Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

C-TAPER HEAD 22/+10 #06-2210

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$995.00
Max. Negotiated Rate	$1,930.30
Rate for Payer: AlohaCare Medicaid	$995.00
Rate for Payer: AlohaCare Medicare	$1,512.40
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Devoted Health Medicare	$1,671.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,512.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Humana Medicare	$1,512.40
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: Kaiser Permanente Medicaid	$1,014.90
Rate for Payer: Kaiser Permanente Medicare	$1,512.40
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: Ohana Health Plan Medicaid	$1,512.40
Rate for Payer: Ohana Health Plan Medicare	$1,512.40
Rate for Payer: UnitedHealthcare Medicare	$1,512.40
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 22/+10 #06-2210

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.40
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 26/+10 #06-2610

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$995.00
Max. Negotiated Rate	$1,930.30
Rate for Payer: AlohaCare Medicaid	$995.00
Rate for Payer: AlohaCare Medicare	$1,512.40
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Devoted Health Medicare	$1,671.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,512.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Humana Medicare	$1,512.40
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: Kaiser Permanente Medicaid	$1,014.90
Rate for Payer: Kaiser Permanente Medicare	$1,512.40
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: Ohana Health Plan Medicaid	$1,512.40
Rate for Payer: Ohana Health Plan Medicare	$1,512.40
Rate for Payer: UnitedHealthcare Medicare	$1,512.40
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 26/+10 #06-2610

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.40
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 26/+5 06-2605

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$985.50
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$1,497.96
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$1,655.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,497.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$1,497.96
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$1,497.96
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$1,497.96
Rate for Payer: Ohana Health Plan Medicare	$1,497.96
Rate for Payer: UnitedHealthcare Medicare	$1,497.96
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD 26/+5 06-2605

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD 28/+0 #06-2800

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$985.50
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$1,497.96
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$1,655.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,497.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$1,497.96
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$1,497.96
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$1,497.96
Rate for Payer: Ohana Health Plan Medicare	$1,497.96
Rate for Payer: UnitedHealthcare Medicare	$1,497.96
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD 28/+0 #06-2800

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD 28/+5 #06-2805

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD 28/+5 #06-2805

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$985.50
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$1,497.96
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$1,655.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,497.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$1,497.96
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$1,497.96
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$1,497.96
Rate for Payer: Ohana Health Plan Medicare	$1,497.96
Rate for Payer: UnitedHealthcare Medicare	$1,497.96
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD 32/+0 #06-3200

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$995.00
Max. Negotiated Rate	$1,930.30
Rate for Payer: AlohaCare Medicaid	$995.00
Rate for Payer: AlohaCare Medicare	$1,512.40
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Devoted Health Medicare	$1,671.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,512.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Humana Medicare	$1,512.40
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: Kaiser Permanente Medicaid	$1,014.90
Rate for Payer: Kaiser Permanente Medicare	$1,512.40
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: Ohana Health Plan Medicaid	$1,512.40
Rate for Payer: Ohana Health Plan Medicare	$1,512.40
Rate for Payer: UnitedHealthcare Medicare	$1,512.40
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 32/+0 #06-3200

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.40
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 32/+5 #06-3205

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$995.00
Max. Negotiated Rate	$1,930.30
Rate for Payer: AlohaCare Medicaid	$995.00
Rate for Payer: AlohaCare Medicare	$1,512.40
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Devoted Health Medicare	$1,671.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,512.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Humana Medicare	$1,512.40
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: Kaiser Permanente Medicaid	$1,014.90
Rate for Payer: Kaiser Permanente Medicare	$1,512.40
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: Ohana Health Plan Medicaid	$1,512.40
Rate for Payer: Ohana Health Plan Medicare	$1,512.40
Rate for Payer: UnitedHealthcare Medicare	$1,512.40
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 32/+5 #06-3205

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.40
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 32/-5 #06-3299

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.40
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 32/-5 #06-3299

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$995.00
Max. Negotiated Rate	$1,930.30
Rate for Payer: AlohaCare Medicaid	$995.00
Rate for Payer: AlohaCare Medicare	$1,512.40
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Devoted Health Medicare	$1,671.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,512.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Humana Medicare	$1,512.40
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: Kaiser Permanente Medicaid	$1,014.90
Rate for Payer: Kaiser Permanente Medicare	$1,512.40
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: Ohana Health Plan Medicaid	$1,512.40
Rate for Payer: Ohana Health Plan Medicare	$1,512.40
Rate for Payer: UnitedHealthcare Medicare	$1,512.40
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 36/-5 #06-3699

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$995.00
Max. Negotiated Rate	$1,930.30
Rate for Payer: AlohaCare Medicaid	$995.00
Rate for Payer: AlohaCare Medicare	$1,512.40
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Devoted Health Medicare	$1,671.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,512.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Humana Medicare	$1,512.40
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: Kaiser Permanente Medicaid	$1,014.90
Rate for Payer: Kaiser Permanente Medicare	$1,512.40
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: Ohana Health Plan Medicaid	$1,512.40
Rate for Payer: Ohana Health Plan Medicare	$1,512.40
Rate for Payer: UnitedHealthcare Medicare	$1,512.40
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD 36/-5 #06-3699

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.40
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER HEAD LOW FRICT 06-2200

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD LOW FRICT 06-2200

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$985.50
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$1,497.96
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$1,655.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,497.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$1,497.96
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$1,497.96
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$1,497.96
Rate for Payer: Ohana Health Plan Medicare	$1,497.96
Rate for Payer: UnitedHealthcare Medicare	$1,497.96
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD S-1400-HH82

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER HEAD S-1400-HH82

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$985.50
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$1,497.96
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$1,655.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,497.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$1,497.96
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$1,497.96
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$1,497.96
Rate for Payer: Ohana Health Plan Medicare	$1,497.96
Rate for Payer: UnitedHealthcare Medicare	$1,497.96
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TPR FEM HEAD 36/+0 06-3600

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$995.00
Max. Negotiated Rate	$1,930.30
Rate for Payer: AlohaCare Medicaid	$995.00
Rate for Payer: AlohaCare Medicare	$1,512.40
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Devoted Health Medicare	$1,671.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,512.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Humana Medicare	$1,512.40
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: Kaiser Permanente Medicaid	$1,014.90
Rate for Payer: Kaiser Permanente Medicare	$1,512.40
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: Ohana Health Plan Medicaid	$1,512.40
Rate for Payer: Ohana Health Plan Medicare	$1,512.40
Rate for Payer: UnitedHealthcare Medicare	$1,512.40
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TPR FEM HEAD 36/+0 06-3600

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.40
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TPR FEM HEAD 36/+10 06-3610

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,430.00
Max. Negotiated Rate	$4,714.20
Rate for Payer: AlohaCare Medicaid	$2,430.00
Rate for Payer: AlohaCare Medicare	$3,693.60
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Devoted Health Medicare	$4,082.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3,693.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: Humana Medicare	$3,693.60
Rate for Payer: Kaiser Permanente Commercial	$4,374.00
Rate for Payer: Kaiser Permanente Medicaid	$2,478.60
Rate for Payer: Kaiser Permanente Medicare	$3,693.60
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: Ohana Health Plan Medicaid	$3,693.60
Rate for Payer: Ohana Health Plan Medicare	$3,693.60
Rate for Payer: UnitedHealthcare Medicare	$3,693.60
Rate for Payer: University Health Alliance Commercial	$2,721.60

Know your out-of-pocket cost for care.

All Charges