Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW HIGH MDM 60 MIN

Professional

Both

$305.00

Service Code	HCPCS 98011
Min. Negotiated Rate	$259.25
Max. Negotiated Rate	$259.25
Rate for Payer: Cash Price	$183.00
Rate for Payer: Health Management Network Commercial	$259.25

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW LOW MDM 30 MIN

Professional

Both

$151.00

Service Code	HCPCS 98009
Min. Negotiated Rate	$128.35
Max. Negotiated Rate	$128.35
Rate for Payer: Cash Price	$90.60
Rate for Payer: Health Management Network Commercial	$128.35

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW MOD MDM 45 MIN

Professional

Both

$234.00

Service Code	HCPCS 98010
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$198.90
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Management Network Commercial	$198.90

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW SF MDM 15 MIN

Professional

Both

$92.00

Service Code	HCPCS 98008
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$78.20
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST LOW MDM 20 MIN

Professional

Both

$129.00

Service Code	HCPCS 98005
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$109.65
Rate for Payer: Cash Price	$77.40
Rate for Payer: Health Management Network Commercial	$109.65

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST MOD MDM 30 MIN

Professional

Both

$191.00

Service Code	HCPCS 98006
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$114.60
Rate for Payer: Health Management Network Commercial	$162.35

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST SF MDM 10 MIN

Professional

Both

$75.00

Service Code	HCPCS 98004
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Management Network Commercial	$63.75

PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW LOW MDM 30 MIN

Professional

Both

$158.00

Service Code	HCPCS 98001
Min. Negotiated Rate	$134.30
Max. Negotiated Rate	$134.30
Rate for Payer: Cash Price	$94.80
Rate for Payer: Health Management Network Commercial	$134.30

PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW MOD MDM 45 MIN

Professional

Both

$252.00

Service Code	HCPCS 98002
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$214.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Health Management Network Commercial	$214.20

PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW SF MDM 15 MIN

Professional

Both

$97.00

Service Code	HCPCS 98000
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$58.20
Rate for Payer: Health Management Network Commercial	$82.45

PR SYNCHRONOUS AUDIO-VIDEO VST EST HIGH MDM 40 MIN

Professional

Both

$252.00

Service Code	HCPCS 98007
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$214.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Health Management Network Commercial	$214.20

PR SYNCHRONOUS AUDIO-VIDEO VST NEW HIGH MDM 60 MIN

Professional

Both

$334.00

Service Code	HCPCS 98003
Min. Negotiated Rate	$283.90
Max. Negotiated Rate	$283.90
Rate for Payer: Cash Price	$200.40
Rate for Payer: Health Management Network Commercial	$283.90

PR SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN

Professional

Both

$945.00

Service Code	HCPCS 26145
Min. Negotiated Rate	$390.78
Max. Negotiated Rate	$803.25
Rate for Payer: AlohaCare Medicaid	$548.81
Rate for Payer: AlohaCare Medicare	$502.18
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Devoted Health Medicare	$552.40
Rate for Payer: Hawaii Medical Service Association Medicare	$502.18
Rate for Payer: Hawaii Western Management Group Commercial	$390.78
Rate for Payer: Health Management Network Commercial	$803.25
Rate for Payer: Kaiser Permanente Commercial	$602.62
Rate for Payer: Kaiser Permanente Medicaid	$602.62
Rate for Payer: Kaiser Permanente Medicare	$602.62
Rate for Payer: Ohana Health Plan Medicaid	$548.81
Rate for Payer: Ohana Health Plan Medicare	$502.18
Rate for Payer: UnitedHealthcare Medicaid	$548.81
Rate for Payer: UnitedHealthcare Medicare	$502.18

PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION

Professional

Both

$92.77

Service Code	HCPCS 11103
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$78.85
Rate for Payer: AlohaCare Medicaid	$22.19
Rate for Payer: AlohaCare Medicare	$17.69
Rate for Payer: Cash Price	$55.66
Rate for Payer: Cash Price	$55.66
Rate for Payer: Devoted Health Medicare	$19.46
Rate for Payer: Hawaii Medical Service Association ABD	$22.19
Rate for Payer: Hawaii Medical Service Association Commercial	$31.84
Rate for Payer: Hawaii Medical Service Association Medicare	$17.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.19
Rate for Payer: Hawaii Western Management Group Commercial	$59.54
Rate for Payer: Health Management Network Commercial	$78.85
Rate for Payer: Kaiser Permanente Commercial	$21.23
Rate for Payer: Kaiser Permanente Medicaid	$21.23
Rate for Payer: Kaiser Permanente Medicare	$21.23
Rate for Payer: Ohana Health Plan Medicaid	$22.19
Rate for Payer: Ohana Health Plan Medicare	$17.69
Rate for Payer: UnitedHealthcare Medicaid	$22.19
Rate for Payer: UnitedHealthcare Medicare	$17.69
Rate for Payer: University Health Alliance Commercial	$25.44

PR TANGENTIAL BIOPSY SKIN SINGLE LESION

Professional

Both

$185.00

Service Code	HCPCS 11102
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$157.25
Rate for Payer: AlohaCare Medicaid	$38.19
Rate for Payer: AlohaCare Medicare	$30.13
Rate for Payer: Cash Price	$111.00
Rate for Payer: Cash Price	$111.00
Rate for Payer: Devoted Health Medicare	$33.14
Rate for Payer: Hawaii Medical Service Association ABD	$38.19
Rate for Payer: Hawaii Medical Service Association Commercial	$60.04
Rate for Payer: Hawaii Medical Service Association Medicare	$30.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$38.19
Rate for Payer: Hawaii Western Management Group Commercial	$110.50
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Kaiser Permanente Commercial	$36.16
Rate for Payer: Kaiser Permanente Medicaid	$36.16
Rate for Payer: Kaiser Permanente Medicare	$36.16
Rate for Payer: Ohana Health Plan Medicaid	$38.19
Rate for Payer: Ohana Health Plan Medicare	$30.13
Rate for Payer: UnitedHealthcare Medicaid	$38.19
Rate for Payer: UnitedHealthcare Medicare	$30.13
Rate for Payer: University Health Alliance Commercial	$43.67

PR TAP BLOCK BILATERAL BY INJECTION(S)

Professional

Both

$278.86

Service Code	HCPCS 64488
Min. Negotiated Rate	$56.06
Max. Negotiated Rate	$237.03
Rate for Payer: AlohaCare Medicaid	$67.16
Rate for Payer: AlohaCare Medicare	$56.06
Rate for Payer: Cash Price	$167.32
Rate for Payer: Cash Price	$167.32
Rate for Payer: Devoted Health Medicare	$61.67
Rate for Payer: Hawaii Medical Service Association ABD	$67.16
Rate for Payer: Hawaii Medical Service Association Commercial	$115.05
Rate for Payer: Hawaii Medical Service Association Medicare	$56.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$67.16
Rate for Payer: Hawaii Western Management Group Commercial	$169.00
Rate for Payer: Health Management Network Commercial	$237.03
Rate for Payer: Kaiser Permanente Commercial	$67.27
Rate for Payer: Kaiser Permanente Medicaid	$67.27
Rate for Payer: Kaiser Permanente Medicare	$67.27
Rate for Payer: Ohana Health Plan Medicaid	$67.16
Rate for Payer: Ohana Health Plan Medicare	$56.06
Rate for Payer: UnitedHealthcare Medicaid	$67.16
Rate for Payer: UnitedHealthcare Medicare	$56.06
Rate for Payer: University Health Alliance Commercial	$73.25

PR TAP BLOCK UNILATERAL BY INJECTION(S)

