Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

GUIDE WIRE 2.8X300MM 292.68

Facility

$221.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$214.37

GUIDE WIRE 2.8X300MM 292.68

Facility

$221.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$214.37
Rate for Payer: AlohaCare Medicaid	$110.50
Rate for Payer: AlohaCare Medicare	$167.96
Rate for Payer: Cash Price	$132.60
Rate for Payer: Devoted Health Medicare	$185.64
Rate for Payer: Hawaii Medical Service Association Medicare	$167.96
Rate for Payer: Hawaii Western Management Group Commercial	$209.95
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Humana Medicare	$167.96
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: Kaiser Permanente Medicaid	$112.71
Rate for Payer: Kaiser Permanente Medicare	$167.96
Rate for Payer: MDX Hawaii PPO	$214.37
Rate for Payer: Ohana Health Plan Medicaid	$167.96
Rate for Payer: Ohana Health Plan Medicare	$167.96
Rate for Payer: UnitedHealthcare Medicare	$167.96
Rate for Payer: University Health Alliance Commercial	$161.09

GUIDE WIRE 2.8X300MM 900.726

Facility

$409.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$347.65
Max. Negotiated Rate	$396.73
Rate for Payer: Cash Price	$245.40
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Kaiser Permanente Commercial	$368.10
Rate for Payer: MDX Hawaii PPO	$396.73

GUIDE WIRE 2.8X300MM 900.726

Facility

$409.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$204.50
Max. Negotiated Rate	$396.73
Rate for Payer: AlohaCare Medicaid	$204.50
Rate for Payer: AlohaCare Medicare	$310.84
Rate for Payer: Cash Price	$245.40
Rate for Payer: Devoted Health Medicare	$343.56
Rate for Payer: Hawaii Medical Service Association Medicare	$310.84
Rate for Payer: Hawaii Western Management Group Commercial	$388.55
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Humana Medicare	$310.84
Rate for Payer: Kaiser Permanente Commercial	$368.10
Rate for Payer: Kaiser Permanente Medicaid	$208.59
Rate for Payer: Kaiser Permanente Medicare	$310.84
Rate for Payer: MDX Hawaii PPO	$396.73
Rate for Payer: Ohana Health Plan Medicaid	$310.84
Rate for Payer: Ohana Health Plan Medicare	$310.84
Rate for Payer: UnitedHealthcare Medicare	$310.84
Rate for Payer: University Health Alliance Commercial	$298.12

GUIDEWIRE 2.8X450 02.207.001

Facility

$404.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$202.00
Max. Negotiated Rate	$391.88
Rate for Payer: AlohaCare Medicaid	$202.00
Rate for Payer: AlohaCare Medicare	$307.04
Rate for Payer: Cash Price	$242.40
Rate for Payer: Devoted Health Medicare	$339.36
Rate for Payer: Hawaii Medical Service Association Medicare	$307.04
Rate for Payer: Hawaii Western Management Group Commercial	$383.80
Rate for Payer: Health Management Network Commercial	$343.40
Rate for Payer: Humana Medicare	$307.04
Rate for Payer: Kaiser Permanente Commercial	$363.60
Rate for Payer: Kaiser Permanente Medicaid	$206.04
Rate for Payer: Kaiser Permanente Medicare	$307.04
Rate for Payer: MDX Hawaii PPO	$391.88
Rate for Payer: Ohana Health Plan Medicaid	$307.04
Rate for Payer: Ohana Health Plan Medicare	$307.04
Rate for Payer: UnitedHealthcare Medicare	$307.04
Rate for Payer: University Health Alliance Commercial	$294.48

GUIDEWIRE 2.8X450 02.207.001

Facility

$404.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$343.40
Max. Negotiated Rate	$391.88
Rate for Payer: Cash Price	$242.40
Rate for Payer: Health Management Network Commercial	$343.40
Rate for Payer: Kaiser Permanente Commercial	$363.60
Rate for Payer: MDX Hawaii PPO	$391.88

