Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

WIRE COMP 2.8X50MM 03.118.050

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 2.8X55MM 03.118.055

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 2.8X55MM 03.118.055

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 2.8X60MM 03.118.060

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 2.8X60MM 03.118.060

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 DUAL FLEX NITINOL

Facility

$211.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$126.60
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: MDX Hawaii PPO	$204.67

WIRE DUAL FLEX NITINOL

Facility

$211.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$105.50
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$105.50
Rate for Payer: AlohaCare Medicare	$160.36
Rate for Payer: Cash Price	$126.60
Rate for Payer: Devoted Health Medicare	$177.24
Rate for Payer: Hawaii Medical Service Association Medicare	$160.36
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$160.36
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$160.36
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$160.36
Rate for Payer: Ohana Health Plan Medicare	$160.36
Rate for Payer: UnitedHealthcare Medicare	$160.36
Rate for Payer: University Health Alliance Commercial	$153.80

WIRE GUIDE 1.6MMX150MM 292.72

Facility

$204.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$197.88

WIRE GUIDE 1.6MMX150MM 292.72

Facility

$204.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$102.00
Rate for Payer: AlohaCare Medicare	$155.04
Rate for Payer: Cash Price	$122.40
Rate for Payer: Devoted Health Medicare	$171.36
Rate for Payer: Hawaii Medical Service Association Medicare	$155.04
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$155.04
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$155.04
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$155.04
Rate for Payer: Ohana Health Plan Medicare	$155.04
Rate for Payer: UnitedHealthcare Medicare	$155.04
Rate for Payer: University Health Alliance Commercial	$148.70

WIRE GUIDE 200CM SAVARY

Facility

$380.00

Hospital Revenue Code	272
Min. Negotiated Rate	$323.00
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$228.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Kaiser Permanente Commercial	$342.00
Rate for Payer: MDX Hawaii PPO	$368.60

WIRE GUIDE 200CM SAVARY

Facility

$380.00

Hospital Revenue Code	272
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$368.60
Rate for Payer: AlohaCare Medicaid	$190.00
Rate for Payer: AlohaCare Medicare	$288.80
Rate for Payer: Cash Price	$228.00
Rate for Payer: Devoted Health Medicare	$319.20
Rate for Payer: Hawaii Medical Service Association Medicare	$288.80
Rate for Payer: Hawaii Western Management Group Commercial	$361.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Humana Medicare	$288.80
Rate for Payer: Kaiser Permanente Commercial	$342.00
Rate for Payer: Kaiser Permanente Medicaid	$193.80
Rate for Payer: Kaiser Permanente Medicare	$288.80
Rate for Payer: MDX Hawaii PPO	$368.60
Rate for Payer: Ohana Health Plan Medicaid	$288.80
Rate for Payer: Ohana Health Plan Medicare	$288.80
Rate for Payer: UnitedHealthcare Medicare	$288.80
Rate for Payer: University Health Alliance Commercial	$276.98

WIRE GUIDE 2.5X300 03.120.026

Facility

$331.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$165.50
Max. Negotiated Rate	$321.07
Rate for Payer: AlohaCare Medicaid	$165.50
Rate for Payer: AlohaCare Medicare	$251.56
Rate for Payer: Cash Price	$198.60
Rate for Payer: Devoted Health Medicare	$278.04
Rate for Payer: Hawaii Medical Service Association Medicare	$251.56
Rate for Payer: Hawaii Western Management Group Commercial	$314.45
Rate for Payer: Health Management Network Commercial	$281.35
Rate for Payer: Humana Medicare	$251.56
Rate for Payer: Kaiser Permanente Commercial	$297.90
Rate for Payer: Kaiser Permanente Medicaid	$168.81
Rate for Payer: Kaiser Permanente Medicare	$251.56
Rate for Payer: MDX Hawaii PPO	$321.07
Rate for Payer: Ohana Health Plan Medicaid	$251.56
Rate for Payer: Ohana Health Plan Medicare	$251.56
Rate for Payer: UnitedHealthcare Medicare	$251.56
Rate for Payer: University Health Alliance Commercial	$241.27

WIRE GUIDE 2.5X300 03.120.026

Facility

$331.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$281.35
Max. Negotiated Rate	$321.07
Rate for Payer: Cash Price	$198.60
Rate for Payer: Health Management Network Commercial	$281.35
Rate for Payer: Kaiser Permanente Commercial	$297.90
Rate for Payer: MDX Hawaii PPO	$321.07

WIRE GUIDE 3X800 ST 1806-0080S

Facility

$751.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$375.50
Max. Negotiated Rate	$728.47
Rate for Payer: AlohaCare Medicaid	$375.50
Rate for Payer: AlohaCare Medicare	$570.76
Rate for Payer: Cash Price	$450.60
Rate for Payer: Devoted Health Medicare	$630.84
Rate for Payer: Hawaii Medical Service Association Medicare	$570.76
Rate for Payer: Hawaii Western Management Group Commercial	$713.45
Rate for Payer: Health Management Network Commercial	$638.35
Rate for Payer: Humana Medicare	$570.76
Rate for Payer: Kaiser Permanente Commercial	$675.90
Rate for Payer: Kaiser Permanente Medicaid	$383.01
Rate for Payer: Kaiser Permanente Medicare	$570.76
Rate for Payer: MDX Hawaii PPO	$728.47
Rate for Payer: Ohana Health Plan Medicaid	$570.76
Rate for Payer: Ohana Health Plan Medicare	$570.76
Rate for Payer: UnitedHealthcare Medicare	$570.76
Rate for Payer: University Health Alliance Commercial	$547.40

