Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SAWBLADE OXFORD #506269

Facility

$2,550.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,167.50
Max. Negotiated Rate	$2,473.50
Rate for Payer: Cash Price	$1,530.00
Rate for Payer: Health Management Network Commercial	$2,167.50
Rate for Payer: Kaiser Permanente Commercial	$2,295.00
Rate for Payer: MDX Hawaii PPO	$2,473.50

SCALPEL TISSUE HARMONIC HAR9F

Facility

$1,103.00

Hospital Revenue Code	272
Min. Negotiated Rate	$551.50
Max. Negotiated Rate	$1,069.91
Rate for Payer: AlohaCare Medicaid	$551.50
Rate for Payer: AlohaCare Medicare	$838.28
Rate for Payer: Cash Price	$661.80
Rate for Payer: Devoted Health Medicare	$926.52
Rate for Payer: Hawaii Medical Service Association Medicare	$838.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.85
Rate for Payer: Health Management Network Commercial	$937.55
Rate for Payer: Humana Medicare	$838.28
Rate for Payer: Kaiser Permanente Commercial	$992.70
Rate for Payer: Kaiser Permanente Medicaid	$562.53
Rate for Payer: Kaiser Permanente Medicare	$838.28
Rate for Payer: MDX Hawaii PPO	$1,069.91
Rate for Payer: Ohana Health Plan Medicaid	$838.28
Rate for Payer: Ohana Health Plan Medicare	$838.28
Rate for Payer: UnitedHealthcare Medicare	$838.28
Rate for Payer: University Health Alliance Commercial	$803.98

SCALPEL TISSUE HARMONIC HAR9F

Facility

$1,103.00

Hospital Revenue Code	272
Min. Negotiated Rate	$937.55
Max. Negotiated Rate	$1,069.91
Rate for Payer: Cash Price	$661.80
Rate for Payer: Health Management Network Commercial	$937.55
Rate for Payer: Kaiser Permanente Commercial	$992.70
Rate for Payer: MDX Hawaii PPO	$1,069.91

SCANLAN INSRT GRN SM 9009-18

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29

SCANLAN INSRT GRN SM 9009-18

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$128.50
Max. Negotiated Rate	$249.29
Rate for Payer: AlohaCare Medicaid	$128.50
Rate for Payer: AlohaCare Medicare	$195.32
Rate for Payer: Cash Price	$154.20
Rate for Payer: Devoted Health Medicare	$215.88
Rate for Payer: Hawaii Medical Service Association Medicare	$195.32
Rate for Payer: Hawaii Western Management Group Commercial	$244.15
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Humana Medicare	$195.32
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: Kaiser Permanente Medicare	$195.32
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: Ohana Health Plan Medicaid	$195.32
Rate for Payer: Ohana Health Plan Medicare	$195.32
Rate for Payer: UnitedHealthcare Medicare	$195.32
Rate for Payer: University Health Alliance Commercial	$187.33

SCANLAN INSRT YEL SM 9009-23

Facility

$218.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$185.30
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: MDX Hawaii PPO	$211.46

SCANLAN INSRT YEL SM 9009-23

Facility

$218.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$109.00
Max. Negotiated Rate	$211.46
Rate for Payer: AlohaCare Medicaid	$109.00
Rate for Payer: AlohaCare Medicare	$165.68
Rate for Payer: Cash Price	$130.80
Rate for Payer: Devoted Health Medicare	$183.12
Rate for Payer: Hawaii Medical Service Association Medicare	$165.68
Rate for Payer: Hawaii Western Management Group Commercial	$207.10
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Humana Medicare	$165.68
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: Kaiser Permanente Medicare	$165.68
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: Ohana Health Plan Medicaid	$165.68
Rate for Payer: Ohana Health Plan Medicare	$165.68
Rate for Payer: UnitedHealthcare Medicare	$165.68
Rate for Payer: University Health Alliance Commercial	$158.90

SCARF GUIDE ACCUCUT 19511

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$398.65
Max. Negotiated Rate	$454.93
Rate for Payer: Cash Price	$281.40
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: MDX Hawaii PPO	$454.93

