Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

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

CATH FOLEY COUDE 2WAY 20F

Facility

$98.00

Hospital Revenue Code	272
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$58.80
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: MDX Hawaii PPO	$95.06

CATH FOLEY COUDE 2WAY 20F

Facility

$98.00

Hospital Revenue Code	272
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$95.06
Rate for Payer: AlohaCare Medicaid	$49.00
Rate for Payer: AlohaCare Medicare	$74.48
Rate for Payer: Cash Price	$58.80
Rate for Payer: Devoted Health Medicare	$82.32
Rate for Payer: Hawaii Medical Service Association Medicare	$74.48
Rate for Payer: Hawaii Western Management Group Commercial	$93.10
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Humana Medicare	$74.48
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$49.98
Rate for Payer: Kaiser Permanente Medicare	$74.48
Rate for Payer: MDX Hawaii PPO	$95.06
Rate for Payer: Ohana Health Plan Medicaid	$74.48
Rate for Payer: Ohana Health Plan Medicare	$74.48
Rate for Payer: UnitedHealthcare Medicare	$74.48
Rate for Payer: University Health Alliance Commercial	$71.43

CATH FOLEY COUNCIL

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$57.00
Rate for Payer: AlohaCare Medicare	$86.64
Rate for Payer: Cash Price	$68.40
Rate for Payer: Devoted Health Medicare	$95.76
Rate for Payer: Hawaii Medical Service Association Medicare	$86.64
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$86.64
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$86.64
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$86.64
Rate for Payer: Ohana Health Plan Medicare	$86.64
Rate for Payer: UnitedHealthcare Medicare	$86.64
Rate for Payer: University Health Alliance Commercial	$83.09

CATH FOLEY COUNCIL

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: MDX Hawaii PPO	$110.58

CATH LATEX 2W 25FR 30CC

Facility

$82.00

Hospital Revenue Code	272
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$49.20
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

CATH LATEX 2W 25FR 30CC

Facility

$82.00

Hospital Revenue Code	272
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$79.54
Rate for Payer: AlohaCare Medicaid	$41.00
Rate for Payer: AlohaCare Medicare	$62.32
Rate for Payer: Cash Price	$49.20
Rate for Payer: Devoted Health Medicare	$68.88
Rate for Payer: Hawaii Medical Service Association Medicare	$62.32
Rate for Payer: Hawaii Western Management Group Commercial	$77.90
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Humana Medicare	$62.32
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: Kaiser Permanente Medicare	$62.32
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: Ohana Health Plan Medicaid	$62.32
Rate for Payer: Ohana Health Plan Medicare	$62.32
Rate for Payer: UnitedHealthcare Medicare	$62.32
Rate for Payer: University Health Alliance Commercial	$59.77

CATH MAHURKAR HP 3LUMEN

Facility

$509.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$432.65
Max. Negotiated Rate	$493.73
Rate for Payer: Cash Price	$305.40
Rate for Payer: Health Management Network Commercial	$432.65
Rate for Payer: Kaiser Permanente Commercial	$458.10
Rate for Payer: MDX Hawaii PPO	$493.73

CATH MAHURKAR HP 3LUMEN

Facility

$509.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$254.50
Max. Negotiated Rate	$493.73
Rate for Payer: AlohaCare Medicaid	$254.50
Rate for Payer: AlohaCare Medicare	$386.84
Rate for Payer: Cash Price	$305.40
Rate for Payer: Devoted Health Medicare	$427.56
Rate for Payer: Hawaii Medical Service Association Medicare	$386.84
Rate for Payer: Hawaii Western Management Group Commercial	$483.55
Rate for Payer: Health Management Network Commercial	$432.65
Rate for Payer: Humana Medicare	$386.84
Rate for Payer: Kaiser Permanente Commercial	$458.10
Rate for Payer: Kaiser Permanente Medicaid	$259.59
Rate for Payer: Kaiser Permanente Medicare	$386.84
Rate for Payer: MDX Hawaii PPO	$493.73
Rate for Payer: Ohana Health Plan Medicaid	$386.84
Rate for Payer: Ohana Health Plan Medicare	$386.84
Rate for Payer: UnitedHealthcare Medicare	$386.84
Rate for Payer: University Health Alliance Commercial	$371.01

CATH NASAL CATH EPISTAT

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$326.50
Max. Negotiated Rate	$633.41
Rate for Payer: AlohaCare Medicaid	$326.50
Rate for Payer: AlohaCare Medicare	$496.28
Rate for Payer: Cash Price	$391.80
Rate for Payer: Devoted Health Medicare	$548.52
Rate for Payer: Hawaii Medical Service Association Medicare	$496.28
Rate for Payer: Hawaii Western Management Group Commercial	$620.35
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Humana Medicare	$496.28
Rate for Payer: Kaiser Permanente Commercial	$587.70
Rate for Payer: Kaiser Permanente Medicaid	$333.03
Rate for Payer: Kaiser Permanente Medicare	$496.28
Rate for Payer: MDX Hawaii PPO	$633.41
Rate for Payer: Ohana Health Plan Medicaid	$496.28
Rate for Payer: Ohana Health Plan Medicare	$496.28
Rate for Payer: UnitedHealthcare Medicare	$496.28
Rate for Payer: University Health Alliance Commercial	$475.97

