Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HC PT PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS

Facility

$486.00

Service Code	HCPCS 97163 GP
Hospital Charge Code	4249716301
Hospital Revenue Code	424
Min. Negotiated Rate	$413.10
Max. Negotiated Rate	$471.42
Rate for Payer: Cash Price	$291.60
Rate for Payer: Health Management Network Commercial	$413.10
Rate for Payer: Kaiser Permanente Commercial	$437.40
Rate for Payer: MDX Hawaii PPO	$471.42

HC PT PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS

Facility

$486.00

Service Code	HCPCS 97161 GP
Hospital Charge Code	4249716101
Hospital Revenue Code	424
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$471.42
Rate for Payer: AlohaCare Medicaid	$243.00
Rate for Payer: AlohaCare Medicare	$369.36
Rate for Payer: Cash Price	$291.60
Rate for Payer: Cash Price	$291.60
Rate for Payer: Devoted Health Medicare	$408.24
Rate for Payer: Hawaii Medical Service Association Medicare	$369.36
Rate for Payer: Hawaii Western Management Group Commercial	$461.70
Rate for Payer: Health Management Network Commercial	$413.10
Rate for Payer: Humana Medicare	$369.36
Rate for Payer: Kaiser Permanente Commercial	$437.40
Rate for Payer: Kaiser Permanente Medicaid	$247.86
Rate for Payer: Kaiser Permanente Medicare	$369.36
Rate for Payer: MDX Hawaii PPO	$471.42
Rate for Payer: Ohana Health Plan Medicaid	$369.36
Rate for Payer: Ohana Health Plan Medicare	$369.36
Rate for Payer: UnitedHealthcare Medicaid	$106.70
Rate for Payer: UnitedHealthcare Medicare	$369.36
Rate for Payer: University Health Alliance Commercial	$354.25

HC PT PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS

Facility

$486.00

Service Code	HCPCS 97161 GP
Hospital Charge Code	4249716101
Hospital Revenue Code	424
Min. Negotiated Rate	$413.10
Max. Negotiated Rate	$471.42
Rate for Payer: Cash Price	$291.60
Rate for Payer: Health Management Network Commercial	$413.10
Rate for Payer: Kaiser Permanente Commercial	$437.40
Rate for Payer: MDX Hawaii PPO	$471.42

HC PT PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS

Facility

$486.00

Service Code	HCPCS 97162 GP
Hospital Charge Code	4249716201
Hospital Revenue Code	424
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$471.42
Rate for Payer: AlohaCare Medicaid	$243.00
Rate for Payer: AlohaCare Medicare	$369.36
Rate for Payer: Cash Price	$291.60
Rate for Payer: Cash Price	$291.60
Rate for Payer: Devoted Health Medicare	$408.24
Rate for Payer: Hawaii Medical Service Association Medicare	$369.36
Rate for Payer: Hawaii Western Management Group Commercial	$461.70
Rate for Payer: Health Management Network Commercial	$413.10
Rate for Payer: Humana Medicare	$369.36
Rate for Payer: Kaiser Permanente Commercial	$437.40
Rate for Payer: Kaiser Permanente Medicaid	$247.86
Rate for Payer: Kaiser Permanente Medicare	$369.36
Rate for Payer: MDX Hawaii PPO	$471.42
Rate for Payer: Ohana Health Plan Medicaid	$369.36
Rate for Payer: Ohana Health Plan Medicare	$369.36
Rate for Payer: UnitedHealthcare Medicaid	$106.70
Rate for Payer: UnitedHealthcare Medicare	$369.36
Rate for Payer: University Health Alliance Commercial	$354.25

HC PT PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS

Facility

$486.00

Service Code	HCPCS 97162 GP
Hospital Charge Code	4249716201
Hospital Revenue Code	424
Min. Negotiated Rate	$413.10
Max. Negotiated Rate	$471.42
Rate for Payer: Cash Price	$291.60
Rate for Payer: Health Management Network Commercial	$413.10
Rate for Payer: Kaiser Permanente Commercial	$437.40
Rate for Payer: MDX Hawaii PPO	$471.42

