Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$15,975.15

Service Code	MSDRG 814
Min. Negotiated Rate	$15,975.15
Max. Negotiated Rate	$15,975.15
Rate for Payer: Hawaii Medical Service Association Commercial	$15,975.15

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$11,685.09

Service Code	MSDRG 816
Min. Negotiated Rate	$11,685.09
Max. Negotiated Rate	$11,685.09
Rate for Payer: Hawaii Medical Service Association Commercial	$11,685.09

RETRACT ENDO PADDLE 12MM

Facility

$1,024.00

Hospital Revenue Code	272
Min. Negotiated Rate	$870.40
Max. Negotiated Rate	$993.28
Rate for Payer: Cash Price	$614.40
Rate for Payer: Health Management Network Commercial	$870.40
Rate for Payer: Kaiser Permanente Commercial	$921.60
Rate for Payer: MDX Hawaii PPO	$993.28

RETRACT ENDO PADDLE 12MM

Facility

$1,024.00

Hospital Revenue Code	272
Min. Negotiated Rate	$512.00
Max. Negotiated Rate	$993.28
Rate for Payer: AlohaCare Medicaid	$512.00
Rate for Payer: AlohaCare Medicare	$778.24
Rate for Payer: Cash Price	$614.40
Rate for Payer: Devoted Health Medicare	$860.16
Rate for Payer: Hawaii Medical Service Association Medicare	$778.24
Rate for Payer: Hawaii Western Management Group Commercial	$972.80
Rate for Payer: Health Management Network Commercial	$870.40
Rate for Payer: Humana Medicare	$778.24
Rate for Payer: Kaiser Permanente Commercial	$921.60
Rate for Payer: Kaiser Permanente Medicaid	$522.24
Rate for Payer: Kaiser Permanente Medicare	$778.24
Rate for Payer: MDX Hawaii PPO	$993.28
Rate for Payer: Ohana Health Plan Medicaid	$778.24
Rate for Payer: Ohana Health Plan Medicare	$778.24
Rate for Payer: UnitedHealthcare Medicare	$778.24
Rate for Payer: University Health Alliance Commercial	$746.39

RETRACTOR ALEXIS-O LG

Facility

$344.00

Hospital Revenue Code	272
Min. Negotiated Rate	$172.00
Max. Negotiated Rate	$333.68
Rate for Payer: AlohaCare Medicaid	$172.00
Rate for Payer: AlohaCare Medicare	$261.44
Rate for Payer: Cash Price	$206.40
Rate for Payer: Devoted Health Medicare	$288.96
Rate for Payer: Hawaii Medical Service Association Medicare	$261.44
Rate for Payer: Hawaii Western Management Group Commercial	$326.80
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: Humana Medicare	$261.44
Rate for Payer: Kaiser Permanente Commercial	$309.60
Rate for Payer: Kaiser Permanente Medicaid	$175.44
Rate for Payer: Kaiser Permanente Medicare	$261.44
Rate for Payer: MDX Hawaii PPO	$333.68
Rate for Payer: Ohana Health Plan Medicaid	$261.44
Rate for Payer: Ohana Health Plan Medicare	$261.44
Rate for Payer: UnitedHealthcare Medicare	$261.44
Rate for Payer: University Health Alliance Commercial	$250.74

RETRACTOR ALEXIS-O LG

Facility

$344.00

Hospital Revenue Code	272
Min. Negotiated Rate	$292.40
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$206.40
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: Kaiser Permanente Commercial	$309.60
Rate for Payer: MDX Hawaii PPO	$333.68

RETRACTOR ALEXIS-O MED

Facility

$248.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$124.00
Rate for Payer: AlohaCare Medicare	$188.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Devoted Health Medicare	$208.32
Rate for Payer: Hawaii Medical Service Association Medicare	$188.48
Rate for Payer: Hawaii Western Management Group Commercial	$235.60
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$188.48
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$188.48
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$188.48
Rate for Payer: Ohana Health Plan Medicare	$188.48
Rate for Payer: UnitedHealthcare Medicare	$188.48
Rate for Payer: University Health Alliance Commercial	$180.77

RETRACTOR ALEXIS-O MED

Facility

$248.00

Hospital Revenue Code	272
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$148.80
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: MDX Hawaii PPO	$240.56

RETRACTOR ALEXIS-O SM

Facility

$248.00

Hospital Revenue Code	272
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$148.80
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: MDX Hawaii PPO	$240.56

