Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

ANCHOR CORKSCREW AR-1927BCT

Facility

$1,243.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$696.08
Max. Negotiated Rate	$1,205.71
Rate for Payer: Cash Price	$745.80
Rate for Payer: Hawaii Western Management Group Commercial	$870.10
Rate for Payer: Health Management Network Commercial	$1,056.55
Rate for Payer: Kaiser Permanente Commercial	$1,118.70
Rate for Payer: MDX Hawaii PPO	$1,205.71
Rate for Payer: University Health Alliance Commercial	$696.08

ANCHOR DBL 4.75MM AR-2324BCT-2

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$874.72
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

ANCHOR DBL 4.75MM AR-2324BCT-2

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$781.00
Max. Negotiated Rate	$1,515.14
Rate for Payer: AlohaCare Medicaid	$781.00
Rate for Payer: AlohaCare Medicare	$1,187.12
Rate for Payer: Cash Price	$937.20
Rate for Payer: Devoted Health Medicare	$1,312.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,187.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Humana Medicare	$1,187.12
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: Kaiser Permanente Medicaid	$796.62
Rate for Payer: Kaiser Permanente Medicare	$1,187.12
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: Ohana Health Plan Medicaid	$1,187.12
Rate for Payer: Ohana Health Plan Medicare	$1,187.12
Rate for Payer: UnitedHealthcare Medicare	$1,187.12
Rate for Payer: University Health Alliance Commercial	$874.72

ANCHOR DOUBLE LOADED 2 #2

Facility

$1,830.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,024.80
Max. Negotiated Rate	$1,775.10
Rate for Payer: Cash Price	$1,098.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,281.00
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: Kaiser Permanente Commercial	$1,647.00
Rate for Payer: MDX Hawaii PPO	$1,775.10
Rate for Payer: University Health Alliance Commercial	$1,024.80

ANCHOR DOUBLE LOADED 2 #2

Facility

$1,830.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$1,775.10
Rate for Payer: AlohaCare Medicaid	$915.00
Rate for Payer: AlohaCare Medicare	$1,390.80
Rate for Payer: Cash Price	$1,098.00
Rate for Payer: Devoted Health Medicare	$1,537.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,390.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,281.00
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: Humana Medicare	$1,390.80
Rate for Payer: Kaiser Permanente Commercial	$1,647.00
Rate for Payer: Kaiser Permanente Medicaid	$933.30
Rate for Payer: Kaiser Permanente Medicare	$1,390.80
Rate for Payer: MDX Hawaii PPO	$1,775.10
Rate for Payer: Ohana Health Plan Medicaid	$1,390.80
Rate for Payer: Ohana Health Plan Medicare	$1,390.80
Rate for Payer: UnitedHealthcare Medicare	$1,390.80
Rate for Payer: University Health Alliance Commercial	$1,024.80

ANCHOR ICONIX 2.3MM 3910500422

Facility

$1,569.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$878.64
Max. Negotiated Rate	$1,521.93
Rate for Payer: Cash Price	$941.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,098.30
Rate for Payer: Health Management Network Commercial	$1,333.65
Rate for Payer: Kaiser Permanente Commercial	$1,412.10
Rate for Payer: MDX Hawaii PPO	$1,521.93
Rate for Payer: University Health Alliance Commercial	$878.64

ANCHOR ICONIX 2.3MM 3910500422

Facility

$1,569.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$784.50
Max. Negotiated Rate	$1,521.93
Rate for Payer: AlohaCare Medicaid	$784.50
Rate for Payer: AlohaCare Medicare	$1,192.44
Rate for Payer: Cash Price	$941.40
Rate for Payer: Devoted Health Medicare	$1,317.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,192.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,098.30
Rate for Payer: Health Management Network Commercial	$1,333.65
Rate for Payer: Humana Medicare	$1,192.44
Rate for Payer: Kaiser Permanente Commercial	$1,412.10
Rate for Payer: Kaiser Permanente Medicaid	$800.19
Rate for Payer: Kaiser Permanente Medicare	$1,192.44
Rate for Payer: MDX Hawaii PPO	$1,521.93
Rate for Payer: Ohana Health Plan Medicaid	$1,192.44
Rate for Payer: Ohana Health Plan Medicare	$1,192.44
Rate for Payer: UnitedHealthcare Medicare	$1,192.44
Rate for Payer: University Health Alliance Commercial	$878.64