GUIDE WIRE 2.8X450MM 292.81

Facility

$458.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$229.00
Max. Negotiated Rate	$444.26
Rate for Payer: AlohaCare Medicaid	$229.00
Rate for Payer: AlohaCare Medicare	$348.08
Rate for Payer: Cash Price	$274.80
Rate for Payer: Devoted Health Medicare	$384.72
Rate for Payer: Hawaii Medical Service Association Medicare	$348.08
Rate for Payer: Hawaii Western Management Group Commercial	$435.10
Rate for Payer: Health Management Network Commercial	$389.30
Rate for Payer: Humana Medicare	$348.08
Rate for Payer: Kaiser Permanente Commercial	$412.20
Rate for Payer: Kaiser Permanente Medicaid	$233.58
Rate for Payer: Kaiser Permanente Medicare	$348.08
Rate for Payer: MDX Hawaii PPO	$444.26
Rate for Payer: Ohana Health Plan Medicaid	$348.08
Rate for Payer: Ohana Health Plan Medicare	$348.08
Rate for Payer: UnitedHealthcare Medicare	$348.08
Rate for Payer: University Health Alliance Commercial	$333.84

GUIDE WIRE 2.8X450MM 292.81

Facility

$458.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$389.30
Max. Negotiated Rate	$444.26
Rate for Payer: Cash Price	$274.80
Rate for Payer: Health Management Network Commercial	$389.30
Rate for Payer: Kaiser Permanente Commercial	$412.20
Rate for Payer: MDX Hawaii PPO	$444.26

GUIDEWIRE 3.2X290MM 03.010.115

Facility

$427.00

Hospital Revenue Code	272
Min. Negotiated Rate	$362.95
Max. Negotiated Rate	$414.19
Rate for Payer: Cash Price	$256.20
Rate for Payer: Health Management Network Commercial	$362.95
Rate for Payer: Kaiser Permanente Commercial	$384.30
Rate for Payer: MDX Hawaii PPO	$414.19

GUIDEWIRE 3.2X290MM 03.010.115

Facility

$427.00

Hospital Revenue Code	272
Min. Negotiated Rate	$213.50
Max. Negotiated Rate	$414.19
Rate for Payer: AlohaCare Medicaid	$213.50
Rate for Payer: AlohaCare Medicare	$324.52
Rate for Payer: Cash Price	$256.20
Rate for Payer: Devoted Health Medicare	$358.68
Rate for Payer: Hawaii Medical Service Association Medicare	$324.52
Rate for Payer: Hawaii Western Management Group Commercial	$405.65
Rate for Payer: Health Management Network Commercial	$362.95
Rate for Payer: Humana Medicare	$324.52
Rate for Payer: Kaiser Permanente Commercial	$384.30
Rate for Payer: Kaiser Permanente Medicaid	$217.77
Rate for Payer: Kaiser Permanente Medicare	$324.52
Rate for Payer: MDX Hawaii PPO	$414.19
Rate for Payer: Ohana Health Plan Medicaid	$324.52
Rate for Payer: Ohana Health Plan Medicare	$324.52
Rate for Payer: UnitedHealthcare Medicare	$324.52
Rate for Payer: University Health Alliance Commercial	$311.24

GUIDE WIRE 3.2X30 ST 702462S

Facility

$567.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$549.99
Rate for Payer: AlohaCare Medicaid	$283.50
Rate for Payer: AlohaCare Medicare	$430.92
Rate for Payer: Cash Price	$340.20
Rate for Payer: Devoted Health Medicare	$476.28
Rate for Payer: Hawaii Medical Service Association Medicare	$430.92
Rate for Payer: Hawaii Western Management Group Commercial	$538.65
Rate for Payer: Health Management Network Commercial	$481.95
Rate for Payer: Humana Medicare	$430.92
Rate for Payer: Kaiser Permanente Commercial	$510.30
Rate for Payer: Kaiser Permanente Medicaid	$289.17
Rate for Payer: Kaiser Permanente Medicare	$430.92
Rate for Payer: MDX Hawaii PPO	$549.99
Rate for Payer: Ohana Health Plan Medicaid	$430.92
Rate for Payer: Ohana Health Plan Medicare	$430.92
Rate for Payer: UnitedHealthcare Medicare	$430.92
Rate for Payer: University Health Alliance Commercial	$413.29

GUIDE WIRE 3.2X30 ST 702462S

Facility

$567.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$481.95
Max. Negotiated Rate	$549.99
Rate for Payer: Cash Price	$340.20
Rate for Payer: Health Management Network Commercial	$481.95
Rate for Payer: Kaiser Permanente Commercial	$510.30
Rate for Payer: MDX Hawaii PPO	$549.99

