Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CATH 12X20 HEMODIALYSIS

Facility

$434.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$368.90
Max. Negotiated Rate	$420.98
Rate for Payer: Cash Price	$260.40
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: MDX Hawaii PPO	$420.98

CATH 12X20 HEMODIALYSIS

Facility

$434.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$217.00
Max. Negotiated Rate	$420.98
Rate for Payer: AlohaCare Medicaid	$217.00
Rate for Payer: AlohaCare Medicare	$329.84
Rate for Payer: Cash Price	$260.40
Rate for Payer: Devoted Health Medicare	$364.56
Rate for Payer: Hawaii Medical Service Association Medicare	$329.84
Rate for Payer: Hawaii Western Management Group Commercial	$412.30
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Humana Medicare	$329.84
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: Kaiser Permanente Medicaid	$221.34
Rate for Payer: Kaiser Permanente Medicare	$329.84
Rate for Payer: MDX Hawaii PPO	$420.98
Rate for Payer: Ohana Health Plan Medicaid	$329.84
Rate for Payer: Ohana Health Plan Medicare	$329.84
Rate for Payer: UnitedHealthcare Medicare	$329.84
Rate for Payer: University Health Alliance Commercial	$316.34

CATH 14F FOLEY IC COMPLETE

Facility

$87.00

Hospital Revenue Code	272
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$66.12
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$73.08
Rate for Payer: Hawaii Medical Service Association Medicare	$66.12
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$66.12
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$66.12
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$66.12
Rate for Payer: Ohana Health Plan Medicare	$66.12
Rate for Payer: UnitedHealthcare Medicare	$66.12
Rate for Payer: University Health Alliance Commercial	$63.41

CATH 14F FOLEY IC COMPLETE

Facility

$87.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

CATH 14FR MALECOT

Facility

$89.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$44.50
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$67.64
Rate for Payer: Cash Price	$53.40
Rate for Payer: Devoted Health Medicare	$74.76
Rate for Payer: Hawaii Medical Service Association Medicare	$67.64
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$67.64
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$67.64
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$67.64
Rate for Payer: Ohana Health Plan Medicare	$67.64
Rate for Payer: UnitedHealthcare Medicare	$67.64
Rate for Payer: University Health Alliance Commercial	$64.87

CATH 14FR MALECOT

Facility

$89.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$53.40
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

CATH 16F FOLEY IC COMPLETE

Facility

$87.00

Hospital Revenue Code	272
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$66.12
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$73.08
Rate for Payer: Hawaii Medical Service Association Medicare	$66.12
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$66.12
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$66.12
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$66.12
Rate for Payer: Ohana Health Plan Medicare	$66.12
Rate for Payer: UnitedHealthcare Medicare	$66.12
Rate for Payer: University Health Alliance Commercial	$63.41

CATH 16F FOLEY IC COMPLETE

Facility

$87.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

CATH 16FR FOLEY 3WAY

Facility

$85.00

Hospital Revenue Code	272
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$82.45
Rate for Payer: AlohaCare Medicaid	$42.50
Rate for Payer: AlohaCare Medicare	$64.60
Rate for Payer: Cash Price	$51.00
Rate for Payer: Devoted Health Medicare	$71.40
Rate for Payer: Hawaii Medical Service Association Medicare	$64.60
Rate for Payer: Hawaii Western Management Group Commercial	$80.75
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Humana Medicare	$64.60
Rate for Payer: Kaiser Permanente Commercial	$76.50
Rate for Payer: Kaiser Permanente Medicaid	$43.35
Rate for Payer: Kaiser Permanente Medicare	$64.60
Rate for Payer: MDX Hawaii PPO	$82.45
Rate for Payer: Ohana Health Plan Medicaid	$64.60
Rate for Payer: Ohana Health Plan Medicare	$64.60
Rate for Payer: UnitedHealthcare Medicare	$64.60
Rate for Payer: University Health Alliance Commercial	$61.96

CATH 16FR FOLEY 3WAY

Facility

$85.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Kaiser Permanente Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$82.45

CATH 16FR MALECOT

Facility

$127.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

CATH 16FR MALECOT

Facility

$127.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$63.50
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$96.52
Rate for Payer: Cash Price	$76.20
Rate for Payer: Devoted Health Medicare	$106.68
Rate for Payer: Hawaii Medical Service Association Medicare	$96.52
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$96.52
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$96.52
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$96.52
Rate for Payer: Ohana Health Plan Medicare	$96.52
Rate for Payer: UnitedHealthcare Medicare	$96.52
Rate for Payer: University Health Alliance Commercial	$92.57

CATH 18F LATEX 3-WAY 30ML

Facility

$81.00

Hospital Revenue Code	272
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Kaiser Permanente Commercial	$72.90
Rate for Payer: MDX Hawaii PPO	$78.57

