Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PIN SET UNIVERS II AR-9207S

Facility

$963.00

Hospital Revenue Code	272
Min. Negotiated Rate	$481.50
Max. Negotiated Rate	$934.11
Rate for Payer: AlohaCare Medicaid	$481.50
Rate for Payer: AlohaCare Medicare	$731.88
Rate for Payer: Cash Price	$577.80
Rate for Payer: Devoted Health Medicare	$808.92
Rate for Payer: Hawaii Medical Service Association Medicare	$731.88
Rate for Payer: Hawaii Western Management Group Commercial	$914.85
Rate for Payer: Health Management Network Commercial	$818.55
Rate for Payer: Humana Medicare	$731.88
Rate for Payer: Kaiser Permanente Commercial	$866.70
Rate for Payer: Kaiser Permanente Medicaid	$491.13
Rate for Payer: Kaiser Permanente Medicare	$731.88
Rate for Payer: MDX Hawaii PPO	$934.11
Rate for Payer: Ohana Health Plan Medicaid	$731.88
Rate for Payer: Ohana Health Plan Medicare	$731.88
Rate for Payer: UnitedHealthcare Medicare	$731.88
Rate for Payer: University Health Alliance Commercial	$701.93

PIN SET UNIVERS II AR-9207S

Facility

$963.00

Hospital Revenue Code	272
Min. Negotiated Rate	$818.55
Max. Negotiated Rate	$934.11
Rate for Payer: Cash Price	$577.80
Rate for Payer: Health Management Network Commercial	$818.55
Rate for Payer: Kaiser Permanente Commercial	$866.70
Rate for Payer: MDX Hawaii PPO	$934.11

PINS SHORT THREADED 11.00007

Facility

$750.00

Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: MDX Hawaii PPO	$727.50

PINS SHORT THREADED 11.00007

Facility

$750.00

Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$727.50
Rate for Payer: AlohaCare Medicaid	$375.00
Rate for Payer: AlohaCare Medicare	$570.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Devoted Health Medicare	$630.00
Rate for Payer: Hawaii Medical Service Association Medicare	$570.00
Rate for Payer: Hawaii Western Management Group Commercial	$712.50
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Humana Medicare	$570.00
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: Kaiser Permanente Medicare	$570.00
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: Ohana Health Plan Medicaid	$570.00
Rate for Payer: Ohana Health Plan Medicare	$570.00
Rate for Payer: UnitedHealthcare Medicare	$570.00
Rate for Payer: University Health Alliance Commercial	$546.67

PIN STEIN BAY TIP 144256

Facility

$320.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$310.40
Rate for Payer: AlohaCare Medicaid	$160.00
Rate for Payer: AlohaCare Medicare	$243.20
Rate for Payer: Cash Price	$192.00
Rate for Payer: Devoted Health Medicare	$268.80
Rate for Payer: Hawaii Medical Service Association Medicare	$243.20
Rate for Payer: Hawaii Western Management Group Commercial	$224.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: Humana Medicare	$243.20
Rate for Payer: Kaiser Permanente Commercial	$288.00
Rate for Payer: Kaiser Permanente Medicaid	$163.20
Rate for Payer: Kaiser Permanente Medicare	$243.20
Rate for Payer: MDX Hawaii PPO	$310.40
Rate for Payer: Ohana Health Plan Medicaid	$243.20
Rate for Payer: Ohana Health Plan Medicare	$243.20
Rate for Payer: UnitedHealthcare Medicare	$243.20
Rate for Payer: University Health Alliance Commercial	$179.20

PIN STEIN BAY TIP 144256

Facility

$320.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$310.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Hawaii Western Management Group Commercial	$224.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: Kaiser Permanente Commercial	$288.00
Rate for Payer: MDX Hawaii PPO	$310.40
Rate for Payer: University Health Alliance Commercial	$179.20

