Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

WASHER 6.5MM 219.972

Facility

$176.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$170.72
Rate for Payer: AlohaCare Medicaid	$88.00
Rate for Payer: AlohaCare Medicare	$133.76
Rate for Payer: Cash Price	$105.60
Rate for Payer: Devoted Health Medicare	$147.84
Rate for Payer: Hawaii Medical Service Association Medicare	$133.76
Rate for Payer: Hawaii Western Management Group Commercial	$123.20
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Humana Medicare	$133.76
Rate for Payer: Kaiser Permanente Commercial	$158.40
Rate for Payer: Kaiser Permanente Medicaid	$89.76
Rate for Payer: Kaiser Permanente Medicare	$133.76
Rate for Payer: MDX Hawaii PPO	$170.72
Rate for Payer: Ohana Health Plan Medicaid	$133.76
Rate for Payer: Ohana Health Plan Medicare	$133.76
Rate for Payer: UnitedHealthcare Medicare	$133.76
Rate for Payer: University Health Alliance Commercial	$98.56

WASHER 7.0MM 219.98

Facility

$166.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$161.02
Rate for Payer: AlohaCare Medicaid	$83.00
Rate for Payer: AlohaCare Medicare	$126.16
Rate for Payer: Cash Price	$99.60
Rate for Payer: Devoted Health Medicare	$139.44
Rate for Payer: Hawaii Medical Service Association Medicare	$126.16
Rate for Payer: Hawaii Western Management Group Commercial	$116.20
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Humana Medicare	$126.16
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: Kaiser Permanente Medicare	$126.16
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: Ohana Health Plan Medicaid	$126.16
Rate for Payer: Ohana Health Plan Medicare	$126.16
Rate for Payer: UnitedHealthcare Medicare	$126.16
Rate for Payer: University Health Alliance Commercial	$92.96

WASHER 7.0MM 219.98

Facility

$166.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$92.96
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$99.60
Rate for Payer: Hawaii Western Management Group Commercial	$116.20
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: University Health Alliance Commercial	$92.96

WASHER 7.0MM SS AR-8870W

Facility

$169.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$84.50
Max. Negotiated Rate	$163.93
Rate for Payer: AlohaCare Medicaid	$84.50
Rate for Payer: AlohaCare Medicare	$128.44
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$141.96
Rate for Payer: Hawaii Medical Service Association Medicare	$128.44
Rate for Payer: Hawaii Western Management Group Commercial	$118.30
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Humana Medicare	$128.44
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: Kaiser Permanente Medicaid	$86.19
Rate for Payer: Kaiser Permanente Medicare	$128.44
Rate for Payer: MDX Hawaii PPO	$163.93
Rate for Payer: Ohana Health Plan Medicaid	$128.44
Rate for Payer: Ohana Health Plan Medicare	$128.44
Rate for Payer: UnitedHealthcare Medicare	$128.44
Rate for Payer: University Health Alliance Commercial	$94.64

WASHER 7.0MM SS AR-8870W

Facility

$169.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$94.64
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$101.40
Rate for Payer: Hawaii Western Management Group Commercial	$118.30
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: MDX Hawaii PPO	$163.93
Rate for Payer: University Health Alliance Commercial	$94.64

WASHER 8X4.0MM 7112-0006

Facility

$360.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$349.20
Rate for Payer: AlohaCare Medicaid	$180.00
Rate for Payer: AlohaCare Medicare	$273.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Devoted Health Medicare	$302.40
Rate for Payer: Hawaii Medical Service Association Medicare	$273.60
Rate for Payer: Hawaii Western Management Group Commercial	$252.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Humana Medicare	$273.60
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: Kaiser Permanente Medicare	$273.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: Ohana Health Plan Medicaid	$273.60
Rate for Payer: Ohana Health Plan Medicare	$273.60
Rate for Payer: UnitedHealthcare Medicare	$273.60
Rate for Payer: University Health Alliance Commercial	$201.60

WASHER 8X4.0MM 7112-0006

Facility

$360.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$252.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: University Health Alliance Commercial	$201.60

WASHER AR-7000-15

Facility

$334.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$167.00
Max. Negotiated Rate	$323.98
Rate for Payer: AlohaCare Medicaid	$167.00
Rate for Payer: AlohaCare Medicare	$253.84
Rate for Payer: Cash Price	$200.40
Rate for Payer: Devoted Health Medicare	$280.56
Rate for Payer: Hawaii Medical Service Association Medicare	$253.84
Rate for Payer: Hawaii Western Management Group Commercial	$233.80
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Humana Medicare	$253.84
Rate for Payer: Kaiser Permanente Commercial	$300.60
Rate for Payer: Kaiser Permanente Medicaid	$170.34
Rate for Payer: Kaiser Permanente Medicare	$253.84
Rate for Payer: MDX Hawaii PPO	$323.98
Rate for Payer: Ohana Health Plan Medicaid	$253.84
Rate for Payer: Ohana Health Plan Medicare	$253.84
Rate for Payer: UnitedHealthcare Medicare	$253.84
Rate for Payer: University Health Alliance Commercial	$187.04