GUIDE WIRE 3.2X400MM 357.399

Facility

$505.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$429.25
Max. Negotiated Rate	$489.85
Rate for Payer: Cash Price	$303.00
Rate for Payer: Health Management Network Commercial	$429.25
Rate for Payer: Kaiser Permanente Commercial	$454.50
Rate for Payer: MDX Hawaii PPO	$489.85

GUIDE WIRE 3.2X400MM 357.399

Facility

$505.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$252.50
Max. Negotiated Rate	$489.85
Rate for Payer: AlohaCare Medicaid	$252.50
Rate for Payer: AlohaCare Medicare	$383.80
Rate for Payer: Cash Price	$303.00
Rate for Payer: Devoted Health Medicare	$424.20
Rate for Payer: Hawaii Medical Service Association Medicare	$383.80
Rate for Payer: Hawaii Western Management Group Commercial	$479.75
Rate for Payer: Health Management Network Commercial	$429.25
Rate for Payer: Humana Medicare	$383.80
Rate for Payer: Kaiser Permanente Commercial	$454.50
Rate for Payer: Kaiser Permanente Medicaid	$257.55
Rate for Payer: Kaiser Permanente Medicare	$383.80
Rate for Payer: MDX Hawaii PPO	$489.85
Rate for Payer: Ohana Health Plan Medicaid	$383.80
Rate for Payer: Ohana Health Plan Medicare	$383.80
Rate for Payer: UnitedHealthcare Medicare	$383.80
Rate for Payer: University Health Alliance Commercial	$368.09

GUIDEWIRE AMPL 035X80CM

Facility

$147.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

GUIDEWIRE AMPL 035X80CM

Facility

$147.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$111.72
Rate for Payer: Cash Price	$88.20
Rate for Payer: Devoted Health Medicare	$123.48
Rate for Payer: Hawaii Medical Service Association Medicare	$111.72
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$111.72
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$111.72
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$111.72
Rate for Payer: Ohana Health Plan Medicare	$111.72
Rate for Payer: UnitedHealthcare Medicare	$111.72
Rate for Payer: University Health Alliance Commercial	$107.15

GUIDEWIRE AMPLATZ STR TIP .035

Facility

$127.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$63.50
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$96.52
Rate for Payer: Cash Price	$76.20
Rate for Payer: Devoted Health Medicare	$106.68
Rate for Payer: Hawaii Medical Service Association Medicare	$96.52
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$96.52
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$96.52
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$96.52
Rate for Payer: Ohana Health Plan Medicare	$96.52
Rate for Payer: UnitedHealthcare Medicare	$96.52
Rate for Payer: University Health Alliance Commercial	$92.57

GUIDEWIRE AMPLATZ STR TIP .035

Facility

$127.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

GUIDEWIRE ANG 035X450CM

Facility

$695.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$347.50
Max. Negotiated Rate	$674.15
Rate for Payer: AlohaCare Medicaid	$347.50
Rate for Payer: AlohaCare Medicare	$528.20
Rate for Payer: Cash Price	$417.00
Rate for Payer: Devoted Health Medicare	$583.80
Rate for Payer: Hawaii Medical Service Association Medicare	$528.20
Rate for Payer: Hawaii Western Management Group Commercial	$660.25
Rate for Payer: Health Management Network Commercial	$590.75
Rate for Payer: Humana Medicare	$528.20
Rate for Payer: Kaiser Permanente Commercial	$625.50
Rate for Payer: Kaiser Permanente Medicaid	$354.45
Rate for Payer: Kaiser Permanente Medicare	$528.20
Rate for Payer: MDX Hawaii PPO	$674.15
Rate for Payer: Ohana Health Plan Medicaid	$528.20
Rate for Payer: Ohana Health Plan Medicare	$528.20
Rate for Payer: UnitedHealthcare Medicare	$528.20
Rate for Payer: University Health Alliance Commercial	$506.59

GUIDEWIRE ANG 035X450CM

Facility

$695.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$590.75
Max. Negotiated Rate	$674.15
Rate for Payer: Cash Price	$417.00
Rate for Payer: Health Management Network Commercial	$590.75
Rate for Payer: Kaiser Permanente Commercial	$625.50
Rate for Payer: MDX Hawaii PPO	$674.15