HC PT PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS

Facility

$339.00

Service Code	HCPCS 97164 GP
Hospital Charge Code	4249716401
Hospital Revenue Code	424
Min. Negotiated Rate	$74.59
Max. Negotiated Rate	$328.83
Rate for Payer: AlohaCare Medicaid	$169.50
Rate for Payer: AlohaCare Medicare	$257.64
Rate for Payer: Cash Price	$203.40
Rate for Payer: Cash Price	$203.40
Rate for Payer: Devoted Health Medicare	$284.76
Rate for Payer: Hawaii Medical Service Association Medicare	$257.64
Rate for Payer: Hawaii Western Management Group Commercial	$322.05
Rate for Payer: Health Management Network Commercial	$288.15
Rate for Payer: Humana Medicare	$257.64
Rate for Payer: Kaiser Permanente Commercial	$305.10
Rate for Payer: Kaiser Permanente Medicaid	$172.89
Rate for Payer: Kaiser Permanente Medicare	$257.64
Rate for Payer: MDX Hawaii PPO	$328.83
Rate for Payer: Ohana Health Plan Medicaid	$257.64
Rate for Payer: Ohana Health Plan Medicare	$257.64
Rate for Payer: UnitedHealthcare Medicaid	$74.59
Rate for Payer: UnitedHealthcare Medicare	$257.64
Rate for Payer: University Health Alliance Commercial	$247.10

HC PT PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS

Facility

$339.00

Service Code	HCPCS 97164 GP
Hospital Charge Code	4249716401
Hospital Revenue Code	424
Min. Negotiated Rate	$288.15
Max. Negotiated Rate	$328.83
Rate for Payer: Cash Price	$203.40
Rate for Payer: Health Management Network Commercial	$288.15
Rate for Payer: Kaiser Permanente Commercial	$305.10
Rate for Payer: MDX Hawaii PPO	$328.83

HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN

Facility

$181.00

Service Code	HCPCS 97530 GP
Hospital Charge Code	4209753001
Hospital Revenue Code	420
Min. Negotiated Rate	$153.85
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$108.60
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Kaiser Permanente Commercial	$162.90
Rate for Payer: MDX Hawaii PPO	$175.57

HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN

Facility

$181.00

Service Code	HCPCS 97530 GP
Hospital Charge Code	4209753001
Hospital Revenue Code	420
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$175.57
Rate for Payer: AlohaCare Medicaid	$90.50
Rate for Payer: AlohaCare Medicare	$137.56
Rate for Payer: Cash Price	$108.60
Rate for Payer: Cash Price	$108.60
Rate for Payer: Devoted Health Medicare	$152.04
Rate for Payer: Hawaii Medical Service Association Medicare	$137.56
Rate for Payer: Hawaii Western Management Group Commercial	$171.95
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Humana Medicare	$137.56
Rate for Payer: Kaiser Permanente Commercial	$162.90
Rate for Payer: Kaiser Permanente Medicaid	$92.31
Rate for Payer: Kaiser Permanente Medicare	$137.56
Rate for Payer: MDX Hawaii PPO	$175.57
Rate for Payer: Ohana Health Plan Medicaid	$137.56
Rate for Payer: Ohana Health Plan Medicare	$137.56
Rate for Payer: UnitedHealthcare Medicaid	$18.32
Rate for Payer: UnitedHealthcare Medicare	$137.56
Rate for Payer: University Health Alliance Commercial	$131.93

