Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CONT LONGEVITY NEUT LINER 00

Facility

$3,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,514.00
Max. Negotiated Rate	$2,937.16
Rate for Payer: AlohaCare Medicaid	$1,514.00
Rate for Payer: AlohaCare Medicare	$2,301.28
Rate for Payer: Cash Price	$1,816.80
Rate for Payer: Devoted Health Medicare	$2,543.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,301.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,119.60
Rate for Payer: Health Management Network Commercial	$2,573.80
Rate for Payer: Humana Medicare	$2,301.28
Rate for Payer: Kaiser Permanente Commercial	$2,725.20
Rate for Payer: Kaiser Permanente Medicaid	$1,544.28
Rate for Payer: Kaiser Permanente Medicare	$2,301.28
Rate for Payer: MDX Hawaii PPO	$2,937.16
Rate for Payer: Ohana Health Plan Medicaid	$2,301.28
Rate for Payer: Ohana Health Plan Medicare	$2,301.28
Rate for Payer: UnitedHealthcare Medicare	$2,301.28
Rate for Payer: University Health Alliance Commercial	$1,695.68

CONT LONGEVITY NEUT LINER 00

Facility

$3,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.68
Max. Negotiated Rate	$2,937.16
Rate for Payer: Cash Price	$1,816.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,119.60
Rate for Payer: Health Management Network Commercial	$2,573.80
Rate for Payer: Kaiser Permanente Commercial	$2,725.20
Rate for Payer: MDX Hawaii PPO	$2,937.16
Rate for Payer: University Health Alliance Commercial	$1,695.68

CONT LONGEVITY NEUT LINER LL

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONT LONGEVITY NEUT LINER LL

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

CONTOUR 40MM LINEAR STAPLER

Facility

$2,964.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,482.00
Max. Negotiated Rate	$2,875.08
Rate for Payer: AlohaCare Medicaid	$1,482.00
Rate for Payer: AlohaCare Medicare	$2,252.64
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Devoted Health Medicare	$2,489.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,252.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,815.80
Rate for Payer: Health Management Network Commercial	$2,519.40
Rate for Payer: Humana Medicare	$2,252.64
Rate for Payer: Kaiser Permanente Commercial	$2,667.60
Rate for Payer: Kaiser Permanente Medicaid	$1,511.64
Rate for Payer: Kaiser Permanente Medicare	$2,252.64
Rate for Payer: MDX Hawaii PPO	$2,875.08
Rate for Payer: Ohana Health Plan Medicaid	$2,252.64
Rate for Payer: Ohana Health Plan Medicare	$2,252.64
Rate for Payer: UnitedHealthcare Medicare	$2,252.64
Rate for Payer: University Health Alliance Commercial	$2,160.46

CONTOUR 40MM LINEAR STAPLER

Facility

$2,964.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,519.40
Max. Negotiated Rate	$2,875.08
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Health Management Network Commercial	$2,519.40
Rate for Payer: Kaiser Permanente Commercial	$2,667.60
Rate for Payer: MDX Hawaii PPO	$2,875.08

CONTRALATERAL LEF ENDOPROSTHES

Facility

$8,800.00

Hospital Revenue Code	278
Min. Negotiated Rate	$4,400.00
Max. Negotiated Rate	$8,536.00
Rate for Payer: AlohaCare Medicaid	$4,400.00
Rate for Payer: AlohaCare Medicare	$6,688.00
Rate for Payer: Cash Price	$5,280.00
Rate for Payer: Devoted Health Medicare	$7,392.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,688.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,160.00
Rate for Payer: Health Management Network Commercial	$7,480.00
Rate for Payer: Humana Medicare	$6,688.00
Rate for Payer: Kaiser Permanente Commercial	$7,920.00
Rate for Payer: Kaiser Permanente Medicaid	$4,488.00
Rate for Payer: Kaiser Permanente Medicare	$6,688.00
Rate for Payer: MDX Hawaii PPO	$8,536.00
Rate for Payer: Ohana Health Plan Medicaid	$6,688.00
Rate for Payer: Ohana Health Plan Medicare	$6,688.00
Rate for Payer: UnitedHealthcare Medicare	$6,688.00
Rate for Payer: University Health Alliance Commercial	$4,928.00

CONTRALATERAL LEF ENDOPROSTHES

Facility

$8,800.00

Hospital Revenue Code	278
Min. Negotiated Rate	$4,928.00
Max. Negotiated Rate	$8,536.00
Rate for Payer: Cash Price	$5,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,160.00
Rate for Payer: Health Management Network Commercial	$7,480.00
Rate for Payer: Kaiser Permanente Commercial	$7,920.00
Rate for Payer: MDX Hawaii PPO	$8,536.00
Rate for Payer: University Health Alliance Commercial	$4,928.00

