Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

INSTR FORCEP BIOPSY PULM

Facility

$201.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

INSTR FORCEP GRASPING

Facility

$288.00

Hospital Revenue Code	272
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: MDX Hawaii PPO	$279.36

INSTR FORCEP GRASPING

Facility

$288.00

Hospital Revenue Code	272
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$279.36
Rate for Payer: AlohaCare Medicaid	$144.00
Rate for Payer: AlohaCare Medicare	$218.88
Rate for Payer: Cash Price	$172.80
Rate for Payer: Devoted Health Medicare	$241.92
Rate for Payer: Hawaii Medical Service Association Medicare	$218.88
Rate for Payer: Hawaii Western Management Group Commercial	$273.60
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Humana Medicare	$218.88
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: Kaiser Permanente Medicaid	$146.88
Rate for Payer: Kaiser Permanente Medicare	$218.88
Rate for Payer: MDX Hawaii PPO	$279.36
Rate for Payer: Ohana Health Plan Medicaid	$218.88
Rate for Payer: Ohana Health Plan Medicare	$218.88
Rate for Payer: UnitedHealthcare Medicare	$218.88
Rate for Payer: University Health Alliance Commercial	$209.92

INSTR FORCEP RAPTOR GRASPING

Facility

$396.00

Hospital Revenue Code	272
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$237.60
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: MDX Hawaii PPO	$384.12

INSTR FORCEP RAPTOR GRASPING

Facility

$396.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$384.12
Rate for Payer: AlohaCare Medicaid	$198.00
Rate for Payer: AlohaCare Medicare	$300.96
Rate for Payer: Cash Price	$237.60
Rate for Payer: Devoted Health Medicare	$332.64
Rate for Payer: Hawaii Medical Service Association Medicare	$300.96
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Humana Medicare	$300.96
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: Kaiser Permanente Medicare	$300.96
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: Ohana Health Plan Medicaid	$300.96
Rate for Payer: Ohana Health Plan Medicare	$300.96
Rate for Payer: UnitedHealthcare Medicare	$300.96
Rate for Payer: University Health Alliance Commercial	$288.64

INSTR FORCEP RESCUE GRASP

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 RESCUE GRASP

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 FORCEPS BIOPSY

Facility

$1,364.00

Hospital Revenue Code	272
Min. Negotiated Rate	$682.00
Max. Negotiated Rate	$1,323.08
Rate for Payer: AlohaCare Medicaid	$682.00
Rate for Payer: AlohaCare Medicaid	$784.00
Rate for Payer: AlohaCare Medicare	$1,036.64
Rate for Payer: AlohaCare Medicare	$1,191.68
Rate for Payer: Cash Price	$940.80
Rate for Payer: Cash Price	$818.40
Rate for Payer: Devoted Health Medicare	$1,145.76
Rate for Payer: Devoted Health Medicare	$1,317.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,191.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,036.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,489.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,295.80
Rate for Payer: Health Management Network Commercial	$1,159.40
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: Humana Medicare	$1,191.68
Rate for Payer: Humana Medicare	$1,036.64
Rate for Payer: Kaiser Permanente Commercial	$1,227.60
Rate for Payer: Kaiser Permanente Commercial	$1,411.20
Rate for Payer: Kaiser Permanente Medicaid	$799.68
Rate for Payer: Kaiser Permanente Medicaid	$695.64
Rate for Payer: Kaiser Permanente Medicare	$1,191.68
Rate for Payer: Kaiser Permanente Medicare	$1,036.64
Rate for Payer: MDX Hawaii PPO	$1,520.96
Rate for Payer: MDX Hawaii PPO	$1,323.08
Rate for Payer: Ohana Health Plan Medicaid	$1,036.64
Rate for Payer: Ohana Health Plan Medicaid	$1,191.68
Rate for Payer: Ohana Health Plan Medicare	$1,036.64
Rate for Payer: Ohana Health Plan Medicare	$1,191.68
Rate for Payer: UnitedHealthcare Medicare	$1,036.64
Rate for Payer: UnitedHealthcare Medicare	$1,191.68
Rate for Payer: University Health Alliance Commercial	$1,142.92
Rate for Payer: University Health Alliance Commercial	$994.22

