Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

NEEDLE HUBER 20G X 1 W/EXT SET

Facility

$42.00

Hospital Charge Code	8266742
Hospital Revenue Code	272
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$40.74
Rate for Payer: AlohaCare Medicaid	$21.00
Rate for Payer: AlohaCare Medicare	$21.00
Rate for Payer: Cash Price	$27.30
Rate for Payer: Devoted Health Medicare	$23.10
Rate for Payer: Hawaii Medical Service Association Medicare	$21.00
Rate for Payer: Hawaii Western Management Group Commercial	$39.90
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Humana Medicare	$21.00
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Medicaid	$21.42
Rate for Payer: Kaiser Permanente Medicare	$21.00
Rate for Payer: MDX Hawaii PPO	$40.74
Rate for Payer: Ohana Health Plan Medicaid	$21.00
Rate for Payer: Ohana Health Plan Medicare	$21.00
Rate for Payer: UnitedHealthcare Medicare	$21.00
Rate for Payer: University Health Alliance Commercial	$30.61

NEEDLE IO SET 15MM 15 GAUGE

Facility

$513.00

Hospital Charge Code	8274458
Hospital Revenue Code	272
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$497.61
Rate for Payer: AlohaCare Medicaid	$256.50
Rate for Payer: AlohaCare Medicare	$256.50
Rate for Payer: Cash Price	$333.45
Rate for Payer: Devoted Health Medicare	$282.15
Rate for Payer: Hawaii Medical Service Association Medicare	$256.50
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$256.50
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: Kaiser Permanente Medicaid	$261.63
Rate for Payer: Kaiser Permanente Medicare	$256.50
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$256.50
Rate for Payer: Ohana Health Plan Medicare	$256.50
Rate for Payer: UnitedHealthcare Medicare	$256.50
Rate for Payer: University Health Alliance Commercial	$373.93

NEEDLE IO SET 15MM 15 GAUGE

Facility

$513.00

Hospital Charge Code	8274458
Hospital Revenue Code	272
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$333.45
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: MDX Hawaii PPO	$497.61

NEEDLE IO SET 25MM 15 GAUGE

Facility

$513.00

Hospital Charge Code	8274460
Hospital Revenue Code	272
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$333.45
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: MDX Hawaii PPO	$497.61

NEEDLE IO SET 25MM 15 GAUGE

Facility

$513.00

Hospital Charge Code	8274460
Hospital Revenue Code	272
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$497.61
Rate for Payer: AlohaCare Medicaid	$256.50
Rate for Payer: AlohaCare Medicare	$256.50
Rate for Payer: Cash Price	$333.45
Rate for Payer: Devoted Health Medicare	$282.15
Rate for Payer: Hawaii Medical Service Association Medicare	$256.50
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$256.50
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: Kaiser Permanente Medicaid	$261.63
Rate for Payer: Kaiser Permanente Medicare	$256.50
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$256.50
Rate for Payer: Ohana Health Plan Medicare	$256.50
Rate for Payer: UnitedHealthcare Medicare	$256.50
Rate for Payer: University Health Alliance Commercial	$373.93

NEEDLE IO SET 45MM 15 GAUGE

Facility

$555.00

Hospital Charge Code	8274459
Hospital Revenue Code	272
Min. Negotiated Rate	$471.75
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$360.75
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35

NEEDLE IO SET 45MM 15 GAUGE

Facility

$555.00

Hospital Charge Code	8274459
Hospital Revenue Code	272
Min. Negotiated Rate	$277.50
Max. Negotiated Rate	$538.35
Rate for Payer: AlohaCare Medicaid	$277.50
Rate for Payer: AlohaCare Medicare	$277.50
Rate for Payer: Cash Price	$360.75
Rate for Payer: Devoted Health Medicare	$305.25
Rate for Payer: Hawaii Medical Service Association Medicare	$277.50
Rate for Payer: Hawaii Western Management Group Commercial	$527.25
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Humana Medicare	$277.50
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: Kaiser Permanente Medicare	$277.50
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: Ohana Health Plan Medicaid	$277.50
Rate for Payer: Ohana Health Plan Medicare	$277.50
Rate for Payer: UnitedHealthcare Medicare	$277.50
Rate for Payer: University Health Alliance Commercial	$404.54

NEEDLE, MAYO

Facility

$90.00

Hospital Charge Code	8274431
Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$58.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

NEEDLE, MAYO

Facility

$90.00

Hospital Charge Code	8274431
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$45.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$49.50
Rate for Payer: Hawaii Medical Service Association Medicare	$45.00
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$45.00
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$45.00
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$45.00
Rate for Payer: Ohana Health Plan Medicare	$45.00
Rate for Payer: UnitedHealthcare Medicare	$45.00
Rate for Payer: University Health Alliance Commercial	$65.60

NEEDLE SPINAL 20G X 3.5 QUINCKE

Facility

$15.00

Hospital Charge Code	8266477
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$7.50
Rate for Payer: Cash Price	$9.75
Rate for Payer: Devoted Health Medicare	$8.25
Rate for Payer: Hawaii Medical Service Association Medicare	$7.50
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$7.50
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$7.50
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$7.50
Rate for Payer: Ohana Health Plan Medicare	$7.50
Rate for Payer: UnitedHealthcare Medicare	$7.50
Rate for Payer: University Health Alliance Commercial	$10.93

NEEDLE SPINAL 20G X 3.5 QUINCKE

Facility

$15.00

Hospital Charge Code	8266477
Hospital Revenue Code	272
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