WIRE GUIDE 3X800 ST 1806-0080S

Facility

$751.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$638.35
Max. Negotiated Rate	$728.47
Rate for Payer: Cash Price	$450.60
Rate for Payer: Health Management Network Commercial	$638.35
Rate for Payer: Kaiser Permanente Commercial	$675.90
Rate for Payer: MDX Hawaii PPO	$728.47

WIRE GUIDE 3X800 ST 1806-0090S

Facility

$986.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$493.00
Max. Negotiated Rate	$956.42
Rate for Payer: AlohaCare Medicaid	$493.00
Rate for Payer: AlohaCare Medicare	$749.36
Rate for Payer: Cash Price	$591.60
Rate for Payer: Devoted Health Medicare	$828.24
Rate for Payer: Hawaii Medical Service Association Medicare	$749.36
Rate for Payer: Hawaii Western Management Group Commercial	$936.70
Rate for Payer: Health Management Network Commercial	$838.10
Rate for Payer: Humana Medicare	$749.36
Rate for Payer: Kaiser Permanente Commercial	$887.40
Rate for Payer: Kaiser Permanente Medicaid	$502.86
Rate for Payer: Kaiser Permanente Medicare	$749.36
Rate for Payer: MDX Hawaii PPO	$956.42
Rate for Payer: Ohana Health Plan Medicaid	$749.36
Rate for Payer: Ohana Health Plan Medicare	$749.36
Rate for Payer: UnitedHealthcare Medicare	$749.36
Rate for Payer: University Health Alliance Commercial	$718.70

WIRE GUIDE 3X800 ST 1806-0090S

Facility

$986.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$838.10
Max. Negotiated Rate	$956.42
Rate for Payer: Cash Price	$591.60
Rate for Payer: Health Management Network Commercial	$838.10
Rate for Payer: Kaiser Permanente Commercial	$887.40
Rate for Payer: MDX Hawaii PPO	$956.42

WIRE GUIDE W/TROCAR AR-8941K

Facility

$95.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$57.00
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: MDX Hawaii PPO	$92.15

WIRE GUIDE W/TROCAR AR-8941K

Facility

$95.00

Hospital Revenue Code	272
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$47.50
Rate for Payer: AlohaCare Medicare	$72.20
Rate for Payer: Cash Price	$57.00
Rate for Payer: Devoted Health Medicare	$79.80
Rate for Payer: Hawaii Medical Service Association Medicare	$72.20
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$72.20
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$72.20
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$72.20
Rate for Payer: Ohana Health Plan Medicare	$72.20
Rate for Payer: UnitedHealthcare Medicare	$72.20
Rate for Payer: University Health Alliance Commercial	$69.25

WIRE K 1.6MM AR-5050K-1

Facility

$230.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$115.00
Rate for Payer: AlohaCare Medicare	$174.80
Rate for Payer: Cash Price	$138.00
Rate for Payer: Devoted Health Medicare	$193.20
Rate for Payer: Hawaii Medical Service Association Medicare	$174.80
Rate for Payer: Hawaii Western Management Group Commercial	$218.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$174.80
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$174.80
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$174.80
Rate for Payer: Ohana Health Plan Medicare	$174.80
Rate for Payer: UnitedHealthcare Medicare	$174.80
Rate for Payer: University Health Alliance Commercial	$167.65

WIRE K 1.6MM AR-5050K-1

Facility

$230.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$138.00
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: MDX Hawaii PPO	$223.10

WIRE-K 1.6X150MM 292.16

Facility

$70.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$35.00
Rate for Payer: AlohaCare Medicare	$53.20
Rate for Payer: Cash Price	$42.00
Rate for Payer: Devoted Health Medicare	$58.80
Rate for Payer: Hawaii Medical Service Association Medicare	$53.20
Rate for Payer: Hawaii Western Management Group Commercial	$66.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Humana Medicare	$53.20
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: Kaiser Permanente Medicare	$53.20
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: Ohana Health Plan Medicaid	$53.20
Rate for Payer: Ohana Health Plan Medicare	$53.20
Rate for Payer: UnitedHealthcare Medicare	$53.20
Rate for Payer: University Health Alliance Commercial	$51.02

WIRE-K 1.6X150MM 292.16

Facility

$70.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

WIRE KIRSCHNER 2.0 290.20.280

Facility

$260.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: MDX Hawaii PPO	$252.20

WIRE KIRSCHNER 2.0 290.20.280

Facility

$260.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$252.20
Rate for Payer: AlohaCare Medicaid	$130.00
Rate for Payer: AlohaCare Medicare	$197.60
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$218.40
Rate for Payer: Hawaii Medical Service Association Medicare	$197.60
Rate for Payer: Hawaii Western Management Group Commercial	$247.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Humana Medicare	$197.60
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: Kaiser Permanente Medicaid	$132.60
Rate for Payer: Kaiser Permanente Medicare	$197.60
Rate for Payer: MDX Hawaii PPO	$252.20
Rate for Payer: Ohana Health Plan Medicaid	$197.60
Rate for Payer: Ohana Health Plan Medicare	$197.60
Rate for Payer: UnitedHealthcare Medicare	$197.60
Rate for Payer: University Health Alliance Commercial	$189.51

Know your out-of-pocket cost for care.

All Charges