Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

BUR 2.0X54 ROUND 1608-006-087

Facility

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$363.75
Rate for Payer: AlohaCare Medicaid	$187.50
Rate for Payer: AlohaCare Medicare	$285.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Devoted Health Medicare	$315.00
Rate for Payer: Hawaii Medical Service Association Medicare	$285.00
Rate for Payer: Hawaii Western Management Group Commercial	$356.25
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Humana Medicare	$285.00
Rate for Payer: Kaiser Permanente Commercial	$337.50
Rate for Payer: Kaiser Permanente Medicaid	$191.25
Rate for Payer: Kaiser Permanente Medicare	$285.00
Rate for Payer: MDX Hawaii PPO	$363.75
Rate for Payer: Ohana Health Plan Medicaid	$285.00
Rate for Payer: Ohana Health Plan Medicare	$285.00
Rate for Payer: UnitedHealthcare Medicare	$285.00
Rate for Payer: University Health Alliance Commercial	$273.34

BUR 3.0MM ROUND 1608-006-091

Facility

$356.00

Hospital Revenue Code	272
Min. Negotiated Rate	$178.00
Max. Negotiated Rate	$345.32
Rate for Payer: AlohaCare Medicaid	$178.00
Rate for Payer: AlohaCare Medicare	$270.56
Rate for Payer: Cash Price	$213.60
Rate for Payer: Devoted Health Medicare	$299.04
Rate for Payer: Hawaii Medical Service Association Medicare	$270.56
Rate for Payer: Hawaii Western Management Group Commercial	$338.20
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Humana Medicare	$270.56
Rate for Payer: Kaiser Permanente Commercial	$320.40
Rate for Payer: Kaiser Permanente Medicaid	$181.56
Rate for Payer: Kaiser Permanente Medicare	$270.56
Rate for Payer: MDX Hawaii PPO	$345.32
Rate for Payer: Ohana Health Plan Medicaid	$270.56
Rate for Payer: Ohana Health Plan Medicare	$270.56
Rate for Payer: UnitedHealthcare Medicare	$270.56
Rate for Payer: University Health Alliance Commercial	$259.49

BUR 3.0MM ROUND 1608-006-091

Facility

$356.00

Hospital Revenue Code	272
Min. Negotiated Rate	$302.60
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$213.60
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Kaiser Permanente Commercial	$320.40
Rate for Payer: MDX Hawaii PPO	$345.32

BUR DIAMOND 4MM 15 DEG

Facility

$998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$848.30
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$598.80
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: Kaiser Permanente Commercial	$898.20
Rate for Payer: MDX Hawaii PPO	$968.06

BUR DIAMOND 4MM 15 DEG

Facility

$998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$499.00
Max. Negotiated Rate	$968.06
Rate for Payer: AlohaCare Medicaid	$499.00
Rate for Payer: AlohaCare Medicare	$758.48
Rate for Payer: Cash Price	$598.80
Rate for Payer: Devoted Health Medicare	$838.32
Rate for Payer: Hawaii Medical Service Association Medicare	$758.48
Rate for Payer: Hawaii Western Management Group Commercial	$948.10
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: Humana Medicare	$758.48
Rate for Payer: Kaiser Permanente Commercial	$898.20
Rate for Payer: Kaiser Permanente Medicaid	$508.98
Rate for Payer: Kaiser Permanente Medicare	$758.48
Rate for Payer: MDX Hawaii PPO	$968.06
Rate for Payer: Ohana Health Plan Medicaid	$758.48
Rate for Payer: Ohana Health Plan Medicare	$758.48
Rate for Payer: UnitedHealthcare Medicare	$758.48
Rate for Payer: University Health Alliance Commercial	$727.44

BUR DIAMOND 4MM 70 DEG

Facility

$998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$499.00
Max. Negotiated Rate	$968.06
Rate for Payer: AlohaCare Medicaid	$499.00
Rate for Payer: AlohaCare Medicare	$758.48
Rate for Payer: Cash Price	$598.80
Rate for Payer: Devoted Health Medicare	$838.32
Rate for Payer: Hawaii Medical Service Association Medicare	$758.48
Rate for Payer: Hawaii Western Management Group Commercial	$948.10
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: Humana Medicare	$758.48
Rate for Payer: Kaiser Permanente Commercial	$898.20
Rate for Payer: Kaiser Permanente Medicaid	$508.98
Rate for Payer: Kaiser Permanente Medicare	$758.48
Rate for Payer: MDX Hawaii PPO	$968.06
Rate for Payer: Ohana Health Plan Medicaid	$758.48
Rate for Payer: Ohana Health Plan Medicare	$758.48
Rate for Payer: UnitedHealthcare Medicare	$758.48
Rate for Payer: University Health Alliance Commercial	$727.44

