Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

BIOLOX DELTA V40 FH 6570-0-232

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

BIOLOX DELTA V40 FH 6570-0-232

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.00
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$2,033.76
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$2,247.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,033.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$2,033.76
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$2,033.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$2,033.76
Rate for Payer: Ohana Health Plan Medicare	$2,033.76
Rate for Payer: UnitedHealthcare Medicare	$2,033.76
Rate for Payer: University Health Alliance Commercial	$1,498.56

BIOLOX FEM HEAD 00-8775-036-03

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

BIOLOX FEM HEAD 00-8775-036-03

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: AlohaCare Medicaid	$1,300.00
Rate for Payer: AlohaCare Medicare	$1,976.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Devoted Health Medicare	$2,184.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,976.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Humana Medicare	$1,976.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: Kaiser Permanente Medicare	$1,976.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: Ohana Health Plan Medicaid	$1,976.00
Rate for Payer: Ohana Health Plan Medicare	$1,976.00
Rate for Payer: UnitedHealthcare Medicare	$1,976.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

BIOLOX FEM HEAD 1365-36-220

Facility

$4,880.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,440.00
Max. Negotiated Rate	$4,733.60
Rate for Payer: AlohaCare Medicaid	$2,440.00
Rate for Payer: AlohaCare Medicare	$3,708.80
Rate for Payer: Cash Price	$2,928.00
Rate for Payer: Devoted Health Medicare	$4,099.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3,708.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,416.00
Rate for Payer: Health Management Network Commercial	$4,148.00
Rate for Payer: Humana Medicare	$3,708.80
Rate for Payer: Kaiser Permanente Commercial	$4,392.00
Rate for Payer: Kaiser Permanente Medicaid	$2,488.80
Rate for Payer: Kaiser Permanente Medicare	$3,708.80
Rate for Payer: MDX Hawaii PPO	$4,733.60
Rate for Payer: Ohana Health Plan Medicaid	$3,708.80
Rate for Payer: Ohana Health Plan Medicare	$3,708.80
Rate for Payer: UnitedHealthcare Medicare	$3,708.80
Rate for Payer: University Health Alliance Commercial	$2,732.80

BIOLOX FEM HEAD 1365-36-220

Facility

$4,880.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,732.80
Max. Negotiated Rate	$4,733.60
Rate for Payer: Cash Price	$2,928.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,416.00
Rate for Payer: Health Management Network Commercial	$4,148.00
Rate for Payer: Kaiser Permanente Commercial	$4,392.00
Rate for Payer: MDX Hawaii PPO	$4,733.60
Rate for Payer: University Health Alliance Commercial	$2,732.80

BIOLOX FEMORAL HEAD 6570-0-032

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BIOLOX FEMORAL HEAD 6570-0-032

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$2,054.28
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$2,270.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,054.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$2,054.28
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$2,054.28
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$2,054.28
Rate for Payer: Ohana Health Plan Medicare	$2,054.28
Rate for Payer: UnitedHealthcare Medicare	$2,054.28
Rate for Payer: University Health Alliance Commercial	$1,513.68

BIOLOX V40 FEM HEAD 6570-0-132

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$2,054.28
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$2,270.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,054.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$2,054.28
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$2,054.28
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$2,054.28
Rate for Payer: Ohana Health Plan Medicare	$2,054.28
Rate for Payer: UnitedHealthcare Medicare	$2,054.28
Rate for Payer: University Health Alliance Commercial	$1,513.68

BIOLOX V40 FEM HEAD 6570-0-132

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

BIOLX DLTA FEM #00-8775-036-04

Facility

$4,270.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,135.00
Max. Negotiated Rate	$4,141.90
Rate for Payer: AlohaCare Medicaid	$2,135.00
Rate for Payer: AlohaCare Medicare	$3,245.20
Rate for Payer: Cash Price	$2,562.00
Rate for Payer: Devoted Health Medicare	$3,586.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,245.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,989.00
Rate for Payer: Health Management Network Commercial	$3,629.50
Rate for Payer: Humana Medicare	$3,245.20
Rate for Payer: Kaiser Permanente Commercial	$3,843.00
Rate for Payer: Kaiser Permanente Medicaid	$2,177.70
Rate for Payer: Kaiser Permanente Medicare	$3,245.20
Rate for Payer: MDX Hawaii PPO	$4,141.90
Rate for Payer: Ohana Health Plan Medicaid	$3,245.20
Rate for Payer: Ohana Health Plan Medicare	$3,245.20
Rate for Payer: UnitedHealthcare Medicare	$3,245.20
Rate for Payer: University Health Alliance Commercial	$2,391.20

BIOLX DLTA FEM #00-8775-036-04

Facility

$4,270.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,391.20
Max. Negotiated Rate	$4,141.90
Rate for Payer: Cash Price	$2,562.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,989.00
Rate for Payer: Health Management Network Commercial	$3,629.50
Rate for Payer: Kaiser Permanente Commercial	$3,843.00
Rate for Payer: MDX Hawaii PPO	$4,141.90
Rate for Payer: University Health Alliance Commercial	$2,391.20

