Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

KIRSCHNER WIRE 47-186-78

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$91.84

KIT 3.0 SUTURE TAK AR-1938DS

Facility

$1,084.00

Hospital Revenue Code	272
Min. Negotiated Rate	$542.00
Max. Negotiated Rate	$1,051.48
Rate for Payer: AlohaCare Medicaid	$542.00
Rate for Payer: AlohaCare Medicare	$823.84
Rate for Payer: Cash Price	$650.40
Rate for Payer: Devoted Health Medicare	$910.56
Rate for Payer: Hawaii Medical Service Association Medicare	$823.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,029.80
Rate for Payer: Health Management Network Commercial	$921.40
Rate for Payer: Humana Medicare	$823.84
Rate for Payer: Kaiser Permanente Commercial	$975.60
Rate for Payer: Kaiser Permanente Medicaid	$552.84
Rate for Payer: Kaiser Permanente Medicare	$823.84
Rate for Payer: MDX Hawaii PPO	$1,051.48
Rate for Payer: Ohana Health Plan Medicaid	$823.84
Rate for Payer: Ohana Health Plan Medicare	$823.84
Rate for Payer: UnitedHealthcare Medicare	$823.84
Rate for Payer: University Health Alliance Commercial	$790.13

KIT 3.0 SUTURE TAK AR-1938DS

Facility

$1,084.00

Hospital Revenue Code	272
Min. Negotiated Rate	$921.40
Max. Negotiated Rate	$1,051.48
Rate for Payer: Cash Price	$650.40
Rate for Payer: Health Management Network Commercial	$921.40
Rate for Payer: Kaiser Permanente Commercial	$975.60
Rate for Payer: MDX Hawaii PPO	$1,051.48

KIT 3MM SUTURETAK #AR-1934DS-2

Facility

$859.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$730.15
Max. Negotiated Rate	$833.23
Rate for Payer: Cash Price	$515.40
Rate for Payer: Health Management Network Commercial	$730.15
Rate for Payer: Kaiser Permanente Commercial	$773.10
Rate for Payer: MDX Hawaii PPO	$833.23

KIT 3MM SUTURETAK #AR-1934DS-2

Facility

$859.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$429.50
Max. Negotiated Rate	$833.23
Rate for Payer: AlohaCare Medicaid	$429.50
Rate for Payer: AlohaCare Medicare	$652.84
Rate for Payer: Cash Price	$515.40
Rate for Payer: Devoted Health Medicare	$721.56
Rate for Payer: Hawaii Medical Service Association Medicare	$652.84
Rate for Payer: Hawaii Western Management Group Commercial	$816.05
Rate for Payer: Health Management Network Commercial	$730.15
Rate for Payer: Humana Medicare	$652.84
Rate for Payer: Kaiser Permanente Commercial	$773.10
Rate for Payer: Kaiser Permanente Medicaid	$438.09
Rate for Payer: Kaiser Permanente Medicare	$652.84
Rate for Payer: MDX Hawaii PPO	$833.23
Rate for Payer: Ohana Health Plan Medicaid	$652.84
Rate for Payer: Ohana Health Plan Medicare	$652.84
Rate for Payer: UnitedHealthcare Medicare	$652.84
Rate for Payer: University Health Alliance Commercial	$626.13

KIT ANKLE SPRAIN CARE UNIVERS

Facility

$111.00

Service Code	HCPCS L4350
Hospital Revenue Code	274
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Hawaii Western Management Group Commercial	$77.70
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: University Health Alliance Commercial	$62.16

KIT ANKLE SPRAIN CARE UNIVERS

Facility

$111.00

Service Code	HCPCS L4350
Hospital Revenue Code	274
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$107.67
Rate for Payer: AlohaCare Medicaid	$55.50
Rate for Payer: AlohaCare Medicare	$84.36
Rate for Payer: Cash Price	$66.60
Rate for Payer: Cash Price	$66.60
Rate for Payer: Devoted Health Medicare	$93.24
Rate for Payer: Hawaii Medical Service Association Medicare	$84.36
Rate for Payer: Hawaii Western Management Group Commercial	$77.70
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Humana Medicare	$84.36
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: Kaiser Permanente Medicare	$84.36
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: Ohana Health Plan Medicaid	$84.36
Rate for Payer: Ohana Health Plan Medicare	$84.36
Rate for Payer: UnitedHealthcare Medicaid	$81.51
Rate for Payer: UnitedHealthcare Medicare	$84.36
Rate for Payer: University Health Alliance Commercial	$62.16

