Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

3/8" IM DRILL

Facility

$1,620.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,377.00
Max. Negotiated Rate	$1,571.40
Rate for Payer: Cash Price	$972.00
Rate for Payer: Health Management Network Commercial	$1,377.00
Rate for Payer: Kaiser Permanente Commercial	$1,458.00
Rate for Payer: MDX Hawaii PPO	$1,571.40

3FR URETER BIOPSY FOREPS

Facility

$1,111.00

Hospital Revenue Code	272
Min. Negotiated Rate	$555.50
Max. Negotiated Rate	$1,077.67
Rate for Payer: AlohaCare Medicaid	$555.50
Rate for Payer: AlohaCare Medicare	$844.36
Rate for Payer: Cash Price	$666.60
Rate for Payer: Devoted Health Medicare	$933.24
Rate for Payer: Hawaii Medical Service Association Medicare	$844.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,055.45
Rate for Payer: Health Management Network Commercial	$944.35
Rate for Payer: Humana Medicare	$844.36
Rate for Payer: Kaiser Permanente Commercial	$999.90
Rate for Payer: Kaiser Permanente Medicaid	$566.61
Rate for Payer: Kaiser Permanente Medicare	$844.36
Rate for Payer: MDX Hawaii PPO	$1,077.67
Rate for Payer: Ohana Health Plan Medicaid	$844.36
Rate for Payer: Ohana Health Plan Medicare	$844.36
Rate for Payer: UnitedHealthcare Medicare	$844.36
Rate for Payer: University Health Alliance Commercial	$809.81

3FR URETER BIOPSY FOREPS

Facility

$1,111.00

Hospital Revenue Code	272
Min. Negotiated Rate	$944.35
Max. Negotiated Rate	$1,077.67
Rate for Payer: Cash Price	$666.60
Rate for Payer: Health Management Network Commercial	$944.35
Rate for Payer: Kaiser Permanente Commercial	$999.90
Rate for Payer: MDX Hawaii PPO	$1,077.67

3LOOP SNARE RETRIEVAL KIT

Facility

$1,770.00

Service Code	HCPCS C1773
Hospital Revenue Code	272
Min. Negotiated Rate	$1,504.50
Max. Negotiated Rate	$1,716.90
Rate for Payer: Cash Price	$1,062.00
Rate for Payer: Health Management Network Commercial	$1,504.50
Rate for Payer: Kaiser Permanente Commercial	$1,593.00
Rate for Payer: MDX Hawaii PPO	$1,716.90

3LOOP SNARE RETRIEVAL KIT

Facility

$1,770.00

Service Code	HCPCS C1773
Hospital Revenue Code	272
Min. Negotiated Rate	$885.00
Max. Negotiated Rate	$1,716.90
Rate for Payer: AlohaCare Medicaid	$885.00
Rate for Payer: AlohaCare Medicare	$1,345.20
Rate for Payer: Cash Price	$1,062.00
Rate for Payer: Devoted Health Medicare	$1,486.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,345.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,681.50
Rate for Payer: Health Management Network Commercial	$1,504.50
Rate for Payer: Humana Medicare	$1,345.20
Rate for Payer: Kaiser Permanente Commercial	$1,593.00
Rate for Payer: Kaiser Permanente Medicaid	$902.70
Rate for Payer: Kaiser Permanente Medicare	$1,345.20
Rate for Payer: MDX Hawaii PPO	$1,716.90
Rate for Payer: Ohana Health Plan Medicaid	$1,345.20
Rate for Payer: Ohana Health Plan Medicare	$1,345.20
Rate for Payer: UnitedHealthcare Medicare	$1,345.20
Rate for Payer: University Health Alliance Commercial	$1,290.15

4.5M LCP CONDYLAR PLATE

Facility

$4,310.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,413.60
Max. Negotiated Rate	$4,180.70
Rate for Payer: Cash Price	$2,586.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,017.00
Rate for Payer: Health Management Network Commercial	$3,663.50
Rate for Payer: Kaiser Permanente Commercial	$3,879.00
Rate for Payer: MDX Hawaii PPO	$4,180.70
Rate for Payer: University Health Alliance Commercial	$2,413.60

