Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

INSERT X3 TIBIAL 5531-G-612-E

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

INSERT X3 TIBIAL 5531-G-612-E

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.00
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$2,033.76
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$2,247.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,033.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$2,033.76
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$2,033.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$2,033.76
Rate for Payer: Ohana Health Plan Medicare	$2,033.76
Rate for Payer: UnitedHealthcare Medicare	$2,033.76
Rate for Payer: University Health Alliance Commercial	$1,498.56

INSERT X3 TIBIAL 5537-G-509-E

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,451.50
Max. Negotiated Rate	$4,755.91
Rate for Payer: AlohaCare Medicaid	$2,451.50
Rate for Payer: AlohaCare Medicare	$3,726.28
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Devoted Health Medicare	$4,118.52
Rate for Payer: Hawaii Medical Service Association Medicare	$3,726.28
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Humana Medicare	$3,726.28
Rate for Payer: Kaiser Permanente Commercial	$4,412.70
Rate for Payer: Kaiser Permanente Medicaid	$2,500.53
Rate for Payer: Kaiser Permanente Medicare	$3,726.28
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: Ohana Health Plan Medicaid	$3,726.28
Rate for Payer: Ohana Health Plan Medicare	$3,726.28
Rate for Payer: UnitedHealthcare Medicare	$3,726.28
Rate for Payer: University Health Alliance Commercial	$2,745.68

INSERT X3 TIBIAL 5537-G-509-E

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,745.68
Max. Negotiated Rate	$4,755.91
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Kaiser Permanente Commercial	$4,412.70
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: University Health Alliance Commercial	$2,745.68

INSERT X3 TIBIA SZ6 5531-G-611

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

INSERT X3 TIBIA SZ6 5531-G-611

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$2,054.28
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$2,270.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,054.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$2,054.28
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$2,054.28
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$2,054.28
Rate for Payer: Ohana Health Plan Medicare	$2,054.28
Rate for Payer: UnitedHealthcare Medicare	$2,054.28
Rate for Payer: University Health Alliance Commercial	$1,513.68

INSPACE US MEDIUM 0131

Facility

$11,000.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$6,160.00
Max. Negotiated Rate	$10,670.00
Rate for Payer: Cash Price	$6,600.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,700.00
Rate for Payer: Health Management Network Commercial	$9,350.00
Rate for Payer: Kaiser Permanente Commercial	$9,900.00
Rate for Payer: MDX Hawaii PPO	$10,670.00
Rate for Payer: University Health Alliance Commercial	$6,160.00

INSPACE US MEDIUM 0131

Facility

$11,000.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$5,500.00
Max. Negotiated Rate	$10,670.00
Rate for Payer: AlohaCare Medicaid	$5,500.00
Rate for Payer: AlohaCare Medicare	$8,360.00
Rate for Payer: Cash Price	$6,600.00
Rate for Payer: Devoted Health Medicare	$9,240.00
Rate for Payer: Hawaii Medical Service Association Medicare	$8,360.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,700.00
Rate for Payer: Health Management Network Commercial	$9,350.00
Rate for Payer: Humana Medicare	$8,360.00
Rate for Payer: Kaiser Permanente Commercial	$9,900.00
Rate for Payer: Kaiser Permanente Medicaid	$5,610.00
Rate for Payer: Kaiser Permanente Medicare	$8,360.00
Rate for Payer: MDX Hawaii PPO	$10,670.00
Rate for Payer: Ohana Health Plan Medicaid	$8,360.00
Rate for Payer: Ohana Health Plan Medicare	$8,360.00
Rate for Payer: UnitedHealthcare Medicare	$8,360.00
Rate for Payer: University Health Alliance Commercial	$6,160.00

INSTR 10MM ENDO RETRACT II

Facility

$395.00

Hospital Revenue Code	272
Min. Negotiated Rate	$335.75
Max. Negotiated Rate	$383.15
Rate for Payer: Cash Price	$237.00
Rate for Payer: Health Management Network Commercial	$335.75
Rate for Payer: Kaiser Permanente Commercial	$355.50
Rate for Payer: MDX Hawaii PPO	$383.15

