Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

GUIDEWIRE 0.014 SR-014-GW

Facility

$750.00

Service Code	HCPCS C1769
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

GUIDEWIRE 0.014 SR-014-GW

Facility

$750.00

Service Code	HCPCS C1769
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

GUIDEWIRE 0.045X6" 316-0004

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$91.84

GUIDEWIRE 0.045X6" 316-0004

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

GUIDEWIRE 035X150 PTFE COATED

Facility

$69.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$52.44
Rate for Payer: Cash Price	$41.40
Rate for Payer: Devoted Health Medicare	$57.96
Rate for Payer: Hawaii Medical Service Association Medicare	$52.44
Rate for Payer: Hawaii Western Management Group Commercial	$65.55
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$52.44
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$52.44
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$52.44
Rate for Payer: Ohana Health Plan Medicare	$52.44
Rate for Payer: UnitedHealthcare Medicare	$52.44
Rate for Payer: University Health Alliance Commercial	$50.29

GUIDEWIRE 035X150 PTFE COATED

Facility

$69.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$41.40
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

GUIDEWIRE 035X260 BENTSON

Facility

$140.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$135.80
Rate for Payer: AlohaCare Medicaid	$70.00
Rate for Payer: AlohaCare Medicare	$106.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Devoted Health Medicare	$117.60
Rate for Payer: Hawaii Medical Service Association Medicare	$106.40
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Humana Medicare	$106.40
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicare	$106.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: Ohana Health Plan Medicaid	$106.40
Rate for Payer: Ohana Health Plan Medicare	$106.40
Rate for Payer: UnitedHealthcare Medicare	$106.40
Rate for Payer: University Health Alliance Commercial	$102.05

GUIDEWIRE 035X260 BENTSON

Facility

$140.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80

GUIDE WIRE .035X4" LONG

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$91.84

GUIDE WIRE .035X4" LONG

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

GUIDE WIRE 0.45X4 #316-0003

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

GUIDE WIRE 0.45X4 #316-0003

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$91.84

GUIDEWIRE 0.62X12 AR-8941-12

Facility

$300.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

GUIDEWIRE 0.62X12 AR-8941-12

Facility

$300.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$228.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Devoted Health Medicare	$252.00
Rate for Payer: Hawaii Medical Service Association Medicare	$228.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$228.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$228.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$228.00
Rate for Payer: Ohana Health Plan Medicare	$228.00
Rate for Payer: UnitedHealthcare Medicare	$228.00
Rate for Payer: University Health Alliance Commercial	$218.67

GUIDE WIRE .062X7 #AR-8941-7

Facility

$268.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$227.80
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$160.80
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: MDX Hawaii PPO	$259.96

GUIDE WIRE .062X7 #AR-8941-7

Facility

$268.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$259.96
Rate for Payer: AlohaCare Medicaid	$134.00
Rate for Payer: AlohaCare Medicare	$203.68
Rate for Payer: Cash Price	$160.80
Rate for Payer: Devoted Health Medicare	$225.12
Rate for Payer: Hawaii Medical Service Association Medicare	$203.68
Rate for Payer: Hawaii Western Management Group Commercial	$254.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Humana Medicare	$203.68
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: Kaiser Permanente Medicaid	$136.68
Rate for Payer: Kaiser Permanente Medicare	$203.68
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: Ohana Health Plan Medicaid	$203.68
Rate for Payer: Ohana Health Plan Medicare	$203.68
Rate for Payer: UnitedHealthcare Medicare	$203.68
Rate for Payer: University Health Alliance Commercial	$195.35

GUIDEWIRE 1.1MMX150MM #292.622

Facility

$179.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$100.24
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$107.40
Rate for Payer: Hawaii Western Management Group Commercial	$125.30
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: University Health Alliance Commercial	$100.24

