Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SWIVELOCK C 5.5 #AR-2323BCC

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 5.5 #AR-2323BCC

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

SWIVELOCK SP PUNCH #AR-2324BCM

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$805.00
Max. Negotiated Rate	$1,561.70
Rate for Payer: AlohaCare Medicaid	$805.00
Rate for Payer: AlohaCare Medicare	$1,223.60
Rate for Payer: Cash Price	$966.00
Rate for Payer: Devoted Health Medicare	$1,352.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,223.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.00
Rate for Payer: Health Management Network Commercial	$1,368.50
Rate for Payer: Humana Medicare	$1,223.60
Rate for Payer: Kaiser Permanente Commercial	$1,449.00
Rate for Payer: Kaiser Permanente Medicaid	$821.10
Rate for Payer: Kaiser Permanente Medicare	$1,223.60
Rate for Payer: MDX Hawaii PPO	$1,561.70
Rate for Payer: Ohana Health Plan Medicaid	$1,223.60
Rate for Payer: Ohana Health Plan Medicare	$1,223.60
Rate for Payer: UnitedHealthcare Medicare	$1,223.60
Rate for Payer: University Health Alliance Commercial	$901.60

SWIVELOCK SP PUNCH #AR-2324BCM

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$901.60
Max. Negotiated Rate	$1,561.70
Rate for Payer: Cash Price	$966.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.00
Rate for Payer: Health Management Network Commercial	$1,368.50
Rate for Payer: Kaiser Permanente Commercial	$1,449.00
Rate for Payer: MDX Hawaii PPO	$1,561.70
Rate for Payer: University Health Alliance Commercial	$901.60

SWIVELOCK W/FIBER #AR-2324BCCT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,955.52
Rate for Payer: AlohaCare Medicaid	$1,008.00
Rate for Payer: AlohaCare Medicare	$1,532.16
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Devoted Health Medicare	$1,693.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,532.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Humana Medicare	$1,532.16
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: Kaiser Permanente Medicaid	$1,028.16
Rate for Payer: Kaiser Permanente Medicare	$1,532.16
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: Ohana Health Plan Medicaid	$1,532.16
Rate for Payer: Ohana Health Plan Medicare	$1,532.16
Rate for Payer: UnitedHealthcare Medicare	$1,532.16
Rate for Payer: University Health Alliance Commercial	$1,128.96

SWIVELOCK W/FIBER #AR-2324BCCT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

SWIVELOCK W/TIGER#AR2324BCCTT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,955.52
Rate for Payer: AlohaCare Medicaid	$1,008.00
Rate for Payer: AlohaCare Medicare	$1,532.16
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Devoted Health Medicare	$1,693.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,532.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Humana Medicare	$1,532.16
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: Kaiser Permanente Medicaid	$1,028.16
Rate for Payer: Kaiser Permanente Medicare	$1,532.16
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: Ohana Health Plan Medicaid	$1,532.16
Rate for Payer: Ohana Health Plan Medicare	$1,532.16
Rate for Payer: UnitedHealthcare Medicare	$1,532.16
Rate for Payer: University Health Alliance Commercial	$1,128.96

SWIVELOCK W/TIGER#AR2324BCCTT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

SW JAVELIN FLX IVL 1.5X25

Facility

$9,400.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$7,990.00
Max. Negotiated Rate	$9,118.00
Rate for Payer: Cash Price	$5,640.00
Rate for Payer: Health Management Network Commercial	$7,990.00
Rate for Payer: Kaiser Permanente Commercial	$8,460.00
Rate for Payer: MDX Hawaii PPO	$9,118.00

SW JAVELIN FLX IVL 1.5X25

Facility

$9,400.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$4,700.00
Max. Negotiated Rate	$9,118.00
Rate for Payer: AlohaCare Medicaid	$4,700.00
Rate for Payer: AlohaCare Medicare	$7,144.00
Rate for Payer: Cash Price	$5,640.00
Rate for Payer: Devoted Health Medicare	$7,896.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,144.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,930.00
Rate for Payer: Health Management Network Commercial	$7,990.00
Rate for Payer: Humana Medicare	$7,144.00
Rate for Payer: Kaiser Permanente Commercial	$8,460.00
Rate for Payer: Kaiser Permanente Medicaid	$4,794.00
Rate for Payer: Kaiser Permanente Medicare	$7,144.00
Rate for Payer: MDX Hawaii PPO	$9,118.00
Rate for Payer: Ohana Health Plan Medicaid	$7,144.00
Rate for Payer: Ohana Health Plan Medicare	$7,144.00
Rate for Payer: UnitedHealthcare Medicare	$7,144.00
Rate for Payer: University Health Alliance Commercial	$6,851.66

SWVLLCK 3.5X8.5MM AR-8978P

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$833.28
Max. Negotiated Rate	$1,443.36
Rate for Payer: Cash Price	$892.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: University Health Alliance Commercial	$833.28

SWVLLCK 3.5X8.5MM AR-8978P

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$1,443.36
Rate for Payer: AlohaCare Medicaid	$744.00
Rate for Payer: AlohaCare Medicare	$1,130.88
Rate for Payer: Cash Price	$892.80
Rate for Payer: Devoted Health Medicare	$1,249.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,130.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Humana Medicare	$1,130.88
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: Kaiser Permanente Medicaid	$758.88
Rate for Payer: Kaiser Permanente Medicare	$1,130.88
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: Ohana Health Plan Medicaid	$1,130.88
Rate for Payer: Ohana Health Plan Medicare	$1,130.88
Rate for Payer: UnitedHealthcare Medicare	$1,130.88
Rate for Payer: University Health Alliance Commercial	$833.28