PIN STEINMAN 5.0X200MM 293.74

Facility

$638.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$357.28
Max. Negotiated Rate	$618.86
Rate for Payer: Cash Price	$382.80
Rate for Payer: Hawaii Western Management Group Commercial	$446.60
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: Kaiser Permanente Commercial	$574.20
Rate for Payer: MDX Hawaii PPO	$618.86
Rate for Payer: University Health Alliance Commercial	$357.28

PIN STEINMAN 5.0X200MM 293.74

Facility

$638.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$319.00
Max. Negotiated Rate	$618.86
Rate for Payer: AlohaCare Medicaid	$319.00
Rate for Payer: AlohaCare Medicare	$484.88
Rate for Payer: Cash Price	$382.80
Rate for Payer: Devoted Health Medicare	$535.92
Rate for Payer: Hawaii Medical Service Association Medicare	$484.88
Rate for Payer: Hawaii Western Management Group Commercial	$446.60
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: Humana Medicare	$484.88
Rate for Payer: Kaiser Permanente Commercial	$574.20
Rate for Payer: Kaiser Permanente Medicaid	$325.38
Rate for Payer: Kaiser Permanente Medicare	$484.88
Rate for Payer: MDX Hawaii PPO	$618.86
Rate for Payer: Ohana Health Plan Medicaid	$484.88
Rate for Payer: Ohana Health Plan Medicare	$484.88
Rate for Payer: UnitedHealthcare Medicare	$484.88
Rate for Payer: University Health Alliance Commercial	$357.28

PIN STEINMANN 3.2MM 405800

Facility

$544.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$304.64
Max. Negotiated Rate	$527.68
Rate for Payer: Cash Price	$326.40
Rate for Payer: Hawaii Western Management Group Commercial	$380.80
Rate for Payer: Health Management Network Commercial	$462.40
Rate for Payer: Kaiser Permanente Commercial	$489.60
Rate for Payer: MDX Hawaii PPO	$527.68
Rate for Payer: University Health Alliance Commercial	$304.64

PIN STEINMANN 3.2MM 405800

Facility

$544.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$272.00
Max. Negotiated Rate	$527.68
Rate for Payer: AlohaCare Medicaid	$272.00
Rate for Payer: AlohaCare Medicare	$413.44
Rate for Payer: Cash Price	$326.40
Rate for Payer: Devoted Health Medicare	$456.96
Rate for Payer: Hawaii Medical Service Association Medicare	$413.44
Rate for Payer: Hawaii Western Management Group Commercial	$380.80
Rate for Payer: Health Management Network Commercial	$462.40
Rate for Payer: Humana Medicare	$413.44
Rate for Payer: Kaiser Permanente Commercial	$489.60
Rate for Payer: Kaiser Permanente Medicaid	$277.44
Rate for Payer: Kaiser Permanente Medicare	$413.44
Rate for Payer: MDX Hawaii PPO	$527.68
Rate for Payer: Ohana Health Plan Medicaid	$413.44
Rate for Payer: Ohana Health Plan Medicare	$413.44
Rate for Payer: UnitedHealthcare Medicare	$413.44
Rate for Payer: University Health Alliance Commercial	$304.64

PIN STEINMANN 3.2X9 110003484

Facility

$431.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$241.36
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$258.60
Rate for Payer: Hawaii Western Management Group Commercial	$301.70
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Kaiser Permanente Commercial	$387.90
Rate for Payer: MDX Hawaii PPO	$418.07
Rate for Payer: University Health Alliance Commercial	$241.36

