Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MESH SELF GRIPPING LT 12X8

Facility

$981.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$549.36
Max. Negotiated Rate	$951.57
Rate for Payer: Cash Price	$588.60
Rate for Payer: Hawaii Western Management Group Commercial	$686.70
Rate for Payer: Health Management Network Commercial	$833.85
Rate for Payer: Kaiser Permanente Commercial	$882.90
Rate for Payer: MDX Hawaii PPO	$951.57
Rate for Payer: University Health Alliance Commercial	$549.36

MESH SELF GRIPPING RT 12X9

Facility

$1,665.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$932.40
Max. Negotiated Rate	$1,615.05
Rate for Payer: Cash Price	$999.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,165.50
Rate for Payer: Health Management Network Commercial	$1,415.25
Rate for Payer: Kaiser Permanente Commercial	$1,498.50
Rate for Payer: MDX Hawaii PPO	$1,615.05
Rate for Payer: University Health Alliance Commercial	$932.40

MESH SELF GRIPPING RT 12X9

Facility

$1,665.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,615.05
Rate for Payer: AlohaCare Medicaid	$832.50
Rate for Payer: AlohaCare Medicare	$1,265.40
Rate for Payer: Cash Price	$999.00
Rate for Payer: Devoted Health Medicare	$1,398.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,265.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,165.50
Rate for Payer: Health Management Network Commercial	$1,415.25
Rate for Payer: Humana Medicare	$1,265.40
Rate for Payer: Kaiser Permanente Commercial	$1,498.50
Rate for Payer: Kaiser Permanente Medicaid	$849.15
Rate for Payer: Kaiser Permanente Medicare	$1,265.40
Rate for Payer: MDX Hawaii PPO	$1,615.05
Rate for Payer: Ohana Health Plan Medicaid	$1,265.40
Rate for Payer: Ohana Health Plan Medicare	$1,265.40
Rate for Payer: UnitedHealthcare Medicare	$1,265.40
Rate for Payer: University Health Alliance Commercial	$932.40

MESH STEX 15X10CM

Facility

$2,099.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,175.44
Max. Negotiated Rate	$2,036.03
Rate for Payer: Cash Price	$1,259.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,469.30
Rate for Payer: Health Management Network Commercial	$1,784.15
Rate for Payer: Kaiser Permanente Commercial	$1,889.10
Rate for Payer: MDX Hawaii PPO	$2,036.03
Rate for Payer: University Health Alliance Commercial	$1,175.44

MESH STEX 15X10CM

Facility

$2,099.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.50
Max. Negotiated Rate	$2,036.03
Rate for Payer: AlohaCare Medicaid	$1,049.50
Rate for Payer: AlohaCare Medicare	$1,595.24
Rate for Payer: Cash Price	$1,259.40
Rate for Payer: Devoted Health Medicare	$1,763.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,595.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,469.30
Rate for Payer: Health Management Network Commercial	$1,784.15
Rate for Payer: Humana Medicare	$1,595.24
Rate for Payer: Kaiser Permanente Commercial	$1,889.10
Rate for Payer: Kaiser Permanente Medicaid	$1,070.49
Rate for Payer: Kaiser Permanente Medicare	$1,595.24
Rate for Payer: MDX Hawaii PPO	$2,036.03
Rate for Payer: Ohana Health Plan Medicaid	$1,595.24
Rate for Payer: Ohana Health Plan Medicare	$1,595.24
Rate for Payer: UnitedHealthcare Medicare	$1,595.24
Rate for Payer: University Health Alliance Commercial	$1,175.44

MESH SURGICL W10XL10 GBWR1010

Facility

$2,688.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,505.28
Max. Negotiated Rate	$2,607.36
Rate for Payer: Cash Price	$1,612.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: Kaiser Permanente Commercial	$2,419.20
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: University Health Alliance Commercial	$1,505.28

MESH SURGICL W10XL10 GBWR1010

Facility

$2,688.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,607.36
Rate for Payer: AlohaCare Medicaid	$1,344.00
Rate for Payer: AlohaCare Medicare	$2,042.88
Rate for Payer: Cash Price	$1,612.80
Rate for Payer: Devoted Health Medicare	$2,257.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,042.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: Humana Medicare	$2,042.88
Rate for Payer: Kaiser Permanente Commercial	$2,419.20
Rate for Payer: Kaiser Permanente Medicaid	$1,370.88
Rate for Payer: Kaiser Permanente Medicare	$2,042.88
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: Ohana Health Plan Medicaid	$2,042.88
Rate for Payer: Ohana Health Plan Medicare	$2,042.88
Rate for Payer: UnitedHealthcare Medicare	$2,042.88
Rate for Payer: University Health Alliance Commercial	$1,505.28

