Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

STEM SECUR-FIT 6051-0625S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$5,606.60
Rate for Payer: AlohaCare Medicaid	$2,890.00
Rate for Payer: AlohaCare Medicare	$4,392.80
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Devoted Health Medicare	$4,855.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4,392.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Humana Medicare	$4,392.80
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: Kaiser Permanente Medicare	$4,392.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: Ohana Health Plan Medicaid	$4,392.80
Rate for Payer: Ohana Health Plan Medicare	$4,392.80
Rate for Payer: UnitedHealthcare Medicare	$4,392.80
Rate for Payer: University Health Alliance Commercial	$3,236.80

STEM SECUR-FIT 6051-0625S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

STEM TRIATHLON 5565-S-018

Facility

$2,421.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,355.76
Max. Negotiated Rate	$2,348.37
Rate for Payer: Cash Price	$1,452.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,694.70
Rate for Payer: Health Management Network Commercial	$2,057.85
Rate for Payer: Kaiser Permanente Commercial	$2,178.90
Rate for Payer: MDX Hawaii PPO	$2,348.37
Rate for Payer: University Health Alliance Commercial	$1,355.76

STEM TRIATHLON 5565-S-018

Facility

$2,421.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,210.50
Max. Negotiated Rate	$2,348.37
Rate for Payer: AlohaCare Medicaid	$1,210.50
Rate for Payer: AlohaCare Medicare	$1,839.96
Rate for Payer: Cash Price	$1,452.60
Rate for Payer: Devoted Health Medicare	$2,033.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,839.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,694.70
Rate for Payer: Health Management Network Commercial	$2,057.85
Rate for Payer: Humana Medicare	$1,839.96
Rate for Payer: Kaiser Permanente Commercial	$2,178.90
Rate for Payer: Kaiser Permanente Medicaid	$1,234.71
Rate for Payer: Kaiser Permanente Medicare	$1,839.96
Rate for Payer: MDX Hawaii PPO	$2,348.37
Rate for Payer: Ohana Health Plan Medicaid	$1,839.96
Rate for Payer: Ohana Health Plan Medicare	$1,839.96
Rate for Payer: UnitedHealthcare Medicare	$1,839.96
Rate for Payer: University Health Alliance Commercial	$1,355.76

STEM ULNAR SMALL LEFT 70MM

Facility

$10,406.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,827.36
Max. Negotiated Rate	$10,093.82
Rate for Payer: Cash Price	$6,243.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,284.20
Rate for Payer: Health Management Network Commercial	$8,845.10
Rate for Payer: Kaiser Permanente Commercial	$9,365.40
Rate for Payer: MDX Hawaii PPO	$10,093.82
Rate for Payer: University Health Alliance Commercial	$5,827.36

STEM ULNAR SMALL LEFT 70MM

Facility

$10,406.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,203.00
Max. Negotiated Rate	$10,093.82
Rate for Payer: AlohaCare Medicaid	$5,203.00
Rate for Payer: AlohaCare Medicare	$7,908.56
Rate for Payer: Cash Price	$6,243.60
Rate for Payer: Devoted Health Medicare	$8,741.04
Rate for Payer: Hawaii Medical Service Association Medicare	$7,908.56
Rate for Payer: Hawaii Western Management Group Commercial	$7,284.20
Rate for Payer: Health Management Network Commercial	$8,845.10
Rate for Payer: Humana Medicare	$7,908.56
Rate for Payer: Kaiser Permanente Commercial	$9,365.40
Rate for Payer: Kaiser Permanente Medicaid	$5,307.06
Rate for Payer: Kaiser Permanente Medicare	$7,908.56
Rate for Payer: MDX Hawaii PPO	$10,093.82
Rate for Payer: Ohana Health Plan Medicaid	$7,908.56
Rate for Payer: Ohana Health Plan Medicare	$7,908.56
Rate for Payer: UnitedHealthcare Medicare	$7,908.56
Rate for Payer: University Health Alliance Commercial	$5,827.36