ANCHOR ICONIX 3910-500-921

Facility

$2,499.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,399.44
Max. Negotiated Rate	$2,424.03
Rate for Payer: Cash Price	$1,499.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,749.30
Rate for Payer: Health Management Network Commercial	$2,124.15
Rate for Payer: Kaiser Permanente Commercial	$2,249.10
Rate for Payer: MDX Hawaii PPO	$2,424.03
Rate for Payer: University Health Alliance Commercial	$1,399.44

ANCHOR ICONIX 3910-500-921

Facility

$2,499.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$2,424.03
Rate for Payer: AlohaCare Medicaid	$1,249.50
Rate for Payer: AlohaCare Medicare	$1,899.24
Rate for Payer: Cash Price	$1,499.40
Rate for Payer: Devoted Health Medicare	$2,099.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,899.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,749.30
Rate for Payer: Health Management Network Commercial	$2,124.15
Rate for Payer: Humana Medicare	$1,899.24
Rate for Payer: Kaiser Permanente Commercial	$2,249.10
Rate for Payer: Kaiser Permanente Medicaid	$1,274.49
Rate for Payer: Kaiser Permanente Medicare	$1,899.24
Rate for Payer: MDX Hawaii PPO	$2,424.03
Rate for Payer: Ohana Health Plan Medicaid	$1,899.24
Rate for Payer: Ohana Health Plan Medicare	$1,899.24
Rate for Payer: UnitedHealthcare Medicare	$1,899.24
Rate for Payer: University Health Alliance Commercial	$1,399.44

ANCHOR PROXIMAL TENDO AR-2290

Facility

$2,126.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,063.00
Max. Negotiated Rate	$2,062.22
Rate for Payer: AlohaCare Medicaid	$1,063.00
Rate for Payer: AlohaCare Medicare	$1,615.76
Rate for Payer: Cash Price	$1,275.60
Rate for Payer: Devoted Health Medicare	$1,785.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,615.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,488.20
Rate for Payer: Health Management Network Commercial	$1,807.10
Rate for Payer: Humana Medicare	$1,615.76
Rate for Payer: Kaiser Permanente Commercial	$1,913.40
Rate for Payer: Kaiser Permanente Medicaid	$1,084.26
Rate for Payer: Kaiser Permanente Medicare	$1,615.76
Rate for Payer: MDX Hawaii PPO	$2,062.22
Rate for Payer: Ohana Health Plan Medicaid	$1,615.76
Rate for Payer: Ohana Health Plan Medicare	$1,615.76
Rate for Payer: UnitedHealthcare Medicare	$1,615.76
Rate for Payer: University Health Alliance Commercial	$1,190.56

ANCHOR PROXIMAL TENDO AR-2290

Facility

$2,126.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,190.56
Max. Negotiated Rate	$2,062.22
Rate for Payer: Cash Price	$1,275.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,488.20
Rate for Payer: Health Management Network Commercial	$1,807.10
Rate for Payer: Kaiser Permanente Commercial	$1,913.40
Rate for Payer: MDX Hawaii PPO	$2,062.22
Rate for Payer: University Health Alliance Commercial	$1,190.56

ANCHOR REELX 5.5 #3910-600-060

Facility

$1,566.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$783.00
Max. Negotiated Rate	$1,519.02
Rate for Payer: AlohaCare Medicaid	$783.00
Rate for Payer: AlohaCare Medicare	$1,190.16
Rate for Payer: Cash Price	$939.60
Rate for Payer: Devoted Health Medicare	$1,315.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,190.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,096.20
Rate for Payer: Health Management Network Commercial	$1,331.10
Rate for Payer: Humana Medicare	$1,190.16
Rate for Payer: Kaiser Permanente Commercial	$1,409.40
Rate for Payer: Kaiser Permanente Medicaid	$798.66
Rate for Payer: Kaiser Permanente Medicare	$1,190.16
Rate for Payer: MDX Hawaii PPO	$1,519.02
Rate for Payer: Ohana Health Plan Medicaid	$1,190.16
Rate for Payer: Ohana Health Plan Medicare	$1,190.16
Rate for Payer: UnitedHealthcare Medicare	$1,190.16
Rate for Payer: University Health Alliance Commercial	$876.96

ANCHOR REELX 5.5 #3910-600-060

Facility

$1,566.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$876.96
Max. Negotiated Rate	$1,519.02
Rate for Payer: Cash Price	$939.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,096.20
Rate for Payer: Health Management Network Commercial	$1,331.10
Rate for Payer: Kaiser Permanente Commercial	$1,409.40
Rate for Payer: MDX Hawaii PPO	$1,519.02
Rate for Payer: University Health Alliance Commercial	$876.96