HC PT THERAPEUTIC EXERCISES

Facility

$140.00

Service Code	HCPCS 97110 GP
Hospital Charge Code	4209711001
Hospital Revenue Code	420
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$135.80
Rate for Payer: AlohaCare Medicaid	$70.00
Rate for Payer: AlohaCare Medicare	$106.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Devoted Health Medicare	$117.60
Rate for Payer: Hawaii Medical Service Association Medicare	$106.40
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Humana Medicare	$106.40
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicare	$106.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: Ohana Health Plan Medicaid	$106.40
Rate for Payer: Ohana Health Plan Medicare	$106.40
Rate for Payer: UnitedHealthcare Medicaid	$17.65
Rate for Payer: UnitedHealthcare Medicare	$106.40
Rate for Payer: University Health Alliance Commercial	$102.05

HC PT THERAPEUTIC EXERCISES

Facility

$140.00

Service Code	HCPCS 97110 GP
Hospital Charge Code	4209711001
Hospital Revenue Code	420
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80

HC PT ULTRASOUND THERAPY

Facility

$68.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	4209703501
Hospital Revenue Code	420
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

HC PT ULTRASOUND THERAPY

Facility

$68.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	4209703501
Hospital Revenue Code	420
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$34.00
Rate for Payer: AlohaCare Medicare	$51.68
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$57.12
Rate for Payer: Hawaii Medical Service Association Medicare	$51.68
Rate for Payer: Hawaii Western Management Group Commercial	$64.60
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$51.68
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$51.68
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$51.68
Rate for Payer: Ohana Health Plan Medicare	$51.68
Rate for Payer: UnitedHealthcare Medicaid	$9.52
Rate for Payer: UnitedHealthcare Medicare	$51.68
Rate for Payer: University Health Alliance Commercial	$49.57

HC PT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN

Facility

$154.00

Service Code	HCPCS 97542 GP
Hospital Charge Code	4209754201
Hospital Revenue Code	420
Min. Negotiated Rate	$17.54
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$77.00
Rate for Payer: AlohaCare Medicare	$117.04
Rate for Payer: Cash Price	$92.40
Rate for Payer: Cash Price	$92.40
Rate for Payer: Devoted Health Medicare	$129.36
Rate for Payer: Hawaii Medical Service Association Medicare	$117.04
Rate for Payer: Hawaii Western Management Group Commercial	$146.30
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$117.04
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$117.04
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$117.04
Rate for Payer: Ohana Health Plan Medicare	$117.04
Rate for Payer: UnitedHealthcare Medicaid	$17.54
Rate for Payer: UnitedHealthcare Medicare	$117.04
Rate for Payer: University Health Alliance Commercial	$112.25

HC PT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN

Facility

$154.00

Service Code	HCPCS 97542 GP
Hospital Charge Code	4209754201
Hospital Revenue Code	420
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$92.40
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: MDX Hawaii PPO	$149.38

HC PULSE OXIMETRY MULTIPLE

Facility

$201.00

Service Code	HCPCS 94761
Hospital Charge Code	4609476101
Hospital Revenue Code	460
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$152.76
Rate for Payer: Cash Price	$120.60
Rate for Payer: Cash Price	$120.60
Rate for Payer: Devoted Health Medicare	$168.84
Rate for Payer: Hawaii Medical Service Association Medicare	$152.76
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$152.76
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$152.76
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$152.76
Rate for Payer: Ohana Health Plan Medicare	$152.76
Rate for Payer: UnitedHealthcare Medicaid	$4.77
Rate for Payer: UnitedHealthcare Medicare	$152.76
Rate for Payer: University Health Alliance Commercial	$146.51

HC PULSE OXIMETRY MULTIPLE

Facility

$201.00

Service Code	HCPCS 94761
Hospital Charge Code	4609476101
Hospital Revenue Code	460
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