CATH 18F LATEX 3-WAY 30ML

Facility

$81.00

Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$78.57
Rate for Payer: AlohaCare Medicaid	$40.50
Rate for Payer: AlohaCare Medicare	$61.56
Rate for Payer: Cash Price	$48.60
Rate for Payer: Devoted Health Medicare	$68.04
Rate for Payer: Hawaii Medical Service Association Medicare	$61.56
Rate for Payer: Hawaii Western Management Group Commercial	$76.95
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Humana Medicare	$61.56
Rate for Payer: Kaiser Permanente Commercial	$72.90
Rate for Payer: Kaiser Permanente Medicaid	$41.31
Rate for Payer: Kaiser Permanente Medicare	$61.56
Rate for Payer: MDX Hawaii PPO	$78.57
Rate for Payer: Ohana Health Plan Medicaid	$61.56
Rate for Payer: Ohana Health Plan Medicare	$61.56
Rate for Payer: UnitedHealthcare Medicare	$61.56
Rate for Payer: University Health Alliance Commercial	$59.04

CATH 18FR MALECOT

Facility

$89.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$44.50
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$67.64
Rate for Payer: Cash Price	$53.40
Rate for Payer: Devoted Health Medicare	$74.76
Rate for Payer: Hawaii Medical Service Association Medicare	$67.64
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$67.64
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$67.64
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$67.64
Rate for Payer: Ohana Health Plan Medicare	$67.64
Rate for Payer: UnitedHealthcare Medicare	$67.64
Rate for Payer: University Health Alliance Commercial	$64.87

CATH 18FR MALECOT

Facility

$89.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$53.40
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

CATH 18G FEMORAL ART

Facility

$136.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92

CATH 18G FEMORAL ART

Facility

$136.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$103.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Devoted Health Medicare	$114.24
Rate for Payer: Hawaii Medical Service Association Medicare	$103.36
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$103.36
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$103.36
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$103.36
Rate for Payer: Ohana Health Plan Medicare	$103.36
Rate for Payer: UnitedHealthcare Medicare	$103.36
Rate for Payer: University Health Alliance Commercial	$99.13

CATH 18X4 URETHRAL BALLOON

Facility

$910.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$773.50
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Kaiser Permanente Commercial	$819.00
Rate for Payer: MDX Hawaii PPO	$882.70

CATH 18X4 URETHRAL BALLOON

Facility

$910.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$882.70
Rate for Payer: AlohaCare Medicaid	$455.00
Rate for Payer: AlohaCare Medicare	$691.60
Rate for Payer: Cash Price	$546.00
Rate for Payer: Devoted Health Medicare	$764.40
Rate for Payer: Hawaii Medical Service Association Medicare	$691.60
Rate for Payer: Hawaii Western Management Group Commercial	$864.50
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Humana Medicare	$691.60
Rate for Payer: Kaiser Permanente Commercial	$819.00
Rate for Payer: Kaiser Permanente Medicaid	$464.10
Rate for Payer: Kaiser Permanente Medicare	$691.60
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: Ohana Health Plan Medicaid	$691.60
Rate for Payer: Ohana Health Plan Medicare	$691.60
Rate for Payer: UnitedHealthcare Medicare	$691.60
Rate for Payer: University Health Alliance Commercial	$663.30

CATH 18X6 URETHRAL BALLOON

Facility

$850.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$722.50
Max. Negotiated Rate	$824.50
Rate for Payer: Cash Price	$510.00
Rate for Payer: Health Management Network Commercial	$722.50
Rate for Payer: Kaiser Permanente Commercial	$765.00
Rate for Payer: MDX Hawaii PPO	$824.50

CATH 18X6 URETHRAL BALLOON

Facility

$850.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$425.00
Max. Negotiated Rate	$824.50
Rate for Payer: AlohaCare Medicaid	$425.00
Rate for Payer: AlohaCare Medicare	$646.00
Rate for Payer: Cash Price	$510.00
Rate for Payer: Devoted Health Medicare	$714.00
Rate for Payer: Hawaii Medical Service Association Medicare	$646.00
Rate for Payer: Hawaii Western Management Group Commercial	$807.50
Rate for Payer: Health Management Network Commercial	$722.50
Rate for Payer: Humana Medicare	$646.00
Rate for Payer: Kaiser Permanente Commercial	$765.00
Rate for Payer: Kaiser Permanente Medicaid	$433.50
Rate for Payer: Kaiser Permanente Medicare	$646.00
Rate for Payer: MDX Hawaii PPO	$824.50
Rate for Payer: Ohana Health Plan Medicaid	$646.00
Rate for Payer: Ohana Health Plan Medicare	$646.00
Rate for Payer: UnitedHealthcare Medicare	$646.00
Rate for Payer: University Health Alliance Commercial	$619.57

CATH 20F LATEX 3-WAY 30ML

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$110.20
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$121.80
Rate for Payer: Hawaii Medical Service Association Medicare	$110.20
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$110.20
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$110.20
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$110.20
Rate for Payer: Ohana Health Plan Medicare	$110.20
Rate for Payer: UnitedHealthcare Medicare	$110.20
Rate for Payer: University Health Alliance Commercial	$105.69

CATH 20F LATEX 3-WAY 30ML

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65

CATH 20FR MALECOT

Facility

$89.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$44.50
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$67.64
Rate for Payer: Cash Price	$53.40
Rate for Payer: Devoted Health Medicare	$74.76
Rate for Payer: Hawaii Medical Service Association Medicare	$67.64
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$67.64
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$67.64
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$67.64
Rate for Payer: Ohana Health Plan Medicare	$67.64
Rate for Payer: UnitedHealthcare Medicare	$67.64
Rate for Payer: University Health Alliance Commercial	$64.87

Know your out-of-pocket cost for care.

All Charges