WASHER AR-7000-15

Facility

$334.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$187.04
Max. Negotiated Rate	$323.98
Rate for Payer: Cash Price	$200.40
Rate for Payer: Hawaii Western Management Group Commercial	$233.80
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Kaiser Permanente Commercial	$300.60
Rate for Payer: MDX Hawaii PPO	$323.98
Rate for Payer: University Health Alliance Commercial	$187.04

WASHER ASNIS 4.5/6.5/8 619904

Facility

$246.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$238.62
Rate for Payer: AlohaCare Medicaid	$123.00
Rate for Payer: AlohaCare Medicare	$186.96
Rate for Payer: Cash Price	$147.60
Rate for Payer: Devoted Health Medicare	$206.64
Rate for Payer: Hawaii Medical Service Association Medicare	$186.96
Rate for Payer: Hawaii Western Management Group Commercial	$172.20
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Humana Medicare	$186.96
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: Kaiser Permanente Medicare	$186.96
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: Ohana Health Plan Medicaid	$186.96
Rate for Payer: Ohana Health Plan Medicare	$186.96
Rate for Payer: UnitedHealthcare Medicare	$186.96
Rate for Payer: University Health Alliance Commercial	$137.76

WASHER ASNIS 4.5/6.5/8 619904

Facility

$246.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$147.60
Rate for Payer: Hawaii Western Management Group Commercial	$172.20
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: University Health Alliance Commercial	$137.76

WASHER FLAT 7.0MM P20-070-WF00

Facility

$633.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$354.48
Max. Negotiated Rate	$614.01
Rate for Payer: Cash Price	$379.80
Rate for Payer: Hawaii Western Management Group Commercial	$443.10
Rate for Payer: Health Management Network Commercial	$538.05
Rate for Payer: Kaiser Permanente Commercial	$569.70
Rate for Payer: MDX Hawaii PPO	$614.01
Rate for Payer: University Health Alliance Commercial	$354.48

WASHER FLAT 7.0MM P20-070-WF00

Facility

$633.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$316.50
Max. Negotiated Rate	$614.01
Rate for Payer: AlohaCare Medicaid	$316.50
Rate for Payer: AlohaCare Medicare	$481.08
Rate for Payer: Cash Price	$379.80
Rate for Payer: Devoted Health Medicare	$531.72
Rate for Payer: Hawaii Medical Service Association Medicare	$481.08
Rate for Payer: Hawaii Western Management Group Commercial	$443.10
Rate for Payer: Health Management Network Commercial	$538.05
Rate for Payer: Humana Medicare	$481.08
Rate for Payer: Kaiser Permanente Commercial	$569.70
Rate for Payer: Kaiser Permanente Medicaid	$322.83
Rate for Payer: Kaiser Permanente Medicare	$481.08
Rate for Payer: MDX Hawaii PPO	$614.01
Rate for Payer: Ohana Health Plan Medicaid	$481.08
Rate for Payer: Ohana Health Plan Medicare	$481.08
Rate for Payer: UnitedHealthcare Medicare	$481.08
Rate for Payer: University Health Alliance Commercial	$354.48

WASHER SLED OLECRANON OSW

Facility

$910.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$509.60
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Hawaii Western Management Group Commercial	$637.00
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
Rate for Payer: University Health Alliance Commercial	$509.60

WASHER SLED OLECRANON OSW

Facility

$910.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
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	$637.00
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	$509.60

WASHER SPIKE 8.0/3.2MM 219.931

Facility

$372.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$360.84
Rate for Payer: AlohaCare Medicaid	$186.00
Rate for Payer: AlohaCare Medicare	$282.72
Rate for Payer: Cash Price	$223.20
Rate for Payer: Devoted Health Medicare	$312.48
Rate for Payer: Hawaii Medical Service Association Medicare	$282.72
Rate for Payer: Hawaii Western Management Group Commercial	$260.40
Rate for Payer: Health Management Network Commercial	$316.20
Rate for Payer: Humana Medicare	$282.72
Rate for Payer: Kaiser Permanente Commercial	$334.80
Rate for Payer: Kaiser Permanente Medicaid	$189.72
Rate for Payer: Kaiser Permanente Medicare	$282.72
Rate for Payer: MDX Hawaii PPO	$360.84
Rate for Payer: Ohana Health Plan Medicaid	$282.72
Rate for Payer: Ohana Health Plan Medicare	$282.72
Rate for Payer: UnitedHealthcare Medicare	$282.72
Rate for Payer: University Health Alliance Commercial	$208.32