MESH SYNECOR 10X15CM GKFV1015

Facility

$2,295.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,285.20
Max. Negotiated Rate	$2,226.15
Rate for Payer: Cash Price	$1,377.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,606.50
Rate for Payer: Health Management Network Commercial	$1,950.75
Rate for Payer: Kaiser Permanente Commercial	$2,065.50
Rate for Payer: MDX Hawaii PPO	$2,226.15
Rate for Payer: University Health Alliance Commercial	$1,285.20

MESH SYNECOR 10X15CM GKFV1015

Facility

$2,295.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$2,226.15
Rate for Payer: AlohaCare Medicaid	$1,147.50
Rate for Payer: AlohaCare Medicare	$1,744.20
Rate for Payer: Cash Price	$1,377.00
Rate for Payer: Devoted Health Medicare	$1,927.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,744.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,606.50
Rate for Payer: Health Management Network Commercial	$1,950.75
Rate for Payer: Humana Medicare	$1,744.20
Rate for Payer: Kaiser Permanente Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Medicaid	$1,170.45
Rate for Payer: Kaiser Permanente Medicare	$1,744.20
Rate for Payer: MDX Hawaii PPO	$2,226.15
Rate for Payer: Ohana Health Plan Medicaid	$1,744.20
Rate for Payer: Ohana Health Plan Medicare	$1,744.20
Rate for Payer: UnitedHealthcare Medicare	$1,744.20
Rate for Payer: University Health Alliance Commercial	$1,285.20

MESH SYNTHETIC HERNIA TEM1509G

Facility

$923.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$461.50
Max. Negotiated Rate	$895.31
Rate for Payer: AlohaCare Medicaid	$461.50
Rate for Payer: AlohaCare Medicare	$701.48
Rate for Payer: Cash Price	$553.80
Rate for Payer: Devoted Health Medicare	$775.32
Rate for Payer: Hawaii Medical Service Association Medicare	$701.48
Rate for Payer: Hawaii Western Management Group Commercial	$646.10
Rate for Payer: Health Management Network Commercial	$784.55
Rate for Payer: Humana Medicare	$701.48
Rate for Payer: Kaiser Permanente Commercial	$830.70
Rate for Payer: Kaiser Permanente Medicaid	$470.73
Rate for Payer: Kaiser Permanente Medicare	$701.48
Rate for Payer: MDX Hawaii PPO	$895.31
Rate for Payer: Ohana Health Plan Medicaid	$701.48
Rate for Payer: Ohana Health Plan Medicare	$701.48
Rate for Payer: UnitedHealthcare Medicare	$701.48
Rate for Payer: University Health Alliance Commercial	$516.88

MESH SYNTHETIC HERNIA TEM1509G

Facility

$923.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$516.88
Max. Negotiated Rate	$895.31
Rate for Payer: Cash Price	$553.80
Rate for Payer: Hawaii Western Management Group Commercial	$646.10
Rate for Payer: Health Management Network Commercial	$784.55
Rate for Payer: Kaiser Permanente Commercial	$830.70
Rate for Payer: MDX Hawaii PPO	$895.31
Rate for Payer: University Health Alliance Commercial	$516.88

MESH SYNTHETIC NON AB LG

Facility

$2,016.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

MESH SYNTHETIC NON AB LG

Facility

$2,016.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,955.52
Rate for Payer: AlohaCare Medicaid	$1,008.00
Rate for Payer: AlohaCare Medicare	$1,532.16
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Devoted Health Medicare	$1,693.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,532.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Humana Medicare	$1,532.16
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: Kaiser Permanente Medicaid	$1,028.16
Rate for Payer: Kaiser Permanente Medicare	$1,532.16
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: Ohana Health Plan Medicaid	$1,532.16
Rate for Payer: Ohana Health Plan Medicare	$1,532.16
Rate for Payer: UnitedHealthcare Medicare	$1,532.16
Rate for Payer: University Health Alliance Commercial	$1,128.96

MESH VENTRALEX SMALL 5950007

Facility

$2,280.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,276.80
Max. Negotiated Rate	$2,211.60
Rate for Payer: Cash Price	$1,368.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,938.00
Rate for Payer: Kaiser Permanente Commercial	$2,052.00
Rate for Payer: MDX Hawaii PPO	$2,211.60
Rate for Payer: University Health Alliance Commercial	$1,276.80

