Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SUTURE ANCHOR AR-8934BCST

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$874.72
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

SUTURE ANCHOR AR-8934BCST

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$781.00
Max. Negotiated Rate	$1,515.14
Rate for Payer: AlohaCare Medicaid	$781.00
Rate for Payer: AlohaCare Medicare	$1,187.12
Rate for Payer: Cash Price	$937.20
Rate for Payer: Devoted Health Medicare	$1,312.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,187.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Humana Medicare	$1,187.12
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: Kaiser Permanente Medicaid	$796.62
Rate for Payer: Kaiser Permanente Medicare	$1,187.12
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: Ohana Health Plan Medicaid	$1,187.12
Rate for Payer: Ohana Health Plan Medicare	$1,187.12
Rate for Payer: UnitedHealthcare Medicare	$1,187.12
Rate for Payer: University Health Alliance Commercial	$874.72

SUTURE ANCHOR BIOCOMPOSITE

Facility

$1,288.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$721.28
Max. Negotiated Rate	$1,249.36
Rate for Payer: Cash Price	$772.80
Rate for Payer: Hawaii Western Management Group Commercial	$901.60
Rate for Payer: Health Management Network Commercial	$1,094.80
Rate for Payer: Kaiser Permanente Commercial	$1,159.20
Rate for Payer: MDX Hawaii PPO	$1,249.36
Rate for Payer: University Health Alliance Commercial	$721.28

SUTURE ANCHOR BIOCOMPOSITE

Facility

$1,288.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$644.00
Max. Negotiated Rate	$1,249.36
Rate for Payer: AlohaCare Medicaid	$644.00
Rate for Payer: AlohaCare Medicare	$978.88
Rate for Payer: Cash Price	$772.80
Rate for Payer: Devoted Health Medicare	$1,081.92
Rate for Payer: Hawaii Medical Service Association Medicare	$978.88
Rate for Payer: Hawaii Western Management Group Commercial	$901.60
Rate for Payer: Health Management Network Commercial	$1,094.80
Rate for Payer: Humana Medicare	$978.88
Rate for Payer: Kaiser Permanente Commercial	$1,159.20
Rate for Payer: Kaiser Permanente Medicaid	$656.88
Rate for Payer: Kaiser Permanente Medicare	$978.88
Rate for Payer: MDX Hawaii PPO	$1,249.36
Rate for Payer: Ohana Health Plan Medicaid	$978.88
Rate for Payer: Ohana Health Plan Medicare	$978.88
Rate for Payer: UnitedHealthcare Medicare	$978.88
Rate for Payer: University Health Alliance Commercial	$721.28

SUTURE ANCHOR BIO-PUSHLOCK

Facility

$1,701.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$952.56
Max. Negotiated Rate	$1,649.97
Rate for Payer: Cash Price	$1,020.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,190.70
Rate for Payer: Health Management Network Commercial	$1,445.85
Rate for Payer: Kaiser Permanente Commercial	$1,530.90
Rate for Payer: MDX Hawaii PPO	$1,649.97
Rate for Payer: University Health Alliance Commercial	$952.56

SUTURE ANCHOR BIO-PUSHLOCK

Facility

$1,701.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$850.50
Max. Negotiated Rate	$1,649.97
Rate for Payer: AlohaCare Medicaid	$850.50
Rate for Payer: AlohaCare Medicare	$1,292.76
Rate for Payer: Cash Price	$1,020.60
Rate for Payer: Devoted Health Medicare	$1,428.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,292.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,190.70
Rate for Payer: Health Management Network Commercial	$1,445.85
Rate for Payer: Humana Medicare	$1,292.76
Rate for Payer: Kaiser Permanente Commercial	$1,530.90
Rate for Payer: Kaiser Permanente Medicaid	$867.51
Rate for Payer: Kaiser Permanente Medicare	$1,292.76
Rate for Payer: MDX Hawaii PPO	$1,649.97
Rate for Payer: Ohana Health Plan Medicaid	$1,292.76
Rate for Payer: Ohana Health Plan Medicare	$1,292.76
Rate for Payer: UnitedHealthcare Medicare	$1,292.76
Rate for Payer: University Health Alliance Commercial	$952.56

