer: AlohaCare Medicare	$1,687.96
Rate for Payer: Cash Price	$1,332.60
Rate for Payer: Devoted Health Medicare	$1,865.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,687.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,109.95
Rate for Payer: Health Management Network Commercial	$1,887.85
Rate for Payer: Humana Medicare	$1,687.96
Rate for Payer: Kaiser Permanente Commercial	$1,998.90
Rate for Payer: Kaiser Permanente Medicaid	$1,132.71
Rate for Payer: Kaiser Permanente Medicare	$1,687.96
Rate for Payer: MDX Hawaii PPO	$2,154.37
Rate for Payer: Ohana Health Plan Medicaid	$1,687.96
Rate for Payer: Ohana Health Plan Medicare	$1,687.96
Rate for Payer: UnitedHealthcare Medicare	$1,687.96
Rate for Payer: University Health Alliance Commercial	$1,618.89

CLAMP PIN 5 HOLE 4922-2-020

Facility

$2,221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,887.85
Max. Negotiated Rate	$2,154.37
Rate for Payer: Cash Price	$1,332.60
Rate for Payer: Health Management Network Commercial	$1,887.85
Rate for Payer: Kaiser Permanente Commercial	$1,998.90
Rate for Payer: MDX Hawaii PPO	$2,154.37

CLAMP PIN 6 POSITION #390.036

Facility

$2,576.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,288.00
Max. Negotiated Rate	$2,498.72
Rate for Payer: AlohaCare Medicaid	$1,288.00
Rate for Payer: AlohaCare Medicare	$1,957.76
Rate for Payer: Cash Price	$1,545.60
Rate for Payer: Devoted Health Medicare	$2,163.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,957.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,447.20
Rate for Payer: Health Management Network Commercial	$2,189.60
Rate for Payer: Humana Medicare	$1,957.76
Rate for Payer: Kaiser Permanente Commercial	$2,318.40
Rate for Payer: Kaiser Permanente Medicaid	$1,313.76
Rate for Payer: Kaiser Permanente Medicare	$1,957.76
Rate for Payer: MDX Hawaii PPO	$2,498.72
Rate for Payer: Ohana Health Plan Medicaid	$1,957.76
Rate for Payer: Ohana Health Plan Medicare	$1,957.76
Rate for Payer: UnitedHealthcare Medicare	$1,957.76
Rate for Payer: University Health Alliance Commercial	$1,877.65

CLAMP PIN 6 POSITION #390.036

Facility

$2,576.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,189.60
Max. Negotiated Rate	$2,498.72
Rate for Payer: Cash Price	$1,545.60
Rate for Payer: Health Management Network Commercial	$2,189.60
Rate for Payer: Kaiser Permanente Commercial	$2,318.40
Rate for Payer: MDX Hawaii PPO	$2,498.72

CLAMP SCREW M4X8 MINIFIX M132

Facility

$158.00

Hospital Revenue Code	272
Min. Negotiated Rate	$134.30
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$94.80
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26

CLAMP SCREW M4X8 MINIFIX M132

Facility

$158.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$120.08
Rate for Payer: Cash Price	$94.80
Rate for Payer: Devoted Health Medicare	$132.72
Rate for Payer: Hawaii Medical Service Association Medicare	$120.08
Rate for Payer: Hawaii Western Management Group Commercial	$150.10
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$120.08
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$120.08
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$120.08
Rate for Payer: Ohana Health Plan Medicare	$120.08
Rate for Payer: UnitedHealthcare Medicare	$120.08
Rate for Payer: University Health Alliance Commercial	$115.17

