Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

IMPELLA CP

Facility

$56,000.00

Hospital Revenue Code	278
Min. Negotiated Rate	$31,360.00
Max. Negotiated Rate	$54,320.00
Rate for Payer: Cash Price	$33,600.00
Rate for Payer: Hawaii Western Management Group Commercial	$39,200.00
Rate for Payer: Health Management Network Commercial	$47,600.00
Rate for Payer: Kaiser Permanente Commercial	$50,400.00
Rate for Payer: MDX Hawaii PPO	$54,320.00
Rate for Payer: University Health Alliance Commercial	$31,360.00

IMPELLA CP

Facility

$56,000.00

Hospital Revenue Code	278
Min. Negotiated Rate	$28,000.00
Max. Negotiated Rate	$54,320.00
Rate for Payer: AlohaCare Medicaid	$28,000.00
Rate for Payer: AlohaCare Medicare	$42,560.00
Rate for Payer: Cash Price	$33,600.00
Rate for Payer: Devoted Health Medicare	$47,040.00
Rate for Payer: Hawaii Medical Service Association Medicare	$42,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$39,200.00
Rate for Payer: Health Management Network Commercial	$47,600.00
Rate for Payer: Humana Medicare	$42,560.00
Rate for Payer: Kaiser Permanente Commercial	$50,400.00
Rate for Payer: Kaiser Permanente Medicaid	$28,560.00
Rate for Payer: Kaiser Permanente Medicare	$42,560.00
Rate for Payer: MDX Hawaii PPO	$54,320.00
Rate for Payer: Ohana Health Plan Medicaid	$42,560.00
Rate for Payer: Ohana Health Plan Medicare	$42,560.00
Rate for Payer: UnitedHealthcare Medicare	$42,560.00
Rate for Payer: University Health Alliance Commercial	$31,360.00

IMPELLA LP COMPANION SHEATH 7F

Facility

$875.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$665.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$735.00
Rate for Payer: Hawaii Medical Service Association Medicare	$665.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$665.00
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$665.00
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$665.00
Rate for Payer: Ohana Health Plan Medicare	$665.00
Rate for Payer: UnitedHealthcare Medicare	$665.00
Rate for Payer: University Health Alliance Commercial	$637.79

IMPELLA LP COMPANION SHEATH 7F

Facility

$875.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75

IMPLAN .15X50X40 NASAL PERF

Facility

$1,692.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$846.00
Max. Negotiated Rate	$1,641.24
Rate for Payer: AlohaCare Medicaid	$846.00
Rate for Payer: AlohaCare Medicare	$1,285.92
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Devoted Health Medicare	$1,421.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,285.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,184.40
Rate for Payer: Health Management Network Commercial	$1,438.20
Rate for Payer: Humana Medicare	$1,285.92
Rate for Payer: Kaiser Permanente Commercial	$1,522.80
Rate for Payer: Kaiser Permanente Medicaid	$862.92
Rate for Payer: Kaiser Permanente Medicare	$1,285.92
Rate for Payer: MDX Hawaii PPO	$1,641.24
Rate for Payer: Ohana Health Plan Medicaid	$1,285.92
Rate for Payer: Ohana Health Plan Medicare	$1,285.92
Rate for Payer: UnitedHealthcare Medicare	$1,285.92
Rate for Payer: University Health Alliance Commercial	$947.52

IMPLAN .15X50X40 NASAL PERF

Facility

$1,692.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$947.52
Max. Negotiated Rate	$1,641.24
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,184.40
Rate for Payer: Health Management Network Commercial	$1,438.20
Rate for Payer: Kaiser Permanente Commercial	$1,522.80
Rate for Payer: MDX Hawaii PPO	$1,641.24
Rate for Payer: University Health Alliance Commercial	$947.52

IMPLAN .25X40X50 NASAL FLEX

Facility

$1,692.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$846.00
Max. Negotiated Rate	$1,641.24
Rate for Payer: AlohaCare Medicaid	$846.00
Rate for Payer: AlohaCare Medicare	$1,285.92
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Devoted Health Medicare	$1,421.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,285.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,184.40
Rate for Payer: Health Management Network Commercial	$1,438.20
Rate for Payer: Humana Medicare	$1,285.92
Rate for Payer: Kaiser Permanente Commercial	$1,522.80
Rate for Payer: Kaiser Permanente Medicaid	$862.92
Rate for Payer: Kaiser Permanente Medicare	$1,285.92
Rate for Payer: MDX Hawaii PPO	$1,641.24
Rate for Payer: Ohana Health Plan Medicaid	$1,285.92
Rate for Payer: Ohana Health Plan Medicare	$1,285.92
Rate for Payer: UnitedHealthcare Medicare	$1,285.92
Rate for Payer: University Health Alliance Commercial	$947.52

