Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

VESSEL SEALER EXTENDED 480422

Facility

$1,969.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,673.65
Max. Negotiated Rate	$1,909.93
Rate for Payer: Cash Price	$1,181.40
Rate for Payer: Health Management Network Commercial	$1,673.65
Rate for Payer: Kaiser Permanente Commercial	$1,772.10
Rate for Payer: MDX Hawaii PPO	$1,909.93

VESSEL SEALER EXTENDED 480422

Facility

$1,969.00

Hospital Revenue Code	272
Min. Negotiated Rate	$984.50
Max. Negotiated Rate	$1,909.93
Rate for Payer: AlohaCare Medicaid	$984.50
Rate for Payer: AlohaCare Medicare	$1,496.44
Rate for Payer: Cash Price	$1,181.40
Rate for Payer: Devoted Health Medicare	$1,653.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,496.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,870.55
Rate for Payer: Health Management Network Commercial	$1,673.65
Rate for Payer: Humana Medicare	$1,496.44
Rate for Payer: Kaiser Permanente Commercial	$1,772.10
Rate for Payer: Kaiser Permanente Medicaid	$1,004.19
Rate for Payer: Kaiser Permanente Medicare	$1,496.44
Rate for Payer: MDX Hawaii PPO	$1,909.93
Rate for Payer: Ohana Health Plan Medicaid	$1,496.44
Rate for Payer: Ohana Health Plan Medicare	$1,496.44
Rate for Payer: UnitedHealthcare Medicare	$1,496.44
Rate for Payer: University Health Alliance Commercial	$1,435.20

VIABAHN BALLOON BXB085902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,053.00
Max. Negotiated Rate	$7,862.82
Rate for Payer: AlohaCare Medicaid	$4,053.00
Rate for Payer: AlohaCare Medicare	$6,160.56
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Devoted Health Medicare	$6,809.04
Rate for Payer: Hawaii Medical Service Association Medicare	$6,160.56
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Humana Medicare	$6,160.56
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: Kaiser Permanente Medicaid	$4,134.06
Rate for Payer: Kaiser Permanente Medicare	$6,160.56
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: Ohana Health Plan Medicaid	$6,160.56
Rate for Payer: Ohana Health Plan Medicare	$6,160.56
Rate for Payer: UnitedHealthcare Medicare	$6,160.56
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BALLOON BXB085902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,539.36
Max. Negotiated Rate	$7,862.82
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BALLOON BXBL083902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,539.36
Max. Negotiated Rate	$7,862.82
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BALLOON BXBL083902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,053.00
Max. Negotiated Rate	$7,862.82
Rate for Payer: AlohaCare Medicaid	$4,053.00
Rate for Payer: AlohaCare Medicare	$6,160.56
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Devoted Health Medicare	$6,809.04
Rate for Payer: Hawaii Medical Service Association Medicare	$6,160.56
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Humana Medicare	$6,160.56
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: Kaiser Permanente Medicaid	$4,134.06
Rate for Payer: Kaiser Permanente Medicare	$6,160.56
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: Ohana Health Plan Medicaid	$6,160.56
Rate for Payer: Ohana Health Plan Medicare	$6,160.56
Rate for Payer: UnitedHealthcare Medicare	$6,160.56
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BALLOON BXBL085902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,053.00
Max. Negotiated Rate	$7,862.82
Rate for Payer: AlohaCare Medicaid	$4,053.00
Rate for Payer: AlohaCare Medicare	$6,160.56
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Devoted Health Medicare	$6,809.04
Rate for Payer: Hawaii Medical Service Association Medicare	$6,160.56
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Humana Medicare	$6,160.56
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: Kaiser Permanente Medicaid	$4,134.06
Rate for Payer: Kaiser Permanente Medicare	$6,160.56
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: Ohana Health Plan Medicaid	$6,160.56
Rate for Payer: Ohana Health Plan Medicare	$6,160.56
Rate for Payer: UnitedHealthcare Medicare	$6,160.56
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BALLOON BXBL085902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,539.36
Max. Negotiated Rate	$7,862.82
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BX BALLOON BXA085901A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,053.00
Max. Negotiated Rate	$7,862.82
Rate for Payer: AlohaCare Medicaid	$4,053.00
Rate for Payer: AlohaCare Medicare	$6,160.56
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Devoted Health Medicare	$6,809.04
Rate for Payer: Hawaii Medical Service Association Medicare	$6,160.56
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Humana Medicare	$6,160.56
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: Kaiser Permanente Medicaid	$4,134.06
Rate for Payer: Kaiser Permanente Medicare	$6,160.56
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: Ohana Health Plan Medicaid	$6,160.56
Rate for Payer: Ohana Health Plan Medicare	$6,160.56
Rate for Payer: UnitedHealthcare Medicare	$6,160.56
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BX BALLOON BXA085901A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,539.36
Max. Negotiated Rate	$7,862.82
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BX BALLOON BXAL087901A