WASHER SPIKE 8.0/3.2MM 219.931

Facility

$372.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$208.32
Max. Negotiated Rate	$360.84
Rate for Payer: Cash Price	$223.20
Rate for Payer: Hawaii Western Management Group Commercial	$260.40
Rate for Payer: Health Management Network Commercial	$316.20
Rate for Payer: Kaiser Permanente Commercial	$334.80
Rate for Payer: MDX Hawaii PPO	$360.84
Rate for Payer: University Health Alliance Commercial	$208.32

WASHER WIRE FORM WASHR

Facility

$506.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$253.00
Max. Negotiated Rate	$490.82
Rate for Payer: AlohaCare Medicaid	$253.00
Rate for Payer: AlohaCare Medicare	$384.56
Rate for Payer: Cash Price	$303.60
Rate for Payer: Devoted Health Medicare	$425.04
Rate for Payer: Hawaii Medical Service Association Medicare	$384.56
Rate for Payer: Hawaii Western Management Group Commercial	$354.20
Rate for Payer: Health Management Network Commercial	$430.10
Rate for Payer: Humana Medicare	$384.56
Rate for Payer: Kaiser Permanente Commercial	$455.40
Rate for Payer: Kaiser Permanente Medicaid	$258.06
Rate for Payer: Kaiser Permanente Medicare	$384.56
Rate for Payer: MDX Hawaii PPO	$490.82
Rate for Payer: Ohana Health Plan Medicaid	$384.56
Rate for Payer: Ohana Health Plan Medicare	$384.56
Rate for Payer: UnitedHealthcare Medicare	$384.56
Rate for Payer: University Health Alliance Commercial	$283.36

WASHER WIRE FORM WASHR

Facility

$506.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$283.36
Max. Negotiated Rate	$490.82
Rate for Payer: Cash Price	$303.60
Rate for Payer: Hawaii Western Management Group Commercial	$354.20
Rate for Payer: Health Management Network Commercial	$430.10
Rate for Payer: Kaiser Permanente Commercial	$455.40
Rate for Payer: MDX Hawaii PPO	$490.82
Rate for Payer: University Health Alliance Commercial	$283.36

WASHR SPIKE 13.5/4.0MM 219.941

Facility

$589.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$329.84
Max. Negotiated Rate	$571.33
Rate for Payer: Cash Price	$353.40
Rate for Payer: Hawaii Western Management Group Commercial	$412.30
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: Kaiser Permanente Commercial	$530.10
Rate for Payer: MDX Hawaii PPO	$571.33
Rate for Payer: University Health Alliance Commercial	$329.84

WASHR SPIKE 13.5/4.0MM 219.941

Facility

$589.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$294.50
Max. Negotiated Rate	$571.33
Rate for Payer: AlohaCare Medicaid	$294.50
Rate for Payer: AlohaCare Medicare	$447.64
Rate for Payer: Cash Price	$353.40
Rate for Payer: Devoted Health Medicare	$494.76
Rate for Payer: Hawaii Medical Service Association Medicare	$447.64
Rate for Payer: Hawaii Western Management Group Commercial	$412.30
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: Humana Medicare	$447.64
Rate for Payer: Kaiser Permanente Commercial	$530.10
Rate for Payer: Kaiser Permanente Medicaid	$300.39
Rate for Payer: Kaiser Permanente Medicare	$447.64
Rate for Payer: MDX Hawaii PPO	$571.33
Rate for Payer: Ohana Health Plan Medicaid	$447.64
Rate for Payer: Ohana Health Plan Medicare	$447.64
Rate for Payer: UnitedHealthcare Medicare	$447.64
Rate for Payer: University Health Alliance Commercial	$329.84

WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION [14979]

Facility

$27.00

Service Code	NDC 00409397701
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION [14979]

Facility

$27.00

Service Code	NDC 00409397703
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

WATER FOR INJECTION, STERILE INJECTION SOLUTION [7484]

Facility

$28.00

Service Code	NDC 63323018520
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

WATER FOR INJECTION, STERILE INJECTION SOLUTION [7484]

Facility

$21.00

Service Code	NDC 63323018507
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

Know your out-of-pocket cost for care.

All Charges