Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CATH 5FRX65CM SOFT-VU FLUSH

Facility

$207.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$200.79
Rate for Payer: AlohaCare Medicaid	$103.50
Rate for Payer: AlohaCare Medicare	$157.32
Rate for Payer: Cash Price	$124.20
Rate for Payer: Devoted Health Medicare	$173.88
Rate for Payer: Hawaii Medical Service Association Medicare	$157.32
Rate for Payer: Hawaii Western Management Group Commercial	$196.65
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Humana Medicare	$157.32
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: Kaiser Permanente Medicaid	$105.57
Rate for Payer: Kaiser Permanente Medicare	$157.32
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: Ohana Health Plan Medicaid	$157.32
Rate for Payer: Ohana Health Plan Medicare	$157.32
Rate for Payer: UnitedHealthcare Medicare	$157.32
Rate for Payer: University Health Alliance Commercial	$150.88

CATH 5FRX65 SIM1 BEACON TIP

Facility

$130.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$98.80
Rate for Payer: Cash Price	$78.00
Rate for Payer: Devoted Health Medicare	$109.20
Rate for Payer: Hawaii Medical Service Association Medicare	$98.80
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$98.80
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$98.80
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$98.80
Rate for Payer: Ohana Health Plan Medicare	$98.80
Rate for Payer: UnitedHealthcare Medicare	$98.80
Rate for Payer: University Health Alliance Commercial	$94.76

CATH 5FRX65 SIM1 BEACON TIP

Facility

$130.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

CATH 5FRX65 SOFT-VU RIM

Facility

$130.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

CATH 5FRX65 SOFT-VU RIM

Facility

$130.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$98.80
Rate for Payer: Cash Price	$78.00
Rate for Payer: Devoted Health Medicare	$109.20
Rate for Payer: Hawaii Medical Service Association Medicare	$98.80
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$98.80
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$98.80
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$98.80
Rate for Payer: Ohana Health Plan Medicare	$98.80
Rate for Payer: UnitedHealthcare Medicare	$98.80
Rate for Payer: University Health Alliance Commercial	$94.76

CATH 6F FOLEY LUBRISIL

Facility

$138.00

Hospital Revenue Code	272
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$69.00
Rate for Payer: AlohaCare Medicare	$104.88
Rate for Payer: Cash Price	$82.80
Rate for Payer: Devoted Health Medicare	$115.92
Rate for Payer: Hawaii Medical Service Association Medicare	$104.88
Rate for Payer: Hawaii Western Management Group Commercial	$131.10
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$104.88
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$104.88
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$104.88
Rate for Payer: Ohana Health Plan Medicare	$104.88
Rate for Payer: UnitedHealthcare Medicare	$104.88
Rate for Payer: University Health Alliance Commercial	$100.59

CATH 6F FOLEY LUBRISIL

Facility

$138.00

Hospital Revenue Code	272
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: MDX Hawaii PPO	$133.86

CATH 6FR OPEN END URETERAL

Facility

$71.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$53.96
Rate for Payer: Cash Price	$42.60
Rate for Payer: Devoted Health Medicare	$59.64
Rate for Payer: Hawaii Medical Service Association Medicare	$53.96
Rate for Payer: Hawaii Western Management Group Commercial	$67.45
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$53.96
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$53.96
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$53.96
Rate for Payer: Ohana Health Plan Medicare	$53.96
Rate for Payer: UnitedHealthcare Medicare	$53.96
Rate for Payer: University Health Alliance Commercial	$51.75

CATH 6FR OPEN END URETERAL

Facility

$71.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

CATH 6X4 ECRPO BDC HURRICANE

Facility

$925.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$462.50
Max. Negotiated Rate	$897.25
Rate for Payer: AlohaCare Medicaid	$462.50
Rate for Payer: AlohaCare Medicare	$703.00
Rate for Payer: Cash Price	$555.00
Rate for Payer: Devoted Health Medicare	$777.00
Rate for Payer: Hawaii Medical Service Association Medicare	$703.00
Rate for Payer: Hawaii Western Management Group Commercial	$878.75
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: Humana Medicare	$703.00
Rate for Payer: Kaiser Permanente Commercial	$832.50
Rate for Payer: Kaiser Permanente Medicaid	$471.75
Rate for Payer: Kaiser Permanente Medicare	$703.00
Rate for Payer: MDX Hawaii PPO	$897.25
Rate for Payer: Ohana Health Plan Medicaid	$703.00
Rate for Payer: Ohana Health Plan Medicare	$703.00
Rate for Payer: UnitedHealthcare Medicare	$703.00
Rate for Payer: University Health Alliance Commercial	$674.23