Facility

$8,894.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,980.64
Max. Negotiated Rate	$8,627.18
Rate for Payer: Cash Price	$5,336.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,225.80
Rate for Payer: Health Management Network Commercial	$7,559.90
Rate for Payer: Kaiser Permanente Commercial	$8,004.60
Rate for Payer: MDX Hawaii PPO	$8,627.18
Rate for Payer: University Health Alliance Commercial	$4,980.64

VIABAHN BX BALLOON BXAL087901A

Facility

$8,894.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,447.00
Max. Negotiated Rate	$8,627.18
Rate for Payer: AlohaCare Medicaid	$4,447.00
Rate for Payer: AlohaCare Medicare	$6,759.44
Rate for Payer: Cash Price	$5,336.40
Rate for Payer: Devoted Health Medicare	$7,470.96
Rate for Payer: Hawaii Medical Service Association Medicare	$6,759.44
Rate for Payer: Hawaii Western Management Group Commercial	$6,225.80
Rate for Payer: Health Management Network Commercial	$7,559.90
Rate for Payer: Humana Medicare	$6,759.44
Rate for Payer: Kaiser Permanente Commercial	$8,004.60
Rate for Payer: Kaiser Permanente Medicaid	$4,535.94
Rate for Payer: Kaiser Permanente Medicare	$6,759.44
Rate for Payer: MDX Hawaii PPO	$8,627.18
Rate for Payer: Ohana Health Plan Medicaid	$6,759.44
Rate for Payer: Ohana Health Plan Medicare	$6,759.44
Rate for Payer: UnitedHealthcare Medicare	$6,759.44
Rate for Payer: University Health Alliance Commercial	$4,980.64

VIABAHN ENDOPROSTH VBHR060501A

Facility

$7,918.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,959.00
Max. Negotiated Rate	$7,680.46
Rate for Payer: AlohaCare Medicaid	$3,959.00
Rate for Payer: AlohaCare Medicare	$6,017.68
Rate for Payer: Cash Price	$4,750.80
Rate for Payer: Devoted Health Medicare	$6,651.12
Rate for Payer: Hawaii Medical Service Association Medicare	$6,017.68
Rate for Payer: Hawaii Western Management Group Commercial	$5,542.60
Rate for Payer: Health Management Network Commercial	$6,730.30
Rate for Payer: Humana Medicare	$6,017.68
Rate for Payer: Kaiser Permanente Commercial	$7,126.20
Rate for Payer: Kaiser Permanente Medicaid	$4,038.18
Rate for Payer: Kaiser Permanente Medicare	$6,017.68
Rate for Payer: MDX Hawaii PPO	$7,680.46
Rate for Payer: Ohana Health Plan Medicaid	$6,017.68
Rate for Payer: Ohana Health Plan Medicare	$6,017.68
Rate for Payer: UnitedHealthcare Medicare	$6,017.68
Rate for Payer: University Health Alliance Commercial	$4,434.08

VIABAHN ENDOPROSTH VBHR060501A

Facility

$7,918.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,434.08
Max. Negotiated Rate	$7,680.46
Rate for Payer: Cash Price	$4,750.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,542.60
Rate for Payer: Health Management Network Commercial	$6,730.30
Rate for Payer: Kaiser Permanente Commercial	$7,126.20
Rate for Payer: MDX Hawaii PPO	$7,680.46
Rate for Payer: University Health Alliance Commercial	$4,434.08

