Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

GRAFT LEG 18X13.5CM PLC181400

Facility

$10,156.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,687.36
Max. Negotiated Rate	$9,851.32
Rate for Payer: Cash Price	$6,093.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,109.20
Rate for Payer: Health Management Network Commercial	$8,632.60
Rate for Payer: Kaiser Permanente Commercial	$9,140.40
Rate for Payer: MDX Hawaii PPO	$9,851.32
Rate for Payer: University Health Alliance Commercial	$5,687.36

GRAFT LEG 18X9.5CM PLC181000

Facility

$9,956.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$4,978.00
Max. Negotiated Rate	$9,657.32
Rate for Payer: AlohaCare Medicaid	$4,978.00
Rate for Payer: AlohaCare Medicare	$7,566.56
Rate for Payer: Cash Price	$5,973.60
Rate for Payer: Devoted Health Medicare	$8,363.04
Rate for Payer: Hawaii Medical Service Association Medicare	$7,566.56
Rate for Payer: Hawaii Western Management Group Commercial	$6,969.20
Rate for Payer: Health Management Network Commercial	$8,462.60
Rate for Payer: Humana Medicare	$7,566.56
Rate for Payer: Kaiser Permanente Commercial	$8,960.40
Rate for Payer: Kaiser Permanente Medicaid	$5,077.56
Rate for Payer: Kaiser Permanente Medicare	$7,566.56
Rate for Payer: MDX Hawaii PPO	$9,657.32
Rate for Payer: Ohana Health Plan Medicaid	$7,566.56
Rate for Payer: Ohana Health Plan Medicare	$7,566.56
Rate for Payer: UnitedHealthcare Medicare	$7,566.56
Rate for Payer: University Health Alliance Commercial	$5,575.36

GRAFT LEG 18X9.5CM PLC181000

Facility

$9,956.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,575.36
Max. Negotiated Rate	$9,657.32
Rate for Payer: Cash Price	$5,973.60
Rate for Payer: Hawaii Western Management Group Commercial	$6,969.20
Rate for Payer: Health Management Network Commercial	$8,462.60
Rate for Payer: Kaiser Permanente Commercial	$8,960.40
Rate for Payer: MDX Hawaii PPO	$9,657.32
Rate for Payer: University Health Alliance Commercial	$5,575.36

GRAFT LEG 20X11.5CM PLC201200

Facility

$11,540.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,770.00
Max. Negotiated Rate	$11,193.80
Rate for Payer: AlohaCare Medicaid	$5,770.00
Rate for Payer: AlohaCare Medicare	$8,770.40
Rate for Payer: Cash Price	$6,924.00
Rate for Payer: Devoted Health Medicare	$9,693.60
Rate for Payer: Hawaii Medical Service Association Medicare	$8,770.40
Rate for Payer: Hawaii Western Management Group Commercial	$8,078.00
Rate for Payer: Health Management Network Commercial	$9,809.00
Rate for Payer: Humana Medicare	$8,770.40
Rate for Payer: Kaiser Permanente Commercial	$10,386.00
Rate for Payer: Kaiser Permanente Medicaid	$5,885.40
Rate for Payer: Kaiser Permanente Medicare	$8,770.40
Rate for Payer: MDX Hawaii PPO	$11,193.80
Rate for Payer: Ohana Health Plan Medicaid	$8,770.40
Rate for Payer: Ohana Health Plan Medicare	$8,770.40
Rate for Payer: UnitedHealthcare Medicare	$8,770.40
Rate for Payer: University Health Alliance Commercial	$6,462.40

GRAFT LEG 20X11.5CM PLC201200

Facility

$11,540.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$6,462.40
Max. Negotiated Rate	$11,193.80
Rate for Payer: Cash Price	$6,924.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,078.00
Rate for Payer: Health Management Network Commercial	$9,809.00
Rate for Payer: Kaiser Permanente Commercial	$10,386.00
Rate for Payer: MDX Hawaii PPO	$11,193.80
Rate for Payer: University Health Alliance Commercial	$6,462.40

