Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TRI TIB BASE CEMENT 5520-B-500

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,900.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: AlohaCare Medicaid	$2,900.00
Rate for Payer: AlohaCare Medicare	$4,408.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Devoted Health Medicare	$4,872.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,408.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Humana Medicare	$4,408.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: Kaiser Permanente Medicaid	$2,958.00
Rate for Payer: Kaiser Permanente Medicare	$4,408.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: Ohana Health Plan Medicaid	$4,408.00
Rate for Payer: Ohana Health Plan Medicare	$4,408.00
Rate for Payer: UnitedHealthcare Medicare	$4,408.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TRI TIB BASE CEMENT 5520-B-500

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,248.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TRI TIB BASE CEMENT 5520-B-600

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,248.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TRI TIB BASE CEMENT 5520-B-600

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,900.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: AlohaCare Medicaid	$2,900.00
Rate for Payer: AlohaCare Medicare	$4,408.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Devoted Health Medicare	$4,872.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,408.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Humana Medicare	$4,408.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: Kaiser Permanente Medicaid	$2,958.00
Rate for Payer: Kaiser Permanente Medicare	$4,408.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: Ohana Health Plan Medicaid	$4,408.00
Rate for Payer: Ohana Health Plan Medicare	$4,408.00
Rate for Payer: UnitedHealthcare Medicare	$4,408.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TRI TIB BASE CEMENT 5520-B-700

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,248.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TRI TIB BASE CEMENT 5520-B-700

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,900.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: AlohaCare Medicaid	$2,900.00
Rate for Payer: AlohaCare Medicare	$4,408.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Devoted Health Medicare	$4,872.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,408.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Humana Medicare	$4,408.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: Kaiser Permanente Medicaid	$2,958.00
Rate for Payer: Kaiser Permanente Medicare	$4,408.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: Ohana Health Plan Medicaid	$4,408.00
Rate for Payer: Ohana Health Plan Medicare	$4,408.00
Rate for Payer: UnitedHealthcare Medicare	$4,408.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TROCAR 11.5 THORACPORT

Facility

$529.00

Hospital Revenue Code	272
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$402.04
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$444.36
Rate for Payer: Hawaii Medical Service Association Medicare	$402.04
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$402.04
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$402.04
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$402.04
Rate for Payer: Ohana Health Plan Medicare	$402.04
Rate for Payer: UnitedHealthcare Medicare	$402.04
Rate for Payer: University Health Alliance Commercial	$385.59

TROCAR 11.5 THORACPORT

Facility

$529.00

Hospital Revenue Code	272
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: MDX Hawaii PPO	$513.13

TROCAR 11MM VERSAONE

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$160.05
Rate for Payer: AlohaCare Medicaid	$82.50
Rate for Payer: AlohaCare Medicare	$125.40
Rate for Payer: Cash Price	$99.00
Rate for Payer: Devoted Health Medicare	$138.60
Rate for Payer: Hawaii Medical Service Association Medicare	$125.40
Rate for Payer: Hawaii Western Management Group Commercial	$156.75
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Humana Medicare	$125.40
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: Kaiser Permanente Medicaid	$84.15
Rate for Payer: Kaiser Permanente Medicare	$125.40
Rate for Payer: MDX Hawaii PPO	$160.05
Rate for Payer: Ohana Health Plan Medicaid	$125.40
Rate for Payer: Ohana Health Plan Medicare	$125.40
Rate for Payer: UnitedHealthcare Medicare	$125.40
Rate for Payer: University Health Alliance Commercial	$120.27

TROCAR 11MM VERSAONE

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$99.00
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: MDX Hawaii PPO	$160.05

TROCAR 12MM BLUNTPORT

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$160.05
Rate for Payer: AlohaCare Medicaid	$82.50
Rate for Payer: AlohaCare Medicare	$125.40
Rate for Payer: Cash Price	$99.00
Rate for Payer: Devoted Health Medicare	$138.60
Rate for Payer: Hawaii Medical Service Association Medicare	$125.40
Rate for Payer: Hawaii Western Management Group Commercial	$156.75
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Humana Medicare	$125.40
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: Kaiser Permanente Medicaid	$84.15
Rate for Payer: Kaiser Permanente Medicare	$125.40
Rate for Payer: MDX Hawaii PPO	$160.05
Rate for Payer: Ohana Health Plan Medicaid	$125.40
Rate for Payer: Ohana Health Plan Medicare	$125.40
Rate for Payer: UnitedHealthcare Medicare	$125.40
Rate for Payer: University Health Alliance Commercial	$120.27

TROCAR 12MM BLUNTPORT

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$99.00
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: MDX Hawaii PPO	$160.05

TROCAR 12MM VERSAONE

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$99.00
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: MDX Hawaii PPO	$160.05

TROCAR 12MM VERSAONE

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$160.05
Rate for Payer: AlohaCare Medicaid	$82.50
Rate for Payer: AlohaCare Medicare	$125.40
Rate for Payer: Cash Price	$99.00
Rate for Payer: Devoted Health Medicare	$138.60
Rate for Payer: Hawaii Medical Service Association Medicare	$125.40
Rate for Payer: Hawaii Western Management Group Commercial	$156.75
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Humana Medicare	$125.40
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: Kaiser Permanente Medicaid	$84.15
Rate for Payer: Kaiser Permanente Medicare	$125.40
Rate for Payer: MDX Hawaii PPO	$160.05
Rate for Payer: Ohana Health Plan Medicaid	$125.40
Rate for Payer: Ohana Health Plan Medicare	$125.40
Rate for Payer: UnitedHealthcare Medicare	$125.40
Rate for Payer: University Health Alliance Commercial	$120.27