VIABAHN GORE VBHR081001A

Facility

$8,002.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,481.12
Max. Negotiated Rate	$7,761.94
Rate for Payer: Cash Price	$4,801.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,601.40
Rate for Payer: Health Management Network Commercial	$6,801.70
Rate for Payer: Kaiser Permanente Commercial	$7,201.80
Rate for Payer: MDX Hawaii PPO	$7,761.94
Rate for Payer: University Health Alliance Commercial	$4,481.12

VIABAHN GORE VBHR081001A

Facility

$8,002.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,001.00
Max. Negotiated Rate	$7,761.94
Rate for Payer: AlohaCare Medicaid	$4,001.00
Rate for Payer: AlohaCare Medicare	$6,081.52
Rate for Payer: Cash Price	$4,801.20
Rate for Payer: Devoted Health Medicare	$6,721.68
Rate for Payer: Hawaii Medical Service Association Medicare	$6,081.52
Rate for Payer: Hawaii Western Management Group Commercial	$5,601.40
Rate for Payer: Health Management Network Commercial	$6,801.70
Rate for Payer: Humana Medicare	$6,081.52
Rate for Payer: Kaiser Permanente Commercial	$7,201.80
Rate for Payer: Kaiser Permanente Medicaid	$4,081.02
Rate for Payer: Kaiser Permanente Medicare	$6,081.52
Rate for Payer: MDX Hawaii PPO	$7,761.94
Rate for Payer: Ohana Health Plan Medicaid	$6,081.52
Rate for Payer: Ohana Health Plan Medicare	$6,081.52
Rate for Payer: UnitedHealthcare Medicare	$6,081.52
Rate for Payer: University Health Alliance Commercial	$4,481.12

VIABAHN SX ENDO VBHR061001A

Facility

$8,684.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,863.04
Max. Negotiated Rate	$8,423.48
Rate for Payer: Cash Price	$5,210.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,078.80
Rate for Payer: Health Management Network Commercial	$7,381.40
Rate for Payer: Kaiser Permanente Commercial	$7,815.60
Rate for Payer: MDX Hawaii PPO	$8,423.48
Rate for Payer: University Health Alliance Commercial	$4,863.04

VIABAHN SX ENDO VBHR061001A

Facility

$8,684.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,342.00
Max. Negotiated Rate	$8,423.48
Rate for Payer: AlohaCare Medicaid	$4,342.00
Rate for Payer: AlohaCare Medicare	$6,599.84
Rate for Payer: Cash Price	$5,210.40
Rate for Payer: Devoted Health Medicare	$7,294.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6,599.84
Rate for Payer: Hawaii Western Management Group Commercial	$6,078.80
Rate for Payer: Health Management Network Commercial	$7,381.40
Rate for Payer: Humana Medicare	$6,599.84
Rate for Payer: Kaiser Permanente Commercial	$7,815.60
Rate for Payer: Kaiser Permanente Medicaid	$4,428.84
Rate for Payer: Kaiser Permanente Medicare	$6,599.84
Rate for Payer: MDX Hawaii PPO	$8,423.48
Rate for Payer: Ohana Health Plan Medicaid	$6,599.84
Rate for Payer: Ohana Health Plan Medicare	$6,599.84
Rate for Payer: UnitedHealthcare Medicare	$6,599.84
Rate for Payer: University Health Alliance Commercial	$4,863.04

VIABAHN VBX EX BAL BXA073901A

Facility

$6,510.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,645.60
Max. Negotiated Rate	$6,314.70
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,557.00
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: Kaiser Permanente Commercial	$5,859.00
Rate for Payer: MDX Hawaii PPO	$6,314.70
Rate for Payer: University Health Alliance Commercial	$3,645.60

VIABAHN VBX EX BAL BXA073901A

Facility

$6,510.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,255.00
Max. Negotiated Rate	$6,314.70
Rate for Payer: AlohaCare Medicaid	$3,255.00
Rate for Payer: AlohaCare Medicare	$4,947.60
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Devoted Health Medicare	$5,468.40
Rate for Payer: Hawaii Medical Service Association Medicare	$4,947.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,557.00
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: Humana Medicare	$4,947.60
Rate for Payer: Kaiser Permanente Commercial	$5,859.00
Rate for Payer: Kaiser Permanente Medicaid	$3,320.10
Rate for Payer: Kaiser Permanente Medicare	$4,947.60
Rate for Payer: MDX Hawaii PPO	$6,314.70
Rate for Payer: Ohana Health Plan Medicaid	$4,947.60
Rate for Payer: Ohana Health Plan Medicare	$4,947.60
Rate for Payer: UnitedHealthcare Medicare	$4,947.60
Rate for Payer: University Health Alliance Commercial	$3,645.60