4.5M LCP CONDYLAR PLATE

Facility

$4,310.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,155.00
Max. Negotiated Rate	$4,180.70
Rate for Payer: AlohaCare Medicaid	$2,155.00
Rate for Payer: AlohaCare Medicare	$3,275.60
Rate for Payer: Cash Price	$2,586.00
Rate for Payer: Devoted Health Medicare	$3,620.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3,275.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,017.00
Rate for Payer: Health Management Network Commercial	$3,663.50
Rate for Payer: Humana Medicare	$3,275.60
Rate for Payer: Kaiser Permanente Commercial	$3,879.00
Rate for Payer: Kaiser Permanente Medicaid	$2,198.10
Rate for Payer: Kaiser Permanente Medicare	$3,275.60
Rate for Payer: MDX Hawaii PPO	$4,180.70
Rate for Payer: Ohana Health Plan Medicaid	$3,275.60
Rate for Payer: Ohana Health Plan Medicare	$3,275.60
Rate for Payer: UnitedHealthcare Medicare	$3,275.60
Rate for Payer: University Health Alliance Commercial	$2,413.60

4.5MM LCP CONDYLAR PLATE

Facility

$3,542.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,983.52
Max. Negotiated Rate	$3,435.74
Rate for Payer: Cash Price	$2,125.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,479.40
Rate for Payer: Health Management Network Commercial	$3,010.70
Rate for Payer: Kaiser Permanente Commercial	$3,187.80
Rate for Payer: MDX Hawaii PPO	$3,435.74
Rate for Payer: University Health Alliance Commercial	$1,983.52

4.5MM LCP CONDYLAR PLATE

Facility

$3,542.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,771.00
Max. Negotiated Rate	$3,435.74
Rate for Payer: AlohaCare Medicaid	$1,771.00
Rate for Payer: AlohaCare Medicare	$2,691.92
Rate for Payer: Cash Price	$2,125.20
Rate for Payer: Devoted Health Medicare	$2,975.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,691.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,479.40
Rate for Payer: Health Management Network Commercial	$3,010.70
Rate for Payer: Humana Medicare	$2,691.92
Rate for Payer: Kaiser Permanente Commercial	$3,187.80
Rate for Payer: Kaiser Permanente Medicaid	$1,806.42
Rate for Payer: Kaiser Permanente Medicare	$2,691.92
Rate for Payer: MDX Hawaii PPO	$3,435.74
Rate for Payer: Ohana Health Plan Medicaid	$2,691.92
Rate for Payer: Ohana Health Plan Medicare	$2,691.92
Rate for Payer: UnitedHealthcare Medicare	$2,691.92
Rate for Payer: University Health Alliance Commercial	$1,983.52

4806-110-25 DRILLBIT QC 2.5MM

Facility

$750.00

Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: MDX Hawaii PPO	$727.50

4806-110-25 DRILLBIT QC 2.5MM

Facility

$750.00

Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$727.50
Rate for Payer: AlohaCare Medicaid	$375.00
Rate for Payer: AlohaCare Medicare	$570.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Devoted Health Medicare	$630.00
Rate for Payer: Hawaii Medical Service Association Medicare	$570.00
Rate for Payer: Hawaii Western Management Group Commercial	$712.50
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Humana Medicare	$570.00
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: Kaiser Permanente Medicare	$570.00
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: Ohana Health Plan Medicaid	$570.00
Rate for Payer: Ohana Health Plan Medicare	$570.00
Rate for Payer: UnitedHealthcare Medicare	$570.00
Rate for Payer: University Health Alliance Commercial	$546.67

4806-110-35 DRILLBIT QC 3.5MM

Facility

$638.00

Hospital Revenue Code	272
Min. Negotiated Rate	$542.30
Max. Negotiated Rate	$618.86
Rate for Payer: Cash Price	$382.80
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: Kaiser Permanente Commercial	$574.20
Rate for Payer: MDX Hawaii PPO	$618.86

4806-110-35 DRILLBIT QC 3.5MM

Facility

$638.00

Hospital Revenue Code	272
Min. Negotiated Rate	$319.00
Max. Negotiated Rate	$618.86
Rate for Payer: AlohaCare Medicaid	$319.00
Rate for Payer: AlohaCare Medicare	$484.88
Rate for Payer: Cash Price	$382.80
Rate for Payer: Devoted Health Medicare	$535.92
Rate for Payer: Hawaii Medical Service Association Medicare	$484.88
Rate for Payer: Hawaii Western Management Group Commercial	$606.10
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: Humana Medicare	$484.88
Rate for Payer: Kaiser Permanente Commercial	$574.20
Rate for Payer: Kaiser Permanente Medicaid	$325.38
Rate for Payer: Kaiser Permanente Medicare	$484.88
Rate for Payer: MDX Hawaii PPO	$618.86
Rate for Payer: Ohana Health Plan Medicaid	$484.88
Rate for Payer: Ohana Health Plan Medicare	$484.88
Rate for Payer: UnitedHealthcare Medicare	$484.88
Rate for Payer: University Health Alliance Commercial	$465.04

