Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TUBING SUCTN-IRR 12FT

Facility

$128.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$124.16
Rate for Payer: AlohaCare Medicaid	$64.00
Rate for Payer: AlohaCare Medicare	$97.28
Rate for Payer: Cash Price	$76.80
Rate for Payer: Devoted Health Medicare	$107.52
Rate for Payer: Hawaii Medical Service Association Medicare	$97.28
Rate for Payer: Hawaii Western Management Group Commercial	$121.60
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Humana Medicare	$97.28
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: Kaiser Permanente Medicare	$97.28
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: Ohana Health Plan Medicaid	$97.28
Rate for Payer: Ohana Health Plan Medicare	$97.28
Rate for Payer: UnitedHealthcare Medicare	$97.28
Rate for Payer: University Health Alliance Commercial	$93.30

TUBING SUCTN-IRR 12FT

Facility

$128.00

Hospital Revenue Code	272
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$76.80
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: MDX Hawaii PPO	$124.16

TUBING SWIVEL HANDLE

Facility

$96.00

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

TUBING SWIVEL HANDLE

Facility

$96.00

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

TUBULAR LCK SS 12H AR-8943T-12

Facility

$1,502.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$751.00
Max. Negotiated Rate	$1,456.94
Rate for Payer: AlohaCare Medicaid	$751.00
Rate for Payer: AlohaCare Medicare	$1,141.52
Rate for Payer: Cash Price	$901.20
Rate for Payer: Devoted Health Medicare	$1,261.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,141.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,051.40
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Humana Medicare	$1,141.52
Rate for Payer: Kaiser Permanente Commercial	$1,351.80
Rate for Payer: Kaiser Permanente Medicaid	$766.02
Rate for Payer: Kaiser Permanente Medicare	$1,141.52
Rate for Payer: MDX Hawaii PPO	$1,456.94
Rate for Payer: Ohana Health Plan Medicaid	$1,141.52
Rate for Payer: Ohana Health Plan Medicare	$1,141.52
Rate for Payer: UnitedHealthcare Medicare	$1,141.52
Rate for Payer: University Health Alliance Commercial	$841.12

TUBULAR LCK SS 12H AR-8943T-12

Facility

$1,502.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$841.12
Max. Negotiated Rate	$1,456.94
Rate for Payer: Cash Price	$901.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,051.40
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Kaiser Permanente Commercial	$1,351.80
Rate for Payer: MDX Hawaii PPO	$1,456.94
Rate for Payer: University Health Alliance Commercial	$841.12

TUBULAR PLATE 1/3 4H 241.34

Facility

$422.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$236.32
Max. Negotiated Rate	$409.34
Rate for Payer: Cash Price	$253.20
Rate for Payer: Hawaii Western Management Group Commercial	$295.40
Rate for Payer: Health Management Network Commercial	$358.70
Rate for Payer: Kaiser Permanente Commercial	$379.80
Rate for Payer: MDX Hawaii PPO	$409.34
Rate for Payer: University Health Alliance Commercial	$236.32

TUBULAR PLATE 1/3 4H 241.34

Facility

$422.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$211.00
Max. Negotiated Rate	$409.34
Rate for Payer: AlohaCare Medicaid	$211.00
Rate for Payer: AlohaCare Medicare	$320.72
Rate for Payer: Cash Price	$253.20
Rate for Payer: Devoted Health Medicare	$354.48
Rate for Payer: Hawaii Medical Service Association Medicare	$320.72
Rate for Payer: Hawaii Western Management Group Commercial	$295.40
Rate for Payer: Health Management Network Commercial	$358.70
Rate for Payer: Humana Medicare	$320.72
Rate for Payer: Kaiser Permanente Commercial	$379.80
Rate for Payer: Kaiser Permanente Medicaid	$215.22
Rate for Payer: Kaiser Permanente Medicare	$320.72
Rate for Payer: MDX Hawaii PPO	$409.34
Rate for Payer: Ohana Health Plan Medicaid	$320.72
Rate for Payer: Ohana Health Plan Medicare	$320.72
Rate for Payer: UnitedHealthcare Medicare	$320.72
Rate for Payer: University Health Alliance Commercial	$236.32