CONTROLLER 97745

Facility

$4,400.00

Service Code	HCPCS C1787
Hospital Revenue Code	278
Min. Negotiated Rate	$2,464.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,080.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: Kaiser Permanente Commercial	$3,960.00
Rate for Payer: MDX Hawaii PPO	$4,268.00
Rate for Payer: University Health Alliance Commercial	$2,464.00

CONTROLLER 97745

Facility

$4,400.00

Service Code	HCPCS C1787
Hospital Revenue Code	278
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: AlohaCare Medicaid	$2,200.00
Rate for Payer: AlohaCare Medicare	$3,344.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Devoted Health Medicare	$3,696.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,344.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,080.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: Humana Medicare	$3,344.00
Rate for Payer: Kaiser Permanente Commercial	$3,960.00
Rate for Payer: Kaiser Permanente Medicaid	$2,244.00
Rate for Payer: Kaiser Permanente Medicare	$3,344.00
Rate for Payer: MDX Hawaii PPO	$4,268.00
Rate for Payer: Ohana Health Plan Medicaid	$3,344.00
Rate for Payer: Ohana Health Plan Medicare	$3,344.00
Rate for Payer: UnitedHealthcare Medicare	$3,344.00
Rate for Payer: University Health Alliance Commercial	$2,464.00

COOK VASCULAR DILATORS 20/22

Facility

$761.00

Hospital Revenue Code	272
Min. Negotiated Rate	$380.50
Max. Negotiated Rate	$738.17
Rate for Payer: AlohaCare Medicaid	$380.50
Rate for Payer: AlohaCare Medicare	$578.36
Rate for Payer: Cash Price	$456.60
Rate for Payer: Devoted Health Medicare	$639.24
Rate for Payer: Hawaii Medical Service Association Medicare	$578.36
Rate for Payer: Hawaii Western Management Group Commercial	$722.95
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Humana Medicare	$578.36
Rate for Payer: Kaiser Permanente Commercial	$684.90
Rate for Payer: Kaiser Permanente Medicaid	$388.11
Rate for Payer: Kaiser Permanente Medicare	$578.36
Rate for Payer: MDX Hawaii PPO	$738.17
Rate for Payer: Ohana Health Plan Medicaid	$578.36
Rate for Payer: Ohana Health Plan Medicare	$578.36
Rate for Payer: UnitedHealthcare Medicare	$578.36
Rate for Payer: University Health Alliance Commercial	$554.69

COOK VASCULAR DILATORS 20/22

Facility

$761.00

Hospital Revenue Code	272
Min. Negotiated Rate	$646.85
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$456.60
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Kaiser Permanente Commercial	$684.90
Rate for Payer: MDX Hawaii PPO	$738.17

COOLER W/ ADAPTER 51A

Facility

$247.00

Hospital Revenue Code	272
Min. Negotiated Rate	$209.95
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: MDX Hawaii PPO	$239.59

COOLER W/ ADAPTER 51A

Facility

$247.00

Hospital Revenue Code	272
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$239.59
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$187.72
Rate for Payer: Cash Price	$148.20
Rate for Payer: Devoted Health Medicare	$207.48
Rate for Payer: Hawaii Medical Service Association Medicare	$187.72
Rate for Payer: Hawaii Western Management Group Commercial	$234.65
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Humana Medicare	$187.72
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: Kaiser Permanente Medicaid	$125.97
Rate for Payer: Kaiser Permanente Medicare	$187.72
Rate for Payer: MDX Hawaii PPO	$239.59
Rate for Payer: Ohana Health Plan Medicaid	$187.72
Rate for Payer: Ohana Health Plan Medicare	$187.72
Rate for Payer: UnitedHealthcare Medicare	$187.72
Rate for Payer: University Health Alliance Commercial	$180.04

COONS TAPER DILATOR G03928

Facility

$104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$100.88
Rate for Payer: AlohaCare Medicaid	$52.00
Rate for Payer: AlohaCare Medicare	$79.04
Rate for Payer: Cash Price	$62.40
Rate for Payer: Devoted Health Medicare	$87.36
Rate for Payer: Hawaii Medical Service Association Medicare	$79.04
Rate for Payer: Hawaii Western Management Group Commercial	$98.80
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Humana Medicare	$79.04
Rate for Payer: Kaiser Permanente Commercial	$93.60
Rate for Payer: Kaiser Permanente Medicaid	$53.04
Rate for Payer: Kaiser Permanente Medicare	$79.04
Rate for Payer: MDX Hawaii PPO	$100.88
Rate for Payer: Ohana Health Plan Medicaid	$79.04
Rate for Payer: Ohana Health Plan Medicare	$79.04
Rate for Payer: UnitedHealthcare Medicare	$79.04
Rate for Payer: University Health Alliance Commercial	$75.81

COONS TAPER DILATOR G03928

Facility

$104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Kaiser Permanente Commercial	$93.60
Rate for Payer: MDX Hawaii PPO	$100.88