SCARF GUIDE ACCUCUT 19511

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$234.50
Max. Negotiated Rate	$454.93
Rate for Payer: AlohaCare Medicaid	$234.50
Rate for Payer: AlohaCare Medicare	$356.44
Rate for Payer: Cash Price	$281.40
Rate for Payer: Devoted Health Medicare	$393.96
Rate for Payer: Hawaii Medical Service Association Medicare	$356.44
Rate for Payer: Hawaii Western Management Group Commercial	$445.55
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Humana Medicare	$356.44
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: Kaiser Permanente Medicaid	$239.19
Rate for Payer: Kaiser Permanente Medicare	$356.44
Rate for Payer: MDX Hawaii PPO	$454.93
Rate for Payer: Ohana Health Plan Medicaid	$356.44
Rate for Payer: Ohana Health Plan Medicare	$356.44
Rate for Payer: UnitedHealthcare Medicare	$356.44
Rate for Payer: University Health Alliance Commercial	$341.85

SCD FOOT CUFF MED

Facility

$92.00

Hospital Revenue Code	271
Min. Negotiated Rate	$46.00
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$69.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Devoted Health Medicare	$77.28
Rate for Payer: Hawaii Medical Service Association Medicare	$69.92
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$69.92
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$69.92
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$69.92
Rate for Payer: Ohana Health Plan Medicare	$69.92
Rate for Payer: UnitedHealthcare Medicare	$69.92
Rate for Payer: University Health Alliance Commercial	$67.06

SCD FOOT CUFF MED

Facility

$92.00

Hospital Revenue Code	271
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: MDX Hawaii PPO	$89.24

SCD KNEE SLEEVE XL

Facility

$102.00

Hospital Revenue Code	271
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$98.94

SCD KNEE SLEEVE XL

Facility

$102.00

Hospital Revenue Code	271
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$98.94
Rate for Payer: AlohaCare Medicaid	$51.00
Rate for Payer: AlohaCare Medicare	$77.52
Rate for Payer: Cash Price	$61.20
Rate for Payer: Devoted Health Medicare	$85.68
Rate for Payer: Hawaii Medical Service Association Medicare	$77.52
Rate for Payer: Hawaii Western Management Group Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Humana Medicare	$77.52
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: Kaiser Permanente Medicare	$77.52
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: Ohana Health Plan Medicaid	$77.52
Rate for Payer: Ohana Health Plan Medicare	$77.52
Rate for Payer: UnitedHealthcare Medicare	$77.52
Rate for Payer: University Health Alliance Commercial	$74.35

SCD SLEEVE THIGH STERILE 9736

Facility

$204.00

Hospital Revenue Code	271
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$197.88

SCD SLEEVE THIGH STERILE 9736

Facility

$204.00

Hospital Revenue Code	271
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$102.00
Rate for Payer: AlohaCare Medicare	$155.04
Rate for Payer: Cash Price	$122.40
Rate for Payer: Devoted Health Medicare	$171.36
Rate for Payer: Hawaii Medical Service Association Medicare	$155.04
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$155.04
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$155.04
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$155.04
Rate for Payer: Ohana Health Plan Medicare	$155.04
Rate for Payer: UnitedHealthcare Medicare	$155.04
Rate for Payer: University Health Alliance Commercial	$148.70

SCD THIGH SLEEVE LG

Facility

$96.00

Hospital Revenue Code	271
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$72.96
Rate for Payer: Cash Price	$57.60
Rate for Payer: Devoted Health Medicare	$80.64
Rate for Payer: Hawaii Medical Service Association Medicare	$72.96
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$72.96
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$72.96
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$72.96
Rate for Payer: Ohana Health Plan Medicare	$72.96
Rate for Payer: UnitedHealthcare Medicare	$72.96
Rate for Payer: University Health Alliance Commercial	$69.97

SCD THIGH SLEEVE LG

Facility

$96.00

Hospital Revenue Code	271
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

SCISSOR ENDSIZER ES26235-3

Facility

$2,190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,861.50
Max. Negotiated Rate	$2,124.30
Rate for Payer: Cash Price	$1,314.00
Rate for Payer: Health Management Network Commercial	$1,861.50
Rate for Payer: Kaiser Permanente Commercial	$1,971.00
Rate for Payer: MDX Hawaii PPO	$2,124.30