TUNNELER SHEATH LG BLU 9009-16

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$128.50
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: AlohaCare Medicaid	$128.50
Rate for Payer: AlohaCare Medicare	$195.32
Rate for Payer: Devoted Health Medicare	$215.88
Rate for Payer: Hawaii Medical Service Association Medicare	$195.32
Rate for Payer: Hawaii Western Management Group Commercial	$244.15
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Humana Medicare	$195.32
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: Kaiser Permanente Medicare	$195.32
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: Ohana Health Plan Medicaid	$195.32
Rate for Payer: Ohana Health Plan Medicare	$195.32
Rate for Payer: UnitedHealthcare Medicare	$195.32
Rate for Payer: University Health Alliance Commercial	$187.33

TUNNELER SHEATH LG BLU 9009-16

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29

TUNNELER SHEATH LG ORG 9009-20

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29

TUNNELER SHEATH LG ORG 9009-20

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$128.50
Max. Negotiated Rate	$249.29
Rate for Payer: AlohaCare Medicaid	$128.50
Rate for Payer: AlohaCare Medicare	$195.32
Rate for Payer: Cash Price	$154.20
Rate for Payer: Devoted Health Medicare	$215.88
Rate for Payer: Hawaii Medical Service Association Medicare	$195.32
Rate for Payer: Hawaii Western Management Group Commercial	$244.15
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Humana Medicare	$195.32
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: Kaiser Permanente Medicare	$195.32
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: Ohana Health Plan Medicaid	$195.32
Rate for Payer: Ohana Health Plan Medicare	$195.32
Rate for Payer: UnitedHealthcare Medicare	$195.32
Rate for Payer: University Health Alliance Commercial	$187.33

TUNNELER SHEATH SM YEL 9009-22

Facility

$211.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$105.50
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$105.50
Rate for Payer: AlohaCare Medicare	$160.36
Rate for Payer: Cash Price	$126.60
Rate for Payer: Devoted Health Medicare	$177.24
Rate for Payer: Hawaii Medical Service Association Medicare	$160.36
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$160.36
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$160.36
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$160.36
Rate for Payer: Ohana Health Plan Medicare	$160.36
Rate for Payer: UnitedHealthcare Medicare	$160.36
Rate for Payer: University Health Alliance Commercial	$153.80

TUNNELER SHEATH SM YEL 9009-22

Facility

$211.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$126.60
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: MDX Hawaii PPO	$204.67

TURBOVAC 90 XL ASC1336-01

Facility

$1,642.00

Hospital Revenue Code	272
Min. Negotiated Rate	$821.00
Max. Negotiated Rate	$1,592.74
Rate for Payer: AlohaCare Medicaid	$821.00
Rate for Payer: AlohaCare Medicare	$1,247.92
Rate for Payer: Cash Price	$985.20
Rate for Payer: Devoted Health Medicare	$1,379.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,247.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,559.90
Rate for Payer: Health Management Network Commercial	$1,395.70
Rate for Payer: Humana Medicare	$1,247.92
Rate for Payer: Kaiser Permanente Commercial	$1,477.80
Rate for Payer: Kaiser Permanente Medicaid	$837.42
Rate for Payer: Kaiser Permanente Medicare	$1,247.92
Rate for Payer: MDX Hawaii PPO	$1,592.74
Rate for Payer: Ohana Health Plan Medicaid	$1,247.92
Rate for Payer: Ohana Health Plan Medicare	$1,247.92
Rate for Payer: UnitedHealthcare Medicare	$1,247.92
Rate for Payer: University Health Alliance Commercial	$1,196.85

