Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PR MASTOPEXY

Professional

Both

$1,400.00

Service Code	HCPCS 19316
Min. Negotiated Rate	$666.12
Max. Negotiated Rate	$1,190.00
Rate for Payer: AlohaCare Medicaid	$814.91
Rate for Payer: AlohaCare Medicare	$739.87
Rate for Payer: Cash Price	$840.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Devoted Health Medicare	$813.86
Rate for Payer: Hawaii Medical Service Association Medicare	$739.87
Rate for Payer: Hawaii Western Management Group Commercial	$666.12
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: Kaiser Permanente Commercial	$887.84
Rate for Payer: Kaiser Permanente Medicaid	$887.84
Rate for Payer: Kaiser Permanente Medicare	$887.84
Rate for Payer: Ohana Health Plan Medicaid	$814.91
Rate for Payer: Ohana Health Plan Medicare	$739.87
Rate for Payer: UnitedHealthcare Medicaid	$814.91
Rate for Payer: UnitedHealthcare Medicare	$739.87

PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP

Professional

Both

$963.25

Service Code	HCPCS 19020
Min. Negotiated Rate	$227.24
Max. Negotiated Rate	$818.76
Rate for Payer: AlohaCare Medicaid	$326.92
Rate for Payer: AlohaCare Medicare	$325.43
Rate for Payer: Cash Price	$577.95
Rate for Payer: Cash Price	$577.95
Rate for Payer: Devoted Health Medicare	$357.97
Rate for Payer: Hawaii Medical Service Association ABD	$326.92
Rate for Payer: Hawaii Medical Service Association Commercial	$501.20
Rate for Payer: Hawaii Medical Service Association Medicare	$325.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$326.92
Rate for Payer: Hawaii Western Management Group Commercial	$227.24
Rate for Payer: Health Management Network Commercial	$818.76
Rate for Payer: Kaiser Permanente Commercial	$390.52
Rate for Payer: Kaiser Permanente Medicaid	$390.52
Rate for Payer: Kaiser Permanente Medicare	$390.52
Rate for Payer: Ohana Health Plan Medicaid	$326.92
Rate for Payer: Ohana Health Plan Medicare	$325.43
Rate for Payer: UnitedHealthcare Medicaid	$326.92
Rate for Payer: UnitedHealthcare Medicare	$325.43
Rate for Payer: University Health Alliance Commercial	$354.70

PR MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN

Professional

Both

$224.51

Service Code	HCPCS 36596
Min. Negotiated Rate	$41.32
Max. Negotiated Rate	$190.83
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$41.32
Rate for Payer: Cash Price	$134.71
Rate for Payer: Cash Price	$134.71
Rate for Payer: Devoted Health Medicare	$45.45
Rate for Payer: Hawaii Medical Service Association ABD	$45.00
Rate for Payer: Hawaii Medical Service Association Commercial	$68.93
Rate for Payer: Hawaii Medical Service Association Medicare	$41.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$45.00
Rate for Payer: Health Management Network Commercial	$190.83
Rate for Payer: Kaiser Permanente Commercial	$49.58
Rate for Payer: Kaiser Permanente Medicaid	$49.58
Rate for Payer: Kaiser Permanente Medicare	$49.58
Rate for Payer: Ohana Health Plan Medicaid	$45.00
Rate for Payer: Ohana Health Plan Medicare	$41.32
Rate for Payer: UnitedHealthcare Medicaid	$45.00
Rate for Payer: UnitedHealthcare Medicare	$41.32
Rate for Payer: University Health Alliance Commercial	$68.36

PR MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS

Professional

Both

$1,113.33

Service Code	HCPCS 36595
Min. Negotiated Rate	$155.41
Max. Negotiated Rate	$946.33
Rate for Payer: AlohaCare Medicaid	$176.30
Rate for Payer: AlohaCare Medicare	$155.41
Rate for Payer: Cash Price	$668.00
Rate for Payer: Cash Price	$668.00
Rate for Payer: Devoted Health Medicare	$170.95
Rate for Payer: Hawaii Medical Service Association ABD	$176.30
Rate for Payer: Hawaii Medical Service Association Commercial	$279.36
Rate for Payer: Hawaii Medical Service Association Medicare	$155.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$176.30
Rate for Payer: Health Management Network Commercial	$946.33
Rate for Payer: Kaiser Permanente Commercial	$186.49
Rate for Payer: Kaiser Permanente Medicaid	$186.49
Rate for Payer: Kaiser Permanente Medicare	$186.49
Rate for Payer: Ohana Health Plan Medicaid	$176.30
Rate for Payer: Ohana Health Plan Medicare	$155.41
Rate for Payer: UnitedHealthcare Medicaid	$176.30
Rate for Payer: UnitedHealthcare Medicare	$155.41
Rate for Payer: University Health Alliance Commercial	$246.52

PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ

Professional

Both

$583.00

Service Code	HCPCS 90710
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$495.55
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$349.80
Rate for Payer: Cash Price	$349.80
Rate for Payer: Hawaii Western Management Group Commercial	$230.98
Rate for Payer: Health Management Network Commercial	$495.55
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ

Professional

Both

$221.00

Service Code	HCPCS 90707
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$187.85
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$132.60
Rate for Payer: Cash Price	$132.60
Rate for Payer: Hawaii Western Management Group Commercial	$80.64
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

PR MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP

Professional

Both

$25.00

Service Code	HCPCS 51798
Min. Negotiated Rate	$12.81
Max. Negotiated Rate	$21.25
Rate for Payer: AlohaCare Medicaid	$12.81
Rate for Payer: AlohaCare Medicare	$14.06
Rate for Payer: Cash Price	$15.00
Rate for Payer: Cash Price	$15.00
Rate for Payer: Devoted Health Medicare	$15.47
Rate for Payer: Hawaii Medical Service Association Medicare	$14.06
Rate for Payer: Hawaii Western Management Group Commercial	$18.98
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$16.87
Rate for Payer: Kaiser Permanente Medicaid	$16.87
Rate for Payer: Kaiser Permanente Medicare	$16.87
Rate for Payer: Ohana Health Plan Medicaid	$12.81
Rate for Payer: Ohana Health Plan Medicare	$14.06
Rate for Payer: UnitedHealthcare Medicaid	$12.81
Rate for Payer: UnitedHealthcare Medicare	$14.06

PR MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT

Professional

Both

$166.00

Service Code	HCPCS 53020
Min. Negotiated Rate	$86.15
Max. Negotiated Rate	$141.10
Rate for Payer: AlohaCare Medicaid	$96.68
Rate for Payer: AlohaCare Medicare	$86.15
Rate for Payer: Cash Price	$99.60
Rate for Payer: Cash Price	$99.60
Rate for Payer: Devoted Health Medicare	$94.77
Rate for Payer: Hawaii Medical Service Association Medicare	$86.15
Rate for Payer: Hawaii Western Management Group Commercial	$106.86
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$103.38
Rate for Payer: Kaiser Permanente Medicaid	$103.38
Rate for Payer: Kaiser Permanente Medicare	$103.38
Rate for Payer: Ohana Health Plan Medicaid	$96.68
Rate for Payer: Ohana Health Plan Medicare	$86.15
Rate for Payer: UnitedHealthcare Medicaid	$96.68
Rate for Payer: UnitedHealthcare Medicare	$86.15

PR MED ABORTION INC ALL EX DRUG

Professional

Both

$32.00

Service Code	HCPCS S0199
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$424.51
Rate for Payer: AlohaCare Medicaid	$424.51
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Hawaii Western Management Group Commercial	$46.52
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Ohana Health Plan Medicaid	$424.51
Rate for Payer: UnitedHealthcare Medicaid	$424.51

PR MED GENETICS&GENETIC COUNSELING SVCS EACH 30 MIN

Professional

Both

$99.00

Service Code	HCPCS 96041
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$84.15
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15

