Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

AAA ILIAC 12MMX10CM CEB231210A

Facility

$24,810.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$13,893.60
Max. Negotiated Rate	$24,065.70
Rate for Payer: Cash Price	$14,886.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,367.00
Rate for Payer: Health Management Network Commercial	$21,088.50
Rate for Payer: Kaiser Permanente Commercial	$22,329.00
Rate for Payer: MDX Hawaii PPO	$24,065.70
Rate for Payer: University Health Alliance Commercial	$13,893.60

AAA ILIAC 12MMX10CM CEB231210A

Facility

$24,810.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$12,405.00
Max. Negotiated Rate	$24,065.70
Rate for Payer: AlohaCare Medicaid	$12,405.00
Rate for Payer: AlohaCare Medicare	$18,855.60
Rate for Payer: Cash Price	$14,886.00
Rate for Payer: Devoted Health Medicare	$20,840.40
Rate for Payer: Hawaii Medical Service Association Medicare	$18,855.60
Rate for Payer: Hawaii Western Management Group Commercial	$17,367.00
Rate for Payer: Health Management Network Commercial	$21,088.50
Rate for Payer: Humana Medicare	$18,855.60
Rate for Payer: Kaiser Permanente Commercial	$22,329.00
Rate for Payer: Kaiser Permanente Medicaid	$12,653.10
Rate for Payer: Kaiser Permanente Medicare	$18,855.60
Rate for Payer: MDX Hawaii PPO	$24,065.70
Rate for Payer: Ohana Health Plan Medicaid	$18,855.60
Rate for Payer: Ohana Health Plan Medicare	$18,855.60
Rate for Payer: UnitedHealthcare Medicare	$18,855.60
Rate for Payer: University Health Alliance Commercial	$13,893.60

AAA ILIAC 12MMX7CM HGB161207A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$10,750.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: AlohaCare Medicaid	$10,750.00
Rate for Payer: AlohaCare Medicare	$16,340.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Devoted Health Medicare	$18,060.00
Rate for Payer: Hawaii Medical Service Association Medicare	$16,340.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Humana Medicare	$16,340.00
Rate for Payer: Kaiser Permanente Commercial	$19,350.00
Rate for Payer: Kaiser Permanente Medicaid	$10,965.00
Rate for Payer: Kaiser Permanente Medicare	$16,340.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: Ohana Health Plan Medicaid	$16,340.00
Rate for Payer: Ohana Health Plan Medicare	$16,340.00
Rate for Payer: UnitedHealthcare Medicare	$16,340.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 12MMX7CM HGB161207A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$12,040.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Kaiser Permanente Commercial	$19,350.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 14.5X10CM CEB231410A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$10,750.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: AlohaCare Medicaid	$10,750.00
Rate for Payer: AlohaCare Medicare	$16,340.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Devoted Health Medicare	$18,060.00
Rate for Payer: Hawaii Medical Service Association Medicare	$16,340.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Humana Medicare	$16,340.00
Rate for Payer: Kaiser Permanente Commercial	$19,350.00
Rate for Payer: Kaiser Permanente Medicaid	$10,965.00
Rate for Payer: Kaiser Permanente Medicare	$16,340.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: Ohana Health Plan Medicaid	$16,340.00
Rate for Payer: Ohana Health Plan Medicare	$16,340.00
Rate for Payer: UnitedHealthcare Medicare	$16,340.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 14.5X10CM CEB231410A

Facility

$21,500.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$12,040.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Kaiser Permanente Commercial	$19,350.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 14.5X7CM HGB161407A

Facility

$21,500.00

Hospital Revenue Code	278
Min. Negotiated Rate	$12,040.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Kaiser Permanente Commercial	$19,350.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

