Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

ANCHR FOOTPRINT 4.5MM 72202901

Facility

$1,384.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$692.00
Max. Negotiated Rate	$1,342.48
Rate for Payer: AlohaCare Medicaid	$692.00
Rate for Payer: AlohaCare Medicare	$1,051.84
Rate for Payer: Cash Price	$830.40
Rate for Payer: Devoted Health Medicare	$1,162.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,051.84
Rate for Payer: Hawaii Western Management Group Commercial	$968.80
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Humana Medicare	$1,051.84
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: Kaiser Permanente Medicaid	$705.84
Rate for Payer: Kaiser Permanente Medicare	$1,051.84
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: Ohana Health Plan Medicaid	$1,051.84
Rate for Payer: Ohana Health Plan Medicare	$1,051.84
Rate for Payer: UnitedHealthcare Medicare	$1,051.84
Rate for Payer: University Health Alliance Commercial	$775.04

ANGINA PECTORIS

Facility

$12,704.27

Service Code	MSDRG 311
Min. Negotiated Rate	$12,704.27
Max. Negotiated Rate	$12,704.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12,704.27

ANGIOSEAL 6FR

Facility

$1,575.00

Service Code	HCPCS C1760
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,527.75
Rate for Payer: AlohaCare Medicaid	$787.50
Rate for Payer: AlohaCare Medicare	$1,197.00
Rate for Payer: Cash Price	$945.00
Rate for Payer: Devoted Health Medicare	$1,323.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,197.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Humana Medicare	$1,197.00
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$803.25
Rate for Payer: Kaiser Permanente Medicare	$1,197.00
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: Ohana Health Plan Medicaid	$1,197.00
Rate for Payer: Ohana Health Plan Medicare	$1,197.00
Rate for Payer: UnitedHealthcare Medicare	$1,197.00
Rate for Payer: University Health Alliance Commercial	$882.00

ANGIOSEAL 6FR

Facility

$1,575.00

Service Code	HCPCS C1760
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: University Health Alliance Commercial	$882.00

ANGULAR TL ASSM 100MM 51-10460

Facility

$2,565.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,180.25
Max. Negotiated Rate	$2,488.05
Rate for Payer: Cash Price	$1,539.00
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Kaiser Permanente Commercial	$2,308.50
Rate for Payer: MDX Hawaii PPO	$2,488.05

ANGULAR TL ASSM 100MM 51-10460

Facility

$2,565.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,282.50
Max. Negotiated Rate	$2,488.05
Rate for Payer: AlohaCare Medicaid	$1,282.50
Rate for Payer: AlohaCare Medicare	$1,949.40
Rate for Payer: Cash Price	$1,539.00
Rate for Payer: Devoted Health Medicare	$2,154.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,949.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,436.75
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Humana Medicare	$1,949.40
Rate for Payer: Kaiser Permanente Commercial	$2,308.50
Rate for Payer: Kaiser Permanente Medicaid	$1,308.15
Rate for Payer: Kaiser Permanente Medicare	$1,949.40
Rate for Payer: MDX Hawaii PPO	$2,488.05
Rate for Payer: Ohana Health Plan Medicaid	$1,949.40
Rate for Payer: Ohana Health Plan Medicare	$1,949.40
Rate for Payer: UnitedHealthcare Medicare	$1,949.40
Rate for Payer: University Health Alliance Commercial	$1,869.63

ANKLE CRYO CUFF 10A01

Facility

$181.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.85
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$108.60
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Kaiser Permanente Commercial	$162.90
Rate for Payer: MDX Hawaii PPO	$175.57

ANKLE CRYO CUFF 10A01

Facility

$181.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.50
Max. Negotiated Rate	$175.57
Rate for Payer: AlohaCare Medicaid	$90.50
Rate for Payer: AlohaCare Medicare	$137.56
Rate for Payer: Cash Price	$108.60
Rate for Payer: Devoted Health Medicare	$152.04
Rate for Payer: Hawaii Medical Service Association Medicare	$137.56
Rate for Payer: Hawaii Western Management Group Commercial	$171.95
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Humana Medicare	$137.56
Rate for Payer: Kaiser Permanente Commercial	$162.90
Rate for Payer: Kaiser Permanente Medicaid	$92.31
Rate for Payer: Kaiser Permanente Medicare	$137.56
Rate for Payer: MDX Hawaii PPO	$175.57
Rate for Payer: Ohana Health Plan Medicaid	$137.56
Rate for Payer: Ohana Health Plan Medicare	$137.56
Rate for Payer: UnitedHealthcare Medicare	$137.56
Rate for Payer: University Health Alliance Commercial	$131.93

ANKLE FIXATION SYS WASHER AFSW

Facility

$394.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$220.64
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Hawaii Western Management Group Commercial	$275.80
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: University Health Alliance Commercial	$220.64

