Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

EXCLUDER COMFORMABLE CXT361414

Facility

$30,044.00

Hospital Revenue Code	278
Min. Negotiated Rate	$16,824.64
Max. Negotiated Rate	$29,142.68
Rate for Payer: Cash Price	$18,026.40
Rate for Payer: Hawaii Western Management Group Commercial	$21,030.80
Rate for Payer: Health Management Network Commercial	$25,537.40
Rate for Payer: Kaiser Permanente Commercial	$27,039.60
Rate for Payer: MDX Hawaii PPO	$29,142.68
Rate for Payer: University Health Alliance Commercial	$16,824.64

EXCLUDER COMFORMABLE CXT361414

Facility

$30,044.00

Hospital Revenue Code	278
Min. Negotiated Rate	$15,022.00
Max. Negotiated Rate	$29,142.68
Rate for Payer: AlohaCare Medicaid	$15,022.00
Rate for Payer: AlohaCare Medicare	$22,833.44
Rate for Payer: Cash Price	$18,026.40
Rate for Payer: Devoted Health Medicare	$25,236.96
Rate for Payer: Hawaii Medical Service Association Medicare	$22,833.44
Rate for Payer: Hawaii Western Management Group Commercial	$21,030.80
Rate for Payer: Health Management Network Commercial	$25,537.40
Rate for Payer: Humana Medicare	$22,833.44
Rate for Payer: Kaiser Permanente Commercial	$27,039.60
Rate for Payer: Kaiser Permanente Medicaid	$15,322.44
Rate for Payer: Kaiser Permanente Medicare	$22,833.44
Rate for Payer: MDX Hawaii PPO	$29,142.68
Rate for Payer: Ohana Health Plan Medicaid	$22,833.44
Rate for Payer: Ohana Health Plan Medicare	$22,833.44
Rate for Payer: UnitedHealthcare Medicare	$22,833.44
Rate for Payer: University Health Alliance Commercial	$16,824.64

EXCLUDER CONFORM AAA CXT281412

Facility

$31,656.00

Hospital Revenue Code	278
Min. Negotiated Rate	$17,727.36
Max. Negotiated Rate	$30,706.32
Rate for Payer: Cash Price	$18,993.60
Rate for Payer: Hawaii Western Management Group Commercial	$22,159.20
Rate for Payer: Health Management Network Commercial	$26,907.60
Rate for Payer: Kaiser Permanente Commercial	$28,490.40
Rate for Payer: MDX Hawaii PPO	$30,706.32
Rate for Payer: University Health Alliance Commercial	$17,727.36

EXCLUDER CONFORM AAA CXT281412

Facility

$31,656.00

Hospital Revenue Code	278
Min. Negotiated Rate	$15,828.00
Max. Negotiated Rate	$30,706.32
Rate for Payer: AlohaCare Medicaid	$15,828.00
Rate for Payer: AlohaCare Medicare	$24,058.56
Rate for Payer: Cash Price	$18,993.60
Rate for Payer: Devoted Health Medicare	$26,591.04
Rate for Payer: Hawaii Medical Service Association Medicare	$24,058.56
Rate for Payer: Hawaii Western Management Group Commercial	$22,159.20
Rate for Payer: Health Management Network Commercial	$26,907.60
Rate for Payer: Humana Medicare	$24,058.56
Rate for Payer: Kaiser Permanente Commercial	$28,490.40
Rate for Payer: Kaiser Permanente Medicaid	$16,144.56
Rate for Payer: Kaiser Permanente Medicare	$24,058.56
Rate for Payer: MDX Hawaii PPO	$30,706.32
Rate for Payer: Ohana Health Plan Medicaid	$24,058.56
Rate for Payer: Ohana Health Plan Medicare	$24,058.56
Rate for Payer: UnitedHealthcare Medicare	$24,058.56
Rate for Payer: University Health Alliance Commercial	$17,727.36

EXCLUDER CONFORM AAA CXT321414

Facility

$29,168.00

Hospital Revenue Code	278
Min. Negotiated Rate	$16,334.08
Max. Negotiated Rate	$28,292.96
Rate for Payer: Cash Price	$17,500.80
Rate for Payer: Hawaii Western Management Group Commercial	$20,417.60
Rate for Payer: Health Management Network Commercial	$24,792.80
Rate for Payer: Kaiser Permanente Commercial	$26,251.20
Rate for Payer: MDX Hawaii PPO	$28,292.96
Rate for Payer: University Health Alliance Commercial	$16,334.08