AAA ILIAC 14.5X7CM HGB161407A

Facility

$21,500.00

Hospital Revenue Code	278
Min. Negotiated Rate	$10,750.00
Max. Negotiated Rate	$20,855.00
Rate for Payer: AlohaCare Medicaid	$10,750.00
Rate for Payer: AlohaCare Medicare	$16,340.00
Rate for Payer: Cash Price	$12,900.00
Rate for Payer: Devoted Health Medicare	$18,060.00
Rate for Payer: Hawaii Medical Service Association Medicare	$16,340.00
Rate for Payer: Hawaii Western Management Group Commercial	$15,050.00
Rate for Payer: Health Management Network Commercial	$18,275.00
Rate for Payer: Humana Medicare	$16,340.00
Rate for Payer: Kaiser Permanente Commercial	$19,350.00
Rate for Payer: Kaiser Permanente Medicaid	$10,965.00
Rate for Payer: Kaiser Permanente Medicare	$16,340.00
Rate for Payer: MDX Hawaii PPO	$20,855.00
Rate for Payer: Ohana Health Plan Medicaid	$16,340.00
Rate for Payer: Ohana Health Plan Medicare	$16,340.00
Rate for Payer: UnitedHealthcare Medicare	$16,340.00
Rate for Payer: University Health Alliance Commercial	$12,040.00

ABLATOR APOLLO ASP 90° AR-9821

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$606.05
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Kaiser Permanente Commercial	$641.70
Rate for Payer: MDX Hawaii PPO	$691.61

ABLATOR APOLLO ASP 90° AR-9821

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$356.50
Max. Negotiated Rate	$691.61
Rate for Payer: AlohaCare Medicaid	$356.50
Rate for Payer: AlohaCare Medicare	$541.88
Rate for Payer: Cash Price	$427.80
Rate for Payer: Devoted Health Medicare	$598.92
Rate for Payer: Hawaii Medical Service Association Medicare	$541.88
Rate for Payer: Hawaii Western Management Group Commercial	$677.35
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Humana Medicare	$541.88
Rate for Payer: Kaiser Permanente Commercial	$641.70
Rate for Payer: Kaiser Permanente Medicaid	$363.63
Rate for Payer: Kaiser Permanente Medicare	$541.88
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: Ohana Health Plan Medicaid	$541.88
Rate for Payer: Ohana Health Plan Medicare	$541.88
Rate for Payer: UnitedHealthcare Medicare	$541.88
Rate for Payer: University Health Alliance Commercial	$519.71

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$10,760.71

Service Code	MSDRG 770
Min. Negotiated Rate	$10,760.71
Max. Negotiated Rate	$10,760.71
Rate for Payer: Hawaii Medical Service Association Commercial	$10,760.71

ABORTION WITHOUT D&C

Facility

$7,347.62

Service Code	MSDRG 779
Min. Negotiated Rate	$7,347.62
Max. Negotiated Rate	$7,347.62
Rate for Payer: Hawaii Medical Service Association Commercial	$7,347.62

ABSORBATACK FIX HERNIA REP 5MM

Facility

$1,724.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$862.00
Max. Negotiated Rate	$1,672.28
Rate for Payer: AlohaCare Medicaid	$862.00
Rate for Payer: AlohaCare Medicare	$1,310.24
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Devoted Health Medicare	$1,448.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,310.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,206.80
Rate for Payer: Health Management Network Commercial	$1,465.40
Rate for Payer: Humana Medicare	$1,310.24
Rate for Payer: Kaiser Permanente Commercial	$1,551.60
Rate for Payer: Kaiser Permanente Medicaid	$879.24
Rate for Payer: Kaiser Permanente Medicare	$1,310.24
Rate for Payer: MDX Hawaii PPO	$1,672.28
Rate for Payer: Ohana Health Plan Medicaid	$1,310.24
Rate for Payer: Ohana Health Plan Medicare	$1,310.24
Rate for Payer: UnitedHealthcare Medicare	$1,310.24
Rate for Payer: University Health Alliance Commercial	$965.44

ABSORBATACK FIX HERNIA REP 5MM

Facility

$1,724.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$965.44
Max. Negotiated Rate	$1,672.28
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,206.80
Rate for Payer: Health Management Network Commercial	$1,465.40
Rate for Payer: Kaiser Permanente Commercial	$1,551.60
Rate for Payer: MDX Hawaii PPO	$1,672.28
Rate for Payer: University Health Alliance Commercial	$965.44

