Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

IMPLAN GASTRO PADLOCK CLIP

Facility

$1,977.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,107.12
Max. Negotiated Rate	$1,917.69
Rate for Payer: Cash Price	$1,186.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.90
Rate for Payer: Health Management Network Commercial	$1,680.45
Rate for Payer: Kaiser Permanente Commercial	$1,779.30
Rate for Payer: MDX Hawaii PPO	$1,917.69
Rate for Payer: University Health Alliance Commercial	$1,107.12

IMPLAN GASTRO PADLOCK CLIP PRO

Facility

$2,157.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,078.50
Max. Negotiated Rate	$2,092.29
Rate for Payer: AlohaCare Medicaid	$1,078.50
Rate for Payer: AlohaCare Medicare	$1,639.32
Rate for Payer: Cash Price	$1,294.20
Rate for Payer: Devoted Health Medicare	$1,811.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,639.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.90
Rate for Payer: Health Management Network Commercial	$1,833.45
Rate for Payer: Humana Medicare	$1,639.32
Rate for Payer: Kaiser Permanente Commercial	$1,941.30
Rate for Payer: Kaiser Permanente Medicaid	$1,100.07
Rate for Payer: Kaiser Permanente Medicare	$1,639.32
Rate for Payer: MDX Hawaii PPO	$2,092.29
Rate for Payer: Ohana Health Plan Medicaid	$1,639.32
Rate for Payer: Ohana Health Plan Medicare	$1,639.32
Rate for Payer: UnitedHealthcare Medicare	$1,639.32
Rate for Payer: University Health Alliance Commercial	$1,207.92

IMPLAN GASTRO PADLOCK CLIP PRO

Facility

$2,157.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.92
Max. Negotiated Rate	$2,092.29
Rate for Payer: Cash Price	$1,294.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.90
Rate for Payer: Health Management Network Commercial	$1,833.45
Rate for Payer: Kaiser Permanente Commercial	$1,941.30
Rate for Payer: MDX Hawaii PPO	$2,092.29
Rate for Payer: University Health Alliance Commercial	$1,207.92

IMPLAN GEL PROLARYN 1.0CC

Facility

$2,205.00

Service Code	HCPCS L8607
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$2,138.85
Rate for Payer: AlohaCare Medicaid	$1,102.50
Rate for Payer: AlohaCare Medicare	$1,675.80
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Devoted Health Medicare	$1,852.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,675.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Humana Medicare	$1,675.80
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: Kaiser Permanente Medicaid	$1,124.55
Rate for Payer: Kaiser Permanente Medicare	$1,675.80
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: Ohana Health Plan Medicaid	$1,675.80
Rate for Payer: Ohana Health Plan Medicare	$1,675.80
Rate for Payer: UnitedHealthcare Medicare	$1,675.80
Rate for Payer: University Health Alliance Commercial	$1,234.80

IMPLAN GEL PROLARYN 1.0CC

Facility

$2,205.00

Service Code	HCPCS L8607
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.80
Max. Negotiated Rate	$2,138.85
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: University Health Alliance Commercial	$1,234.80

IMPLAN GEL PROLARYN PLUS 1CC

Facility

$2,205.00

Service Code	HCPCS L8607
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.80
Max. Negotiated Rate	$2,138.85
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: University Health Alliance Commercial	$1,234.80

IMPLAN GEL PROLARYN PLUS 1CC

Facility

$2,205.00

Service Code	HCPCS L8607
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$2,138.85
Rate for Payer: AlohaCare Medicaid	$1,102.50
Rate for Payer: AlohaCare Medicare	$1,675.80
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Devoted Health Medicare	$1,852.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,675.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Humana Medicare	$1,675.80
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: Kaiser Permanente Medicaid	$1,124.55
Rate for Payer: Kaiser Permanente Medicare	$1,675.80
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: Ohana Health Plan Medicaid	$1,675.80
Rate for Payer: Ohana Health Plan Medicare	$1,675.80
Rate for Payer: UnitedHealthcare Medicare	$1,675.80
Rate for Payer: University Health Alliance Commercial	$1,234.80

