Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CATH ENT DILATION 7X20

Facility

$3,300.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$2,508.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$2,772.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,508.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,135.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$2,508.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$2,508.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$2,508.00
Rate for Payer: Ohana Health Plan Medicare	$2,508.00
Rate for Payer: UnitedHealthcare Medicare	$2,508.00
Rate for Payer: University Health Alliance Commercial	$2,405.37

CATH ERCP 5X20 SPHINCTEROTOME

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 ERCP 5X20 SPHINCTEROTOME

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 ERCP ELECTRO .64X260

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 ERCP ELECTRO .64X260

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 ET DILATION TUBE

Facility

$4,600.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$2,300.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: AlohaCare Medicaid	$2,300.00
Rate for Payer: AlohaCare Medicare	$3,496.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Devoted Health Medicare	$3,864.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,496.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,370.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Humana Medicare	$3,496.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: Kaiser Permanente Medicaid	$2,346.00
Rate for Payer: Kaiser Permanente Medicare	$3,496.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: Ohana Health Plan Medicaid	$3,496.00
Rate for Payer: Ohana Health Plan Medicare	$3,496.00
Rate for Payer: UnitedHealthcare Medicare	$3,496.00
Rate for Payer: University Health Alliance Commercial	$3,352.94

CATH ET DILATION TUBE

Facility

$4,600.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$3,910.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: MDX Hawaii PPO	$4,462.00

CATHETER 12FR 4CM BDC

Facility

$829.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$704.65
Max. Negotiated Rate	$804.13
Rate for Payer: Cash Price	$497.40
Rate for Payer: Health Management Network Commercial	$704.65
Rate for Payer: Kaiser Permanente Commercial	$746.10
Rate for Payer: MDX Hawaii PPO	$804.13

CATHETER 12FR 4CM BDC

Facility

$829.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$414.50
Max. Negotiated Rate	$804.13
Rate for Payer: AlohaCare Medicaid	$414.50
Rate for Payer: AlohaCare Medicare	$630.04
Rate for Payer: Cash Price	$497.40
Rate for Payer: Devoted Health Medicare	$696.36
Rate for Payer: Hawaii Medical Service Association Medicare	$630.04
Rate for Payer: Hawaii Western Management Group Commercial	$787.55
Rate for Payer: Health Management Network Commercial	$704.65
Rate for Payer: Humana Medicare	$630.04
Rate for Payer: Kaiser Permanente Commercial	$746.10
Rate for Payer: Kaiser Permanente Medicaid	$422.79
Rate for Payer: Kaiser Permanente Medicare	$630.04
Rate for Payer: MDX Hawaii PPO	$804.13
Rate for Payer: Ohana Health Plan Medicaid	$630.04
Rate for Payer: Ohana Health Plan Medicare	$630.04
Rate for Payer: UnitedHealthcare Medicare	$630.04
Rate for Payer: University Health Alliance Commercial	$604.26

CATHETER 20G ARTERIAL LINE SET

Facility

$79.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.50
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$39.50
Rate for Payer: AlohaCare Medicare	$60.04
Rate for Payer: Cash Price	$47.40
Rate for Payer: Devoted Health Medicare	$66.36
Rate for Payer: Hawaii Medical Service Association Medicare	$60.04
Rate for Payer: Hawaii Western Management Group Commercial	$75.05
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$60.04
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$60.04
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$60.04
Rate for Payer: Ohana Health Plan Medicare	$60.04
Rate for Payer: UnitedHealthcare Medicare	$60.04
Rate for Payer: University Health Alliance Commercial	$57.58

CATHETER 20G ARTERIAL LINE SET

Facility

$79.00

Hospital Revenue Code	272
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: MDX Hawaii PPO	$76.63

