Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID [194491]

Facility

$15.00

Service Code	NDC 00559000000
Hospital Revenue Code	637
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]

Facility

$1.00

Service Code	NDC 59161000000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]

Facility

$1.00

Service Code	NDC 59161000000
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

FEVER AND INFLAMMATORY CONDITIONS

Facility

$22,564.30

Service Code	MSDRG 864
Min. Negotiated Rate	$22,564.30
Max. Negotiated Rate	$22,564.30
Rate for Payer: Hawaii Medical Service Association Commercial	$22,564.30

FIBER 200 MOSES LASER

Facility

$1,732.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$866.00
Max. Negotiated Rate	$1,680.04
Rate for Payer: AlohaCare Medicaid	$866.00
Rate for Payer: AlohaCare Medicare	$1,316.32
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Devoted Health Medicare	$1,454.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,316.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,645.40
Rate for Payer: Health Management Network Commercial	$1,472.20
Rate for Payer: Humana Medicare	$1,316.32
Rate for Payer: Kaiser Permanente Commercial	$1,558.80
Rate for Payer: Kaiser Permanente Medicaid	$883.32
Rate for Payer: Kaiser Permanente Medicare	$1,316.32
Rate for Payer: MDX Hawaii PPO	$1,680.04
Rate for Payer: Ohana Health Plan Medicaid	$1,316.32
Rate for Payer: Ohana Health Plan Medicare	$1,316.32
Rate for Payer: UnitedHealthcare Medicare	$1,316.32
Rate for Payer: University Health Alliance Commercial	$1,262.45

FIBER 200 MOSES LASER

Facility

$1,732.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,472.20
Max. Negotiated Rate	$1,680.04
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Health Management Network Commercial	$1,472.20
Rate for Payer: Kaiser Permanente Commercial	$1,558.80
Rate for Payer: MDX Hawaii PPO	$1,680.04

FIBER 365 MOSES LASER

Facility

$1,382.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$691.00
Max. Negotiated Rate	$1,340.54
Rate for Payer: AlohaCare Medicaid	$691.00
Rate for Payer: AlohaCare Medicare	$1,050.32
Rate for Payer: Cash Price	$829.20
Rate for Payer: Devoted Health Medicare	$1,160.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,050.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,312.90
Rate for Payer: Health Management Network Commercial	$1,174.70
Rate for Payer: Humana Medicare	$1,050.32
Rate for Payer: Kaiser Permanente Commercial	$1,243.80
Rate for Payer: Kaiser Permanente Medicaid	$704.82
Rate for Payer: Kaiser Permanente Medicare	$1,050.32
Rate for Payer: MDX Hawaii PPO	$1,340.54
Rate for Payer: Ohana Health Plan Medicaid	$1,050.32
Rate for Payer: Ohana Health Plan Medicare	$1,050.32
Rate for Payer: UnitedHealthcare Medicare	$1,050.32
Rate for Payer: University Health Alliance Commercial	$1,007.34

FIBER 365 MOSES LASER

Facility

$1,382.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,174.70
Max. Negotiated Rate	$1,340.54
Rate for Payer: Cash Price	$829.20
Rate for Payer: Health Management Network Commercial	$1,174.70
Rate for Payer: Kaiser Permanente Commercial	$1,243.80
Rate for Payer: MDX Hawaii PPO	$1,340.54

FIBER 550 MOSES LASER

Facility

$1,589.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$794.50
Max. Negotiated Rate	$1,541.33
Rate for Payer: AlohaCare Medicaid	$794.50
Rate for Payer: AlohaCare Medicare	$1,207.64
Rate for Payer: Cash Price	$953.40
Rate for Payer: Devoted Health Medicare	$1,334.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,207.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.55
Rate for Payer: Health Management Network Commercial	$1,350.65
Rate for Payer: Humana Medicare	$1,207.64
Rate for Payer: Kaiser Permanente Commercial	$1,430.10
Rate for Payer: Kaiser Permanente Medicaid	$810.39
Rate for Payer: Kaiser Permanente Medicare	$1,207.64
Rate for Payer: MDX Hawaii PPO	$1,541.33
Rate for Payer: Ohana Health Plan Medicaid	$1,207.64
Rate for Payer: Ohana Health Plan Medicare	$1,207.64
Rate for Payer: UnitedHealthcare Medicare	$1,207.64
Rate for Payer: University Health Alliance Commercial	$1,158.22

FIBER 550 MOSES LASER

Facility

$1,589.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,350.65
Max. Negotiated Rate	$1,541.33
Rate for Payer: Cash Price	$953.40
Rate for Payer: Health Management Network Commercial	$1,350.65
Rate for Payer: Kaiser Permanente Commercial	$1,430.10
Rate for Payer: MDX Hawaii PPO	$1,541.33