INSTR 10MM ENDO RETRACT II

Facility

$395.00

Hospital Revenue Code	272
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$383.15
Rate for Payer: AlohaCare Medicaid	$197.50
Rate for Payer: AlohaCare Medicare	$300.20
Rate for Payer: Cash Price	$237.00
Rate for Payer: Devoted Health Medicare	$331.80
Rate for Payer: Hawaii Medical Service Association Medicare	$300.20
Rate for Payer: Hawaii Western Management Group Commercial	$375.25
Rate for Payer: Health Management Network Commercial	$335.75
Rate for Payer: Humana Medicare	$300.20
Rate for Payer: Kaiser Permanente Commercial	$355.50
Rate for Payer: Kaiser Permanente Medicaid	$201.45
Rate for Payer: Kaiser Permanente Medicare	$300.20
Rate for Payer: MDX Hawaii PPO	$383.15
Rate for Payer: Ohana Health Plan Medicaid	$300.20
Rate for Payer: Ohana Health Plan Medicare	$300.20
Rate for Payer: UnitedHealthcare Medicare	$300.20
Rate for Payer: University Health Alliance Commercial	$287.92

INSTR 5MM ENDO GRASPER

Facility

$234.00

Hospital Revenue Code	272
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$226.98
Rate for Payer: AlohaCare Medicaid	$117.00
Rate for Payer: AlohaCare Medicare	$177.84
Rate for Payer: Cash Price	$140.40
Rate for Payer: Devoted Health Medicare	$196.56
Rate for Payer: Hawaii Medical Service Association Medicare	$177.84
Rate for Payer: Hawaii Western Management Group Commercial	$222.30
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Humana Medicare	$177.84
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: Kaiser Permanente Medicaid	$119.34
Rate for Payer: Kaiser Permanente Medicare	$177.84
Rate for Payer: MDX Hawaii PPO	$226.98
Rate for Payer: Ohana Health Plan Medicaid	$177.84
Rate for Payer: Ohana Health Plan Medicare	$177.84
Rate for Payer: UnitedHealthcare Medicare	$177.84
Rate for Payer: University Health Alliance Commercial	$170.56

INSTR 5MM ENDO GRASPER

Facility

$234.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: MDX Hawaii PPO	$226.98

INSTR 5MM MINI SHEARS

Facility

$149.00

Hospital Revenue Code	272
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$89.40
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: MDX Hawaii PPO	$144.53

INSTR 5MM MINI SHEARS

Facility

$149.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.50
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$74.50
Rate for Payer: AlohaCare Medicare	$113.24
Rate for Payer: Cash Price	$89.40
Rate for Payer: Devoted Health Medicare	$125.16
Rate for Payer: Hawaii Medical Service Association Medicare	$113.24
Rate for Payer: Hawaii Western Management Group Commercial	$141.55
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$113.24
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$113.24
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$113.24
Rate for Payer: Ohana Health Plan Medicare	$113.24
Rate for Payer: UnitedHealthcare Medicare	$113.24
Rate for Payer: University Health Alliance Commercial	$108.61

INSTR BIOPSY NEEDLE MONOPTY

Facility

$162.00

Hospital Revenue Code	272
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$157.14
Rate for Payer: AlohaCare Medicaid	$81.00
Rate for Payer: AlohaCare Medicare	$123.12
Rate for Payer: Cash Price	$97.20
Rate for Payer: Devoted Health Medicare	$136.08
Rate for Payer: Hawaii Medical Service Association Medicare	$123.12
Rate for Payer: Hawaii Western Management Group Commercial	$153.90
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Humana Medicare	$123.12
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: Kaiser Permanente Medicaid	$82.62
Rate for Payer: Kaiser Permanente Medicare	$123.12
Rate for Payer: MDX Hawaii PPO	$157.14
Rate for Payer: Ohana Health Plan Medicaid	$123.12
Rate for Payer: Ohana Health Plan Medicare	$123.12
Rate for Payer: UnitedHealthcare Medicare	$123.12
Rate for Payer: University Health Alliance Commercial	$118.08

INSTR BIOPSY NEEDLE MONOPTY

Facility

$162.00

Hospital Revenue Code	272
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$97.20
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: MDX Hawaii PPO	$157.14

INSTR DUODENOSCOPE

Facility

$7,650.00

Service Code	HCPCS C1748
Hospital Revenue Code	272
Min. Negotiated Rate	$6,502.50
Max. Negotiated Rate	$7,420.50
Rate for Payer: Cash Price	$4,590.00
Rate for Payer: Health Management Network Commercial	$6,502.50
Rate for Payer: Kaiser Permanente Commercial	$6,885.00
Rate for Payer: MDX Hawaii PPO	$7,420.50