RETRACTOR ALEXIS-O SM

Facility

$248.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$124.00
Rate for Payer: AlohaCare Medicare	$188.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Devoted Health Medicare	$208.32
Rate for Payer: Hawaii Medical Service Association Medicare	$188.48
Rate for Payer: Hawaii Western Management Group Commercial	$235.60
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$188.48
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$188.48
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$188.48
Rate for Payer: Ohana Health Plan Medicare	$188.48
Rate for Payer: UnitedHealthcare Medicare	$188.48
Rate for Payer: University Health Alliance Commercial	$180.77

RETRACTOR ALEXIS-O XLG

Facility

$413.00

Hospital Revenue Code	272
Min. Negotiated Rate	$351.05
Max. Negotiated Rate	$400.61
Rate for Payer: Cash Price	$247.80
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: MDX Hawaii PPO	$400.61

RETRACTOR ALEXIS-O XLG

Facility

$413.00

Hospital Revenue Code	272
Min. Negotiated Rate	$206.50
Max. Negotiated Rate	$400.61
Rate for Payer: AlohaCare Medicaid	$206.50
Rate for Payer: AlohaCare Medicare	$313.88
Rate for Payer: Cash Price	$247.80
Rate for Payer: Devoted Health Medicare	$346.92
Rate for Payer: Hawaii Medical Service Association Medicare	$313.88
Rate for Payer: Hawaii Western Management Group Commercial	$392.35
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Humana Medicare	$313.88
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: Kaiser Permanente Medicaid	$210.63
Rate for Payer: Kaiser Permanente Medicare	$313.88
Rate for Payer: MDX Hawaii PPO	$400.61
Rate for Payer: Ohana Health Plan Medicaid	$313.88
Rate for Payer: Ohana Health Plan Medicare	$313.88
Rate for Payer: UnitedHealthcare Medicare	$313.88
Rate for Payer: University Health Alliance Commercial	$301.04

RETRACTOR ELASTIC 12MM

Facility

$82.00

Hospital Revenue Code	272
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$79.54
Rate for Payer: AlohaCare Medicaid	$41.00
Rate for Payer: AlohaCare Medicare	$62.32
Rate for Payer: Cash Price	$49.20
Rate for Payer: Devoted Health Medicare	$68.88
Rate for Payer: Hawaii Medical Service Association Medicare	$62.32
Rate for Payer: Hawaii Western Management Group Commercial	$77.90
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Humana Medicare	$62.32
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: Kaiser Permanente Medicare	$62.32
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: Ohana Health Plan Medicaid	$62.32
Rate for Payer: Ohana Health Plan Medicare	$62.32
Rate for Payer: UnitedHealthcare Medicare	$62.32
Rate for Payer: University Health Alliance Commercial	$59.77

RETRACTOR ELASTIC 12MM

Facility

$82.00

Hospital Revenue Code	272
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$49.20
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

RETRACTOR ELASTIC STAYS 5MM

Facility

$85.00

Hospital Revenue Code	272
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$82.45
Rate for Payer: AlohaCare Medicaid	$42.50
Rate for Payer: AlohaCare Medicare	$64.60
Rate for Payer: Cash Price	$51.00
Rate for Payer: Devoted Health Medicare	$71.40
Rate for Payer: Hawaii Medical Service Association Medicare	$64.60
Rate for Payer: Hawaii Western Management Group Commercial	$80.75
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Humana Medicare	$64.60
Rate for Payer: Kaiser Permanente Commercial	$76.50
Rate for Payer: Kaiser Permanente Medicaid	$43.35
Rate for Payer: Kaiser Permanente Medicare	$64.60
Rate for Payer: MDX Hawaii PPO	$82.45
Rate for Payer: Ohana Health Plan Medicaid	$64.60
Rate for Payer: Ohana Health Plan Medicare	$64.60
Rate for Payer: UnitedHealthcare Medicare	$64.60
Rate for Payer: University Health Alliance Commercial	$61.96

RETRACTOR ELASTIC STAYS 5MM

Facility

$85.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Kaiser Permanente Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$82.45