Professional

Both

$238.24

Service Code	HCPCS 64486
Min. Negotiated Rate	$48.04
Max. Negotiated Rate	$202.50
Rate for Payer: AlohaCare Medicaid	$53.89
Rate for Payer: AlohaCare Medicare	$48.04
Rate for Payer: Cash Price	$142.94
Rate for Payer: Cash Price	$142.94
Rate for Payer: Devoted Health Medicare	$52.84
Rate for Payer: Hawaii Medical Service Association ABD	$53.89
Rate for Payer: Hawaii Medical Service Association Commercial	$92.25
Rate for Payer: Hawaii Medical Service Association Medicare	$48.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53.89
Rate for Payer: Hawaii Western Management Group Commercial	$137.54
Rate for Payer: Health Management Network Commercial	$202.50
Rate for Payer: Kaiser Permanente Commercial	$57.65
Rate for Payer: Kaiser Permanente Medicaid	$57.65
Rate for Payer: Kaiser Permanente Medicare	$57.65
Rate for Payer: Ohana Health Plan Medicaid	$53.89
Rate for Payer: Ohana Health Plan Medicare	$48.04
Rate for Payer: UnitedHealthcare Medicaid	$53.89
Rate for Payer: UnitedHealthcare Medicare	$48.04
Rate for Payer: University Health Alliance Commercial	$63.40

PR TATTOOING INCL MICROPIGMENTATION 6.0 CM/<

Professional

Both

$408.96

Service Code	HCPCS 11920
Min. Negotiated Rate	$88.92
Max. Negotiated Rate	$347.62
Rate for Payer: AlohaCare Medicaid	$116.57
Rate for Payer: AlohaCare Medicare	$104.19
Rate for Payer: Cash Price	$245.38
Rate for Payer: Cash Price	$245.38
Rate for Payer: Devoted Health Medicare	$114.61
Rate for Payer: Hawaii Medical Service Association ABD	$116.57
Rate for Payer: Hawaii Medical Service Association Commercial	$173.37
Rate for Payer: Hawaii Medical Service Association Medicare	$104.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$116.57
Rate for Payer: Hawaii Western Management Group Commercial	$88.92
Rate for Payer: Health Management Network Commercial	$347.62
Rate for Payer: Kaiser Permanente Commercial	$125.03
Rate for Payer: Kaiser Permanente Medicaid	$125.03
Rate for Payer: Kaiser Permanente Medicare	$125.03
Rate for Payer: Ohana Health Plan Medicaid	$116.57
Rate for Payer: Ohana Health Plan Medicare	$104.19
Rate for Payer: UnitedHealthcare Medicaid	$116.57
Rate for Payer: UnitedHealthcare Medicare	$104.19
Rate for Payer: University Health Alliance Commercial	$128.29

PR TC99M SULFUR COLLOID

Professional

Both

$439.00

Service Code	HCPCS A9541
Min. Negotiated Rate	$373.15
Max. Negotiated Rate	$373.15
Rate for Payer: Cash Price	$263.40
Rate for Payer: Health Management Network Commercial	$373.15

PR TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR

Professional

Both

$543.00

Service Code	HCPCS 33289
Min. Negotiated Rate	$274.23
Max. Negotiated Rate	$461.55
Rate for Payer: AlohaCare Medicaid	$318.26
Rate for Payer: AlohaCare Medicare	$274.23
Rate for Payer: Cash Price	$325.80
Rate for Payer: Cash Price	$325.80
Rate for Payer: Devoted Health Medicare	$301.65
Rate for Payer: Hawaii Medical Service Association Medicare	$274.23
Rate for Payer: Hawaii Western Management Group Commercial	$336.96
Rate for Payer: Health Management Network Commercial	$461.55
Rate for Payer: Kaiser Permanente Commercial	$329.08
Rate for Payer: Kaiser Permanente Medicaid	$329.08
Rate for Payer: Kaiser Permanente Medicare	$329.08
Rate for Payer: Ohana Health Plan Medicaid	$318.26
Rate for Payer: Ohana Health Plan Medicare	$274.23
Rate for Payer: UnitedHealthcare Medicaid	$318.26
Rate for Payer: UnitedHealthcare Medicare	$274.23

PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG

Professional

Both

$794.00

Service Code	HCPCS 33274
Min. Negotiated Rate	$409.18
Max. Negotiated Rate	$674.90
Rate for Payer: AlohaCare Medicaid	$465.19
Rate for Payer: AlohaCare Medicare	$409.18
Rate for Payer: Cash Price	$476.40
Rate for Payer: Cash Price	$476.40
Rate for Payer: Devoted Health Medicare	$450.10
Rate for Payer: Hawaii Medical Service Association Medicare	$409.18
Rate for Payer: Hawaii Western Management Group Commercial	$511.42
Rate for Payer: Health Management Network Commercial	$674.90
Rate for Payer: Kaiser Permanente Commercial	$491.02
Rate for Payer: Kaiser Permanente Medicaid	$491.02
Rate for Payer: Kaiser Permanente Medicare	$491.02
Rate for Payer: Ohana Health Plan Medicaid	$465.19
Rate for Payer: Ohana Health Plan Medicare	$409.18
Rate for Payer: UnitedHealthcare Medicaid	$465.19
Rate for Payer: UnitedHealthcare Medicare	$409.18

PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ

Professional

Both

$1,586.00

Service Code	HCPCS 37215
Min. Negotiated Rate	$846.01
Max. Negotiated Rate	$1,348.10
Rate for Payer: AlohaCare Medicaid	$933.02
Rate for Payer: AlohaCare Medicare	$846.01
Rate for Payer: Cash Price	$951.60
Rate for Payer: Cash Price	$951.60
Rate for Payer: Devoted Health Medicare	$930.61
Rate for Payer: Hawaii Medical Service Association Medicare	$846.01
Rate for Payer: Health Management Network Commercial	$1,348.10
Rate for Payer: Kaiser Permanente Commercial	$1,015.21
Rate for Payer: Kaiser Permanente Medicaid	$1,015.21
Rate for Payer: Kaiser Permanente Medicare	$1,015.21
Rate for Payer: Ohana Health Plan Medicaid	$933.02
Rate for Payer: Ohana Health Plan Medicare	$846.01
Rate for Payer: UnitedHealthcare Medicaid	$933.02
Rate for Payer: UnitedHealthcare Medicare	$846.01
Rate for Payer: University Health Alliance Commercial	$1,300.00

PR TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ

Professional

Both

$1,693.00

Service Code	HCPCS 37216
Min. Negotiated Rate	$991.06
Max. Negotiated Rate	$1,439.05
Rate for Payer: AlohaCare Medicaid	$991.06
Rate for Payer: Cash Price	$1,015.80
Rate for Payer: Cash Price	$1,015.80
Rate for Payer: Health Management Network Commercial	$1,439.05
Rate for Payer: Ohana Health Plan Medicaid	$991.06
Rate for Payer: UnitedHealthcare Medicaid	$991.06

PR TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG

Professional

Both

$832.00

Service Code	HCPCS 33275
Min. Negotiated Rate	$432.89
Max. Negotiated Rate	$707.20
Rate for Payer: AlohaCare Medicaid	$487.57
Rate for Payer: AlohaCare Medicare	$432.89
Rate for Payer: Cash Price	$499.20
Rate for Payer: Cash Price	$499.20
Rate for Payer: Devoted Health Medicare	$476.18
Rate for Payer: Hawaii Medical Service Association Medicare	$432.89
Rate for Payer: Hawaii Western Management Group Commercial	$539.76
Rate for Payer: Health Management Network Commercial	$707.20
Rate for Payer: Kaiser Permanente Commercial	$519.47
Rate for Payer: Kaiser Permanente Medicaid	$519.47
Rate for Payer: Kaiser Permanente Medicare	$519.47
Rate for Payer: Ohana Health Plan Medicaid	$487.57
Rate for Payer: Ohana Health Plan Medicare	$432.89
Rate for Payer: UnitedHealthcare Medicaid	$487.57
Rate for Payer: UnitedHealthcare Medicare	$432.89

PR TDAP VACCINE 7 YRS/> IM

Professional

Both

$116.00

Service Code	HCPCS 90715
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$98.60
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$39.48
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$69.60
Rate for Payer: Devoted Health Medicare	$43.43
Rate for Payer: Hawaii Medical Service Association Medicare	$39.48
Rate for Payer: Hawaii Western Management Group Commercial	$46.89
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Kaiser Permanente Commercial	$47.38
Rate for Payer: Kaiser Permanente Medicaid	$47.38
Rate for Payer: Kaiser Permanente Medicare	$47.38
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: Ohana Health Plan Medicare	$39.48
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$39.48

Know your out-of-pocket cost for care.

All Charges