Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

FIXATION SECONDARY AR-1593-P

Facility

$2,284.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,279.04
Max. Negotiated Rate	$2,215.48
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,598.80
Rate for Payer: Health Management Network Commercial	$1,941.40
Rate for Payer: Kaiser Permanente Commercial	$2,055.60
Rate for Payer: MDX Hawaii PPO	$2,215.48
Rate for Payer: University Health Alliance Commercial	$1,279.04

FIXATION TOOL 6616

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

FIXATION TOOL 6616

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

FIXATOR CALCANEAL M145

Facility

$5,778.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,911.30
Max. Negotiated Rate	$5,604.66
Rate for Payer: Cash Price	$3,466.80
Rate for Payer: Health Management Network Commercial	$4,911.30
Rate for Payer: Kaiser Permanente Commercial	$5,200.20
Rate for Payer: MDX Hawaii PPO	$5,604.66

FIXATOR CALCANEAL M145

Facility

$5,778.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,889.00
Max. Negotiated Rate	$5,604.66
Rate for Payer: AlohaCare Medicaid	$2,889.00
Rate for Payer: AlohaCare Medicare	$4,391.28
Rate for Payer: Cash Price	$3,466.80
Rate for Payer: Devoted Health Medicare	$4,853.52
Rate for Payer: Hawaii Medical Service Association Medicare	$4,391.28
Rate for Payer: Hawaii Western Management Group Commercial	$5,489.10
Rate for Payer: Health Management Network Commercial	$4,911.30
Rate for Payer: Humana Medicare	$4,391.28
Rate for Payer: Kaiser Permanente Commercial	$5,200.20
Rate for Payer: Kaiser Permanente Medicaid	$2,946.78
Rate for Payer: Kaiser Permanente Medicare	$4,391.28
Rate for Payer: MDX Hawaii PPO	$5,604.66
Rate for Payer: Ohana Health Plan Medicaid	$4,391.28
Rate for Payer: Ohana Health Plan Medicare	$4,391.28
Rate for Payer: UnitedHealthcare Medicare	$4,391.28
Rate for Payer: University Health Alliance Commercial	$4,211.58

FIXATOR ENDOSCOPIC MARKER

Facility

$152.00

Hospital Revenue Code	272
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

FIXATOR ENDOSCOPIC MARKER

Facility

$152.00

Hospital Revenue Code	272
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: AlohaCare Medicare	$115.52
Rate for Payer: Cash Price	$91.20
Rate for Payer: Devoted Health Medicare	$127.68
Rate for Payer: Hawaii Medical Service Association Medicare	$115.52
Rate for Payer: Hawaii Western Management Group Commercial	$144.40
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Humana Medicare	$115.52
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: Kaiser Permanente Medicare	$115.52
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: Ohana Health Plan Medicaid	$115.52
Rate for Payer: Ohana Health Plan Medicare	$115.52
Rate for Payer: UnitedHealthcare Medicare	$115.52
Rate for Payer: University Health Alliance Commercial	$110.79

FIXATOR ENDOSCOPIC TATTOO 5ML

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$184.30
Rate for Payer: AlohaCare Medicaid	$95.00
Rate for Payer: AlohaCare Medicare	$144.40
Rate for Payer: Cash Price	$114.00
Rate for Payer: Devoted Health Medicare	$159.60
Rate for Payer: Hawaii Medical Service Association Medicare	$144.40
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Humana Medicare	$144.40
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: Kaiser Permanente Medicare	$144.40
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: Ohana Health Plan Medicaid	$144.40
Rate for Payer: Ohana Health Plan Medicare	$144.40
Rate for Payer: UnitedHealthcare Medicare	$144.40
Rate for Payer: University Health Alliance Commercial	$138.49

FIXATOR ENDOSCOPIC TATTOO 5ML

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$161.50
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: MDX Hawaii PPO	$184.30

FIXATOR MINIRAIL M2 M511

Facility

$5,328.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,664.00
Max. Negotiated Rate	$5,168.16
Rate for Payer: AlohaCare Medicaid	$2,664.00
Rate for Payer: AlohaCare Medicare	$4,049.28
Rate for Payer: Cash Price	$3,196.80
Rate for Payer: Devoted Health Medicare	$4,475.52
Rate for Payer: Hawaii Medical Service Association Medicare	$4,049.28
Rate for Payer: Hawaii Western Management Group Commercial	$5,061.60
Rate for Payer: Health Management Network Commercial	$4,528.80
Rate for Payer: Humana Medicare	$4,049.28
Rate for Payer: Kaiser Permanente Commercial	$4,795.20
Rate for Payer: Kaiser Permanente Medicaid	$2,717.28
Rate for Payer: Kaiser Permanente Medicare	$4,049.28
Rate for Payer: MDX Hawaii PPO	$5,168.16
Rate for Payer: Ohana Health Plan Medicaid	$4,049.28
Rate for Payer: Ohana Health Plan Medicare	$4,049.28
Rate for Payer: UnitedHealthcare Medicare	$4,049.28
Rate for Payer: University Health Alliance Commercial	$3,883.58

