Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CATH UMBIL 5FR

Facility

$74.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$71.78
Rate for Payer: AlohaCare Medicaid	$37.00
Rate for Payer: AlohaCare Medicare	$56.24
Rate for Payer: Cash Price	$44.40
Rate for Payer: Devoted Health Medicare	$62.16
Rate for Payer: Hawaii Medical Service Association Medicare	$56.24
Rate for Payer: Hawaii Western Management Group Commercial	$70.30
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: Humana Medicare	$56.24
Rate for Payer: Kaiser Permanente Commercial	$66.60
Rate for Payer: Kaiser Permanente Medicaid	$37.74
Rate for Payer: Kaiser Permanente Medicare	$56.24
Rate for Payer: MDX Hawaii PPO	$71.78
Rate for Payer: Ohana Health Plan Medicaid	$56.24
Rate for Payer: Ohana Health Plan Medicare	$56.24
Rate for Payer: UnitedHealthcare Medicare	$56.24
Rate for Payer: University Health Alliance Commercial	$53.94

CATH UMBIL 5FR

Facility

$74.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$44.40
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: Kaiser Permanente Commercial	$66.60
Rate for Payer: MDX Hawaii PPO	$71.78

CATH UMBILICAL 3.5FR

Facility

$77.00

Service Code	HCPCS C1751
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 UMBILICAL 3.5FR

Facility

$77.00

Service Code	HCPCS C1751
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 UROMAX ULTRA BALLOON

Facility

$919.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$459.50
Max. Negotiated Rate	$891.43
Rate for Payer: AlohaCare Medicaid	$459.50
Rate for Payer: AlohaCare Medicare	$698.44
Rate for Payer: Cash Price	$551.40
Rate for Payer: Devoted Health Medicare	$771.96
Rate for Payer: Hawaii Medical Service Association Medicare	$698.44
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Humana Medicare	$698.44
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: Kaiser Permanente Medicare	$698.44
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: Ohana Health Plan Medicaid	$698.44
Rate for Payer: Ohana Health Plan Medicare	$698.44
Rate for Payer: UnitedHealthcare Medicare	$698.44
Rate for Payer: University Health Alliance Commercial	$669.86

CATH UROMAX ULTRA BALLOON

Facility

$919.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: MDX Hawaii PPO	$891.43

CATH VIDEO CHOLEDOCHOSCOPE

Facility

$5,500.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$2,750.00
Max. Negotiated Rate	$5,335.00
Rate for Payer: AlohaCare Medicaid	$2,750.00
Rate for Payer: AlohaCare Medicare	$4,180.00
Rate for Payer: Cash Price	$3,300.00
Rate for Payer: Devoted Health Medicare	$4,620.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,180.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,225.00
Rate for Payer: Health Management Network Commercial	$4,675.00
Rate for Payer: Humana Medicare	$4,180.00
Rate for Payer: Kaiser Permanente Commercial	$4,950.00
Rate for Payer: Kaiser Permanente Medicaid	$2,805.00
Rate for Payer: Kaiser Permanente Medicare	$4,180.00
Rate for Payer: MDX Hawaii PPO	$5,335.00
Rate for Payer: Ohana Health Plan Medicaid	$4,180.00
Rate for Payer: Ohana Health Plan Medicare	$4,180.00
Rate for Payer: UnitedHealthcare Medicare	$4,180.00
Rate for Payer: University Health Alliance Commercial	$4,008.95

CATH VIDEO CHOLEDOCHOSCOPE

Facility

$5,500.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$4,675.00
Max. Negotiated Rate	$5,335.00
Rate for Payer: Cash Price	$3,300.00
Rate for Payer: Health Management Network Commercial	$4,675.00
Rate for Payer: Kaiser Permanente Commercial	$4,950.00
Rate for Payer: MDX Hawaii PPO	$5,335.00

CAUT ELECTROD 5X58 FULGURATING

Facility

$286.00

Hospital Revenue Code	272
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$277.42
Rate for Payer: AlohaCare Medicaid	$143.00
Rate for Payer: AlohaCare Medicare	$217.36
Rate for Payer: Cash Price	$171.60
Rate for Payer: Devoted Health Medicare	$240.24
Rate for Payer: Hawaii Medical Service Association Medicare	$217.36
Rate for Payer: Hawaii Western Management Group Commercial	$271.70
Rate for Payer: Health Management Network Commercial	$243.10
Rate for Payer: Humana Medicare	$217.36
Rate for Payer: Kaiser Permanente Commercial	$257.40
Rate for Payer: Kaiser Permanente Medicaid	$145.86
Rate for Payer: Kaiser Permanente Medicare	$217.36
Rate for Payer: MDX Hawaii PPO	$277.42
Rate for Payer: Ohana Health Plan Medicaid	$217.36
Rate for Payer: Ohana Health Plan Medicare	$217.36
Rate for Payer: UnitedHealthcare Medicare	$217.36
Rate for Payer: University Health Alliance Commercial	$208.47