IMPLAN INTRANASAL SPLINT

Facility

$445.00

Hospital Revenue Code	278
Min. Negotiated Rate	$249.20
Max. Negotiated Rate	$431.65
Rate for Payer: Cash Price	$267.00
Rate for Payer: Hawaii Western Management Group Commercial	$311.50
Rate for Payer: Health Management Network Commercial	$378.25
Rate for Payer: Kaiser Permanente Commercial	$400.50
Rate for Payer: MDX Hawaii PPO	$431.65
Rate for Payer: University Health Alliance Commercial	$249.20

IMPLAN INTRANASAL SPLINT

Facility

$445.00

Hospital Revenue Code	278
Min. Negotiated Rate	$222.50
Max. Negotiated Rate	$431.65
Rate for Payer: AlohaCare Medicaid	$222.50
Rate for Payer: AlohaCare Medicare	$338.20
Rate for Payer: Cash Price	$267.00
Rate for Payer: Devoted Health Medicare	$373.80
Rate for Payer: Hawaii Medical Service Association Medicare	$338.20
Rate for Payer: Hawaii Western Management Group Commercial	$311.50
Rate for Payer: Health Management Network Commercial	$378.25
Rate for Payer: Humana Medicare	$338.20
Rate for Payer: Kaiser Permanente Commercial	$400.50
Rate for Payer: Kaiser Permanente Medicaid	$226.95
Rate for Payer: Kaiser Permanente Medicare	$338.20
Rate for Payer: MDX Hawaii PPO	$431.65
Rate for Payer: Ohana Health Plan Medicaid	$338.20
Rate for Payer: Ohana Health Plan Medicare	$338.20
Rate for Payer: UnitedHealthcare Medicare	$338.20
Rate for Payer: University Health Alliance Commercial	$249.20

IMPLAN OSSICULAR CENTERED PART

Facility

$1,568.00

Hospital Revenue Code	278
Min. Negotiated Rate	$878.08
Max. Negotiated Rate	$1,520.96
Rate for Payer: Cash Price	$940.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,097.60
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: Kaiser Permanente Commercial	$1,411.20
Rate for Payer: MDX Hawaii PPO	$1,520.96
Rate for Payer: University Health Alliance Commercial	$878.08

IMPLAN OSSICULAR CENTERED PART

Facility

$1,568.00

Hospital Revenue Code	278
Min. Negotiated Rate	$784.00
Max. Negotiated Rate	$1,520.96
Rate for Payer: AlohaCare Medicaid	$784.00
Rate for Payer: AlohaCare Medicare	$1,191.68
Rate for Payer: Cash Price	$940.80
Rate for Payer: Devoted Health Medicare	$1,317.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,191.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,097.60
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: Humana Medicare	$1,191.68
Rate for Payer: Kaiser Permanente Commercial	$1,411.20
Rate for Payer: Kaiser Permanente Medicaid	$799.68
Rate for Payer: Kaiser Permanente Medicare	$1,191.68
Rate for Payer: MDX Hawaii PPO	$1,520.96
Rate for Payer: Ohana Health Plan Medicaid	$1,191.68
Rate for Payer: Ohana Health Plan Medicare	$1,191.68
Rate for Payer: UnitedHealthcare Medicare	$1,191.68
Rate for Payer: University Health Alliance Commercial	$878.08

IMPLAN OSSICULAR PARTIAL

Facility

$1,503.00

Hospital Revenue Code	278
Min. Negotiated Rate	$841.68
Max. Negotiated Rate	$1,457.91
Rate for Payer: Cash Price	$901.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,052.10
Rate for Payer: Health Management Network Commercial	$1,277.55
Rate for Payer: Kaiser Permanente Commercial	$1,352.70
Rate for Payer: MDX Hawaii PPO	$1,457.91
Rate for Payer: University Health Alliance Commercial	$841.68

