Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

K-WIRE OLI OLIVE-1.6/100

Facility

$428.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$363.80
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$256.80
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Kaiser Permanente Commercial	$385.20
Rate for Payer: MDX Hawaii PPO	$415.16

KWIRE OLIVE 705150

Facility

$402.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$201.00
Max. Negotiated Rate	$389.94
Rate for Payer: AlohaCare Medicaid	$201.00
Rate for Payer: AlohaCare Medicare	$305.52
Rate for Payer: Cash Price	$241.20
Rate for Payer: Devoted Health Medicare	$337.68
Rate for Payer: Hawaii Medical Service Association Medicare	$305.52
Rate for Payer: Hawaii Western Management Group Commercial	$381.90
Rate for Payer: Health Management Network Commercial	$341.70
Rate for Payer: Humana Medicare	$305.52
Rate for Payer: Kaiser Permanente Commercial	$361.80
Rate for Payer: Kaiser Permanente Medicaid	$205.02
Rate for Payer: Kaiser Permanente Medicare	$305.52
Rate for Payer: MDX Hawaii PPO	$389.94
Rate for Payer: Ohana Health Plan Medicaid	$305.52
Rate for Payer: Ohana Health Plan Medicare	$305.52
Rate for Payer: UnitedHealthcare Medicare	$305.52
Rate for Payer: University Health Alliance Commercial	$293.02

KWIRE OLIVE 705150

Facility

$402.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$341.70
Max. Negotiated Rate	$389.94
Rate for Payer: Cash Price	$241.20
Rate for Payer: Health Management Network Commercial	$341.70
Rate for Payer: Kaiser Permanente Commercial	$361.80
Rate for Payer: MDX Hawaii PPO	$389.94

K-WIRE OLIVE TIP 1.6MMX100MM

Facility

$769.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$384.50
Max. Negotiated Rate	$745.93
Rate for Payer: AlohaCare Medicaid	$384.50
Rate for Payer: AlohaCare Medicare	$584.44
Rate for Payer: Cash Price	$461.40
Rate for Payer: Devoted Health Medicare	$645.96
Rate for Payer: Hawaii Medical Service Association Medicare	$584.44
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Humana Medicare	$584.44
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: Kaiser Permanente Medicaid	$392.19
Rate for Payer: Kaiser Permanente Medicare	$584.44
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: Ohana Health Plan Medicaid	$584.44
Rate for Payer: Ohana Health Plan Medicare	$584.44
Rate for Payer: UnitedHealthcare Medicare	$584.44
Rate for Payer: University Health Alliance Commercial	$430.64

K-WIRE OLIVE TIP 1.6MMX100MM

Facility

$769.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$430.64
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$461.40
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: University Health Alliance Commercial	$430.64

K-WIRE S3 2.0X152MM KW20SS

Facility

$288.00

Service Code	HCPCS C1713
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

K-WIRE S3 2.0X152MM KW20SS

Facility

$288.00

Service Code	HCPCS C1713
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

K-WIRE TI 2.0X150MM 492.20

Facility

$131.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$65.50
Max. Negotiated Rate	$127.07
Rate for Payer: AlohaCare Medicaid	$65.50
Rate for Payer: AlohaCare Medicare	$99.56
Rate for Payer: Cash Price	$78.60
Rate for Payer: Devoted Health Medicare	$110.04
Rate for Payer: Hawaii Medical Service Association Medicare	$99.56
Rate for Payer: Hawaii Western Management Group Commercial	$124.45
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$99.56
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$99.56
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$99.56
Rate for Payer: Ohana Health Plan Medicare	$99.56
Rate for Payer: UnitedHealthcare Medicare	$99.56
Rate for Payer: University Health Alliance Commercial	$95.49

K-WIRE TI 2.0X150MM 492.20

Facility

$131.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$78.60
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: MDX Hawaii PPO	$127.07

KWIRE W/STOP 2MM 703818

Facility

$392.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$235.20
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

KWIRE W/STOP 2MM 703818

Facility

$392.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$196.00
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$297.92
Rate for Payer: Cash Price	$235.20
Rate for Payer: Devoted Health Medicare	$329.28
Rate for Payer: Hawaii Medical Service Association Medicare	$297.92
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$297.92
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$297.92
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$297.92
Rate for Payer: Ohana Health Plan Medicare	$297.92
Rate for Payer: UnitedHealthcare Medicare	$297.92
Rate for Payer: University Health Alliance Commercial	$285.73

K-WIRE ZIMMER 4901-10-15

Facility

$90.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$68.40
Rate for Payer: Cash Price	$54.00
Rate for Payer: Devoted Health Medicare	$75.60
Rate for Payer: Hawaii Medical Service Association Medicare	$68.40
Rate for Payer: Hawaii Western Management Group Commercial	$63.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$68.40
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$68.40
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$68.40
Rate for Payer: Ohana Health Plan Medicare	$68.40
Rate for Payer: UnitedHealthcare Medicare	$68.40
Rate for Payer: University Health Alliance Commercial	$50.40

K-WIRE ZIMMER 4901-10-15

Facility

$90.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Hawaii Western Management Group Commercial	$63.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: University Health Alliance Commercial	$50.40

LABETALOL 100 MG TABLET [10373]

Facility

$2.00

Service Code	NDC 60687043911
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

LABETALOL 100 MG TABLET [10373]

Facility

$2.00

Service Code	NDC 60687043911
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

LABETALOL 100 MG TABLET [10373]

Facility

$2.00

Service Code	NDC 60687043901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

LABETALOL 100 MG TABLET [10373]

Facility

$2.00

Service Code	NDC 60687043901
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

LABETALOL 200 MG TABLET [10374]

Facility

$3.00

Service Code	NDC 60687045001
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

LABETALOL 200 MG TABLET [10374]

Facility

$3.00

Service Code	NDC 60687045001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

LABETALOL 200 MG TABLET [10374]

Facility

$3.00

Service Code	NDC 60687045011
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

LABETALOL 200 MG TABLET [10374]

Facility

$3.00

Service Code	NDC 60687045011
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE [151255]

Facility

$33.00

Service Code	HCPCS J1920
Hospital Revenue Code	250
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: MDX Hawaii PPO	$32.01

LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE [151255]

Facility

$33.00

Service Code	HCPCS J1920
Hospital Revenue Code	636
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$32.01
Rate for Payer: AlohaCare Medicaid	$16.50
Rate for Payer: AlohaCare Medicare	$25.08
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Devoted Health Medicare	$27.72
Rate for Payer: Hawaii Medical Service Association ABD	$0.39
Rate for Payer: Hawaii Medical Service Association Medicare	$25.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.39
Rate for Payer: Hawaii Western Management Group Commercial	$31.35
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Humana Medicare	$25.08
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: Kaiser Permanente Medicare	$25.08
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: Ohana Health Plan Medicaid	$25.08
Rate for Payer: Ohana Health Plan Medicare	$25.08
Rate for Payer: UnitedHealthcare Medicaid	$19.80
Rate for Payer: UnitedHealthcare Medicare	$25.08
Rate for Payer: University Health Alliance Commercial	$24.05

LABETALOL 300 MG TABLET [10375]

Facility

$4.00

Service Code	NDC 68001038300
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

LABETALOL 300 MG TABLET [10375]

Facility

$4.00

Service Code	NDC 68001038300
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

Know your out-of-pocket cost for care.

All Charges