Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SLING LATERAL TRACT S3 AR-1652

Facility

$344.00

Hospital Revenue Code	271
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

SLING LATERAL TRACT S3 AR-1652

Facility

$344.00

Hospital Revenue Code	271
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

SLING SUPER PLUS LG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$122.08
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Hawaii Western Management Group Commercial	$152.60
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
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SUPER PLUS LG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$43.27
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: 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	$152.60
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 Medicaid	$43.27
Rate for Payer: UnitedHealthcare Medicare	$165.68
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SUPER PLUS XLG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$43.27
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: 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	$152.60
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 Medicaid	$43.27
Rate for Payer: UnitedHealthcare Medicare	$165.68
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SUPER PLUS XLG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$122.08
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Hawaii Western Management Group Commercial	$152.60
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
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SWATHE LG

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: University Health Alliance Commercial	$26.88

SLING SWATHE LG

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: AlohaCare Medicare	$36.48
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Devoted Health Medicare	$40.32
Rate for Payer: Hawaii Medical Service Association Medicare	$36.48
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$36.48
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$36.48
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$36.48
Rate for Payer: Ohana Health Plan Medicare	$36.48
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: UnitedHealthcare Medicare	$36.48
Rate for Payer: University Health Alliance Commercial	$26.88

SLING SWATHE SM

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: AlohaCare Medicare	$36.48
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Devoted Health Medicare	$40.32
Rate for Payer: Hawaii Medical Service Association Medicare	$36.48
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$36.48
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$36.48
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$36.48
Rate for Payer: Ohana Health Plan Medicare	$36.48
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: UnitedHealthcare Medicare	$36.48
Rate for Payer: University Health Alliance Commercial	$26.88

SLING SWATHE SM

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: University Health Alliance Commercial	$26.88

SLOTTED WHISKER 3.8M AR-8380SW

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$329.80
Rate for Payer: AlohaCare Medicaid	$170.00
Rate for Payer: AlohaCare Medicare	$258.40
Rate for Payer: Cash Price	$204.00
Rate for Payer: Devoted Health Medicare	$285.60
Rate for Payer: Hawaii Medical Service Association Medicare	$258.40
Rate for Payer: Hawaii Western Management Group Commercial	$323.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Humana Medicare	$258.40
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: Kaiser Permanente Medicare	$258.40
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: Ohana Health Plan Medicaid	$258.40
Rate for Payer: Ohana Health Plan Medicare	$258.40
Rate for Payer: UnitedHealthcare Medicare	$258.40
Rate for Payer: University Health Alliance Commercial	$247.83

SLOTTED WHISKER 3.8M AR-8380SW

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$329.80

SMART PROGRAMMER TH90Q01

Facility

$4,095.00

Service Code	HCPCS C1787
Hospital Revenue Code	272
Min. Negotiated Rate	$3,480.75
Max. Negotiated Rate	$3,972.15
Rate for Payer: Cash Price	$2,457.00
Rate for Payer: Health Management Network Commercial	$3,480.75
Rate for Payer: Kaiser Permanente Commercial	$3,685.50
Rate for Payer: MDX Hawaii PPO	$3,972.15

SMART PROGRAMMER TH90Q01

Facility

$4,095.00

Service Code	HCPCS C1787
Hospital Revenue Code	272
Min. Negotiated Rate	$2,047.50
Max. Negotiated Rate	$3,972.15
Rate for Payer: AlohaCare Medicaid	$2,047.50
Rate for Payer: AlohaCare Medicare	$3,112.20
Rate for Payer: Cash Price	$2,457.00
Rate for Payer: Devoted Health Medicare	$3,439.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,112.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,890.25
Rate for Payer: Health Management Network Commercial	$3,480.75
Rate for Payer: Humana Medicare	$3,112.20
Rate for Payer: Kaiser Permanente Commercial	$3,685.50
Rate for Payer: Kaiser Permanente Medicaid	$2,088.45
Rate for Payer: Kaiser Permanente Medicare	$3,112.20
Rate for Payer: MDX Hawaii PPO	$3,972.15
Rate for Payer: Ohana Health Plan Medicaid	$3,112.20
Rate for Payer: Ohana Health Plan Medicare	$3,112.20
Rate for Payer: UnitedHealthcare Medicare	$3,112.20
Rate for Payer: University Health Alliance Commercial	$2,984.85

SMETRIC PTLA 33x9MM 5550-G-339

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,031.68
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Kaiser Permanente Commercial	$3,265.20
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: University Health Alliance Commercial	$2,031.68

