Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PACK BASIC CATARACT

Facility

$80.00

Hospital Revenue Code	272
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$40.00
Rate for Payer: AlohaCare Medicare	$60.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Devoted Health Medicare	$67.20
Rate for Payer: Hawaii Medical Service Association Medicare	$60.80
Rate for Payer: Hawaii Western Management Group Commercial	$76.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$60.80
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$60.80
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$60.80
Rate for Payer: Ohana Health Plan Medicare	$60.80
Rate for Payer: UnitedHealthcare Medicare	$60.80
Rate for Payer: University Health Alliance Commercial	$58.31

PACK CESAREAN

Facility

$291.00

Hospital Revenue Code	272
Min. Negotiated Rate	$247.35
Max. Negotiated Rate	$282.27
Rate for Payer: Cash Price	$174.60
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Kaiser Permanente Commercial	$261.90
Rate for Payer: MDX Hawaii PPO	$282.27

PACK CESAREAN

Facility

$291.00

Hospital Revenue Code	272
Min. Negotiated Rate	$145.50
Max. Negotiated Rate	$282.27
Rate for Payer: AlohaCare Medicaid	$145.50
Rate for Payer: AlohaCare Medicare	$221.16
Rate for Payer: Cash Price	$174.60
Rate for Payer: Devoted Health Medicare	$244.44
Rate for Payer: Hawaii Medical Service Association Medicare	$221.16
Rate for Payer: Hawaii Western Management Group Commercial	$276.45
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Humana Medicare	$221.16
Rate for Payer: Kaiser Permanente Commercial	$261.90
Rate for Payer: Kaiser Permanente Medicaid	$148.41
Rate for Payer: Kaiser Permanente Medicare	$221.16
Rate for Payer: MDX Hawaii PPO	$282.27
Rate for Payer: Ohana Health Plan Medicaid	$221.16
Rate for Payer: Ohana Health Plan Medicare	$221.16
Rate for Payer: UnitedHealthcare Medicare	$221.16
Rate for Payer: University Health Alliance Commercial	$212.11

PACK CYSTO

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$171.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$189.00
Rate for Payer: Hawaii Medical Service Association Medicare	$171.00
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$171.00
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$171.00
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$171.00
Rate for Payer: Ohana Health Plan Medicare	$171.00
Rate for Payer: UnitedHealthcare Medicare	$171.00
Rate for Payer: University Health Alliance Commercial	$164.00

PACK CYSTO

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

PACK ENDO TYMPANOPLASTY

Facility

$745.00

Hospital Revenue Code	272
Min. Negotiated Rate	$633.25
Max. Negotiated Rate	$722.65
Rate for Payer: Cash Price	$447.00
Rate for Payer: Health Management Network Commercial	$633.25
Rate for Payer: Kaiser Permanente Commercial	$670.50
Rate for Payer: MDX Hawaii PPO	$722.65

PACK ENDO TYMPANOPLASTY

Facility

$745.00

Hospital Revenue Code	272
Min. Negotiated Rate	$372.50
Max. Negotiated Rate	$722.65
Rate for Payer: AlohaCare Medicaid	$372.50
Rate for Payer: AlohaCare Medicare	$566.20
Rate for Payer: Cash Price	$447.00
Rate for Payer: Devoted Health Medicare	$625.80
Rate for Payer: Hawaii Medical Service Association Medicare	$566.20
Rate for Payer: Hawaii Western Management Group Commercial	$707.75
Rate for Payer: Health Management Network Commercial	$633.25
Rate for Payer: Humana Medicare	$566.20
Rate for Payer: Kaiser Permanente Commercial	$670.50
Rate for Payer: Kaiser Permanente Medicaid	$379.95
Rate for Payer: Kaiser Permanente Medicare	$566.20
Rate for Payer: MDX Hawaii PPO	$722.65
Rate for Payer: Ohana Health Plan Medicaid	$566.20
Rate for Payer: Ohana Health Plan Medicare	$566.20
Rate for Payer: UnitedHealthcare Medicare	$566.20
Rate for Payer: University Health Alliance Commercial	$543.03

