Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SFC COMBO 27/14MM SFCBP.27/14

Facility

$1,593.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$796.50
Max. Negotiated Rate	$1,545.21
Rate for Payer: AlohaCare Medicaid	$796.50
Rate for Payer: AlohaCare Medicare	$1,210.68
Rate for Payer: Cash Price	$955.80
Rate for Payer: Devoted Health Medicare	$1,338.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,210.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Humana Medicare	$1,210.68
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: Kaiser Permanente Medicaid	$812.43
Rate for Payer: Kaiser Permanente Medicare	$1,210.68
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: Ohana Health Plan Medicaid	$1,210.68
Rate for Payer: Ohana Health Plan Medicare	$1,210.68
Rate for Payer: UnitedHealthcare Medicare	$1,210.68
Rate for Payer: University Health Alliance Commercial	$892.08

SFC IN COM 24/10MM SFCIC.24/10

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$647.50
Max. Negotiated Rate	$1,256.15
Rate for Payer: AlohaCare Medicaid	$647.50
Rate for Payer: AlohaCare Medicare	$984.20
Rate for Payer: Cash Price	$777.00
Rate for Payer: Devoted Health Medicare	$1,087.80
Rate for Payer: Hawaii Medical Service Association Medicare	$984.20
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Humana Medicare	$984.20
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: Kaiser Permanente Medicaid	$660.45
Rate for Payer: Kaiser Permanente Medicare	$984.20
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: Ohana Health Plan Medicaid	$984.20
Rate for Payer: Ohana Health Plan Medicare	$984.20
Rate for Payer: UnitedHealthcare Medicare	$984.20
Rate for Payer: University Health Alliance Commercial	$725.20

SFC IN COM 24/10MM SFCIC.24/10

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$725.20
Max. Negotiated Rate	$1,256.15
Rate for Payer: Cash Price	$777.00
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: University Health Alliance Commercial	$725.20

SFC IN COM 24/14MM SFCIC.24/14

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$647.50
Max. Negotiated Rate	$1,256.15
Rate for Payer: AlohaCare Medicaid	$647.50
Rate for Payer: AlohaCare Medicare	$984.20
Rate for Payer: Cash Price	$777.00
Rate for Payer: Devoted Health Medicare	$1,087.80
Rate for Payer: Hawaii Medical Service Association Medicare	$984.20
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Humana Medicare	$984.20
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: Kaiser Permanente Medicaid	$660.45
Rate for Payer: Kaiser Permanente Medicare	$984.20
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: Ohana Health Plan Medicaid	$984.20
Rate for Payer: Ohana Health Plan Medicare	$984.20
Rate for Payer: UnitedHealthcare Medicare	$984.20
Rate for Payer: University Health Alliance Commercial	$725.20

SFC IN COM 24/14MM SFCIC.24/14

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$725.20
Max. Negotiated Rate	$1,256.15
Rate for Payer: Cash Price	$777.00
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: University Health Alliance Commercial	$725.20

SFC OUTER COM 28MM SFCOC.28/28

Facility

$1,015.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$507.50
Max. Negotiated Rate	$984.55
Rate for Payer: AlohaCare Medicaid	$507.50
Rate for Payer: AlohaCare Medicare	$771.40
Rate for Payer: Cash Price	$609.00
Rate for Payer: Devoted Health Medicare	$852.60
Rate for Payer: Hawaii Medical Service Association Medicare	$771.40
Rate for Payer: Hawaii Western Management Group Commercial	$710.50
Rate for Payer: Health Management Network Commercial	$862.75
Rate for Payer: Humana Medicare	$771.40
Rate for Payer: Kaiser Permanente Commercial	$913.50
Rate for Payer: Kaiser Permanente Medicaid	$517.65
Rate for Payer: Kaiser Permanente Medicare	$771.40
Rate for Payer: MDX Hawaii PPO	$984.55
Rate for Payer: Ohana Health Plan Medicaid	$771.40
Rate for Payer: Ohana Health Plan Medicare	$771.40
Rate for Payer: UnitedHealthcare Medicare	$771.40
Rate for Payer: University Health Alliance Commercial	$568.40

SFC OUTER COM 28MM SFCOC.28/28

Facility

$1,015.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$568.40
Max. Negotiated Rate	$984.55
Rate for Payer: Cash Price	$609.00
Rate for Payer: Hawaii Western Management Group Commercial	$710.50
Rate for Payer: Health Management Network Commercial	$862.75
Rate for Payer: Kaiser Permanente Commercial	$913.50
Rate for Payer: MDX Hawaii PPO	$984.55
Rate for Payer: University Health Alliance Commercial	$568.40