NEEDLE SPINAL 22G X 1.5 IN QUINCKE

Facility

$12.00

Hospital Charge Code	8266341
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$6.00
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$6.60
Rate for Payer: Hawaii Medical Service Association Medicare	$6.00
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$6.00
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$6.00
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$6.00
Rate for Payer: Ohana Health Plan Medicare	$6.00
Rate for Payer: UnitedHealthcare Medicare	$6.00
Rate for Payer: University Health Alliance Commercial	$8.75

NEEDLE SPINAL 22G X 1.5 IN QUINCKE

Facility

$12.00

Hospital Charge Code	8266341
Hospital Revenue Code	272
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

NEEDLE SPINAL 22G X 3.5 QUINCKE

Facility

$25.00

Hospital Charge Code	8266478
Hospital Revenue Code	272
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

NEEDLE SPINAL 22G X 3.5 QUINCKE

Facility

$25.00

Hospital Charge Code	8266478
Hospital Revenue Code	272
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$24.25
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$12.50
Rate for Payer: Cash Price	$16.25
Rate for Payer: Devoted Health Medicare	$13.75
Rate for Payer: Hawaii Medical Service Association Medicare	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$23.75
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$12.50
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$12.50
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$12.50
Rate for Payer: Ohana Health Plan Medicare	$12.50
Rate for Payer: UnitedHealthcare Medicare	$12.50
Rate for Payer: University Health Alliance Commercial	$18.22

NEEDLE SPINAL 25G X 2 QUINCKE

Facility

$121.00

Hospital Charge Code	8266551
Hospital Revenue Code	272
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$78.65
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: MDX Hawaii PPO	$117.37

NEEDLE SPINAL 25G X 2 QUINCKE

Facility

$121.00

Hospital Charge Code	8266551
Hospital Revenue Code	272
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$117.37
Rate for Payer: AlohaCare Medicaid	$60.50
Rate for Payer: AlohaCare Medicare	$60.50
Rate for Payer: Cash Price	$78.65
Rate for Payer: Devoted Health Medicare	$66.55
Rate for Payer: Hawaii Medical Service Association Medicare	$60.50
Rate for Payer: Hawaii Western Management Group Commercial	$114.95
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Humana Medicare	$60.50
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: Kaiser Permanente Medicare	$60.50
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: Ohana Health Plan Medicaid	$60.50
Rate for Payer: Ohana Health Plan Medicare	$60.50
Rate for Payer: UnitedHealthcare Medicare	$60.50
Rate for Payer: University Health Alliance Commercial	$88.20

NEEDLE SPINAL 25G X 3.5 QUINCKE

Facility

$15.00

Hospital Charge Code	8266479
Hospital Revenue Code	272
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

NEEDLE SPINAL 25G X 3.5 QUINCKE

Facility

$15.00

Hospital Charge Code	8266479
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$7.50
Rate for Payer: Cash Price	$9.75
Rate for Payer: Devoted Health Medicare	$8.25
Rate for Payer: Hawaii Medical Service Association Medicare	$7.50
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$7.50
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$7.50
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$7.50
Rate for Payer: Ohana Health Plan Medicare	$7.50
Rate for Payer: UnitedHealthcare Medicare	$7.50
Rate for Payer: University Health Alliance Commercial	$10.93

NEEDLE VERES 120MM DS SURGINEEDLE

Facility

$59.00

Hospital Charge Code	8274303
Hospital Revenue Code	272
Min. Negotiated Rate	$29.50
Max. Negotiated Rate	$57.23
Rate for Payer: AlohaCare Medicaid	$29.50
Rate for Payer: AlohaCare Medicare	$29.50
Rate for Payer: Cash Price	$38.35
Rate for Payer: Devoted Health Medicare	$32.45
Rate for Payer: Hawaii Medical Service Association Medicare	$29.50
Rate for Payer: Hawaii Western Management Group Commercial	$56.05
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Humana Medicare	$29.50
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: Kaiser Permanente Medicare	$29.50
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: Ohana Health Plan Medicaid	$29.50
Rate for Payer: Ohana Health Plan Medicare	$29.50
Rate for Payer: UnitedHealthcare Medicare	$29.50
Rate for Payer: University Health Alliance Commercial	$43.01

NEEDLE VERES 120MM DS SURGINEEDLE

Facility

$59.00

Hospital Charge Code	8274303
Hospital Revenue Code	272
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$38.35
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: MDX Hawaii PPO	$57.23

NEEDLE YUEH CENTESIS DISP 5FR/7CM (CT)

Facility

$137.00

Hospital Charge Code	8889999
Hospital Revenue Code	272
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$89.05
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: MDX Hawaii PPO	$132.89

NEEDLE YUEH CENTESIS DISP 5FR/7CM (CT)

Facility

$137.00

Hospital Charge Code	8889999
Hospital Revenue Code	272
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$68.50
Rate for Payer: AlohaCare Medicare	$68.50
Rate for Payer: Cash Price	$89.05
Rate for Payer: Devoted Health Medicare	$75.35
Rate for Payer: Hawaii Medical Service Association Medicare	$68.50
Rate for Payer: Hawaii Western Management Group Commercial	$130.15
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$68.50
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$68.50
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$68.50
Rate for Payer: Ohana Health Plan Medicare	$68.50
Rate for Payer: UnitedHealthcare Medicare	$68.50
Rate for Payer: University Health Alliance Commercial	$99.86

NEEDLE YUEH CENTESIS DISP 5FR/7CM (US)

Facility

$133.00

Hospital Charge Code	8889998
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$96.94

NEEDLE YUEH CENTESIS DISP 5FR/7CM (US)

Facility

$133.00

Hospital Charge Code	8889998
Hospital Revenue Code	272
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

Know your out-of-pocket cost for care.

All Charges