SUTURE BUTTON 12MM #AR-8922

Facility

$536.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$300.16
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Hawaii Western Management Group Commercial	$375.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: University Health Alliance Commercial	$300.16

SUTURE BUTTON 12MM #AR-8922

Facility

$536.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$268.00
Max. Negotiated Rate	$519.92
Rate for Payer: AlohaCare Medicaid	$268.00
Rate for Payer: AlohaCare Medicare	$407.36
Rate for Payer: Cash Price	$321.60
Rate for Payer: Devoted Health Medicare	$450.24
Rate for Payer: Hawaii Medical Service Association Medicare	$407.36
Rate for Payer: Hawaii Western Management Group Commercial	$375.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Humana Medicare	$407.36
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: Kaiser Permanente Medicare	$407.36
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: Ohana Health Plan Medicaid	$407.36
Rate for Payer: Ohana Health Plan Medicare	$407.36
Rate for Payer: UnitedHealthcare Medicare	$407.36
Rate for Payer: University Health Alliance Commercial	$300.16

SUTURE CINCH-LNG M00505550

Facility

$684.00

Hospital Revenue Code	272
Min. Negotiated Rate	$581.40
Max. Negotiated Rate	$663.48
Rate for Payer: Cash Price	$410.40
Rate for Payer: Health Management Network Commercial	$581.40
Rate for Payer: Kaiser Permanente Commercial	$615.60
Rate for Payer: MDX Hawaii PPO	$663.48

SUTURE CINCH-LNG M00505550

Facility

$684.00

Hospital Revenue Code	272
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$663.48
Rate for Payer: AlohaCare Medicaid	$342.00
Rate for Payer: AlohaCare Medicare	$519.84
Rate for Payer: Cash Price	$410.40
Rate for Payer: Devoted Health Medicare	$574.56
Rate for Payer: Hawaii Medical Service Association Medicare	$519.84
Rate for Payer: Hawaii Western Management Group Commercial	$649.80
Rate for Payer: Health Management Network Commercial	$581.40
Rate for Payer: Humana Medicare	$519.84
Rate for Payer: Kaiser Permanente Commercial	$615.60
Rate for Payer: Kaiser Permanente Medicaid	$348.84
Rate for Payer: Kaiser Permanente Medicare	$519.84
Rate for Payer: MDX Hawaii PPO	$663.48
Rate for Payer: Ohana Health Plan Medicaid	$519.84
Rate for Payer: Ohana Health Plan Medicare	$519.84
Rate for Payer: UnitedHealthcare Medicare	$519.84
Rate for Payer: University Health Alliance Commercial	$498.57

SUTURE FIX ANCHOR #72203853

Facility

$1,188.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$594.00
Max. Negotiated Rate	$1,152.36
Rate for Payer: AlohaCare Medicaid	$594.00
Rate for Payer: AlohaCare Medicare	$902.88
Rate for Payer: Cash Price	$712.80
Rate for Payer: Devoted Health Medicare	$997.92
Rate for Payer: Hawaii Medical Service Association Medicare	$902.88
Rate for Payer: Hawaii Western Management Group Commercial	$831.60
Rate for Payer: Health Management Network Commercial	$1,009.80
Rate for Payer: Humana Medicare	$902.88
Rate for Payer: Kaiser Permanente Commercial	$1,069.20
Rate for Payer: Kaiser Permanente Medicaid	$605.88
Rate for Payer: Kaiser Permanente Medicare	$902.88
Rate for Payer: MDX Hawaii PPO	$1,152.36
Rate for Payer: Ohana Health Plan Medicaid	$902.88
Rate for Payer: Ohana Health Plan Medicare	$902.88
Rate for Payer: UnitedHealthcare Medicare	$902.88
Rate for Payer: University Health Alliance Commercial	$665.28

