Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CATH 30CC 20F 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

CATH 30CC 20F 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 22F 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 22F 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

CATH 30F 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 30F 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 30FX12 NEPH BALLOON

Facility

$929.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$464.50
Max. Negotiated Rate	$901.13
Rate for Payer: AlohaCare Medicaid	$464.50
Rate for Payer: AlohaCare Medicaid	$452.00
Rate for Payer: AlohaCare Medicare	$687.04
Rate for Payer: AlohaCare Medicare	$706.04
Rate for Payer: Cash Price	$542.40
Rate for Payer: Cash Price	$557.40
Rate for Payer: Devoted Health Medicare	$780.36
Rate for Payer: Devoted Health Medicare	$759.36
Rate for Payer: Hawaii Medical Service Association Medicare	$687.04
Rate for Payer: Hawaii Medical Service Association Medicare	$706.04
Rate for Payer: Hawaii Western Management Group Commercial	$858.80
Rate for Payer: Hawaii Western Management Group Commercial	$882.55
Rate for Payer: Health Management Network Commercial	$789.65
Rate for Payer: Health Management Network Commercial	$768.40
Rate for Payer: Humana Medicare	$706.04
Rate for Payer: Humana Medicare	$687.04
Rate for Payer: Kaiser Permanente Commercial	$813.60
Rate for Payer: Kaiser Permanente Commercial	$836.10
Rate for Payer: Kaiser Permanente Medicaid	$473.79
Rate for Payer: Kaiser Permanente Medicaid	$461.04
Rate for Payer: Kaiser Permanente Medicare	$687.04
Rate for Payer: Kaiser Permanente Medicare	$706.04
Rate for Payer: MDX Hawaii PPO	$876.88
Rate for Payer: MDX Hawaii PPO	$901.13
Rate for Payer: Ohana Health Plan Medicaid	$687.04
Rate for Payer: Ohana Health Plan Medicaid	$706.04
Rate for Payer: Ohana Health Plan Medicare	$687.04
Rate for Payer: Ohana Health Plan Medicare	$706.04
Rate for Payer: UnitedHealthcare Medicare	$706.04
Rate for Payer: UnitedHealthcare Medicare	$687.04
Rate for Payer: University Health Alliance Commercial	$677.15
Rate for Payer: University Health Alliance Commercial	$658.93

CATH 30FX12 NEPH BALLOON

Facility

$904.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$768.40
Max. Negotiated Rate	$876.88
Rate for Payer: Cash Price	$542.40
Rate for Payer: Cash Price	$557.40
Rate for Payer: Health Management Network Commercial	$768.40
Rate for Payer: Health Management Network Commercial	$789.65
Rate for Payer: Kaiser Permanente Commercial	$813.60
Rate for Payer: Kaiser Permanente Commercial	$836.10
Rate for Payer: MDX Hawaii PPO	$901.13
Rate for Payer: MDX Hawaii PPO	$876.88

CATH 3.5 UMBILICAL VEIN/ARTERY

Facility

$153.00

Service Code	HCPCS C1751
Hospital Revenue Code	278
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$76.50
Rate for Payer: AlohaCare Medicare	$116.28
Rate for Payer: Cash Price	$91.80
Rate for Payer: Devoted Health Medicare	$128.52
Rate for Payer: Hawaii Medical Service Association Medicare	$116.28
Rate for Payer: Hawaii Western Management Group Commercial	$107.10
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$116.28
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$116.28
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$116.28
Rate for Payer: Ohana Health Plan Medicare	$116.28
Rate for Payer: UnitedHealthcare Medicare	$116.28
Rate for Payer: University Health Alliance Commercial	$85.68

CATH 3.5 UMBILICAL VEIN/ARTERY

Facility

$153.00

Service Code	HCPCS C1751
Hospital Revenue Code	278
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$91.80
Rate for Payer: Hawaii Western Management Group Commercial	$107.10
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: University Health Alliance Commercial	$85.68

CATH 3F 40CM FOGARTY

Facility

$744.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$721.68
Rate for Payer: AlohaCare Medicaid	$372.00
Rate for Payer: AlohaCare Medicare	$565.44
Rate for Payer: Cash Price	$446.40
Rate for Payer: Devoted Health Medicare	$624.96
Rate for Payer: Hawaii Medical Service Association Medicare	$565.44
Rate for Payer: Hawaii Western Management Group Commercial	$706.80
Rate for Payer: Health Management Network Commercial	$632.40
Rate for Payer: Humana Medicare	$565.44
Rate for Payer: Kaiser Permanente Commercial	$669.60
Rate for Payer: Kaiser Permanente Medicaid	$379.44
Rate for Payer: Kaiser Permanente Medicare	$565.44
Rate for Payer: MDX Hawaii PPO	$721.68
Rate for Payer: Ohana Health Plan Medicaid	$565.44
Rate for Payer: Ohana Health Plan Medicare	$565.44
Rate for Payer: UnitedHealthcare Medicare	$565.44
Rate for Payer: University Health Alliance Commercial	$542.30

CATH 3F 40CM FOGARTY

Facility

$744.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$632.40
Max. Negotiated Rate	$721.68
Rate for Payer: Cash Price	$446.40
Rate for Payer: Health Management Network Commercial	$632.40
Rate for Payer: Kaiser Permanente Commercial	$669.60
Rate for Payer: MDX Hawaii PPO	$721.68

CATH 3W 22FR SIMPLASTIC

Facility

$136.00

Hospital Revenue Code	272
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92

CATH 3W 22FR SIMPLASTIC

Facility

$136.00

Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$103.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Devoted Health Medicare	$114.24
Rate for Payer: Hawaii Medical Service Association Medicare	$103.36
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$103.36
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$103.36
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$103.36
Rate for Payer: Ohana Health Plan Medicare	$103.36
Rate for Payer: UnitedHealthcare Medicare	$103.36
Rate for Payer: University Health Alliance Commercial	$99.13