BUR DIAMOND 4MM 70 DEG

Facility

$998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$848.30
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$598.80
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: Kaiser Permanente Commercial	$898.20
Rate for Payer: MDX Hawaii PPO	$968.06

BUR OVAL CUTTING 14-S0903

Facility

$91.00

Hospital Revenue Code	272
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: MDX Hawaii PPO	$88.27

BUR OVAL CUTTING 14-S0903

Facility

$91.00

Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$88.27
Rate for Payer: AlohaCare Medicaid	$45.50
Rate for Payer: AlohaCare Medicare	$69.16
Rate for Payer: Cash Price	$54.60
Rate for Payer: Devoted Health Medicare	$76.44
Rate for Payer: Hawaii Medical Service Association Medicare	$69.16
Rate for Payer: Hawaii Western Management Group Commercial	$86.45
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$69.16
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$69.16
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$69.16
Rate for Payer: Ohana Health Plan Medicare	$69.16
Rate for Payer: UnitedHealthcare Medicare	$69.16
Rate for Payer: University Health Alliance Commercial	$66.33

BURR 12 FLUTE OVAL AR-8550OBT

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: AlohaCare Medicare	$158.08
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$174.72
Rate for Payer: Hawaii Medical Service Association Medicare	$158.08
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$158.08
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$158.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$158.08
Rate for Payer: Ohana Health Plan Medicare	$158.08
Rate for Payer: UnitedHealthcare Medicare	$158.08
Rate for Payer: University Health Alliance Commercial	$151.61

BURR 12 FLUTE OVAL AR-8550OBT

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

BURR 2.2 X 16MM NEURO 7021-815

Facility

$246.00

Hospital Revenue Code	272
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$238.62
Rate for Payer: AlohaCare Medicaid	$123.00
Rate for Payer: AlohaCare Medicare	$186.96
Rate for Payer: Cash Price	$147.60
Rate for Payer: Devoted Health Medicare	$206.64
Rate for Payer: Hawaii Medical Service Association Medicare	$186.96
Rate for Payer: Hawaii Western Management Group Commercial	$233.70
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Humana Medicare	$186.96
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: Kaiser Permanente Medicare	$186.96
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: Ohana Health Plan Medicaid	$186.96
Rate for Payer: Ohana Health Plan Medicare	$186.96
Rate for Payer: UnitedHealthcare Medicare	$186.96
Rate for Payer: University Health Alliance Commercial	$179.31

BURR 2.2 X 16MM NEURO 7021-815

Facility

$246.00

Hospital Revenue Code	272
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$147.60
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: MDX Hawaii PPO	$238.62

BURR 3MM 15 DEG

Facility

$2,430.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,065.50
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: MDX Hawaii PPO	$2,357.10

BURR 3MM 15 DEG

Facility

$2,430.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$2,357.10
Rate for Payer: AlohaCare Medicaid	$1,215.00
Rate for Payer: AlohaCare Medicare	$1,846.80
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Devoted Health Medicare	$2,041.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,846.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,308.50
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Humana Medicare	$1,846.80
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: Kaiser Permanente Medicaid	$1,239.30
Rate for Payer: Kaiser Permanente Medicare	$1,846.80
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: Ohana Health Plan Medicaid	$1,846.80
Rate for Payer: Ohana Health Plan Medicare	$1,846.80
Rate for Payer: UnitedHealthcare Medicare	$1,846.80
Rate for Payer: University Health Alliance Commercial	$1,771.23

BURR 3MM X 25MM NEURO 7021-917

Facility

$216.00

Hospital Revenue Code	272
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$129.60
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: MDX Hawaii PPO	$209.52

BURR 3MM X 25MM NEURO 7021-917

Facility

$216.00

Hospital Revenue Code	272
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$209.52
Rate for Payer: AlohaCare Medicaid	$108.00
Rate for Payer: AlohaCare Medicare	$164.16
Rate for Payer: Cash Price	$129.60
Rate for Payer: Devoted Health Medicare	$181.44
Rate for Payer: Hawaii Medical Service Association Medicare	$164.16
Rate for Payer: Hawaii Western Management Group Commercial	$205.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Humana Medicare	$164.16
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: Kaiser Permanente Medicaid	$110.16
Rate for Payer: Kaiser Permanente Medicare	$164.16
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: Ohana Health Plan Medicaid	$164.16
Rate for Payer: Ohana Health Plan Medicare	$164.16
Rate for Payer: UnitedHealthcare Medicare	$164.16
Rate for Payer: University Health Alliance Commercial	$157.44