ANCHORS SOFT SZ1 110005307

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$560.00
Max. Negotiated Rate	$1,086.40
Rate for Payer: AlohaCare Medicaid	$560.00
Rate for Payer: AlohaCare Medicare	$851.20
Rate for Payer: Cash Price	$672.00
Rate for Payer: Devoted Health Medicare	$940.80
Rate for Payer: Hawaii Medical Service Association Medicare	$851.20
Rate for Payer: Hawaii Western Management Group Commercial	$784.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Humana Medicare	$851.20
Rate for Payer: Kaiser Permanente Commercial	$1,008.00
Rate for Payer: Kaiser Permanente Medicaid	$571.20
Rate for Payer: Kaiser Permanente Medicare	$851.20
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: Ohana Health Plan Medicaid	$851.20
Rate for Payer: Ohana Health Plan Medicare	$851.20
Rate for Payer: UnitedHealthcare Medicare	$851.20
Rate for Payer: University Health Alliance Commercial	$627.20

ANCHORS SOFT SZ1 110005307

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$627.20
Max. Negotiated Rate	$1,086.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Hawaii Western Management Group Commercial	$784.00
Rate for Payer: Health Management Network Commercial	$952.00
Rate for Payer: Kaiser Permanente Commercial	$1,008.00
Rate for Payer: MDX Hawaii PPO	$1,086.40
Rate for Payer: University Health Alliance Commercial	$627.20

ANCHORSURE STITCH #A-SURE02

Facility

$731.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$365.50
Max. Negotiated Rate	$709.07
Rate for Payer: AlohaCare Medicaid	$365.50
Rate for Payer: AlohaCare Medicare	$555.56
Rate for Payer: Cash Price	$438.60
Rate for Payer: Devoted Health Medicare	$614.04
Rate for Payer: Hawaii Medical Service Association Medicare	$555.56
Rate for Payer: Hawaii Western Management Group Commercial	$511.70
Rate for Payer: Health Management Network Commercial	$621.35
Rate for Payer: Humana Medicare	$555.56
Rate for Payer: Kaiser Permanente Commercial	$657.90
Rate for Payer: Kaiser Permanente Medicaid	$372.81
Rate for Payer: Kaiser Permanente Medicare	$555.56
Rate for Payer: MDX Hawaii PPO	$709.07
Rate for Payer: Ohana Health Plan Medicaid	$555.56
Rate for Payer: Ohana Health Plan Medicare	$555.56
Rate for Payer: UnitedHealthcare Medicare	$555.56
Rate for Payer: University Health Alliance Commercial	$409.36

ANCHORSURE STITCH #A-SURE02

Facility

$731.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$409.36
Max. Negotiated Rate	$709.07
Rate for Payer: Cash Price	$438.60
Rate for Payer: Hawaii Western Management Group Commercial	$511.70
Rate for Payer: Health Management Network Commercial	$621.35
Rate for Payer: Kaiser Permanente Commercial	$657.90
Rate for Payer: MDX Hawaii PPO	$709.07
Rate for Payer: University Health Alliance Commercial	$409.36

ANCHORSURE SUT DEVICE A-SURE

Facility

$1,747.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$873.50
Max. Negotiated Rate	$1,694.59
Rate for Payer: AlohaCare Medicaid	$873.50
Rate for Payer: AlohaCare Medicare	$1,327.72
Rate for Payer: Cash Price	$1,048.20
Rate for Payer: Devoted Health Medicare	$1,467.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,327.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.90
Rate for Payer: Health Management Network Commercial	$1,484.95
Rate for Payer: Humana Medicare	$1,327.72
Rate for Payer: Kaiser Permanente Commercial	$1,572.30
Rate for Payer: Kaiser Permanente Medicaid	$890.97
Rate for Payer: Kaiser Permanente Medicare	$1,327.72
Rate for Payer: MDX Hawaii PPO	$1,694.59
Rate for Payer: Ohana Health Plan Medicaid	$1,327.72
Rate for Payer: Ohana Health Plan Medicare	$1,327.72
Rate for Payer: UnitedHealthcare Medicare	$1,327.72
Rate for Payer: University Health Alliance Commercial	$978.32

