Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

STABILIZER FEMORAL 5512-F-201

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,141.50
Max. Negotiated Rate	$11,914.51
Rate for Payer: AlohaCare Medicaid	$6,141.50
Rate for Payer: AlohaCare Medicare	$9,335.08
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Devoted Health Medicare	$10,317.72
Rate for Payer: Hawaii Medical Service Association Medicare	$9,335.08
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Humana Medicare	$9,335.08
Rate for Payer: Kaiser Permanente Commercial	$11,054.70
Rate for Payer: Kaiser Permanente Medicaid	$6,264.33
Rate for Payer: Kaiser Permanente Medicare	$9,335.08
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: Ohana Health Plan Medicaid	$9,335.08
Rate for Payer: Ohana Health Plan Medicare	$9,335.08
Rate for Payer: UnitedHealthcare Medicare	$9,335.08
Rate for Payer: University Health Alliance Commercial	$6,878.48

STABILIZER FEMORAL 5512-F-502

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,878.48
Max. Negotiated Rate	$11,914.51
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Kaiser Permanente Commercial	$11,054.70
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: University Health Alliance Commercial	$6,878.48

STABILIZER FEMORAL 5512-F-502

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,141.50
Max. Negotiated Rate	$11,914.51
Rate for Payer: AlohaCare Medicaid	$6,141.50
Rate for Payer: AlohaCare Medicare	$9,335.08
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Devoted Health Medicare	$10,317.72
Rate for Payer: Hawaii Medical Service Association Medicare	$9,335.08
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Humana Medicare	$9,335.08
Rate for Payer: Kaiser Permanente Commercial	$11,054.70
Rate for Payer: Kaiser Permanente Medicaid	$6,264.33
Rate for Payer: Kaiser Permanente Medicare	$9,335.08
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: Ohana Health Plan Medicaid	$9,335.08
Rate for Payer: Ohana Health Plan Medicare	$9,335.08
Rate for Payer: UnitedHealthcare Medicare	$9,335.08
Rate for Payer: University Health Alliance Commercial	$6,878.48

STABILIZER FEMORAL 5515-F-302

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER FEMORAL 5515-F-302

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER INSERT 5537-G-113

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,451.50
Max. Negotiated Rate	$4,755.91
Rate for Payer: AlohaCare Medicaid	$2,451.50
Rate for Payer: AlohaCare Medicare	$3,726.28
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Devoted Health Medicare	$4,118.52
Rate for Payer: Hawaii Medical Service Association Medicare	$3,726.28
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Humana Medicare	$3,726.28
Rate for Payer: Kaiser Permanente Commercial	$4,412.70
Rate for Payer: Kaiser Permanente Medicaid	$2,500.53
Rate for Payer: Kaiser Permanente Medicare	$3,726.28
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: Ohana Health Plan Medicaid	$3,726.28
Rate for Payer: Ohana Health Plan Medicare	$3,726.28
Rate for Payer: UnitedHealthcare Medicare	$3,726.28
Rate for Payer: University Health Alliance Commercial	$2,745.68

STABILIZER INSERT 5537-G-113

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,745.68
Max. Negotiated Rate	$4,755.91
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Kaiser Permanente Commercial	$4,412.70
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: University Health Alliance Commercial	$2,745.68

STABILIZER POST SZ8 5515-F-802

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER POST SZ8 5515-F-802

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER SZ.6 5515-F-602

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER SZ.6 5515-F-602

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER TIBIAL 5537-G-513-E

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,745.68
Max. Negotiated Rate	$4,755.91
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Kaiser Permanente Commercial	$4,412.70
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: University Health Alliance Commercial	$2,745.68

STABILIZER TIBIAL 5537-G-513-E

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,451.50
Max. Negotiated Rate	$4,755.91
Rate for Payer: AlohaCare Medicaid	$2,451.50
Rate for Payer: AlohaCare Medicare	$3,726.28
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Devoted Health Medicare	$4,118.52
Rate for Payer: Hawaii Medical Service Association Medicare	$3,726.28
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Humana Medicare	$3,726.28
Rate for Payer: Kaiser Permanente Commercial	$4,412.70
Rate for Payer: Kaiser Permanente Medicaid	$2,500.53
Rate for Payer: Kaiser Permanente Medicare	$3,726.28
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: Ohana Health Plan Medicaid	$3,726.28
Rate for Payer: Ohana Health Plan Medicare	$3,726.28
Rate for Payer: UnitedHealthcare Medicare	$3,726.28
Rate for Payer: University Health Alliance Commercial	$2,745.68