STEN SYSTEM ENROUTE TRANSCAROT

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

STEN SYSTEM ENROUTE TRANSCAROT

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

STENT 10X60 BILIARY RX BARE

Facility

$3,357.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,678.50
Max. Negotiated Rate	$3,256.29
Rate for Payer: AlohaCare Medicaid	$1,678.50
Rate for Payer: AlohaCare Medicare	$2,551.32
Rate for Payer: Cash Price	$2,014.20
Rate for Payer: Devoted Health Medicare	$2,819.88
Rate for Payer: Hawaii Medical Service Association Medicare	$2,551.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,349.90
Rate for Payer: Health Management Network Commercial	$2,853.45
Rate for Payer: Humana Medicare	$2,551.32
Rate for Payer: Kaiser Permanente Commercial	$3,021.30
Rate for Payer: Kaiser Permanente Medicaid	$1,712.07
Rate for Payer: Kaiser Permanente Medicare	$2,551.32
Rate for Payer: MDX Hawaii PPO	$3,256.29
Rate for Payer: Ohana Health Plan Medicaid	$2,551.32
Rate for Payer: Ohana Health Plan Medicare	$2,551.32
Rate for Payer: UnitedHealthcare Medicare	$2,551.32
Rate for Payer: University Health Alliance Commercial	$1,879.92

STENT 10X60 BILIARY RX BARE

Facility

$3,357.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,879.92
Max. Negotiated Rate	$3,256.29
Rate for Payer: Cash Price	$2,014.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,349.90
Rate for Payer: Health Management Network Commercial	$2,853.45
Rate for Payer: Kaiser Permanente Commercial	$3,021.30
Rate for Payer: MDX Hawaii PPO	$3,256.29
Rate for Payer: University Health Alliance Commercial	$1,879.92

STENT 10X7 ADVANIX BILIARY RX

Facility

$490.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$274.40
Max. Negotiated Rate	$475.30
Rate for Payer: Cash Price	$294.00
Rate for Payer: Hawaii Western Management Group Commercial	$343.00
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: MDX Hawaii PPO	$475.30
Rate for Payer: University Health Alliance Commercial	$274.40

STENT 10X7 ADVANIX BILIARY RX

Facility

$490.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$475.30
Rate for Payer: AlohaCare Medicaid	$245.00
Rate for Payer: AlohaCare Medicare	$372.40
Rate for Payer: Cash Price	$294.00
Rate for Payer: Devoted Health Medicare	$411.60
Rate for Payer: Hawaii Medical Service Association Medicare	$372.40
Rate for Payer: Hawaii Western Management Group Commercial	$343.00
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Humana Medicare	$372.40
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: Kaiser Permanente Medicaid	$249.90
Rate for Payer: Kaiser Permanente Medicare	$372.40
Rate for Payer: MDX Hawaii PPO	$475.30
Rate for Payer: Ohana Health Plan Medicaid	$372.40
Rate for Payer: Ohana Health Plan Medicare	$372.40
Rate for Payer: UnitedHealthcare Medicare	$372.40
Rate for Payer: University Health Alliance Commercial	$274.40

STENT 10X80 8F WALLFLEX

Facility

$2,849.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.44
Max. Negotiated Rate	$2,763.53
Rate for Payer: Cash Price	$1,709.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,994.30
Rate for Payer: Health Management Network Commercial	$2,421.65
Rate for Payer: Kaiser Permanente Commercial	$2,564.10
Rate for Payer: MDX Hawaii PPO	$2,763.53
Rate for Payer: University Health Alliance Commercial	$1,595.44

STENT 10X80 8F WALLFLEX

Facility

$2,849.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,424.50
Max. Negotiated Rate	$2,763.53
Rate for Payer: AlohaCare Medicaid	$1,424.50
Rate for Payer: AlohaCare Medicare	$2,165.24
Rate for Payer: Cash Price	$1,709.40
Rate for Payer: Devoted Health Medicare	$2,393.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,165.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,994.30
Rate for Payer: Health Management Network Commercial	$2,421.65
Rate for Payer: Humana Medicare	$2,165.24
Rate for Payer: Kaiser Permanente Commercial	$2,564.10
Rate for Payer: Kaiser Permanente Medicaid	$1,452.99
Rate for Payer: Kaiser Permanente Medicare	$2,165.24
Rate for Payer: MDX Hawaii PPO	$2,763.53
Rate for Payer: Ohana Health Plan Medicaid	$2,165.24
Rate for Payer: Ohana Health Plan Medicare	$2,165.24
Rate for Payer: UnitedHealthcare Medicare	$2,165.24
Rate for Payer: University Health Alliance Commercial	$1,595.44