TURBOVAC 90 XL ASC1336-01

Facility

$1,642.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,395.70
Max. Negotiated Rate	$1,592.74
Rate for Payer: Cash Price	$985.20
Rate for Payer: Health Management Network Commercial	$1,395.70
Rate for Payer: Kaiser Permanente Commercial	$1,477.80
Rate for Payer: MDX Hawaii PPO	$1,592.74

TVT OBTURATOR SYSTEM 810081L

Facility

$4,486.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.16
Max. Negotiated Rate	$4,351.42
Rate for Payer: Cash Price	$2,691.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,140.20
Rate for Payer: Health Management Network Commercial	$3,813.10
Rate for Payer: Kaiser Permanente Commercial	$4,037.40
Rate for Payer: MDX Hawaii PPO	$4,351.42
Rate for Payer: University Health Alliance Commercial	$2,512.16

TVT OBTURATOR SYSTEM 810081L

Facility

$4,486.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$2,243.00
Max. Negotiated Rate	$4,351.42
Rate for Payer: AlohaCare Medicaid	$2,243.00
Rate for Payer: AlohaCare Medicare	$3,409.36
Rate for Payer: Cash Price	$2,691.60
Rate for Payer: Devoted Health Medicare	$3,768.24
Rate for Payer: Hawaii Medical Service Association Medicare	$3,409.36
Rate for Payer: Hawaii Western Management Group Commercial	$3,140.20
Rate for Payer: Health Management Network Commercial	$3,813.10
Rate for Payer: Humana Medicare	$3,409.36
Rate for Payer: Kaiser Permanente Commercial	$4,037.40
Rate for Payer: Kaiser Permanente Medicaid	$2,287.86
Rate for Payer: Kaiser Permanente Medicare	$3,409.36
Rate for Payer: MDX Hawaii PPO	$4,351.42
Rate for Payer: Ohana Health Plan Medicaid	$3,409.36
Rate for Payer: Ohana Health Plan Medicare	$3,409.36
Rate for Payer: UnitedHealthcare Medicare	$3,409.36
Rate for Payer: University Health Alliance Commercial	$2,512.16

UCL SYSTEM INTER BRACE AR-7715

Facility

$2,476.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,238.00
Max. Negotiated Rate	$2,401.72
Rate for Payer: AlohaCare Medicaid	$1,238.00
Rate for Payer: AlohaCare Medicare	$1,881.76
Rate for Payer: Cash Price	$1,485.60
Rate for Payer: Devoted Health Medicare	$2,079.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,881.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,733.20
Rate for Payer: Health Management Network Commercial	$2,104.60
Rate for Payer: Humana Medicare	$1,881.76
Rate for Payer: Kaiser Permanente Commercial	$2,228.40
Rate for Payer: Kaiser Permanente Medicaid	$1,262.76
Rate for Payer: Kaiser Permanente Medicare	$1,881.76
Rate for Payer: MDX Hawaii PPO	$2,401.72
Rate for Payer: Ohana Health Plan Medicaid	$1,881.76
Rate for Payer: Ohana Health Plan Medicare	$1,881.76
Rate for Payer: UnitedHealthcare Medicare	$1,881.76
Rate for Payer: University Health Alliance Commercial	$1,386.56

UCL SYSTEM INTER BRACE AR-7715

Facility

$2,476.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,386.56
Max. Negotiated Rate	$2,401.72
Rate for Payer: Cash Price	$1,485.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,733.20
Rate for Payer: Health Management Network Commercial	$2,104.60
Rate for Payer: Kaiser Permanente Commercial	$2,228.40
Rate for Payer: MDX Hawaii PPO	$2,401.72
Rate for Payer: University Health Alliance Commercial	$1,386.56

UHR BIPOLAR 28X44MM UH1-44-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X44MM UH1-44-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X45MM UH1-45-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X45MM UH1-45-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X46MM UH1-46-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

Know your out-of-pocket cost for care.

All Charges