Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

BLADE MICRODEBRIDER SINUS

Facility

$945.00

Hospital Revenue Code	272
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$916.65
Rate for Payer: AlohaCare Medicaid	$472.50
Rate for Payer: AlohaCare Medicare	$718.20
Rate for Payer: Cash Price	$567.00
Rate for Payer: Devoted Health Medicare	$793.80
Rate for Payer: Hawaii Medical Service Association Medicare	$718.20
Rate for Payer: Hawaii Western Management Group Commercial	$897.75
Rate for Payer: Health Management Network Commercial	$803.25
Rate for Payer: Humana Medicare	$718.20
Rate for Payer: Kaiser Permanente Commercial	$850.50
Rate for Payer: Kaiser Permanente Medicaid	$481.95
Rate for Payer: Kaiser Permanente Medicare	$718.20
Rate for Payer: MDX Hawaii PPO	$916.65
Rate for Payer: Ohana Health Plan Medicaid	$718.20
Rate for Payer: Ohana Health Plan Medicare	$718.20
Rate for Payer: UnitedHealthcare Medicare	$718.20
Rate for Payer: University Health Alliance Commercial	$688.81

BLADE MINI SAW 2296-003-511

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$90.00
Rate for Payer: AlohaCare Medicare	$136.80
Rate for Payer: Cash Price	$108.00
Rate for Payer: Devoted Health Medicare	$151.20
Rate for Payer: Hawaii Medical Service Association Medicare	$136.80
Rate for Payer: Hawaii Western Management Group Commercial	$171.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$136.80
Rate for Payer: Kaiser Permanente Commercial	$162.00
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$136.80
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$136.80
Rate for Payer: Ohana Health Plan Medicare	$136.80
Rate for Payer: UnitedHealthcare Medicare	$136.80
Rate for Payer: University Health Alliance Commercial	$131.20

BLADE MINI SAW 2296-003-511

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Kaiser Permanente Commercial	$162.00
Rate for Payer: MDX Hawaii PPO	$174.60

BLADE OSTEOTOME 00-9986-21-21

Facility

$454.00

Hospital Revenue Code	272
Min. Negotiated Rate	$227.00
Max. Negotiated Rate	$440.38
Rate for Payer: AlohaCare Medicaid	$227.00
Rate for Payer: AlohaCare Medicare	$345.04
Rate for Payer: Cash Price	$272.40
Rate for Payer: Devoted Health Medicare	$381.36
Rate for Payer: Hawaii Medical Service Association Medicare	$345.04
Rate for Payer: Hawaii Western Management Group Commercial	$431.30
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Humana Medicare	$345.04
Rate for Payer: Kaiser Permanente Commercial	$408.60
Rate for Payer: Kaiser Permanente Medicaid	$231.54
Rate for Payer: Kaiser Permanente Medicare	$345.04
Rate for Payer: MDX Hawaii PPO	$440.38
Rate for Payer: Ohana Health Plan Medicaid	$345.04
Rate for Payer: Ohana Health Plan Medicare	$345.04
Rate for Payer: UnitedHealthcare Medicare	$345.04
Rate for Payer: University Health Alliance Commercial	$330.92

BLADE OSTEOTOME 00-9986-21-21

Facility

$454.00

Hospital Revenue Code	272
Min. Negotiated Rate	$385.90
Max. Negotiated Rate	$440.38
Rate for Payer: Cash Price	$272.40
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Kaiser Permanente Commercial	$408.60
Rate for Payer: MDX Hawaii PPO	$440.38

BLADE SAG DUAL 4125-127-100

Facility

$234.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: MDX Hawaii PPO	$226.98

BLADE SAG DUAL 4125-127-100

Facility

$234.00

Hospital Revenue Code	272
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$226.98
Rate for Payer: AlohaCare Medicaid	$117.00
Rate for Payer: AlohaCare Medicare	$177.84
Rate for Payer: Cash Price	$140.40
Rate for Payer: Devoted Health Medicare	$196.56
Rate for Payer: Hawaii Medical Service Association Medicare	$177.84
Rate for Payer: Hawaii Western Management Group Commercial	$222.30
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Humana Medicare	$177.84
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: Kaiser Permanente Medicaid	$119.34
Rate for Payer: Kaiser Permanente Medicare	$177.84
Rate for Payer: MDX Hawaii PPO	$226.98
Rate for Payer: Ohana Health Plan Medicaid	$177.84
Rate for Payer: Ohana Health Plan Medicare	$177.84
Rate for Payer: UnitedHealthcare Medicare	$177.84
Rate for Payer: University Health Alliance Commercial	$170.56

