Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

GUIDEWIRE L150MM 03.333.002

Facility

$377.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$320.45
Max. Negotiated Rate	$365.69
Rate for Payer: Cash Price	$226.20
Rate for Payer: Health Management Network Commercial	$320.45
Rate for Payer: Kaiser Permanente Commercial	$339.30
Rate for Payer: MDX Hawaii PPO	$365.69

GUIDEWIRE LONG .062X6

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

GUIDEWIRE LONG .062X6

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 SMOOTH 1806-0093S

Facility

$709.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$602.65
Max. Negotiated Rate	$687.73
Rate for Payer: Cash Price	$425.40
Rate for Payer: Health Management Network Commercial	$602.65
Rate for Payer: Kaiser Permanente Commercial	$638.10
Rate for Payer: MDX Hawaii PPO	$687.73

GUIDEWIRE SMOOTH 1806-0093S

Facility

$709.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$354.50
Max. Negotiated Rate	$687.73
Rate for Payer: AlohaCare Medicaid	$354.50
Rate for Payer: AlohaCare Medicare	$538.84
Rate for Payer: Cash Price	$425.40
Rate for Payer: Devoted Health Medicare	$595.56
Rate for Payer: Hawaii Medical Service Association Medicare	$538.84
Rate for Payer: Hawaii Western Management Group Commercial	$673.55
Rate for Payer: Health Management Network Commercial	$602.65
Rate for Payer: Humana Medicare	$538.84
Rate for Payer: Kaiser Permanente Commercial	$638.10
Rate for Payer: Kaiser Permanente Medicaid	$361.59
Rate for Payer: Kaiser Permanente Medicare	$538.84
Rate for Payer: MDX Hawaii PPO	$687.73
Rate for Payer: Ohana Health Plan Medicaid	$538.84
Rate for Payer: Ohana Health Plan Medicare	$538.84
Rate for Payer: UnitedHealthcare Medicare	$538.84
Rate for Payer: University Health Alliance Commercial	$516.79

GUIDEWIRE SPRING ARROW .25

Facility

$73.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$36.50
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$36.50
Rate for Payer: AlohaCare Medicare	$55.48
Rate for Payer: Cash Price	$43.80
Rate for Payer: Devoted Health Medicare	$61.32
Rate for Payer: Hawaii Medical Service Association Medicare	$55.48
Rate for Payer: Hawaii Western Management Group Commercial	$69.35
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$55.48
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$55.48
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$55.48
Rate for Payer: Ohana Health Plan Medicare	$55.48
Rate for Payer: UnitedHealthcare Medicare	$55.48
Rate for Payer: University Health Alliance Commercial	$53.21

GUIDEWIRE SPRING ARROW .25

Facility

$73.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: MDX Hawaii PPO	$70.81

GUIDEWIRE STANDARD

Facility

$694.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$589.90
Max. Negotiated Rate	$673.18
Rate for Payer: Cash Price	$416.40
Rate for Payer: Health Management Network Commercial	$589.90
Rate for Payer: Kaiser Permanente Commercial	$624.60
Rate for Payer: MDX Hawaii PPO	$673.18

GUIDEWIRE STANDARD

Facility

$694.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$347.00
Max. Negotiated Rate	$673.18
Rate for Payer: AlohaCare Medicaid	$347.00
Rate for Payer: AlohaCare Medicare	$527.44
Rate for Payer: Cash Price	$416.40
Rate for Payer: Devoted Health Medicare	$582.96
Rate for Payer: Hawaii Medical Service Association Medicare	$527.44
Rate for Payer: Hawaii Western Management Group Commercial	$659.30
Rate for Payer: Health Management Network Commercial	$589.90
Rate for Payer: Humana Medicare	$527.44
Rate for Payer: Kaiser Permanente Commercial	$624.60
Rate for Payer: Kaiser Permanente Medicaid	$353.94
Rate for Payer: Kaiser Permanente Medicare	$527.44
Rate for Payer: MDX Hawaii PPO	$673.18
Rate for Payer: Ohana Health Plan Medicaid	$527.44
Rate for Payer: Ohana Health Plan Medicare	$527.44
Rate for Payer: UnitedHealthcare Medicare	$527.44
Rate for Payer: University Health Alliance Commercial	$505.86

GUIDEWIRE STR 035X450CM

Facility

$432.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$419.04
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: MDX Hawaii PPO	$419.04

GUIDEWIRE STR 035X450CM

Facility

$432.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$216.00
Max. Negotiated Rate	$419.04
Rate for Payer: AlohaCare Medicaid	$216.00
Rate for Payer: AlohaCare Medicare	$328.32
Rate for Payer: Cash Price	$259.20
Rate for Payer: Devoted Health Medicare	$362.88
Rate for Payer: Hawaii Medical Service Association Medicare	$328.32
Rate for Payer: Hawaii Western Management Group Commercial	$410.40
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Humana Medicare	$328.32
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: Kaiser Permanente Medicaid	$220.32
Rate for Payer: Kaiser Permanente Medicare	$328.32
Rate for Payer: MDX Hawaii PPO	$419.04
Rate for Payer: Ohana Health Plan Medicaid	$328.32
Rate for Payer: Ohana Health Plan Medicare	$328.32
Rate for Payer: UnitedHealthcare Medicare	$328.32
Rate for Payer: University Health Alliance Commercial	$314.88