FIXATOR MINIRAIL M2 M511

Facility

$5,328.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,528.80
Max. Negotiated Rate	$5,168.16
Rate for Payer: Cash Price	$3,196.80
Rate for Payer: Health Management Network Commercial	$4,528.80
Rate for Payer: Kaiser Permanente Commercial	$4,795.20
Rate for Payer: MDX Hawaii PPO	$5,168.16

FIXATR ARTIC MINIRAIL DBL M514

Facility

$5,328.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,528.80
Max. Negotiated Rate	$5,168.16
Rate for Payer: Cash Price	$3,196.80
Rate for Payer: Health Management Network Commercial	$4,528.80
Rate for Payer: Kaiser Permanente Commercial	$4,795.20
Rate for Payer: MDX Hawaii PPO	$5,168.16

FIXATR ARTIC MINIRAIL DBL M514

Facility

$5,328.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,664.00
Max. Negotiated Rate	$5,168.16
Rate for Payer: AlohaCare Medicaid	$2,664.00
Rate for Payer: AlohaCare Medicare	$4,049.28
Rate for Payer: Cash Price	$3,196.80
Rate for Payer: Devoted Health Medicare	$4,475.52
Rate for Payer: Hawaii Medical Service Association Medicare	$4,049.28
Rate for Payer: Hawaii Western Management Group Commercial	$5,061.60
Rate for Payer: Health Management Network Commercial	$4,528.80
Rate for Payer: Humana Medicare	$4,049.28
Rate for Payer: Kaiser Permanente Commercial	$4,795.20
Rate for Payer: Kaiser Permanente Medicaid	$2,717.28
Rate for Payer: Kaiser Permanente Medicare	$4,049.28
Rate for Payer: MDX Hawaii PPO	$5,168.16
Rate for Payer: Ohana Health Plan Medicaid	$4,049.28
Rate for Payer: Ohana Health Plan Medicare	$4,049.28
Rate for Payer: UnitedHealthcare Medicare	$4,049.28
Rate for Payer: University Health Alliance Commercial	$3,883.58

FIXATR CAP/WIRE LOCK MODEL D

Facility

$102.00

Hospital Revenue Code	272
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$98.94

FIXATR CAP/WIRE LOCK MODEL D

Facility

$102.00

Hospital Revenue Code	272
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$98.94
Rate for Payer: AlohaCare Medicaid	$51.00
Rate for Payer: AlohaCare Medicare	$77.52
Rate for Payer: Cash Price	$61.20
Rate for Payer: Devoted Health Medicare	$85.68
Rate for Payer: Hawaii Medical Service Association Medicare	$77.52
Rate for Payer: Hawaii Western Management Group Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Humana Medicare	$77.52
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: Kaiser Permanente Medicare	$77.52
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: Ohana Health Plan Medicaid	$77.52
Rate for Payer: Ohana Health Plan Medicare	$77.52
Rate for Payer: UnitedHealthcare Medicare	$77.52
Rate for Payer: University Health Alliance Commercial	$74.35

FIXATR CAP/WIRE LOCK OLYMPUS

Facility

$102.00

Hospital Revenue Code	272
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$98.94
Rate for Payer: AlohaCare Medicaid	$51.00
Rate for Payer: AlohaCare Medicare	$77.52
Rate for Payer: Cash Price	$61.20
Rate for Payer: Devoted Health Medicare	$85.68
Rate for Payer: Hawaii Medical Service Association Medicare	$77.52
Rate for Payer: Hawaii Western Management Group Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Humana Medicare	$77.52
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: Kaiser Permanente Medicare	$77.52
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: Ohana Health Plan Medicaid	$77.52
Rate for Payer: Ohana Health Plan Medicare	$77.52
Rate for Payer: UnitedHealthcare Medicare	$77.52
Rate for Payer: University Health Alliance Commercial	$74.35

FIXATR CAP/WIRE LOCK OLYMPUS

Facility

$102.00

Hospital Revenue Code	272
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$98.94

