Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

STRETCH VASCULA GRAFT SBT1201D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.12
Max. Negotiated Rate	$2,717.94
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT1201D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.00
Max. Negotiated Rate	$2,717.94
Rate for Payer: AlohaCare Medicaid	$1,401.00
Rate for Payer: AlohaCare Medicare	$2,129.52
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Devoted Health Medicare	$2,353.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,129.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Humana Medicare	$2,129.52
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: Kaiser Permanente Medicaid	$1,429.02
Rate for Payer: Kaiser Permanente Medicare	$2,129.52
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: Ohana Health Plan Medicaid	$2,129.52
Rate for Payer: Ohana Health Plan Medicare	$2,129.52
Rate for Payer: UnitedHealthcare Medicare	$2,129.52
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT1401D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.00
Max. Negotiated Rate	$2,717.94
Rate for Payer: AlohaCare Medicaid	$1,401.00
Rate for Payer: AlohaCare Medicare	$2,129.52
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Devoted Health Medicare	$2,353.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,129.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Humana Medicare	$2,129.52
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: Kaiser Permanente Medicaid	$1,429.02
Rate for Payer: Kaiser Permanente Medicare	$2,129.52
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: Ohana Health Plan Medicaid	$2,129.52
Rate for Payer: Ohana Health Plan Medicare	$2,129.52
Rate for Payer: UnitedHealthcare Medicare	$2,129.52
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT1401D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.12
Max. Negotiated Rate	$2,717.94
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT1801D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.12
Max. Negotiated Rate	$2,717.94
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT1801D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.00
Max. Negotiated Rate	$2,717.94
Rate for Payer: AlohaCare Medicaid	$1,401.00
Rate for Payer: AlohaCare Medicare	$2,129.52
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Devoted Health Medicare	$2,353.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,129.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Humana Medicare	$2,129.52
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: Kaiser Permanente Medicaid	$1,429.02
Rate for Payer: Kaiser Permanente Medicare	$2,129.52
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: Ohana Health Plan Medicaid	$2,129.52
Rate for Payer: Ohana Health Plan Medicare	$2,129.52
Rate for Payer: UnitedHealthcare Medicare	$2,129.52
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT2001D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.12
Max. Negotiated Rate	$2,717.94
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT2001D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.00
Max. Negotiated Rate	$2,717.94
Rate for Payer: AlohaCare Medicaid	$1,401.00
Rate for Payer: AlohaCare Medicare	$2,129.52
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Devoted Health Medicare	$2,353.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,129.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Humana Medicare	$2,129.52
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: Kaiser Permanente Medicaid	$1,429.02
Rate for Payer: Kaiser Permanente Medicare	$2,129.52
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: Ohana Health Plan Medicaid	$2,129.52
Rate for Payer: Ohana Health Plan Medicare	$2,129.52
Rate for Payer: UnitedHealthcare Medicare	$2,129.52
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULAR GRAFT S0602

Facility

$1,103.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$617.68
Max. Negotiated Rate	$1,069.91
Rate for Payer: Cash Price	$661.80
Rate for Payer: Hawaii Western Management Group Commercial	$772.10
Rate for Payer: Health Management Network Commercial	$937.55
Rate for Payer: Kaiser Permanente Commercial	$992.70
Rate for Payer: MDX Hawaii PPO	$1,069.91
Rate for Payer: University Health Alliance Commercial	$617.68

STRETCH VASCULAR GRAFT S0602

Facility

$1,103.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$551.50
Max. Negotiated Rate	$1,069.91
Rate for Payer: AlohaCare Medicaid	$551.50
Rate for Payer: AlohaCare Medicare	$838.28
Rate for Payer: Cash Price	$661.80
Rate for Payer: Devoted Health Medicare	$926.52
Rate for Payer: Hawaii Medical Service Association Medicare	$838.28
Rate for Payer: Hawaii Western Management Group Commercial	$772.10
Rate for Payer: Health Management Network Commercial	$937.55
Rate for Payer: Humana Medicare	$838.28
Rate for Payer: Kaiser Permanente Commercial	$992.70
Rate for Payer: Kaiser Permanente Medicaid	$562.53
Rate for Payer: Kaiser Permanente Medicare	$838.28
Rate for Payer: MDX Hawaii PPO	$1,069.91
Rate for Payer: Ohana Health Plan Medicaid	$838.28
Rate for Payer: Ohana Health Plan Medicare	$838.28
Rate for Payer: UnitedHealthcare Medicare	$838.28
Rate for Payer: University Health Alliance Commercial	$617.68