HC PUNCTURE DRAINAGE OF LESION

Facility

$1,590.00

Service Code	HCPCS 10160
Hospital Charge Code	3611016001
Hospital Revenue Code	361
Min. Negotiated Rate	$57.25
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$795.00
Rate for Payer: AlohaCare Medicare	$1,208.40
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Devoted Health Medicare	$1,335.60
Rate for Payer: Hawaii Medical Service Association Commercial	$519.15
Rate for Payer: Hawaii Medical Service Association Medicare	$1,208.40
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: Humana Medicare	$1,208.40
Rate for Payer: Kaiser Permanente Commercial	$1,431.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,208.40
Rate for Payer: MDX Hawaii PPO	$1,542.30
Rate for Payer: Ohana Health Plan Medicaid	$1,208.40
Rate for Payer: Ohana Health Plan Medicare	$1,208.40
Rate for Payer: UnitedHealthcare Medicaid	$57.25
Rate for Payer: UnitedHealthcare Medicare	$1,208.40
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC PUNCTURE DRAINAGE OF LESION

Facility

$1,590.00

Service Code	HCPCS 10160
Hospital Charge Code	3611016001
Hospital Revenue Code	361
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$1,542.30
Rate for Payer: Cash Price	$954.00
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: Kaiser Permanente Commercial	$1,431.00
Rate for Payer: MDX Hawaii PPO	$1,542.30

HC QUANT THERA DRUG NOS SO

Facility

$156.00

Service Code	HCPCS 80299
Hospital Charge Code	3018029919
Hospital Revenue Code	301
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$151.32
Rate for Payer: AlohaCare Medicaid	$78.00
Rate for Payer: AlohaCare Medicare	$118.56
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Devoted Health Medicare	$131.04
Rate for Payer: Hawaii Medical Service Association ABD	$18.92
Rate for Payer: Hawaii Medical Service Association Commercial	$23.30
Rate for Payer: Hawaii Medical Service Association Medicare	$118.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.87
Rate for Payer: Hawaii Western Management Group Commercial	$18.64
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$118.56
Rate for Payer: Kaiser Permanente Commercial	$140.40
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$118.56
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$118.56
Rate for Payer: Ohana Health Plan Medicare	$118.56
Rate for Payer: UnitedHealthcare Medicaid	$18.92
Rate for Payer: UnitedHealthcare Medicare	$118.56
Rate for Payer: University Health Alliance Commercial	$35.39

HC QUANT THERA DRUG NOS SO

Facility

$156.00

Service Code	HCPCS 80299
Hospital Charge Code	3018029919
Hospital Revenue Code	301
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Kaiser Permanente Commercial	$140.40
Rate for Payer: MDX Hawaii PPO	$151.32

HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 2-3 VIEWS

Facility

$438.00

Service Code	HCPCS 72040
Hospital Charge Code	3207204002
Hospital Revenue Code	320
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$424.86
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$332.88
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: Devoted Health Medicare	$367.92
Rate for Payer: Hawaii Medical Service Association ABD	$19.78
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$332.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.66
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$332.88
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$332.88
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$332.88
Rate for Payer: Ohana Health Plan Medicare	$332.88
Rate for Payer: UnitedHealthcare Medicaid	$19.78
Rate for Payer: UnitedHealthcare Medicare	$332.88
Rate for Payer: University Health Alliance Commercial	$73.65

HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 2-3 VIEWS

Facility

$438.00

Service Code	HCPCS 72040
Hospital Charge Code	3207204002
Hospital Revenue Code	320
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$262.80
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

HC RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS

Facility

$529.00

Service Code	HCPCS 72050
Hospital Charge Code	3207205001
Hospital Revenue Code	320
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$402.04
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$444.36
Rate for Payer: Hawaii Medical Service Association ABD	$29.64
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$402.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$32.30
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$402.04
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$402.04
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$402.04
Rate for Payer: Ohana Health Plan Medicare	$402.04
Rate for Payer: UnitedHealthcare Medicaid	$29.64
Rate for Payer: UnitedHealthcare Medicare	$402.04
Rate for Payer: University Health Alliance Commercial	$105.14

HC RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS

Facility

$529.00

Service Code	HCPCS 72050
Hospital Charge Code	3207205001
Hospital Revenue Code	320
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: MDX Hawaii PPO	$513.13

Know your out-of-pocket cost for care.

All Charges