CLAMPS MEDIUM ADJUST #390.035

Facility

$1,695.00

Hospital Revenue Code	272
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,644.15
Rate for Payer: AlohaCare Medicaid	$847.50
Rate for Payer: AlohaCare Medicare	$1,288.20
Rate for Payer: Cash Price	$1,017.00
Rate for Payer: Devoted Health Medicare	$1,423.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,288.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,610.25
Rate for Payer: Health Management Network Commercial	$1,440.75
Rate for Payer: Humana Medicare	$1,288.20
Rate for Payer: Kaiser Permanente Commercial	$1,525.50
Rate for Payer: Kaiser Permanente Medicaid	$864.45
Rate for Payer: Kaiser Permanente Medicare	$1,288.20
Rate for Payer: MDX Hawaii PPO	$1,644.15
Rate for Payer: Ohana Health Plan Medicaid	$1,288.20
Rate for Payer: Ohana Health Plan Medicare	$1,288.20
Rate for Payer: UnitedHealthcare Medicare	$1,288.20
Rate for Payer: University Health Alliance Commercial	$1,235.49

CLAMPS MEDIUM ADJUST #390.035

Facility

$1,695.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,440.75
Max. Negotiated Rate	$1,644.15
Rate for Payer: Cash Price	$1,017.00
Rate for Payer: Health Management Network Commercial	$1,440.75
Rate for Payer: Kaiser Permanente Commercial	$1,525.50
Rate for Payer: MDX Hawaii PPO	$1,644.15

CLAMPS MINI LNGTHER SSM501

Facility

$2,790.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,371.50
Max. Negotiated Rate	$2,706.30
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Health Management Network Commercial	$2,371.50
Rate for Payer: Kaiser Permanente Commercial	$2,511.00
Rate for Payer: MDX Hawaii PPO	$2,706.30

CLAMPS MINI LNGTHER SSM501

Facility

$2,790.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,395.00
Max. Negotiated Rate	$2,706.30
Rate for Payer: AlohaCare Medicaid	$1,395.00
Rate for Payer: AlohaCare Medicare	$2,120.40
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Devoted Health Medicare	$2,343.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,120.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,650.50
Rate for Payer: Health Management Network Commercial	$2,371.50
Rate for Payer: Humana Medicare	$2,120.40
Rate for Payer: Kaiser Permanente Commercial	$2,511.00
Rate for Payer: Kaiser Permanente Medicaid	$1,422.90
Rate for Payer: Kaiser Permanente Medicare	$2,120.40
Rate for Payer: MDX Hawaii PPO	$2,706.30
Rate for Payer: Ohana Health Plan Medicaid	$2,120.40
Rate for Payer: Ohana Health Plan Medicare	$2,120.40
Rate for Payer: UnitedHealthcare Medicare	$2,120.40
Rate for Payer: University Health Alliance Commercial	$2,033.63

CLAMPS MR CONDITIONAL #390.034

Facility

$1,666.00

Hospital Revenue Code	272
Min. Negotiated Rate	$833.00
Max. Negotiated Rate	$1,616.02
Rate for Payer: AlohaCare Medicaid	$833.00
Rate for Payer: AlohaCare Medicare	$1,266.16
Rate for Payer: Cash Price	$999.60
Rate for Payer: Devoted Health Medicare	$1,399.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,266.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,582.70
Rate for Payer: Health Management Network Commercial	$1,416.10
Rate for Payer: Humana Medicare	$1,266.16
Rate for Payer: Kaiser Permanente Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Medicaid	$849.66
Rate for Payer: Kaiser Permanente Medicare	$1,266.16
Rate for Payer: MDX Hawaii PPO	$1,616.02
Rate for Payer: Ohana Health Plan Medicaid	$1,266.16
Rate for Payer: Ohana Health Plan Medicare	$1,266.16
Rate for Payer: UnitedHealthcare Medicare	$1,266.16
Rate for Payer: University Health Alliance Commercial	$1,214.35

CLAMPS MR CONDITIONAL #390.034

Facility

$1,666.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,416.10
Max. Negotiated Rate	$1,616.02
Rate for Payer: Cash Price	$999.60
Rate for Payer: Health Management Network Commercial	$1,416.10
Rate for Payer: Kaiser Permanente Commercial	$1,499.40
Rate for Payer: MDX Hawaii PPO	$1,616.02