KIT BIOCUE MINI 30ML 800-0610A

Facility

$5,104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,338.40
Max. Negotiated Rate	$4,950.88
Rate for Payer: Cash Price	$3,062.40
Rate for Payer: Health Management Network Commercial	$4,338.40
Rate for Payer: Kaiser Permanente Commercial	$4,593.60
Rate for Payer: MDX Hawaii PPO	$4,950.88

KIT BIOCUE MINI 30ML 800-0610A

Facility

$5,104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,552.00
Max. Negotiated Rate	$4,950.88
Rate for Payer: AlohaCare Medicaid	$2,552.00
Rate for Payer: AlohaCare Medicare	$3,879.04
Rate for Payer: Cash Price	$3,062.40
Rate for Payer: Devoted Health Medicare	$4,287.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3,879.04
Rate for Payer: Hawaii Western Management Group Commercial	$4,848.80
Rate for Payer: Health Management Network Commercial	$4,338.40
Rate for Payer: Humana Medicare	$3,879.04
Rate for Payer: Kaiser Permanente Commercial	$4,593.60
Rate for Payer: Kaiser Permanente Medicaid	$2,603.04
Rate for Payer: Kaiser Permanente Medicare	$3,879.04
Rate for Payer: MDX Hawaii PPO	$4,950.88
Rate for Payer: Ohana Health Plan Medicaid	$3,879.04
Rate for Payer: Ohana Health Plan Medicare	$3,879.04
Rate for Payer: UnitedHealthcare Medicare	$3,879.04
Rate for Payer: University Health Alliance Commercial	$3,720.31

KIT BIOCUE STD 60ML 800-0611A

Facility

$5,104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,552.00
Max. Negotiated Rate	$4,950.88
Rate for Payer: AlohaCare Medicaid	$2,552.00
Rate for Payer: AlohaCare Medicare	$3,879.04
Rate for Payer: Cash Price	$3,062.40
Rate for Payer: Devoted Health Medicare	$4,287.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3,879.04
Rate for Payer: Hawaii Western Management Group Commercial	$4,848.80
Rate for Payer: Health Management Network Commercial	$4,338.40
Rate for Payer: Humana Medicare	$3,879.04
Rate for Payer: Kaiser Permanente Commercial	$4,593.60
Rate for Payer: Kaiser Permanente Medicaid	$2,603.04
Rate for Payer: Kaiser Permanente Medicare	$3,879.04
Rate for Payer: MDX Hawaii PPO	$4,950.88
Rate for Payer: Ohana Health Plan Medicaid	$3,879.04
Rate for Payer: Ohana Health Plan Medicare	$3,879.04
Rate for Payer: UnitedHealthcare Medicare	$3,879.04
Rate for Payer: University Health Alliance Commercial	$3,720.31

KIT BIOCUE STD 60ML 800-0611A

Facility

$5,104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,338.40
Max. Negotiated Rate	$4,950.88
Rate for Payer: Cash Price	$3,062.40
Rate for Payer: Health Management Network Commercial	$4,338.40
Rate for Payer: Kaiser Permanente Commercial	$4,593.60
Rate for Payer: MDX Hawaii PPO	$4,950.88

KIT BIO DISTAL BICEP AR-2260BC

Facility

$2,310.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,293.60
Max. Negotiated Rate	$2,240.70
Rate for Payer: Cash Price	$1,386.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,617.00
Rate for Payer: Health Management Network Commercial	$1,963.50
Rate for Payer: Kaiser Permanente Commercial	$2,079.00
Rate for Payer: MDX Hawaii PPO	$2,240.70
Rate for Payer: University Health Alliance Commercial	$1,293.60