FIBER CO2 LASER 320

Facility

$2,970.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,524.50
Max. Negotiated Rate	$2,880.90
Rate for Payer: Cash Price	$1,782.00
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: Kaiser Permanente Commercial	$2,673.00
Rate for Payer: MDX Hawaii PPO	$2,880.90

FIBER CO2 LASER 320

Facility

$2,970.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,880.90
Rate for Payer: AlohaCare Medicaid	$1,485.00
Rate for Payer: AlohaCare Medicare	$2,257.20
Rate for Payer: Cash Price	$1,782.00
Rate for Payer: Devoted Health Medicare	$2,494.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,257.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,821.50
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: Humana Medicare	$2,257.20
Rate for Payer: Kaiser Permanente Commercial	$2,673.00
Rate for Payer: Kaiser Permanente Medicaid	$1,514.70
Rate for Payer: Kaiser Permanente Medicare	$2,257.20
Rate for Payer: MDX Hawaii PPO	$2,880.90
Rate for Payer: Ohana Health Plan Medicaid	$2,257.20
Rate for Payer: Ohana Health Plan Medicare	$2,257.20
Rate for Payer: UnitedHealthcare Medicare	$2,257.20
Rate for Payer: University Health Alliance Commercial	$2,164.83

FIBER PROBE SIDEFIRE W/FILTER

Facility

$911.00

Hospital Revenue Code	272
Min. Negotiated Rate	$455.50
Max. Negotiated Rate	$883.67
Rate for Payer: AlohaCare Medicaid	$455.50
Rate for Payer: AlohaCare Medicare	$692.36
Rate for Payer: Cash Price	$546.60
Rate for Payer: Devoted Health Medicare	$765.24
Rate for Payer: Hawaii Medical Service Association Medicare	$692.36
Rate for Payer: Hawaii Western Management Group Commercial	$865.45
Rate for Payer: Health Management Network Commercial	$774.35
Rate for Payer: Humana Medicare	$692.36
Rate for Payer: Kaiser Permanente Commercial	$819.90
Rate for Payer: Kaiser Permanente Medicaid	$464.61
Rate for Payer: Kaiser Permanente Medicare	$692.36
Rate for Payer: MDX Hawaii PPO	$883.67
Rate for Payer: Ohana Health Plan Medicaid	$692.36
Rate for Payer: Ohana Health Plan Medicare	$692.36
Rate for Payer: UnitedHealthcare Medicare	$692.36
Rate for Payer: University Health Alliance Commercial	$664.03

FIBER PROBE SIDEFIRE W/FILTER

Facility

$911.00

Hospital Revenue Code	272
Min. Negotiated Rate	$774.35
Max. Negotiated Rate	$883.67
Rate for Payer: Cash Price	$546.60
Rate for Payer: Health Management Network Commercial	$774.35
Rate for Payer: Kaiser Permanente Commercial	$819.90
Rate for Payer: MDX Hawaii PPO	$883.67

FIBER PROBE W/FILTER 6.9F

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

FIBER PROBE W/FILTER 6.9F

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.50
Max. Negotiated Rate	$208.55
Rate for Payer: AlohaCare Medicaid	$107.50
Rate for Payer: AlohaCare Medicare	$163.40
Rate for Payer: Cash Price	$129.00
Rate for Payer: Devoted Health Medicare	$180.60
Rate for Payer: Hawaii Medical Service Association Medicare	$163.40
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Humana Medicare	$163.40
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: Kaiser Permanente Medicare	$163.40
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: Ohana Health Plan Medicaid	$163.40
Rate for Payer: Ohana Health Plan Medicare	$163.40
Rate for Payer: UnitedHealthcare Medicare	$163.40
Rate for Payer: University Health Alliance Commercial	$156.71

FIBERSTITCH 1.5 24" AR-4580-24

Facility

$1,733.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$866.50
Max. Negotiated Rate	$1,681.01
Rate for Payer: AlohaCare Medicaid	$866.50
Rate for Payer: AlohaCare Medicare	$1,317.08
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Devoted Health Medicare	$1,455.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,317.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,213.10
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Humana Medicare	$1,317.08
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: Kaiser Permanente Medicare	$1,317.08
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: Ohana Health Plan Medicaid	$1,317.08
Rate for Payer: Ohana Health Plan Medicare	$1,317.08
Rate for Payer: UnitedHealthcare Medicare	$1,317.08
Rate for Payer: University Health Alliance Commercial	$970.48

