Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PILLOW HIP ABDUCT MED

Facility

$137.00

Hospital Revenue Code	271
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$68.50
Rate for Payer: AlohaCare Medicare	$104.12
Rate for Payer: Cash Price	$82.20
Rate for Payer: Devoted Health Medicare	$115.08
Rate for Payer: Hawaii Medical Service Association Medicare	$104.12
Rate for Payer: Hawaii Western Management Group Commercial	$130.15
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$104.12
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$104.12
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$104.12
Rate for Payer: Ohana Health Plan Medicare	$104.12
Rate for Payer: UnitedHealthcare Medicare	$104.12
Rate for Payer: University Health Alliance Commercial	$99.86

PILLOW HIP ABDUCT MED

Facility

$137.00

Hospital Revenue Code	271
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$82.20
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

PILLOW HIP ABDUCT SML

Facility

$106.00

Hospital Revenue Code	271
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$102.82
Rate for Payer: AlohaCare Medicaid	$53.00
Rate for Payer: AlohaCare Medicare	$80.56
Rate for Payer: Cash Price	$63.60
Rate for Payer: Devoted Health Medicare	$89.04
Rate for Payer: Hawaii Medical Service Association Medicare	$80.56
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Humana Medicare	$80.56
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: Kaiser Permanente Medicare	$80.56
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: Ohana Health Plan Medicaid	$80.56
Rate for Payer: Ohana Health Plan Medicare	$80.56
Rate for Payer: UnitedHealthcare Medicare	$80.56
Rate for Payer: University Health Alliance Commercial	$77.26

PILLOW HIP ABDUCT SML

Facility

$106.00

Hospital Revenue Code	271
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: MDX Hawaii PPO	$102.82

PILOCARPINE 1 % EYE DROPS [6279]

Facility

$279.00

Service Code	NDC 70069018101
Hospital Revenue Code	637
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$270.63
Rate for Payer: AlohaCare Medicaid	$139.50
Rate for Payer: AlohaCare Medicare	$212.04
Rate for Payer: Cash Price	$167.40
Rate for Payer: Devoted Health Medicare	$234.36
Rate for Payer: Hawaii Medical Service Association Medicare	$212.04
Rate for Payer: Hawaii Western Management Group Commercial	$265.05
Rate for Payer: Health Management Network Commercial	$237.15
Rate for Payer: Humana Medicare	$212.04
Rate for Payer: Kaiser Permanente Commercial	$251.10
Rate for Payer: Kaiser Permanente Medicaid	$142.29
Rate for Payer: Kaiser Permanente Medicare	$212.04
Rate for Payer: MDX Hawaii PPO	$270.63
Rate for Payer: Ohana Health Plan Medicaid	$212.04
Rate for Payer: Ohana Health Plan Medicare	$212.04
Rate for Payer: UnitedHealthcare Medicare	$212.04
Rate for Payer: University Health Alliance Commercial	$203.36

PILOCARPINE 1 % EYE DROPS [6279]

Facility

$296.00

Service Code	NDC 61314020315
Hospital Revenue Code	637
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$287.12
Rate for Payer: AlohaCare Medicaid	$148.00
Rate for Payer: AlohaCare Medicare	$224.96
Rate for Payer: Cash Price	$177.60
Rate for Payer: Devoted Health Medicare	$248.64
Rate for Payer: Hawaii Medical Service Association Medicare	$224.96
Rate for Payer: Hawaii Western Management Group Commercial	$281.20
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: Humana Medicare	$224.96
Rate for Payer: Kaiser Permanente Commercial	$266.40
Rate for Payer: Kaiser Permanente Medicaid	$150.96
Rate for Payer: Kaiser Permanente Medicare	$224.96
Rate for Payer: MDX Hawaii PPO	$287.12
Rate for Payer: Ohana Health Plan Medicaid	$224.96
Rate for Payer: Ohana Health Plan Medicare	$224.96
Rate for Payer: UnitedHealthcare Medicare	$224.96
Rate for Payer: University Health Alliance Commercial	$215.75

PILOCARPINE 1 % EYE DROPS [6279]