SUTURE FIX ANCHOR #72203853

Facility

$1,188.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$665.28
Max. Negotiated Rate	$1,152.36
Rate for Payer: Cash Price	$712.80
Rate for Payer: Hawaii Western Management Group Commercial	$831.60
Rate for Payer: Health Management Network Commercial	$1,009.80
Rate for Payer: Kaiser Permanente Commercial	$1,069.20
Rate for Payer: MDX Hawaii PPO	$1,152.36
Rate for Payer: University Health Alliance Commercial	$665.28

SUTURE KIT UNIV APEX AR-7298

Facility

$1,400.00

Hospital Revenue Code	272
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: AlohaCare Medicaid	$700.00
Rate for Payer: AlohaCare Medicare	$1,064.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Devoted Health Medicare	$1,176.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,064.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: Humana Medicare	$1,064.00
Rate for Payer: Kaiser Permanente Commercial	$1,260.00
Rate for Payer: Kaiser Permanente Medicaid	$714.00
Rate for Payer: Kaiser Permanente Medicare	$1,064.00
Rate for Payer: MDX Hawaii PPO	$1,358.00
Rate for Payer: Ohana Health Plan Medicaid	$1,064.00
Rate for Payer: Ohana Health Plan Medicare	$1,064.00
Rate for Payer: UnitedHealthcare Medicare	$1,064.00
Rate for Payer: University Health Alliance Commercial	$1,020.46

SUTURE KIT UNIV APEX AR-7298

Facility

$1,400.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: Kaiser Permanente Commercial	$1,260.00
Rate for Payer: MDX Hawaii PPO	$1,358.00

SUTURE LASSO #AR-4068-25TLF

Facility

$893.00

Hospital Revenue Code	272
Min. Negotiated Rate	$759.05
Max. Negotiated Rate	$866.21
Rate for Payer: Cash Price	$535.80
Rate for Payer: Health Management Network Commercial	$759.05
Rate for Payer: Kaiser Permanente Commercial	$803.70
Rate for Payer: MDX Hawaii PPO	$866.21

SUTURE LASSO #AR-4068-25TLF

Facility

$893.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.50
Max. Negotiated Rate	$866.21
Rate for Payer: AlohaCare Medicaid	$446.50
Rate for Payer: AlohaCare Medicare	$678.68
Rate for Payer: Cash Price	$535.80
Rate for Payer: Devoted Health Medicare	$750.12
Rate for Payer: Hawaii Medical Service Association Medicare	$678.68
Rate for Payer: Hawaii Western Management Group Commercial	$848.35
Rate for Payer: Health Management Network Commercial	$759.05
Rate for Payer: Humana Medicare	$678.68
Rate for Payer: Kaiser Permanente Commercial	$803.70
Rate for Payer: Kaiser Permanente Medicaid	$455.43
Rate for Payer: Kaiser Permanente Medicare	$678.68
Rate for Payer: MDX Hawaii PPO	$866.21
Rate for Payer: Ohana Health Plan Medicaid	$678.68
Rate for Payer: Ohana Health Plan Medicare	$678.68
Rate for Payer: UnitedHealthcare Medicare	$678.68
Rate for Payer: University Health Alliance Commercial	$650.91

SUTURE LASSO #AR-4068-45R

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: MDX Hawaii PPO	$509.25

SUTURE LASSO #AR-4068-45R

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$509.25
Rate for Payer: AlohaCare Medicaid	$262.50
Rate for Payer: AlohaCare Medicare	$399.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Devoted Health Medicare	$441.00
Rate for Payer: Hawaii Medical Service Association Medicare	$399.00
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Humana Medicare	$399.00
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: Kaiser Permanente Medicare	$399.00
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: Ohana Health Plan Medicaid	$399.00
Rate for Payer: Ohana Health Plan Medicare	$399.00
Rate for Payer: UnitedHealthcare Medicare	$399.00
Rate for Payer: University Health Alliance Commercial	$382.67