STRETCH VASCULAR GRAFT S0607

Facility

$2,598.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,454.88
Max. Negotiated Rate	$2,520.06
Rate for Payer: Cash Price	$1,558.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,818.60
Rate for Payer: Health Management Network Commercial	$2,208.30
Rate for Payer: Kaiser Permanente Commercial	$2,338.20
Rate for Payer: MDX Hawaii PPO	$2,520.06
Rate for Payer: University Health Alliance Commercial	$1,454.88

STRETCH VASCULAR GRAFT S0607

Facility

$2,598.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.00
Max. Negotiated Rate	$2,520.06
Rate for Payer: AlohaCare Medicaid	$1,299.00
Rate for Payer: AlohaCare Medicare	$1,974.48
Rate for Payer: Cash Price	$1,558.80
Rate for Payer: Devoted Health Medicare	$2,182.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,974.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,818.60
Rate for Payer: Health Management Network Commercial	$2,208.30
Rate for Payer: Humana Medicare	$1,974.48
Rate for Payer: Kaiser Permanente Commercial	$2,338.20
Rate for Payer: Kaiser Permanente Medicaid	$1,324.98
Rate for Payer: Kaiser Permanente Medicare	$1,974.48
Rate for Payer: MDX Hawaii PPO	$2,520.06
Rate for Payer: Ohana Health Plan Medicaid	$1,974.48
Rate for Payer: Ohana Health Plan Medicare	$1,974.48
Rate for Payer: UnitedHealthcare Medicare	$1,974.48
Rate for Payer: University Health Alliance Commercial	$1,454.88

STRETCH VASCULAR GRAFT S0804

Facility

$1,584.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$887.04
Max. Negotiated Rate	$1,536.48
Rate for Payer: Cash Price	$950.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,108.80
Rate for Payer: Health Management Network Commercial	$1,346.40
Rate for Payer: Kaiser Permanente Commercial	$1,425.60
Rate for Payer: MDX Hawaii PPO	$1,536.48
Rate for Payer: University Health Alliance Commercial	$887.04

STRETCH VASCULAR GRAFT S0804

Facility

$1,584.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,536.48
Rate for Payer: AlohaCare Medicaid	$792.00
Rate for Payer: AlohaCare Medicare	$1,203.84
Rate for Payer: Cash Price	$950.40
Rate for Payer: Devoted Health Medicare	$1,330.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,203.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,108.80
Rate for Payer: Health Management Network Commercial	$1,346.40
Rate for Payer: Humana Medicare	$1,203.84
Rate for Payer: Kaiser Permanente Commercial	$1,425.60
Rate for Payer: Kaiser Permanente Medicaid	$807.84
Rate for Payer: Kaiser Permanente Medicare	$1,203.84
Rate for Payer: MDX Hawaii PPO	$1,536.48
Rate for Payer: Ohana Health Plan Medicaid	$1,203.84
Rate for Payer: Ohana Health Plan Medicare	$1,203.84
Rate for Payer: UnitedHealthcare Medicare	$1,203.84
Rate for Payer: University Health Alliance Commercial	$887.04

STRETCH VASCULAR GRAFT S47045

Facility

$2,139.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,069.50
Max. Negotiated Rate	$2,074.83
Rate for Payer: AlohaCare Medicaid	$1,069.50
Rate for Payer: AlohaCare Medicare	$1,625.64
Rate for Payer: Cash Price	$1,283.40
Rate for Payer: Devoted Health Medicare	$1,796.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,625.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,497.30
Rate for Payer: Health Management Network Commercial	$1,818.15
Rate for Payer: Humana Medicare	$1,625.64
Rate for Payer: Kaiser Permanente Commercial	$1,925.10
Rate for Payer: Kaiser Permanente Medicaid	$1,090.89
Rate for Payer: Kaiser Permanente Medicare	$1,625.64
Rate for Payer: MDX Hawaii PPO	$2,074.83
Rate for Payer: Ohana Health Plan Medicaid	$1,625.64
Rate for Payer: Ohana Health Plan Medicare	$1,625.64
Rate for Payer: UnitedHealthcare Medicare	$1,625.64
Rate for Payer: University Health Alliance Commercial	$1,197.84