ANKLE FIXATION SYS WASHER AFSW

Facility

$394.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$197.00
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$197.00
Rate for Payer: AlohaCare Medicare	$299.44
Rate for Payer: Cash Price	$236.40
Rate for Payer: Devoted Health Medicare	$330.96
Rate for Payer: Hawaii Medical Service Association Medicare	$299.44
Rate for Payer: Hawaii Western Management Group Commercial	$275.80
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$299.44
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$299.44
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$299.44
Rate for Payer: Ohana Health Plan Medicare	$299.44
Rate for Payer: UnitedHealthcare Medicare	$299.44
Rate for Payer: University Health Alliance Commercial	$220.64

ANKLE HOOK PLATE 6H HOOK-6

Facility

$2,130.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.00
Max. Negotiated Rate	$2,066.10
Rate for Payer: AlohaCare Medicaid	$1,065.00
Rate for Payer: AlohaCare Medicare	$1,618.80
Rate for Payer: Cash Price	$1,278.00
Rate for Payer: Devoted Health Medicare	$1,789.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,618.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,491.00
Rate for Payer: Health Management Network Commercial	$1,810.50
Rate for Payer: Humana Medicare	$1,618.80
Rate for Payer: Kaiser Permanente Commercial	$1,917.00
Rate for Payer: Kaiser Permanente Medicaid	$1,086.30
Rate for Payer: Kaiser Permanente Medicare	$1,618.80
Rate for Payer: MDX Hawaii PPO	$2,066.10
Rate for Payer: Ohana Health Plan Medicaid	$1,618.80
Rate for Payer: Ohana Health Plan Medicare	$1,618.80
Rate for Payer: UnitedHealthcare Medicare	$1,618.80
Rate for Payer: University Health Alliance Commercial	$1,192.80

ANKLE HOOK PLATE 6H HOOK-6

Facility

$2,130.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.80
Max. Negotiated Rate	$2,066.10
Rate for Payer: Cash Price	$1,278.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,491.00
Rate for Payer: Health Management Network Commercial	$1,810.50
Rate for Payer: Kaiser Permanente Commercial	$1,917.00
Rate for Payer: MDX Hawaii PPO	$2,066.10
Rate for Payer: University Health Alliance Commercial	$1,192.80

ANKLE HOOK PLATE HOOK-4

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: AlohaCare Medicaid	$1,000.00
Rate for Payer: AlohaCare Medicare	$1,520.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Devoted Health Medicare	$1,680.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Humana Medicare	$1,520.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: Kaiser Permanente Medicaid	$1,020.00
Rate for Payer: Kaiser Permanente Medicare	$1,520.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: Ohana Health Plan Medicaid	$1,520.00
Rate for Payer: Ohana Health Plan Medicare	$1,520.00
Rate for Payer: UnitedHealthcare Medicare	$1,520.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

ANKLE HOOK PLATE HOOK-4

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

ANKLE RECONS KIT AR-1675BC-CP

Facility

$3,500.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: AlohaCare Medicaid	$1,750.00
Rate for Payer: AlohaCare Medicare	$2,660.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Devoted Health Medicare	$2,940.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,660.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Humana Medicare	$2,660.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$1,785.00
Rate for Payer: Kaiser Permanente Medicare	$2,660.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: Ohana Health Plan Medicaid	$2,660.00
Rate for Payer: Ohana Health Plan Medicare	$2,660.00
Rate for Payer: UnitedHealthcare Medicare	$2,660.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

ANKLE RECONS KIT AR-1675BC-CP

Facility

$3,500.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

ANTIBIOTIC BIOENVELOPE LRG

Facility

$2,985.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,895.45
Rate for Payer: AlohaCare Medicaid	$1,492.50
Rate for Payer: AlohaCare Medicare	$2,268.60
Rate for Payer: Cash Price	$1,791.00
Rate for Payer: Devoted Health Medicare	$2,507.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,268.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Humana Medicare	$2,268.60
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: Kaiser Permanente Medicaid	$1,522.35
Rate for Payer: Kaiser Permanente Medicare	$2,268.60
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: Ohana Health Plan Medicaid	$2,268.60
Rate for Payer: Ohana Health Plan Medicare	$2,268.60
Rate for Payer: UnitedHealthcare Medicare	$2,268.60
Rate for Payer: University Health Alliance Commercial	$1,671.60

ANTIBIOTIC BIOENVELOPE LRG

Facility

$2,985.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.60
Max. Negotiated Rate	$2,895.45
Rate for Payer: Cash Price	$1,791.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: University Health Alliance Commercial	$1,671.60

ANTIBIOTIC BIOENVELOPE MED

Facility

$2,985.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,895.45
Rate for Payer: AlohaCare Medicaid	$1,492.50
Rate for Payer: AlohaCare Medicare	$2,268.60
Rate for Payer: Cash Price	$1,791.00
Rate for Payer: Devoted Health Medicare	$2,507.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,268.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Humana Medicare	$2,268.60
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: Kaiser Permanente Medicaid	$1,522.35
Rate for Payer: Kaiser Permanente Medicare	$2,268.60
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: Ohana Health Plan Medicaid	$2,268.60
Rate for Payer: Ohana Health Plan Medicare	$2,268.60
Rate for Payer: UnitedHealthcare Medicare	$2,268.60
Rate for Payer: University Health Alliance Commercial	$1,671.60