5.5 ABRADER BURR 180MM

Facility

$417.00

Hospital Revenue Code	272
Min. Negotiated Rate	$354.45
Max. Negotiated Rate	$404.49
Rate for Payer: Cash Price	$250.20
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Kaiser Permanente Commercial	$375.30
Rate for Payer: MDX Hawaii PPO	$404.49

5.5 ABRADER BURR 180MM

Facility

$417.00

Hospital Revenue Code	272
Min. Negotiated Rate	$208.50
Max. Negotiated Rate	$404.49
Rate for Payer: AlohaCare Medicaid	$208.50
Rate for Payer: AlohaCare Medicare	$316.92
Rate for Payer: Cash Price	$250.20
Rate for Payer: Devoted Health Medicare	$350.28
Rate for Payer: Hawaii Medical Service Association Medicare	$316.92
Rate for Payer: Hawaii Western Management Group Commercial	$396.15
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Humana Medicare	$316.92
Rate for Payer: Kaiser Permanente Commercial	$375.30
Rate for Payer: Kaiser Permanente Medicaid	$212.67
Rate for Payer: Kaiser Permanente Medicare	$316.92
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: Ohana Health Plan Medicaid	$316.92
Rate for Payer: Ohana Health Plan Medicare	$316.92
Rate for Payer: UnitedHealthcare Medicare	$316.92
Rate for Payer: University Health Alliance Commercial	$303.95

7.0 MM MALYUGIN RING

Facility

$531.00

Hospital Revenue Code	272
Min. Negotiated Rate	$265.50
Max. Negotiated Rate	$515.07
Rate for Payer: AlohaCare Medicaid	$265.50
Rate for Payer: AlohaCare Medicare	$403.56
Rate for Payer: Cash Price	$318.60
Rate for Payer: Devoted Health Medicare	$446.04
Rate for Payer: Hawaii Medical Service Association Medicare	$403.56
Rate for Payer: Hawaii Western Management Group Commercial	$504.45
Rate for Payer: Health Management Network Commercial	$451.35
Rate for Payer: Humana Medicare	$403.56
Rate for Payer: Kaiser Permanente Commercial	$477.90
Rate for Payer: Kaiser Permanente Medicaid	$270.81
Rate for Payer: Kaiser Permanente Medicare	$403.56
Rate for Payer: MDX Hawaii PPO	$515.07
Rate for Payer: Ohana Health Plan Medicaid	$403.56
Rate for Payer: Ohana Health Plan Medicare	$403.56
Rate for Payer: UnitedHealthcare Medicare	$403.56
Rate for Payer: University Health Alliance Commercial	$387.05

7.0 MM MALYUGIN RING

Facility

$531.00

Hospital Revenue Code	272
Min. Negotiated Rate	$451.35
Max. Negotiated Rate	$515.07
Rate for Payer: Cash Price	$318.60
Rate for Payer: Health Management Network Commercial	$451.35
Rate for Payer: Kaiser Permanente Commercial	$477.90
Rate for Payer: MDX Hawaii PPO	$515.07

AAA ENDOPROSTHESIS #PLC161000

Facility

$9,714.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$4,857.00
Max. Negotiated Rate	$9,422.58
Rate for Payer: AlohaCare Medicaid	$4,857.00
Rate for Payer: AlohaCare Medicare	$7,382.64
Rate for Payer: Cash Price	$5,828.40
Rate for Payer: Devoted Health Medicare	$8,159.76
Rate for Payer: Hawaii Medical Service Association Medicare	$7,382.64
Rate for Payer: Hawaii Western Management Group Commercial	$6,799.80
Rate for Payer: Health Management Network Commercial	$8,256.90
Rate for Payer: Humana Medicare	$7,382.64
Rate for Payer: Kaiser Permanente Commercial	$8,742.60
Rate for Payer: Kaiser Permanente Medicaid	$4,954.14
Rate for Payer: Kaiser Permanente Medicare	$7,382.64
Rate for Payer: MDX Hawaii PPO	$9,422.58
Rate for Payer: Ohana Health Plan Medicaid	$7,382.64
Rate for Payer: Ohana Health Plan Medicare	$7,382.64
Rate for Payer: UnitedHealthcare Medicare	$7,382.64
Rate for Payer: University Health Alliance Commercial	$5,439.84

AAA ENDOPROSTHESIS #PLC161000

Facility

$9,714.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,439.84
Max. Negotiated Rate	$9,422.58
Rate for Payer: Cash Price	$5,828.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,799.80
Rate for Payer: Health Management Network Commercial	$8,256.90
Rate for Payer: Kaiser Permanente Commercial	$8,742.60
Rate for Payer: MDX Hawaii PPO	$9,422.58
Rate for Payer: University Health Alliance Commercial	$5,439.84