GRAFT LEG 20X13.5CM PLC201400

Facility

$9,020.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$4,510.00
Max. Negotiated Rate	$8,749.40
Rate for Payer: AlohaCare Medicaid	$4,510.00
Rate for Payer: AlohaCare Medicare	$6,855.20
Rate for Payer: Cash Price	$5,412.00
Rate for Payer: Devoted Health Medicare	$7,576.80
Rate for Payer: Hawaii Medical Service Association Medicare	$6,855.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,314.00
Rate for Payer: Health Management Network Commercial	$7,667.00
Rate for Payer: Humana Medicare	$6,855.20
Rate for Payer: Kaiser Permanente Commercial	$8,118.00
Rate for Payer: Kaiser Permanente Medicaid	$4,600.20
Rate for Payer: Kaiser Permanente Medicare	$6,855.20
Rate for Payer: MDX Hawaii PPO	$8,749.40
Rate for Payer: Ohana Health Plan Medicaid	$6,855.20
Rate for Payer: Ohana Health Plan Medicare	$6,855.20
Rate for Payer: UnitedHealthcare Medicare	$6,855.20
Rate for Payer: University Health Alliance Commercial	$5,051.20

GRAFT LEG 20X13.5CM PLC201400

Facility

$9,020.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,051.20
Max. Negotiated Rate	$8,749.40
Rate for Payer: Cash Price	$5,412.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,314.00
Rate for Payer: Health Management Network Commercial	$7,667.00
Rate for Payer: Kaiser Permanente Commercial	$8,118.00
Rate for Payer: MDX Hawaii PPO	$8,749.40
Rate for Payer: University Health Alliance Commercial	$5,051.20

GRAFT LEG 20X9.5CM PLC201000

Facility

$11,540.00

Hospital Revenue Code	278
Min. Negotiated Rate	$5,770.00
Max. Negotiated Rate	$11,193.80
Rate for Payer: AlohaCare Medicaid	$5,770.00
Rate for Payer: AlohaCare Medicare	$8,770.40
Rate for Payer: Cash Price	$6,924.00
Rate for Payer: Devoted Health Medicare	$9,693.60
Rate for Payer: Hawaii Medical Service Association Medicare	$8,770.40
Rate for Payer: Hawaii Western Management Group Commercial	$8,078.00
Rate for Payer: Health Management Network Commercial	$9,809.00
Rate for Payer: Humana Medicare	$8,770.40
Rate for Payer: Kaiser Permanente Commercial	$10,386.00
Rate for Payer: Kaiser Permanente Medicaid	$5,885.40
Rate for Payer: Kaiser Permanente Medicare	$8,770.40
Rate for Payer: MDX Hawaii PPO	$11,193.80
Rate for Payer: Ohana Health Plan Medicaid	$8,770.40
Rate for Payer: Ohana Health Plan Medicare	$8,770.40
Rate for Payer: UnitedHealthcare Medicare	$8,770.40
Rate for Payer: University Health Alliance Commercial	$6,462.40

GRAFT LEG 20X9.5CM PLC201000

Facility

$11,540.00

Hospital Revenue Code	278
Min. Negotiated Rate	$6,462.40
Max. Negotiated Rate	$11,193.80
Rate for Payer: Cash Price	$6,924.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,078.00
Rate for Payer: Health Management Network Commercial	$9,809.00
Rate for Payer: Kaiser Permanente Commercial	$10,386.00
Rate for Payer: MDX Hawaii PPO	$11,193.80
Rate for Payer: University Health Alliance Commercial	$6,462.40

GRAFT LEG 23X10CM PLC231000

Facility

$9,020.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,051.20
Max. Negotiated Rate	$8,749.40
Rate for Payer: Cash Price	$5,412.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,314.00
Rate for Payer: Health Management Network Commercial	$7,667.00
Rate for Payer: Kaiser Permanente Commercial	$8,118.00
Rate for Payer: MDX Hawaii PPO	$8,749.40
Rate for Payer: University Health Alliance Commercial	$5,051.20