KIT BIO DISTAL BICEP AR-2260BC

Facility

$2,310.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$2,240.70
Rate for Payer: AlohaCare Medicaid	$1,155.00
Rate for Payer: AlohaCare Medicare	$1,755.60
Rate for Payer: Cash Price	$1,386.00
Rate for Payer: Devoted Health Medicare	$1,940.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,755.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,617.00
Rate for Payer: Health Management Network Commercial	$1,963.50
Rate for Payer: Humana Medicare	$1,755.60
Rate for Payer: Kaiser Permanente Commercial	$2,079.00
Rate for Payer: Kaiser Permanente Medicaid	$1,178.10
Rate for Payer: Kaiser Permanente Medicare	$1,755.60
Rate for Payer: MDX Hawaii PPO	$2,240.70
Rate for Payer: Ohana Health Plan Medicaid	$1,755.60
Rate for Payer: Ohana Health Plan Medicare	$1,755.60
Rate for Payer: UnitedHealthcare Medicare	$1,755.60
Rate for Payer: University Health Alliance Commercial	$1,293.60

KIT CATH TRAY SILICONE 16FR

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$91.18
Rate for Payer: AlohaCare Medicaid	$47.00
Rate for Payer: AlohaCare Medicare	$71.44
Rate for Payer: Cash Price	$56.40
Rate for Payer: Devoted Health Medicare	$78.96
Rate for Payer: Hawaii Medical Service Association Medicare	$71.44
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Humana Medicare	$71.44
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: Kaiser Permanente Medicare	$71.44
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: Ohana Health Plan Medicaid	$71.44
Rate for Payer: Ohana Health Plan Medicare	$71.44
Rate for Payer: UnitedHealthcare Medicare	$71.44
Rate for Payer: University Health Alliance Commercial	$68.52

KIT CATH TRAY SILICONE 16FR

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: MDX Hawaii PPO	$91.18

KIT CENTESIS 5FR CATHETER

Facility

$394.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: MDX Hawaii PPO	$382.18

KIT CENTESIS 5FR CATHETER

Facility

$394.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$197.00
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$197.00
Rate for Payer: AlohaCare Medicare	$299.44
Rate for Payer: Cash Price	$236.40
Rate for Payer: Devoted Health Medicare	$330.96
Rate for Payer: Hawaii Medical Service Association Medicare	$299.44
Rate for Payer: Hawaii Western Management Group Commercial	$374.30
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$299.44
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$299.44
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$299.44
Rate for Payer: Ohana Health Plan Medicare	$299.44
Rate for Payer: UnitedHealthcare Medicare	$299.44
Rate for Payer: University Health Alliance Commercial	$287.19

KIT CRICOTHYROTOMY 2MM

Facility

$655.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$327.50
Max. Negotiated Rate	$635.35
Rate for Payer: AlohaCare Medicaid	$327.50
Rate for Payer: AlohaCare Medicare	$497.80
Rate for Payer: Cash Price	$393.00
Rate for Payer: Devoted Health Medicare	$550.20
Rate for Payer: Hawaii Medical Service Association Medicare	$497.80
Rate for Payer: Hawaii Western Management Group Commercial	$622.25
Rate for Payer: Health Management Network Commercial	$556.75
Rate for Payer: Humana Medicare	$497.80
Rate for Payer: Kaiser Permanente Commercial	$589.50
Rate for Payer: Kaiser Permanente Medicaid	$334.05
Rate for Payer: Kaiser Permanente Medicare	$497.80
Rate for Payer: MDX Hawaii PPO	$635.35
Rate for Payer: Ohana Health Plan Medicaid	$497.80
Rate for Payer: Ohana Health Plan Medicare	$497.80
Rate for Payer: UnitedHealthcare Medicare	$497.80
Rate for Payer: University Health Alliance Commercial	$477.43

