Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

ELECTRODE BUTTON 24FR

Facility

$1,568.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,332.80
Max. Negotiated Rate	$1,520.96
Rate for Payer: Cash Price	$940.80
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: Kaiser Permanente Commercial	$1,411.20
Rate for Payer: MDX Hawaii PPO	$1,520.96

ELECTRODE BUTTON 24FR

Facility

$1,568.00

Hospital Revenue Code	272
Min. Negotiated Rate	$784.00
Max. Negotiated Rate	$1,520.96
Rate for Payer: AlohaCare Medicaid	$784.00
Rate for Payer: AlohaCare Medicare	$1,191.68
Rate for Payer: Cash Price	$940.80
Rate for Payer: Devoted Health Medicare	$1,317.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,191.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,489.60
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: Humana Medicare	$1,191.68
Rate for Payer: Kaiser Permanente Commercial	$1,411.20
Rate for Payer: Kaiser Permanente Medicaid	$799.68
Rate for Payer: Kaiser Permanente Medicare	$1,191.68
Rate for Payer: MDX Hawaii PPO	$1,520.96
Rate for Payer: Ohana Health Plan Medicaid	$1,191.68
Rate for Payer: Ohana Health Plan Medicare	$1,191.68
Rate for Payer: UnitedHealthcare Medicare	$1,191.68
Rate for Payer: University Health Alliance Commercial	$1,142.92

ELECTRODE ELECTROSURGICAL 24F

Facility

$1,501.00

Hospital Revenue Code	272
Min. Negotiated Rate	$750.50
Max. Negotiated Rate	$1,455.97
Rate for Payer: AlohaCare Medicaid	$750.50
Rate for Payer: AlohaCare Medicare	$1,140.76
Rate for Payer: Cash Price	$900.60
Rate for Payer: Devoted Health Medicare	$1,260.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,140.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,425.95
Rate for Payer: Health Management Network Commercial	$1,275.85
Rate for Payer: Humana Medicare	$1,140.76
Rate for Payer: Kaiser Permanente Commercial	$1,350.90
Rate for Payer: Kaiser Permanente Medicaid	$765.51
Rate for Payer: Kaiser Permanente Medicare	$1,140.76
Rate for Payer: MDX Hawaii PPO	$1,455.97
Rate for Payer: Ohana Health Plan Medicaid	$1,140.76
Rate for Payer: Ohana Health Plan Medicare	$1,140.76
Rate for Payer: UnitedHealthcare Medicare	$1,140.76
Rate for Payer: University Health Alliance Commercial	$1,094.08

ELECTRODE ELECTROSURGICAL 24F

Facility

$1,501.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,275.85
Max. Negotiated Rate	$1,455.97
Rate for Payer: Cash Price	$900.60
Rate for Payer: Health Management Network Commercial	$1,275.85
Rate for Payer: Kaiser Permanente Commercial	$1,350.90
Rate for Payer: MDX Hawaii PPO	$1,455.97

ELECTRODE LOOP 10x10MM DLP-S11

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$91.18
Rate for Payer: AlohaCare Medicaid	$47.00
Rate for Payer: AlohaCare Medicare	$71.44
Rate for Payer: Cash Price	$56.40
Rate for Payer: Devoted Health Medicare	$78.96
Rate for Payer: Hawaii Medical Service Association Medicare	$71.44
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Humana Medicare	$71.44
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: Kaiser Permanente Medicare	$71.44
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: Ohana Health Plan Medicaid	$71.44
Rate for Payer: Ohana Health Plan Medicare	$71.44
Rate for Payer: UnitedHealthcare Medicare	$71.44
Rate for Payer: University Health Alliance Commercial	$68.52

ELECTRODE LOOP 10x10MM DLP-S11

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: MDX Hawaii PPO	$91.18

ELECTRODE LOOP 15MM X 12MM

Facility

$90.00

Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$68.40
Rate for Payer: Cash Price	$54.00
Rate for Payer: Devoted Health Medicare	$75.60
Rate for Payer: Hawaii Medical Service Association Medicare	$68.40
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$68.40
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$68.40
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$68.40
Rate for Payer: Ohana Health Plan Medicare	$68.40
Rate for Payer: UnitedHealthcare Medicare	$68.40
Rate for Payer: University Health Alliance Commercial	$65.60