SUTURE LASSO #AR-6069-90

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$611.10
Rate for Payer: AlohaCare Medicaid	$315.00
Rate for Payer: AlohaCare Medicare	$478.80
Rate for Payer: Cash Price	$378.00
Rate for Payer: Devoted Health Medicare	$529.20
Rate for Payer: Hawaii Medical Service Association Medicare	$478.80
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Humana Medicare	$478.80
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: Kaiser Permanente Medicare	$478.80
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: Ohana Health Plan Medicaid	$478.80
Rate for Payer: Ohana Health Plan Medicare	$478.80
Rate for Payer: UnitedHealthcare Medicare	$478.80
Rate for Payer: University Health Alliance Commercial	$459.21

SUTURE LASSO #AR-6069-90

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: MDX Hawaii PPO	$611.10

SUTURE LASSO AR-8703

Facility

$551.00

Hospital Revenue Code	272
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$534.47
Rate for Payer: AlohaCare Medicaid	$275.50
Rate for Payer: AlohaCare Medicare	$418.76
Rate for Payer: Cash Price	$330.60
Rate for Payer: Devoted Health Medicare	$462.84
Rate for Payer: Hawaii Medical Service Association Medicare	$418.76
Rate for Payer: Hawaii Western Management Group Commercial	$523.45
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Humana Medicare	$418.76
Rate for Payer: Kaiser Permanente Commercial	$495.90
Rate for Payer: Kaiser Permanente Medicaid	$281.01
Rate for Payer: Kaiser Permanente Medicare	$418.76
Rate for Payer: MDX Hawaii PPO	$534.47
Rate for Payer: Ohana Health Plan Medicaid	$418.76
Rate for Payer: Ohana Health Plan Medicare	$418.76
Rate for Payer: UnitedHealthcare Medicare	$418.76
Rate for Payer: University Health Alliance Commercial	$401.62

SUTURE LASSO AR-8703

Facility

$551.00

Hospital Revenue Code	272
Min. Negotiated Rate	$468.35
Max. Negotiated Rate	$534.47
Rate for Payer: Cash Price	$330.60
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Kaiser Permanente Commercial	$495.90
Rate for Payer: MDX Hawaii PPO	$534.47

SUTURELOC SYSTEM AR-4551

Facility

$4,201.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.50
Max. Negotiated Rate	$4,074.97
Rate for Payer: AlohaCare Medicaid	$2,100.50
Rate for Payer: AlohaCare Medicare	$3,192.76
Rate for Payer: Cash Price	$2,520.60
Rate for Payer: Devoted Health Medicare	$3,528.84
Rate for Payer: Hawaii Medical Service Association Medicare	$3,192.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,940.70
Rate for Payer: Health Management Network Commercial	$3,570.85
Rate for Payer: Humana Medicare	$3,192.76
Rate for Payer: Kaiser Permanente Commercial	$3,780.90
Rate for Payer: Kaiser Permanente Medicaid	$2,142.51
Rate for Payer: Kaiser Permanente Medicare	$3,192.76
Rate for Payer: MDX Hawaii PPO	$4,074.97
Rate for Payer: Ohana Health Plan Medicaid	$3,192.76
Rate for Payer: Ohana Health Plan Medicare	$3,192.76
Rate for Payer: UnitedHealthcare Medicare	$3,192.76
Rate for Payer: University Health Alliance Commercial	$2,352.56

SUTURELOC SYSTEM AR-4551

Facility

$4,201.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,352.56
Max. Negotiated Rate	$4,074.97
Rate for Payer: Cash Price	$2,520.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,940.70
Rate for Payer: Health Management Network Commercial	$3,570.85
Rate for Payer: Kaiser Permanente Commercial	$3,780.90
Rate for Payer: MDX Hawaii PPO	$4,074.97
Rate for Payer: University Health Alliance Commercial	$2,352.56

SUTURE PASSER AR-1000

Facility

$273.00

Hospital Revenue Code	272
Min. Negotiated Rate	$232.05
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$163.80
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: Kaiser Permanente Commercial	$245.70
Rate for Payer: MDX Hawaii PPO	$264.81

Know your out-of-pocket cost for care.

All Charges