Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

DRILL TWIST 4.00MM DRILL-4.00L

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: MDX Hawaii PPO	$436.50

DRIVER T10 DRVR-UQC-T10

Facility

$383.00

Hospital Revenue Code	272
Min. Negotiated Rate	$325.55
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$229.80
Rate for Payer: Health Management Network Commercial	$325.55
Rate for Payer: Kaiser Permanente Commercial	$344.70
Rate for Payer: MDX Hawaii PPO	$371.51

DRIVER T10 DRVR-UQC-T10

Facility

$383.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.50
Max. Negotiated Rate	$371.51
Rate for Payer: AlohaCare Medicaid	$191.50
Rate for Payer: AlohaCare Medicare	$291.08
Rate for Payer: Cash Price	$229.80
Rate for Payer: Devoted Health Medicare	$321.72
Rate for Payer: Hawaii Medical Service Association Medicare	$291.08
Rate for Payer: Hawaii Western Management Group Commercial	$363.85
Rate for Payer: Health Management Network Commercial	$325.55
Rate for Payer: Humana Medicare	$291.08
Rate for Payer: Kaiser Permanente Commercial	$344.70
Rate for Payer: Kaiser Permanente Medicaid	$195.33
Rate for Payer: Kaiser Permanente Medicare	$291.08
Rate for Payer: MDX Hawaii PPO	$371.51
Rate for Payer: Ohana Health Plan Medicaid	$291.08
Rate for Payer: Ohana Health Plan Medicare	$291.08
Rate for Payer: UnitedHealthcare Medicare	$291.08
Rate for Payer: University Health Alliance Commercial	$279.17

DRSG 36X10 INTERDRY ANTIMICRO

Facility

$185.00

Service Code	HCPCS A6250
Hospital Revenue Code	272
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$92.50
Rate for Payer: AlohaCare Medicare	$140.60
Rate for Payer: Cash Price	$111.00
Rate for Payer: Devoted Health Medicare	$155.40
Rate for Payer: Hawaii Medical Service Association Medicare	$140.60
Rate for Payer: Hawaii Western Management Group Commercial	$175.75
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$140.60
Rate for Payer: Kaiser Permanente Commercial	$166.50
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$140.60
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$140.60
Rate for Payer: Ohana Health Plan Medicare	$140.60
Rate for Payer: UnitedHealthcare Medicare	$140.60
Rate for Payer: University Health Alliance Commercial	$134.85

DRSG 36X10 INTERDRY ANTIMICRO

Facility

$185.00

Service Code	HCPCS A6250
Hospital Revenue Code	272
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$111.00
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Kaiser Permanente Commercial	$166.50
Rate for Payer: MDX Hawaii PPO	$179.45

DRSG 4X10 MEPILEX AG ANTIMICRO

Facility

$127.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

DRSG 4X10 MEPILEX AG ANTIMICRO

Facility

$127.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$96.52
Rate for Payer: Cash Price	$76.20
Rate for Payer: Cash Price	$76.20
Rate for Payer: Devoted Health Medicare	$106.68
Rate for Payer: Hawaii Medical Service Association Medicare	$96.52
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$96.52
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$96.52
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$96.52
Rate for Payer: Ohana Health Plan Medicare	$96.52
Rate for Payer: UnitedHealthcare Medicaid	$10.11
Rate for Payer: UnitedHealthcare Medicare	$96.52
Rate for Payer: University Health Alliance Commercial	$92.57

DRSG 4X12 MEPILEX AG ANTIMICRO

Facility

$145.00

Service Code	HCPCS A6213
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

DRSG 4X12 MEPILEX AG ANTIMICRO

Facility

$145.00

Service Code	HCPCS A6213
Hospital Revenue Code	272
Min. Negotiated Rate	$10.39
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: 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 Medicaid	$10.39
Rate for Payer: UnitedHealthcare Medicare	$110.20
Rate for Payer: University Health Alliance Commercial	$105.69