STANDARD INTENSITY HEPARIN CALCULATOR PRN BOLUS [4080208]

Facility

$31.00

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$30.07
Rate for Payer: AlohaCare Medicaid	$15.50
Rate for Payer: AlohaCare Medicare	$23.56
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$18.60
Rate for Payer: Devoted Health Medicare	$26.04
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$23.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Humana Medicare	$23.56
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: Kaiser Permanente Medicare	$23.56
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: Ohana Health Plan Medicaid	$23.56
Rate for Payer: Ohana Health Plan Medicare	$23.56
Rate for Payer: UnitedHealthcare Medicaid	$18.60
Rate for Payer: UnitedHealthcare Medicare	$23.56
Rate for Payer: University Health Alliance Commercial	$22.60

STANDARD INTENSITY HEPARIN CALCULATOR PRN BOLUS [4080208]

Facility

$31.00

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

STAPLE CEEA PREM PLUS 21MM

Facility

$944.00

Hospital Revenue Code	272
Min. Negotiated Rate	$472.00
Max. Negotiated Rate	$915.68
Rate for Payer: AlohaCare Medicaid	$472.00
Rate for Payer: AlohaCare Medicare	$717.44
Rate for Payer: Cash Price	$566.40
Rate for Payer: Devoted Health Medicare	$792.96
Rate for Payer: Hawaii Medical Service Association Medicare	$717.44
Rate for Payer: Hawaii Western Management Group Commercial	$896.80
Rate for Payer: Health Management Network Commercial	$802.40
Rate for Payer: Humana Medicare	$717.44
Rate for Payer: Kaiser Permanente Commercial	$849.60
Rate for Payer: Kaiser Permanente Medicaid	$481.44
Rate for Payer: Kaiser Permanente Medicare	$717.44
Rate for Payer: MDX Hawaii PPO	$915.68
Rate for Payer: Ohana Health Plan Medicaid	$717.44
Rate for Payer: Ohana Health Plan Medicare	$717.44
Rate for Payer: UnitedHealthcare Medicare	$717.44
Rate for Payer: University Health Alliance Commercial	$688.08

STAPLE CEEA PREM PLUS 21MM

Facility

$944.00

Hospital Revenue Code	272
Min. Negotiated Rate	$802.40
Max. Negotiated Rate	$915.68
Rate for Payer: Cash Price	$566.40
Rate for Payer: Health Management Network Commercial	$802.40
Rate for Payer: Kaiser Permanente Commercial	$849.60
Rate for Payer: MDX Hawaii PPO	$915.68

STAPLE CEEA PREM PLUS 25MM

Facility

$999.00

Hospital Revenue Code	272
Min. Negotiated Rate	$499.50
Max. Negotiated Rate	$969.03
Rate for Payer: AlohaCare Medicare	$759.24
Rate for Payer: AlohaCare Medicaid	$499.50
Rate for Payer: Cash Price	$599.40
Rate for Payer: Devoted Health Medicare	$839.16
Rate for Payer: Hawaii Medical Service Association Medicare	$759.24
Rate for Payer: Hawaii Western Management Group Commercial	$949.05
Rate for Payer: Health Management Network Commercial	$849.15
Rate for Payer: Humana Medicare	$759.24
Rate for Payer: Kaiser Permanente Commercial	$899.10
Rate for Payer: Kaiser Permanente Medicaid	$509.49
Rate for Payer: Kaiser Permanente Medicare	$759.24
Rate for Payer: MDX Hawaii PPO	$969.03
Rate for Payer: Ohana Health Plan Medicaid	$759.24
Rate for Payer: Ohana Health Plan Medicare	$759.24
Rate for Payer: UnitedHealthcare Medicare	$759.24
Rate for Payer: University Health Alliance Commercial	$728.17

STAPLE CEEA PREM PLUS 25MM

Facility

$999.00

Hospital Revenue Code	272
Min. Negotiated Rate	$849.15
Max. Negotiated Rate	$969.03
Rate for Payer: Cash Price	$599.40
Rate for Payer: Health Management Network Commercial	$849.15
Rate for Payer: Kaiser Permanente Commercial	$899.10
Rate for Payer: MDX Hawaii PPO	$969.03