CATH 6X4 ECRPO BDC HURRICANE

Facility

$925.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$786.25
Max. Negotiated Rate	$897.25
Rate for Payer: Cash Price	$555.00
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: Kaiser Permanente Commercial	$832.50
Rate for Payer: MDX Hawaii PPO	$897.25

CATH 7.5F SWAN GANZ

Facility

$360.00

Hospital Revenue Code	272
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	$342.00
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	$262.40

CATH 7.5F SWAN GANZ

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
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

CATH 8FR DRAINAGE APD

Facility

$400.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$388.00
Rate for Payer: AlohaCare Medicaid	$200.00
Rate for Payer: AlohaCare Medicare	$304.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Devoted Health Medicare	$336.00
Rate for Payer: Hawaii Medical Service Association Medicare	$304.00
Rate for Payer: Hawaii Western Management Group Commercial	$380.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Humana Medicare	$304.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: Kaiser Permanente Medicaid	$204.00
Rate for Payer: Kaiser Permanente Medicare	$304.00
Rate for Payer: MDX Hawaii PPO	$388.00
Rate for Payer: Ohana Health Plan Medicaid	$304.00
Rate for Payer: Ohana Health Plan Medicare	$304.00
Rate for Payer: UnitedHealthcare Medicare	$304.00
Rate for Payer: University Health Alliance Commercial	$291.56

CATH 8FR DRAINAGE APD

Facility

$400.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: MDX Hawaii PPO	$388.00

CATH 8X4 ERCP BDC HURRICANE

Facility

$925.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$462.50
Max. Negotiated Rate	$897.25
Rate for Payer: AlohaCare Medicaid	$462.50
Rate for Payer: AlohaCare Medicare	$703.00
Rate for Payer: Cash Price	$555.00
Rate for Payer: Devoted Health Medicare	$777.00
Rate for Payer: Hawaii Medical Service Association Medicare	$703.00
Rate for Payer: Hawaii Western Management Group Commercial	$878.75
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: Humana Medicare	$703.00
Rate for Payer: Kaiser Permanente Commercial	$832.50
Rate for Payer: Kaiser Permanente Medicaid	$471.75
Rate for Payer: Kaiser Permanente Medicare	$703.00
Rate for Payer: MDX Hawaii PPO	$897.25
Rate for Payer: Ohana Health Plan Medicaid	$703.00
Rate for Payer: Ohana Health Plan Medicare	$703.00
Rate for Payer: UnitedHealthcare Medicare	$703.00
Rate for Payer: University Health Alliance Commercial	$674.23

CATH 8X4 ERCP BDC HURRICANE

Facility

$925.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$786.25
Max. Negotiated Rate	$897.25
Rate for Payer: Cash Price	$555.00
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: Kaiser Permanente Commercial	$832.50
Rate for Payer: MDX Hawaii PPO	$897.25

CATH ADAPTER 8FR

Facility

$240.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: MDX Hawaii PPO	$232.80

CATH ADAPTER 8FR

Facility

$240.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$232.80
Rate for Payer: AlohaCare Medicaid	$120.00
Rate for Payer: AlohaCare Medicare	$182.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Devoted Health Medicare	$201.60
Rate for Payer: Hawaii Medical Service Association Medicare	$182.40
Rate for Payer: Hawaii Western Management Group Commercial	$228.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Humana Medicare	$182.40
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: Kaiser Permanente Medicare	$182.40
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: Ohana Health Plan Medicaid	$182.40
Rate for Payer: Ohana Health Plan Medicare	$182.40
Rate for Payer: UnitedHealthcare Medicare	$182.40
Rate for Payer: University Health Alliance Commercial	$174.94

