Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CATHETER COUDE SILICONE 3W 22F

Facility

$109.00

Hospital Revenue Code	272
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$105.73
Rate for Payer: AlohaCare Medicaid	$54.50
Rate for Payer: AlohaCare Medicare	$82.84
Rate for Payer: Cash Price	$65.40
Rate for Payer: Devoted Health Medicare	$91.56
Rate for Payer: Hawaii Medical Service Association Medicare	$82.84
Rate for Payer: Hawaii Western Management Group Commercial	$103.55
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Humana Medicare	$82.84
Rate for Payer: Kaiser Permanente Commercial	$98.10
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: Kaiser Permanente Medicare	$82.84
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: Ohana Health Plan Medicaid	$82.84
Rate for Payer: Ohana Health Plan Medicare	$82.84
Rate for Payer: UnitedHealthcare Medicare	$82.84
Rate for Payer: University Health Alliance Commercial	$79.45

CATHETER COUDE SILICONE 3W 22F

Facility

$109.00

Hospital Revenue Code	272
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$65.40
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Kaiser Permanente Commercial	$98.10
Rate for Payer: MDX Hawaii PPO	$105.73

CATHETER COUDE SILICONE 3W 24F

Facility

$92.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.00
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$69.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Devoted Health Medicare	$77.28
Rate for Payer: Hawaii Medical Service Association Medicare	$69.92
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$69.92
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$69.92
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$69.92
Rate for Payer: Ohana Health Plan Medicare	$69.92
Rate for Payer: UnitedHealthcare Medicare	$69.92
Rate for Payer: University Health Alliance Commercial	$67.06

CATHETER COUDE SILICONE 3W 24F

Facility

$92.00

Hospital Revenue Code	272
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: MDX Hawaii PPO	$89.24

CATHETER DIGITAL VIDEO

Facility

$5,665.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$2,832.50
Max. Negotiated Rate	$5,495.05
Rate for Payer: AlohaCare Medicaid	$2,832.50
Rate for Payer: AlohaCare Medicare	$4,305.40
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Devoted Health Medicare	$4,758.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4,305.40
Rate for Payer: Hawaii Western Management Group Commercial	$5,381.75
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Humana Medicare	$4,305.40
Rate for Payer: Kaiser Permanente Commercial	$5,098.50
Rate for Payer: Kaiser Permanente Medicaid	$2,889.15
Rate for Payer: Kaiser Permanente Medicare	$4,305.40
Rate for Payer: MDX Hawaii PPO	$5,495.05
Rate for Payer: Ohana Health Plan Medicaid	$4,305.40
Rate for Payer: Ohana Health Plan Medicare	$4,305.40
Rate for Payer: UnitedHealthcare Medicare	$4,305.40
Rate for Payer: University Health Alliance Commercial	$4,129.22

CATHETER DIGITAL VIDEO

Facility

$5,665.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$4,815.25
Max. Negotiated Rate	$5,495.05
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Kaiser Permanente Commercial	$5,098.50
Rate for Payer: MDX Hawaii PPO	$5,495.05

CATHETER OPEN 5FRX70CM

Facility

$78.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

CATHETER OPEN 5FRX70CM

Facility

$78.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: AlohaCare Medicare	$59.28
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$65.52
Rate for Payer: Hawaii Medical Service Association Medicare	$59.28
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$59.28
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$59.28
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$59.28
Rate for Payer: Ohana Health Plan Medicare	$59.28
Rate for Payer: UnitedHealthcare Medicare	$59.28
Rate for Payer: University Health Alliance Commercial	$56.85

CATHETER PUSHER

Facility

$198.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$118.80
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Kaiser Permanente Commercial	$178.20
Rate for Payer: MDX Hawaii PPO	$192.06

CATHETER PUSHER

Facility

$198.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$192.06
Rate for Payer: AlohaCare Medicaid	$99.00
Rate for Payer: AlohaCare Medicare	$150.48
Rate for Payer: Cash Price	$118.80
Rate for Payer: Devoted Health Medicare	$166.32
Rate for Payer: Hawaii Medical Service Association Medicare	$150.48
Rate for Payer: Hawaii Western Management Group Commercial	$188.10
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Humana Medicare	$150.48
Rate for Payer: Kaiser Permanente Commercial	$178.20
Rate for Payer: Kaiser Permanente Medicaid	$100.98
Rate for Payer: Kaiser Permanente Medicare	$150.48
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: Ohana Health Plan Medicaid	$150.48
Rate for Payer: Ohana Health Plan Medicare	$150.48
Rate for Payer: UnitedHealthcare Medicare	$150.48
Rate for Payer: University Health Alliance Commercial	$144.32

CATHETER SWAN NECK PD

Facility

$891.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$757.35
Max. Negotiated Rate	$864.27
Rate for Payer: Cash Price	$534.60
Rate for Payer: Health Management Network Commercial	$757.35
Rate for Payer: Kaiser Permanente Commercial	$801.90
Rate for Payer: MDX Hawaii PPO	$864.27