GRAFT LEG 23X10CM PLC231000

Facility

$9,020.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$4,510.00
Max. Negotiated Rate	$8,749.40
Rate for Payer: AlohaCare Medicaid	$4,510.00
Rate for Payer: AlohaCare Medicare	$6,855.20
Rate for Payer: Cash Price	$5,412.00
Rate for Payer: Devoted Health Medicare	$7,576.80
Rate for Payer: Hawaii Medical Service Association Medicare	$6,855.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,314.00
Rate for Payer: Health Management Network Commercial	$7,667.00
Rate for Payer: Humana Medicare	$6,855.20
Rate for Payer: Kaiser Permanente Commercial	$8,118.00
Rate for Payer: Kaiser Permanente Medicaid	$4,600.20
Rate for Payer: Kaiser Permanente Medicare	$6,855.20
Rate for Payer: MDX Hawaii PPO	$8,749.40
Rate for Payer: Ohana Health Plan Medicaid	$6,855.20
Rate for Payer: Ohana Health Plan Medicare	$6,855.20
Rate for Payer: UnitedHealthcare Medicare	$6,855.20
Rate for Payer: University Health Alliance Commercial	$5,051.20

GRAFT LEG 23X12CM PLC231200

Facility

$10,156.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,078.00
Max. Negotiated Rate	$9,851.32
Rate for Payer: AlohaCare Medicaid	$5,078.00
Rate for Payer: AlohaCare Medicare	$7,718.56
Rate for Payer: Cash Price	$6,093.60
Rate for Payer: Devoted Health Medicare	$8,531.04
Rate for Payer: Hawaii Medical Service Association Medicare	$7,718.56
Rate for Payer: Hawaii Western Management Group Commercial	$7,109.20
Rate for Payer: Health Management Network Commercial	$8,632.60
Rate for Payer: Humana Medicare	$7,718.56
Rate for Payer: Kaiser Permanente Commercial	$9,140.40
Rate for Payer: Kaiser Permanente Medicaid	$5,179.56
Rate for Payer: Kaiser Permanente Medicare	$7,718.56
Rate for Payer: MDX Hawaii PPO	$9,851.32
Rate for Payer: Ohana Health Plan Medicaid	$7,718.56
Rate for Payer: Ohana Health Plan Medicare	$7,718.56
Rate for Payer: UnitedHealthcare Medicare	$7,718.56
Rate for Payer: University Health Alliance Commercial	$5,687.36

GRAFT LEG 23X12CM PLC231200

Facility

$10,156.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,687.36
Max. Negotiated Rate	$9,851.32
Rate for Payer: Cash Price	$6,093.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,109.20
Rate for Payer: Health Management Network Commercial	$8,632.60
Rate for Payer: Kaiser Permanente Commercial	$9,140.40
Rate for Payer: MDX Hawaii PPO	$9,851.32
Rate for Payer: University Health Alliance Commercial	$5,687.36

GRAFT LEG 23X14CM PLC231400

Facility

$9,714.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$4,857.00
Max. Negotiated Rate	$9,422.58
Rate for Payer: AlohaCare Medicaid	$4,857.00
Rate for Payer: AlohaCare Medicare	$7,382.64
Rate for Payer: Cash Price	$5,828.40
Rate for Payer: Devoted Health Medicare	$8,159.76
Rate for Payer: Hawaii Medical Service Association Medicare	$7,382.64
Rate for Payer: Hawaii Western Management Group Commercial	$6,799.80
Rate for Payer: Health Management Network Commercial	$8,256.90
Rate for Payer: Humana Medicare	$7,382.64
Rate for Payer: Kaiser Permanente Commercial	$8,742.60
Rate for Payer: Kaiser Permanente Medicaid	$4,954.14
Rate for Payer: Kaiser Permanente Medicare	$7,382.64
Rate for Payer: MDX Hawaii PPO	$9,422.58
Rate for Payer: Ohana Health Plan Medicaid	$7,382.64
Rate for Payer: Ohana Health Plan Medicare	$7,382.64
Rate for Payer: UnitedHealthcare Medicare	$7,382.64
Rate for Payer: University Health Alliance Commercial	$5,439.84

GRAFT LEG 23X14CM PLC231400

Facility

$9,714.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,439.84
Max. Negotiated Rate	$9,422.58
Rate for Payer: Cash Price	$5,828.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,799.80
Rate for Payer: Health Management Network Commercial	$8,256.90
Rate for Payer: Kaiser Permanente Commercial	$8,742.60
Rate for Payer: MDX Hawaii PPO	$9,422.58
Rate for Payer: University Health Alliance Commercial	$5,439.84