PR MEDICAL RECORDS REVIEW

Professional

Both

$150.00

Service Code	HCPCS 98394
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50

PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT

Professional

Both

$170.56

Service Code	HCPCS 93463
Min. Negotiated Rate	$82.65
Max. Negotiated Rate	$144.98
Rate for Payer: AlohaCare Medicaid	$96.34
Rate for Payer: AlohaCare Medicare	$82.65
Rate for Payer: Cash Price	$102.34
Rate for Payer: Cash Price	$102.34
Rate for Payer: Devoted Health Medicare	$90.92
Rate for Payer: Hawaii Medical Service Association Medicare	$82.65
Rate for Payer: Hawaii Western Management Group Commercial	$105.61
Rate for Payer: Health Management Network Commercial	$144.98
Rate for Payer: Kaiser Permanente Commercial	$99.18
Rate for Payer: Kaiser Permanente Medicaid	$99.18
Rate for Payer: Kaiser Permanente Medicare	$99.18
Rate for Payer: Ohana Health Plan Medicaid	$96.34
Rate for Payer: Ohana Health Plan Medicare	$82.65
Rate for Payer: UnitedHealthcare Medicaid	$96.34
Rate for Payer: UnitedHealthcare Medicare	$82.65

PR MEDICATION THERAPY EACH ADDITIONAL 15 MIN

Professional

Both

$44.00

Service Code	HCPCS 99607
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Management Network Commercial	$37.40

PR MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT

Professional

Both

$107.00

Service Code	HCPCS 99606
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$90.95
Rate for Payer: Cash Price	$64.20
Rate for Payer: Health Management Network Commercial	$90.95

PR MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT

Professional

Both

$138.00

Service Code	HCPCS 99605
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$117.30
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30

PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE

Professional

Both

$700.00

Service Code	HCPCS 90734
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$595.00
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Hawaii Western Management Group Commercial	$125.47
Rate for Payer: Health Management Network Commercial	$595.00
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE

Professional

Both

$624.00

Service Code	HCPCS 90619
Min. Negotiated Rate	$530.40
Max. Negotiated Rate	$530.40
Rate for Payer: Cash Price	$374.40
Rate for Payer: Health Management Network Commercial	$530.40

PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM

Professional

Both

$304.00

Service Code	HCPCS 90620
Min. Negotiated Rate	$193.50
Max. Negotiated Rate	$258.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Hawaii Western Management Group Commercial	$193.50
Rate for Payer: Health Management Network Commercial	$258.40

PR MENIGCCAL PNTVLNT MENACWY TT MENB FHBP VACC IM

Professional

Both

$624.00

Service Code	HCPCS 90623
Min. Negotiated Rate	$530.40
Max. Negotiated Rate	$530.40
Rate for Payer: Cash Price	$374.40
Rate for Payer: Health Management Network Commercial	$530.40

PR METACARP FX ORTHOSIS PRE OTS

Professional

Both

$198.00

Service Code	HCPCS L3918
Min. Negotiated Rate	$84.77
Max. Negotiated Rate	$168.30
Rate for Payer: AlohaCare Medicaid	$88.51
Rate for Payer: AlohaCare Medicare	$115.37
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
Rate for Payer: Devoted Health Medicare	$126.91
Rate for Payer: Hawaii Medical Service Association Medicare	$115.37
Rate for Payer: Hawaii Western Management Group Commercial	$84.77
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Kaiser Permanente Commercial	$138.44
Rate for Payer: Kaiser Permanente Medicaid	$138.44
Rate for Payer: Kaiser Permanente Medicare	$138.44
Rate for Payer: Ohana Health Plan Medicaid	$88.51
Rate for Payer: Ohana Health Plan Medicare	$115.37
Rate for Payer: UnitedHealthcare Medicaid	$88.51
Rate for Payer: UnitedHealthcare Medicare	$115.37

PR METATARSECTOMY

Professional

Both

$1,033.08

Service Code	HCPCS 28140
Min. Negotiated Rate	$368.16
Max. Negotiated Rate	$878.12
Rate for Payer: AlohaCare Medicaid	$437.48
Rate for Payer: AlohaCare Medicare	$401.97
Rate for Payer: Cash Price	$619.85
Rate for Payer: Cash Price	$619.85
Rate for Payer: Devoted Health Medicare	$442.17
Rate for Payer: Hawaii Medical Service Association ABD	$437.48
Rate for Payer: Hawaii Medical Service Association Commercial	$679.97
Rate for Payer: Hawaii Medical Service Association Medicare	$401.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$437.48
Rate for Payer: Hawaii Western Management Group Commercial	$368.16
Rate for Payer: Health Management Network Commercial	$878.12
Rate for Payer: Kaiser Permanente Commercial	$482.36
Rate for Payer: Kaiser Permanente Medicaid	$482.36
Rate for Payer: Kaiser Permanente Medicare	$482.36
Rate for Payer: Ohana Health Plan Medicaid	$437.48
Rate for Payer: Ohana Health Plan Medicare	$401.97
Rate for Payer: UnitedHealthcare Medicaid	$437.48
Rate for Payer: UnitedHealthcare Medicare	$401.97
Rate for Payer: University Health Alliance Commercial	$575.70

PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR

Professional

Both

$5,006.00

Service Code	HCPCS 47361
Min. Negotiated Rate	$1,322.10
Max. Negotiated Rate	$4,255.10
Rate for Payer: AlohaCare Medicaid	$2,922.09
Rate for Payer: AlohaCare Medicare	$2,671.86
Rate for Payer: Cash Price	$3,003.60
Rate for Payer: Cash Price	$3,003.60
Rate for Payer: Devoted Health Medicare	$2,939.05
Rate for Payer: Hawaii Medical Service Association Medicare	$2,671.86
Rate for Payer: Hawaii Western Management Group Commercial	$1,322.10
Rate for Payer: Health Management Network Commercial	$4,255.10
Rate for Payer: Kaiser Permanente Commercial	$3,206.23
Rate for Payer: Kaiser Permanente Medicaid	$3,206.23
Rate for Payer: Kaiser Permanente Medicare	$3,206.23
Rate for Payer: Ohana Health Plan Medicaid	$2,922.09
Rate for Payer: Ohana Health Plan Medicare	$2,671.86
Rate for Payer: UnitedHealthcare Medicaid	$2,922.09
Rate for Payer: UnitedHealthcare Medicare	$2,671.86

PR MICROSURG TQS REQ USE OPERATING MICROSCOPE

Professional

Both

$351.00

Service Code	HCPCS 69990
Min. Negotiated Rate	$183.88
Max. Negotiated Rate	$298.35
Rate for Payer: AlohaCare Medicaid	$204.81
Rate for Payer: AlohaCare Medicare	$183.88
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Devoted Health Medicare	$202.27
Rate for Payer: Hawaii Medical Service Association Medicare	$183.88
Rate for Payer: Hawaii Western Management Group Commercial	$213.72
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Kaiser Permanente Commercial	$220.66
Rate for Payer: Kaiser Permanente Medicaid	$220.66
Rate for Payer: Kaiser Permanente Medicare	$220.66
Rate for Payer: Ohana Health Plan Medicaid	$204.81
Rate for Payer: Ohana Health Plan Medicare	$183.88
Rate for Payer: UnitedHealthcare Medicaid	$204.81
Rate for Payer: UnitedHealthcare Medicare	$183.88

PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC

Professional

Both

$1,245.00

Service Code	HCPCS 69440
Min. Negotiated Rate	$95.16
Max. Negotiated Rate	$1,058.25
Rate for Payer: AlohaCare Medicaid	$740.15
Rate for Payer: AlohaCare Medicare	$654.69
Rate for Payer: Cash Price	$747.00
Rate for Payer: Cash Price	$747.00
Rate for Payer: Devoted Health Medicare	$720.16
Rate for Payer: Hawaii Medical Service Association Medicare	$654.69
Rate for Payer: Hawaii Western Management Group Commercial	$95.16
Rate for Payer: Health Management Network Commercial	$1,058.25
Rate for Payer: Kaiser Permanente Commercial	$785.63
Rate for Payer: Kaiser Permanente Medicaid	$785.63
Rate for Payer: Kaiser Permanente Medicare	$785.63
Rate for Payer: Ohana Health Plan Medicaid	$740.15
Rate for Payer: Ohana Health Plan Medicare	$654.69
Rate for Payer: UnitedHealthcare Medicaid	$740.15
Rate for Payer: UnitedHealthcare Medicare	$654.69

PR MIFEPRISTONE, ORAL, 200 MG

Professional

Both

$140.00

Service Code	HCPCS S0190
Min. Negotiated Rate	$81.05
Max. Negotiated Rate	$119.00
Rate for Payer: AlohaCare Medicaid	$81.05
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$90.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Ohana Health Plan Medicaid	$81.05
Rate for Payer: UnitedHealthcare Medicaid	$81.05

Know your out-of-pocket cost for care.

All Charges