IMPLAN .25X40X50 NASAL FLEX

Facility

$1,692.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$947.52
Max. Negotiated Rate	$1,641.24
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,184.40
Rate for Payer: Health Management Network Commercial	$1,438.20
Rate for Payer: Kaiser Permanente Commercial	$1,522.80
Rate for Payer: MDX Hawaii PPO	$1,641.24
Rate for Payer: University Health Alliance Commercial	$947.52

IMPLAN BUCKET HANDLE .4X4.25

Facility

$930.00

Hospital Revenue Code	278
Min. Negotiated Rate	$465.00
Max. Negotiated Rate	$902.10
Rate for Payer: AlohaCare Medicaid	$465.00
Rate for Payer: AlohaCare Medicare	$706.80
Rate for Payer: Cash Price	$558.00
Rate for Payer: Devoted Health Medicare	$781.20
Rate for Payer: Hawaii Medical Service Association Medicare	$706.80
Rate for Payer: Hawaii Western Management Group Commercial	$651.00
Rate for Payer: Health Management Network Commercial	$790.50
Rate for Payer: Humana Medicare	$706.80
Rate for Payer: Kaiser Permanente Commercial	$837.00
Rate for Payer: Kaiser Permanente Medicaid	$474.30
Rate for Payer: Kaiser Permanente Medicare	$706.80
Rate for Payer: MDX Hawaii PPO	$902.10
Rate for Payer: Ohana Health Plan Medicaid	$706.80
Rate for Payer: Ohana Health Plan Medicare	$706.80
Rate for Payer: UnitedHealthcare Medicare	$706.80
Rate for Payer: University Health Alliance Commercial	$520.80

IMPLAN BUCKET HANDLE .4X4.25

Facility

$930.00

Hospital Revenue Code	278
Min. Negotiated Rate	$520.80
Max. Negotiated Rate	$902.10
Rate for Payer: Cash Price	$558.00
Rate for Payer: Hawaii Western Management Group Commercial	$651.00
Rate for Payer: Health Management Network Commercial	$790.50
Rate for Payer: Kaiser Permanente Commercial	$837.00
Rate for Payer: MDX Hawaii PPO	$902.10
Rate for Payer: University Health Alliance Commercial	$520.80

IMPLAN BUCKET HANDLE .5X4.5

Facility

$930.00

Hospital Revenue Code	278
Min. Negotiated Rate	$520.80
Max. Negotiated Rate	$902.10
Rate for Payer: Cash Price	$558.00
Rate for Payer: Hawaii Western Management Group Commercial	$651.00
Rate for Payer: Health Management Network Commercial	$790.50
Rate for Payer: Kaiser Permanente Commercial	$837.00
Rate for Payer: MDX Hawaii PPO	$902.10
Rate for Payer: University Health Alliance Commercial	$520.80

IMPLAN BUCKET HANDLE .5X4.5

Facility

$930.00

Hospital Revenue Code	278
Min. Negotiated Rate	$465.00
Max. Negotiated Rate	$902.10
Rate for Payer: AlohaCare Medicaid	$465.00
Rate for Payer: AlohaCare Medicare	$706.80
Rate for Payer: Cash Price	$558.00
Rate for Payer: Devoted Health Medicare	$781.20
Rate for Payer: Hawaii Medical Service Association Medicare	$706.80
Rate for Payer: Hawaii Western Management Group Commercial	$651.00
Rate for Payer: Health Management Network Commercial	$790.50
Rate for Payer: Humana Medicare	$706.80
Rate for Payer: Kaiser Permanente Commercial	$837.00
Rate for Payer: Kaiser Permanente Medicaid	$474.30
Rate for Payer: Kaiser Permanente Medicare	$706.80
Rate for Payer: MDX Hawaii PPO	$902.10
Rate for Payer: Ohana Health Plan Medicaid	$706.80
Rate for Payer: Ohana Health Plan Medicare	$706.80
Rate for Payer: UnitedHealthcare Medicare	$706.80
Rate for Payer: University Health Alliance Commercial	$520.80