Facility

$296.00

Service Code	NDC 61314020315
Hospital Revenue Code	250
Min. Negotiated Rate	$251.60
Max. Negotiated Rate	$287.12
Rate for Payer: Cash Price	$177.60
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: Kaiser Permanente Commercial	$266.40
Rate for Payer: MDX Hawaii PPO	$287.12

PILOCARPINE 1 % EYE DROPS [6279]

Facility

$279.00

Service Code	NDC 70069018101
Hospital Revenue Code	250
Min. Negotiated Rate	$237.15
Max. Negotiated Rate	$270.63
Rate for Payer: Cash Price	$167.40
Rate for Payer: Health Management Network Commercial	$237.15
Rate for Payer: Kaiser Permanente Commercial	$251.10
Rate for Payer: MDX Hawaii PPO	$270.63

PILOCARPINE 2 % EYE DROPS [6280]

Facility

$285.00

Service Code	NDC 70069019101
Hospital Revenue Code	250
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$171.00
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: MDX Hawaii PPO	$276.45

PILOCARPINE 2 % EYE DROPS [6280]

Facility

$285.00

Service Code	NDC 70069019101
Hospital Revenue Code	637
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$276.45
Rate for Payer: AlohaCare Medicaid	$142.50
Rate for Payer: AlohaCare Medicare	$216.60
Rate for Payer: Cash Price	$171.00
Rate for Payer: Devoted Health Medicare	$239.40
Rate for Payer: Hawaii Medical Service Association Medicare	$216.60
Rate for Payer: Hawaii Western Management Group Commercial	$270.75
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Humana Medicare	$216.60
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: Kaiser Permanente Medicaid	$145.35
Rate for Payer: Kaiser Permanente Medicare	$216.60
Rate for Payer: MDX Hawaii PPO	$276.45
Rate for Payer: Ohana Health Plan Medicaid	$216.60
Rate for Payer: Ohana Health Plan Medicare	$216.60
Rate for Payer: UnitedHealthcare Medicare	$216.60
Rate for Payer: University Health Alliance Commercial	$207.74

PILOCARPINE 4 % EYE DROPS [6282]

Facility

$318.00

Service Code	NDC 61314020615
Hospital Revenue Code	250
Min. Negotiated Rate	$270.30
Max. Negotiated Rate	$308.46
Rate for Payer: Cash Price	$190.80
Rate for Payer: Health Management Network Commercial	$270.30
Rate for Payer: Kaiser Permanente Commercial	$286.20
Rate for Payer: MDX Hawaii PPO	$308.46

PILOCARPINE 4 % EYE DROPS [6282]

Facility

$318.00

Service Code	NDC 61314020615
Hospital Revenue Code	637
Min. Negotiated Rate	$159.00
Max. Negotiated Rate	$308.46
Rate for Payer: AlohaCare Medicaid	$159.00
Rate for Payer: AlohaCare Medicare	$241.68
Rate for Payer: Cash Price	$190.80
Rate for Payer: Devoted Health Medicare	$267.12
Rate for Payer: Hawaii Medical Service Association Medicare	$241.68
Rate for Payer: Hawaii Western Management Group Commercial	$302.10
Rate for Payer: Health Management Network Commercial	$270.30
Rate for Payer: Humana Medicare	$241.68
Rate for Payer: Kaiser Permanente Commercial	$286.20
Rate for Payer: Kaiser Permanente Medicaid	$162.18
Rate for Payer: Kaiser Permanente Medicare	$241.68
Rate for Payer: MDX Hawaii PPO	$308.46
Rate for Payer: Ohana Health Plan Medicaid	$241.68
Rate for Payer: Ohana Health Plan Medicare	$241.68
Rate for Payer: UnitedHealthcare Medicare	$241.68
Rate for Payer: University Health Alliance Commercial	$231.79

PILOCARPINE 4 % EYE DROPS [6282]