PACK GENERAL

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$290.70
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$205.20
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Kaiser Permanente Commercial	$307.80
Rate for Payer: MDX Hawaii PPO	$331.74

PACK GENERAL

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$331.74
Rate for Payer: AlohaCare Medicaid	$171.00
Rate for Payer: AlohaCare Medicare	$259.92
Rate for Payer: Cash Price	$205.20
Rate for Payer: Devoted Health Medicare	$287.28
Rate for Payer: Hawaii Medical Service Association Medicare	$259.92
Rate for Payer: Hawaii Western Management Group Commercial	$324.90
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Humana Medicare	$259.92
Rate for Payer: Kaiser Permanente Commercial	$307.80
Rate for Payer: Kaiser Permanente Medicaid	$174.42
Rate for Payer: Kaiser Permanente Medicare	$259.92
Rate for Payer: MDX Hawaii PPO	$331.74
Rate for Payer: Ohana Health Plan Medicaid	$259.92
Rate for Payer: Ohana Health Plan Medicare	$259.92
Rate for Payer: UnitedHealthcare Medicare	$259.92
Rate for Payer: University Health Alliance Commercial	$249.28

PACK HEAD

Facility

$71.00

Hospital Revenue Code	272
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$53.96
Rate for Payer: Cash Price	$42.60
Rate for Payer: Devoted Health Medicare	$59.64
Rate for Payer: Hawaii Medical Service Association Medicare	$53.96
Rate for Payer: Hawaii Western Management Group Commercial	$67.45
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$53.96
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$53.96
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$53.96
Rate for Payer: Ohana Health Plan Medicare	$53.96
Rate for Payer: UnitedHealthcare Medicare	$53.96
Rate for Payer: University Health Alliance Commercial	$51.75

PACK HEAD

Facility

$71.00

Hospital Revenue Code	272
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

PACKING 4.5CM NASAL

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

PACKING 4.5CM NASAL

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

PACKING 8CM NASAL

Facility

$146.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$141.62
Rate for Payer: AlohaCare Medicaid	$73.00
Rate for Payer: AlohaCare Medicare	$110.96
Rate for Payer: Cash Price	$87.60
Rate for Payer: Devoted Health Medicare	$122.64
Rate for Payer: Hawaii Medical Service Association Medicare	$110.96
Rate for Payer: Hawaii Western Management Group Commercial	$138.70
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Humana Medicare	$110.96
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: Kaiser Permanente Medicare	$110.96
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: Ohana Health Plan Medicaid	$110.96
Rate for Payer: Ohana Health Plan Medicare	$110.96
Rate for Payer: UnitedHealthcare Medicare	$110.96
Rate for Payer: University Health Alliance Commercial	$106.42

PACKING 8CM NASAL

Facility

$146.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$87.60
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: MDX Hawaii PPO	$141.62

PACKING POPE EAR 24MM

Facility

$142.00

Hospital Revenue Code	272
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$107.92
Rate for Payer: Cash Price	$85.20
Rate for Payer: Devoted Health Medicare	$119.28
Rate for Payer: Hawaii Medical Service Association Medicare	$107.92
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$107.92
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$107.92
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$107.92
Rate for Payer: Ohana Health Plan Medicare	$107.92
Rate for Payer: UnitedHealthcare Medicare	$107.92
Rate for Payer: University Health Alliance Commercial	$103.50

PACKING POPE EAR 24MM

Facility

$142.00

Hospital Revenue Code	272
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$85.20
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

PACK LAP CHOLE

Facility

$1,218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$609.00
Max. Negotiated Rate	$1,181.46
Rate for Payer: AlohaCare Medicaid	$609.00
Rate for Payer: AlohaCare Medicare	$925.68
Rate for Payer: Cash Price	$730.80
Rate for Payer: Devoted Health Medicare	$1,023.12
Rate for Payer: Hawaii Medical Service Association Medicare	$925.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,157.10
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: Humana Medicare	$925.68
Rate for Payer: Kaiser Permanente Commercial	$1,096.20
Rate for Payer: Kaiser Permanente Medicaid	$621.18
Rate for Payer: Kaiser Permanente Medicare	$925.68
Rate for Payer: MDX Hawaii PPO	$1,181.46
Rate for Payer: Ohana Health Plan Medicaid	$925.68
Rate for Payer: Ohana Health Plan Medicare	$925.68
Rate for Payer: UnitedHealthcare Medicare	$925.68
Rate for Payer: University Health Alliance Commercial	$887.80

