Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

WILLIAMS CYSTO INJ NEEDLE

Facility

$144.00

Hospital Revenue Code	272
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: MDX Hawaii PPO	$139.68

WILLIAMS CYSTO INJ NEEDLE

Facility

$144.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$72.00
Rate for Payer: AlohaCare Medicare	$109.44
Rate for Payer: Cash Price	$86.40
Rate for Payer: Devoted Health Medicare	$120.96
Rate for Payer: Hawaii Medical Service Association Medicare	$109.44
Rate for Payer: Hawaii Western Management Group Commercial	$136.80
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$109.44
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$109.44
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$109.44
Rate for Payer: Ohana Health Plan Medicare	$109.44
Rate for Payer: UnitedHealthcare Medicare	$109.44
Rate for Payer: University Health Alliance Commercial	$104.96

WIRE 2.0 KIRSCHNER 390192

Facility

$145.00

Service Code	HCPCS C1713
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

WIRE 2.0 KIRSCHNER 390192

Facility

$145.00

Service Code	HCPCS C1713
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

WIRE 260 GLIDEWIRE ADVANTAGE

Facility

$675.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$654.75
Rate for Payer: Cash Price	$405.00
Rate for Payer: Health Management Network Commercial	$573.75
Rate for Payer: Kaiser Permanente Commercial	$607.50
Rate for Payer: MDX Hawaii PPO	$654.75

WIRE 260 GLIDEWIRE ADVANTAGE

Facility

$675.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$654.75
Rate for Payer: AlohaCare Medicaid	$337.50
Rate for Payer: AlohaCare Medicare	$513.00
Rate for Payer: Cash Price	$405.00
Rate for Payer: Devoted Health Medicare	$567.00
Rate for Payer: Hawaii Medical Service Association Medicare	$513.00
Rate for Payer: Hawaii Western Management Group Commercial	$641.25
Rate for Payer: Health Management Network Commercial	$573.75
Rate for Payer: Humana Medicare	$513.00
Rate for Payer: Kaiser Permanente Commercial	$607.50
Rate for Payer: Kaiser Permanente Medicaid	$344.25
Rate for Payer: Kaiser Permanente Medicare	$513.00
Rate for Payer: MDX Hawaii PPO	$654.75
Rate for Payer: Ohana Health Plan Medicaid	$513.00
Rate for Payer: Ohana Health Plan Medicare	$513.00
Rate for Payer: UnitedHealthcare Medicare	$513.00
Rate for Payer: University Health Alliance Commercial	$492.01

WIRE BAYONET 54-1216

Facility

$825.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$800.25
Rate for Payer: AlohaCare Medicaid	$412.50
Rate for Payer: AlohaCare Medicare	$627.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Devoted Health Medicare	$693.00
Rate for Payer: Hawaii Medical Service Association Medicare	$627.00
Rate for Payer: Hawaii Western Management Group Commercial	$783.75
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Humana Medicare	$627.00
Rate for Payer: Kaiser Permanente Commercial	$742.50
Rate for Payer: Kaiser Permanente Medicaid	$420.75
Rate for Payer: Kaiser Permanente Medicare	$627.00
Rate for Payer: MDX Hawaii PPO	$800.25
Rate for Payer: Ohana Health Plan Medicaid	$627.00
Rate for Payer: Ohana Health Plan Medicare	$627.00
Rate for Payer: UnitedHealthcare Medicare	$627.00
Rate for Payer: University Health Alliance Commercial	$601.34

WIRE BAYONET 54-1216

Facility

$825.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Kaiser Permanente Commercial	$742.50
Rate for Payer: MDX Hawaii PPO	$800.25

WIRE COMP 2.8X10MM 03.118.010

Facility

$279.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$270.63
Rate for Payer: AlohaCare Medicaid	$139.50
Rate for Payer: AlohaCare Medicare	$212.04
Rate for Payer: Cash Price	$167.40
Rate for Payer: Devoted Health Medicare	$234.36
Rate for Payer: Hawaii Medical Service Association Medicare	$212.04
Rate for Payer: Hawaii Western Management Group Commercial	$265.05
Rate for Payer: Health Management Network Commercial	$237.15
Rate for Payer: Humana Medicare	$212.04
Rate for Payer: Kaiser Permanente Commercial	$251.10
Rate for Payer: Kaiser Permanente Medicaid	$142.29
Rate for Payer: Kaiser Permanente Medicare	$212.04
Rate for Payer: MDX Hawaii PPO	$270.63
Rate for Payer: Ohana Health Plan Medicaid	$212.04
Rate for Payer: Ohana Health Plan Medicare	$212.04
Rate for Payer: UnitedHealthcare Medicare	$212.04
Rate for Payer: University Health Alliance Commercial	$203.36

