Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SOLUTION 2.5% 2L PD

Facility

$188.00

Hospital Revenue Code	272
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$182.36
Rate for Payer: Cash Price	$112.80
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Kaiser Permanente Commercial	$169.20
Rate for Payer: MDX Hawaii PPO	$182.36

SOLUTION 4.25% 2L PD

Facility

$148.00

Hospital Revenue Code	272
Min. Negotiated Rate	$125.80
Max. Negotiated Rate	$143.56
Rate for Payer: Cash Price	$88.80
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Kaiser Permanente Commercial	$133.20
Rate for Payer: MDX Hawaii PPO	$143.56

SOLUTION 4.25% 2L PD

Facility

$148.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$143.56
Rate for Payer: AlohaCare Medicaid	$74.00
Rate for Payer: AlohaCare Medicare	$112.48
Rate for Payer: Cash Price	$88.80
Rate for Payer: Devoted Health Medicare	$124.32
Rate for Payer: Hawaii Medical Service Association Medicare	$112.48
Rate for Payer: Hawaii Western Management Group Commercial	$140.60
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Humana Medicare	$112.48
Rate for Payer: Kaiser Permanente Commercial	$133.20
Rate for Payer: Kaiser Permanente Medicaid	$75.48
Rate for Payer: Kaiser Permanente Medicare	$112.48
Rate for Payer: MDX Hawaii PPO	$143.56
Rate for Payer: Ohana Health Plan Medicaid	$112.48
Rate for Payer: Ohana Health Plan Medicare	$112.48
Rate for Payer: UnitedHealthcare Medicare	$112.48
Rate for Payer: University Health Alliance Commercial	$107.88

SOLUTION CR GREEN #5976-40-12

Facility

$2,228.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.00
Max. Negotiated Rate	$2,161.16
Rate for Payer: AlohaCare Medicaid	$1,114.00
Rate for Payer: AlohaCare Medicare	$1,693.28
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Devoted Health Medicare	$1,871.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,693.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,559.60
Rate for Payer: Health Management Network Commercial	$1,893.80
Rate for Payer: Humana Medicare	$1,693.28
Rate for Payer: Kaiser Permanente Commercial	$2,005.20
Rate for Payer: Kaiser Permanente Medicaid	$1,136.28
Rate for Payer: Kaiser Permanente Medicare	$1,693.28
Rate for Payer: MDX Hawaii PPO	$2,161.16
Rate for Payer: Ohana Health Plan Medicaid	$1,693.28
Rate for Payer: Ohana Health Plan Medicare	$1,693.28
Rate for Payer: UnitedHealthcare Medicare	$1,693.28
Rate for Payer: University Health Alliance Commercial	$1,247.68

SOLUTION CR GREEN #5976-40-12

Facility

$2,228.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.68
Max. Negotiated Rate	$2,161.16
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,559.60
Rate for Payer: Health Management Network Commercial	$1,893.80
Rate for Payer: Kaiser Permanente Commercial	$2,005.20
Rate for Payer: MDX Hawaii PPO	$2,161.16
Rate for Payer: University Health Alliance Commercial	$1,247.68

SORBITOL 70 % SOLUTION [7413]

Facility

$15.00

Service Code	NDC 50030000000
Hospital Revenue Code	637
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

SORBITOL 70 % SOLUTION [7413]

Facility

$15.00

Service Code	NDC 50030000000
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

SOTALOL 80 MG TABLET [11421]

Facility

$9.00

Service Code	NDC 68084065401
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

SOTALOL 80 MG TABLET [11421]

Facility

$9.00

Service Code	NDC 00093106101
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

SOTALOL 80 MG TABLET [11421]

Facility

$9.00

Service Code	NDC 00093106101
Hospital Revenue Code	637
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$6.84
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$6.84
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$6.84
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$6.84
Rate for Payer: Ohana Health Plan Medicare	$6.84
Rate for Payer: UnitedHealthcare Medicare	$6.84
Rate for Payer: University Health Alliance Commercial	$6.56

SOTALOL 80 MG TABLET [11421]

Facility

$9.00

Service Code	NDC 68084065401
Hospital Revenue Code	637
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$6.84
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$6.84
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$6.84
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$6.84
Rate for Payer: Ohana Health Plan Medicare	$6.84
Rate for Payer: UnitedHealthcare Medicare	$6.84
Rate for Payer: University Health Alliance Commercial	$6.56

SPACER FEMORAL 64MM RKFMMD

Facility

$9,460.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,730.00
Max. Negotiated Rate	$9,176.20
Rate for Payer: AlohaCare Medicaid	$4,730.00
Rate for Payer: AlohaCare Medicare	$7,189.60
Rate for Payer: Cash Price	$5,676.00
Rate for Payer: Devoted Health Medicare	$7,946.40
Rate for Payer: Hawaii Medical Service Association Medicare	$7,189.60
Rate for Payer: Hawaii Western Management Group Commercial	$6,622.00
Rate for Payer: Health Management Network Commercial	$8,041.00
Rate for Payer: Humana Medicare	$7,189.60
Rate for Payer: Kaiser Permanente Commercial	$8,514.00
Rate for Payer: Kaiser Permanente Medicaid	$4,824.60
Rate for Payer: Kaiser Permanente Medicare	$7,189.60
Rate for Payer: MDX Hawaii PPO	$9,176.20
Rate for Payer: Ohana Health Plan Medicaid	$7,189.60
Rate for Payer: Ohana Health Plan Medicare	$7,189.60
Rate for Payer: UnitedHealthcare Medicare	$7,189.60
Rate for Payer: University Health Alliance Commercial	$5,297.60

