Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

BLADE SAW CUT D 6720-127-105

Facility

$1,276.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,084.60
Max. Negotiated Rate	$1,237.72
Rate for Payer: Cash Price	$765.60
Rate for Payer: Health Management Network Commercial	$1,084.60
Rate for Payer: Kaiser Permanente Commercial	$1,148.40
Rate for Payer: MDX Hawaii PPO	$1,237.72

BLADE SAW CUT D 6720-127-105

Facility

$1,276.00

Hospital Revenue Code	272
Min. Negotiated Rate	$638.00
Max. Negotiated Rate	$1,237.72
Rate for Payer: AlohaCare Medicaid	$638.00
Rate for Payer: AlohaCare Medicare	$969.76
Rate for Payer: Cash Price	$765.60
Rate for Payer: Devoted Health Medicare	$1,071.84
Rate for Payer: Hawaii Medical Service Association Medicare	$969.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,212.20
Rate for Payer: Health Management Network Commercial	$1,084.60
Rate for Payer: Humana Medicare	$969.76
Rate for Payer: Kaiser Permanente Commercial	$1,148.40
Rate for Payer: Kaiser Permanente Medicaid	$650.76
Rate for Payer: Kaiser Permanente Medicare	$969.76
Rate for Payer: MDX Hawaii PPO	$1,237.72
Rate for Payer: Ohana Health Plan Medicaid	$969.76
Rate for Payer: Ohana Health Plan Medicare	$969.76
Rate for Payer: UnitedHealthcare Medicare	$969.76
Rate for Payer: University Health Alliance Commercial	$930.08

BLADE SAW SAGITTAL 100MM 1.14M

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 SAGITTAL 100MM 1.14M

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

BLADE SHAVER 2MM

Facility

$1,958.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,664.30
Max. Negotiated Rate	$1,899.26
Rate for Payer: Cash Price	$1,174.80
Rate for Payer: Health Management Network Commercial	$1,664.30
Rate for Payer: Kaiser Permanente Commercial	$1,762.20
Rate for Payer: MDX Hawaii PPO	$1,899.26

BLADE SHAVER 2MM

Facility

$1,958.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$979.00
Max. Negotiated Rate	$1,899.26
Rate for Payer: AlohaCare Medicaid	$979.00
Rate for Payer: AlohaCare Medicare	$1,488.08
Rate for Payer: Cash Price	$1,174.80
Rate for Payer: Devoted Health Medicare	$1,644.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,488.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,860.10
Rate for Payer: Health Management Network Commercial	$1,664.30
Rate for Payer: Humana Medicare	$1,488.08
Rate for Payer: Kaiser Permanente Commercial	$1,762.20
Rate for Payer: Kaiser Permanente Medicaid	$998.58
Rate for Payer: Kaiser Permanente Medicare	$1,488.08
Rate for Payer: MDX Hawaii PPO	$1,899.26
Rate for Payer: Ohana Health Plan Medicaid	$1,488.08
Rate for Payer: Ohana Health Plan Medicare	$1,488.08
Rate for Payer: UnitedHealthcare Medicare	$1,488.08
Rate for Payer: University Health Alliance Commercial	$1,427.19

BLADE SHAVER 3MM STR

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$459.50
Max. Negotiated Rate	$891.43
Rate for Payer: AlohaCare Medicaid	$459.50
Rate for Payer: AlohaCare Medicare	$698.44
Rate for Payer: Cash Price	$551.40
Rate for Payer: Devoted Health Medicare	$771.96
Rate for Payer: Hawaii Medical Service Association Medicare	$698.44
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Humana Medicare	$698.44
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: Kaiser Permanente Medicare	$698.44
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: Ohana Health Plan Medicaid	$698.44
Rate for Payer: Ohana Health Plan Medicare	$698.44
Rate for Payer: UnitedHealthcare Medicare	$698.44
Rate for Payer: University Health Alliance Commercial	$669.86

BLADE SHAVER 3MM STR

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: MDX Hawaii PPO	$891.43

BLADE SHAVER 4MM 12 DEG

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: MDX Hawaii PPO	$891.43

BLADE SHAVER 4MM 12 DEG

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$459.50
Max. Negotiated Rate	$891.43
Rate for Payer: AlohaCare Medicaid	$459.50
Rate for Payer: AlohaCare Medicare	$698.44
Rate for Payer: Cash Price	$551.40
Rate for Payer: Devoted Health Medicare	$771.96
Rate for Payer: Hawaii Medical Service Association Medicare	$698.44
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Humana Medicare	$698.44
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: Kaiser Permanente Medicare	$698.44
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: Ohana Health Plan Medicaid	$698.44
Rate for Payer: Ohana Health Plan Medicare	$698.44
Rate for Payer: UnitedHealthcare Medicare	$698.44
Rate for Payer: University Health Alliance Commercial	$669.86