SMETRIC PTLA 33x9MM 5550-G-339

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,814.00
Max. Negotiated Rate	$3,519.16
Rate for Payer: AlohaCare Medicaid	$1,814.00
Rate for Payer: AlohaCare Medicare	$2,757.28
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Devoted Health Medicare	$3,047.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,757.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Humana Medicare	$2,757.28
Rate for Payer: Kaiser Permanente Commercial	$3,265.20
Rate for Payer: Kaiser Permanente Medicaid	$1,850.28
Rate for Payer: Kaiser Permanente Medicare	$2,757.28
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: Ohana Health Plan Medicaid	$2,757.28
Rate for Payer: Ohana Health Plan Medicare	$2,757.28
Rate for Payer: UnitedHealthcare Medicare	$2,757.28
Rate for Payer: University Health Alliance Commercial	$2,031.68

SMOKE PENCIL W/EDGE 10FT

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

SMOKE PENCIL W/EDGE 10FT

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

SMOOTH RND MODE RT 10721-255MP

Facility

$2,685.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,342.50
Max. Negotiated Rate	$2,604.45
Rate for Payer: AlohaCare Medicaid	$1,342.50
Rate for Payer: AlohaCare Medicare	$2,040.60
Rate for Payer: Cash Price	$1,611.00
Rate for Payer: Devoted Health Medicare	$2,255.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,040.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,879.50
Rate for Payer: Health Management Network Commercial	$2,282.25
Rate for Payer: Humana Medicare	$2,040.60
Rate for Payer: Kaiser Permanente Commercial	$2,416.50
Rate for Payer: Kaiser Permanente Medicaid	$1,369.35
Rate for Payer: Kaiser Permanente Medicare	$2,040.60
Rate for Payer: MDX Hawaii PPO	$2,604.45
Rate for Payer: Ohana Health Plan Medicaid	$2,040.60
Rate for Payer: Ohana Health Plan Medicare	$2,040.60
Rate for Payer: UnitedHealthcare Medicare	$2,040.60
Rate for Payer: University Health Alliance Commercial	$1,503.60

SMOOTH RND MODE RT 10721-255MP

Facility

$2,685.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,503.60
Max. Negotiated Rate	$2,604.45
Rate for Payer: Cash Price	$1,611.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,879.50
Rate for Payer: Health Management Network Commercial	$2,282.25
Rate for Payer: Kaiser Permanente Commercial	$2,416.50
Rate for Payer: MDX Hawaii PPO	$2,604.45
Rate for Payer: University Health Alliance Commercial	$1,503.60

SNARE 10MM ROTATABLE

Facility

$90.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

SNARE 10MM ROTATABLE

Facility

$90.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$68.40
Rate for Payer: Cash Price	$54.00
Rate for Payer: Devoted Health Medicare	$75.60
Rate for Payer: Hawaii Medical Service Association Medicare	$68.40
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$68.40
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$68.40
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$68.40
Rate for Payer: Ohana Health Plan Medicare	$68.40
Rate for Payer: UnitedHealthcare Medicare	$68.40
Rate for Payer: University Health Alliance Commercial	$65.60

SNARE 6FR ATRIEVE VASCULAR

Facility

$1,770.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$885.00
Max. Negotiated Rate	$1,716.90
Rate for Payer: AlohaCare Medicaid	$885.00
Rate for Payer: AlohaCare Medicare	$1,345.20
Rate for Payer: Cash Price	$1,062.00
Rate for Payer: Devoted Health Medicare	$1,486.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,345.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,681.50
Rate for Payer: Health Management Network Commercial	$1,504.50
Rate for Payer: Humana Medicare	$1,345.20
Rate for Payer: Kaiser Permanente Commercial	$1,593.00
Rate for Payer: Kaiser Permanente Medicaid	$902.70
Rate for Payer: Kaiser Permanente Medicare	$1,345.20
Rate for Payer: MDX Hawaii PPO	$1,716.90
Rate for Payer: Ohana Health Plan Medicaid	$1,345.20
Rate for Payer: Ohana Health Plan Medicare	$1,345.20
Rate for Payer: UnitedHealthcare Medicare	$1,345.20
Rate for Payer: University Health Alliance Commercial	$1,290.15

SNARE 6FR ATRIEVE VASCULAR

Facility

$1,770.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,504.50
Max. Negotiated Rate	$1,716.90
Rate for Payer: Cash Price	$1,062.00
Rate for Payer: Health Management Network Commercial	$1,504.50
Rate for Payer: Kaiser Permanente Commercial	$1,593.00
Rate for Payer: MDX Hawaii PPO	$1,716.90

SNARE 6FX15X120 AMPLATZ GN

Facility

$631.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$536.35
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: MDX Hawaii PPO	$612.07

Know your out-of-pocket cost for care.

All Charges