DRSG 4X6 MEPILEX AG ANTIMICRO

Facility

$122.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$73.20
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

DRSG 4X6 MEPILEX AG ANTIMICRO

Facility

$122.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$92.72
Rate for Payer: Cash Price	$73.20
Rate for Payer: Cash Price	$73.20
Rate for Payer: Devoted Health Medicare	$102.48
Rate for Payer: Hawaii Medical Service Association Medicare	$92.72
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$92.72
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$92.72
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$92.72
Rate for Payer: Ohana Health Plan Medicare	$92.72
Rate for Payer: UnitedHealthcare Medicaid	$10.11
Rate for Payer: UnitedHealthcare Medicare	$92.72
Rate for Payer: University Health Alliance Commercial	$88.93

DRSG 4X8 MEPILEX AG ANTIMICRO

Facility

$141.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$70.50
Rate for Payer: AlohaCare Medicare	$107.16
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cash Price	$84.60
Rate for Payer: Devoted Health Medicare	$118.44
Rate for Payer: Hawaii Medical Service Association Medicare	$107.16
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$107.16
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$107.16
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$107.16
Rate for Payer: Ohana Health Plan Medicare	$107.16
Rate for Payer: UnitedHealthcare Medicaid	$10.11
Rate for Payer: UnitedHealthcare Medicare	$107.16
Rate for Payer: University Health Alliance Commercial	$102.77

DRSG 4X8 MEPILEX AG ANTIMICRO

Facility

$141.00

Service Code	HCPCS A6212
Hospital Revenue Code	272
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: MDX Hawaii PPO	$136.77

DRSG 6X6 HYDROFERA BLUE

Facility

$146.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$141.62
Rate for Payer: AlohaCare Medicaid	$73.00
Rate for Payer: AlohaCare Medicare	$110.96
Rate for Payer: Cash Price	$87.60
Rate for Payer: Devoted Health Medicare	$122.64
Rate for Payer: Hawaii Medical Service Association Medicare	$110.96
Rate for Payer: Hawaii Western Management Group Commercial	$138.70
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Humana Medicare	$110.96
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: Kaiser Permanente Medicare	$110.96
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: Ohana Health Plan Medicaid	$110.96
Rate for Payer: Ohana Health Plan Medicare	$110.96
Rate for Payer: UnitedHealthcare Medicare	$110.96
Rate for Payer: University Health Alliance Commercial	$106.42

DRSG 6X6 HYDROFERA BLUE

Facility

$146.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$87.60
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: MDX Hawaii PPO	$141.62

DRSG 6X6 HYDROFERA COMFORTCEL

Facility

$156.00

Service Code	HCPCS A6210
Hospital Revenue Code	272
Min. Negotiated Rate	$16.82
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: 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 Medicaid	$16.82
Rate for Payer: UnitedHealthcare Medicare	$118.56
Rate for Payer: University Health Alliance Commercial	$113.71

DRSG 6X6 HYDROFERA COMFORTCEL

Facility

$156.00

Service Code	HCPCS A6210
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

DRSG 8X8 HYDROFERA READY

Facility

$95.00

Service Code	HCPCS A6211
Hospital Revenue Code	272
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$57.00
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: MDX Hawaii PPO	$92.15

DRSG 8X8 HYDROFERA READY

Facility

$95.00

Service Code	HCPCS A6211
Hospital Revenue Code	272
Min. Negotiated Rate	$30.61
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$47.50
Rate for Payer: AlohaCare Medicare	$72.20
Rate for Payer: Cash Price	$57.00
Rate for Payer: Cash Price	$57.00
Rate for Payer: Devoted Health Medicare	$79.80
Rate for Payer: Hawaii Medical Service Association Medicare	$72.20
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$72.20
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$72.20
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$72.20
Rate for Payer: Ohana Health Plan Medicare	$72.20
Rate for Payer: UnitedHealthcare Medicaid	$30.61
Rate for Payer: UnitedHealthcare Medicare	$72.20
Rate for Payer: University Health Alliance Commercial	$69.25

