Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CATH 20FR 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 20GX1.50 RADIAL ART

Facility

$79.00

Hospital Revenue Code	272
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: MDX Hawaii PPO	$76.63

CATH 20GX1.50 RADIAL ART

Facility

$79.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.50
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$39.50
Rate for Payer: AlohaCare Medicare	$60.04
Rate for Payer: Cash Price	$47.40
Rate for Payer: Devoted Health Medicare	$66.36
Rate for Payer: Hawaii Medical Service Association Medicare	$60.04
Rate for Payer: Hawaii Western Management Group Commercial	$75.05
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$60.04
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$60.04
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$60.04
Rate for Payer: Ohana Health Plan Medicare	$60.04
Rate for Payer: UnitedHealthcare Medicare	$60.04
Rate for Payer: University Health Alliance Commercial	$57.58

CATH 22F LATEX 3-WAY 30ML

Facility

$93.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21

CATH 22F LATEX 3-WAY 30ML

Facility

$93.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$70.68
Rate for Payer: Cash Price	$55.80
Rate for Payer: Devoted Health Medicare	$78.12
Rate for Payer: Hawaii Medical Service Association Medicare	$70.68
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$70.68
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$70.68
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$70.68
Rate for Payer: Ohana Health Plan Medicare	$70.68
Rate for Payer: UnitedHealthcare Medicare	$70.68
Rate for Payer: University Health Alliance Commercial	$67.79

CATH 22FR LATEX RED COUNCIL

Facility

$78.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: AlohaCare Medicare	$59.28
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$65.52
Rate for Payer: Hawaii Medical Service Association Medicare	$59.28
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$59.28
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$59.28
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$59.28
Rate for Payer: Ohana Health Plan Medicare	$59.28
Rate for Payer: UnitedHealthcare Medicare	$59.28
Rate for Payer: University Health Alliance Commercial	$56.85

CATH 22FR LATEX RED COUNCIL

Facility

$78.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

CATH 24F FOLEY LUBRIL

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

CATH 24F FOLEY LUBRIL

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$74.69
Rate for Payer: AlohaCare Medicaid	$38.50
Rate for Payer: AlohaCare Medicare	$58.52
Rate for Payer: Cash Price	$46.20
Rate for Payer: Devoted Health Medicare	$64.68
Rate for Payer: Hawaii Medical Service Association Medicare	$58.52
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Humana Medicare	$58.52
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: Kaiser Permanente Medicare	$58.52
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: Ohana Health Plan Medicaid	$58.52
Rate for Payer: Ohana Health Plan Medicare	$58.52
Rate for Payer: UnitedHealthcare Medicare	$58.52
Rate for Payer: University Health Alliance Commercial	$56.13

CATH 24FR HEMO FOLEY

Facility

$125.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$95.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Devoted Health Medicare	$105.00
Rate for Payer: Hawaii Medical Service Association Medicare	$95.00
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$95.00
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$95.00
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$95.00
Rate for Payer: Ohana Health Plan Medicare	$95.00
Rate for Payer: UnitedHealthcare Medicare	$95.00
Rate for Payer: University Health Alliance Commercial	$91.11

CATH 24FR HEMO FOLEY

Facility

$125.00

Hospital Revenue Code	272
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

CATH 24FR MALECOT

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

CATH 24FR MALECOT

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$111.72
Rate for Payer: Cash Price	$88.20
Rate for Payer: Devoted Health Medicare	$123.48
Rate for Payer: Hawaii Medical Service Association Medicare	$111.72
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$111.72
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$111.72
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$111.72
Rate for Payer: Ohana Health Plan Medicare	$111.72
Rate for Payer: UnitedHealthcare Medicare	$111.72
Rate for Payer: University Health Alliance Commercial	$107.15

CATH 24F URETHRAL DCB

Facility

$6,510.00

Hospital Revenue Code	272
Min. Negotiated Rate	$5,533.50
Max. Negotiated Rate	$6,314.70
Rate for Payer: Cash Price	$3,906.00
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

CATH 24F URETHRAL DCB

Facility

$6,510.00

Hospital Revenue Code	272
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	$6,184.50
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	$4,745.14