ABS TIGHTROPE II AR-1588TN-20

Facility

$998.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$499.00
Max. Negotiated Rate	$968.06
Rate for Payer: AlohaCare Medicaid	$499.00
Rate for Payer: AlohaCare Medicare	$758.48
Rate for Payer: Cash Price	$598.80
Rate for Payer: Devoted Health Medicare	$838.32
Rate for Payer: Hawaii Medical Service Association Medicare	$758.48
Rate for Payer: Hawaii Western Management Group Commercial	$698.60
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: Humana Medicare	$758.48
Rate for Payer: Kaiser Permanente Commercial	$898.20
Rate for Payer: Kaiser Permanente Medicaid	$508.98
Rate for Payer: Kaiser Permanente Medicare	$758.48
Rate for Payer: MDX Hawaii PPO	$968.06
Rate for Payer: Ohana Health Plan Medicaid	$758.48
Rate for Payer: Ohana Health Plan Medicare	$758.48
Rate for Payer: UnitedHealthcare Medicare	$758.48
Rate for Payer: University Health Alliance Commercial	$558.88

ABS TIGHTROPE II AR-1588TN-20

Facility

$998.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$558.88
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$598.80
Rate for Payer: Hawaii Western Management Group Commercial	$698.60
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: Kaiser Permanente Commercial	$898.20
Rate for Payer: MDX Hawaii PPO	$968.06
Rate for Payer: University Health Alliance Commercial	$558.88

AB THERA DRESSING KIT

Facility

$383.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.50
Max. Negotiated Rate	$371.51
Rate for Payer: AlohaCare Medicaid	$191.50
Rate for Payer: AlohaCare Medicare	$291.08
Rate for Payer: Cash Price	$229.80
Rate for Payer: Devoted Health Medicare	$321.72
Rate for Payer: Hawaii Medical Service Association Medicare	$291.08
Rate for Payer: Hawaii Western Management Group Commercial	$363.85
Rate for Payer: Health Management Network Commercial	$325.55
Rate for Payer: Humana Medicare	$291.08
Rate for Payer: Kaiser Permanente Commercial	$344.70
Rate for Payer: Kaiser Permanente Medicaid	$195.33
Rate for Payer: Kaiser Permanente Medicare	$291.08
Rate for Payer: MDX Hawaii PPO	$371.51
Rate for Payer: Ohana Health Plan Medicaid	$291.08
Rate for Payer: Ohana Health Plan Medicare	$291.08
Rate for Payer: UnitedHealthcare Medicare	$291.08
Rate for Payer: University Health Alliance Commercial	$279.17

AB THERA DRESSING KIT

Facility

$383.00

Hospital Revenue Code	272
Min. Negotiated Rate	$325.55
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$229.80
Rate for Payer: Health Management Network Commercial	$325.55
Rate for Payer: Kaiser Permanente Commercial	$344.70
Rate for Payer: MDX Hawaii PPO	$371.51

ACARBOSE 25 MG TABLET [22148]

Facility

$4.00

Service Code	NDC 64380075806
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

ACARBOSE 25 MG TABLET [22148]

Facility

$4.00

Service Code	NDC 64380075806
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

ACARBOSE 25 MG TABLET [22148]

Facility

$4.00

Service Code	NDC 23155014701
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

ACARBOSE 25 MG TABLET [22148]

Facility

$4.00

Service Code	NDC 23155014701
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

ACCESSORY KIT 3550-80

Facility

$220.00

Hospital Revenue Code	272
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$132.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

ACCESSORY KIT 3550-80

Facility

$220.00

Hospital Revenue Code	272
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$167.20
Rate for Payer: Cash Price	$132.00
Rate for Payer: Devoted Health Medicare	$184.80
Rate for Payer: Hawaii Medical Service Association Medicare	$167.20
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$167.20
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$167.20
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$167.20
Rate for Payer: Ohana Health Plan Medicare	$167.20
Rate for Payer: UnitedHealthcare Medicare	$167.20
Rate for Payer: University Health Alliance Commercial	$160.36

ACCOLADE C 127 DEG 6057-0637D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

Know your out-of-pocket cost for care.

All Charges