ANTIBIOTIC BIOENVELOPE MED

Facility

$2,985.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.60
Max. Negotiated Rate	$2,895.45
Rate for Payer: Cash Price	$1,791.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: University Health Alliance Commercial	$1,671.60

ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 3,000 (+/-) UNIT IV SOLUTION [82525]

Facility

$7,259.00

Service Code	HCPCS J7192
Hospital Revenue Code	636
Min. Negotiated Rate	$6,170.15
Max. Negotiated Rate	$7,041.23
Rate for Payer: Cash Price	$4,355.40
Rate for Payer: Health Management Network Commercial	$6,170.15
Rate for Payer: Kaiser Permanente Commercial	$6,533.10
Rate for Payer: MDX Hawaii PPO	$7,041.23

ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 3,000 (+/-) UNIT IV SOLUTION [82525]

Facility

$7,259.00

Service Code	HCPCS J7192
Hospital Revenue Code	636
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$7,041.23
Rate for Payer: AlohaCare Medicaid	$3,629.50
Rate for Payer: AlohaCare Medicare	$5,516.84
Rate for Payer: Cash Price	$4,355.40
Rate for Payer: Cash Price	$4,355.40
Rate for Payer: Devoted Health Medicare	$6,097.56
Rate for Payer: Hawaii Medical Service Association Commercial	$1.96
Rate for Payer: Hawaii Medical Service Association Medicare	$5,516.84
Rate for Payer: Hawaii Western Management Group Commercial	$6,896.05
Rate for Payer: Health Management Network Commercial	$6,170.15
Rate for Payer: Humana Medicare	$5,516.84
Rate for Payer: Kaiser Permanente Commercial	$6,533.10
Rate for Payer: Kaiser Permanente Medicaid	$3,702.09
Rate for Payer: Kaiser Permanente Medicare	$5,516.84
Rate for Payer: MDX Hawaii PPO	$7,041.23
Rate for Payer: Ohana Health Plan Medicaid	$5,516.84
Rate for Payer: Ohana Health Plan Medicare	$5,516.84
Rate for Payer: UnitedHealthcare Medicaid	$4,355.40
Rate for Payer: UnitedHealthcare Medicare	$5,516.84
Rate for Payer: University Health Alliance Commercial	$5,291.09

ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 4,000 (+/-) UNIT IV SOLUTION [117087]

Facility

$9,943.00

Service Code	HCPCS J7192
Hospital Revenue Code	636
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$9,644.71
Rate for Payer: AlohaCare Medicaid	$4,971.50
Rate for Payer: AlohaCare Medicare	$7,556.68
Rate for Payer: Cash Price	$5,965.80
Rate for Payer: Cash Price	$5,965.80
Rate for Payer: Devoted Health Medicare	$8,352.12
Rate for Payer: Hawaii Medical Service Association Commercial	$1.96
Rate for Payer: Hawaii Medical Service Association Medicare	$7,556.68
Rate for Payer: Hawaii Western Management Group Commercial	$9,445.85
Rate for Payer: Health Management Network Commercial	$8,451.55
Rate for Payer: Humana Medicare	$7,556.68
Rate for Payer: Kaiser Permanente Commercial	$8,948.70
Rate for Payer: Kaiser Permanente Medicaid	$5,070.93
Rate for Payer: Kaiser Permanente Medicare	$7,556.68
Rate for Payer: MDX Hawaii PPO	$9,644.71
Rate for Payer: Ohana Health Plan Medicaid	$7,556.68
Rate for Payer: Ohana Health Plan Medicare	$7,556.68
Rate for Payer: UnitedHealthcare Medicaid	$5,965.80
Rate for Payer: UnitedHealthcare Medicare	$7,556.68
Rate for Payer: University Health Alliance Commercial	$7,247.45

ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 4,000 (+/-) UNIT IV SOLUTION [117087]

Facility

$9,943.00

Service Code	HCPCS J7192
Hospital Revenue Code	636
Min. Negotiated Rate	$8,451.55
Max. Negotiated Rate	$9,644.71
Rate for Payer: Cash Price	$5,965.80
Rate for Payer: Health Management Network Commercial	$8,451.55
Rate for Payer: Kaiser Permanente Commercial	$8,948.70
Rate for Payer: MDX Hawaii PPO	$9,644.71

AO DRIVER SHAFT

Facility

$578.00

Hospital Revenue Code	272
Min. Negotiated Rate	$491.30
Max. Negotiated Rate	$560.66
Rate for Payer: Cash Price	$346.80
Rate for Payer: Health Management Network Commercial	$491.30
Rate for Payer: Kaiser Permanente Commercial	$520.20
Rate for Payer: MDX Hawaii PPO	$560.66

Know your out-of-pocket cost for care.

All Charges