CATH AND BURR ADVANCE DEVICE 1

Facility

$6,710.00

Service Code	HCPCS C1724
Hospital Revenue Code	272
Min. Negotiated Rate	$3,355.00
Max. Negotiated Rate	$6,508.70
Rate for Payer: AlohaCare Medicaid	$3,355.00
Rate for Payer: AlohaCare Medicare	$5,099.60
Rate for Payer: Cash Price	$4,026.00
Rate for Payer: Devoted Health Medicare	$5,636.40
Rate for Payer: Hawaii Medical Service Association Medicare	$5,099.60
Rate for Payer: Hawaii Western Management Group Commercial	$6,374.50
Rate for Payer: Health Management Network Commercial	$5,703.50
Rate for Payer: Humana Medicare	$5,099.60
Rate for Payer: Kaiser Permanente Commercial	$6,039.00
Rate for Payer: Kaiser Permanente Medicaid	$3,422.10
Rate for Payer: Kaiser Permanente Medicare	$5,099.60
Rate for Payer: MDX Hawaii PPO	$6,508.70
Rate for Payer: Ohana Health Plan Medicaid	$5,099.60
Rate for Payer: Ohana Health Plan Medicare	$5,099.60
Rate for Payer: UnitedHealthcare Medicare	$5,099.60
Rate for Payer: University Health Alliance Commercial	$4,890.92

CATH AND BURR ADVANCE DEVICE 1

Facility

$6,710.00

Service Code	HCPCS C1724
Hospital Revenue Code	272
Min. Negotiated Rate	$5,703.50
Max. Negotiated Rate	$6,508.70
Rate for Payer: Cash Price	$4,026.00
Rate for Payer: Health Management Network Commercial	$5,703.50
Rate for Payer: Kaiser Permanente Commercial	$6,039.00
Rate for Payer: MDX Hawaii PPO	$6,508.70

CATH AND BURR ADVANCE DEVICE 2

Facility

$6,692.00

Service Code	HCPCS C1724
Hospital Revenue Code	272
Min. Negotiated Rate	$5,688.20
Max. Negotiated Rate	$6,491.24
Rate for Payer: Cash Price	$4,015.20
Rate for Payer: Health Management Network Commercial	$5,688.20
Rate for Payer: Kaiser Permanente Commercial	$6,022.80
Rate for Payer: MDX Hawaii PPO	$6,491.24

CATH AND BURR ADVANCE DEVICE 2

Facility

$6,692.00

Service Code	HCPCS C1724
Hospital Revenue Code	272
Min. Negotiated Rate	$3,346.00
Max. Negotiated Rate	$6,491.24
Rate for Payer: AlohaCare Medicaid	$3,346.00
Rate for Payer: AlohaCare Medicare	$5,085.92
Rate for Payer: Cash Price	$4,015.20
Rate for Payer: Devoted Health Medicare	$5,621.28
Rate for Payer: Hawaii Medical Service Association Medicare	$5,085.92
Rate for Payer: Hawaii Western Management Group Commercial	$6,357.40
Rate for Payer: Health Management Network Commercial	$5,688.20
Rate for Payer: Humana Medicare	$5,085.92
Rate for Payer: Kaiser Permanente Commercial	$6,022.80
Rate for Payer: Kaiser Permanente Medicaid	$3,412.92
Rate for Payer: Kaiser Permanente Medicare	$5,085.92
Rate for Payer: MDX Hawaii PPO	$6,491.24
Rate for Payer: Ohana Health Plan Medicaid	$5,085.92
Rate for Payer: Ohana Health Plan Medicare	$5,085.92
Rate for Payer: UnitedHealthcare Medicare	$5,085.92
Rate for Payer: University Health Alliance Commercial	$4,877.80

CATH ARROW TRIPLE LM

Facility

$432.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$216.00
Max. Negotiated Rate	$419.04
Rate for Payer: AlohaCare Medicaid	$216.00
Rate for Payer: AlohaCare Medicare	$328.32
Rate for Payer: Cash Price	$259.20
Rate for Payer: Devoted Health Medicare	$362.88
Rate for Payer: Hawaii Medical Service Association Medicare	$328.32
Rate for Payer: Hawaii Western Management Group Commercial	$410.40
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Humana Medicare	$328.32
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: Kaiser Permanente Medicaid	$220.32
Rate for Payer: Kaiser Permanente Medicare	$328.32
Rate for Payer: MDX Hawaii PPO	$419.04
Rate for Payer: Ohana Health Plan Medicaid	$328.32
Rate for Payer: Ohana Health Plan Medicare	$328.32
Rate for Payer: UnitedHealthcare Medicare	$328.32
Rate for Payer: University Health Alliance Commercial	$314.88

CATH ARROW TRIPLE LM

Facility

$432.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$419.04
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: MDX Hawaii PPO	$419.04

Know your out-of-pocket cost for care.

All Charges