RETRACTOR RING LONE STAR 3715

Facility

$478.00

Hospital Revenue Code	272
Min. Negotiated Rate	$406.30
Max. Negotiated Rate	$463.66
Rate for Payer: Cash Price	$286.80
Rate for Payer: Health Management Network Commercial	$406.30
Rate for Payer: Kaiser Permanente Commercial	$430.20
Rate for Payer: MDX Hawaii PPO	$463.66

RETRACTOR RING LONE STAR 3715

Facility

$478.00

Hospital Revenue Code	272
Min. Negotiated Rate	$239.00
Max. Negotiated Rate	$463.66
Rate for Payer: AlohaCare Medicaid	$239.00
Rate for Payer: AlohaCare Medicare	$363.28
Rate for Payer: Cash Price	$286.80
Rate for Payer: Devoted Health Medicare	$401.52
Rate for Payer: Hawaii Medical Service Association Medicare	$363.28
Rate for Payer: Hawaii Western Management Group Commercial	$454.10
Rate for Payer: Health Management Network Commercial	$406.30
Rate for Payer: Humana Medicare	$363.28
Rate for Payer: Kaiser Permanente Commercial	$430.20
Rate for Payer: Kaiser Permanente Medicaid	$243.78
Rate for Payer: Kaiser Permanente Medicare	$363.28
Rate for Payer: MDX Hawaii PPO	$463.66
Rate for Payer: Ohana Health Plan Medicaid	$363.28
Rate for Payer: Ohana Health Plan Medicare	$363.28
Rate for Payer: UnitedHealthcare Medicare	$363.28
Rate for Payer: University Health Alliance Commercial	$348.41

RETREV 10MM ENDO CATCH

Facility

$201.00

Hospital Revenue Code	272
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$152.76
Rate for Payer: Cash Price	$120.60
Rate for Payer: Devoted Health Medicare	$168.84
Rate for Payer: Hawaii Medical Service Association Medicare	$152.76
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$152.76
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$152.76
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$152.76
Rate for Payer: Ohana Health Plan Medicare	$152.76
Rate for Payer: UnitedHealthcare Medicare	$152.76
Rate for Payer: University Health Alliance Commercial	$146.51

RETREV 10MM ENDO CATCH

Facility

$201.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

RETRIEVAL NET DGN-538-5

Facility

$350.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

RETRIEVAL NET DGN-538-5

Facility

$350.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$175.00
Rate for Payer: AlohaCare Medicare	$266.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$294.00
Rate for Payer: Hawaii Medical Service Association Medicare	$266.00
Rate for Payer: Hawaii Western Management Group Commercial	$332.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$266.00
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$266.00
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$266.00
Rate for Payer: Ohana Health Plan Medicare	$266.00
Rate for Payer: UnitedHealthcare Medicare	$266.00
Rate for Payer: University Health Alliance Commercial	$255.12

RETRIEVER 2.5MM FOREIGN BODY

Facility

$376.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$188.00
Max. Negotiated Rate	$364.72
Rate for Payer: AlohaCare Medicaid	$188.00
Rate for Payer: AlohaCare Medicare	$285.76
Rate for Payer: Cash Price	$225.60
Rate for Payer: Devoted Health Medicare	$315.84
Rate for Payer: Hawaii Medical Service Association Medicare	$285.76
Rate for Payer: Hawaii Western Management Group Commercial	$357.20
Rate for Payer: Health Management Network Commercial	$319.60
Rate for Payer: Humana Medicare	$285.76
Rate for Payer: Kaiser Permanente Commercial	$338.40
Rate for Payer: Kaiser Permanente Medicaid	$191.76
Rate for Payer: Kaiser Permanente Medicare	$285.76
Rate for Payer: MDX Hawaii PPO	$364.72
Rate for Payer: Ohana Health Plan Medicaid	$285.76
Rate for Payer: Ohana Health Plan Medicare	$285.76
Rate for Payer: UnitedHealthcare Medicare	$285.76
Rate for Payer: University Health Alliance Commercial	$274.07

RETRIEVER 2.5MM FOREIGN BODY

Facility

$376.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$319.60
Max. Negotiated Rate	$364.72
Rate for Payer: Cash Price	$225.60
Rate for Payer: Health Management Network Commercial	$319.60
Rate for Payer: Kaiser Permanente Commercial	$338.40
Rate for Payer: MDX Hawaii PPO	$364.72

RETRIEVER 3.0MM ROTH ENDO

Facility

$454.00

Service Code	HCPCS C1769
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

Know your out-of-pocket cost for care.

All Charges