CATH 3W 24FR SIMPLASTIC

Facility

$136.00

Hospital Revenue Code	272
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92

CATH 3W 24FR SIMPLASTIC

Facility

$136.00

Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$103.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Devoted Health Medicare	$114.24
Rate for Payer: Hawaii Medical Service Association Medicare	$103.36
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$103.36
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$103.36
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$103.36
Rate for Payer: Ohana Health Plan Medicare	$103.36
Rate for Payer: UnitedHealthcare Medicare	$103.36
Rate for Payer: University Health Alliance Commercial	$99.13

CATH 44-20MM ECRP SPHINCT

Facility

$1,452.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,234.20
Max. Negotiated Rate	$1,408.44
Rate for Payer: Cash Price	$871.20
Rate for Payer: Health Management Network Commercial	$1,234.20
Rate for Payer: Kaiser Permanente Commercial	$1,306.80
Rate for Payer: MDX Hawaii PPO	$1,408.44

CATH 44-20MM ECRP SPHINCT

Facility

$1,452.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$726.00
Max. Negotiated Rate	$1,408.44
Rate for Payer: AlohaCare Medicaid	$726.00
Rate for Payer: AlohaCare Medicare	$1,103.52
Rate for Payer: Cash Price	$871.20
Rate for Payer: Devoted Health Medicare	$1,219.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,103.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.40
Rate for Payer: Health Management Network Commercial	$1,234.20
Rate for Payer: Humana Medicare	$1,103.52
Rate for Payer: Kaiser Permanente Commercial	$1,306.80
Rate for Payer: Kaiser Permanente Medicaid	$740.52
Rate for Payer: Kaiser Permanente Medicare	$1,103.52
Rate for Payer: MDX Hawaii PPO	$1,408.44
Rate for Payer: Ohana Health Plan Medicaid	$1,103.52
Rate for Payer: Ohana Health Plan Medicare	$1,103.52
Rate for Payer: UnitedHealthcare Medicare	$1,103.52
Rate for Payer: University Health Alliance Commercial	$1,058.36

CATH 4X4 BDC HURRICANE

Facility

$898.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$763.30
Max. Negotiated Rate	$871.06
Rate for Payer: Cash Price	$538.80
Rate for Payer: Health Management Network Commercial	$763.30
Rate for Payer: Kaiser Permanente Commercial	$808.20
Rate for Payer: MDX Hawaii PPO	$871.06

CATH 4X4 BDC HURRICANE

Facility

$898.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$449.00
Max. Negotiated Rate	$871.06
Rate for Payer: AlohaCare Medicaid	$449.00
Rate for Payer: AlohaCare Medicare	$682.48
Rate for Payer: Cash Price	$538.80
Rate for Payer: Devoted Health Medicare	$754.32
Rate for Payer: Hawaii Medical Service Association Medicare	$682.48
Rate for Payer: Hawaii Western Management Group Commercial	$853.10
Rate for Payer: Health Management Network Commercial	$763.30
Rate for Payer: Humana Medicare	$682.48
Rate for Payer: Kaiser Permanente Commercial	$808.20
Rate for Payer: Kaiser Permanente Medicaid	$457.98
Rate for Payer: Kaiser Permanente Medicare	$682.48
Rate for Payer: MDX Hawaii PPO	$871.06
Rate for Payer: Ohana Health Plan Medicaid	$682.48
Rate for Payer: Ohana Health Plan Medicare	$682.48
Rate for Payer: UnitedHealthcare Medicare	$682.48
Rate for Payer: University Health Alliance Commercial	$654.55

CATH 5F IV UMBIL LUMEN

Facility

$146.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$87.60
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: MDX Hawaii PPO	$141.62

CATH 5F IV UMBIL LUMEN

Facility

$146.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$141.62
Rate for Payer: AlohaCare Medicaid	$73.00
Rate for Payer: AlohaCare Medicare	$110.96
Rate for Payer: Cash Price	$87.60
Rate for Payer: Devoted Health Medicare	$122.64
Rate for Payer: Hawaii Medical Service Association Medicare	$110.96
Rate for Payer: Hawaii Western Management Group Commercial	$138.70
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Humana Medicare	$110.96
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: Kaiser Permanente Medicare	$110.96
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: Ohana Health Plan Medicaid	$110.96
Rate for Payer: Ohana Health Plan Medicare	$110.96
Rate for Payer: UnitedHealthcare Medicare	$110.96
Rate for Payer: University Health Alliance Commercial	$106.42

CATH 5FRX40 KMP BEACON TIP

Facility

$110.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$66.00
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: MDX Hawaii PPO	$106.70

CATH 5FRX40 KMP BEACON TIP

Facility

$110.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$106.70
Rate for Payer: AlohaCare Medicaid	$55.00
Rate for Payer: AlohaCare Medicare	$83.60
Rate for Payer: Cash Price	$66.00
Rate for Payer: Devoted Health Medicare	$92.40
Rate for Payer: Hawaii Medical Service Association Medicare	$83.60
Rate for Payer: Hawaii Western Management Group Commercial	$104.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Humana Medicare	$83.60
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: Kaiser Permanente Medicare	$83.60
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: Ohana Health Plan Medicaid	$83.60
Rate for Payer: Ohana Health Plan Medicare	$83.60
Rate for Payer: UnitedHealthcare Medicare	$83.60
Rate for Payer: University Health Alliance Commercial	$80.18

CATH 5FRX65CM SOFT-VU FLUSH

Facility

$207.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$175.95
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$124.20
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: MDX Hawaii PPO	$200.79

Know your out-of-pocket cost for care.

All Charges