WIRE COMP 2.8X10MM 03.118.010

Facility

$279.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$237.15
Max. Negotiated Rate	$270.63
Rate for Payer: Cash Price	$167.40
Rate for Payer: Health Management Network Commercial	$237.15
Rate for Payer: Kaiser Permanente Commercial	$251.10
Rate for Payer: MDX Hawaii PPO	$270.63

WIRE COMP 2.8X15MM 03.118.015

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

WIRE COMP 2.8X15MM 03.118.015

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$175.00
Rate for Payer: AlohaCare Medicare	$266.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$294.00
Rate for Payer: Hawaii Medical Service Association Medicare	$266.00
Rate for Payer: Hawaii Western Management Group Commercial	$332.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$266.00
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$266.00
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$266.00
Rate for Payer: Ohana Health Plan Medicare	$266.00
Rate for Payer: UnitedHealthcare Medicare	$266.00
Rate for Payer: University Health Alliance Commercial	$255.12

WIRE COMP 2.8X20MM 03.118.020

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

WIRE COMP 2.8X20MM 03.118.020

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$175.00
Rate for Payer: AlohaCare Medicare	$266.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$294.00
Rate for Payer: Hawaii Medical Service Association Medicare	$266.00
Rate for Payer: Hawaii Western Management Group Commercial	$332.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$266.00
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$266.00
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$266.00
Rate for Payer: Ohana Health Plan Medicare	$266.00
Rate for Payer: UnitedHealthcare Medicare	$266.00
Rate for Payer: University Health Alliance Commercial	$255.12

WIRE COMP 2.8X25MM 03.118.025

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$175.00
Rate for Payer: AlohaCare Medicare	$266.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$294.00
Rate for Payer: Hawaii Medical Service Association Medicare	$266.00
Rate for Payer: Hawaii Western Management Group Commercial	$332.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$266.00
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$266.00
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$266.00
Rate for Payer: Ohana Health Plan Medicare	$266.00
Rate for Payer: UnitedHealthcare Medicare	$266.00
Rate for Payer: University Health Alliance Commercial	$255.12

WIRE COMP 2.8X25MM 03.118.025

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

WIRE COMP 2.8X30MM 03.118.030

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$175.00
Rate for Payer: AlohaCare Medicare	$266.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$294.00
Rate for Payer: Hawaii Medical Service Association Medicare	$266.00
Rate for Payer: Hawaii Western Management Group Commercial	$332.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$266.00
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$266.00
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$266.00
Rate for Payer: Ohana Health Plan Medicare	$266.00
Rate for Payer: UnitedHealthcare Medicare	$266.00
Rate for Payer: University Health Alliance Commercial	$255.12

WIRE COMP 2.8X30MM 03.118.030

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

WIRE COMP 2.8X35MM 03.118.035

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

WIRE COMP 2.8X35MM 03.118.035

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$175.00
Rate for Payer: AlohaCare Medicare	$266.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$294.00
Rate for Payer: Hawaii Medical Service Association Medicare	$266.00
Rate for Payer: Hawaii Western Management Group Commercial	$332.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$266.00
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$266.00
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$266.00
Rate for Payer: Ohana Health Plan Medicare	$266.00
Rate for Payer: UnitedHealthcare Medicare	$266.00
Rate for Payer: University Health Alliance Commercial	$255.12

WIRE COMP 2.8X40MM 03.118.040

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

WIRE COMP 2.8X40MM 03.118.040

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$175.00
Rate for Payer: AlohaCare Medicare	$266.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$294.00
Rate for Payer: Hawaii Medical Service Association Medicare	$266.00
Rate for Payer: Hawaii Western Management Group Commercial	$332.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$266.00
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$266.00
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$266.00
Rate for Payer: Ohana Health Plan Medicare	$266.00
Rate for Payer: UnitedHealthcare Medicare	$266.00
Rate for Payer: University Health Alliance Commercial	$255.12

WIRE COMP 2.8X45MM 03.118.045

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

WIRE COMP 2.8X45MM 03.118.045

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$175.00
Rate for Payer: AlohaCare Medicare	$266.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$294.00
Rate for Payer: Hawaii Medical Service Association Medicare	$266.00
Rate for Payer: Hawaii Western Management Group Commercial	$332.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$266.00
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$266.00
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$266.00
Rate for Payer: Ohana Health Plan Medicare	$266.00
Rate for Payer: UnitedHealthcare Medicare	$266.00
Rate for Payer: University Health Alliance Commercial	$255.12

WIRE COMP 2.8X50MM 03.118.050

Facility

$350.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

Know your out-of-pocket cost for care.

All Charges