GRAFT LEG 27X12CM PLC271200

Facility

$11,540.00

Hospital Revenue Code	278
Min. Negotiated Rate	$5,770.00
Max. Negotiated Rate	$11,193.80
Rate for Payer: AlohaCare Medicaid	$5,770.00
Rate for Payer: AlohaCare Medicare	$8,770.40
Rate for Payer: Cash Price	$6,924.00
Rate for Payer: Devoted Health Medicare	$9,693.60
Rate for Payer: Hawaii Medical Service Association Medicare	$8,770.40
Rate for Payer: Hawaii Western Management Group Commercial	$8,078.00
Rate for Payer: Health Management Network Commercial	$9,809.00
Rate for Payer: Humana Medicare	$8,770.40
Rate for Payer: Kaiser Permanente Commercial	$10,386.00
Rate for Payer: Kaiser Permanente Medicaid	$5,885.40
Rate for Payer: Kaiser Permanente Medicare	$8,770.40
Rate for Payer: MDX Hawaii PPO	$11,193.80
Rate for Payer: Ohana Health Plan Medicaid	$8,770.40
Rate for Payer: Ohana Health Plan Medicare	$8,770.40
Rate for Payer: UnitedHealthcare Medicare	$8,770.40
Rate for Payer: University Health Alliance Commercial	$6,462.40

GRAFT LEG 27X12CM PLC271200

Facility

$11,540.00

Hospital Revenue Code	278
Min. Negotiated Rate	$6,462.40
Max. Negotiated Rate	$11,193.80
Rate for Payer: Cash Price	$6,924.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,078.00
Rate for Payer: Health Management Network Commercial	$9,809.00
Rate for Payer: Kaiser Permanente Commercial	$10,386.00
Rate for Payer: MDX Hawaii PPO	$11,193.80
Rate for Payer: University Health Alliance Commercial	$6,462.40

GRAFT LEG 27X14CM PLC271400

Facility

$9,020.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$4,510.00
Max. Negotiated Rate	$8,749.40
Rate for Payer: AlohaCare Medicaid	$4,510.00
Rate for Payer: AlohaCare Medicare	$6,855.20
Rate for Payer: Cash Price	$5,412.00
Rate for Payer: Devoted Health Medicare	$7,576.80
Rate for Payer: Hawaii Medical Service Association Medicare	$6,855.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,314.00
Rate for Payer: Health Management Network Commercial	$7,667.00
Rate for Payer: Humana Medicare	$6,855.20
Rate for Payer: Kaiser Permanente Commercial	$8,118.00
Rate for Payer: Kaiser Permanente Medicaid	$4,600.20
Rate for Payer: Kaiser Permanente Medicare	$6,855.20
Rate for Payer: MDX Hawaii PPO	$8,749.40
Rate for Payer: Ohana Health Plan Medicaid	$6,855.20
Rate for Payer: Ohana Health Plan Medicare	$6,855.20
Rate for Payer: UnitedHealthcare Medicare	$6,855.20
Rate for Payer: University Health Alliance Commercial	$5,051.20

GRAFT LEG 27X14CM PLC271400

Facility

$9,020.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,051.20
Max. Negotiated Rate	$8,749.40
Rate for Payer: Cash Price	$5,412.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,314.00
Rate for Payer: Health Management Network Commercial	$7,667.00
Rate for Payer: Kaiser Permanente Commercial	$8,118.00
Rate for Payer: MDX Hawaii PPO	$8,749.40
Rate for Payer: University Health Alliance Commercial	$5,051.20

GRAFT LEG 4.5MMX10CM PXC141000

Facility

$4,510.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$2,255.00
Max. Negotiated Rate	$4,374.70
Rate for Payer: AlohaCare Medicaid	$2,255.00
Rate for Payer: AlohaCare Medicare	$3,427.60
Rate for Payer: Cash Price	$2,706.00
Rate for Payer: Devoted Health Medicare	$3,788.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3,427.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,157.00
Rate for Payer: Health Management Network Commercial	$3,833.50
Rate for Payer: Humana Medicare	$3,427.60
Rate for Payer: Kaiser Permanente Commercial	$4,059.00
Rate for Payer: Kaiser Permanente Medicaid	$2,300.10
Rate for Payer: Kaiser Permanente Medicare	$3,427.60
Rate for Payer: MDX Hawaii PPO	$4,374.70
Rate for Payer: Ohana Health Plan Medicaid	$3,427.60
Rate for Payer: Ohana Health Plan Medicare	$3,427.60
Rate for Payer: UnitedHealthcare Medicare	$3,427.60
Rate for Payer: University Health Alliance Commercial	$2,525.60