SCISSOR ENDSIZER ES26235-3

Facility

$2,190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,095.00
Max. Negotiated Rate	$2,124.30
Rate for Payer: AlohaCare Medicaid	$1,095.00
Rate for Payer: AlohaCare Medicare	$1,664.40
Rate for Payer: Cash Price	$1,314.00
Rate for Payer: Devoted Health Medicare	$1,839.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,664.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,080.50
Rate for Payer: Health Management Network Commercial	$1,861.50
Rate for Payer: Humana Medicare	$1,664.40
Rate for Payer: Kaiser Permanente Commercial	$1,971.00
Rate for Payer: Kaiser Permanente Medicaid	$1,116.90
Rate for Payer: Kaiser Permanente Medicare	$1,664.40
Rate for Payer: MDX Hawaii PPO	$2,124.30
Rate for Payer: Ohana Health Plan Medicaid	$1,664.40
Rate for Payer: Ohana Health Plan Medicare	$1,664.40
Rate for Payer: UnitedHealthcare Medicare	$1,664.40
Rate for Payer: University Health Alliance Commercial	$1,596.29

SCOPE URETEROSCOPE FLEXIBLE

Facility

$3,000.00

Service Code	HCPCS C1747
Hospital Revenue Code	272
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: AlohaCare Medicaid	$1,500.00
Rate for Payer: AlohaCare Medicare	$2,280.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Devoted Health Medicare	$2,520.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,850.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Humana Medicare	$2,280.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: Kaiser Permanente Medicaid	$1,530.00
Rate for Payer: Kaiser Permanente Medicare	$2,280.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: Ohana Health Plan Medicaid	$2,280.00
Rate for Payer: Ohana Health Plan Medicare	$2,280.00
Rate for Payer: UnitedHealthcare Medicare	$2,280.00
Rate for Payer: University Health Alliance Commercial	$2,186.70

SCOPE URETEROSCOPE FLEXIBLE

Facility

$3,000.00

Service Code	HCPCS C1747
Hospital Revenue Code	272
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: MDX Hawaii PPO	$2,910.00

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [128147]

Facility

$58.00

Service Code	NDC 45802058001
Hospital Revenue Code	637
Min. Negotiated Rate	$29.00
Max. Negotiated Rate	$56.26
Rate for Payer: AlohaCare Medicaid	$29.00
Rate for Payer: AlohaCare Medicare	$44.08
Rate for Payer: Cash Price	$34.80
Rate for Payer: Devoted Health Medicare	$48.72
Rate for Payer: Hawaii Medical Service Association Medicare	$44.08
Rate for Payer: Hawaii Western Management Group Commercial	$55.10
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Humana Medicare	$44.08
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: Kaiser Permanente Medicare	$44.08
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: Ohana Health Plan Medicaid	$44.08
Rate for Payer: Ohana Health Plan Medicare	$44.08
Rate for Payer: UnitedHealthcare Medicare	$44.08
Rate for Payer: University Health Alliance Commercial	$42.28

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [128147]

Facility

$58.00

Service Code	NDC 45802058046
Hospital Revenue Code	250
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: MDX Hawaii PPO	$56.26

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [128147]

Facility

$58.00

Service Code	NDC 45802058046
Hospital Revenue Code	637
Min. Negotiated Rate	$29.00
Max. Negotiated Rate	$56.26
Rate for Payer: AlohaCare Medicaid	$29.00
Rate for Payer: AlohaCare Medicare	$44.08
Rate for Payer: Cash Price	$34.80
Rate for Payer: Devoted Health Medicare	$48.72
Rate for Payer: Hawaii Medical Service Association Medicare	$44.08
Rate for Payer: Hawaii Western Management Group Commercial	$55.10
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Humana Medicare	$44.08
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: Kaiser Permanente Medicare	$44.08
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: Ohana Health Plan Medicaid	$44.08
Rate for Payer: Ohana Health Plan Medicare	$44.08
Rate for Payer: UnitedHealthcare Medicare	$44.08
Rate for Payer: University Health Alliance Commercial	$42.28

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [128147]

Facility

$58.00

Service Code	NDC 45802058001
Hospital Revenue Code	250
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: MDX Hawaii PPO	$56.26

Know your out-of-pocket cost for care.

All Charges