ANCHORSURE SUT DEVICE A-SURE

Facility

$1,747.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$978.32
Max. Negotiated Rate	$1,694.59
Rate for Payer: Cash Price	$1,048.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.90
Rate for Payer: Health Management Network Commercial	$1,484.95
Rate for Payer: Kaiser Permanente Commercial	$1,572.30
Rate for Payer: MDX Hawaii PPO	$1,694.59
Rate for Payer: University Health Alliance Commercial	$978.32

ANCHOR SUT FIBRTAK DBL AR-3632

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$647.50
Max. Negotiated Rate	$1,256.15
Rate for Payer: AlohaCare Medicaid	$647.50
Rate for Payer: AlohaCare Medicare	$984.20
Rate for Payer: Cash Price	$777.00
Rate for Payer: Devoted Health Medicare	$1,087.80
Rate for Payer: Hawaii Medical Service Association Medicare	$984.20
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Humana Medicare	$984.20
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: Kaiser Permanente Medicaid	$660.45
Rate for Payer: Kaiser Permanente Medicare	$984.20
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: Ohana Health Plan Medicaid	$984.20
Rate for Payer: Ohana Health Plan Medicare	$984.20
Rate for Payer: UnitedHealthcare Medicare	$984.20
Rate for Payer: University Health Alliance Commercial	$725.20

ANCHOR SUT FIBRTAK DBL AR-3632

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$725.20
Max. Negotiated Rate	$1,256.15
Rate for Payer: Cash Price	$777.00
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: University Health Alliance Commercial	$725.20

ANCHOR SUTURE 3910-947-120

Facility

$2,059.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,153.04
Max. Negotiated Rate	$1,997.23
Rate for Payer: Cash Price	$1,235.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,441.30
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: Kaiser Permanente Commercial	$1,853.10
Rate for Payer: MDX Hawaii PPO	$1,997.23
Rate for Payer: University Health Alliance Commercial	$1,153.04

ANCHOR SUTURE 3910-947-120

Facility

$2,059.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,029.50
Max. Negotiated Rate	$1,997.23
Rate for Payer: AlohaCare Medicaid	$1,029.50
Rate for Payer: AlohaCare Medicare	$1,564.84
Rate for Payer: Cash Price	$1,235.40
Rate for Payer: Devoted Health Medicare	$1,729.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,564.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,441.30
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: Humana Medicare	$1,564.84
Rate for Payer: Kaiser Permanente Commercial	$1,853.10
Rate for Payer: Kaiser Permanente Medicaid	$1,050.09
Rate for Payer: Kaiser Permanente Medicare	$1,564.84
Rate for Payer: MDX Hawaii PPO	$1,997.23
Rate for Payer: Ohana Health Plan Medicaid	$1,564.84
Rate for Payer: Ohana Health Plan Medicare	$1,564.84
Rate for Payer: UnitedHealthcare Medicare	$1,564.84
Rate for Payer: University Health Alliance Commercial	$1,153.04

ANCHOR SUTURE 4.75 3910500471

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,052.80
Max. Negotiated Rate	$1,823.60
Rate for Payer: Cash Price	$1,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,316.00
Rate for Payer: Health Management Network Commercial	$1,598.00
Rate for Payer: Kaiser Permanente Commercial	$1,692.00
Rate for Payer: MDX Hawaii PPO	$1,823.60
Rate for Payer: University Health Alliance Commercial	$1,052.80

ANCHOR SUTURE 4.75 3910500471

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$940.00
Max. Negotiated Rate	$1,823.60
Rate for Payer: AlohaCare Medicaid	$940.00
Rate for Payer: AlohaCare Medicare	$1,428.80
Rate for Payer: Cash Price	$1,128.00
Rate for Payer: Devoted Health Medicare	$1,579.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,428.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,316.00
Rate for Payer: Health Management Network Commercial	$1,598.00
Rate for Payer: Humana Medicare	$1,428.80
Rate for Payer: Kaiser Permanente Commercial	$1,692.00
Rate for Payer: Kaiser Permanente Medicaid	$958.80
Rate for Payer: Kaiser Permanente Medicare	$1,428.80
Rate for Payer: MDX Hawaii PPO	$1,823.60
Rate for Payer: Ohana Health Plan Medicaid	$1,428.80
Rate for Payer: Ohana Health Plan Medicare	$1,428.80
Rate for Payer: UnitedHealthcare Medicare	$1,428.80
Rate for Payer: University Health Alliance Commercial	$1,052.80

Know your out-of-pocket cost for care.

All Charges