IMPLAN OSSICULAR PARTIAL

Facility

$1,503.00

Hospital Revenue Code	278
Min. Negotiated Rate	$751.50
Max. Negotiated Rate	$1,457.91
Rate for Payer: AlohaCare Medicaid	$751.50
Rate for Payer: AlohaCare Medicare	$1,142.28
Rate for Payer: Cash Price	$901.80
Rate for Payer: Devoted Health Medicare	$1,262.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,142.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,052.10
Rate for Payer: Health Management Network Commercial	$1,277.55
Rate for Payer: Humana Medicare	$1,142.28
Rate for Payer: Kaiser Permanente Commercial	$1,352.70
Rate for Payer: Kaiser Permanente Medicaid	$766.53
Rate for Payer: Kaiser Permanente Medicare	$1,142.28
Rate for Payer: MDX Hawaii PPO	$1,457.91
Rate for Payer: Ohana Health Plan Medicaid	$1,142.28
Rate for Payer: Ohana Health Plan Medicare	$1,142.28
Rate for Payer: UnitedHealthcare Medicare	$1,142.28
Rate for Payer: University Health Alliance Commercial	$841.68

IMPLAN OSSICULAR PROST

Facility

$1,460.00

Hospital Revenue Code	278
Min. Negotiated Rate	$730.00
Max. Negotiated Rate	$1,416.20
Rate for Payer: AlohaCare Medicaid	$730.00
Rate for Payer: AlohaCare Medicare	$1,109.60
Rate for Payer: Cash Price	$876.00
Rate for Payer: Devoted Health Medicare	$1,226.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,109.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,022.00
Rate for Payer: Health Management Network Commercial	$1,241.00
Rate for Payer: Humana Medicare	$1,109.60
Rate for Payer: Kaiser Permanente Commercial	$1,314.00
Rate for Payer: Kaiser Permanente Medicaid	$744.60
Rate for Payer: Kaiser Permanente Medicare	$1,109.60
Rate for Payer: MDX Hawaii PPO	$1,416.20
Rate for Payer: Ohana Health Plan Medicaid	$1,109.60
Rate for Payer: Ohana Health Plan Medicare	$1,109.60
Rate for Payer: UnitedHealthcare Medicare	$1,109.60
Rate for Payer: University Health Alliance Commercial	$817.60

IMPLAN OSSICULAR PROST

Facility

$1,460.00

Hospital Revenue Code	278
Min. Negotiated Rate	$817.60
Max. Negotiated Rate	$1,416.20
Rate for Payer: Cash Price	$876.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,022.00
Rate for Payer: Health Management Network Commercial	$1,241.00
Rate for Payer: Kaiser Permanente Commercial	$1,314.00
Rate for Payer: MDX Hawaii PPO	$1,416.20
Rate for Payer: University Health Alliance Commercial	$817.60

IMPLAN OSS NIT PISTON .6X4.25

Facility

$1,265.00

Hospital Revenue Code	278
Min. Negotiated Rate	$632.50
Max. Negotiated Rate	$1,227.05
Rate for Payer: AlohaCare Medicaid	$632.50
Rate for Payer: AlohaCare Medicare	$961.40
Rate for Payer: Cash Price	$759.00
Rate for Payer: Devoted Health Medicare	$1,062.60
Rate for Payer: Hawaii Medical Service Association Medicare	$961.40
Rate for Payer: Hawaii Western Management Group Commercial	$885.50
Rate for Payer: Health Management Network Commercial	$1,075.25
Rate for Payer: Humana Medicare	$961.40
Rate for Payer: Kaiser Permanente Commercial	$1,138.50
Rate for Payer: Kaiser Permanente Medicaid	$645.15
Rate for Payer: Kaiser Permanente Medicare	$961.40
Rate for Payer: MDX Hawaii PPO	$1,227.05
Rate for Payer: Ohana Health Plan Medicaid	$961.40
Rate for Payer: Ohana Health Plan Medicare	$961.40
Rate for Payer: UnitedHealthcare Medicare	$961.40
Rate for Payer: University Health Alliance Commercial	$708.40