BLADE SAGITTAL 2296-003-109S2

Facility

$316.00

Hospital Revenue Code	272
Min. Negotiated Rate	$158.00
Max. Negotiated Rate	$306.52
Rate for Payer: AlohaCare Medicaid	$158.00
Rate for Payer: AlohaCare Medicare	$240.16
Rate for Payer: Cash Price	$189.60
Rate for Payer: Devoted Health Medicare	$265.44
Rate for Payer: Hawaii Medical Service Association Medicare	$240.16
Rate for Payer: Hawaii Western Management Group Commercial	$300.20
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Humana Medicare	$240.16
Rate for Payer: Kaiser Permanente Commercial	$284.40
Rate for Payer: Kaiser Permanente Medicaid	$161.16
Rate for Payer: Kaiser Permanente Medicare	$240.16
Rate for Payer: MDX Hawaii PPO	$306.52
Rate for Payer: Ohana Health Plan Medicaid	$240.16
Rate for Payer: Ohana Health Plan Medicare	$240.16
Rate for Payer: UnitedHealthcare Medicare	$240.16
Rate for Payer: University Health Alliance Commercial	$230.33

BLADE SAGITTAL 2296-003-109S2

Facility

$316.00

Hospital Revenue Code	272
Min. Negotiated Rate	$268.60
Max. Negotiated Rate	$306.52
Rate for Payer: Cash Price	$189.60
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Kaiser Permanente Commercial	$284.40
Rate for Payer: MDX Hawaii PPO	$306.52

BLADE SAGITTAL 2296-003-114

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Kaiser Permanente Commercial	$162.00
Rate for Payer: MDX Hawaii PPO	$174.60

BLADE SAGITTAL 2296-003-114

Facility

$180.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$90.00
Rate for Payer: AlohaCare Medicare	$136.80
Rate for Payer: Cash Price	$108.00
Rate for Payer: Devoted Health Medicare	$151.20
Rate for Payer: Hawaii Medical Service Association Medicare	$136.80
Rate for Payer: Hawaii Western Management Group Commercial	$171.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$136.80
Rate for Payer: Kaiser Permanente Commercial	$162.00
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$136.80
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$136.80
Rate for Payer: Ohana Health Plan Medicare	$136.80
Rate for Payer: UnitedHealthcare Medicare	$136.80
Rate for Payer: University Health Alliance Commercial	$131.20

BLADE SAGITTAL 2296-003-225

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$161.50
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: MDX Hawaii PPO	$184.30

BLADE SAGITTAL 2296-003-225

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$184.30
Rate for Payer: AlohaCare Medicaid	$95.00
Rate for Payer: AlohaCare Medicare	$144.40
Rate for Payer: Cash Price	$114.00
Rate for Payer: Devoted Health Medicare	$159.60
Rate for Payer: Hawaii Medical Service Association Medicare	$144.40
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Humana Medicare	$144.40
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: Kaiser Permanente Medicare	$144.40
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: Ohana Health Plan Medicaid	$144.40
Rate for Payer: Ohana Health Plan Medicare	$144.40
Rate for Payer: UnitedHealthcare Medicare	$144.40
Rate for Payer: University Health Alliance Commercial	$138.49

BLADE SAGITTAL 4118-127-100

Facility

$78.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

BLADE SAGITTAL 4118-127-100

Facility

$78.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: AlohaCare Medicare	$59.28
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$65.52
Rate for Payer: Hawaii Medical Service Association Medicare	$59.28
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$59.28
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$59.28
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$59.28
Rate for Payer: Ohana Health Plan Medicare	$59.28
Rate for Payer: UnitedHealthcare Medicare	$59.28
Rate for Payer: University Health Alliance Commercial	$56.85

BLADE SAGITTAL 6118-089-075

Facility

$240.00

Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$232.80
Rate for Payer: AlohaCare Medicaid	$120.00
Rate for Payer: AlohaCare Medicare	$182.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Devoted Health Medicare	$201.60
Rate for Payer: Hawaii Medical Service Association Medicare	$182.40
Rate for Payer: Hawaii Western Management Group Commercial	$228.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Humana Medicare	$182.40
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: Kaiser Permanente Medicare	$182.40
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: Ohana Health Plan Medicaid	$182.40
Rate for Payer: Ohana Health Plan Medicare	$182.40
Rate for Payer: UnitedHealthcare Medicare	$182.40
Rate for Payer: University Health Alliance Commercial	$174.94