GUIDEWIRE BENTSON 035X80CM

Facility

$117.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$113.49
Rate for Payer: AlohaCare Medicaid	$58.50
Rate for Payer: AlohaCare Medicare	$88.92
Rate for Payer: Cash Price	$70.20
Rate for Payer: Devoted Health Medicare	$98.28
Rate for Payer: Hawaii Medical Service Association Medicare	$88.92
Rate for Payer: Hawaii Western Management Group Commercial	$111.15
Rate for Payer: Health Management Network Commercial	$99.45
Rate for Payer: Humana Medicare	$88.92
Rate for Payer: Kaiser Permanente Commercial	$105.30
Rate for Payer: Kaiser Permanente Medicaid	$59.67
Rate for Payer: Kaiser Permanente Medicare	$88.92
Rate for Payer: MDX Hawaii PPO	$113.49
Rate for Payer: Ohana Health Plan Medicaid	$88.92
Rate for Payer: Ohana Health Plan Medicare	$88.92
Rate for Payer: UnitedHealthcare Medicare	$88.92
Rate for Payer: University Health Alliance Commercial	$85.28

GUIDEWIRE BENTSON 035X80CM

Facility

$117.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$113.49
Rate for Payer: Cash Price	$70.20
Rate for Payer: Health Management Network Commercial	$99.45
Rate for Payer: Kaiser Permanente Commercial	$105.30
Rate for Payer: MDX Hawaii PPO	$113.49

GUIDEWIRE BILIARY STR

Facility

$659.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$560.15
Max. Negotiated Rate	$639.23
Rate for Payer: Cash Price	$395.40
Rate for Payer: Health Management Network Commercial	$560.15
Rate for Payer: Kaiser Permanente Commercial	$593.10
Rate for Payer: MDX Hawaii PPO	$639.23

GUIDEWIRE BILIARY STR

Facility

$659.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$329.50
Max. Negotiated Rate	$639.23
Rate for Payer: AlohaCare Medicaid	$329.50
Rate for Payer: AlohaCare Medicare	$500.84
Rate for Payer: Cash Price	$395.40
Rate for Payer: Devoted Health Medicare	$553.56
Rate for Payer: Hawaii Medical Service Association Medicare	$500.84
Rate for Payer: Hawaii Western Management Group Commercial	$626.05
Rate for Payer: Health Management Network Commercial	$560.15
Rate for Payer: Humana Medicare	$500.84
Rate for Payer: Kaiser Permanente Commercial	$593.10
Rate for Payer: Kaiser Permanente Medicaid	$336.09
Rate for Payer: Kaiser Permanente Medicare	$500.84
Rate for Payer: MDX Hawaii PPO	$639.23
Rate for Payer: Ohana Health Plan Medicaid	$500.84
Rate for Payer: Ohana Health Plan Medicare	$500.84
Rate for Payer: UnitedHealthcare Medicare	$500.84
Rate for Payer: University Health Alliance Commercial	$480.35

GUIDEWIRE L150MM 03.333.002

Facility

$377.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$188.50
Max. Negotiated Rate	$365.69
Rate for Payer: AlohaCare Medicaid	$188.50
Rate for Payer: AlohaCare Medicare	$286.52
Rate for Payer: Cash Price	$226.20
Rate for Payer: Devoted Health Medicare	$316.68
Rate for Payer: Hawaii Medical Service Association Medicare	$286.52
Rate for Payer: Hawaii Western Management Group Commercial	$358.15
Rate for Payer: Health Management Network Commercial	$320.45
Rate for Payer: Humana Medicare	$286.52
Rate for Payer: Kaiser Permanente Commercial	$339.30
Rate for Payer: Kaiser Permanente Medicaid	$192.27
Rate for Payer: Kaiser Permanente Medicare	$286.52
Rate for Payer: MDX Hawaii PPO	$365.69
Rate for Payer: Ohana Health Plan Medicaid	$286.52
Rate for Payer: Ohana Health Plan Medicare	$286.52
Rate for Payer: UnitedHealthcare Medicare	$286.52
Rate for Payer: University Health Alliance Commercial	$274.80

Know your out-of-pocket cost for care.

All Charges