Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CLIP II M/L ENDO

Facility

$338.00

Hospital Revenue Code	272
Min. Negotiated Rate	$169.00
Max. Negotiated Rate	$327.86
Rate for Payer: AlohaCare Medicaid	$169.00
Rate for Payer: AlohaCare Medicare	$256.88
Rate for Payer: Cash Price	$202.80
Rate for Payer: Devoted Health Medicare	$283.92
Rate for Payer: Hawaii Medical Service Association Medicare	$256.88
Rate for Payer: Hawaii Western Management Group Commercial	$321.10
Rate for Payer: Health Management Network Commercial	$287.30
Rate for Payer: Humana Medicare	$256.88
Rate for Payer: Kaiser Permanente Commercial	$304.20
Rate for Payer: Kaiser Permanente Medicaid	$172.38
Rate for Payer: Kaiser Permanente Medicare	$256.88
Rate for Payer: MDX Hawaii PPO	$327.86
Rate for Payer: Ohana Health Plan Medicaid	$256.88
Rate for Payer: Ohana Health Plan Medicare	$256.88
Rate for Payer: UnitedHealthcare Medicare	$256.88
Rate for Payer: University Health Alliance Commercial	$246.37

CLIP II M/L ENDO

Facility

$338.00

Hospital Revenue Code	272
Min. Negotiated Rate	$287.30
Max. Negotiated Rate	$327.86
Rate for Payer: Cash Price	$202.80
Rate for Payer: Health Management Network Commercial	$287.30
Rate for Payer: Kaiser Permanente Commercial	$304.20
Rate for Payer: MDX Hawaii PPO	$327.86

CLIP LIGATING SMALL LT100

Facility

$70.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

CLIP LIGATING SMALL LT100

Facility

$70.00

Hospital Revenue Code	272
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$35.00
Rate for Payer: AlohaCare Medicare	$53.20
Rate for Payer: Cash Price	$42.00
Rate for Payer: Devoted Health Medicare	$58.80
Rate for Payer: Hawaii Medical Service Association Medicare	$53.20
Rate for Payer: Hawaii Western Management Group Commercial	$66.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Humana Medicare	$53.20
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: Kaiser Permanente Medicare	$53.20
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: Ohana Health Plan Medicaid	$53.20
Rate for Payer: Ohana Health Plan Medicare	$53.20
Rate for Payer: UnitedHealthcare Medicare	$53.20
Rate for Payer: University Health Alliance Commercial	$51.02

CLIP LOCKING STERILE 352.260S

Facility

$354.00

Hospital Revenue Code	272
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$343.38
Rate for Payer: AlohaCare Medicaid	$177.00
Rate for Payer: AlohaCare Medicare	$269.04
Rate for Payer: Cash Price	$212.40
Rate for Payer: Devoted Health Medicare	$297.36
Rate for Payer: Hawaii Medical Service Association Medicare	$269.04
Rate for Payer: Hawaii Western Management Group Commercial	$336.30
Rate for Payer: Health Management Network Commercial	$300.90
Rate for Payer: Humana Medicare	$269.04
Rate for Payer: Kaiser Permanente Commercial	$318.60
Rate for Payer: Kaiser Permanente Medicaid	$180.54
Rate for Payer: Kaiser Permanente Medicare	$269.04
Rate for Payer: MDX Hawaii PPO	$343.38
Rate for Payer: Ohana Health Plan Medicaid	$269.04
Rate for Payer: Ohana Health Plan Medicare	$269.04
Rate for Payer: UnitedHealthcare Medicare	$269.04
Rate for Payer: University Health Alliance Commercial	$258.03

CLIP LOCKING STERILE 352.260S

Facility

$354.00

Hospital Revenue Code	272
Min. Negotiated Rate	$300.90
Max. Negotiated Rate	$343.38
Rate for Payer: Cash Price	$212.40
Rate for Payer: Health Management Network Commercial	$300.90
Rate for Payer: Kaiser Permanente Commercial	$318.60
Rate for Payer: MDX Hawaii PPO	$343.38

CLIP QUICK PRO

Facility

$1,278.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,086.30
Max. Negotiated Rate	$1,239.66
Rate for Payer: Cash Price	$766.80
Rate for Payer: Health Management Network Commercial	$1,086.30
Rate for Payer: Kaiser Permanente Commercial	$1,150.20
Rate for Payer: MDX Hawaii PPO	$1,239.66

CLIP QUICK PRO

Facility

$1,278.00

Hospital Revenue Code	272
Min. Negotiated Rate	$639.00
Max. Negotiated Rate	$1,239.66
Rate for Payer: AlohaCare Medicaid	$639.00
Rate for Payer: AlohaCare Medicare	$971.28
Rate for Payer: Cash Price	$766.80
Rate for Payer: Devoted Health Medicare	$1,073.52
Rate for Payer: Hawaii Medical Service Association Medicare	$971.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,214.10
Rate for Payer: Health Management Network Commercial	$1,086.30
Rate for Payer: Humana Medicare	$971.28
Rate for Payer: Kaiser Permanente Commercial	$1,150.20
Rate for Payer: Kaiser Permanente Medicaid	$651.78
Rate for Payer: Kaiser Permanente Medicare	$971.28
Rate for Payer: MDX Hawaii PPO	$1,239.66
Rate for Payer: Ohana Health Plan Medicaid	$971.28
Rate for Payer: Ohana Health Plan Medicare	$971.28
Rate for Payer: UnitedHealthcare Medicare	$971.28
Rate for Payer: University Health Alliance Commercial	$931.53