Facility

$299.00

Service Code	NDC 70069020101
Hospital Revenue Code	637
Min. Negotiated Rate	$149.50
Max. Negotiated Rate	$290.03
Rate for Payer: AlohaCare Medicaid	$149.50
Rate for Payer: AlohaCare Medicare	$227.24
Rate for Payer: Cash Price	$179.40
Rate for Payer: Devoted Health Medicare	$251.16
Rate for Payer: Hawaii Medical Service Association Medicare	$227.24
Rate for Payer: Hawaii Western Management Group Commercial	$284.05
Rate for Payer: Health Management Network Commercial	$254.15
Rate for Payer: Humana Medicare	$227.24
Rate for Payer: Kaiser Permanente Commercial	$269.10
Rate for Payer: Kaiser Permanente Medicaid	$152.49
Rate for Payer: Kaiser Permanente Medicare	$227.24
Rate for Payer: MDX Hawaii PPO	$290.03
Rate for Payer: Ohana Health Plan Medicaid	$227.24
Rate for Payer: Ohana Health Plan Medicare	$227.24
Rate for Payer: UnitedHealthcare Medicare	$227.24
Rate for Payer: University Health Alliance Commercial	$217.94

PILOCARPINE 4 % EYE DROPS [6282]

Facility

$299.00

Service Code	NDC 70069020101
Hospital Revenue Code	250
Min. Negotiated Rate	$254.15
Max. Negotiated Rate	$290.03
Rate for Payer: Cash Price	$179.40
Rate for Payer: Health Management Network Commercial	$254.15
Rate for Payer: Kaiser Permanente Commercial	$269.10
Rate for Payer: MDX Hawaii PPO	$290.03

PIN 4.5 POSITIONING #298.803S

Facility

$815.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$456.40
Max. Negotiated Rate	$790.55
Rate for Payer: Cash Price	$489.00
Rate for Payer: Hawaii Western Management Group Commercial	$570.50
Rate for Payer: Health Management Network Commercial	$692.75
Rate for Payer: Kaiser Permanente Commercial	$733.50
Rate for Payer: MDX Hawaii PPO	$790.55
Rate for Payer: University Health Alliance Commercial	$456.40

PIN 4.5 POSITIONING #298.803S

Facility

$815.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$407.50
Max. Negotiated Rate	$790.55
Rate for Payer: AlohaCare Medicaid	$407.50
Rate for Payer: AlohaCare Medicare	$619.40
Rate for Payer: Cash Price	$489.00
Rate for Payer: Devoted Health Medicare	$684.60
Rate for Payer: Hawaii Medical Service Association Medicare	$619.40
Rate for Payer: Hawaii Western Management Group Commercial	$570.50
Rate for Payer: Health Management Network Commercial	$692.75
Rate for Payer: Humana Medicare	$619.40
Rate for Payer: Kaiser Permanente Commercial	$733.50
Rate for Payer: Kaiser Permanente Medicaid	$415.65
Rate for Payer: Kaiser Permanente Medicare	$619.40
Rate for Payer: MDX Hawaii PPO	$790.55
Rate for Payer: Ohana Health Plan Medicaid	$619.40
Rate for Payer: Ohana Health Plan Medicare	$619.40
Rate for Payer: UnitedHealthcare Medicare	$619.40
Rate for Payer: University Health Alliance Commercial	$456.40

PIN 5018-5-150

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$353.36
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN 5018-5-150

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$315.50
Max. Negotiated Rate	$612.07
Rate for Payer: AlohaCare Medicaid	$315.50
Rate for Payer: AlohaCare Medicare	$479.56
Rate for Payer: Cash Price	$378.60
Rate for Payer: Devoted Health Medicare	$530.04
Rate for Payer: Hawaii Medical Service Association Medicare	$479.56
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Humana Medicare	$479.56
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: Kaiser Permanente Medicare	$479.56
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: Ohana Health Plan Medicaid	$479.56
Rate for Payer: Ohana Health Plan Medicare	$479.56
Rate for Payer: UnitedHealthcare Medicare	$479.56
Rate for Payer: University Health Alliance Commercial	$353.36

PIN 5X250 APEX HALF 5018-7-250

Facility

$852.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$477.12
Max. Negotiated Rate	$826.44
Rate for Payer: Cash Price	$511.20
Rate for Payer: Hawaii Western Management Group Commercial	$596.40
Rate for Payer: Health Management Network Commercial	$724.20
Rate for Payer: Kaiser Permanente Commercial	$766.80
Rate for Payer: MDX Hawaii PPO	$826.44
Rate for Payer: University Health Alliance Commercial	$477.12