BLADE SAGITTAL 6118-089-075

Facility

$240.00

Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: MDX Hawaii PPO	$232.80

BLADE SAG WIDE

Facility

$155.00

Hospital Revenue Code	272
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$117.80
Rate for Payer: Cash Price	$93.00
Rate for Payer: Devoted Health Medicare	$130.20
Rate for Payer: Hawaii Medical Service Association Medicare	$117.80
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$117.80
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$117.80
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$117.80
Rate for Payer: Ohana Health Plan Medicare	$117.80
Rate for Payer: UnitedHealthcare Medicare	$117.80
Rate for Payer: University Health Alliance Commercial	$112.98

BLADE SAG WIDE

Facility

$155.00

Hospital Revenue Code	272
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

BLADE SAW 0.98IN X 2.76IN

Facility

$104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$100.88
Rate for Payer: AlohaCare Medicaid	$52.00
Rate for Payer: AlohaCare Medicare	$79.04
Rate for Payer: Cash Price	$62.40
Rate for Payer: Devoted Health Medicare	$87.36
Rate for Payer: Hawaii Medical Service Association Medicare	$79.04
Rate for Payer: Hawaii Western Management Group Commercial	$98.80
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Humana Medicare	$79.04
Rate for Payer: Kaiser Permanente Commercial	$93.60
Rate for Payer: Kaiser Permanente Medicaid	$53.04
Rate for Payer: Kaiser Permanente Medicare	$79.04
Rate for Payer: MDX Hawaii PPO	$100.88
Rate for Payer: Ohana Health Plan Medicaid	$79.04
Rate for Payer: Ohana Health Plan Medicare	$79.04
Rate for Payer: UnitedHealthcare Medicare	$79.04
Rate for Payer: University Health Alliance Commercial	$75.81

BLADE SAW 0.98IN X 2.76IN

Facility

$104.00

Hospital Revenue Code	272
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Kaiser Permanente Commercial	$93.60
Rate for Payer: MDX Hawaii PPO	$100.88

BLADE SAW 105X25 6425-127-105

Facility

$1,120.00

Hospital Revenue Code	272
Min. Negotiated Rate	$560.00
Max. Negotiated Rate	$1,086.40
Rate for Payer: AlohaCare Medicaid	$560.00
Rate for Payer: AlohaCare Medicare	$851.20
Rate for Payer: Cash Price	$672.00
Rate for Payer: Devoted Health Medicare	$940.80
Rate for Payer: Hawaii Medical Service Association Medicare	$851.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,064.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Humana Medicare	$851.20
Rate for Payer: Kaiser Permanente Commercial	$1,008.00
Rate for Payer: Kaiser Permanente Medicaid	$571.20
Rate for Payer: Kaiser Permanente Medicare	$851.20
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: Ohana Health Plan Medicaid	$851.20
Rate for Payer: Ohana Health Plan Medicare	$851.20
Rate for Payer: UnitedHealthcare Medicare	$851.20
Rate for Payer: University Health Alliance Commercial	$816.37

BLADE SAW 105X25 6425-127-105

Facility

$1,120.00

Hospital Revenue Code	272
Min. Negotiated Rate	$952.00
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Kaiser Permanente Commercial	$1,008.00
Rate for Payer: MDX Hawaii PPO	$1,086.40

BLADE SAW BR4125-127-100

Facility

$128.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$124.16
Rate for Payer: AlohaCare Medicaid	$64.00
Rate for Payer: AlohaCare Medicare	$97.28
Rate for Payer: Cash Price	$76.80
Rate for Payer: Devoted Health Medicare	$107.52
Rate for Payer: Hawaii Medical Service Association Medicare	$97.28
Rate for Payer: Hawaii Western Management Group Commercial	$121.60
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Humana Medicare	$97.28
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: Kaiser Permanente Medicare	$97.28
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: Ohana Health Plan Medicaid	$97.28
Rate for Payer: Ohana Health Plan Medicare	$97.28
Rate for Payer: UnitedHealthcare Medicare	$97.28
Rate for Payer: University Health Alliance Commercial	$93.30

BLADE SAW BR4125-127-100

Facility

$128.00

Hospital Revenue Code	272
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$76.80
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: MDX Hawaii PPO	$124.16

Know your out-of-pocket cost for care.

All Charges