PIN STEINMANN 3.2X9 110003484

Facility

$431.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$215.50
Max. Negotiated Rate	$418.07
Rate for Payer: AlohaCare Medicaid	$215.50
Rate for Payer: AlohaCare Medicare	$327.56
Rate for Payer: Cash Price	$258.60
Rate for Payer: Devoted Health Medicare	$362.04
Rate for Payer: Hawaii Medical Service Association Medicare	$327.56
Rate for Payer: Hawaii Western Management Group Commercial	$301.70
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Humana Medicare	$327.56
Rate for Payer: Kaiser Permanente Commercial	$387.90
Rate for Payer: Kaiser Permanente Medicaid	$219.81
Rate for Payer: Kaiser Permanente Medicare	$327.56
Rate for Payer: MDX Hawaii PPO	$418.07
Rate for Payer: Ohana Health Plan Medicaid	$327.56
Rate for Payer: Ohana Health Plan Medicare	$327.56
Rate for Payer: UnitedHealthcare Medicare	$327.56
Rate for Payer: University Health Alliance Commercial	$241.36

PIN STEINMANN AR-5050K-2

Facility

$205.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$198.85
Rate for Payer: AlohaCare Medicaid	$102.50
Rate for Payer: AlohaCare Medicare	$155.80
Rate for Payer: Cash Price	$123.00
Rate for Payer: Devoted Health Medicare	$172.20
Rate for Payer: Hawaii Medical Service Association Medicare	$155.80
Rate for Payer: Hawaii Western Management Group Commercial	$194.75
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Humana Medicare	$155.80
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: Kaiser Permanente Medicaid	$104.55
Rate for Payer: Kaiser Permanente Medicare	$155.80
Rate for Payer: MDX Hawaii PPO	$198.85
Rate for Payer: Ohana Health Plan Medicaid	$155.80
Rate for Payer: Ohana Health Plan Medicare	$155.80
Rate for Payer: UnitedHealthcare Medicare	$155.80
Rate for Payer: University Health Alliance Commercial	$149.42

PIN STEINMANN AR-5050K-2

Facility

$205.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$174.25
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$123.00
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: MDX Hawaii PPO	$198.85

PIN TRANSFIX 5050-4-300

Facility

$795.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$771.15
Rate for Payer: AlohaCare Medicaid	$397.50
Rate for Payer: AlohaCare Medicare	$604.20
Rate for Payer: Cash Price	$477.00
Rate for Payer: Devoted Health Medicare	$667.80
Rate for Payer: Hawaii Medical Service Association Medicare	$604.20
Rate for Payer: Hawaii Western Management Group Commercial	$556.50
Rate for Payer: Health Management Network Commercial	$675.75
Rate for Payer: Humana Medicare	$604.20
Rate for Payer: Kaiser Permanente Commercial	$715.50
Rate for Payer: Kaiser Permanente Medicaid	$405.45
Rate for Payer: Kaiser Permanente Medicare	$604.20
Rate for Payer: MDX Hawaii PPO	$771.15
Rate for Payer: Ohana Health Plan Medicaid	$604.20
Rate for Payer: Ohana Health Plan Medicare	$604.20
Rate for Payer: UnitedHealthcare Medicare	$604.20
Rate for Payer: University Health Alliance Commercial	$445.20

PIN TRANSFIX 5050-4-300

Facility

$795.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$445.20
Max. Negotiated Rate	$771.15
Rate for Payer: Cash Price	$477.00
Rate for Payer: Hawaii Western Management Group Commercial	$556.50
Rate for Payer: Health Management Network Commercial	$675.75
Rate for Payer: Kaiser Permanente Commercial	$715.50
Rate for Payer: MDX Hawaii PPO	$771.15
Rate for Payer: University Health Alliance Commercial	$445.20

PIN VOLAR BUTTRESS 32MM VBP32

Facility

$1,680.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$940.80
Max. Negotiated Rate	$1,629.60
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,176.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: MDX Hawaii PPO	$1,629.60
Rate for Payer: University Health Alliance Commercial	$940.80