CORD BIPOLAR SYMMETRY

Facility

$156.00

Hospital Revenue Code	272
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Kaiser Permanente Commercial	$140.40
Rate for Payer: MDX Hawaii PPO	$151.32

CORD BIPOLAR SYMMETRY

Facility

$156.00

Hospital Revenue Code	272
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$151.32
Rate for Payer: AlohaCare Medicaid	$78.00
Rate for Payer: AlohaCare Medicare	$118.56
Rate for Payer: Cash Price	$93.60
Rate for Payer: Devoted Health Medicare	$131.04
Rate for Payer: Hawaii Medical Service Association Medicare	$118.56
Rate for Payer: Hawaii Western Management Group Commercial	$148.20
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$118.56
Rate for Payer: Kaiser Permanente Commercial	$140.40
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$118.56
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$118.56
Rate for Payer: Ohana Health Plan Medicare	$118.56
Rate for Payer: UnitedHealthcare Medicare	$118.56
Rate for Payer: University Health Alliance Commercial	$113.71

CORKSCREW 6.5 #AR-1927BCF-65

Facility

$1,348.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$674.00
Max. Negotiated Rate	$1,307.56
Rate for Payer: AlohaCare Medicaid	$674.00
Rate for Payer: AlohaCare Medicare	$1,024.48
Rate for Payer: Cash Price	$808.80
Rate for Payer: Devoted Health Medicare	$1,132.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,024.48
Rate for Payer: Hawaii Western Management Group Commercial	$943.60
Rate for Payer: Health Management Network Commercial	$1,145.80
Rate for Payer: Humana Medicare	$1,024.48
Rate for Payer: Kaiser Permanente Commercial	$1,213.20
Rate for Payer: Kaiser Permanente Medicaid	$687.48
Rate for Payer: Kaiser Permanente Medicare	$1,024.48
Rate for Payer: MDX Hawaii PPO	$1,307.56
Rate for Payer: Ohana Health Plan Medicaid	$1,024.48
Rate for Payer: Ohana Health Plan Medicare	$1,024.48
Rate for Payer: UnitedHealthcare Medicare	$1,024.48
Rate for Payer: University Health Alliance Commercial	$754.88

CORKSCREW 6.5 #AR-1927BCF-65

Facility

$1,348.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$754.88
Max. Negotiated Rate	$1,307.56
Rate for Payer: Cash Price	$808.80
Rate for Payer: Hawaii Western Management Group Commercial	$943.60
Rate for Payer: Health Management Network Commercial	$1,145.80
Rate for Payer: Kaiser Permanente Commercial	$1,213.20
Rate for Payer: MDX Hawaii PPO	$1,307.56
Rate for Payer: University Health Alliance Commercial	$754.88

CORKSCREW NANO 3-0 AR-1317FT

Facility

$1,824.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,021.44
Max. Negotiated Rate	$1,769.28
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,276.80
Rate for Payer: Health Management Network Commercial	$1,550.40
Rate for Payer: Kaiser Permanente Commercial	$1,641.60
Rate for Payer: MDX Hawaii PPO	$1,769.28
Rate for Payer: University Health Alliance Commercial	$1,021.44

CORKSCREW NANO 3-0 AR-1317FT

Facility

$1,824.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$912.00
Max. Negotiated Rate	$1,769.28
Rate for Payer: AlohaCare Medicaid	$912.00
Rate for Payer: AlohaCare Medicare	$1,386.24
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Devoted Health Medicare	$1,532.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,386.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,276.80
Rate for Payer: Health Management Network Commercial	$1,550.40
Rate for Payer: Humana Medicare	$1,386.24
Rate for Payer: Kaiser Permanente Commercial	$1,641.60
Rate for Payer: Kaiser Permanente Medicaid	$930.24
Rate for Payer: Kaiser Permanente Medicare	$1,386.24
Rate for Payer: MDX Hawaii PPO	$1,769.28
Rate for Payer: Ohana Health Plan Medicaid	$1,386.24
Rate for Payer: Ohana Health Plan Medicare	$1,386.24
Rate for Payer: UnitedHealthcare Medicare	$1,386.24
Rate for Payer: University Health Alliance Commercial	$1,021.44

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$127,327.14

Service Code	MSDRG 233
Min. Negotiated Rate	$127,327.14
Max. Negotiated Rate	$127,327.14
Rate for Payer: Hawaii Medical Service Association Commercial	$127,327.14

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$111,754.93

Service Code	MSDRG 234
Min. Negotiated Rate	$111,754.93
Max. Negotiated Rate	$111,754.93
Rate for Payer: Hawaii Medical Service Association Commercial	$111,754.93

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$97,201.90

Service Code	MSDRG 235
Min. Negotiated Rate	$97,201.90
Max. Negotiated Rate	$97,201.90
Rate for Payer: Hawaii Medical Service Association Commercial	$97,201.90

Know your out-of-pocket cost for care.

All Charges