EXCLUDER CONFORM AAA CXT321414

Facility

$29,168.00

Hospital Revenue Code	278
Min. Negotiated Rate	$14,584.00
Max. Negotiated Rate	$28,292.96
Rate for Payer: AlohaCare Medicaid	$14,584.00
Rate for Payer: AlohaCare Medicare	$22,167.68
Rate for Payer: Cash Price	$17,500.80
Rate for Payer: Devoted Health Medicare	$24,501.12
Rate for Payer: Hawaii Medical Service Association Medicare	$22,167.68
Rate for Payer: Hawaii Western Management Group Commercial	$20,417.60
Rate for Payer: Health Management Network Commercial	$24,792.80
Rate for Payer: Humana Medicare	$22,167.68
Rate for Payer: Kaiser Permanente Commercial	$26,251.20
Rate for Payer: Kaiser Permanente Medicaid	$14,875.68
Rate for Payer: Kaiser Permanente Medicare	$22,167.68
Rate for Payer: MDX Hawaii PPO	$28,292.96
Rate for Payer: Ohana Health Plan Medicaid	$22,167.68
Rate for Payer: Ohana Health Plan Medicare	$22,167.68
Rate for Payer: UnitedHealthcare Medicare	$22,167.68
Rate for Payer: University Health Alliance Commercial	$16,334.08

EXCLUDER CONTRA LIMB PLC141200

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

EXCLUDER CONTRA LIMB PLC141200

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

EXCLUDER CXT261412

Facility

$31,656.00

Hospital Revenue Code	272
Min. Negotiated Rate	$15,828.00
Max. Negotiated Rate	$30,706.32
Rate for Payer: AlohaCare Medicaid	$15,828.00
Rate for Payer: AlohaCare Medicare	$24,058.56
Rate for Payer: Cash Price	$18,993.60
Rate for Payer: Devoted Health Medicare	$26,591.04
Rate for Payer: Hawaii Medical Service Association Medicare	$24,058.56
Rate for Payer: Hawaii Western Management Group Commercial	$30,073.20
Rate for Payer: Health Management Network Commercial	$26,907.60
Rate for Payer: Humana Medicare	$24,058.56
Rate for Payer: Kaiser Permanente Commercial	$28,490.40
Rate for Payer: Kaiser Permanente Medicaid	$16,144.56
Rate for Payer: Kaiser Permanente Medicare	$24,058.56
Rate for Payer: MDX Hawaii PPO	$30,706.32
Rate for Payer: Ohana Health Plan Medicaid	$24,058.56
Rate for Payer: Ohana Health Plan Medicare	$24,058.56
Rate for Payer: UnitedHealthcare Medicare	$24,058.56
Rate for Payer: University Health Alliance Commercial	$23,074.06

EXCLUDER CXT261412

Facility

$31,656.00

Hospital Revenue Code	272
Min. Negotiated Rate	$26,907.60
Max. Negotiated Rate	$30,706.32
Rate for Payer: Cash Price	$18,993.60
Rate for Payer: Health Management Network Commercial	$26,907.60
Rate for Payer: Kaiser Permanente Commercial	$28,490.40
Rate for Payer: MDX Hawaii PPO	$30,706.32

EXCLUDER ENDO AAA CXA260005

Facility

$10,004.00

Hospital Revenue Code	278
Min. Negotiated Rate	$5,002.00
Max. Negotiated Rate	$9,703.88
Rate for Payer: AlohaCare Medicaid	$5,002.00
Rate for Payer: AlohaCare Medicare	$7,603.04
Rate for Payer: Cash Price	$6,002.40
Rate for Payer: Devoted Health Medicare	$8,403.36
Rate for Payer: Hawaii Medical Service Association Medicare	$7,603.04
Rate for Payer: Hawaii Western Management Group Commercial	$7,002.80
Rate for Payer: Health Management Network Commercial	$8,503.40
Rate for Payer: Humana Medicare	$7,603.04
Rate for Payer: Kaiser Permanente Commercial	$9,003.60
Rate for Payer: Kaiser Permanente Medicaid	$5,102.04
Rate for Payer: Kaiser Permanente Medicare	$7,603.04
Rate for Payer: MDX Hawaii PPO	$9,703.88
Rate for Payer: Ohana Health Plan Medicaid	$7,603.04
Rate for Payer: Ohana Health Plan Medicare	$7,603.04
Rate for Payer: UnitedHealthcare Medicare	$7,603.04
Rate for Payer: University Health Alliance Commercial	$5,602.24

