Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

POST 30D ANGLE 11MM 4922-2-140

Facility

$488.00

Hospital Revenue Code	278
Min. Negotiated Rate	$273.28
Max. Negotiated Rate	$473.36
Rate for Payer: Cash Price	$292.80
Rate for Payer: Hawaii Western Management Group Commercial	$341.60
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: Kaiser Permanente Commercial	$439.20
Rate for Payer: MDX Hawaii PPO	$473.36
Rate for Payer: University Health Alliance Commercial	$273.28

POST 30D ANGLE 11MM 4922-2-140

Facility

$488.00

Hospital Revenue Code	278
Min. Negotiated Rate	$244.00
Max. Negotiated Rate	$473.36
Rate for Payer: AlohaCare Medicaid	$244.00
Rate for Payer: AlohaCare Medicare	$370.88
Rate for Payer: Cash Price	$292.80
Rate for Payer: Devoted Health Medicare	$409.92
Rate for Payer: Hawaii Medical Service Association Medicare	$370.88
Rate for Payer: Hawaii Western Management Group Commercial	$341.60
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: Humana Medicare	$370.88
Rate for Payer: Kaiser Permanente Commercial	$439.20
Rate for Payer: Kaiser Permanente Medicaid	$248.88
Rate for Payer: Kaiser Permanente Medicare	$370.88
Rate for Payer: MDX Hawaii PPO	$473.36
Rate for Payer: Ohana Health Plan Medicaid	$370.88
Rate for Payer: Ohana Health Plan Medicare	$370.88
Rate for Payer: UnitedHealthcare Medicare	$370.88
Rate for Payer: University Health Alliance Commercial	$273.28

POST 90 DEG 4922-2-160

Facility

$901.00

Hospital Revenue Code	272
Min. Negotiated Rate	$450.50
Max. Negotiated Rate	$873.97
Rate for Payer: AlohaCare Medicaid	$450.50
Rate for Payer: AlohaCare Medicare	$684.76
Rate for Payer: Cash Price	$540.60
Rate for Payer: Devoted Health Medicare	$756.84
Rate for Payer: Hawaii Medical Service Association Medicare	$684.76
Rate for Payer: Hawaii Western Management Group Commercial	$855.95
Rate for Payer: Health Management Network Commercial	$765.85
Rate for Payer: Humana Medicare	$684.76
Rate for Payer: Kaiser Permanente Commercial	$810.90
Rate for Payer: Kaiser Permanente Medicaid	$459.51
Rate for Payer: Kaiser Permanente Medicare	$684.76
Rate for Payer: MDX Hawaii PPO	$873.97
Rate for Payer: Ohana Health Plan Medicaid	$684.76
Rate for Payer: Ohana Health Plan Medicare	$684.76
Rate for Payer: UnitedHealthcare Medicare	$684.76
Rate for Payer: University Health Alliance Commercial	$656.74

POST 90 DEG 4922-2-160

Facility

$901.00

Hospital Revenue Code	272
Min. Negotiated Rate	$765.85
Max. Negotiated Rate	$873.97
Rate for Payer: Cash Price	$540.60
Rate for Payer: Health Management Network Commercial	$765.85
Rate for Payer: Kaiser Permanente Commercial	$810.90
Rate for Payer: MDX Hawaii PPO	$873.97

POSTLAT DSTL HUM 02.117.307

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,374.50
Max. Negotiated Rate	$2,666.53
Rate for Payer: AlohaCare Medicaid	$1,374.50
Rate for Payer: AlohaCare Medicare	$2,089.24
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Devoted Health Medicare	$2,309.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,089.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Humana Medicare	$2,089.24
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: Kaiser Permanente Medicaid	$1,401.99
Rate for Payer: Kaiser Permanente Medicare	$2,089.24
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: Ohana Health Plan Medicaid	$2,089.24
Rate for Payer: Ohana Health Plan Medicare	$2,089.24
Rate for Payer: UnitedHealthcare Medicare	$2,089.24
Rate for Payer: University Health Alliance Commercial	$1,539.44

POSTLAT DSTL HUM 02.117.307

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.44
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$21,545.12

Service Code	MSDRG 862
Min. Negotiated Rate	$21,545.12
Max. Negotiated Rate	$21,545.12
Rate for Payer: Hawaii Medical Service Association Commercial	$21,545.12

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$21,545.12

Service Code	MSDRG 863
Min. Negotiated Rate	$21,545.12
Max. Negotiated Rate	$21,545.12
Rate for Payer: Hawaii Medical Service Association Commercial	$21,545.12

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$37,899.50

Service Code	MSDRG 857
Min. Negotiated Rate	$37,899.50
Max. Negotiated Rate	$37,899.50
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$37,899.50

Service Code	MSDRG 856
Min. Negotiated Rate	$37,899.50
Max. Negotiated Rate	$37,899.50
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$37,899.50

Service Code	MSDRG 858
Min. Negotiated Rate	$37,899.50
Max. Negotiated Rate	$37,899.50
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50

POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$25,124.12

Service Code	MSDRG 769
Min. Negotiated Rate	$25,124.12
Max. Negotiated Rate	$25,124.12
Rate for Payer: Hawaii Medical Service Association Commercial	$25,124.12

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility

$9,599.31

Service Code	MSDRG 776
Min. Negotiated Rate	$9,599.31
Max. Negotiated Rate	$9,599.31
Rate for Payer: Hawaii Medical Service Association Commercial	$9,599.31