CAUT ELECTROD 5X58 FULGURATING

Facility

$286.00

Hospital Revenue Code	272
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$277.42
Rate for Payer: Cash Price	$171.60
Rate for Payer: Health Management Network Commercial	$243.10
Rate for Payer: Kaiser Permanente Commercial	$257.40
Rate for Payer: MDX Hawaii PPO	$277.42

CAUTERY BLADE

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: MDX Hawaii PPO	$104.76

CAUTERY BLADE

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$104.76
Rate for Payer: AlohaCare Medicaid	$54.00
Rate for Payer: AlohaCare Medicare	$82.08
Rate for Payer: Cash Price	$64.80
Rate for Payer: Devoted Health Medicare	$90.72
Rate for Payer: Hawaii Medical Service Association Medicare	$82.08
Rate for Payer: Hawaii Western Management Group Commercial	$102.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Humana Medicare	$82.08
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: Kaiser Permanente Medicare	$82.08
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: Ohana Health Plan Medicaid	$82.08
Rate for Payer: Ohana Health Plan Medicare	$82.08
Rate for Payer: UnitedHealthcare Medicare	$82.08
Rate for Payer: University Health Alliance Commercial	$78.72

CAUTERY L HOOK

Facility

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$139.80
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: MDX Hawaii PPO	$226.01

CAUTERY L HOOK

Facility

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$116.50
Max. Negotiated Rate	$226.01
Rate for Payer: AlohaCare Medicaid	$116.50
Rate for Payer: AlohaCare Medicare	$177.08
Rate for Payer: Cash Price	$139.80
Rate for Payer: Devoted Health Medicare	$195.72
Rate for Payer: Hawaii Medical Service Association Medicare	$177.08
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Humana Medicare	$177.08
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: Kaiser Permanente Medicaid	$118.83
Rate for Payer: Kaiser Permanente Medicare	$177.08
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: Ohana Health Plan Medicaid	$177.08
Rate for Payer: Ohana Health Plan Medicare	$177.08
Rate for Payer: UnitedHealthcare Medicare	$177.08
Rate for Payer: University Health Alliance Commercial	$169.83

CAUTERY PENVAC MEGADYNE

Facility

$218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.00
Max. Negotiated Rate	$211.46
Rate for Payer: AlohaCare Medicaid	$109.00
Rate for Payer: AlohaCare Medicare	$165.68
Rate for Payer: Cash Price	$130.80
Rate for Payer: Devoted Health Medicare	$183.12
Rate for Payer: Hawaii Medical Service Association Medicare	$165.68
Rate for Payer: Hawaii Western Management Group Commercial	$207.10
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Humana Medicare	$165.68
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: Kaiser Permanente Medicare	$165.68
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: Ohana Health Plan Medicaid	$165.68
Rate for Payer: Ohana Health Plan Medicare	$165.68
Rate for Payer: UnitedHealthcare Medicare	$165.68
Rate for Payer: University Health Alliance Commercial	$158.90

CAUTERY PENVAC MEGADYNE

Facility

$218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$185.30
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: MDX Hawaii PPO	$211.46

CAUT HOOK HAND CONTROL

Facility

$191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$95.50
Max. Negotiated Rate	$185.27
Rate for Payer: AlohaCare Medicaid	$95.50
Rate for Payer: AlohaCare Medicare	$145.16
Rate for Payer: Cash Price	$114.60
Rate for Payer: Devoted Health Medicare	$160.44
Rate for Payer: Hawaii Medical Service Association Medicare	$145.16
Rate for Payer: Hawaii Western Management Group Commercial	$181.45
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Humana Medicare	$145.16
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: Kaiser Permanente Medicaid	$97.41
Rate for Payer: Kaiser Permanente Medicare	$145.16
Rate for Payer: MDX Hawaii PPO	$185.27
Rate for Payer: Ohana Health Plan Medicaid	$145.16
Rate for Payer: Ohana Health Plan Medicare	$145.16
Rate for Payer: UnitedHealthcare Medicare	$145.16
Rate for Payer: University Health Alliance Commercial	$139.22