FLAME FINISHING M58-8812

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

FLAME FINISHING M58-8812

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$74.69
Rate for Payer: AlohaCare Medicaid	$38.50
Rate for Payer: AlohaCare Medicare	$58.52
Rate for Payer: Cash Price	$46.20
Rate for Payer: Devoted Health Medicare	$64.68
Rate for Payer: Hawaii Medical Service Association Medicare	$58.52
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Humana Medicare	$58.52
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: Kaiser Permanente Medicare	$58.52
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: Ohana Health Plan Medicaid	$58.52
Rate for Payer: Ohana Health Plan Medicare	$58.52
Rate for Payer: UnitedHealthcare Medicare	$58.52
Rate for Payer: University Health Alliance Commercial	$56.13

FLECAINIDE 100 MG TABLET [10041]

Facility

$13.00

Service Code	NDC 00054001120
Hospital Revenue Code	637
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$9.88
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$10.92
Rate for Payer: Hawaii Medical Service Association Medicare	$9.88
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$9.88
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$9.88
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$9.88
Rate for Payer: Ohana Health Plan Medicare	$9.88
Rate for Payer: UnitedHealthcare Medicare	$9.88
Rate for Payer: University Health Alliance Commercial	$9.48

FLECAINIDE 100 MG TABLET [10041]

Facility

$13.00

Service Code	NDC 00054001120
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

FLEXIGRAFT FGL

Facility

$4,820.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$2,699.20
Max. Negotiated Rate	$4,675.40
Rate for Payer: Cash Price	$2,892.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,374.00
Rate for Payer: Health Management Network Commercial	$4,097.00
Rate for Payer: Kaiser Permanente Commercial	$4,338.00
Rate for Payer: MDX Hawaii PPO	$4,675.40
Rate for Payer: University Health Alliance Commercial	$2,699.20

FLEXIGRAFT FGL

Facility

$4,820.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$2,410.00
Max. Negotiated Rate	$4,675.40
Rate for Payer: AlohaCare Medicaid	$2,410.00
Rate for Payer: AlohaCare Medicare	$3,663.20
Rate for Payer: Cash Price	$2,892.00
Rate for Payer: Devoted Health Medicare	$4,048.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,663.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,374.00
Rate for Payer: Health Management Network Commercial	$4,097.00
Rate for Payer: Humana Medicare	$3,663.20
Rate for Payer: Kaiser Permanente Commercial	$4,338.00
Rate for Payer: Kaiser Permanente Medicaid	$2,458.20
Rate for Payer: Kaiser Permanente Medicare	$3,663.20
Rate for Payer: MDX Hawaii PPO	$4,675.40
Rate for Payer: Ohana Health Plan Medicaid	$3,663.20
Rate for Payer: Ohana Health Plan Medicare	$3,663.20
Rate for Payer: UnitedHealthcare Medicare	$3,663.20
Rate for Payer: University Health Alliance Commercial	$2,699.20

FLEXIGRAFT TENDSON HAM FST

Facility

$3,026.00

Service Code	HCPCS C1716
Hospital Revenue Code	278
Min. Negotiated Rate	$1,694.56
Max. Negotiated Rate	$2,935.22
Rate for Payer: Cash Price	$1,815.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,118.20
Rate for Payer: Health Management Network Commercial	$2,572.10
Rate for Payer: Kaiser Permanente Commercial	$2,723.40
Rate for Payer: MDX Hawaii PPO	$2,935.22
Rate for Payer: University Health Alliance Commercial	$1,694.56

FLEXIGRAFT TENDSON HAM FST

Facility

$3,026.00

Service Code	HCPCS C1716
Hospital Revenue Code	278
Min. Negotiated Rate	$641.96
Max. Negotiated Rate	$2,935.22
Rate for Payer: AlohaCare Medicaid	$1,513.00
Rate for Payer: AlohaCare Medicare	$2,299.76
Rate for Payer: Cash Price	$1,815.60
Rate for Payer: Cash Price	$1,815.60
Rate for Payer: Devoted Health Medicare	$2,541.84
Rate for Payer: Hawaii Medical Service Association Commercial	$641.96
Rate for Payer: Hawaii Medical Service Association Medicare	$2,299.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,118.20
Rate for Payer: Health Management Network Commercial	$2,572.10
Rate for Payer: Humana Medicare	$2,299.76
Rate for Payer: Kaiser Permanente Commercial	$2,723.40
Rate for Payer: Kaiser Permanente Medicaid	$1,543.26
Rate for Payer: Kaiser Permanente Medicare	$2,299.76
Rate for Payer: MDX Hawaii PPO	$2,935.22
Rate for Payer: Ohana Health Plan Medicaid	$2,299.76
Rate for Payer: Ohana Health Plan Medicare	$2,299.76
Rate for Payer: UnitedHealthcare Medicaid	$651.25
Rate for Payer: UnitedHealthcare Medicare	$2,299.76
Rate for Payer: University Health Alliance Commercial	$1,694.56

Know your out-of-pocket cost for care.

All Charges