Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

STYLET-GREY KIT 0.014 6082-52

Facility

$160.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$80.00
Rate for Payer: AlohaCare Medicare	$121.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Devoted Health Medicare	$134.40
Rate for Payer: Hawaii Medical Service Association Medicare	$121.60
Rate for Payer: Hawaii Western Management Group Commercial	$152.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$121.60
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$121.60
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$121.60
Rate for Payer: Ohana Health Plan Medicare	$121.60
Rate for Payer: UnitedHealthcare Medicare	$121.60
Rate for Payer: University Health Alliance Commercial	$116.62

STYLET-GREY KIT 6091-45

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-GREY KIT 6091-45

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 KIT-46CM DS06003/46

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

STYLET KIT-46CM DS06003/46

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$228.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Devoted Health Medicare	$252.00
Rate for Payer: Hawaii Medical Service Association Medicare	$228.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$228.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$228.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$228.00
Rate for Payer: Ohana Health Plan Medicare	$228.00
Rate for Payer: UnitedHealthcare Medicare	$228.00
Rate for Payer: University Health Alliance Commercial	$218.67

STYLET KIT-52CM DS06001/52

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

STYLET KIT-52CM DS06001/52

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$228.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Devoted Health Medicare	$252.00
Rate for Payer: Hawaii Medical Service Association Medicare	$228.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$228.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$228.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$228.00
Rate for Payer: Ohana Health Plan Medicare	$228.00
Rate for Payer: UnitedHealthcare Medicare	$228.00
Rate for Payer: University Health Alliance Commercial	$218.67

STYLET KIT-58CM DS06003/58

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$228.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Devoted Health Medicare	$252.00
Rate for Payer: Hawaii Medical Service Association Medicare	$228.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$228.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$228.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$228.00
Rate for Payer: Ohana Health Plan Medicare	$228.00
Rate for Payer: UnitedHealthcare Medicare	$228.00
Rate for Payer: University Health Alliance Commercial	$218.67

STYLET KIT-58CM DS06003/58

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

STYLET KIT 6082-58

Facility

$160.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$80.00
Rate for Payer: AlohaCare Medicare	$121.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Devoted Health Medicare	$134.40
Rate for Payer: Hawaii Medical Service Association Medicare	$121.60
Rate for Payer: Hawaii Western Management Group Commercial	$152.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$121.60
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$121.60
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$121.60
Rate for Payer: Ohana Health Plan Medicare	$121.60
Rate for Payer: UnitedHealthcare Medicare	$121.60
Rate for Payer: University Health Alliance Commercial	$116.62

STYLET KIT 6082-58

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

STYLET KIT 6094-45

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 KIT 6094-45

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 KIT 6094-52

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

STYLET KIT 6094-52

Facility

$160.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$80.00
Rate for Payer: AlohaCare Medicare	$121.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Devoted Health Medicare	$134.40
Rate for Payer: Hawaii Medical Service Association Medicare	$121.60
Rate for Payer: Hawaii Western Management Group Commercial	$152.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$121.60
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$121.60
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$121.60
Rate for Payer: Ohana Health Plan Medicare	$121.60
Rate for Payer: UnitedHealthcare Medicare	$121.60
Rate for Payer: University Health Alliance Commercial	$116.62

STYLET KIT- GREY 6091-53

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 KIT- GREY 6091-53

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 PACING 333413

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 PACING 333413

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

SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML (20 MG/ML) INTRAVENOUS SYRINGE [132367]

Facility

$105.00

Service Code	NDC 71266200108
Hospital Revenue Code	250
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85

SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [7536]

Facility

$84.00

Service Code	NDC 00781341170
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [7536]

Facility

$84.00

Service Code	NDC 70710137702
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [7536]

Facility

$84.00

Service Code	NDC 00781341195
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

$22.00

Service Code	NDC 68094004159
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$21.34

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

$33.00

Service Code	NDC 68094004362
Hospital Revenue Code	250
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: MDX Hawaii PPO	$32.01

Know your out-of-pocket cost for care.

All Charges