ELECTRODE LOOP 15MM X 12MM

Facility

$90.00

Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

ELECTRODE SEALER DIVIDER

Facility

$1,063.00

Hospital Revenue Code	272
Min. Negotiated Rate	$903.55
Max. Negotiated Rate	$1,031.11
Rate for Payer: Cash Price	$637.80
Rate for Payer: Health Management Network Commercial	$903.55
Rate for Payer: Kaiser Permanente Commercial	$956.70
Rate for Payer: MDX Hawaii PPO	$1,031.11

ELECTRODE SEALER DIVIDER

Facility

$1,063.00

Hospital Revenue Code	272
Min. Negotiated Rate	$531.50
Max. Negotiated Rate	$1,031.11
Rate for Payer: AlohaCare Medicaid	$531.50
Rate for Payer: AlohaCare Medicare	$807.88
Rate for Payer: Cash Price	$637.80
Rate for Payer: Devoted Health Medicare	$892.92
Rate for Payer: Hawaii Medical Service Association Medicare	$807.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,009.85
Rate for Payer: Health Management Network Commercial	$903.55
Rate for Payer: Humana Medicare	$807.88
Rate for Payer: Kaiser Permanente Commercial	$956.70
Rate for Payer: Kaiser Permanente Medicaid	$542.13
Rate for Payer: Kaiser Permanente Medicare	$807.88
Rate for Payer: MDX Hawaii PPO	$1,031.11
Rate for Payer: Ohana Health Plan Medicaid	$807.88
Rate for Payer: Ohana Health Plan Medicare	$807.88
Rate for Payer: UnitedHealthcare Medicare	$807.88
Rate for Payer: University Health Alliance Commercial	$774.82

ELECTROD PAIRED SUBDERMAL

Facility

$540.00

Hospital Revenue Code	272
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$523.80
Rate for Payer: AlohaCare Medicaid	$270.00
Rate for Payer: AlohaCare Medicare	$410.40
Rate for Payer: Cash Price	$324.00
Rate for Payer: Devoted Health Medicare	$453.60
Rate for Payer: Hawaii Medical Service Association Medicare	$410.40
Rate for Payer: Hawaii Western Management Group Commercial	$513.00
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: Humana Medicare	$410.40
Rate for Payer: Kaiser Permanente Commercial	$486.00
Rate for Payer: Kaiser Permanente Medicaid	$275.40
Rate for Payer: Kaiser Permanente Medicare	$410.40
Rate for Payer: MDX Hawaii PPO	$523.80
Rate for Payer: Ohana Health Plan Medicaid	$410.40
Rate for Payer: Ohana Health Plan Medicare	$410.40
Rate for Payer: UnitedHealthcare Medicare	$410.40
Rate for Payer: University Health Alliance Commercial	$393.61

ELECTROD PAIRED SUBDERMAL

Facility

$540.00

Hospital Revenue Code	272
Min. Negotiated Rate	$459.00
Max. Negotiated Rate	$523.80
Rate for Payer: Cash Price	$324.00
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: Kaiser Permanente Commercial	$486.00
Rate for Payer: MDX Hawaii PPO	$523.80

ELECTROD PLASMA RESECTION LOOP

Facility

$1,501.00

Hospital Revenue Code	272
Min. Negotiated Rate	$750.50
Max. Negotiated Rate	$1,455.97
Rate for Payer: AlohaCare Medicaid	$750.50
Rate for Payer: AlohaCare Medicare	$1,140.76
Rate for Payer: Cash Price	$900.60
Rate for Payer: Devoted Health Medicare	$1,260.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,140.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,425.95
Rate for Payer: Health Management Network Commercial	$1,275.85
Rate for Payer: Humana Medicare	$1,140.76
Rate for Payer: Kaiser Permanente Commercial	$1,350.90
Rate for Payer: Kaiser Permanente Medicaid	$765.51
Rate for Payer: Kaiser Permanente Medicare	$1,140.76
Rate for Payer: MDX Hawaii PPO	$1,455.97
Rate for Payer: Ohana Health Plan Medicaid	$1,140.76
Rate for Payer: Ohana Health Plan Medicare	$1,140.76
Rate for Payer: UnitedHealthcare Medicare	$1,140.76
Rate for Payer: University Health Alliance Commercial	$1,094.08