AAA ENDOPROSTHESIS #PLC271000

Facility

$11,540.00

Hospital Revenue Code	278
Min. Negotiated Rate	$5,770.00
Max. Negotiated Rate	$11,193.80
Rate for Payer: AlohaCare Medicaid	$5,770.00
Rate for Payer: AlohaCare Medicare	$8,770.40
Rate for Payer: Cash Price	$6,924.00
Rate for Payer: Devoted Health Medicare	$9,693.60
Rate for Payer: Hawaii Medical Service Association Medicare	$8,770.40
Rate for Payer: Hawaii Western Management Group Commercial	$8,078.00
Rate for Payer: Health Management Network Commercial	$9,809.00
Rate for Payer: Humana Medicare	$8,770.40
Rate for Payer: Kaiser Permanente Commercial	$10,386.00
Rate for Payer: Kaiser Permanente Medicaid	$5,885.40
Rate for Payer: Kaiser Permanente Medicare	$8,770.40
Rate for Payer: MDX Hawaii PPO	$11,193.80
Rate for Payer: Ohana Health Plan Medicaid	$8,770.40
Rate for Payer: Ohana Health Plan Medicare	$8,770.40
Rate for Payer: UnitedHealthcare Medicare	$8,770.40
Rate for Payer: University Health Alliance Commercial	$6,462.40

AAA ENDOPROSTHESIS #PLC271000

Facility

$11,540.00

Hospital Revenue Code	278
Min. Negotiated Rate	$6,462.40
Max. Negotiated Rate	$11,193.80
Rate for Payer: Cash Price	$6,924.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,078.00
Rate for Payer: Health Management Network Commercial	$9,809.00
Rate for Payer: Kaiser Permanente Commercial	$10,386.00
Rate for Payer: MDX Hawaii PPO	$11,193.80
Rate for Payer: University Health Alliance Commercial	$6,462.40

AAA ILIAC 10MMX10CM CEB231010A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$12,040.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Kaiser Permanente Commercial	$19,350.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 10MMX10CM CEB231010A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$10,750.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: AlohaCare Medicaid	$10,750.00
Rate for Payer: AlohaCare Medicare	$16,340.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Devoted Health Medicare	$18,060.00
Rate for Payer: Hawaii Medical Service Association Medicare	$16,340.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Humana Medicare	$16,340.00
Rate for Payer: Kaiser Permanente Commercial	$19,350.00
Rate for Payer: Kaiser Permanente Medicaid	$10,965.00
Rate for Payer: Kaiser Permanente Medicare	$16,340.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: Ohana Health Plan Medicaid	$16,340.00
Rate for Payer: Ohana Health Plan Medicare	$16,340.00
Rate for Payer: UnitedHealthcare Medicare	$16,340.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 10MMX7CM HGB161007A

Facility

$6,924.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,462.00
Max. Negotiated Rate	$6,716.28
Rate for Payer: AlohaCare Medicaid	$3,462.00
Rate for Payer: AlohaCare Medicare	$5,262.24
Rate for Payer: Cash Price	$4,154.40
Rate for Payer: Devoted Health Medicare	$5,816.16
Rate for Payer: Hawaii Medical Service Association Medicare	$5,262.24
Rate for Payer: Hawaii Western Management Group Commercial	$4,846.80
Rate for Payer: Health Management Network Commercial	$5,885.40
Rate for Payer: Humana Medicare	$5,262.24
Rate for Payer: Kaiser Permanente Commercial	$6,231.60
Rate for Payer: Kaiser Permanente Medicaid	$3,531.24
Rate for Payer: Kaiser Permanente Medicare	$5,262.24
Rate for Payer: MDX Hawaii PPO	$6,716.28
Rate for Payer: Ohana Health Plan Medicaid	$5,262.24
Rate for Payer: Ohana Health Plan Medicare	$5,262.24
Rate for Payer: UnitedHealthcare Medicare	$5,262.24
Rate for Payer: University Health Alliance Commercial	$3,877.44

AAA ILIAC 10MMX7CM HGB161007A

Facility

$6,924.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,877.44
Max. Negotiated Rate	$6,716.28
Rate for Payer: Cash Price	$4,154.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,846.80
Rate for Payer: Health Management Network Commercial	$5,885.40
Rate for Payer: Kaiser Permanente Commercial	$6,231.60
Rate for Payer: MDX Hawaii PPO	$6,716.28
Rate for Payer: University Health Alliance Commercial	$3,877.44

Know your out-of-pocket cost for care.

All Charges