CLAMP TRANSVERSE 393.66

Facility

$2,482.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,241.00
Max. Negotiated Rate	$2,407.54
Rate for Payer: AlohaCare Medicaid	$1,241.00
Rate for Payer: AlohaCare Medicare	$1,886.32
Rate for Payer: Cash Price	$1,489.20
Rate for Payer: Devoted Health Medicare	$2,084.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,886.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,357.90
Rate for Payer: Health Management Network Commercial	$2,109.70
Rate for Payer: Humana Medicare	$1,886.32
Rate for Payer: Kaiser Permanente Commercial	$2,233.80
Rate for Payer: Kaiser Permanente Medicaid	$1,265.82
Rate for Payer: Kaiser Permanente Medicare	$1,886.32
Rate for Payer: MDX Hawaii PPO	$2,407.54
Rate for Payer: Ohana Health Plan Medicaid	$1,886.32
Rate for Payer: Ohana Health Plan Medicare	$1,886.32
Rate for Payer: UnitedHealthcare Medicare	$1,886.32
Rate for Payer: University Health Alliance Commercial	$1,809.13

CLAMP TRANSVERSE 393.66

Facility

$2,482.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,109.70
Max. Negotiated Rate	$2,407.54
Rate for Payer: Cash Price	$1,489.20
Rate for Payer: Health Management Network Commercial	$2,109.70
Rate for Payer: Kaiser Permanente Commercial	$2,233.80
Rate for Payer: MDX Hawaii PPO	$2,407.54

CLAMP TUBE-TUBE LRG 390.007

Facility

$2,606.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,303.00
Max. Negotiated Rate	$2,527.82
Rate for Payer: AlohaCare Medicaid	$1,303.00
Rate for Payer: AlohaCare Medicare	$1,980.56
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Devoted Health Medicare	$2,189.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,980.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,475.70
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: Humana Medicare	$1,980.56
Rate for Payer: Kaiser Permanente Commercial	$2,345.40
Rate for Payer: Kaiser Permanente Medicaid	$1,329.06
Rate for Payer: Kaiser Permanente Medicare	$1,980.56
Rate for Payer: MDX Hawaii PPO	$2,527.82
Rate for Payer: Ohana Health Plan Medicaid	$1,980.56
Rate for Payer: Ohana Health Plan Medicare	$1,980.56
Rate for Payer: UnitedHealthcare Medicare	$1,980.56
Rate for Payer: University Health Alliance Commercial	$1,899.51

CLAMP TUBE-TUBE LRG 390.007

Facility

$2,606.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,215.10
Max. Negotiated Rate	$2,527.82
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: Kaiser Permanente Commercial	$2,345.40
Rate for Payer: MDX Hawaii PPO	$2,527.82

CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]

Facility

$225.00

Service Code	NDC 00781602246
Hospital Revenue Code	637
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$171.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$189.00
Rate for Payer: Hawaii Medical Service Association Medicare	$171.00
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$171.00
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$171.00
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$171.00
Rate for Payer: Ohana Health Plan Medicare	$171.00
Rate for Payer: UnitedHealthcare Medicare	$171.00
Rate for Payer: University Health Alliance Commercial	$164.00

CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]

Facility

$225.00

Service Code	NDC 00781602246
Hospital Revenue Code	250
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION [12886]

Facility

$328.00

Service Code	NDC 00781602346
Hospital Revenue Code	250
Min. Negotiated Rate	$278.80
Max. Negotiated Rate	$318.16
Rate for Payer: Cash Price	$196.80
Rate for Payer: Health Management Network Commercial	$278.80
Rate for Payer: Kaiser Permanente Commercial	$295.20
Rate for Payer: MDX Hawaii PPO	$318.16

Know your out-of-pocket cost for care.

All Charges