STENT 18X97 ESOPHAGEAL

Facility

$5,800.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,900.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: AlohaCare Medicaid	$2,900.00
Rate for Payer: AlohaCare Medicare	$4,408.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Devoted Health Medicare	$4,872.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,408.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Humana Medicare	$4,408.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: Kaiser Permanente Medicaid	$2,958.00
Rate for Payer: Kaiser Permanente Medicare	$4,408.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: Ohana Health Plan Medicaid	$4,408.00
Rate for Payer: Ohana Health Plan Medicare	$4,408.00
Rate for Payer: UnitedHealthcare Medicare	$4,408.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

STENT 18X97 ESOPHAGEAL

Facility

$5,800.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,248.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

STENT 22X90 WALLFLEX

Facility

$5,075.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,537.50
Max. Negotiated Rate	$4,922.75
Rate for Payer: AlohaCare Medicaid	$2,537.50
Rate for Payer: AlohaCare Medicare	$3,857.00
Rate for Payer: Cash Price	$3,045.00
Rate for Payer: Devoted Health Medicare	$4,263.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,857.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,552.50
Rate for Payer: Health Management Network Commercial	$4,313.75
Rate for Payer: Humana Medicare	$3,857.00
Rate for Payer: Kaiser Permanente Commercial	$4,567.50
Rate for Payer: Kaiser Permanente Medicaid	$2,588.25
Rate for Payer: Kaiser Permanente Medicare	$3,857.00
Rate for Payer: MDX Hawaii PPO	$4,922.75
Rate for Payer: Ohana Health Plan Medicaid	$3,857.00
Rate for Payer: Ohana Health Plan Medicare	$3,857.00
Rate for Payer: UnitedHealthcare Medicare	$3,857.00
Rate for Payer: University Health Alliance Commercial	$2,842.00

STENT 22X90 WALLFLEX

Facility

$5,075.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,842.00
Max. Negotiated Rate	$4,922.75
Rate for Payer: Cash Price	$3,045.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,552.50
Rate for Payer: Health Management Network Commercial	$4,313.75
Rate for Payer: Kaiser Permanente Commercial	$4,567.50
Rate for Payer: MDX Hawaii PPO	$4,922.75
Rate for Payer: University Health Alliance Commercial	$2,842.00

STENT 4.5FRX20 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$277.50
Max. Negotiated Rate	$538.35
Rate for Payer: AlohaCare Medicaid	$277.50
Rate for Payer: AlohaCare Medicare	$421.80
Rate for Payer: Cash Price	$333.00
Rate for Payer: Devoted Health Medicare	$466.20
Rate for Payer: Hawaii Medical Service Association Medicare	$421.80
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Humana Medicare	$421.80
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: Kaiser Permanente Medicare	$421.80
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: Ohana Health Plan Medicaid	$421.80
Rate for Payer: Ohana Health Plan Medicare	$421.80
Rate for Payer: UnitedHealthcare Medicare	$421.80
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX20 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$310.80
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX22 URETER OPEN TIP

Facility

$769.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$430.64
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$461.40
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: University Health Alliance Commercial	$430.64

STENT 4.5FRX22 URETER OPEN TIP

Facility

$769.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$384.50
Max. Negotiated Rate	$745.93
Rate for Payer: AlohaCare Medicaid	$384.50
Rate for Payer: AlohaCare Medicare	$584.44
Rate for Payer: Cash Price	$461.40
Rate for Payer: Devoted Health Medicare	$645.96
Rate for Payer: Hawaii Medical Service Association Medicare	$584.44
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Humana Medicare	$584.44
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: Kaiser Permanente Medicaid	$392.19
Rate for Payer: Kaiser Permanente Medicare	$584.44
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: Ohana Health Plan Medicaid	$584.44
Rate for Payer: Ohana Health Plan Medicare	$584.44
Rate for Payer: UnitedHealthcare Medicare	$584.44
Rate for Payer: University Health Alliance Commercial	$430.64

STENT 4.5FRX24 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$310.80
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX24 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$277.50
Max. Negotiated Rate	$538.35
Rate for Payer: AlohaCare Medicaid	$277.50
Rate for Payer: AlohaCare Medicare	$421.80
Rate for Payer: Cash Price	$333.00
Rate for Payer: Devoted Health Medicare	$466.20
Rate for Payer: Hawaii Medical Service Association Medicare	$421.80
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Humana Medicare	$421.80
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: Kaiser Permanente Medicare	$421.80
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: Ohana Health Plan Medicaid	$421.80
Rate for Payer: Ohana Health Plan Medicare	$421.80
Rate for Payer: UnitedHealthcare Medicare	$421.80
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX26 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$310.80
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: University Health Alliance Commercial	$310.80

Know your out-of-pocket cost for care.

All Charges