STAPLE CEEA PREM PLUS 28MM

Facility

$1,019.00

Hospital Revenue Code	272
Min. Negotiated Rate	$509.50
Max. Negotiated Rate	$988.43
Rate for Payer: AlohaCare Medicaid	$509.50
Rate for Payer: AlohaCare Medicare	$774.44
Rate for Payer: Cash Price	$611.40
Rate for Payer: Devoted Health Medicare	$855.96
Rate for Payer: Hawaii Medical Service Association Medicare	$774.44
Rate for Payer: Hawaii Western Management Group Commercial	$968.05
Rate for Payer: Health Management Network Commercial	$866.15
Rate for Payer: Humana Medicare	$774.44
Rate for Payer: Kaiser Permanente Commercial	$917.10
Rate for Payer: Kaiser Permanente Medicaid	$519.69
Rate for Payer: Kaiser Permanente Medicare	$774.44
Rate for Payer: MDX Hawaii PPO	$988.43
Rate for Payer: Ohana Health Plan Medicaid	$774.44
Rate for Payer: Ohana Health Plan Medicare	$774.44
Rate for Payer: UnitedHealthcare Medicare	$774.44
Rate for Payer: University Health Alliance Commercial	$742.75

STAPLE CEEA PREM PLUS 28MM

Facility

$1,019.00

Hospital Revenue Code	272
Min. Negotiated Rate	$866.15
Max. Negotiated Rate	$988.43
Rate for Payer: Cash Price	$611.40
Rate for Payer: Health Management Network Commercial	$866.15
Rate for Payer: Kaiser Permanente Commercial	$917.10
Rate for Payer: MDX Hawaii PPO	$988.43

STAPLE CEEA PREM PLUS 31MM

Facility

$1,183.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,005.55
Max. Negotiated Rate	$1,147.51
Rate for Payer: Cash Price	$709.80
Rate for Payer: Health Management Network Commercial	$1,005.55
Rate for Payer: Kaiser Permanente Commercial	$1,064.70
Rate for Payer: MDX Hawaii PPO	$1,147.51

STAPLE CEEA PREM PLUS 31MM

Facility

$1,183.00

Hospital Revenue Code	272
Min. Negotiated Rate	$591.50
Max. Negotiated Rate	$1,147.51
Rate for Payer: AlohaCare Medicaid	$591.50
Rate for Payer: AlohaCare Medicare	$899.08
Rate for Payer: Cash Price	$709.80
Rate for Payer: Devoted Health Medicare	$993.72
Rate for Payer: Hawaii Medical Service Association Medicare	$899.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,123.85
Rate for Payer: Health Management Network Commercial	$1,005.55
Rate for Payer: Humana Medicare	$899.08
Rate for Payer: Kaiser Permanente Commercial	$1,064.70
Rate for Payer: Kaiser Permanente Medicaid	$603.33
Rate for Payer: Kaiser Permanente Medicare	$899.08
Rate for Payer: MDX Hawaii PPO	$1,147.51
Rate for Payer: Ohana Health Plan Medicaid	$899.08
Rate for Payer: Ohana Health Plan Medicare	$899.08
Rate for Payer: UnitedHealthcare Medicare	$899.08
Rate for Payer: University Health Alliance Commercial	$862.29

STAPLER 12MM BLADELESS 470395

Facility

$2,457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,088.45
Max. Negotiated Rate	$2,383.29
Rate for Payer: Cash Price	$1,474.20
Rate for Payer: Health Management Network Commercial	$2,088.45
Rate for Payer: Kaiser Permanente Commercial	$2,211.30
Rate for Payer: MDX Hawaii PPO	$2,383.29

STAPLER 12MM BLADELESS 470395

Facility

$2,457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,228.50
Max. Negotiated Rate	$2,383.29
Rate for Payer: AlohaCare Medicaid	$1,228.50
Rate for Payer: AlohaCare Medicare	$1,867.32
Rate for Payer: Cash Price	$1,474.20
Rate for Payer: Devoted Health Medicare	$2,063.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,867.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,334.15
Rate for Payer: Health Management Network Commercial	$2,088.45
Rate for Payer: Humana Medicare	$1,867.32
Rate for Payer: Kaiser Permanente Commercial	$2,211.30
Rate for Payer: Kaiser Permanente Medicaid	$1,253.07
Rate for Payer: Kaiser Permanente Medicare	$1,867.32
Rate for Payer: MDX Hawaii PPO	$2,383.29
Rate for Payer: Ohana Health Plan Medicaid	$1,867.32
Rate for Payer: Ohana Health Plan Medicare	$1,867.32
Rate for Payer: UnitedHealthcare Medicare	$1,867.32
Rate for Payer: University Health Alliance Commercial	$1,790.91

Know your out-of-pocket cost for care.

All Charges