IMPLAN OSS NIT PISTON .6X4.25

Facility

$1,265.00

Hospital Revenue Code	278
Min. Negotiated Rate	$708.40
Max. Negotiated Rate	$1,227.05
Rate for Payer: Cash Price	$759.00
Rate for Payer: Hawaii Western Management Group Commercial	$885.50
Rate for Payer: Health Management Network Commercial	$1,075.25
Rate for Payer: Kaiser Permanente Commercial	$1,138.50
Rate for Payer: MDX Hawaii PPO	$1,227.05
Rate for Payer: University Health Alliance Commercial	$708.40

IMPLAN OSS NIT PISTON .6X4.5

Facility

$1,253.00

Hospital Revenue Code	278
Min. Negotiated Rate	$626.50
Max. Negotiated Rate	$1,215.41
Rate for Payer: AlohaCare Medicaid	$626.50
Rate for Payer: AlohaCare Medicare	$952.28
Rate for Payer: Cash Price	$751.80
Rate for Payer: Devoted Health Medicare	$1,052.52
Rate for Payer: Hawaii Medical Service Association Medicare	$952.28
Rate for Payer: Hawaii Western Management Group Commercial	$877.10
Rate for Payer: Health Management Network Commercial	$1,065.05
Rate for Payer: Humana Medicare	$952.28
Rate for Payer: Kaiser Permanente Commercial	$1,127.70
Rate for Payer: Kaiser Permanente Medicaid	$639.03
Rate for Payer: Kaiser Permanente Medicare	$952.28
Rate for Payer: MDX Hawaii PPO	$1,215.41
Rate for Payer: Ohana Health Plan Medicaid	$952.28
Rate for Payer: Ohana Health Plan Medicare	$952.28
Rate for Payer: UnitedHealthcare Medicare	$952.28
Rate for Payer: University Health Alliance Commercial	$701.68

IMPLAN OSS NIT PISTON .6X4.5

Facility

$1,253.00

Hospital Revenue Code	278
Min. Negotiated Rate	$701.68
Max. Negotiated Rate	$1,215.41
Rate for Payer: Cash Price	$751.80
Rate for Payer: Hawaii Western Management Group Commercial	$877.10
Rate for Payer: Health Management Network Commercial	$1,065.05
Rate for Payer: Kaiser Permanente Commercial	$1,127.70
Rate for Payer: MDX Hawaii PPO	$1,215.41
Rate for Payer: University Health Alliance Commercial	$701.68

IMPLAN PENILE PRO RES 100ML

Facility

$6,530.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$3,656.80
Max. Negotiated Rate	$6,334.10
Rate for Payer: Cash Price	$3,918.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,571.00
Rate for Payer: Health Management Network Commercial	$5,550.50
Rate for Payer: Kaiser Permanente Commercial	$5,877.00
Rate for Payer: MDX Hawaii PPO	$6,334.10
Rate for Payer: University Health Alliance Commercial	$3,656.80

IMPLAN PENILE PRO RES 100ML

Facility

$6,530.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$3,265.00
Max. Negotiated Rate	$6,334.10
Rate for Payer: AlohaCare Medicaid	$3,265.00
Rate for Payer: AlohaCare Medicare	$4,962.80
Rate for Payer: Cash Price	$3,918.00
Rate for Payer: Devoted Health Medicare	$5,485.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4,962.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,571.00
Rate for Payer: Health Management Network Commercial	$5,550.50
Rate for Payer: Humana Medicare	$4,962.80
Rate for Payer: Kaiser Permanente Commercial	$5,877.00
Rate for Payer: Kaiser Permanente Medicaid	$3,330.30
Rate for Payer: Kaiser Permanente Medicare	$4,962.80
Rate for Payer: MDX Hawaii PPO	$6,334.10
Rate for Payer: Ohana Health Plan Medicaid	$4,962.80
Rate for Payer: Ohana Health Plan Medicare	$4,962.80
Rate for Payer: UnitedHealthcare Medicare	$4,962.80
Rate for Payer: University Health Alliance Commercial	$3,656.80