CLIP RESOLUTION 235CM

Facility

$821.00

Hospital Revenue Code	272
Min. Negotiated Rate	$697.85
Max. Negotiated Rate	$796.37
Rate for Payer: Cash Price	$492.60
Rate for Payer: Health Management Network Commercial	$697.85
Rate for Payer: Kaiser Permanente Commercial	$738.90
Rate for Payer: MDX Hawaii PPO	$796.37

CLIP RESOLUTION 235CM

Facility

$821.00

Hospital Revenue Code	272
Min. Negotiated Rate	$410.50
Max. Negotiated Rate	$796.37
Rate for Payer: AlohaCare Medicaid	$410.50
Rate for Payer: AlohaCare Medicare	$623.96
Rate for Payer: Cash Price	$492.60
Rate for Payer: Devoted Health Medicare	$689.64
Rate for Payer: Hawaii Medical Service Association Medicare	$623.96
Rate for Payer: Hawaii Western Management Group Commercial	$779.95
Rate for Payer: Health Management Network Commercial	$697.85
Rate for Payer: Humana Medicare	$623.96
Rate for Payer: Kaiser Permanente Commercial	$738.90
Rate for Payer: Kaiser Permanente Medicaid	$418.71
Rate for Payer: Kaiser Permanente Medicare	$623.96
Rate for Payer: MDX Hawaii PPO	$796.37
Rate for Payer: Ohana Health Plan Medicaid	$623.96
Rate for Payer: Ohana Health Plan Medicare	$623.96
Rate for Payer: UnitedHealthcare Medicare	$623.96
Rate for Payer: University Health Alliance Commercial	$598.43

CLIPS HEMOLOK MED

Facility

$67.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$37.52
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$40.20
Rate for Payer: Hawaii Western Management Group Commercial	$46.90
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: University Health Alliance Commercial	$37.52

CLIPS HEMOLOK MED

Facility

$67.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$64.99
Rate for Payer: AlohaCare Medicaid	$33.50
Rate for Payer: AlohaCare Medicare	$50.92
Rate for Payer: Cash Price	$40.20
Rate for Payer: Devoted Health Medicare	$56.28
Rate for Payer: Hawaii Medical Service Association Medicare	$50.92
Rate for Payer: Hawaii Western Management Group Commercial	$46.90
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Humana Medicare	$50.92
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: Kaiser Permanente Medicaid	$34.17
Rate for Payer: Kaiser Permanente Medicare	$50.92
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: Ohana Health Plan Medicaid	$50.92
Rate for Payer: Ohana Health Plan Medicare	$50.92
Rate for Payer: UnitedHealthcare Medicare	$50.92
Rate for Payer: University Health Alliance Commercial	$37.52

CLIP SUTURE LAPRA-TY

Facility

$1,569.00

Hospital Revenue Code	272
Min. Negotiated Rate	$784.50
Max. Negotiated Rate	$1,521.93
Rate for Payer: AlohaCare Medicaid	$784.50
Rate for Payer: AlohaCare Medicare	$1,192.44
Rate for Payer: Cash Price	$941.40
Rate for Payer: Devoted Health Medicare	$1,317.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,192.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,490.55
Rate for Payer: Health Management Network Commercial	$1,333.65
Rate for Payer: Humana Medicare	$1,192.44
Rate for Payer: Kaiser Permanente Commercial	$1,412.10
Rate for Payer: Kaiser Permanente Medicaid	$800.19
Rate for Payer: Kaiser Permanente Medicare	$1,192.44
Rate for Payer: MDX Hawaii PPO	$1,521.93
Rate for Payer: Ohana Health Plan Medicaid	$1,192.44
Rate for Payer: Ohana Health Plan Medicare	$1,192.44
Rate for Payer: UnitedHealthcare Medicare	$1,192.44
Rate for Payer: University Health Alliance Commercial	$1,143.64

CLIP SUTURE LAPRA-TY

Facility

$1,569.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,333.65
Max. Negotiated Rate	$1,521.93
Rate for Payer: Cash Price	$941.40
Rate for Payer: Health Management Network Commercial	$1,333.65
Rate for Payer: Kaiser Permanente Commercial	$1,412.10
Rate for Payer: MDX Hawaii PPO	$1,521.93

CLONAZEPAM 0.5 MG TABLET [9637]

Facility

$3.00

Service Code	NDC 60687086111
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

CLONAZEPAM 0.5 MG TABLET [9637]

Facility

$3.00

Service Code	NDC 60687086101
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

CLONAZEPAM 0.5 MG TABLET [9637]

Facility

$3.00

Service Code	NDC 60687054401
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

CLONAZEPAM 0.5 MG TABLET [9637]

Facility

$3.00

Service Code	NDC 60687086111
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

CLONAZEPAM 0.5 MG TABLET [9637]

Facility

$3.00

Service Code	NDC 60687086101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

CLONAZEPAM 0.5 MG TABLET [9637]

Facility

$3.00

Service Code	NDC 60687054401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

CLONAZEPAM 1 MG TABLET [9638]

Facility

$3.00

Service Code	NDC 60687055501
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

CLONAZEPAM 1 MG TABLET [9638]

Facility

$3.00

Service Code	NDC 60687087201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

CLONAZEPAM 1 MG TABLET [9638]

Facility

$3.00

Service Code	NDC 60687087211
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

CLONAZEPAM 1 MG TABLET [9638]

Facility

$3.00

Service Code	NDC 60687087201
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

CLONAZEPAM 1 MG TABLET [9638]

Facility

$3.00

Service Code	NDC 60687055501
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

Know your out-of-pocket cost for care.

All Charges