IMPLAN CATHETER PASSER 38CM

Facility

$776.00

Hospital Revenue Code	278
Min. Negotiated Rate	$388.00
Max. Negotiated Rate	$752.72
Rate for Payer: AlohaCare Medicaid	$388.00
Rate for Payer: AlohaCare Medicare	$589.76
Rate for Payer: Cash Price	$465.60
Rate for Payer: Devoted Health Medicare	$651.84
Rate for Payer: Hawaii Medical Service Association Medicare	$589.76
Rate for Payer: Hawaii Western Management Group Commercial	$543.20
Rate for Payer: Health Management Network Commercial	$659.60
Rate for Payer: Humana Medicare	$589.76
Rate for Payer: Kaiser Permanente Commercial	$698.40
Rate for Payer: Kaiser Permanente Medicaid	$395.76
Rate for Payer: Kaiser Permanente Medicare	$589.76
Rate for Payer: MDX Hawaii PPO	$752.72
Rate for Payer: Ohana Health Plan Medicaid	$589.76
Rate for Payer: Ohana Health Plan Medicare	$589.76
Rate for Payer: UnitedHealthcare Medicare	$589.76
Rate for Payer: University Health Alliance Commercial	$434.56

IMPLAN CATHETER PASSER 38CM

Facility

$776.00

Hospital Revenue Code	278
Min. Negotiated Rate	$434.56
Max. Negotiated Rate	$752.72
Rate for Payer: Cash Price	$465.60
Rate for Payer: Hawaii Western Management Group Commercial	$543.20
Rate for Payer: Health Management Network Commercial	$659.60
Rate for Payer: Kaiser Permanente Commercial	$698.40
Rate for Payer: MDX Hawaii PPO	$752.72
Rate for Payer: University Health Alliance Commercial	$434.56

IMPLAN CUFF OCCLUSIVE

Facility

$15,800.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$7,900.00
Max. Negotiated Rate	$15,326.00
Rate for Payer: AlohaCare Medicaid	$7,900.00
Rate for Payer: AlohaCare Medicare	$12,008.00
Rate for Payer: Cash Price	$9,480.00
Rate for Payer: Devoted Health Medicare	$13,272.00
Rate for Payer: Hawaii Medical Service Association Medicare	$12,008.00
Rate for Payer: Hawaii Western Management Group Commercial	$11,060.00
Rate for Payer: Health Management Network Commercial	$13,430.00
Rate for Payer: Humana Medicare	$12,008.00
Rate for Payer: Kaiser Permanente Commercial	$14,220.00
Rate for Payer: Kaiser Permanente Medicaid	$8,058.00
Rate for Payer: Kaiser Permanente Medicare	$12,008.00
Rate for Payer: MDX Hawaii PPO	$15,326.00
Rate for Payer: Ohana Health Plan Medicaid	$12,008.00
Rate for Payer: Ohana Health Plan Medicare	$12,008.00
Rate for Payer: UnitedHealthcare Medicare	$12,008.00
Rate for Payer: University Health Alliance Commercial	$8,848.00

IMPLAN CUFF OCCLUSIVE

Facility

$15,800.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$8,848.00
Max. Negotiated Rate	$15,326.00
Rate for Payer: Cash Price	$9,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$11,060.00
Rate for Payer: Health Management Network Commercial	$13,430.00
Rate for Payer: Kaiser Permanente Commercial	$14,220.00
Rate for Payer: MDX Hawaii PPO	$15,326.00
Rate for Payer: University Health Alliance Commercial	$8,848.00

IMPLAN DEACTIV PENILE PROT

Facility

$827.00

Hospital Revenue Code	278
Min. Negotiated Rate	$413.50
Max. Negotiated Rate	$802.19
Rate for Payer: AlohaCare Medicaid	$413.50
Rate for Payer: AlohaCare Medicare	$628.52
Rate for Payer: Cash Price	$496.20
Rate for Payer: Devoted Health Medicare	$694.68
Rate for Payer: Hawaii Medical Service Association Medicare	$628.52
Rate for Payer: Hawaii Western Management Group Commercial	$578.90
Rate for Payer: Health Management Network Commercial	$702.95
Rate for Payer: Humana Medicare	$628.52
Rate for Payer: Kaiser Permanente Commercial	$744.30
Rate for Payer: Kaiser Permanente Medicaid	$421.77
Rate for Payer: Kaiser Permanente Medicare	$628.52
Rate for Payer: MDX Hawaii PPO	$802.19
Rate for Payer: Ohana Health Plan Medicaid	$628.52
Rate for Payer: Ohana Health Plan Medicare	$628.52
Rate for Payer: UnitedHealthcare Medicare	$628.52
Rate for Payer: University Health Alliance Commercial	$463.12

IMPLAN DEACTIV PENILE PROT

Facility

$827.00

Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$802.19
Rate for Payer: Cash Price	$496.20
Rate for Payer: Hawaii Western Management Group Commercial	$578.90
Rate for Payer: Health Management Network Commercial	$702.95
Rate for Payer: Kaiser Permanente Commercial	$744.30
Rate for Payer: MDX Hawaii PPO	$802.19
Rate for Payer: University Health Alliance Commercial	$463.12