GRAFT LEG 4.5MMX10CM PXC141000

Facility

$4,510.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$2,525.60
Max. Negotiated Rate	$4,374.70
Rate for Payer: Cash Price	$2,706.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,157.00
Rate for Payer: Health Management Network Commercial	$3,833.50
Rate for Payer: Kaiser Permanente Commercial	$4,059.00
Rate for Payer: MDX Hawaii PPO	$4,374.70
Rate for Payer: University Health Alliance Commercial	$2,525.60

GRAFT MESH PARIETENE 45X30CM

Facility

$860.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$481.60
Max. Negotiated Rate	$834.20
Rate for Payer: Cash Price	$516.00
Rate for Payer: Hawaii Western Management Group Commercial	$602.00
Rate for Payer: Health Management Network Commercial	$731.00
Rate for Payer: Kaiser Permanente Commercial	$774.00
Rate for Payer: MDX Hawaii PPO	$834.20
Rate for Payer: University Health Alliance Commercial	$481.60

GRAFT MESH PARIETENE 45X30CM

Facility

$860.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$834.20
Rate for Payer: AlohaCare Medicaid	$430.00
Rate for Payer: AlohaCare Medicare	$653.60
Rate for Payer: Cash Price	$516.00
Rate for Payer: Devoted Health Medicare	$722.40
Rate for Payer: Hawaii Medical Service Association Medicare	$653.60
Rate for Payer: Hawaii Western Management Group Commercial	$602.00
Rate for Payer: Health Management Network Commercial	$731.00
Rate for Payer: Humana Medicare	$653.60
Rate for Payer: Kaiser Permanente Commercial	$774.00
Rate for Payer: Kaiser Permanente Medicaid	$438.60
Rate for Payer: Kaiser Permanente Medicare	$653.60
Rate for Payer: MDX Hawaii PPO	$834.20
Rate for Payer: Ohana Health Plan Medicaid	$653.60
Rate for Payer: Ohana Health Plan Medicare	$653.60
Rate for Payer: UnitedHealthcare Medicare	$653.60
Rate for Payer: University Health Alliance Commercial	$481.60

GRAFT PROPATEN 6X40 H060040A

Facility

$2,242.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,255.52
Max. Negotiated Rate	$2,174.74
Rate for Payer: Cash Price	$1,345.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,569.40
Rate for Payer: Health Management Network Commercial	$1,905.70
Rate for Payer: Kaiser Permanente Commercial	$2,017.80
Rate for Payer: MDX Hawaii PPO	$2,174.74
Rate for Payer: University Health Alliance Commercial	$1,255.52

GRAFT PROPATEN 6X40 H060040A

Facility

$2,242.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.00
Max. Negotiated Rate	$2,174.74
Rate for Payer: AlohaCare Medicaid	$1,121.00
Rate for Payer: AlohaCare Medicare	$1,703.92
Rate for Payer: Cash Price	$1,345.20
Rate for Payer: Devoted Health Medicare	$1,883.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,703.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,569.40
Rate for Payer: Health Management Network Commercial	$1,905.70
Rate for Payer: Humana Medicare	$1,703.92
Rate for Payer: Kaiser Permanente Commercial	$2,017.80
Rate for Payer: Kaiser Permanente Medicaid	$1,143.42
Rate for Payer: Kaiser Permanente Medicare	$1,703.92
Rate for Payer: MDX Hawaii PPO	$2,174.74
Rate for Payer: Ohana Health Plan Medicaid	$1,703.92
Rate for Payer: Ohana Health Plan Medicare	$1,703.92
Rate for Payer: UnitedHealthcare Medicare	$1,703.92
Rate for Payer: University Health Alliance Commercial	$1,255.52

Know your out-of-pocket cost for care.

All Charges