EXCLUDER ENDO AAA CXA260005

Facility

$10,004.00

Hospital Revenue Code	278
Min. Negotiated Rate	$5,602.24
Max. Negotiated Rate	$9,703.88
Rate for Payer: Cash Price	$6,002.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,002.80
Rate for Payer: Health Management Network Commercial	$8,503.40
Rate for Payer: Kaiser Permanente Commercial	$9,003.60
Rate for Payer: MDX Hawaii PPO	$9,703.88
Rate for Payer: University Health Alliance Commercial	$5,602.24

EXCLUDER GORE CXT201412

Facility

$29,168.00

Hospital Revenue Code	278
Min. Negotiated Rate	$14,584.00
Max. Negotiated Rate	$28,292.96
Rate for Payer: AlohaCare Medicaid	$14,584.00
Rate for Payer: AlohaCare Medicare	$22,167.68
Rate for Payer: Cash Price	$17,500.80
Rate for Payer: Devoted Health Medicare	$24,501.12
Rate for Payer: Hawaii Medical Service Association Medicare	$22,167.68
Rate for Payer: Hawaii Western Management Group Commercial	$20,417.60
Rate for Payer: Health Management Network Commercial	$24,792.80
Rate for Payer: Humana Medicare	$22,167.68
Rate for Payer: Kaiser Permanente Commercial	$26,251.20
Rate for Payer: Kaiser Permanente Medicaid	$14,875.68
Rate for Payer: Kaiser Permanente Medicare	$22,167.68
Rate for Payer: MDX Hawaii PPO	$28,292.96
Rate for Payer: Ohana Health Plan Medicaid	$22,167.68
Rate for Payer: Ohana Health Plan Medicare	$22,167.68
Rate for Payer: UnitedHealthcare Medicare	$22,167.68
Rate for Payer: University Health Alliance Commercial	$16,334.08

EXCLUDER GORE CXT201412

Facility

$29,168.00

Hospital Revenue Code	278
Min. Negotiated Rate	$16,334.08
Max. Negotiated Rate	$28,292.96
Rate for Payer: Cash Price	$17,500.80
Rate for Payer: Hawaii Western Management Group Commercial	$20,417.60
Rate for Payer: Health Management Network Commercial	$24,792.80
Rate for Payer: Kaiser Permanente Commercial	$26,251.20
Rate for Payer: MDX Hawaii PPO	$28,292.96
Rate for Payer: University Health Alliance Commercial	$16,334.08

EXPANDER BREAST ALLOX2-FH15SE

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,637.50
Rate for Payer: AlohaCare Medicaid	$1,875.00
Rate for Payer: AlohaCare Medicare	$2,850.00
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Devoted Health Medicare	$3,150.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,850.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Humana Medicare	$2,850.00
Rate for Payer: Kaiser Permanente Commercial	$3,375.00
Rate for Payer: Kaiser Permanente Medicaid	$1,912.50
Rate for Payer: Kaiser Permanente Medicare	$2,850.00
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: Ohana Health Plan Medicaid	$2,850.00
Rate for Payer: Ohana Health Plan Medicare	$2,850.00
Rate for Payer: UnitedHealthcare Medicare	$2,850.00
Rate for Payer: University Health Alliance Commercial	$2,100.00

EXPANDER BREAST ALLOX2-FH15SE

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,637.50
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Kaiser Permanente Commercial	$3,375.00
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: University Health Alliance Commercial	$2,100.00

EXPANDER SKIN GRAFT 1.5-1

Facility

$230.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$138.00
Rate for Payer: Hawaii Western Management Group Commercial	$161.00
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: University Health Alliance Commercial	$128.80

EXPANDER SKIN GRAFT 1.5-1

Facility

$230.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$115.00
Rate for Payer: AlohaCare Medicare	$174.80
Rate for Payer: Cash Price	$138.00
Rate for Payer: Devoted Health Medicare	$193.20
Rate for Payer: Hawaii Medical Service Association Medicare	$174.80
Rate for Payer: Hawaii Western Management Group Commercial	$161.00
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$174.80
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$174.80
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$174.80
Rate for Payer: Ohana Health Plan Medicare	$174.80
Rate for Payer: UnitedHealthcare Medicare	$174.80
Rate for Payer: University Health Alliance Commercial	$128.80