INSTR FORCEPS BIOPSY

Facility

$1,568.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,332.80
Max. Negotiated Rate	$1,520.96
Rate for Payer: Cash Price	$940.80
Rate for Payer: Cash Price	$818.40
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: Health Management Network Commercial	$1,159.40
Rate for Payer: Kaiser Permanente Commercial	$1,411.20
Rate for Payer: Kaiser Permanente Commercial	$1,227.60
Rate for Payer: MDX Hawaii PPO	$1,323.08
Rate for Payer: MDX Hawaii PPO	$1,520.96

INSTR GRASPING DEVICE MINI

Facility

$396.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$384.12
Rate for Payer: AlohaCare Medicaid	$198.00
Rate for Payer: AlohaCare Medicare	$300.96
Rate for Payer: Cash Price	$237.60
Rate for Payer: Devoted Health Medicare	$332.64
Rate for Payer: Hawaii Medical Service Association Medicare	$300.96
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Humana Medicare	$300.96
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: Kaiser Permanente Medicare	$300.96
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: Ohana Health Plan Medicaid	$300.96
Rate for Payer: Ohana Health Plan Medicare	$300.96
Rate for Payer: UnitedHealthcare Medicare	$300.96
Rate for Payer: University Health Alliance Commercial	$288.64

INSTR GRASPING DEVICE MINI

Facility

$396.00

Hospital Revenue Code	272
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$237.60
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: MDX Hawaii PPO	$384.12

INSTR LITHOTRIPTOR MECH

Facility

$1,830.00

Hospital Revenue Code	272
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$1,775.10
Rate for Payer: AlohaCare Medicaid	$915.00
Rate for Payer: AlohaCare Medicare	$1,390.80
Rate for Payer: Cash Price	$1,098.00
Rate for Payer: Devoted Health Medicare	$1,537.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,390.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.50
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: Humana Medicare	$1,390.80
Rate for Payer: Kaiser Permanente Commercial	$1,647.00
Rate for Payer: Kaiser Permanente Medicaid	$933.30
Rate for Payer: Kaiser Permanente Medicare	$1,390.80
Rate for Payer: MDX Hawaii PPO	$1,775.10
Rate for Payer: Ohana Health Plan Medicaid	$1,390.80
Rate for Payer: Ohana Health Plan Medicare	$1,390.80
Rate for Payer: UnitedHealthcare Medicare	$1,390.80
Rate for Payer: University Health Alliance Commercial	$1,333.89

INSTR LITHOTRIPTOR MECH

Facility

$1,830.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,555.50
Max. Negotiated Rate	$1,775.10
Rate for Payer: Cash Price	$1,098.00
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: Kaiser Permanente Commercial	$1,647.00
Rate for Payer: MDX Hawaii PPO	$1,775.10

INSTR RADIAL JAW FORCEP LG

Facility

$93.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$70.68
Rate for Payer: Cash Price	$55.80
Rate for Payer: Devoted Health Medicare	$78.12
Rate for Payer: Hawaii Medical Service Association Medicare	$70.68
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$70.68
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$70.68
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$70.68
Rate for Payer: Ohana Health Plan Medicare	$70.68
Rate for Payer: UnitedHealthcare Medicare	$70.68
Rate for Payer: University Health Alliance Commercial	$67.79

INSTR RADIAL JAW FORCEP LG

Facility

$93.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21

INSTR RADIAL JAW JUMBO 3.2MM

Facility

$164.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$98.40
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Kaiser Permanente Commercial	$147.60
Rate for Payer: MDX Hawaii PPO	$159.08

INSTR RADIAL JAW JUMBO 3.2MM

Facility

$164.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$159.08
Rate for Payer: AlohaCare Medicaid	$82.00
Rate for Payer: AlohaCare Medicare	$124.64
Rate for Payer: Cash Price	$98.40
Rate for Payer: Devoted Health Medicare	$137.76
Rate for Payer: Hawaii Medical Service Association Medicare	$124.64
Rate for Payer: Hawaii Western Management Group Commercial	$155.80
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Humana Medicare	$124.64
Rate for Payer: Kaiser Permanente Commercial	$147.60
Rate for Payer: Kaiser Permanente Medicaid	$83.64
Rate for Payer: Kaiser Permanente Medicare	$124.64
Rate for Payer: MDX Hawaii PPO	$159.08
Rate for Payer: Ohana Health Plan Medicaid	$124.64
Rate for Payer: Ohana Health Plan Medicare	$124.64
Rate for Payer: UnitedHealthcare Medicare	$124.64
Rate for Payer: University Health Alliance Commercial	$119.54