GUIDEWIRE 1.1MMX150MM #292.622

Facility

$179.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$89.50
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$136.04
Rate for Payer: Cash Price	$107.40
Rate for Payer: Devoted Health Medicare	$150.36
Rate for Payer: Hawaii Medical Service Association Medicare	$136.04
Rate for Payer: Hawaii Western Management Group Commercial	$125.30
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$136.04
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$136.04
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$136.04
Rate for Payer: Ohana Health Plan Medicare	$136.04
Rate for Payer: UnitedHealthcare Medicare	$136.04
Rate for Payer: University Health Alliance Commercial	$100.24

GUIDEWIRE 1.1X150MM #292.623

Facility

$169.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$84.50
Max. Negotiated Rate	$163.93
Rate for Payer: AlohaCare Medicaid	$84.50
Rate for Payer: AlohaCare Medicare	$128.44
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$141.96
Rate for Payer: Hawaii Medical Service Association Medicare	$128.44
Rate for Payer: Hawaii Western Management Group Commercial	$160.55
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Humana Medicare	$128.44
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: Kaiser Permanente Medicaid	$86.19
Rate for Payer: Kaiser Permanente Medicare	$128.44
Rate for Payer: MDX Hawaii PPO	$163.93
Rate for Payer: Ohana Health Plan Medicaid	$128.44
Rate for Payer: Ohana Health Plan Medicare	$128.44
Rate for Payer: UnitedHealthcare Medicare	$128.44
Rate for Payer: University Health Alliance Commercial	$123.18

GUIDEWIRE 1.1X150MM #292.623

Facility

$169.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: MDX Hawaii PPO	$163.93

GUIDE WIRE 1.25MM #900.721

Facility

$169.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: MDX Hawaii PPO	$163.93

GUIDE WIRE 1.25MM #900.721

Facility

$169.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$84.50
Max. Negotiated Rate	$163.93
Rate for Payer: AlohaCare Medicaid	$84.50
Rate for Payer: AlohaCare Medicare	$128.44
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$141.96
Rate for Payer: Hawaii Medical Service Association Medicare	$128.44
Rate for Payer: Hawaii Western Management Group Commercial	$160.55
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Humana Medicare	$128.44
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: Kaiser Permanente Medicaid	$86.19
Rate for Payer: Kaiser Permanente Medicare	$128.44
Rate for Payer: MDX Hawaii PPO	$163.93
Rate for Payer: Ohana Health Plan Medicaid	$128.44
Rate for Payer: Ohana Health Plan Medicare	$128.44
Rate for Payer: UnitedHealthcare Medicare	$128.44
Rate for Payer: University Health Alliance Commercial	$123.18

GUIDE WIRE 1.25X150MM 900.722

Facility

$186.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$158.10
Max. Negotiated Rate	$180.42
Rate for Payer: Cash Price	$111.60
Rate for Payer: Health Management Network Commercial	$158.10
Rate for Payer: Kaiser Permanente Commercial	$167.40
Rate for Payer: MDX Hawaii PPO	$180.42

GUIDE WIRE 1.25X150MM 900.722

Facility

$186.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$180.42
Rate for Payer: AlohaCare Medicaid	$93.00
Rate for Payer: AlohaCare Medicare	$141.36
Rate for Payer: Cash Price	$111.60
Rate for Payer: Devoted Health Medicare	$156.24
Rate for Payer: Hawaii Medical Service Association Medicare	$141.36
Rate for Payer: Hawaii Western Management Group Commercial	$176.70
Rate for Payer: Health Management Network Commercial	$158.10
Rate for Payer: Humana Medicare	$141.36
Rate for Payer: Kaiser Permanente Commercial	$167.40
Rate for Payer: Kaiser Permanente Medicaid	$94.86
Rate for Payer: Kaiser Permanente Medicare	$141.36
Rate for Payer: MDX Hawaii PPO	$180.42
Rate for Payer: Ohana Health Plan Medicaid	$141.36
Rate for Payer: Ohana Health Plan Medicare	$141.36
Rate for Payer: UnitedHealthcare Medicare	$141.36
Rate for Payer: University Health Alliance Commercial	$135.58

GUIDEWIRE 1.35MM AR-5050-01

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

Know your out-of-pocket cost for care.

All Charges