EXPANDER TISSUE ALLOX2-FH13SE

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,637.50
Rate for Payer: AlohaCare Medicaid	$1,875.00
Rate for Payer: AlohaCare Medicare	$2,850.00
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Devoted Health Medicare	$3,150.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,850.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Humana Medicare	$2,850.00
Rate for Payer: Kaiser Permanente Commercial	$3,375.00
Rate for Payer: Kaiser Permanente Medicaid	$1,912.50
Rate for Payer: Kaiser Permanente Medicare	$2,850.00
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: Ohana Health Plan Medicaid	$2,850.00
Rate for Payer: Ohana Health Plan Medicare	$2,850.00
Rate for Payer: UnitedHealthcare Medicare	$2,850.00
Rate for Payer: University Health Alliance Commercial	$2,100.00

EXPANDER TISSUE ALLOX2-FH13SE

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,637.50
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Kaiser Permanente Commercial	$3,375.00
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: University Health Alliance Commercial	$2,100.00

EXSUP STRT TIP GUIDEWIRE 9X330

Facility

$1,120.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$952.00
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Kaiser Permanente Commercial	$1,008.00
Rate for Payer: MDX Hawaii PPO	$1,086.40

EXSUP STRT TIP GUIDEWIRE 9X330

Facility

$1,120.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$560.00
Max. Negotiated Rate	$1,086.40
Rate for Payer: AlohaCare Medicaid	$560.00
Rate for Payer: AlohaCare Medicare	$851.20
Rate for Payer: Cash Price	$672.00
Rate for Payer: Devoted Health Medicare	$940.80
Rate for Payer: Hawaii Medical Service Association Medicare	$851.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,064.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Humana Medicare	$851.20
Rate for Payer: Kaiser Permanente Commercial	$1,008.00
Rate for Payer: Kaiser Permanente Medicaid	$571.20
Rate for Payer: Kaiser Permanente Medicare	$851.20
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: Ohana Health Plan Medicaid	$851.20
Rate for Payer: Ohana Health Plan Medicare	$851.20
Rate for Payer: UnitedHealthcare Medicare	$851.20
Rate for Payer: University Health Alliance Commercial	$816.37

EXTENDER TL 100MM 51-10220

Facility

$743.00

Hospital Revenue Code	272
Min. Negotiated Rate	$631.55
Max. Negotiated Rate	$720.71
Rate for Payer: Cash Price	$445.80
Rate for Payer: Health Management Network Commercial	$631.55
Rate for Payer: Kaiser Permanente Commercial	$668.70
Rate for Payer: MDX Hawaii PPO	$720.71

EXTENDER TL 100MM 51-10220

Facility

$743.00

Hospital Revenue Code	272
Min. Negotiated Rate	$371.50
Max. Negotiated Rate	$720.71
Rate for Payer: AlohaCare Medicaid	$371.50
Rate for Payer: AlohaCare Medicare	$564.68
Rate for Payer: Cash Price	$445.80
Rate for Payer: Devoted Health Medicare	$624.12
Rate for Payer: Hawaii Medical Service Association Medicare	$564.68
Rate for Payer: Hawaii Western Management Group Commercial	$705.85
Rate for Payer: Health Management Network Commercial	$631.55
Rate for Payer: Humana Medicare	$564.68
Rate for Payer: Kaiser Permanente Commercial	$668.70
Rate for Payer: Kaiser Permanente Medicaid	$378.93
Rate for Payer: Kaiser Permanente Medicare	$564.68
Rate for Payer: MDX Hawaii PPO	$720.71
Rate for Payer: Ohana Health Plan Medicaid	$564.68
Rate for Payer: Ohana Health Plan Medicare	$564.68
Rate for Payer: UnitedHealthcare Medicare	$564.68
Rate for Payer: University Health Alliance Commercial	$541.57

EXTENSION PERCUTANEOUS 3560022

Facility

$929.00

Service Code	HCPCS C1883
Hospital Revenue Code	278
Min. Negotiated Rate	$520.24
Max. Negotiated Rate	$901.13
Rate for Payer: Cash Price	$557.40
Rate for Payer: Hawaii Western Management Group Commercial	$650.30
Rate for Payer: Health Management Network Commercial	$789.65
Rate for Payer: Kaiser Permanente Commercial	$836.10
Rate for Payer: MDX Hawaii PPO	$901.13
Rate for Payer: University Health Alliance Commercial	$520.24

Know your out-of-pocket cost for care.

All Charges