CATHETER 4FR GLO-TIP ERCP

Facility

$288.00

Hospital Revenue Code	272
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$279.36
Rate for Payer: AlohaCare Medicaid	$144.00
Rate for Payer: AlohaCare Medicare	$218.88
Rate for Payer: Cash Price	$172.80
Rate for Payer: Devoted Health Medicare	$241.92
Rate for Payer: Hawaii Medical Service Association Medicare	$218.88
Rate for Payer: Hawaii Western Management Group Commercial	$273.60
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Humana Medicare	$218.88
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: Kaiser Permanente Medicaid	$146.88
Rate for Payer: Kaiser Permanente Medicare	$218.88
Rate for Payer: MDX Hawaii PPO	$279.36
Rate for Payer: Ohana Health Plan Medicaid	$218.88
Rate for Payer: Ohana Health Plan Medicare	$218.88
Rate for Payer: UnitedHealthcare Medicare	$218.88
Rate for Payer: University Health Alliance Commercial	$209.92

CATHETER 4FR GLO-TIP ERCP

Facility

$288.00

Hospital Revenue Code	272
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: MDX Hawaii PPO	$279.36

CATHETER 4FRX55 POWERPICC

Facility

$2,270.00

Service Code	HCPCS C1751
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.20
Max. Negotiated Rate	$2,201.90
Rate for Payer: Cash Price	$1,362.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,589.00
Rate for Payer: Health Management Network Commercial	$1,929.50
Rate for Payer: Kaiser Permanente Commercial	$2,043.00
Rate for Payer: MDX Hawaii PPO	$2,201.90
Rate for Payer: University Health Alliance Commercial	$1,271.20

CATHETER 4FRX55 POWERPICC

Facility

$2,270.00

Service Code	HCPCS C1751
Hospital Revenue Code	278
Min. Negotiated Rate	$1,135.00
Max. Negotiated Rate	$2,201.90
Rate for Payer: AlohaCare Medicaid	$1,135.00
Rate for Payer: AlohaCare Medicare	$1,725.20
Rate for Payer: Cash Price	$1,362.00
Rate for Payer: Devoted Health Medicare	$1,906.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,725.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,589.00
Rate for Payer: Health Management Network Commercial	$1,929.50
Rate for Payer: Humana Medicare	$1,725.20
Rate for Payer: Kaiser Permanente Commercial	$2,043.00
Rate for Payer: Kaiser Permanente Medicaid	$1,157.70
Rate for Payer: Kaiser Permanente Medicare	$1,725.20
Rate for Payer: MDX Hawaii PPO	$2,201.90
Rate for Payer: Ohana Health Plan Medicaid	$1,725.20
Rate for Payer: Ohana Health Plan Medicare	$1,725.20
Rate for Payer: UnitedHealthcare Medicare	$1,725.20
Rate for Payer: University Health Alliance Commercial	$1,271.20

CATHETER 5FR POWERPICC TRIPLE

Facility

$2,774.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$1,387.00
Max. Negotiated Rate	$2,690.78
Rate for Payer: AlohaCare Medicaid	$1,387.00
Rate for Payer: AlohaCare Medicare	$2,108.24
Rate for Payer: Cash Price	$1,664.40
Rate for Payer: Devoted Health Medicare	$2,330.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,108.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,635.30
Rate for Payer: Health Management Network Commercial	$2,357.90
Rate for Payer: Humana Medicare	$2,108.24
Rate for Payer: Kaiser Permanente Commercial	$2,496.60
Rate for Payer: Kaiser Permanente Medicaid	$1,414.74
Rate for Payer: Kaiser Permanente Medicare	$2,108.24
Rate for Payer: MDX Hawaii PPO	$2,690.78
Rate for Payer: Ohana Health Plan Medicaid	$2,108.24
Rate for Payer: Ohana Health Plan Medicare	$2,108.24
Rate for Payer: UnitedHealthcare Medicare	$2,108.24
Rate for Payer: University Health Alliance Commercial	$2,021.97

CATHETER 5FR POWERPICC TRIPLE

Facility

$2,774.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$2,357.90
Max. Negotiated Rate	$2,690.78
Rate for Payer: Cash Price	$1,664.40
Rate for Payer: Health Management Network Commercial	$2,357.90
Rate for Payer: Kaiser Permanente Commercial	$2,496.60
Rate for Payer: MDX Hawaii PPO	$2,690.78

