Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SUTURE PASSER AR-1000

Facility

$273.00

Hospital Revenue Code	272
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$264.81
Rate for Payer: AlohaCare Medicaid	$136.50
Rate for Payer: AlohaCare Medicare	$207.48
Rate for Payer: Cash Price	$163.80
Rate for Payer: Devoted Health Medicare	$229.32
Rate for Payer: Hawaii Medical Service Association Medicare	$207.48
Rate for Payer: Hawaii Western Management Group Commercial	$259.35
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: Humana Medicare	$207.48
Rate for Payer: Kaiser Permanente Commercial	$245.70
Rate for Payer: Kaiser Permanente Medicaid	$139.23
Rate for Payer: Kaiser Permanente Medicare	$207.48
Rate for Payer: MDX Hawaii PPO	$264.81
Rate for Payer: Ohana Health Plan Medicaid	$207.48
Rate for Payer: Ohana Health Plan Medicare	$207.48
Rate for Payer: UnitedHealthcare Medicare	$207.48
Rate for Payer: University Health Alliance Commercial	$198.99

SUTURE PASSER COBRA 3910900097

Facility

$844.00

Hospital Revenue Code	272
Min. Negotiated Rate	$717.40
Max. Negotiated Rate	$818.68
Rate for Payer: Cash Price	$506.40
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: MDX Hawaii PPO	$818.68

SUTURE PASSER COBRA 3910900097

Facility

$844.00

Hospital Revenue Code	272
Min. Negotiated Rate	$422.00
Max. Negotiated Rate	$818.68
Rate for Payer: AlohaCare Medicaid	$422.00
Rate for Payer: AlohaCare Medicare	$641.44
Rate for Payer: Cash Price	$506.40
Rate for Payer: Devoted Health Medicare	$708.96
Rate for Payer: Hawaii Medical Service Association Medicare	$641.44
Rate for Payer: Hawaii Western Management Group Commercial	$801.80
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Humana Medicare	$641.44
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: Kaiser Permanente Medicaid	$430.44
Rate for Payer: Kaiser Permanente Medicare	$641.44
Rate for Payer: MDX Hawaii PPO	$818.68
Rate for Payer: Ohana Health Plan Medicaid	$641.44
Rate for Payer: Ohana Health Plan Medicare	$641.44
Rate for Payer: UnitedHealthcare Medicare	$641.44
Rate for Payer: University Health Alliance Commercial	$615.19

SUTURE PASSER NDL 3910900091

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$326.50
Max. Negotiated Rate	$633.41
Rate for Payer: AlohaCare Medicaid	$326.50
Rate for Payer: AlohaCare Medicare	$496.28
Rate for Payer: Cash Price	$391.80
Rate for Payer: Devoted Health Medicare	$548.52
Rate for Payer: Hawaii Medical Service Association Medicare	$496.28
Rate for Payer: Hawaii Western Management Group Commercial	$620.35
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Humana Medicare	$496.28
Rate for Payer: Kaiser Permanente Commercial	$587.70
Rate for Payer: Kaiser Permanente Medicaid	$333.03
Rate for Payer: Kaiser Permanente Medicare	$496.28
Rate for Payer: MDX Hawaii PPO	$633.41
Rate for Payer: Ohana Health Plan Medicaid	$496.28
Rate for Payer: Ohana Health Plan Medicare	$496.28
Rate for Payer: UnitedHealthcare Medicare	$496.28
Rate for Payer: University Health Alliance Commercial	$475.97

SUTURE PASSER NDL 3910900091

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$555.05
Max. Negotiated Rate	$633.41
Rate for Payer: Cash Price	$391.80
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Kaiser Permanente Commercial	$587.70
Rate for Payer: MDX Hawaii PPO	$633.41