CATH 24FX12 NEPH BALLOON

Facility

$913.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$456.50
Max. Negotiated Rate	$885.61
Rate for Payer: AlohaCare Medicaid	$456.50
Rate for Payer: AlohaCare Medicaid	$447.50
Rate for Payer: AlohaCare Medicare	$680.20
Rate for Payer: AlohaCare Medicare	$693.88
Rate for Payer: Cash Price	$537.00
Rate for Payer: Cash Price	$547.80
Rate for Payer: Devoted Health Medicare	$766.92
Rate for Payer: Devoted Health Medicare	$751.80
Rate for Payer: Hawaii Medical Service Association Medicare	$680.20
Rate for Payer: Hawaii Medical Service Association Medicare	$693.88
Rate for Payer: Hawaii Western Management Group Commercial	$850.25
Rate for Payer: Hawaii Western Management Group Commercial	$867.35
Rate for Payer: Health Management Network Commercial	$776.05
Rate for Payer: Health Management Network Commercial	$760.75
Rate for Payer: Humana Medicare	$693.88
Rate for Payer: Humana Medicare	$680.20
Rate for Payer: Kaiser Permanente Commercial	$805.50
Rate for Payer: Kaiser Permanente Commercial	$821.70
Rate for Payer: Kaiser Permanente Medicaid	$465.63
Rate for Payer: Kaiser Permanente Medicaid	$456.45
Rate for Payer: Kaiser Permanente Medicare	$680.20
Rate for Payer: Kaiser Permanente Medicare	$693.88
Rate for Payer: MDX Hawaii PPO	$868.15
Rate for Payer: MDX Hawaii PPO	$885.61
Rate for Payer: Ohana Health Plan Medicaid	$680.20
Rate for Payer: Ohana Health Plan Medicaid	$693.88
Rate for Payer: Ohana Health Plan Medicare	$680.20
Rate for Payer: Ohana Health Plan Medicare	$693.88
Rate for Payer: UnitedHealthcare Medicare	$693.88
Rate for Payer: UnitedHealthcare Medicare	$680.20
Rate for Payer: University Health Alliance Commercial	$665.49
Rate for Payer: University Health Alliance Commercial	$652.37

CATH 24FX12 NEPH BALLOON

Facility

$895.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$760.75
Max. Negotiated Rate	$868.15
Rate for Payer: Cash Price	$537.00
Rate for Payer: Cash Price	$547.80
Rate for Payer: Health Management Network Commercial	$760.75
Rate for Payer: Health Management Network Commercial	$776.05
Rate for Payer: Kaiser Permanente Commercial	$805.50
Rate for Payer: Kaiser Permanente Commercial	$821.70
Rate for Payer: MDX Hawaii PPO	$885.61
Rate for Payer: MDX Hawaii PPO	$868.15

CATH 24FX4 NEPH 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 24FX4 NEPH 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 28FR MALECOT

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$111.72
Rate for Payer: Cash Price	$88.20
Rate for Payer: Devoted Health Medicare	$123.48
Rate for Payer: Hawaii Medical Service Association Medicare	$111.72
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$111.72
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$111.72
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$111.72
Rate for Payer: Ohana Health Plan Medicare	$111.72
Rate for Payer: UnitedHealthcare Medicare	$111.72
Rate for Payer: University Health Alliance Commercial	$107.15

CATH 28FR MALECOT

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

CATH 30CC 16F FOLEY 3WAY

Facility

$83.00

Hospital Revenue Code	272
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$49.80
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: MDX Hawaii PPO	$80.51

CATH 30CC 16F FOLEY 3WAY

Facility

$83.00

Hospital Revenue Code	272
Min. Negotiated Rate	$41.50
Max. Negotiated Rate	$80.51
Rate for Payer: AlohaCare Medicaid	$41.50
Rate for Payer: AlohaCare Medicare	$63.08
Rate for Payer: Cash Price	$49.80
Rate for Payer: Devoted Health Medicare	$69.72
Rate for Payer: Hawaii Medical Service Association Medicare	$63.08
Rate for Payer: Hawaii Western Management Group Commercial	$78.85
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Humana Medicare	$63.08
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: Kaiser Permanente Medicaid	$42.33
Rate for Payer: Kaiser Permanente Medicare	$63.08
Rate for Payer: MDX Hawaii PPO	$80.51
Rate for Payer: Ohana Health Plan Medicaid	$63.08
Rate for Payer: Ohana Health Plan Medicare	$63.08
Rate for Payer: UnitedHealthcare Medicare	$63.08
Rate for Payer: University Health Alliance Commercial	$60.50

CATH 30CC 18F FOLEY 3WAY

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$74.69
Rate for Payer: AlohaCare Medicaid	$38.50
Rate for Payer: AlohaCare Medicare	$58.52
Rate for Payer: Cash Price	$46.20
Rate for Payer: Devoted Health Medicare	$64.68
Rate for Payer: Hawaii Medical Service Association Medicare	$58.52
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Humana Medicare	$58.52
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: Kaiser Permanente Medicare	$58.52
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: Ohana Health Plan Medicaid	$58.52
Rate for Payer: Ohana Health Plan Medicare	$58.52
Rate for Payer: UnitedHealthcare Medicare	$58.52
Rate for Payer: University Health Alliance Commercial	$56.13

CATH 30CC 18F FOLEY 3WAY

Facility

$77.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

Know your out-of-pocket cost for care.

All Charges