CAUT HOOK HAND CONTROL

Facility

$191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$114.60
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: MDX Hawaii PPO	$185.27

CAUT HOOK LAP ELECTRODE

Facility

$325.00

Hospital Revenue Code	272
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$315.25
Rate for Payer: AlohaCare Medicaid	$162.50
Rate for Payer: AlohaCare Medicare	$247.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Devoted Health Medicare	$273.00
Rate for Payer: Hawaii Medical Service Association Medicare	$247.00
Rate for Payer: Hawaii Western Management Group Commercial	$308.75
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Humana Medicare	$247.00
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: Kaiser Permanente Medicaid	$165.75
Rate for Payer: Kaiser Permanente Medicare	$247.00
Rate for Payer: MDX Hawaii PPO	$315.25
Rate for Payer: Ohana Health Plan Medicaid	$247.00
Rate for Payer: Ohana Health Plan Medicare	$247.00
Rate for Payer: UnitedHealthcare Medicare	$247.00
Rate for Payer: University Health Alliance Commercial	$236.89

CAUT HOOK LAP ELECTRODE

Facility

$325.00

Hospital Revenue Code	272
Min. Negotiated Rate	$276.25
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: MDX Hawaii PPO	$315.25

CAUT LIGASURE 5MM BLUNT

Facility

$1,507.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,280.95
Max. Negotiated Rate	$1,461.79
Rate for Payer: Cash Price	$904.20
Rate for Payer: Health Management Network Commercial	$1,280.95
Rate for Payer: Kaiser Permanente Commercial	$1,356.30
Rate for Payer: MDX Hawaii PPO	$1,461.79

CAUT LIGASURE 5MM BLUNT

Facility

$1,507.00

Hospital Revenue Code	272
Min. Negotiated Rate	$753.50
Max. Negotiated Rate	$1,461.79
Rate for Payer: AlohaCare Medicaid	$753.50
Rate for Payer: AlohaCare Medicare	$1,145.32
Rate for Payer: Cash Price	$904.20
Rate for Payer: Devoted Health Medicare	$1,265.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,145.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,431.65
Rate for Payer: Health Management Network Commercial	$1,280.95
Rate for Payer: Humana Medicare	$1,145.32
Rate for Payer: Kaiser Permanente Commercial	$1,356.30
Rate for Payer: Kaiser Permanente Medicaid	$768.57
Rate for Payer: Kaiser Permanente Medicare	$1,145.32
Rate for Payer: MDX Hawaii PPO	$1,461.79
Rate for Payer: Ohana Health Plan Medicaid	$1,145.32
Rate for Payer: Ohana Health Plan Medicare	$1,145.32
Rate for Payer: UnitedHealthcare Medicare	$1,145.32
Rate for Payer: University Health Alliance Commercial	$1,098.45

CAUT LIGASURE ATLAS HANDHELD

Facility

$1,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,356.60
Max. Negotiated Rate	$1,548.12
Rate for Payer: Cash Price	$957.60
Rate for Payer: Health Management Network Commercial	$1,356.60
Rate for Payer: Kaiser Permanente Commercial	$1,436.40
Rate for Payer: MDX Hawaii PPO	$1,548.12

CAUT LIGASURE ATLAS HANDHELD

Facility

$1,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$798.00
Max. Negotiated Rate	$1,548.12
Rate for Payer: AlohaCare Medicaid	$798.00
Rate for Payer: AlohaCare Medicare	$1,212.96
Rate for Payer: Cash Price	$957.60
Rate for Payer: Devoted Health Medicare	$1,340.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,212.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,516.20
Rate for Payer: Health Management Network Commercial	$1,356.60
Rate for Payer: Humana Medicare	$1,212.96
Rate for Payer: Kaiser Permanente Commercial	$1,436.40
Rate for Payer: Kaiser Permanente Medicaid	$813.96
Rate for Payer: Kaiser Permanente Medicare	$1,212.96
Rate for Payer: MDX Hawaii PPO	$1,548.12
Rate for Payer: Ohana Health Plan Medicaid	$1,212.96
Rate for Payer: Ohana Health Plan Medicare	$1,212.96
Rate for Payer: UnitedHealthcare Medicare	$1,212.96
Rate for Payer: University Health Alliance Commercial	$1,163.32

CAUT SURGIWAND II 5M

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$329.80

Know your out-of-pocket cost for care.

All Charges