CATH NASAL CATH EPISTAT

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$555.05
Max. Negotiated Rate	$633.41
Rate for Payer: Cash Price	$391.80
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Kaiser Permanente Commercial	$587.70
Rate for Payer: MDX Hawaii PPO	$633.41

CATH PALIN RIGHT #8888145063P

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,425.90
Rate for Payer: AlohaCare Medicaid	$735.00
Rate for Payer: AlohaCare Medicare	$1,117.20
Rate for Payer: Cash Price	$882.00
Rate for Payer: Devoted Health Medicare	$1,234.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,117.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Humana Medicare	$1,117.20
Rate for Payer: Kaiser Permanente Commercial	$1,323.00
Rate for Payer: Kaiser Permanente Medicaid	$749.70
Rate for Payer: Kaiser Permanente Medicare	$1,117.20
Rate for Payer: MDX Hawaii PPO	$1,425.90
Rate for Payer: Ohana Health Plan Medicaid	$1,117.20
Rate for Payer: Ohana Health Plan Medicare	$1,117.20
Rate for Payer: UnitedHealthcare Medicare	$1,117.20
Rate for Payer: University Health Alliance Commercial	$1,071.48

CATH PALIN RIGHT #8888145063P

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Kaiser Permanente Commercial	$1,323.00
Rate for Payer: MDX Hawaii PPO	$1,425.90

CATH PD TITANI EXT 8888415612

Facility

$391.00

Hospital Revenue Code	272
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$379.27
Rate for Payer: AlohaCare Medicaid	$195.50
Rate for Payer: AlohaCare Medicare	$297.16
Rate for Payer: Cash Price	$234.60
Rate for Payer: Devoted Health Medicare	$328.44
Rate for Payer: Hawaii Medical Service Association Medicare	$297.16
Rate for Payer: Hawaii Western Management Group Commercial	$371.45
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: Humana Medicare	$297.16
Rate for Payer: Kaiser Permanente Commercial	$351.90
Rate for Payer: Kaiser Permanente Medicaid	$199.41
Rate for Payer: Kaiser Permanente Medicare	$297.16
Rate for Payer: MDX Hawaii PPO	$379.27
Rate for Payer: Ohana Health Plan Medicaid	$297.16
Rate for Payer: Ohana Health Plan Medicare	$297.16
Rate for Payer: UnitedHealthcare Medicare	$297.16
Rate for Payer: University Health Alliance Commercial	$285.00

CATH PD TITANI EXT 8888415612

Facility

$391.00

Hospital Revenue Code	272
Min. Negotiated Rate	$332.35
Max. Negotiated Rate	$379.27
Rate for Payer: Cash Price	$234.60
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: Kaiser Permanente Commercial	$351.90
Rate for Payer: MDX Hawaii PPO	$379.27

CATH PERITONEAL 8888414011

Facility

$1,680.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$1,629.60
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: MDX Hawaii PPO	$1,629.60

CATH PERITONEAL 8888414011

Facility

$1,680.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,629.60
Rate for Payer: AlohaCare Medicaid	$840.00
Rate for Payer: AlohaCare Medicare	$1,276.80
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Devoted Health Medicare	$1,411.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,276.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Humana Medicare	$1,276.80
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: Kaiser Permanente Medicaid	$856.80
Rate for Payer: Kaiser Permanente Medicare	$1,276.80
Rate for Payer: MDX Hawaii PPO	$1,629.60
Rate for Payer: Ohana Health Plan Medicaid	$1,276.80
Rate for Payer: Ohana Health Plan Medicare	$1,276.80
Rate for Payer: UnitedHealthcare Medicare	$1,276.80
Rate for Payer: University Health Alliance Commercial	$1,224.55

CATH PNEUMOTHORAX PIGTAIL

Facility

$933.00

Hospital Revenue Code	272
Min. Negotiated Rate	$793.05
Max. Negotiated Rate	$905.01
Rate for Payer: Cash Price	$559.80
Rate for Payer: Health Management Network Commercial	$793.05
Rate for Payer: Kaiser Permanente Commercial	$839.70
Rate for Payer: MDX Hawaii PPO	$905.01