IMPLAN ESOPH 23X101 STENT

Facility

$5,800.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,900.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: AlohaCare Medicaid	$2,900.00
Rate for Payer: AlohaCare Medicare	$4,408.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Devoted Health Medicare	$4,872.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,408.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Humana Medicare	$4,408.00
Rate for Payer: Kaiser Permanente Medicaid	$2,958.00
Rate for Payer: Kaiser Permanente Medicare	$4,408.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: Ohana Health Plan Medicaid	$4,408.00
Rate for Payer: Ohana Health Plan Medicare	$4,408.00
Rate for Payer: UnitedHealthcare Medicare	$4,408.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

IMPLAN ESOPH 23X101 STENT

Facility

$5,800.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,248.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

IMPLAN EXCLUDER AAA 16X12X7

Facility

$7,288.00

Hospital Revenue Code	278
Min. Negotiated Rate	$4,081.28
Max. Negotiated Rate	$7,069.36
Rate for Payer: Cash Price	$4,372.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,101.60
Rate for Payer: Health Management Network Commercial	$6,194.80
Rate for Payer: Kaiser Permanente Commercial	$6,559.20
Rate for Payer: MDX Hawaii PPO	$7,069.36
Rate for Payer: University Health Alliance Commercial	$4,081.28

IMPLAN EXCLUDER AAA 16X12X7

Facility

$7,288.00

Hospital Revenue Code	278
Min. Negotiated Rate	$3,644.00
Max. Negotiated Rate	$7,069.36
Rate for Payer: AlohaCare Medicaid	$3,644.00
Rate for Payer: AlohaCare Medicare	$5,538.88
Rate for Payer: Cash Price	$4,372.80
Rate for Payer: Devoted Health Medicare	$6,121.92
Rate for Payer: Hawaii Medical Service Association Medicare	$5,538.88
Rate for Payer: Hawaii Western Management Group Commercial	$5,101.60
Rate for Payer: Health Management Network Commercial	$6,194.80
Rate for Payer: Humana Medicare	$5,538.88
Rate for Payer: Kaiser Permanente Commercial	$6,559.20
Rate for Payer: Kaiser Permanente Medicaid	$3,716.88
Rate for Payer: Kaiser Permanente Medicare	$5,538.88
Rate for Payer: MDX Hawaii PPO	$7,069.36
Rate for Payer: Ohana Health Plan Medicaid	$5,538.88
Rate for Payer: Ohana Health Plan Medicare	$5,538.88
Rate for Payer: UnitedHealthcare Medicare	$5,538.88
Rate for Payer: University Health Alliance Commercial	$4,081.28

IMPLAN GASTRO CLIP 16MM

Facility

$360.00

Hospital Revenue Code	278
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$252.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: University Health Alliance Commercial	$201.60

IMPLAN GASTRO CLIP 16MM

Facility

$360.00

Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$349.20
Rate for Payer: AlohaCare Medicaid	$180.00
Rate for Payer: AlohaCare Medicare	$273.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Devoted Health Medicare	$302.40
Rate for Payer: Hawaii Medical Service Association Medicare	$273.60
Rate for Payer: Hawaii Western Management Group Commercial	$252.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Humana Medicare	$273.60
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: Kaiser Permanente Medicare	$273.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: Ohana Health Plan Medicaid	$273.60
Rate for Payer: Ohana Health Plan Medicare	$273.60
Rate for Payer: UnitedHealthcare Medicare	$273.60
Rate for Payer: University Health Alliance Commercial	$201.60

IMPLAN GASTRO PADLOCK CLIP

Facility

$1,977.00

Hospital Revenue Code	278
Min. Negotiated Rate	$988.50
Max. Negotiated Rate	$1,917.69
Rate for Payer: AlohaCare Medicaid	$988.50
Rate for Payer: AlohaCare Medicare	$1,502.52
Rate for Payer: Cash Price	$1,186.20
Rate for Payer: Devoted Health Medicare	$1,660.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,502.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.90
Rate for Payer: Health Management Network Commercial	$1,680.45
Rate for Payer: Humana Medicare	$1,502.52
Rate for Payer: Kaiser Permanente Commercial	$1,779.30
Rate for Payer: Kaiser Permanente Medicaid	$1,008.27
Rate for Payer: Kaiser Permanente Medicare	$1,502.52
Rate for Payer: MDX Hawaii PPO	$1,917.69
Rate for Payer: Ohana Health Plan Medicaid	$1,502.52
Rate for Payer: Ohana Health Plan Medicare	$1,502.52
Rate for Payer: UnitedHealthcare Medicare	$1,502.52
Rate for Payer: University Health Alliance Commercial	$1,107.12

Know your out-of-pocket cost for care.

All Charges