PIN VOLAR BUTTRESS 32MM VBP32

Facility

$1,680.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,629.60
Rate for Payer: AlohaCare Medicaid	$840.00
Rate for Payer: AlohaCare Medicare	$1,276.80
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Devoted Health Medicare	$1,411.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,276.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,176.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Humana Medicare	$1,276.80
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: Kaiser Permanente Medicaid	$856.80
Rate for Payer: Kaiser Permanente Medicare	$1,276.80
Rate for Payer: MDX Hawaii PPO	$1,629.60
Rate for Payer: Ohana Health Plan Medicaid	$1,276.80
Rate for Payer: Ohana Health Plan Medicare	$1,276.80
Rate for Payer: UnitedHealthcare Medicare	$1,276.80
Rate for Payer: University Health Alliance Commercial	$940.80

PIN VOLAR BUTTRESS 42MM VBP42

Facility

$1,680.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,629.60
Rate for Payer: AlohaCare Medicaid	$840.00
Rate for Payer: AlohaCare Medicare	$1,276.80
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Devoted Health Medicare	$1,411.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,276.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,176.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Humana Medicare	$1,276.80
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: Kaiser Permanente Medicaid	$856.80
Rate for Payer: Kaiser Permanente Medicare	$1,276.80
Rate for Payer: MDX Hawaii PPO	$1,629.60
Rate for Payer: Ohana Health Plan Medicaid	$1,276.80
Rate for Payer: Ohana Health Plan Medicare	$1,276.80
Rate for Payer: UnitedHealthcare Medicare	$1,276.80
Rate for Payer: University Health Alliance Commercial	$940.80

PIN VOLAR BUTTRESS 42MM VBP42

Facility

$1,680.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$940.80
Max. Negotiated Rate	$1,629.60
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,176.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: MDX Hawaii PPO	$1,629.60
Rate for Payer: University Health Alliance Commercial	$940.80

PIOGLITAZONE 30 MG TABLET [25529]

Facility

$33.00

Service Code	NDC 33342005510
Hospital Revenue Code	637
Min. Negotiated Rate	$16.50
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: Devoted Health Medicare	$27.72
Rate for Payer: Hawaii Medical Service Association Medicare	$25.08
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 Medicare	$25.08
Rate for Payer: University Health Alliance Commercial	$24.05

PIOGLITAZONE 30 MG TABLET [25529]

Facility

$33.00

Service Code	NDC 33342005510
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

PIONEER PLUS CATH PPLUS120

Facility

$5,790.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,895.00
Max. Negotiated Rate	$5,616.30
Rate for Payer: AlohaCare Medicaid	$2,895.00
Rate for Payer: AlohaCare Medicare	$4,400.40
Rate for Payer: Cash Price	$3,474.00
Rate for Payer: Devoted Health Medicare	$4,863.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4,400.40
Rate for Payer: Hawaii Western Management Group Commercial	$5,500.50
Rate for Payer: Health Management Network Commercial	$4,921.50
Rate for Payer: Humana Medicare	$4,400.40
Rate for Payer: Kaiser Permanente Commercial	$5,211.00
Rate for Payer: Kaiser Permanente Medicaid	$2,952.90
Rate for Payer: Kaiser Permanente Medicare	$4,400.40
Rate for Payer: MDX Hawaii PPO	$5,616.30
Rate for Payer: Ohana Health Plan Medicaid	$4,400.40
Rate for Payer: Ohana Health Plan Medicare	$4,400.40
Rate for Payer: UnitedHealthcare Medicare	$4,400.40
Rate for Payer: University Health Alliance Commercial	$4,220.33

PIONEER PLUS CATH PPLUS120

Facility

$5,790.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,921.50
Max. Negotiated Rate	$5,616.30
Rate for Payer: Cash Price	$3,474.00
Rate for Payer: Health Management Network Commercial	$4,921.50
Rate for Payer: Kaiser Permanente Commercial	$5,211.00
Rate for Payer: MDX Hawaii PPO	$5,616.30

PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]

Facility

$29.00

Service Code	HCPCS J2543
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

Know your out-of-pocket cost for care.

All Charges