INSTR RADIAL JAW PEDS 2MM

Facility

$171.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$145.35
Max. Negotiated Rate	$165.87
Rate for Payer: Cash Price	$102.60
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Kaiser Permanente Commercial	$153.90
Rate for Payer: MDX Hawaii PPO	$165.87

INSTR RADIAL JAW PEDS 2MM

Facility

$171.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$165.87
Rate for Payer: AlohaCare Medicaid	$85.50
Rate for Payer: AlohaCare Medicare	$129.96
Rate for Payer: Cash Price	$102.60
Rate for Payer: Devoted Health Medicare	$143.64
Rate for Payer: Hawaii Medical Service Association Medicare	$129.96
Rate for Payer: Hawaii Western Management Group Commercial	$162.45
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Humana Medicare	$129.96
Rate for Payer: Kaiser Permanente Commercial	$153.90
Rate for Payer: Kaiser Permanente Medicaid	$87.21
Rate for Payer: Kaiser Permanente Medicare	$129.96
Rate for Payer: MDX Hawaii PPO	$165.87
Rate for Payer: Ohana Health Plan Medicaid	$129.96
Rate for Payer: Ohana Health Plan Medicare	$129.96
Rate for Payer: UnitedHealthcare Medicare	$129.96
Rate for Payer: University Health Alliance Commercial	$124.64

INSTR ROUTER 2.3MM TAPERED

Facility

$566.00

Hospital Revenue Code	272
Min. Negotiated Rate	$283.00
Max. Negotiated Rate	$549.02
Rate for Payer: AlohaCare Medicaid	$283.00
Rate for Payer: AlohaCare Medicare	$430.16
Rate for Payer: Cash Price	$339.60
Rate for Payer: Devoted Health Medicare	$475.44
Rate for Payer: Hawaii Medical Service Association Medicare	$430.16
Rate for Payer: Hawaii Western Management Group Commercial	$537.70
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Humana Medicare	$430.16
Rate for Payer: Kaiser Permanente Commercial	$509.40
Rate for Payer: Kaiser Permanente Medicaid	$288.66
Rate for Payer: Kaiser Permanente Medicare	$430.16
Rate for Payer: MDX Hawaii PPO	$549.02
Rate for Payer: Ohana Health Plan Medicaid	$430.16
Rate for Payer: Ohana Health Plan Medicare	$430.16
Rate for Payer: UnitedHealthcare Medicare	$430.16
Rate for Payer: University Health Alliance Commercial	$412.56

INSTR ROUTER 2.3MM TAPERED

Facility

$566.00

Hospital Revenue Code	272
Min. Negotiated Rate	$481.10
Max. Negotiated Rate	$549.02
Rate for Payer: Cash Price	$339.60
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Kaiser Permanente Commercial	$509.40
Rate for Payer: MDX Hawaii PPO	$549.02

INSTR SCISSOR METZ TIP

Facility

$221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$214.37
Rate for Payer: AlohaCare Medicaid	$110.50
Rate for Payer: AlohaCare Medicare	$167.96
Rate for Payer: Cash Price	$132.60
Rate for Payer: Devoted Health Medicare	$185.64
Rate for Payer: Hawaii Medical Service Association Medicare	$167.96
Rate for Payer: Hawaii Western Management Group Commercial	$209.95
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Humana Medicare	$167.96
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: Kaiser Permanente Medicaid	$112.71
Rate for Payer: Kaiser Permanente Medicare	$167.96
Rate for Payer: MDX Hawaii PPO	$214.37
Rate for Payer: Ohana Health Plan Medicaid	$167.96
Rate for Payer: Ohana Health Plan Medicare	$167.96
Rate for Payer: UnitedHealthcare Medicare	$167.96
Rate for Payer: University Health Alliance Commercial	$161.09

INSTR SCISSOR METZ TIP

Facility

$221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$214.37

INSULIN ASPAR PROT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS PEN [124856]

Facility

$84.00

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

INSULIN ASPAR PROT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS PEN [124856]

Facility

$84.00

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$63.84
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Devoted Health Medicare	$70.56
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$63.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$63.84
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$63.84
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$63.84
Rate for Payer: Ohana Health Plan Medicare	$63.84
Rate for Payer: UnitedHealthcare Medicaid	$50.40
Rate for Payer: UnitedHealthcare Medicare	$63.84
Rate for Payer: University Health Alliance Commercial	$61.23

Know your out-of-pocket cost for care.

All Charges