SYNCHFIX GRAVITY SUT 86SYN005

Facility

$2,455.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,227.50
Max. Negotiated Rate	$2,381.35
Rate for Payer: AlohaCare Medicaid	$1,227.50
Rate for Payer: AlohaCare Medicare	$1,865.80
Rate for Payer: Cash Price	$1,473.00
Rate for Payer: Devoted Health Medicare	$2,062.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,865.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,718.50
Rate for Payer: Health Management Network Commercial	$2,086.75
Rate for Payer: Humana Medicare	$1,865.80
Rate for Payer: Kaiser Permanente Commercial	$2,209.50
Rate for Payer: Kaiser Permanente Medicaid	$1,252.05
Rate for Payer: Kaiser Permanente Medicare	$1,865.80
Rate for Payer: MDX Hawaii PPO	$2,381.35
Rate for Payer: Ohana Health Plan Medicaid	$1,865.80
Rate for Payer: Ohana Health Plan Medicare	$1,865.80
Rate for Payer: UnitedHealthcare Medicare	$1,865.80
Rate for Payer: University Health Alliance Commercial	$1,374.80

SYNCHFIX GRAVITY SUT 86SYN005

Facility

$2,455.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,374.80
Max. Negotiated Rate	$2,381.35
Rate for Payer: Cash Price	$1,473.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,718.50
Rate for Payer: Health Management Network Commercial	$2,086.75
Rate for Payer: Kaiser Permanente Commercial	$2,209.50
Rate for Payer: MDX Hawaii PPO	$2,381.35
Rate for Payer: University Health Alliance Commercial	$1,374.80

SYNCHROSEAL 480440

Facility

$2,070.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,759.50
Max. Negotiated Rate	$2,007.90
Rate for Payer: Cash Price	$1,242.00
Rate for Payer: Health Management Network Commercial	$1,759.50
Rate for Payer: Kaiser Permanente Commercial	$1,863.00
Rate for Payer: MDX Hawaii PPO	$2,007.90

SYNCHROSEAL 480440

Facility

$2,070.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,035.00
Max. Negotiated Rate	$2,007.90
Rate for Payer: AlohaCare Medicaid	$1,035.00
Rate for Payer: AlohaCare Medicare	$1,573.20
Rate for Payer: Cash Price	$1,242.00
Rate for Payer: Devoted Health Medicare	$1,738.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,573.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,966.50
Rate for Payer: Health Management Network Commercial	$1,759.50
Rate for Payer: Humana Medicare	$1,573.20
Rate for Payer: Kaiser Permanente Commercial	$1,863.00
Rate for Payer: Kaiser Permanente Medicaid	$1,055.70
Rate for Payer: Kaiser Permanente Medicare	$1,573.20
Rate for Payer: MDX Hawaii PPO	$2,007.90
Rate for Payer: Ohana Health Plan Medicaid	$1,573.20
Rate for Payer: Ohana Health Plan Medicare	$1,573.20
Rate for Payer: UnitedHealthcare Medicare	$1,573.20
Rate for Payer: University Health Alliance Commercial	$1,508.82

SYNCOPE AND COLLAPSE

Facility

$14,007.88

Service Code	MSDRG 312
Min. Negotiated Rate	$14,007.88
Max. Negotiated Rate	$14,007.88
Rate for Payer: Hawaii Medical Service Association Commercial	$14,007.88

SYNTEL ART EMBOLECTOMY CATH 80

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

SYNTEL ART EMBOLECTOMY CATH 80

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$260.50
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$395.96
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$437.64
Rate for Payer: Hawaii Medical Service Association Medicare	$395.96
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$395.96
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$395.96
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$395.96
Rate for Payer: Ohana Health Plan Medicare	$395.96
Rate for Payer: UnitedHealthcare Medicare	$395.96
Rate for Payer: University Health Alliance Commercial	$379.76

SYNTEL ARTERIAL EMBOLECTOMY

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

SYNTEL ARTERIAL EMBOLECTOMY

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$260.50
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$395.96
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$437.64
Rate for Payer: Hawaii Medical Service Association Medicare	$395.96
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$395.96
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$395.96
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$395.96
Rate for Payer: Ohana Health Plan Medicare	$395.96
Rate for Payer: UnitedHealthcare Medicare	$395.96
Rate for Payer: University Health Alliance Commercial	$379.76

SYRINGE CONTINUOUS INJECTION

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

SYRINGE CONTINUOUS INJECTION

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$91.84

SYRINGE INFLATION DEVICE

Facility

$167.00

Hospital Revenue Code	272
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$100.20
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Kaiser Permanente Commercial	$150.30
Rate for Payer: MDX Hawaii PPO	$161.99

SYRINGE INFLATION DEVICE

Facility

$167.00

Hospital Revenue Code	272
Min. Negotiated Rate	$83.50
Max. Negotiated Rate	$161.99
Rate for Payer: AlohaCare Medicaid	$83.50
Rate for Payer: AlohaCare Medicare	$126.92
Rate for Payer: Cash Price	$100.20
Rate for Payer: Devoted Health Medicare	$140.28
Rate for Payer: Hawaii Medical Service Association Medicare	$126.92
Rate for Payer: Hawaii Western Management Group Commercial	$158.65
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Humana Medicare	$126.92
Rate for Payer: Kaiser Permanente Commercial	$150.30
Rate for Payer: Kaiser Permanente Medicaid	$85.17
Rate for Payer: Kaiser Permanente Medicare	$126.92
Rate for Payer: MDX Hawaii PPO	$161.99
Rate for Payer: Ohana Health Plan Medicaid	$126.92
Rate for Payer: Ohana Health Plan Medicare	$126.92
Rate for Payer: UnitedHealthcare Medicare	$126.92
Rate for Payer: University Health Alliance Commercial	$121.73

Know your out-of-pocket cost for care.

All Charges