BURR 4.0MM FLAT 180MM LG HIGH

Facility

$444.00

Hospital Revenue Code	272
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$430.68
Rate for Payer: AlohaCare Medicaid	$222.00
Rate for Payer: AlohaCare Medicare	$337.44
Rate for Payer: Cash Price	$266.40
Rate for Payer: Devoted Health Medicare	$372.96
Rate for Payer: Hawaii Medical Service Association Medicare	$337.44
Rate for Payer: Hawaii Western Management Group Commercial	$421.80
Rate for Payer: Health Management Network Commercial	$377.40
Rate for Payer: Humana Medicare	$337.44
Rate for Payer: Kaiser Permanente Commercial	$399.60
Rate for Payer: Kaiser Permanente Medicaid	$226.44
Rate for Payer: Kaiser Permanente Medicare	$337.44
Rate for Payer: MDX Hawaii PPO	$430.68
Rate for Payer: Ohana Health Plan Medicaid	$337.44
Rate for Payer: Ohana Health Plan Medicare	$337.44
Rate for Payer: UnitedHealthcare Medicare	$337.44
Rate for Payer: University Health Alliance Commercial	$323.63

BURR 4.0MM FLAT 180MM LG HIGH

Facility

$444.00

Hospital Revenue Code	272
Min. Negotiated Rate	$377.40
Max. Negotiated Rate	$430.68
Rate for Payer: Cash Price	$266.40
Rate for Payer: Health Management Network Commercial	$377.40
Rate for Payer: Kaiser Permanente Commercial	$399.60
Rate for Payer: MDX Hawaii PPO	$430.68

BURR 4MM 15 DEG

Facility

$2,160.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,836.00
Max. Negotiated Rate	$2,095.20
Rate for Payer: Cash Price	$1,296.00
Rate for Payer: Health Management Network Commercial	$1,836.00
Rate for Payer: Kaiser Permanente Commercial	$1,944.00
Rate for Payer: MDX Hawaii PPO	$2,095.20

BURR 4MM 15 DEG

Facility

$2,160.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$2,095.20
Rate for Payer: AlohaCare Medicaid	$1,080.00
Rate for Payer: AlohaCare Medicare	$1,641.60
Rate for Payer: Cash Price	$1,296.00
Rate for Payer: Devoted Health Medicare	$1,814.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,641.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,052.00
Rate for Payer: Health Management Network Commercial	$1,836.00
Rate for Payer: Humana Medicare	$1,641.60
Rate for Payer: Kaiser Permanente Commercial	$1,944.00
Rate for Payer: Kaiser Permanente Medicaid	$1,101.60
Rate for Payer: Kaiser Permanente Medicare	$1,641.60
Rate for Payer: MDX Hawaii PPO	$2,095.20
Rate for Payer: Ohana Health Plan Medicaid	$1,641.60
Rate for Payer: Ohana Health Plan Medicare	$1,641.60
Rate for Payer: UnitedHealthcare Medicare	$1,641.60
Rate for Payer: University Health Alliance Commercial	$1,574.42

BURR 5.5MMX13CM AR-8550RBE

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

BURR 5.5MMX13CM AR-8550RBE

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: AlohaCare Medicare	$158.08
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$174.72
Rate for Payer: Hawaii Medical Service Association Medicare	$158.08
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$158.08
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$158.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$158.08
Rate for Payer: Ohana Health Plan Medicare	$158.08
Rate for Payer: UnitedHealthcare Medicare	$158.08
Rate for Payer: University Health Alliance Commercial	$151.61

BUR RND CUTTING 17.5MM 3.1MM

Facility

$275.00

Hospital Revenue Code	272
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$266.75
Rate for Payer: AlohaCare Medicaid	$137.50
Rate for Payer: AlohaCare Medicare	$209.00
Rate for Payer: Cash Price	$165.00
Rate for Payer: Devoted Health Medicare	$231.00
Rate for Payer: Hawaii Medical Service Association Medicare	$209.00
Rate for Payer: Hawaii Western Management Group Commercial	$261.25
Rate for Payer: Health Management Network Commercial	$233.75
Rate for Payer: Humana Medicare	$209.00
Rate for Payer: Kaiser Permanente Commercial	$247.50
Rate for Payer: Kaiser Permanente Medicaid	$140.25
Rate for Payer: Kaiser Permanente Medicare	$209.00
Rate for Payer: MDX Hawaii PPO	$266.75
Rate for Payer: Ohana Health Plan Medicaid	$209.00
Rate for Payer: Ohana Health Plan Medicare	$209.00
Rate for Payer: UnitedHealthcare Medicare	$209.00
Rate for Payer: University Health Alliance Commercial	$200.45

BUR RND CUTTING 17.5MM 3.1MM

Facility

$275.00

Hospital Revenue Code	272
Min. Negotiated Rate	$233.75
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$165.00
Rate for Payer: Health Management Network Commercial	$233.75
Rate for Payer: Kaiser Permanente Commercial	$247.50
Rate for Payer: MDX Hawaii PPO	$266.75

Know your out-of-pocket cost for care.

All Charges