SUTURE PASSER ST 72290128

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$665.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$735.00
Rate for Payer: Hawaii Medical Service Association Medicare	$665.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$665.00
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$665.00
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$665.00
Rate for Payer: Ohana Health Plan Medicare	$665.00
Rate for Payer: UnitedHealthcare Medicare	$665.00
Rate for Payer: University Health Alliance Commercial	$637.79

SUTURE PASSER ST 72290128

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75

SUTURETAK 3.0 #AR-1934BCFT-2

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$1,212.50
Rate for Payer: Cash Price	$750.00
Rate for Payer: Hawaii Western Management Group Commercial	$875.00
Rate for Payer: Health Management Network Commercial	$1,062.50
Rate for Payer: Kaiser Permanente Commercial	$1,125.00
Rate for Payer: MDX Hawaii PPO	$1,212.50
Rate for Payer: University Health Alliance Commercial	$700.00

SUTURETAK 3.0 #AR-1934BCFT-2

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$625.00
Max. Negotiated Rate	$1,212.50
Rate for Payer: AlohaCare Medicaid	$625.00
Rate for Payer: AlohaCare Medicare	$950.00
Rate for Payer: Cash Price	$750.00
Rate for Payer: Devoted Health Medicare	$1,050.00
Rate for Payer: Hawaii Medical Service Association Medicare	$950.00
Rate for Payer: Hawaii Western Management Group Commercial	$875.00
Rate for Payer: Health Management Network Commercial	$1,062.50
Rate for Payer: Humana Medicare	$950.00
Rate for Payer: Kaiser Permanente Commercial	$1,125.00
Rate for Payer: Kaiser Permanente Medicaid	$637.50
Rate for Payer: Kaiser Permanente Medicare	$950.00
Rate for Payer: MDX Hawaii PPO	$1,212.50
Rate for Payer: Ohana Health Plan Medicaid	$950.00
Rate for Payer: Ohana Health Plan Medicare	$950.00
Rate for Payer: UnitedHealthcare Medicare	$950.00
Rate for Payer: University Health Alliance Commercial	$700.00

SUTURETAK 3X14.5 #AR-1934BCFT

Facility

$1,628.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$814.00
Max. Negotiated Rate	$1,579.16
Rate for Payer: AlohaCare Medicaid	$814.00
Rate for Payer: AlohaCare Medicare	$1,237.28
Rate for Payer: Cash Price	$976.80
Rate for Payer: Devoted Health Medicare	$1,367.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,237.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,139.60
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: Humana Medicare	$1,237.28
Rate for Payer: Kaiser Permanente Commercial	$1,465.20
Rate for Payer: Kaiser Permanente Medicaid	$830.28
Rate for Payer: Kaiser Permanente Medicare	$1,237.28
Rate for Payer: MDX Hawaii PPO	$1,579.16
Rate for Payer: Ohana Health Plan Medicaid	$1,237.28
Rate for Payer: Ohana Health Plan Medicare	$1,237.28
Rate for Payer: UnitedHealthcare Medicare	$1,237.28
Rate for Payer: University Health Alliance Commercial	$911.68

SUTURETAK 3X14.5 #AR-1934BCFT

Facility

$1,628.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$911.68
Max. Negotiated Rate	$1,579.16
Rate for Payer: Cash Price	$976.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,139.60
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: Kaiser Permanente Commercial	$1,465.20
Rate for Payer: MDX Hawaii PPO	$1,579.16
Rate for Payer: University Health Alliance Commercial	$911.68