ELECTROD PLASMA RESECTION LOOP

Facility

$1,501.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,275.85
Max. Negotiated Rate	$1,455.97
Rate for Payer: Cash Price	$900.60
Rate for Payer: Health Management Network Commercial	$1,275.85
Rate for Payer: Kaiser Permanente Commercial	$1,350.90
Rate for Payer: MDX Hawaii PPO	$1,455.97

ELECTROD PRASS EMG 18MM

Facility

$698.00

Hospital Revenue Code	270
Min. Negotiated Rate	$593.30
Max. Negotiated Rate	$677.06
Rate for Payer: Cash Price	$418.80
Rate for Payer: Health Management Network Commercial	$593.30
Rate for Payer: Kaiser Permanente Commercial	$628.20
Rate for Payer: MDX Hawaii PPO	$677.06

ELECTROD PRASS EMG 18MM

Facility

$698.00

Hospital Revenue Code	270
Min. Negotiated Rate	$349.00
Max. Negotiated Rate	$677.06
Rate for Payer: AlohaCare Medicaid	$349.00
Rate for Payer: AlohaCare Medicare	$530.48
Rate for Payer: Cash Price	$418.80
Rate for Payer: Devoted Health Medicare	$586.32
Rate for Payer: Hawaii Medical Service Association Medicare	$530.48
Rate for Payer: Hawaii Western Management Group Commercial	$663.10
Rate for Payer: Health Management Network Commercial	$593.30
Rate for Payer: Humana Medicare	$530.48
Rate for Payer: Kaiser Permanente Commercial	$628.20
Rate for Payer: Kaiser Permanente Medicaid	$355.98
Rate for Payer: Kaiser Permanente Medicare	$530.48
Rate for Payer: MDX Hawaii PPO	$677.06
Rate for Payer: Ohana Health Plan Medicaid	$530.48
Rate for Payer: Ohana Health Plan Medicare	$530.48
Rate for Payer: UnitedHealthcare Medicare	$530.48
Rate for Payer: University Health Alliance Commercial	$508.77

ELECTROD PROBE 4PRD ROHS

Facility

$814.00

Hospital Revenue Code	272
Min. Negotiated Rate	$407.00
Max. Negotiated Rate	$789.58
Rate for Payer: AlohaCare Medicaid	$407.00
Rate for Payer: AlohaCare Medicare	$618.64
Rate for Payer: Cash Price	$488.40
Rate for Payer: Devoted Health Medicare	$683.76
Rate for Payer: Hawaii Medical Service Association Medicare	$618.64
Rate for Payer: Hawaii Western Management Group Commercial	$773.30
Rate for Payer: Health Management Network Commercial	$691.90
Rate for Payer: Humana Medicare	$618.64
Rate for Payer: Kaiser Permanente Commercial	$732.60
Rate for Payer: Kaiser Permanente Medicaid	$415.14
Rate for Payer: Kaiser Permanente Medicare	$618.64
Rate for Payer: MDX Hawaii PPO	$789.58
Rate for Payer: Ohana Health Plan Medicaid	$618.64
Rate for Payer: Ohana Health Plan Medicare	$618.64
Rate for Payer: UnitedHealthcare Medicare	$618.64
Rate for Payer: University Health Alliance Commercial	$593.32

ELECTROD PROBE 4PRD ROHS

Facility

$814.00

Hospital Revenue Code	272
Min. Negotiated Rate	$691.90
Max. Negotiated Rate	$789.58
Rate for Payer: Cash Price	$488.40
Rate for Payer: Health Management Network Commercial	$691.90
Rate for Payer: Kaiser Permanente Commercial	$732.60
Rate for Payer: MDX Hawaii PPO	$789.58

ELECTROD WAND COBLATION

Facility

$1,238.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,052.30
Max. Negotiated Rate	$1,200.86
Rate for Payer: Cash Price	$742.80
Rate for Payer: Health Management Network Commercial	$1,052.30
Rate for Payer: Kaiser Permanente Commercial	$1,114.20
Rate for Payer: MDX Hawaii PPO	$1,200.86