PIN 5X250 APEX HALF 5018-7-250

Facility

$852.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$826.44
Rate for Payer: AlohaCare Medicaid	$426.00
Rate for Payer: AlohaCare Medicare	$647.52
Rate for Payer: Cash Price	$511.20
Rate for Payer: Devoted Health Medicare	$715.68
Rate for Payer: Hawaii Medical Service Association Medicare	$647.52
Rate for Payer: Hawaii Western Management Group Commercial	$596.40
Rate for Payer: Health Management Network Commercial	$724.20
Rate for Payer: Humana Medicare	$647.52
Rate for Payer: Kaiser Permanente Commercial	$766.80
Rate for Payer: Kaiser Permanente Medicaid	$434.52
Rate for Payer: Kaiser Permanente Medicare	$647.52
Rate for Payer: MDX Hawaii PPO	$826.44
Rate for Payer: Ohana Health Plan Medicaid	$647.52
Rate for Payer: Ohana Health Plan Medicare	$647.52
Rate for Payer: UnitedHealthcare Medicare	$647.52
Rate for Payer: University Health Alliance Commercial	$477.12

PIN 5X25 APEX HALF 5018-6-200

Facility

$547.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$273.50
Max. Negotiated Rate	$530.59
Rate for Payer: AlohaCare Medicaid	$273.50
Rate for Payer: AlohaCare Medicare	$415.72
Rate for Payer: Cash Price	$328.20
Rate for Payer: Devoted Health Medicare	$459.48
Rate for Payer: Hawaii Medical Service Association Medicare	$415.72
Rate for Payer: Hawaii Western Management Group Commercial	$382.90
Rate for Payer: Health Management Network Commercial	$464.95
Rate for Payer: Humana Medicare	$415.72
Rate for Payer: Kaiser Permanente Commercial	$492.30
Rate for Payer: Kaiser Permanente Medicaid	$278.97
Rate for Payer: Kaiser Permanente Medicare	$415.72
Rate for Payer: MDX Hawaii PPO	$530.59
Rate for Payer: Ohana Health Plan Medicaid	$415.72
Rate for Payer: Ohana Health Plan Medicare	$415.72
Rate for Payer: UnitedHealthcare Medicare	$415.72
Rate for Payer: University Health Alliance Commercial	$306.32

PIN 5X25 APEX HALF 5018-6-200

Facility

$547.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$306.32
Max. Negotiated Rate	$530.59
Rate for Payer: Cash Price	$328.20
Rate for Payer: Hawaii Western Management Group Commercial	$382.90
Rate for Payer: Health Management Network Commercial	$464.95
Rate for Payer: Kaiser Permanente Commercial	$492.30
Rate for Payer: MDX Hawaii PPO	$530.59
Rate for Payer: University Health Alliance Commercial	$306.32

PIN APEX 5MM 5018-6-150

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$315.50
Max. Negotiated Rate	$612.07
Rate for Payer: AlohaCare Medicaid	$315.50
Rate for Payer: AlohaCare Medicare	$479.56
Rate for Payer: Cash Price	$378.60
Rate for Payer: Devoted Health Medicare	$530.04
Rate for Payer: Hawaii Medical Service Association Medicare	$479.56
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Humana Medicare	$479.56
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: Kaiser Permanente Medicare	$479.56
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: Ohana Health Plan Medicaid	$479.56
Rate for Payer: Ohana Health Plan Medicare	$479.56
Rate for Payer: UnitedHealthcare Medicare	$479.56
Rate for Payer: University Health Alliance Commercial	$353.36

PIN APEX 5MM 5018-6-150

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$353.36
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN APEX S/D HALF 5018-5-120

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$315.50
Max. Negotiated Rate	$612.07
Rate for Payer: AlohaCare Medicaid	$315.50
Rate for Payer: AlohaCare Medicare	$479.56
Rate for Payer: Cash Price	$378.60
Rate for Payer: Devoted Health Medicare	$530.04
Rate for Payer: Hawaii Medical Service Association Medicare	$479.56
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Humana Medicare	$479.56
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: Kaiser Permanente Medicare	$479.56
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: Ohana Health Plan Medicaid	$479.56
Rate for Payer: Ohana Health Plan Medicare	$479.56
Rate for Payer: UnitedHealthcare Medicare	$479.56
Rate for Payer: University Health Alliance Commercial	$353.36

Know your out-of-pocket cost for care.

All Charges