SUTURETAK KIT 23MM AR-1938PK

Facility

$1,305.00

Hospital Revenue Code	272
Min. Negotiated Rate	$652.50
Max. Negotiated Rate	$1,265.85
Rate for Payer: AlohaCare Medicaid	$652.50
Rate for Payer: AlohaCare Medicare	$991.80
Rate for Payer: Cash Price	$783.00
Rate for Payer: Devoted Health Medicare	$1,096.20
Rate for Payer: Hawaii Medical Service Association Medicare	$991.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,239.75
Rate for Payer: Health Management Network Commercial	$1,109.25
Rate for Payer: Humana Medicare	$991.80
Rate for Payer: Kaiser Permanente Commercial	$1,174.50
Rate for Payer: Kaiser Permanente Medicaid	$665.55
Rate for Payer: Kaiser Permanente Medicare	$991.80
Rate for Payer: MDX Hawaii PPO	$1,265.85
Rate for Payer: Ohana Health Plan Medicaid	$991.80
Rate for Payer: Ohana Health Plan Medicare	$991.80
Rate for Payer: UnitedHealthcare Medicare	$991.80
Rate for Payer: University Health Alliance Commercial	$951.21

SUTURETAK KIT 23MM AR-1938PK

Facility

$1,305.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,109.25
Max. Negotiated Rate	$1,265.85
Rate for Payer: Cash Price	$783.00
Rate for Payer: Health Management Network Commercial	$1,109.25
Rate for Payer: Kaiser Permanente Commercial	$1,174.50
Rate for Payer: MDX Hawaii PPO	$1,265.85

SUTURE TAPE FIBERLOOP AR-7534

Facility

$294.00

Hospital Revenue Code	272
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$147.00
Rate for Payer: AlohaCare Medicare	$223.44
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$246.96
Rate for Payer: Hawaii Medical Service Association Medicare	$223.44
Rate for Payer: Hawaii Western Management Group Commercial	$279.30
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$223.44
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$223.44
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$223.44
Rate for Payer: Ohana Health Plan Medicare	$223.44
Rate for Payer: UnitedHealthcare Medicare	$223.44
Rate for Payer: University Health Alliance Commercial	$214.30

SUTURE TAPE FIBERLOOP AR-7534

Facility

$294.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: MDX Hawaii PPO	$285.18

SUTURE TAPE TIGERLOOP AR-7534T

Facility

$280.00

Hospital Revenue Code	272
Min. Negotiated Rate	$238.00
Max. Negotiated Rate	$271.60
Rate for Payer: Cash Price	$168.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Kaiser Permanente Commercial	$252.00
Rate for Payer: MDX Hawaii PPO	$271.60

SUTURE TAPE TIGERLOOP AR-7534T

Facility

$280.00

Hospital Revenue Code	272
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$271.60
Rate for Payer: AlohaCare Medicaid	$140.00
Rate for Payer: AlohaCare Medicare	$212.80
Rate for Payer: Cash Price	$168.00
Rate for Payer: Devoted Health Medicare	$235.20
Rate for Payer: Hawaii Medical Service Association Medicare	$212.80
Rate for Payer: Hawaii Western Management Group Commercial	$266.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Humana Medicare	$212.80
Rate for Payer: Kaiser Permanente Commercial	$252.00
Rate for Payer: Kaiser Permanente Medicaid	$142.80
Rate for Payer: Kaiser Permanente Medicare	$212.80
Rate for Payer: MDX Hawaii PPO	$271.60
Rate for Payer: Ohana Health Plan Medicaid	$212.80
Rate for Payer: Ohana Health Plan Medicare	$212.80
Rate for Payer: UnitedHealthcare Medicare	$212.80
Rate for Payer: University Health Alliance Commercial	$204.09

SUTURE TISSUE HELIX

Facility

$809.00

Hospital Revenue Code	272
Min. Negotiated Rate	$404.50
Max. Negotiated Rate	$784.73
Rate for Payer: AlohaCare Medicaid	$404.50
Rate for Payer: AlohaCare Medicare	$614.84
Rate for Payer: Cash Price	$485.40
Rate for Payer: Devoted Health Medicare	$679.56
Rate for Payer: Hawaii Medical Service Association Medicare	$614.84
Rate for Payer: Hawaii Western Management Group Commercial	$768.55
Rate for Payer: Health Management Network Commercial	$687.65
Rate for Payer: Humana Medicare	$614.84
Rate for Payer: Kaiser Permanente Commercial	$728.10
Rate for Payer: Kaiser Permanente Medicaid	$412.59
Rate for Payer: Kaiser Permanente Medicare	$614.84
Rate for Payer: MDX Hawaii PPO	$784.73
Rate for Payer: Ohana Health Plan Medicaid	$614.84
Rate for Payer: Ohana Health Plan Medicare	$614.84
Rate for Payer: UnitedHealthcare Medicare	$614.84
Rate for Payer: University Health Alliance Commercial	$589.68