ELECTROD WAND COBLATION

Facility

$1,238.00

Hospital Revenue Code	272
Min. Negotiated Rate	$619.00
Max. Negotiated Rate	$1,200.86
Rate for Payer: AlohaCare Medicaid	$619.00
Rate for Payer: AlohaCare Medicare	$940.88
Rate for Payer: Cash Price	$742.80
Rate for Payer: Devoted Health Medicare	$1,039.92
Rate for Payer: Hawaii Medical Service Association Medicare	$940.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,176.10
Rate for Payer: Health Management Network Commercial	$1,052.30
Rate for Payer: Humana Medicare	$940.88
Rate for Payer: Kaiser Permanente Commercial	$1,114.20
Rate for Payer: Kaiser Permanente Medicaid	$631.38
Rate for Payer: Kaiser Permanente Medicare	$940.88
Rate for Payer: MDX Hawaii PPO	$1,200.86
Rate for Payer: Ohana Health Plan Medicaid	$940.88
Rate for Payer: Ohana Health Plan Medicare	$940.88
Rate for Payer: UnitedHealthcare Medicare	$940.88
Rate for Payer: University Health Alliance Commercial	$902.38

ELECTRO LUBE STERILE EL-101

Facility

$150.00

Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$114.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Devoted Health Medicare	$126.00
Rate for Payer: Hawaii Medical Service Association Medicare	$114.00
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$114.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$114.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$114.00
Rate for Payer: Ohana Health Plan Medicare	$114.00
Rate for Payer: UnitedHealthcare Medicare	$114.00
Rate for Payer: University Health Alliance Commercial	$109.33

ELECTRO LUBE STERILE EL-101

Facility

$150.00

Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

ELECTRTODE WAND

Facility

$1,091.00

Hospital Revenue Code	272
Min. Negotiated Rate	$927.35
Max. Negotiated Rate	$1,058.27
Rate for Payer: Cash Price	$654.60
Rate for Payer: Health Management Network Commercial	$927.35
Rate for Payer: Kaiser Permanente Commercial	$981.90
Rate for Payer: MDX Hawaii PPO	$1,058.27

ELECTRTODE WAND

Facility

$1,091.00

Hospital Revenue Code	272
Min. Negotiated Rate	$545.50
Max. Negotiated Rate	$1,058.27
Rate for Payer: AlohaCare Medicaid	$545.50
Rate for Payer: AlohaCare Medicare	$829.16
Rate for Payer: Cash Price	$654.60
Rate for Payer: Devoted Health Medicare	$916.44
Rate for Payer: Hawaii Medical Service Association Medicare	$829.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,036.45
Rate for Payer: Health Management Network Commercial	$927.35
Rate for Payer: Humana Medicare	$829.16
Rate for Payer: Kaiser Permanente Commercial	$981.90
Rate for Payer: Kaiser Permanente Medicaid	$556.41
Rate for Payer: Kaiser Permanente Medicare	$829.16
Rate for Payer: MDX Hawaii PPO	$1,058.27
Rate for Payer: Ohana Health Plan Medicaid	$829.16
Rate for Payer: Ohana Health Plan Medicare	$829.16
Rate for Payer: UnitedHealthcare Medicare	$829.16
Rate for Payer: University Health Alliance Commercial	$795.23

EMBLEM MRI S-ICD

Facility

$38,000.00

Service Code	HCPCS C1722
Hospital Revenue Code	275
Min. Negotiated Rate	$19,000.00
Max. Negotiated Rate	$36,860.00
Rate for Payer: AlohaCare Medicaid	$19,000.00
Rate for Payer: AlohaCare Medicare	$28,880.00
Rate for Payer: Cash Price	$22,800.00
Rate for Payer: Devoted Health Medicare	$31,920.00
Rate for Payer: Hawaii Medical Service Association Medicare	$28,880.00
Rate for Payer: Hawaii Western Management Group Commercial	$26,600.00
Rate for Payer: Health Management Network Commercial	$32,300.00
Rate for Payer: Humana Medicare	$28,880.00
Rate for Payer: Kaiser Permanente Commercial	$34,200.00
Rate for Payer: Kaiser Permanente Medicaid	$19,380.00
Rate for Payer: Kaiser Permanente Medicare	$28,880.00
Rate for Payer: MDX Hawaii PPO	$36,860.00
Rate for Payer: Ohana Health Plan Medicaid	$28,880.00
Rate for Payer: Ohana Health Plan Medicare	$28,880.00
Rate for Payer: UnitedHealthcare Medicare	$28,880.00
Rate for Payer: University Health Alliance Commercial	$21,280.00

Know your out-of-pocket cost for care.

All Charges