SPACER FEMORAL 64MM RKFMMD

Facility

$9,460.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,297.60
Max. Negotiated Rate	$9,176.20
Rate for Payer: Cash Price	$5,676.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,622.00
Rate for Payer: Health Management Network Commercial	$8,041.00
Rate for Payer: Kaiser Permanente Commercial	$8,514.00
Rate for Payer: MDX Hawaii PPO	$9,176.20
Rate for Payer: University Health Alliance Commercial	$5,297.60

SPEEDBRIDGE SYS AR-8928BC-CP

Facility

$3,480.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,948.80
Max. Negotiated Rate	$3,375.60
Rate for Payer: Cash Price	$2,088.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,436.00
Rate for Payer: Health Management Network Commercial	$2,958.00
Rate for Payer: Kaiser Permanente Commercial	$3,132.00
Rate for Payer: MDX Hawaii PPO	$3,375.60
Rate for Payer: University Health Alliance Commercial	$1,948.80

SPEEDBRIDGE SYS AR-8928BC-CP

Facility

$3,480.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,740.00
Max. Negotiated Rate	$3,375.60
Rate for Payer: AlohaCare Medicaid	$1,740.00
Rate for Payer: AlohaCare Medicare	$2,644.80
Rate for Payer: Cash Price	$2,088.00
Rate for Payer: Devoted Health Medicare	$2,923.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2,644.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,436.00
Rate for Payer: Health Management Network Commercial	$2,958.00
Rate for Payer: Humana Medicare	$2,644.80
Rate for Payer: Kaiser Permanente Commercial	$3,132.00
Rate for Payer: Kaiser Permanente Medicaid	$1,774.80
Rate for Payer: Kaiser Permanente Medicare	$2,644.80
Rate for Payer: MDX Hawaii PPO	$3,375.60
Rate for Payer: Ohana Health Plan Medicaid	$2,644.80
Rate for Payer: Ohana Health Plan Medicare	$2,644.80
Rate for Payer: UnitedHealthcare Medicare	$2,644.80
Rate for Payer: University Health Alliance Commercial	$1,948.80

SPEEDGRAFT JRF 10MM #SPD-001

Facility

$4,650.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$4,510.50
Rate for Payer: AlohaCare Medicaid	$2,325.00
Rate for Payer: AlohaCare Medicare	$3,534.00
Rate for Payer: Cash Price	$2,790.00
Rate for Payer: Devoted Health Medicare	$3,906.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,534.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,255.00
Rate for Payer: Health Management Network Commercial	$3,952.50
Rate for Payer: Humana Medicare	$3,534.00
Rate for Payer: Kaiser Permanente Commercial	$4,185.00
Rate for Payer: Kaiser Permanente Medicaid	$2,371.50
Rate for Payer: Kaiser Permanente Medicare	$3,534.00
Rate for Payer: MDX Hawaii PPO	$4,510.50
Rate for Payer: Ohana Health Plan Medicaid	$3,534.00
Rate for Payer: Ohana Health Plan Medicare	$3,534.00
Rate for Payer: UnitedHealthcare Medicare	$3,534.00
Rate for Payer: University Health Alliance Commercial	$2,604.00

SPEEDGRAFT JRF 10MM #SPD-001

Facility

$4,650.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$2,604.00
Max. Negotiated Rate	$4,510.50
Rate for Payer: Cash Price	$2,790.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,255.00
Rate for Payer: Health Management Network Commercial	$3,952.50
Rate for Payer: Kaiser Permanente Commercial	$4,185.00
Rate for Payer: MDX Hawaii PPO	$4,510.50
Rate for Payer: University Health Alliance Commercial	$2,604.00

SPHERE FEMUR LT 4+ 02.12.0024L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

SPHERE FEMUR LT 4+ 02.12.0024L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,000.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: AlohaCare Medicaid	$2,000.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Devoted Health Medicare	$3,360.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

SPHERE FEMUR RT 5+ 02.12.0025R

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,000.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: AlohaCare Medicaid	$2,000.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Devoted Health Medicare	$3,360.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

SPHERE FEMUR RT 5+ 02.12.0025R

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

SPHERE TIB 10MM 02.12.0410CRL

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

SPHERE TIB 10MM 02.12.0410CRL

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

SPHERE TIB 10 S4 02.12.0410CRR

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

SPHERE TIB 10 S4 02.12.0410CRR

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

Know your out-of-pocket cost for care.

All Charges