KIT CRICOTHYROTOMY 2MM

Facility

$655.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$556.75
Max. Negotiated Rate	$635.35
Rate for Payer: Cash Price	$393.00
Rate for Payer: Health Management Network Commercial	$556.75
Rate for Payer: Kaiser Permanente Commercial	$589.50
Rate for Payer: MDX Hawaii PPO	$635.35

KIT CRICOTHYROTOMY 4.0MM

Facility

$569.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$483.65
Max. Negotiated Rate	$551.93
Rate for Payer: Cash Price	$341.40
Rate for Payer: Health Management Network Commercial	$483.65
Rate for Payer: Kaiser Permanente Commercial	$512.10
Rate for Payer: MDX Hawaii PPO	$551.93

KIT CRICOTHYROTOMY 4.0MM

Facility

$569.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$284.50
Max. Negotiated Rate	$551.93
Rate for Payer: AlohaCare Medicaid	$284.50
Rate for Payer: AlohaCare Medicare	$432.44
Rate for Payer: Cash Price	$341.40
Rate for Payer: Devoted Health Medicare	$477.96
Rate for Payer: Hawaii Medical Service Association Medicare	$432.44
Rate for Payer: Hawaii Western Management Group Commercial	$540.55
Rate for Payer: Health Management Network Commercial	$483.65
Rate for Payer: Humana Medicare	$432.44
Rate for Payer: Kaiser Permanente Commercial	$512.10
Rate for Payer: Kaiser Permanente Medicaid	$290.19
Rate for Payer: Kaiser Permanente Medicare	$432.44
Rate for Payer: MDX Hawaii PPO	$551.93
Rate for Payer: Ohana Health Plan Medicaid	$432.44
Rate for Payer: Ohana Health Plan Medicare	$432.44
Rate for Payer: UnitedHealthcare Medicare	$432.44
Rate for Payer: University Health Alliance Commercial	$414.74

KIT DISPOSABLE DX AR-8990DS

Facility

$1,376.00

Hospital Revenue Code	272
Min. Negotiated Rate	$688.00
Max. Negotiated Rate	$1,334.72
Rate for Payer: AlohaCare Medicaid	$688.00
Rate for Payer: AlohaCare Medicare	$1,045.76
Rate for Payer: Cash Price	$825.60
Rate for Payer: Devoted Health Medicare	$1,155.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,045.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,307.20
Rate for Payer: Health Management Network Commercial	$1,169.60
Rate for Payer: Humana Medicare	$1,045.76
Rate for Payer: Kaiser Permanente Commercial	$1,238.40
Rate for Payer: Kaiser Permanente Medicaid	$701.76
Rate for Payer: Kaiser Permanente Medicare	$1,045.76
Rate for Payer: MDX Hawaii PPO	$1,334.72
Rate for Payer: Ohana Health Plan Medicaid	$1,045.76
Rate for Payer: Ohana Health Plan Medicare	$1,045.76
Rate for Payer: UnitedHealthcare Medicare	$1,045.76
Rate for Payer: University Health Alliance Commercial	$1,002.97

KIT DISPOSABLE DX AR-8990DS

Facility

$1,376.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,169.60
Max. Negotiated Rate	$1,334.72
Rate for Payer: Cash Price	$825.60
Rate for Payer: Health Management Network Commercial	$1,169.60
Rate for Payer: Kaiser Permanente Commercial	$1,238.40
Rate for Payer: MDX Hawaii PPO	$1,334.72

KIT DRAINAGE PLEURX 1000ML

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$118.00
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$118.00
Rate for Payer: AlohaCare Medicare	$179.36
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$198.24
Rate for Payer: Hawaii Medical Service Association Medicare	$179.36
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$179.36
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$179.36
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$179.36
Rate for Payer: Ohana Health Plan Medicare	$179.36
Rate for Payer: UnitedHealthcare Medicare	$179.36
Rate for Payer: University Health Alliance Commercial	$172.02

KIT DRAINAGE PLEURX 1000ML

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: MDX Hawaii PPO	$228.92

Know your out-of-pocket cost for care.

All Charges