SFC OUTER COM 32MM SFCOC.32/32

Facility

$1,015.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$568.40
Max. Negotiated Rate	$984.55
Rate for Payer: Cash Price	$609.00
Rate for Payer: Hawaii Western Management Group Commercial	$710.50
Rate for Payer: Health Management Network Commercial	$862.75
Rate for Payer: Kaiser Permanente Commercial	$913.50
Rate for Payer: MDX Hawaii PPO	$984.55
Rate for Payer: University Health Alliance Commercial	$568.40

SFC OUTER COM 32MM SFCOC.32/32

Facility

$1,015.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$507.50
Max. Negotiated Rate	$984.55
Rate for Payer: AlohaCare Medicaid	$507.50
Rate for Payer: AlohaCare Medicare	$771.40
Rate for Payer: Cash Price	$609.00
Rate for Payer: Devoted Health Medicare	$852.60
Rate for Payer: Hawaii Medical Service Association Medicare	$771.40
Rate for Payer: Hawaii Western Management Group Commercial	$710.50
Rate for Payer: Health Management Network Commercial	$862.75
Rate for Payer: Humana Medicare	$771.40
Rate for Payer: Kaiser Permanente Commercial	$913.50
Rate for Payer: Kaiser Permanente Medicaid	$517.65
Rate for Payer: Kaiser Permanente Medicare	$771.40
Rate for Payer: MDX Hawaii PPO	$984.55
Rate for Payer: Ohana Health Plan Medicaid	$771.40
Rate for Payer: Ohana Health Plan Medicare	$771.40
Rate for Payer: UnitedHealthcare Medicare	$771.40
Rate for Payer: University Health Alliance Commercial	$568.40

SHAFT DRIVR T15 AR-9545-T15-02

Facility

$1,575.00

Hospital Revenue Code	272
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,527.75
Rate for Payer: AlohaCare Medicaid	$787.50
Rate for Payer: AlohaCare Medicare	$1,197.00
Rate for Payer: Cash Price	$945.00
Rate for Payer: Devoted Health Medicare	$1,323.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,197.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,496.25
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Humana Medicare	$1,197.00
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$803.25
Rate for Payer: Kaiser Permanente Medicare	$1,197.00
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: Ohana Health Plan Medicaid	$1,197.00
Rate for Payer: Ohana Health Plan Medicare	$1,197.00
Rate for Payer: UnitedHealthcare Medicare	$1,197.00
Rate for Payer: University Health Alliance Commercial	$1,148.02

SHAFT DRIVR T15 AR-9545-T15-02

Facility

$1,575.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: MDX Hawaii PPO	$1,527.75

SHAFT REAMER 08X510 0227-8510S

Facility

$1,971.00

Hospital Revenue Code	272
Min. Negotiated Rate	$985.50
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$1,497.96
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$1,655.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,497.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,872.45
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$1,497.96
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$1,497.96
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$1,497.96
Rate for Payer: Ohana Health Plan Medicare	$1,497.96
Rate for Payer: UnitedHealthcare Medicare	$1,497.96
Rate for Payer: University Health Alliance Commercial	$1,436.66

SHAFT REAMER 08X510 0227-8510S

Facility

$1,971.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,675.35
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87

SHAVER EXCALIBER AR-8400EX

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: AlohaCare Medicare	$158.08
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$174.72
Rate for Payer: Hawaii Medical Service Association Medicare	$158.08
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$158.08
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$158.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$158.08
Rate for Payer: Ohana Health Plan Medicare	$158.08
Rate for Payer: UnitedHealthcare Medicare	$158.08
Rate for Payer: University Health Alliance Commercial	$151.61

SHAVER EXCALIBER AR-8400EX

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

SHEARS HARMONIC 1100 HAR1136

Facility

$2,965.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,482.50
Max. Negotiated Rate	$2,876.05
Rate for Payer: AlohaCare Medicaid	$1,482.50
Rate for Payer: AlohaCare Medicare	$2,253.40
Rate for Payer: Cash Price	$1,779.00
Rate for Payer: Devoted Health Medicare	$2,490.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,253.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,816.75
Rate for Payer: Health Management Network Commercial	$2,520.25
Rate for Payer: Humana Medicare	$2,253.40
Rate for Payer: Kaiser Permanente Commercial	$2,668.50
Rate for Payer: Kaiser Permanente Medicaid	$1,512.15
Rate for Payer: Kaiser Permanente Medicare	$2,253.40
Rate for Payer: MDX Hawaii PPO	$2,876.05
Rate for Payer: Ohana Health Plan Medicaid	$2,253.40
Rate for Payer: Ohana Health Plan Medicare	$2,253.40
Rate for Payer: UnitedHealthcare Medicare	$2,253.40
Rate for Payer: University Health Alliance Commercial	$2,161.19