DRSG LG VAC PEEL

Facility

$573.00

Hospital Revenue Code	272
Min. Negotiated Rate	$487.05
Max. Negotiated Rate	$555.81
Rate for Payer: Cash Price	$343.80
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: Kaiser Permanente Commercial	$515.70
Rate for Payer: MDX Hawaii PPO	$555.81

DRSG LG VAC PEEL

Facility

$573.00

Hospital Revenue Code	272
Min. Negotiated Rate	$286.50
Max. Negotiated Rate	$555.81
Rate for Payer: AlohaCare Medicaid	$286.50
Rate for Payer: AlohaCare Medicare	$435.48
Rate for Payer: Cash Price	$343.80
Rate for Payer: Devoted Health Medicare	$481.32
Rate for Payer: Hawaii Medical Service Association Medicare	$435.48
Rate for Payer: Hawaii Western Management Group Commercial	$544.35
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: Humana Medicare	$435.48
Rate for Payer: Kaiser Permanente Commercial	$515.70
Rate for Payer: Kaiser Permanente Medicaid	$292.23
Rate for Payer: Kaiser Permanente Medicare	$435.48
Rate for Payer: MDX Hawaii PPO	$555.81
Rate for Payer: Ohana Health Plan Medicaid	$435.48
Rate for Payer: Ohana Health Plan Medicare	$435.48
Rate for Payer: UnitedHealthcare Medicare	$435.48
Rate for Payer: University Health Alliance Commercial	$417.66

DRSG MED VAC PEEL

Facility

$465.00

Hospital Revenue Code	272
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$451.05
Rate for Payer: AlohaCare Medicaid	$232.50
Rate for Payer: AlohaCare Medicare	$353.40
Rate for Payer: Cash Price	$279.00
Rate for Payer: Devoted Health Medicare	$390.60
Rate for Payer: Hawaii Medical Service Association Medicare	$353.40
Rate for Payer: Hawaii Western Management Group Commercial	$441.75
Rate for Payer: Health Management Network Commercial	$395.25
Rate for Payer: Humana Medicare	$353.40
Rate for Payer: Kaiser Permanente Commercial	$418.50
Rate for Payer: Kaiser Permanente Medicaid	$237.15
Rate for Payer: Kaiser Permanente Medicare	$353.40
Rate for Payer: MDX Hawaii PPO	$451.05
Rate for Payer: Ohana Health Plan Medicaid	$353.40
Rate for Payer: Ohana Health Plan Medicare	$353.40
Rate for Payer: UnitedHealthcare Medicare	$353.40
Rate for Payer: University Health Alliance Commercial	$338.94

DRSG MED VAC PEEL

Facility

$465.00

Hospital Revenue Code	272
Min. Negotiated Rate	$395.25
Max. Negotiated Rate	$451.05
Rate for Payer: Cash Price	$279.00
Rate for Payer: Health Management Network Commercial	$395.25
Rate for Payer: Kaiser Permanente Commercial	$418.50
Rate for Payer: MDX Hawaii PPO	$451.05

DRSG SENSATRAC VAC

Facility

$220.00

Hospital Revenue Code	272
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$167.20
Rate for Payer: Cash Price	$132.00
Rate for Payer: Devoted Health Medicare	$184.80
Rate for Payer: Hawaii Medical Service Association Medicare	$167.20
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$167.20
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$167.20
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$167.20
Rate for Payer: Ohana Health Plan Medicare	$167.20
Rate for Payer: UnitedHealthcare Medicare	$167.20
Rate for Payer: University Health Alliance Commercial	$160.36

DRSG SENSATRAC VAC

Facility

$220.00

Hospital Revenue Code	272
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$132.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

Know your out-of-pocket cost for care.

All Charges