VIABAHN VBX EX BAL BXA075902A

Facility

$6,510.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,645.60
Max. Negotiated Rate	$6,314.70
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,557.00
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: Kaiser Permanente Commercial	$5,859.00
Rate for Payer: MDX Hawaii PPO	$6,314.70
Rate for Payer: University Health Alliance Commercial	$3,645.60

VIABAHN VBX EX BAL BXA075902A

Facility

$6,510.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,255.00
Max. Negotiated Rate	$6,314.70
Rate for Payer: AlohaCare Medicaid	$3,255.00
Rate for Payer: AlohaCare Medicare	$4,947.60
Rate for Payer: Cash Price	$3,906.00
Rate for Payer: Devoted Health Medicare	$5,468.40
Rate for Payer: Hawaii Medical Service Association Medicare	$4,947.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,557.00
Rate for Payer: Health Management Network Commercial	$5,533.50
Rate for Payer: Humana Medicare	$4,947.60
Rate for Payer: Kaiser Permanente Commercial	$5,859.00
Rate for Payer: Kaiser Permanente Medicaid	$3,320.10
Rate for Payer: Kaiser Permanente Medicare	$4,947.60
Rate for Payer: MDX Hawaii PPO	$6,314.70
Rate for Payer: Ohana Health Plan Medicaid	$4,947.60
Rate for Payer: Ohana Health Plan Medicare	$4,947.60
Rate for Payer: UnitedHealthcare Medicare	$4,947.60
Rate for Payer: University Health Alliance Commercial	$3,645.60

VIABAHN VBX EX BAL BXA077901A

Facility

$7,140.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,570.00
Max. Negotiated Rate	$6,925.80
Rate for Payer: AlohaCare Medicaid	$3,570.00
Rate for Payer: AlohaCare Medicare	$5,426.40
Rate for Payer: Cash Price	$4,284.00
Rate for Payer: Devoted Health Medicare	$5,997.60
Rate for Payer: Hawaii Medical Service Association Medicare	$5,426.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,998.00
Rate for Payer: Health Management Network Commercial	$6,069.00
Rate for Payer: Humana Medicare	$5,426.40
Rate for Payer: Kaiser Permanente Commercial	$6,426.00
Rate for Payer: Kaiser Permanente Medicaid	$3,641.40
Rate for Payer: Kaiser Permanente Medicare	$5,426.40
Rate for Payer: MDX Hawaii PPO	$6,925.80
Rate for Payer: Ohana Health Plan Medicaid	$5,426.40
Rate for Payer: Ohana Health Plan Medicare	$5,426.40
Rate for Payer: UnitedHealthcare Medicare	$5,426.40
Rate for Payer: University Health Alliance Commercial	$3,998.40

VIABAHN VBX EX BAL BXA077901A

Facility

$7,140.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,998.40
Max. Negotiated Rate	$6,925.80
Rate for Payer: Cash Price	$4,284.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,998.00
Rate for Payer: Health Management Network Commercial	$6,069.00
Rate for Payer: Kaiser Permanente Commercial	$6,426.00
Rate for Payer: MDX Hawaii PPO	$6,925.80
Rate for Payer: University Health Alliance Commercial	$3,998.40

VIABAHN VBX EX BAL BXA097902A

Facility

$7,688.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,305.28
Max. Negotiated Rate	$7,457.36
Rate for Payer: Cash Price	$4,612.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,381.60
Rate for Payer: Health Management Network Commercial	$6,534.80
Rate for Payer: Kaiser Permanente Commercial	$6,919.20
Rate for Payer: MDX Hawaii PPO	$7,457.36
Rate for Payer: University Health Alliance Commercial	$4,305.28

Know your out-of-pocket cost for care.

All Charges