FIBERSTITCH 1.5 24" AR-4580-24

Facility

$1,733.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$970.48
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,213.10
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: University Health Alliance Commercial	$970.48

FIBERSTITCH 1.5 CURVED AR-4580

Facility

$1,733.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$970.48
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,213.10
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: University Health Alliance Commercial	$970.48

FIBERSTITCH 1.5 CURVED AR-4580

Facility

$1,733.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$866.50
Max. Negotiated Rate	$1,681.01
Rate for Payer: AlohaCare Medicaid	$866.50
Rate for Payer: AlohaCare Medicare	$1,317.08
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Devoted Health Medicare	$1,455.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,317.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,213.10
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Humana Medicare	$1,317.08
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: Kaiser Permanente Medicare	$1,317.08
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: Ohana Health Plan Medicaid	$1,317.08
Rate for Payer: Ohana Health Plan Medicare	$1,317.08
Rate for Payer: UnitedHealthcare Medicare	$1,317.08
Rate for Payer: University Health Alliance Commercial	$970.48

FIBERSTITCH IMPLANT AR-4570

Facility

$1,559.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$873.04
Max. Negotiated Rate	$1,512.23
Rate for Payer: Cash Price	$935.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,091.30
Rate for Payer: Health Management Network Commercial	$1,325.15
Rate for Payer: Kaiser Permanente Commercial	$1,403.10
Rate for Payer: MDX Hawaii PPO	$1,512.23
Rate for Payer: University Health Alliance Commercial	$873.04

FIBERSTITCH IMPLANT AR-4570

Facility

$1,559.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$779.50
Max. Negotiated Rate	$1,512.23
Rate for Payer: AlohaCare Medicaid	$779.50
Rate for Payer: AlohaCare Medicare	$1,184.84
Rate for Payer: Cash Price	$935.40
Rate for Payer: Devoted Health Medicare	$1,309.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,184.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,091.30
Rate for Payer: Health Management Network Commercial	$1,325.15
Rate for Payer: Humana Medicare	$1,184.84
Rate for Payer: Kaiser Permanente Commercial	$1,403.10
Rate for Payer: Kaiser Permanente Medicaid	$795.09
Rate for Payer: Kaiser Permanente Medicare	$1,184.84
Rate for Payer: MDX Hawaii PPO	$1,512.23
Rate for Payer: Ohana Health Plan Medicaid	$1,184.84
Rate for Payer: Ohana Health Plan Medicare	$1,184.84
Rate for Payer: UnitedHealthcare Medicare	$1,184.84
Rate for Payer: University Health Alliance Commercial	$873.04

FIBERSTITCH STRAIGHT AR-4580S

Facility

$1,559.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$873.04
Max. Negotiated Rate	$1,512.23
Rate for Payer: Cash Price	$935.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,091.30
Rate for Payer: Health Management Network Commercial	$1,325.15
Rate for Payer: Kaiser Permanente Commercial	$1,403.10
Rate for Payer: MDX Hawaii PPO	$1,512.23
Rate for Payer: University Health Alliance Commercial	$873.04

FIBERSTITCH STRAIGHT AR-4580S

Facility

$1,559.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$779.50
Max. Negotiated Rate	$1,512.23
Rate for Payer: AlohaCare Medicaid	$779.50
Rate for Payer: AlohaCare Medicare	$1,184.84
Rate for Payer: Cash Price	$935.40
Rate for Payer: Devoted Health Medicare	$1,309.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,184.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,091.30
Rate for Payer: Health Management Network Commercial	$1,325.15
Rate for Payer: Humana Medicare	$1,184.84
Rate for Payer: Kaiser Permanente Commercial	$1,403.10
Rate for Payer: Kaiser Permanente Medicaid	$795.09
Rate for Payer: Kaiser Permanente Medicare	$1,184.84
Rate for Payer: MDX Hawaii PPO	$1,512.23
Rate for Payer: Ohana Health Plan Medicaid	$1,184.84
Rate for Payer: Ohana Health Plan Medicare	$1,184.84
Rate for Payer: UnitedHealthcare Medicare	$1,184.84
Rate for Payer: University Health Alliance Commercial	$873.04

FIBERTAG TIGHTROPE II ABS

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.00
Max. Negotiated Rate	$1,964.25
Rate for Payer: Cash Price	$1,215.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,417.50
Rate for Payer: Health Management Network Commercial	$1,721.25
Rate for Payer: Kaiser Permanente Commercial	$1,822.50
Rate for Payer: MDX Hawaii PPO	$1,964.25
Rate for Payer: University Health Alliance Commercial	$1,134.00

Know your out-of-pocket cost for care.

All Charges