SHEARS HARMONIC 1100 HAR1136

Facility

$2,965.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,520.25
Max. Negotiated Rate	$2,876.05
Rate for Payer: Cash Price	$1,779.00
Rate for Payer: Health Management Network Commercial	$2,520.25
Rate for Payer: Kaiser Permanente Commercial	$2,668.50
Rate for Payer: MDX Hawaii PPO	$2,876.05

SHEARS LAPARASCOPE HAR736

Facility

$2,348.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,995.80
Max. Negotiated Rate	$2,277.56
Rate for Payer: Cash Price	$1,408.80
Rate for Payer: Health Management Network Commercial	$1,995.80
Rate for Payer: Kaiser Permanente Commercial	$2,113.20
Rate for Payer: MDX Hawaii PPO	$2,277.56

SHEARS LAPARASCOPE HAR736

Facility

$2,348.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,174.00
Max. Negotiated Rate	$2,277.56
Rate for Payer: AlohaCare Medicaid	$1,174.00
Rate for Payer: AlohaCare Medicare	$1,784.48
Rate for Payer: Cash Price	$1,408.80
Rate for Payer: Devoted Health Medicare	$1,972.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,784.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,230.60
Rate for Payer: Health Management Network Commercial	$1,995.80
Rate for Payer: Humana Medicare	$1,784.48
Rate for Payer: Kaiser Permanente Commercial	$2,113.20
Rate for Payer: Kaiser Permanente Medicaid	$1,197.48
Rate for Payer: Kaiser Permanente Medicare	$1,784.48
Rate for Payer: MDX Hawaii PPO	$2,277.56
Rate for Payer: Ohana Health Plan Medicaid	$1,784.48
Rate for Payer: Ohana Health Plan Medicare	$1,784.48
Rate for Payer: UnitedHealthcare Medicare	$1,784.48
Rate for Payer: University Health Alliance Commercial	$1,711.46

SHEARS MONOPOLOAR 470179

Facility

$6,720.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,360.00
Max. Negotiated Rate	$6,518.40
Rate for Payer: AlohaCare Medicaid	$3,360.00
Rate for Payer: AlohaCare Medicare	$5,107.20
Rate for Payer: Cash Price	$4,032.00
Rate for Payer: Devoted Health Medicare	$5,644.80
Rate for Payer: Hawaii Medical Service Association Medicare	$5,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,384.00
Rate for Payer: Health Management Network Commercial	$5,712.00
Rate for Payer: Humana Medicare	$5,107.20
Rate for Payer: Kaiser Permanente Commercial	$6,048.00
Rate for Payer: Kaiser Permanente Medicaid	$3,427.20
Rate for Payer: Kaiser Permanente Medicare	$5,107.20
Rate for Payer: MDX Hawaii PPO	$6,518.40
Rate for Payer: Ohana Health Plan Medicaid	$5,107.20
Rate for Payer: Ohana Health Plan Medicare	$5,107.20
Rate for Payer: UnitedHealthcare Medicare	$5,107.20
Rate for Payer: University Health Alliance Commercial	$4,898.21

SHEARS MONOPOLOAR 470179

Facility

$6,720.00

Hospital Revenue Code	272
Min. Negotiated Rate	$5,712.00
Max. Negotiated Rate	$6,518.40
Rate for Payer: Cash Price	$4,032.00
Rate for Payer: Health Management Network Commercial	$5,712.00
Rate for Payer: Kaiser Permanente Commercial	$6,048.00
Rate for Payer: MDX Hawaii PPO	$6,518.40

SHEATH 5FX10 PINNACLE ROII

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80

SHEATH 5FX10 PINNACLE ROII

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$135.80
Rate for Payer: AlohaCare Medicaid	$70.00
Rate for Payer: AlohaCare Medicare	$106.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Devoted Health Medicare	$117.60
Rate for Payer: Hawaii Medical Service Association Medicare	$106.40
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Humana Medicare	$106.40
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicare	$106.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: Ohana Health Plan Medicaid	$106.40
Rate for Payer: Ohana Health Plan Medicare	$106.40
Rate for Payer: UnitedHealthcare Medicare	$106.40
Rate for Payer: University Health Alliance Commercial	$102.05

SHEATH 6FX10 PINNACLE ROII

Facility

$138.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: MDX Hawaii PPO	$133.86

SHEATH 6FX10 PINNACLE ROII

Facility

$138.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$69.00
Rate for Payer: AlohaCare Medicare	$104.88
Rate for Payer: Cash Price	$82.80
Rate for Payer: Devoted Health Medicare	$115.92
Rate for Payer: Hawaii Medical Service Association Medicare	$104.88
Rate for Payer: Hawaii Western Management Group Commercial	$131.10
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$104.88
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$104.88
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$104.88
Rate for Payer: Ohana Health Plan Medicare	$104.88
Rate for Payer: UnitedHealthcare Medicare	$104.88
Rate for Payer: University Health Alliance Commercial	$100.59

Know your out-of-pocket cost for care.

All Charges