STRETCH VASCULAR GRAFT S47045

Facility

$2,139.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,197.84
Max. Negotiated Rate	$2,074.83
Rate for Payer: Cash Price	$1,283.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,497.30
Rate for Payer: Health Management Network Commercial	$1,818.15
Rate for Payer: Kaiser Permanente Commercial	$1,925.10
Rate for Payer: MDX Hawaii PPO	$2,074.83
Rate for Payer: University Health Alliance Commercial	$1,197.84

STRETCH VASCULAR GRAFT S47070

Facility

$2,196.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,098.00
Max. Negotiated Rate	$2,130.12
Rate for Payer: AlohaCare Medicaid	$1,098.00
Rate for Payer: AlohaCare Medicare	$1,668.96
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Devoted Health Medicare	$1,844.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,668.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,537.20
Rate for Payer: Health Management Network Commercial	$1,866.60
Rate for Payer: Humana Medicare	$1,668.96
Rate for Payer: Kaiser Permanente Commercial	$1,976.40
Rate for Payer: Kaiser Permanente Medicaid	$1,119.96
Rate for Payer: Kaiser Permanente Medicare	$1,668.96
Rate for Payer: MDX Hawaii PPO	$2,130.12
Rate for Payer: Ohana Health Plan Medicaid	$1,668.96
Rate for Payer: Ohana Health Plan Medicare	$1,668.96
Rate for Payer: UnitedHealthcare Medicare	$1,668.96
Rate for Payer: University Health Alliance Commercial	$1,229.76

STRETCH VASCULAR GRAFT S47070

Facility

$2,196.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,229.76
Max. Negotiated Rate	$2,130.12
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,537.20
Rate for Payer: Health Management Network Commercial	$1,866.60
Rate for Payer: Kaiser Permanente Commercial	$1,976.40
Rate for Payer: MDX Hawaii PPO	$2,130.12
Rate for Payer: University Health Alliance Commercial	$1,229.76

STRUTS RAPID ADJUST 50-10180CE

Facility

$263.00

Hospital Revenue Code	272
Min. Negotiated Rate	$131.50
Max. Negotiated Rate	$255.11
Rate for Payer: AlohaCare Medicaid	$131.50
Rate for Payer: AlohaCare Medicare	$199.88
Rate for Payer: Cash Price	$157.80
Rate for Payer: Devoted Health Medicare	$220.92
Rate for Payer: Hawaii Medical Service Association Medicare	$199.88
Rate for Payer: Hawaii Western Management Group Commercial	$249.85
Rate for Payer: Health Management Network Commercial	$223.55
Rate for Payer: Humana Medicare	$199.88
Rate for Payer: Kaiser Permanente Commercial	$236.70
Rate for Payer: Kaiser Permanente Medicaid	$134.13
Rate for Payer: Kaiser Permanente Medicare	$199.88
Rate for Payer: MDX Hawaii PPO	$255.11
Rate for Payer: Ohana Health Plan Medicaid	$199.88
Rate for Payer: Ohana Health Plan Medicare	$199.88
Rate for Payer: UnitedHealthcare Medicare	$199.88
Rate for Payer: University Health Alliance Commercial	$191.70

STRUTS RAPID ADJUST 50-10180CE

Facility

$263.00

Hospital Revenue Code	272
Min. Negotiated Rate	$223.55
Max. Negotiated Rate	$255.11
Rate for Payer: Cash Price	$157.80
Rate for Payer: Health Management Network Commercial	$223.55
Rate for Payer: Kaiser Permanente Commercial	$236.70
Rate for Payer: MDX Hawaii PPO	$255.11

STYLET-BALL TIP 45CM 6057-45

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$152.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$168.00
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$152.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$152.00
Rate for Payer: Ohana Health Plan Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: University Health Alliance Commercial	$145.78

STYLET-BALL TIP 45CM 6057-45

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

STYLET-BLUE KIT 0.014 6057-58

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$152.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$168.00
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$152.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$152.00
Rate for Payer: Ohana Health Plan Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: University Health Alliance Commercial	$145.78

STYLET-BLUE KIT 0.014 6057-58

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

STYLET-GREY KIT 0.014 6082-52

Facility

$160.00

Hospital Revenue Code	272
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: MDX Hawaii PPO	$155.20

Know your out-of-pocket cost for care.

All Charges