CATHETER BALLOON #Q50-65P

Facility

$1,740.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$1,479.00
Max. Negotiated Rate	$1,687.80
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Health Management Network Commercial	$1,479.00
Rate for Payer: Kaiser Permanente Commercial	$1,566.00
Rate for Payer: MDX Hawaii PPO	$1,687.80

CATHETER BALLOON #Q50-65P

Facility

$1,740.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$870.00
Max. Negotiated Rate	$1,687.80
Rate for Payer: AlohaCare Medicaid	$870.00
Rate for Payer: AlohaCare Medicare	$1,322.40
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Devoted Health Medicare	$1,461.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,322.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,653.00
Rate for Payer: Health Management Network Commercial	$1,479.00
Rate for Payer: Humana Medicare	$1,322.40
Rate for Payer: Kaiser Permanente Commercial	$1,566.00
Rate for Payer: Kaiser Permanente Medicaid	$887.40
Rate for Payer: Kaiser Permanente Medicare	$1,322.40
Rate for Payer: MDX Hawaii PPO	$1,687.80
Rate for Payer: Ohana Health Plan Medicaid	$1,322.40
Rate for Payer: Ohana Health Plan Medicare	$1,322.40
Rate for Payer: UnitedHealthcare Medicare	$1,322.40
Rate for Payer: University Health Alliance Commercial	$1,268.29

CATHETER BLN DILAT SR-4525-BC

Facility

$1,397.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$698.50
Max. Negotiated Rate	$1,355.09
Rate for Payer: AlohaCare Medicaid	$698.50
Rate for Payer: AlohaCare Medicare	$1,061.72
Rate for Payer: Cash Price	$838.20
Rate for Payer: Devoted Health Medicare	$1,173.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,061.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,327.15
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Humana Medicare	$1,061.72
Rate for Payer: Kaiser Permanente Commercial	$1,257.30
Rate for Payer: Kaiser Permanente Medicaid	$712.47
Rate for Payer: Kaiser Permanente Medicare	$1,061.72
Rate for Payer: MDX Hawaii PPO	$1,355.09
Rate for Payer: Ohana Health Plan Medicaid	$1,061.72
Rate for Payer: Ohana Health Plan Medicare	$1,061.72
Rate for Payer: UnitedHealthcare Medicare	$1,061.72
Rate for Payer: University Health Alliance Commercial	$1,018.27

CATHETER BLN DILAT SR-4525-BC

Facility

$1,397.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$1,187.45
Max. Negotiated Rate	$1,355.09
Rate for Payer: Cash Price	$838.20
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Kaiser Permanente Commercial	$1,257.30
Rate for Payer: MDX Hawaii PPO	$1,355.09

CATHETER C1 TIP 65CM

Facility

$396.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$237.60
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: MDX Hawaii PPO	$384.12

CATHETER C1 TIP 65CM

Facility

$396.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$384.12
Rate for Payer: AlohaCare Medicaid	$198.00
Rate for Payer: AlohaCare Medicare	$300.96
Rate for Payer: Cash Price	$237.60
Rate for Payer: Devoted Health Medicare	$332.64
Rate for Payer: Hawaii Medical Service Association Medicare	$300.96
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Humana Medicare	$300.96
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: Kaiser Permanente Medicare	$300.96
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: Ohana Health Plan Medicaid	$300.96
Rate for Payer: Ohana Health Plan Medicare	$300.96
Rate for Payer: UnitedHealthcare Medicare	$300.96
Rate for Payer: University Health Alliance Commercial	$288.64

CATHETER CENTESIS DRAINER 5X19

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$111.72
Rate for Payer: Cash Price	$88.20
Rate for Payer: Devoted Health Medicare	$123.48
Rate for Payer: Hawaii Medical Service Association Medicare	$111.72
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$111.72
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$111.72
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$111.72
Rate for Payer: Ohana Health Plan Medicare	$111.72
Rate for Payer: UnitedHealthcare Medicare	$111.72
Rate for Payer: University Health Alliance Commercial	$107.15

CATHETER CENTESIS DRAINER 5X19

Facility

$147.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

Know your out-of-pocket cost for care.

All Charges