POST STRAIGHT 11MM 4922-2-120

Facility

$594.00

Hospital Revenue Code	278
Min. Negotiated Rate	$332.64
Max. Negotiated Rate	$576.18
Rate for Payer: Cash Price	$356.40
Rate for Payer: Hawaii Western Management Group Commercial	$415.80
Rate for Payer: Health Management Network Commercial	$504.90
Rate for Payer: Kaiser Permanente Commercial	$534.60
Rate for Payer: MDX Hawaii PPO	$576.18
Rate for Payer: University Health Alliance Commercial	$332.64

POST STRAIGHT 11MM 4922-2-120

Facility

$594.00

Hospital Revenue Code	278
Min. Negotiated Rate	$297.00
Max. Negotiated Rate	$576.18
Rate for Payer: AlohaCare Medicaid	$297.00
Rate for Payer: AlohaCare Medicare	$451.44
Rate for Payer: Cash Price	$356.40
Rate for Payer: Devoted Health Medicare	$498.96
Rate for Payer: Hawaii Medical Service Association Medicare	$451.44
Rate for Payer: Hawaii Western Management Group Commercial	$415.80
Rate for Payer: Health Management Network Commercial	$504.90
Rate for Payer: Humana Medicare	$451.44
Rate for Payer: Kaiser Permanente Commercial	$534.60
Rate for Payer: Kaiser Permanente Medicaid	$302.94
Rate for Payer: Kaiser Permanente Medicare	$451.44
Rate for Payer: MDX Hawaii PPO	$576.18
Rate for Payer: Ohana Health Plan Medicaid	$451.44
Rate for Payer: Ohana Health Plan Medicare	$451.44
Rate for Payer: UnitedHealthcare Medicare	$451.44
Rate for Payer: University Health Alliance Commercial	$332.64

POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN [11057]

Facility

$118.00

Service Code	NDC 67716000000
Hospital Revenue Code	250
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN [11057]

Facility

$118.00

Service Code	NDC 67716000000
Hospital Revenue Code	637
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$89.68
Rate for Payer: Cash Price	$70.80
Rate for Payer: Devoted Health Medicare	$99.12
Rate for Payer: Hawaii Medical Service Association Medicare	$89.68
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$89.68
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$89.68
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$89.68
Rate for Payer: Ohana Health Plan Medicare	$89.68
Rate for Payer: UnitedHealthcare Medicare	$89.68
Rate for Payer: University Health Alliance Commercial	$86.01

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

$23.00

Service Code	NDC 00409818311
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

$23.00

Service Code	NDC 00409818301
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

$23.00

Service Code	NDC 51754200104
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11074]

Facility

$21.00

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11074]

Facility

$21.00

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$15.96
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$17.64
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$15.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$15.96
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$15.96
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$15.96
Rate for Payer: Ohana Health Plan Medicare	$15.96
Rate for Payer: UnitedHealthcare Medicaid	$12.60
Rate for Payer: UnitedHealthcare Medicare	$15.96
Rate for Payer: University Health Alliance Commercial	$15.31

POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9799]

Facility

$42.00

Service Code	NDC 00264763400
Hospital Revenue Code	258
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$25.20
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: MDX Hawaii PPO	$40.74

POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9799]

Facility

$42.00

Service Code	NDC 00264763400
Hospital Revenue Code	258
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$40.74
Rate for Payer: AlohaCare Medicaid	$21.00
Rate for Payer: AlohaCare Medicare	$31.92
Rate for Payer: Cash Price	$25.20
Rate for Payer: Devoted Health Medicare	$35.28
Rate for Payer: Hawaii Medical Service Association Medicare	$31.92
Rate for Payer: Hawaii Western Management Group Commercial	$39.90
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Humana Medicare	$31.92
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Medicaid	$21.42
Rate for Payer: Kaiser Permanente Medicare	$31.92
Rate for Payer: MDX Hawaii PPO	$40.74
Rate for Payer: Ohana Health Plan Medicaid	$31.92
Rate for Payer: Ohana Health Plan Medicare	$31.92
Rate for Payer: UnitedHealthcare Medicare	$31.92
Rate for Payer: University Health Alliance Commercial	$30.61

POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11076]

Facility

$18.00

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$15.96
Rate for Payer: AlohaCare Medicare	$13.68
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$15.12
Rate for Payer: Devoted Health Medicare	$17.64
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$15.96
Rate for Payer: Hawaii Medical Service Association Medicare	$13.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$13.68
Rate for Payer: Humana Medicare	$15.96
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$13.68
Rate for Payer: Kaiser Permanente Medicare	$15.96
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$15.96
Rate for Payer: Ohana Health Plan Medicaid	$13.68
Rate for Payer: Ohana Health Plan Medicare	$13.68
Rate for Payer: Ohana Health Plan Medicare	$15.96
Rate for Payer: UnitedHealthcare Medicaid	$12.60
Rate for Payer: UnitedHealthcare Medicaid	$10.80
Rate for Payer: UnitedHealthcare Medicare	$13.68
Rate for Payer: UnitedHealthcare Medicare	$15.96
Rate for Payer: University Health Alliance Commercial	$13.12
Rate for Payer: University Health Alliance Commercial	$15.31

Know your out-of-pocket cost for care.

All Charges