BLADE SHAVER 4MM 40DEG

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$459.50
Max. Negotiated Rate	$891.43
Rate for Payer: AlohaCare Medicaid	$459.50
Rate for Payer: AlohaCare Medicare	$698.44
Rate for Payer: Cash Price	$551.40
Rate for Payer: Devoted Health Medicare	$771.96
Rate for Payer: Hawaii Medical Service Association Medicare	$698.44
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Humana Medicare	$698.44
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: Kaiser Permanente Medicare	$698.44
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: Ohana Health Plan Medicaid	$698.44
Rate for Payer: Ohana Health Plan Medicare	$698.44
Rate for Payer: UnitedHealthcare Medicare	$698.44
Rate for Payer: University Health Alliance Commercial	$669.86

BLADE SHAVER 4MM 40DEG

Facility

$845.00

Hospital Revenue Code	270
Min. Negotiated Rate	$718.25
Max. Negotiated Rate	$819.65
Rate for Payer: Cash Price	$507.00
Rate for Payer: Health Management Network Commercial	$718.25
Rate for Payer: Kaiser Permanente Commercial	$760.50
Rate for Payer: MDX Hawaii PPO	$819.65

BLADE SHAVER 4MM 40DEG

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: MDX Hawaii PPO	$891.43

BLADE SHAVER 4MM 40DEG

Facility

$845.00

Hospital Revenue Code	270
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$819.65
Rate for Payer: AlohaCare Medicaid	$422.50
Rate for Payer: AlohaCare Medicare	$642.20
Rate for Payer: Cash Price	$507.00
Rate for Payer: Devoted Health Medicare	$709.80
Rate for Payer: Hawaii Medical Service Association Medicare	$642.20
Rate for Payer: Hawaii Western Management Group Commercial	$802.75
Rate for Payer: Health Management Network Commercial	$718.25
Rate for Payer: Humana Medicare	$642.20
Rate for Payer: Kaiser Permanente Commercial	$760.50
Rate for Payer: Kaiser Permanente Medicaid	$430.95
Rate for Payer: Kaiser Permanente Medicare	$642.20
Rate for Payer: MDX Hawaii PPO	$819.65
Rate for Payer: Ohana Health Plan Medicaid	$642.20
Rate for Payer: Ohana Health Plan Medicare	$642.20
Rate for Payer: UnitedHealthcare Medicare	$642.20
Rate for Payer: University Health Alliance Commercial	$615.92

BLADE SHAVER 4MM 60DEG

Facility

$845.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$718.25
Max. Negotiated Rate	$819.65
Rate for Payer: Cash Price	$507.00
Rate for Payer: Health Management Network Commercial	$718.25
Rate for Payer: Kaiser Permanente Commercial	$760.50
Rate for Payer: MDX Hawaii PPO	$819.65

BLADE SHAVER 4MM 60DEG

Facility

$845.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$819.65
Rate for Payer: AlohaCare Medicaid	$422.50
Rate for Payer: AlohaCare Medicare	$642.20
Rate for Payer: Cash Price	$507.00
Rate for Payer: Devoted Health Medicare	$709.80
Rate for Payer: Hawaii Medical Service Association Medicare	$642.20
Rate for Payer: Hawaii Western Management Group Commercial	$802.75
Rate for Payer: Health Management Network Commercial	$718.25
Rate for Payer: Humana Medicare	$642.20
Rate for Payer: Kaiser Permanente Commercial	$760.50
Rate for Payer: Kaiser Permanente Medicaid	$430.95
Rate for Payer: Kaiser Permanente Medicare	$642.20
Rate for Payer: MDX Hawaii PPO	$819.65
Rate for Payer: Ohana Health Plan Medicaid	$642.20
Rate for Payer: Ohana Health Plan Medicare	$642.20
Rate for Payer: UnitedHealthcare Medicare	$642.20
Rate for Payer: University Health Alliance Commercial	$615.92