PACK LAP CHOLE

Facility

$1,218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,035.30
Max. Negotiated Rate	$1,181.46
Rate for Payer: Cash Price	$730.80
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: Kaiser Permanente Commercial	$1,096.20
Rate for Payer: MDX Hawaii PPO	$1,181.46

PACK NASAL GEL 5.5CM

Facility

$194.00

Hospital Revenue Code	272
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$188.18
Rate for Payer: AlohaCare Medicaid	$97.00
Rate for Payer: AlohaCare Medicare	$147.44
Rate for Payer: Cash Price	$116.40
Rate for Payer: Devoted Health Medicare	$162.96
Rate for Payer: Hawaii Medical Service Association Medicare	$147.44
Rate for Payer: Hawaii Western Management Group Commercial	$184.30
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Humana Medicare	$147.44
Rate for Payer: Kaiser Permanente Commercial	$174.60
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: Kaiser Permanente Medicare	$147.44
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: Ohana Health Plan Medicaid	$147.44
Rate for Payer: Ohana Health Plan Medicare	$147.44
Rate for Payer: UnitedHealthcare Medicare	$147.44
Rate for Payer: University Health Alliance Commercial	$141.41

PACK NASAL GEL 5.5CM

Facility

$194.00

Hospital Revenue Code	272
Min. Negotiated Rate	$164.90
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$116.40
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Kaiser Permanente Commercial	$174.60
Rate for Payer: MDX Hawaii PPO	$188.18

PACK ORTHO EXTREMITY

Facility

$147.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

PACK ORTHO EXTREMITY

Facility

$147.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$111.72
Rate for Payer: Cash Price	$88.20
Rate for Payer: Devoted Health Medicare	$123.48
Rate for Payer: Hawaii Medical Service Association Medicare	$111.72
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$111.72
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$111.72
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$111.72
Rate for Payer: Ohana Health Plan Medicare	$111.72
Rate for Payer: UnitedHealthcare Medicare	$111.72
Rate for Payer: University Health Alliance Commercial	$107.15

PACK ROBOTIC PG55KRHH1

Facility

$292.00

Hospital Revenue Code	272
Min. Negotiated Rate	$146.00
Max. Negotiated Rate	$283.24
Rate for Payer: AlohaCare Medicaid	$146.00
Rate for Payer: AlohaCare Medicare	$221.92
Rate for Payer: Cash Price	$175.20
Rate for Payer: Devoted Health Medicare	$245.28
Rate for Payer: Hawaii Medical Service Association Medicare	$221.92
Rate for Payer: Hawaii Western Management Group Commercial	$277.40
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: Humana Medicare	$221.92
Rate for Payer: Kaiser Permanente Commercial	$262.80
Rate for Payer: Kaiser Permanente Medicaid	$148.92
Rate for Payer: Kaiser Permanente Medicare	$221.92
Rate for Payer: MDX Hawaii PPO	$283.24
Rate for Payer: Ohana Health Plan Medicaid	$221.92
Rate for Payer: Ohana Health Plan Medicare	$221.92
Rate for Payer: UnitedHealthcare Medicare	$221.92
Rate for Payer: University Health Alliance Commercial	$212.84

PACK ROBOTIC PG55KRHH1

Facility

$292.00

Hospital Revenue Code	272
Min. Negotiated Rate	$248.20
Max. Negotiated Rate	$283.24
Rate for Payer: Cash Price	$175.20
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: Kaiser Permanente Commercial	$262.80
Rate for Payer: MDX Hawaii PPO	$283.24

Know your out-of-pocket cost for care.

All Charges