IMPLAN PENILE PUMP 15X12

Facility

$27,550.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$13,775.00
Max. Negotiated Rate	$26,723.50
Rate for Payer: AlohaCare Medicaid	$13,775.00
Rate for Payer: AlohaCare Medicare	$20,938.00
Rate for Payer: Cash Price	$16,530.00
Rate for Payer: Devoted Health Medicare	$23,142.00
Rate for Payer: Hawaii Medical Service Association Medicare	$20,938.00
Rate for Payer: Hawaii Western Management Group Commercial	$19,285.00
Rate for Payer: Health Management Network Commercial	$23,417.50
Rate for Payer: Humana Medicare	$20,938.00
Rate for Payer: Kaiser Permanente Commercial	$24,795.00
Rate for Payer: Kaiser Permanente Medicaid	$14,050.50
Rate for Payer: Kaiser Permanente Medicare	$20,938.00
Rate for Payer: MDX Hawaii PPO	$26,723.50
Rate for Payer: Ohana Health Plan Medicaid	$20,938.00
Rate for Payer: Ohana Health Plan Medicare	$20,938.00
Rate for Payer: UnitedHealthcare Medicare	$20,938.00
Rate for Payer: University Health Alliance Commercial	$15,428.00

IMPLAN PENILE PUMP 15X12

Facility

$27,550.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$15,428.00
Max. Negotiated Rate	$26,723.50
Rate for Payer: Cash Price	$16,530.00
Rate for Payer: Hawaii Western Management Group Commercial	$19,285.00
Rate for Payer: Health Management Network Commercial	$23,417.50
Rate for Payer: Kaiser Permanente Commercial	$24,795.00
Rate for Payer: MDX Hawaii PPO	$26,723.50
Rate for Payer: University Health Alliance Commercial	$15,428.00

IMPLAN PORT CHRONOFLEX 8FR

Facility

$889.00

Service Code	HCPCS C1788
Hospital Revenue Code	278
Min. Negotiated Rate	$444.50
Max. Negotiated Rate	$862.33
Rate for Payer: AlohaCare Medicaid	$444.50
Rate for Payer: AlohaCare Medicare	$675.64
Rate for Payer: Cash Price	$533.40
Rate for Payer: Devoted Health Medicare	$746.76
Rate for Payer: Hawaii Medical Service Association Medicare	$675.64
Rate for Payer: Hawaii Western Management Group Commercial	$622.30
Rate for Payer: Health Management Network Commercial	$755.65
Rate for Payer: Humana Medicare	$675.64
Rate for Payer: Kaiser Permanente Commercial	$800.10
Rate for Payer: Kaiser Permanente Medicaid	$453.39
Rate for Payer: Kaiser Permanente Medicare	$675.64
Rate for Payer: MDX Hawaii PPO	$862.33
Rate for Payer: Ohana Health Plan Medicaid	$675.64
Rate for Payer: Ohana Health Plan Medicare	$675.64
Rate for Payer: UnitedHealthcare Medicare	$675.64
Rate for Payer: University Health Alliance Commercial	$497.84

IMPLAN PORT CHRONOFLEX 8FR

Facility

$889.00

Service Code	HCPCS C1788
Hospital Revenue Code	278
Min. Negotiated Rate	$497.84
Max. Negotiated Rate	$862.33
Rate for Payer: Cash Price	$533.40
Rate for Payer: Hawaii Western Management Group Commercial	$622.30
Rate for Payer: Health Management Network Commercial	$755.65
Rate for Payer: Kaiser Permanente Commercial	$800.10
Rate for Payer: MDX Hawaii PPO	$862.33
Rate for Payer: University Health Alliance Commercial	$497.84

Know your out-of-pocket cost for care.

All Charges