INSTR DUODENOSCOPE

Facility

$7,650.00

Service Code	HCPCS C1748
Hospital Revenue Code	272
Min. Negotiated Rate	$3,825.00
Max. Negotiated Rate	$7,420.50
Rate for Payer: AlohaCare Medicaid	$3,825.00
Rate for Payer: AlohaCare Medicare	$5,814.00
Rate for Payer: Cash Price	$4,590.00
Rate for Payer: Devoted Health Medicare	$6,426.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,814.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,267.50
Rate for Payer: Health Management Network Commercial	$6,502.50
Rate for Payer: Humana Medicare	$5,814.00
Rate for Payer: Kaiser Permanente Commercial	$6,885.00
Rate for Payer: Kaiser Permanente Medicaid	$3,901.50
Rate for Payer: Kaiser Permanente Medicare	$5,814.00
Rate for Payer: MDX Hawaii PPO	$7,420.50
Rate for Payer: Ohana Health Plan Medicaid	$5,814.00
Rate for Payer: Ohana Health Plan Medicare	$5,814.00
Rate for Payer: UnitedHealthcare Medicare	$5,814.00
Rate for Payer: University Health Alliance Commercial	$5,576.09

INSTR ENDO BABCOCK

Facility

$293.00

Hospital Revenue Code	272
Min. Negotiated Rate	$146.50
Max. Negotiated Rate	$284.21
Rate for Payer: AlohaCare Medicaid	$146.50
Rate for Payer: AlohaCare Medicare	$222.68
Rate for Payer: Cash Price	$175.80
Rate for Payer: Devoted Health Medicare	$246.12
Rate for Payer: Hawaii Medical Service Association Medicare	$222.68
Rate for Payer: Hawaii Western Management Group Commercial	$278.35
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Humana Medicare	$222.68
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: Kaiser Permanente Medicaid	$149.43
Rate for Payer: Kaiser Permanente Medicare	$222.68
Rate for Payer: MDX Hawaii PPO	$284.21
Rate for Payer: Ohana Health Plan Medicaid	$222.68
Rate for Payer: Ohana Health Plan Medicare	$222.68
Rate for Payer: UnitedHealthcare Medicare	$222.68
Rate for Payer: University Health Alliance Commercial	$213.57

INSTR ENDO BABCOCK

Facility

$293.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.05
Max. Negotiated Rate	$284.21
Rate for Payer: Cash Price	$175.80
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: MDX Hawaii PPO	$284.21

INSTR FORCEP ALLIGA RESCUE

Facility

$309.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$154.50
Max. Negotiated Rate	$299.73
Rate for Payer: AlohaCare Medicaid	$154.50
Rate for Payer: AlohaCare Medicare	$234.84
Rate for Payer: Cash Price	$185.40
Rate for Payer: Devoted Health Medicare	$259.56
Rate for Payer: Hawaii Medical Service Association Medicare	$234.84
Rate for Payer: Hawaii Western Management Group Commercial	$293.55
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Humana Medicare	$234.84
Rate for Payer: Kaiser Permanente Commercial	$278.10
Rate for Payer: Kaiser Permanente Medicaid	$157.59
Rate for Payer: Kaiser Permanente Medicare	$234.84
Rate for Payer: MDX Hawaii PPO	$299.73
Rate for Payer: Ohana Health Plan Medicaid	$234.84
Rate for Payer: Ohana Health Plan Medicare	$234.84
Rate for Payer: UnitedHealthcare Medicare	$234.84
Rate for Payer: University Health Alliance Commercial	$225.23

INSTR FORCEP ALLIGA RESCUE

Facility

$309.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$185.40
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Kaiser Permanente Commercial	$278.10
Rate for Payer: MDX Hawaii PPO	$299.73

INSTR FORCEP BIOP ENDOJAW

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65

INSTR FORCEP BIOP ENDOJAW

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$110.20
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$121.80
Rate for Payer: Hawaii Medical Service Association Medicare	$110.20
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$110.20
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$110.20
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$110.20
Rate for Payer: Ohana Health Plan Medicare	$110.20
Rate for Payer: UnitedHealthcare Medicare	$110.20
Rate for Payer: University Health Alliance Commercial	$105.69

INSTR FORCEP BIOPSY PULM

Facility

$201.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$152.76
Rate for Payer: Cash Price	$120.60
Rate for Payer: Devoted Health Medicare	$168.84
Rate for Payer: Hawaii Medical Service Association Medicare	$152.76
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$152.76
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$152.76
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$152.76
Rate for Payer: Ohana Health Plan Medicare	$152.76
Rate for Payer: UnitedHealthcare Medicare	$152.76
Rate for Payer: University Health Alliance Commercial	$146.51

Know your out-of-pocket cost for care.

All Charges