BLADE SHAVER 4MM STR

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$459.50
Max. Negotiated Rate	$891.43
Rate for Payer: AlohaCare Medicaid	$459.50
Rate for Payer: AlohaCare Medicare	$698.44
Rate for Payer: Cash Price	$551.40
Rate for Payer: Devoted Health Medicare	$771.96
Rate for Payer: Hawaii Medical Service Association Medicare	$698.44
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Humana Medicare	$698.44
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: Kaiser Permanente Medicare	$698.44
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: Ohana Health Plan Medicaid	$698.44
Rate for Payer: Ohana Health Plan Medicare	$698.44
Rate for Payer: UnitedHealthcare Medicare	$698.44
Rate for Payer: University Health Alliance Commercial	$669.86

BLADE SHAVER 4MM STR

Facility

$919.00

Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: MDX Hawaii PPO	$891.43

BLADE SHAVER STD A 4MM 0DEG

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Kaiser Permanente Commercial	$440.10
Rate for Payer: MDX Hawaii PPO	$474.33

BLADE SHAVER STD A 4MM 0DEG

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$244.50
Max. Negotiated Rate	$474.33
Rate for Payer: AlohaCare Medicaid	$244.50
Rate for Payer: AlohaCare Medicare	$371.64
Rate for Payer: Cash Price	$293.40
Rate for Payer: Devoted Health Medicare	$410.76
Rate for Payer: Hawaii Medical Service Association Medicare	$371.64
Rate for Payer: Hawaii Western Management Group Commercial	$464.55
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Humana Medicare	$371.64
Rate for Payer: Kaiser Permanente Commercial	$440.10
Rate for Payer: Kaiser Permanente Medicaid	$249.39
Rate for Payer: Kaiser Permanente Medicare	$371.64
Rate for Payer: MDX Hawaii PPO	$474.33
Rate for Payer: Ohana Health Plan Medicaid	$371.64
Rate for Payer: Ohana Health Plan Medicare	$371.64
Rate for Payer: UnitedHealthcare Medicare	$371.64
Rate for Payer: University Health Alliance Commercial	$356.43

BLADE SMR BIPOLAR SHAVER A

Facility

$641.00

Hospital Revenue Code	272
Min. Negotiated Rate	$320.50
Max. Negotiated Rate	$621.77
Rate for Payer: AlohaCare Medicaid	$320.50
Rate for Payer: AlohaCare Medicare	$487.16
Rate for Payer: Cash Price	$384.60
Rate for Payer: Devoted Health Medicare	$538.44
Rate for Payer: Hawaii Medical Service Association Medicare	$487.16
Rate for Payer: Hawaii Western Management Group Commercial	$608.95
Rate for Payer: Health Management Network Commercial	$544.85
Rate for Payer: Humana Medicare	$487.16
Rate for Payer: Kaiser Permanente Commercial	$576.90
Rate for Payer: Kaiser Permanente Medicaid	$326.91
Rate for Payer: Kaiser Permanente Medicare	$487.16
Rate for Payer: MDX Hawaii PPO	$621.77
Rate for Payer: Ohana Health Plan Medicaid	$487.16
Rate for Payer: Ohana Health Plan Medicare	$487.16
Rate for Payer: UnitedHealthcare Medicare	$487.16
Rate for Payer: University Health Alliance Commercial	$467.22

BLADE SMR BIPOLAR SHAVER A

Facility

$641.00

Hospital Revenue Code	272
Min. Negotiated Rate	$544.85
Max. Negotiated Rate	$621.77
Rate for Payer: Cash Price	$384.60
Rate for Payer: Health Management Network Commercial	$544.85
Rate for Payer: Kaiser Permanente Commercial	$576.90
Rate for Payer: MDX Hawaii PPO	$621.77

BLADE SPIRAL 10MM TI END CAP

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
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	$784.00
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	$627.20

BLADE SPIRAL 10MM TI END CAP

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$627.20
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Hawaii Western Management Group Commercial	$784.00
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
Rate for Payer: University Health Alliance Commercial	$627.20

BLADE SPIRAL ARM #03.010.055

Facility

$3,034.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,578.90
Max. Negotiated Rate	$2,942.98
Rate for Payer: Cash Price	$1,820.40
Rate for Payer: Health Management Network Commercial	$2,578.90
Rate for Payer: Kaiser Permanente Commercial	$2,730.60
Rate for Payer: MDX Hawaii PPO	$2,942.98

Know your out-of-pocket cost for care.

All Charges