MESH VENTRALEX SMALL 5950007

Facility

$2,280.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,140.00
Max. Negotiated Rate	$2,211.60
Rate for Payer: AlohaCare Medicaid	$1,140.00
Rate for Payer: AlohaCare Medicare	$1,732.80
Rate for Payer: Cash Price	$1,368.00
Rate for Payer: Devoted Health Medicare	$1,915.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,732.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,938.00
Rate for Payer: Humana Medicare	$1,732.80
Rate for Payer: Kaiser Permanente Commercial	$2,052.00
Rate for Payer: Kaiser Permanente Medicaid	$1,162.80
Rate for Payer: Kaiser Permanente Medicare	$1,732.80
Rate for Payer: MDX Hawaii PPO	$2,211.60
Rate for Payer: Ohana Health Plan Medicaid	$1,732.80
Rate for Payer: Ohana Health Plan Medicare	$1,732.80
Rate for Payer: UnitedHealthcare Medicare	$1,732.80
Rate for Payer: University Health Alliance Commercial	$1,276.80

MESNA 100 MG/ML INTRAVENOUS SOLUTION [10537]

Facility

$105.00

Service Code	HCPCS J9209
Hospital Revenue Code	250
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: MDX Hawaii PPO	$101.85

MESNA 100 MG/ML INTRAVENOUS SOLUTION [10537]

Facility

$105.00

Service Code	HCPCS J9209
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$101.85
Rate for Payer: AlohaCare Medicaid	$52.50
Rate for Payer: AlohaCare Medicaid	$31.50
Rate for Payer: AlohaCare Medicare	$47.88
Rate for Payer: AlohaCare Medicare	$79.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$37.80
Rate for Payer: Devoted Health Medicare	$88.20
Rate for Payer: Devoted Health Medicare	$52.92
Rate for Payer: Hawaii Medical Service Association ABD	$1.33
Rate for Payer: Hawaii Medical Service Association ABD	$1.33
Rate for Payer: Hawaii Medical Service Association Medicare	$47.88
Rate for Payer: Hawaii Medical Service Association Medicare	$79.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.33
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Hawaii Western Management Group Commercial	$99.75
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$47.88
Rate for Payer: Humana Medicare	$79.80
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: Kaiser Permanente Medicare	$47.88
Rate for Payer: Kaiser Permanente Medicare	$79.80
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$79.80
Rate for Payer: Ohana Health Plan Medicaid	$47.88
Rate for Payer: Ohana Health Plan Medicare	$79.80
Rate for Payer: Ohana Health Plan Medicare	$47.88
Rate for Payer: UnitedHealthcare Medicaid	$63.00
Rate for Payer: UnitedHealthcare Medicaid	$37.80
Rate for Payer: UnitedHealthcare Medicare	$47.88
Rate for Payer: UnitedHealthcare Medicare	$79.80
Rate for Payer: University Health Alliance Commercial	$76.53
Rate for Payer: University Health Alliance Commercial	$45.92

METACARPOPHALANGEAL 5800-MD00

Facility

$7,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,284.00
Max. Negotiated Rate	$7,420.50
Rate for Payer: Cash Price	$4,590.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,355.00
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
Rate for Payer: University Health Alliance Commercial	$4,284.00

METACARPOPHALANGEAL 5800-MD00

Facility

$7,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
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	$5,355.00
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	$4,284.00

METER COIL ERICH ARCH 6001303

Facility

$228.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$221.16
Rate for Payer: AlohaCare Medicaid	$114.00
Rate for Payer: AlohaCare Medicare	$173.28
Rate for Payer: Cash Price	$136.80
Rate for Payer: Devoted Health Medicare	$191.52
Rate for Payer: Hawaii Medical Service Association Medicare	$173.28
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Humana Medicare	$173.28
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicare	$173.28
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: Ohana Health Plan Medicaid	$173.28
Rate for Payer: Ohana Health Plan Medicare	$173.28
Rate for Payer: UnitedHealthcare Medicare	$173.28
Rate for Payer: University Health Alliance Commercial	$127.68

METER COIL ERICH ARCH 6001303

Facility

$228.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$127.68
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$136.80
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: University Health Alliance Commercial	$127.68

METFORMIN 1,000 MG TABLET [24398]

Facility

$6.00

Service Code	NDC 70010006501
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$4.56
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Hawaii Medical Service Association Medicare	$4.56
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$4.56
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$4.56
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$4.56
Rate for Payer: Ohana Health Plan Medicare	$4.56
Rate for Payer: UnitedHealthcare Medicare	$4.56
Rate for Payer: University Health Alliance Commercial	$4.37

METFORMIN 1,000 MG TABLET [24398]

Facility

$6.00

Service Code	NDC 70010006501
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

METFORMIN 500 MG TABLET [10544]

Facility

$1.00

Service Code	NDC 00904716261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

METFORMIN 500 MG TABLET [10544]

Facility

$1.00

Service Code	NDC 00904716261
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

Know your out-of-pocket cost for care.

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