CATHETER SWAN NECK PD

Facility

$891.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$445.50
Max. Negotiated Rate	$864.27
Rate for Payer: AlohaCare Medicaid	$445.50
Rate for Payer: AlohaCare Medicare	$677.16
Rate for Payer: Cash Price	$534.60
Rate for Payer: Devoted Health Medicare	$748.44
Rate for Payer: Hawaii Medical Service Association Medicare	$677.16
Rate for Payer: Hawaii Western Management Group Commercial	$846.45
Rate for Payer: Health Management Network Commercial	$757.35
Rate for Payer: Humana Medicare	$677.16
Rate for Payer: Kaiser Permanente Commercial	$801.90
Rate for Payer: Kaiser Permanente Medicaid	$454.41
Rate for Payer: Kaiser Permanente Medicare	$677.16
Rate for Payer: MDX Hawaii PPO	$864.27
Rate for Payer: Ohana Health Plan Medicaid	$677.16
Rate for Payer: Ohana Health Plan Medicare	$677.16
Rate for Payer: UnitedHealthcare Medicare	$677.16
Rate for Payer: University Health Alliance Commercial	$649.45

CATHETER UROLOGY 5X65

Facility

$105.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85

CATHETER UROLOGY 5X65

Facility

$105.00

Service Code	HCPCS C1758
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$101.85
Rate for Payer: AlohaCare Medicaid	$52.50
Rate for Payer: AlohaCare Medicare	$79.80
Rate for Payer: Cash Price	$63.00
Rate for Payer: Devoted Health Medicare	$88.20
Rate for Payer: Hawaii Medical Service Association Medicare	$79.80
Rate for Payer: Hawaii Western Management Group Commercial	$99.75
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Humana Medicare	$79.80
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: Kaiser Permanente Medicare	$79.80
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: Ohana Health Plan Medicaid	$79.80
Rate for Payer: Ohana Health Plan Medicare	$79.80
Rate for Payer: UnitedHealthcare Medicare	$79.80
Rate for Payer: University Health Alliance Commercial	$76.53

CATH FOLEY 2WAY LF 14F

Facility

$72.00

Hospital Revenue Code	272
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

CATH FOLEY 2WAY LF 14F

Facility

$72.00

Hospital Revenue Code	272
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$54.72
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$60.48
Rate for Payer: Hawaii Medical Service Association Medicare	$54.72
Rate for Payer: Hawaii Western Management Group Commercial	$68.40
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$54.72
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$54.72
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$54.72
Rate for Payer: Ohana Health Plan Medicare	$54.72
Rate for Payer: UnitedHealthcare Medicare	$54.72
Rate for Payer: University Health Alliance Commercial	$52.48

CATH FOLEY 2WAY LF 16F

Facility

$70.00

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

CATH FOLEY 2WAY LF 16F

Facility

$70.00

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

CATH FOLEY 2WAY LF 18F

Facility

$72.00

Hospital Revenue Code	272
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$54.72
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$60.48
Rate for Payer: Hawaii Medical Service Association Medicare	$54.72
Rate for Payer: Hawaii Western Management Group Commercial	$68.40
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$54.72
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$54.72
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$54.72
Rate for Payer: Ohana Health Plan Medicare	$54.72
Rate for Payer: UnitedHealthcare Medicare	$54.72
Rate for Payer: University Health Alliance Commercial	$52.48

CATH FOLEY 2WAY LF 18F

Facility

$72.00

Hospital Revenue Code	272
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

CATH FOLEY COUDE 14F

Facility

$99.00

Hospital Revenue Code	272
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: MDX Hawaii PPO	$96.03

CATH FOLEY COUDE 14F

Facility

$99.00

Hospital Revenue Code	272
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$96.03
Rate for Payer: AlohaCare Medicaid	$49.50
Rate for Payer: AlohaCare Medicare	$75.24
Rate for Payer: Cash Price	$59.40
Rate for Payer: Devoted Health Medicare	$83.16
Rate for Payer: Hawaii Medical Service Association Medicare	$75.24
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Humana Medicare	$75.24
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: Kaiser Permanente Medicare	$75.24
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: Ohana Health Plan Medicaid	$75.24
Rate for Payer: Ohana Health Plan Medicare	$75.24
Rate for Payer: UnitedHealthcare Medicare	$75.24
Rate for Payer: University Health Alliance Commercial	$72.16

CATH FOLEY COUDE 16F

Facility

$99.00

Hospital Revenue Code	272
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: MDX Hawaii PPO	$96.03

CATH FOLEY COUDE 16F

Facility

$99.00

Hospital Revenue Code	272
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$96.03
Rate for Payer: AlohaCare Medicaid	$49.50
Rate for Payer: AlohaCare Medicare	$75.24
Rate for Payer: Cash Price	$59.40
Rate for Payer: Devoted Health Medicare	$83.16
Rate for Payer: Hawaii Medical Service Association Medicare	$75.24
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Humana Medicare	$75.24
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: Kaiser Permanente Medicare	$75.24
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: Ohana Health Plan Medicaid	$75.24
Rate for Payer: Ohana Health Plan Medicare	$75.24
Rate for Payer: UnitedHealthcare Medicare	$75.24
Rate for Payer: University Health Alliance Commercial	$72.16

CATH FOLEY COUDE 2WAY 18F

Facility

$66.00

Hospital Revenue Code	272
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$50.16
Rate for Payer: Cash Price	$39.60
Rate for Payer: Devoted Health Medicare	$55.44
Rate for Payer: Hawaii Medical Service Association Medicare	$50.16
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$50.16
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$50.16
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$50.16
Rate for Payer: Ohana Health Plan Medicare	$50.16
Rate for Payer: UnitedHealthcare Medicare	$50.16
Rate for Payer: University Health Alliance Commercial	$48.11

Know your out-of-pocket cost for care.

All Charges