BIOMONITOR III 436066

Facility

$11,700.00

Service Code	HCPCS C1764
Hospital Revenue Code	278
Min. Negotiated Rate	$5,850.00
Max. Negotiated Rate	$11,349.00
Rate for Payer: AlohaCare Medicaid	$5,850.00
Rate for Payer: AlohaCare Medicare	$8,892.00
Rate for Payer: Cash Price	$7,020.00
Rate for Payer: Devoted Health Medicare	$9,828.00
Rate for Payer: Hawaii Medical Service Association Medicare	$8,892.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,190.00
Rate for Payer: Health Management Network Commercial	$9,945.00
Rate for Payer: Humana Medicare	$8,892.00
Rate for Payer: Kaiser Permanente Commercial	$10,530.00
Rate for Payer: Kaiser Permanente Medicaid	$5,967.00
Rate for Payer: Kaiser Permanente Medicare	$8,892.00
Rate for Payer: MDX Hawaii PPO	$11,349.00
Rate for Payer: Ohana Health Plan Medicaid	$8,892.00
Rate for Payer: Ohana Health Plan Medicare	$8,892.00
Rate for Payer: UnitedHealthcare Medicare	$8,892.00
Rate for Payer: University Health Alliance Commercial	$6,552.00

BIOMONITOR III 436066

Facility

$11,700.00

Service Code	HCPCS C1764
Hospital Revenue Code	278
Min. Negotiated Rate	$6,552.00
Max. Negotiated Rate	$11,349.00
Rate for Payer: Cash Price	$7,020.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,190.00
Rate for Payer: Health Management Network Commercial	$9,945.00
Rate for Payer: Kaiser Permanente Commercial	$10,530.00
Rate for Payer: MDX Hawaii PPO	$11,349.00
Rate for Payer: University Health Alliance Commercial	$6,552.00

BIOPREP PREP KIT 0206-710-000

Facility

$408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$228.48
Max. Negotiated Rate	$395.76
Rate for Payer: Cash Price	$244.80
Rate for Payer: Hawaii Western Management Group Commercial	$285.60
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: MDX Hawaii PPO	$395.76
Rate for Payer: University Health Alliance Commercial	$228.48

BIOPREP PREP KIT 0206-710-000

Facility

$408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$395.76
Rate for Payer: AlohaCare Medicaid	$204.00
Rate for Payer: AlohaCare Medicare	$310.08
Rate for Payer: Cash Price	$244.80
Rate for Payer: Devoted Health Medicare	$342.72
Rate for Payer: Hawaii Medical Service Association Medicare	$310.08
Rate for Payer: Hawaii Western Management Group Commercial	$285.60
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Humana Medicare	$310.08
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: Kaiser Permanente Medicaid	$208.08
Rate for Payer: Kaiser Permanente Medicare	$310.08
Rate for Payer: MDX Hawaii PPO	$395.76
Rate for Payer: Ohana Health Plan Medicaid	$310.08
Rate for Payer: Ohana Health Plan Medicare	$310.08
Rate for Payer: UnitedHealthcare Medicare	$310.08
Rate for Payer: University Health Alliance Commercial	$228.48

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$47,830.64

Service Code	MSDRG 478
Min. Negotiated Rate	$47,830.64
Max. Negotiated Rate	$47,830.64
Rate for Payer: Hawaii Medical Service Association Commercial	$47,830.64

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$47,830.64

Service Code	MSDRG 477
Min. Negotiated Rate	$47,830.64
Max. Negotiated Rate	$47,830.64
Rate for Payer: Hawaii Medical Service Association Commercial	$47,830.64

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$47,830.64

Service Code	MSDRG 479
Min. Negotiated Rate	$47,830.64
Max. Negotiated Rate	$47,830.64
Rate for Payer: Hawaii Medical Service Association Commercial	$47,830.64

BIOPSY MAX-CORE 18X25 MC1825

Facility

$191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$95.50
Max. Negotiated Rate	$185.27
Rate for Payer: AlohaCare Medicaid	$95.50
Rate for Payer: AlohaCare Medicare	$145.16
Rate for Payer: Cash Price	$114.60
Rate for Payer: Devoted Health Medicare	$160.44
Rate for Payer: Hawaii Medical Service Association Medicare	$145.16
Rate for Payer: Hawaii Western Management Group Commercial	$181.45
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Humana Medicare	$145.16
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: Kaiser Permanente Medicaid	$97.41
Rate for Payer: Kaiser Permanente Medicare	$145.16
Rate for Payer: MDX Hawaii PPO	$185.27
Rate for Payer: Ohana Health Plan Medicaid	$145.16
Rate for Payer: Ohana Health Plan Medicare	$145.16
Rate for Payer: UnitedHealthcare Medicare	$145.16
Rate for Payer: University Health Alliance Commercial	$139.22

BIOPSY MAX-CORE 18X25 MC1825

Facility

$191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$114.60
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: MDX Hawaii PPO	$185.27

BIO-SUTURE KIT #AR-1934-24DS

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75

BIO-SUTURE KIT #AR-1934-24DS

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$665.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$735.00
Rate for Payer: Hawaii Medical Service Association Medicare	$665.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$665.00
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$665.00
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$665.00
Rate for Payer: Ohana Health Plan Medicare	$665.00
Rate for Payer: UnitedHealthcare Medicare	$665.00
Rate for Payer: University Health Alliance Commercial	$637.79

BIPOLAR 39X22 00-5001-039-22

Facility

$875.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$665.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$735.00
Rate for Payer: Hawaii Medical Service Association Medicare	$665.00
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$665.00
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$665.00
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$665.00
Rate for Payer: Ohana Health Plan Medicare	$665.00
Rate for Payer: UnitedHealthcare Medicare	$665.00
Rate for Payer: University Health Alliance Commercial	$490.00

BIPOLAR 39X22 00-5001-039-22

Facility

$875.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

Know your out-of-pocket cost for care.

All Charges