CATH PNEUMOTHORAX PIGTAIL

Facility

$933.00

Hospital Revenue Code	272
Min. Negotiated Rate	$466.50
Max. Negotiated Rate	$905.01
Rate for Payer: AlohaCare Medicaid	$466.50
Rate for Payer: AlohaCare Medicare	$709.08
Rate for Payer: Cash Price	$559.80
Rate for Payer: Devoted Health Medicare	$783.72
Rate for Payer: Hawaii Medical Service Association Medicare	$709.08
Rate for Payer: Hawaii Western Management Group Commercial	$886.35
Rate for Payer: Health Management Network Commercial	$793.05
Rate for Payer: Humana Medicare	$709.08
Rate for Payer: Kaiser Permanente Commercial	$839.70
Rate for Payer: Kaiser Permanente Medicaid	$475.83
Rate for Payer: Kaiser Permanente Medicare	$709.08
Rate for Payer: MDX Hawaii PPO	$905.01
Rate for Payer: Ohana Health Plan Medicaid	$709.08
Rate for Payer: Ohana Health Plan Medicare	$709.08
Rate for Payer: UnitedHealthcare Medicare	$709.08
Rate for Payer: University Health Alliance Commercial	$680.06

CATH RED 18FRX5CC FOLEY

Facility

$118.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$89.68
Rate for Payer: Cash Price	$70.80
Rate for Payer: Devoted Health Medicare	$99.12
Rate for Payer: Hawaii Medical Service Association Medicare	$89.68
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$89.68
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$89.68
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$89.68
Rate for Payer: Ohana Health Plan Medicare	$89.68
Rate for Payer: UnitedHealthcare Medicare	$89.68
Rate for Payer: University Health Alliance Commercial	$86.01

CATH RED 18FRX5CC FOLEY

Facility

$118.00

Hospital Revenue Code	272
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

CATH SUPRAPUBC 14FR SET G26648

Facility

$304.00

Service Code	HCPCS C2627
Hospital Revenue Code	272
Min. Negotiated Rate	$258.40
Max. Negotiated Rate	$294.88
Rate for Payer: Cash Price	$182.40
Rate for Payer: Health Management Network Commercial	$258.40
Rate for Payer: Kaiser Permanente Commercial	$273.60
Rate for Payer: MDX Hawaii PPO	$294.88

CATH SUPRAPUBC 14FR SET G26648

Facility

$304.00

Service Code	HCPCS C2627
Hospital Revenue Code	272
Min. Negotiated Rate	$152.00
Max. Negotiated Rate	$294.88
Rate for Payer: AlohaCare Medicaid	$152.00
Rate for Payer: AlohaCare Medicare	$231.04
Rate for Payer: Cash Price	$182.40
Rate for Payer: Devoted Health Medicare	$255.36
Rate for Payer: Hawaii Medical Service Association Medicare	$231.04
Rate for Payer: Hawaii Western Management Group Commercial	$288.80
Rate for Payer: Health Management Network Commercial	$258.40
Rate for Payer: Humana Medicare	$231.04
Rate for Payer: Kaiser Permanente Commercial	$273.60
Rate for Payer: Kaiser Permanente Medicaid	$155.04
Rate for Payer: Kaiser Permanente Medicare	$231.04
Rate for Payer: MDX Hawaii PPO	$294.88
Rate for Payer: Ohana Health Plan Medicaid	$231.04
Rate for Payer: Ohana Health Plan Medicare	$231.04
Rate for Payer: UnitedHealthcare Medicare	$231.04
Rate for Payer: University Health Alliance Commercial	$221.59

CATH SUPRAPUBC 16FR SET

Facility

$349.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$174.50
Max. Negotiated Rate	$338.53
Rate for Payer: AlohaCare Medicaid	$174.50
Rate for Payer: AlohaCare Medicare	$265.24
Rate for Payer: Cash Price	$209.40
Rate for Payer: Devoted Health Medicare	$293.16
Rate for Payer: Hawaii Medical Service Association Medicare	$265.24
Rate for Payer: Hawaii Western Management Group Commercial	$331.55
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: Humana Medicare	$265.24
Rate for Payer: Kaiser Permanente Commercial	$314.10
Rate for Payer: Kaiser Permanente Medicaid	$177.99
Rate for Payer: Kaiser Permanente Medicare	$265.24
Rate for Payer: MDX Hawaii PPO	$338.53
Rate for Payer: Ohana Health Plan Medicaid	$265.24
Rate for Payer: Ohana Health Plan Medicare	$265.24
Rate for Payer: UnitedHealthcare Medicare	$265.24
Rate for Payer: University Health Alliance Commercial	$254.39

CATH SUPRAPUBC 16FR SET

Facility

$349.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$296.65
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$209.40
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: Kaiser Permanente Commercial	$314.10
Rate for Payer: MDX Hawaii PPO	$338.53

Know your out-of-pocket cost for care.

All Charges