GUIDEWIRE ST TIP 035X260

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 ST TIP 035X260

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 THR 3.2/300MM 702462

Facility

$223.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$189.55
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$133.80
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: MDX Hawaii PPO	$216.31

GUIDEWIRE THR 3.2/300MM 702462

Facility

$223.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$111.50
Max. Negotiated Rate	$216.31
Rate for Payer: AlohaCare Medicaid	$111.50
Rate for Payer: AlohaCare Medicare	$169.48
Rate for Payer: Cash Price	$133.80
Rate for Payer: Devoted Health Medicare	$187.32
Rate for Payer: Hawaii Medical Service Association Medicare	$169.48
Rate for Payer: Hawaii Western Management Group Commercial	$211.85
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Humana Medicare	$169.48
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: Kaiser Permanente Medicare	$169.48
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: Ohana Health Plan Medicaid	$169.48
Rate for Payer: Ohana Health Plan Medicare	$169.48
Rate for Payer: UnitedHealthcare Medicare	$169.48
Rate for Payer: University Health Alliance Commercial	$162.54

GUIDEWIRE W/TROCAR AR-8945K

Facility

$72.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$54.72
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$60.48
Rate for Payer: Hawaii Medical Service Association Medicare	$54.72
Rate for Payer: Hawaii Western Management Group Commercial	$68.40
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$54.72
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$54.72
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$54.72
Rate for Payer: Ohana Health Plan Medicare	$54.72
Rate for Payer: UnitedHealthcare Medicare	$54.72
Rate for Payer: University Health Alliance Commercial	$52.48

GUIDEWIRE W/TROCAR AR-8945K

Facility

$72.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

GUIDEWIRE W/TROCAR TIP .078X8"

Facility

$210.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$203.70
Rate for Payer: Cash Price	$126.00
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Kaiser Permanente Commercial	$189.00
Rate for Payer: MDX Hawaii PPO	$203.70

GUIDEWIRE W/TROCAR TIP .078X8"

Facility

$210.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$203.70
Rate for Payer: AlohaCare Medicaid	$105.00
Rate for Payer: AlohaCare Medicare	$159.60
Rate for Payer: Cash Price	$126.00
Rate for Payer: Devoted Health Medicare	$176.40
Rate for Payer: Hawaii Medical Service Association Medicare	$159.60
Rate for Payer: Hawaii Western Management Group Commercial	$199.50
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Humana Medicare	$159.60
Rate for Payer: Kaiser Permanente Commercial	$189.00
Rate for Payer: Kaiser Permanente Medicaid	$107.10
Rate for Payer: Kaiser Permanente Medicare	$159.60
Rate for Payer: MDX Hawaii PPO	$203.70
Rate for Payer: Ohana Health Plan Medicaid	$159.60
Rate for Payer: Ohana Health Plan Medicare	$159.60
Rate for Payer: UnitedHealthcare Medicare	$159.60
Rate for Payer: University Health Alliance Commercial	$153.07

GUIDING CATH W/ SD HLS 7FR XB3

Facility

$230.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$138.00
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

GUIDING CATH W/ SD HLS 7FR XB3

Facility

$230.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
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	$218.50
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	$167.65

GUIDING CATH W/ SD HLS 7FR XB4

Facility

$230.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
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	$218.50
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	$167.65

GUIDING CATH W/ SD HLS 7FR XB4

Facility

$230.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$138.00
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

G-WIRE 2.5MM DRILL TIP 310.243

Facility

$312.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$302.64
Rate for Payer: Cash Price	$187.20
Rate for Payer: Health Management Network Commercial	$265.20
Rate for Payer: Kaiser Permanente Commercial	$280.80
Rate for Payer: MDX Hawaii PPO	$302.64

G-WIRE 2.5MM DRILL TIP 310.243

Facility

$312.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$302.64
Rate for Payer: AlohaCare Medicaid	$156.00
Rate for Payer: AlohaCare Medicare	$237.12
Rate for Payer: Cash Price	$187.20
Rate for Payer: Devoted Health Medicare	$262.08
Rate for Payer: Hawaii Medical Service Association Medicare	$237.12
Rate for Payer: Hawaii Western Management Group Commercial	$296.40
Rate for Payer: Health Management Network Commercial	$265.20
Rate for Payer: Humana Medicare	$237.12
Rate for Payer: Kaiser Permanente Commercial	$280.80
Rate for Payer: Kaiser Permanente Medicaid	$159.12
Rate for Payer: Kaiser Permanente Medicare	$237.12
Rate for Payer: MDX Hawaii PPO	$302.64
Rate for Payer: Ohana Health Plan Medicaid	$237.12
Rate for Payer: Ohana Health Plan Medicare	$237.12
Rate for Payer: UnitedHealthcare Medicare	$237.12
Rate for Payer: University Health Alliance Commercial	$227.42

Know your out-of-pocket cost for care.

All Charges