SUTURE TISSUE HELIX

Facility

$809.00

Hospital Revenue Code	272
Min. Negotiated Rate	$687.65
Max. Negotiated Rate	$784.73
Rate for Payer: Cash Price	$485.40
Rate for Payer: Health Management Network Commercial	$687.65
Rate for Payer: Kaiser Permanente Commercial	$728.10
Rate for Payer: MDX Hawaii PPO	$784.73

SWIVELOCK AR-2600SBS-4

Facility

$3,654.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,827.00
Max. Negotiated Rate	$3,544.38
Rate for Payer: AlohaCare Medicaid	$1,827.00
Rate for Payer: AlohaCare Medicare	$2,777.04
Rate for Payer: Cash Price	$2,192.40
Rate for Payer: Devoted Health Medicare	$3,069.36
Rate for Payer: Hawaii Medical Service Association Medicare	$2,777.04
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.80
Rate for Payer: Health Management Network Commercial	$3,105.90
Rate for Payer: Humana Medicare	$2,777.04
Rate for Payer: Kaiser Permanente Commercial	$3,288.60
Rate for Payer: Kaiser Permanente Medicaid	$1,863.54
Rate for Payer: Kaiser Permanente Medicare	$2,777.04
Rate for Payer: MDX Hawaii PPO	$3,544.38
Rate for Payer: Ohana Health Plan Medicaid	$2,777.04
Rate for Payer: Ohana Health Plan Medicare	$2,777.04
Rate for Payer: UnitedHealthcare Medicare	$2,777.04
Rate for Payer: University Health Alliance Commercial	$2,046.24

SWIVELOCK AR-2600SBS-4

Facility

$3,654.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,046.24
Max. Negotiated Rate	$3,544.38
Rate for Payer: Cash Price	$2,192.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.80
Rate for Payer: Health Management Network Commercial	$3,105.90
Rate for Payer: Kaiser Permanente Commercial	$3,288.60
Rate for Payer: MDX Hawaii PPO	$3,544.38
Rate for Payer: University Health Alliance Commercial	$2,046.24

SWIVELOCK C 3.5 #AR-2325BCC

Facility

$1,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$784.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Hawaii Western Management Group Commercial	$980.00
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
Rate for Payer: University Health Alliance Commercial	$784.00

SWIVELOCK C 3.5 #AR-2325BCC

Facility

$1,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
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	$980.00
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	$784.00

SWIVELOCK C 4.75 #AR-2324BCC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,664.52
Rate for Payer: AlohaCare Medicaid	$858.00
Rate for Payer: AlohaCare Medicare	$1,304.16
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Devoted Health Medicare	$1,441.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,304.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Humana Medicare	$1,304.16
Rate for Payer: Kaiser Permanente Commercial	$1,544.40
Rate for Payer: Kaiser Permanente Medicaid	$875.16
Rate for Payer: Kaiser Permanente Medicare	$1,304.16
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: Ohana Health Plan Medicaid	$1,304.16
Rate for Payer: Ohana Health Plan Medicare	$1,304.16
Rate for Payer: UnitedHealthcare Medicare	$1,304.16
Rate for Payer: University Health Alliance Commercial	$960.96

SWIVELOCK C 4.75 #AR-2324BCC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$960.96
Max. Negotiated Rate	$1,664.52
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Kaiser Permanente Commercial	$1,544.40
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: University Health Alliance Commercial	$960.96

Know your out-of-pocket cost for care.

All Charges