TROCAR 12MM W/CANNULA

Facility

$150.00

Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

TROCAR 12MM W/CANNULA

Facility

$150.00

Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$114.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Devoted Health Medicare	$126.00
Rate for Payer: Hawaii Medical Service Association Medicare	$114.00
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$114.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$114.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$114.00
Rate for Payer: Ohana Health Plan Medicare	$114.00
Rate for Payer: UnitedHealthcare Medicare	$114.00
Rate for Payer: University Health Alliance Commercial	$109.33

TROCAR 24F CHEST TUBE THORACIC

Facility

$96.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

TROCAR 24F CHEST TUBE THORACIC

Facility

$96.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$72.96
Rate for Payer: Cash Price	$57.60
Rate for Payer: Devoted Health Medicare	$80.64
Rate for Payer: Hawaii Medical Service Association Medicare	$72.96
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$72.96
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$72.96
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$72.96
Rate for Payer: Ohana Health Plan Medicare	$72.96
Rate for Payer: UnitedHealthcare Medicare	$72.96
Rate for Payer: University Health Alliance Commercial	$69.97

TROCAR 28F CHEST TUBE THORACIC

Facility

$113.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$67.80
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: MDX Hawaii PPO	$109.61

TROCAR 28F CHEST TUBE THORACIC

Facility

$113.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$56.50
Max. Negotiated Rate	$109.61
Rate for Payer: AlohaCare Medicaid	$56.50
Rate for Payer: AlohaCare Medicare	$85.88
Rate for Payer: Cash Price	$67.80
Rate for Payer: Devoted Health Medicare	$94.92
Rate for Payer: Hawaii Medical Service Association Medicare	$85.88
Rate for Payer: Hawaii Western Management Group Commercial	$107.35
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Humana Medicare	$85.88
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: Kaiser Permanente Medicaid	$57.63
Rate for Payer: Kaiser Permanente Medicare	$85.88
Rate for Payer: MDX Hawaii PPO	$109.61
Rate for Payer: Ohana Health Plan Medicaid	$85.88
Rate for Payer: Ohana Health Plan Medicare	$85.88
Rate for Payer: UnitedHealthcare Medicare	$85.88
Rate for Payer: University Health Alliance Commercial	$82.37

TROCAR 32F CHEST TUBE THORACIC

Facility

$106.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$102.82
Rate for Payer: AlohaCare Medicaid	$53.00
Rate for Payer: AlohaCare Medicare	$80.56
Rate for Payer: Cash Price	$63.60
Rate for Payer: Devoted Health Medicare	$89.04
Rate for Payer: Hawaii Medical Service Association Medicare	$80.56
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Humana Medicare	$80.56
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: Kaiser Permanente Medicare	$80.56
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: Ohana Health Plan Medicaid	$80.56
Rate for Payer: Ohana Health Plan Medicare	$80.56
Rate for Payer: UnitedHealthcare Medicare	$80.56
Rate for Payer: University Health Alliance Commercial	$77.26

TROCAR 32F CHEST TUBE THORACIC

Facility

$106.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: MDX Hawaii PPO	$102.82

TROCAR 5-11MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$233.77
Rate for Payer: AlohaCare Medicaid	$120.50
Rate for Payer: AlohaCare Medicare	$183.16
Rate for Payer: Cash Price	$144.60
Rate for Payer: Devoted Health Medicare	$202.44
Rate for Payer: Hawaii Medical Service Association Medicare	$183.16
Rate for Payer: Hawaii Western Management Group Commercial	$228.95
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Humana Medicare	$183.16
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: Kaiser Permanente Medicaid	$122.91
Rate for Payer: Kaiser Permanente Medicare	$183.16
Rate for Payer: MDX Hawaii PPO	$233.77
Rate for Payer: Ohana Health Plan Medicaid	$183.16
Rate for Payer: Ohana Health Plan Medicare	$183.16
Rate for Payer: UnitedHealthcare Medicare	$183.16
Rate for Payer: University Health Alliance Commercial	$175.66

TROCAR 5-11MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$233.77
Rate for Payer: Cash Price	$144.60
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: MDX Hawaii PPO	$233.77

TROCAR 5-12MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$233.77
Rate for Payer: AlohaCare Medicaid	$120.50
Rate for Payer: AlohaCare Medicare	$183.16
Rate for Payer: Cash Price	$144.60
Rate for Payer: Devoted Health Medicare	$202.44
Rate for Payer: Hawaii Medical Service Association Medicare	$183.16
Rate for Payer: Hawaii Western Management Group Commercial	$228.95
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Humana Medicare	$183.16
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: Kaiser Permanente Medicaid	$122.91
Rate for Payer: Kaiser Permanente Medicare	$183.16
Rate for Payer: MDX Hawaii PPO	$233.77
Rate for Payer: Ohana Health Plan Medicaid	$183.16
Rate for Payer: Ohana Health Plan Medicare	$183.16
Rate for Payer: UnitedHealthcare Medicare	$183.16
Rate for Payer: University Health Alliance Commercial	$175.66

Know your out-of-pocket cost for care.

All Charges