Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HIP STEM 12.5 00-7711-012-00

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,077.00
Max. Negotiated Rate	$9,849.38
Rate for Payer: AlohaCare Medicaid	$5,077.00
Rate for Payer: AlohaCare Medicare	$7,717.04
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Devoted Health Medicare	$8,529.36
Rate for Payer: Hawaii Medical Service Association Medicare	$7,717.04
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Humana Medicare	$7,717.04
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: Kaiser Permanente Medicaid	$5,178.54
Rate for Payer: Kaiser Permanente Medicare	$7,717.04
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: Ohana Health Plan Medicaid	$7,717.04
Rate for Payer: Ohana Health Plan Medicare	$7,717.04
Rate for Payer: UnitedHealthcare Medicare	$7,717.04
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 12.5 00-7711-012-00

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,686.24
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 12.5 00-7711-012-10

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 12.5 00-7711-012-10

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,600.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: AlohaCare Medicaid	$2,600.00
Rate for Payer: AlohaCare Medicare	$3,952.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Devoted Health Medicare	$4,368.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Humana Medicare	$3,952.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: Kaiser Permanente Medicaid	$2,652.00
Rate for Payer: Kaiser Permanente Medicare	$3,952.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: Ohana Health Plan Medicaid	$3,952.00
Rate for Payer: Ohana Health Plan Medicare	$3,952.00
Rate for Payer: UnitedHealthcare Medicare	$3,952.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 127DEGREE 6721-0127

Facility

$5,839.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,919.50
Max. Negotiated Rate	$5,663.83
Rate for Payer: AlohaCare Medicaid	$2,919.50
Rate for Payer: AlohaCare Medicare	$4,437.64
Rate for Payer: Cash Price	$3,503.40
Rate for Payer: Devoted Health Medicare	$4,904.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4,437.64
Rate for Payer: Hawaii Western Management Group Commercial	$4,087.30
Rate for Payer: Health Management Network Commercial	$4,963.15
Rate for Payer: Humana Medicare	$4,437.64
Rate for Payer: Kaiser Permanente Commercial	$5,255.10
Rate for Payer: Kaiser Permanente Medicaid	$2,977.89
Rate for Payer: Kaiser Permanente Medicare	$4,437.64
Rate for Payer: MDX Hawaii PPO	$5,663.83
Rate for Payer: Ohana Health Plan Medicaid	$4,437.64
Rate for Payer: Ohana Health Plan Medicare	$4,437.64
Rate for Payer: UnitedHealthcare Medicare	$4,437.64
Rate for Payer: University Health Alliance Commercial	$3,269.84

HIP STEM 127DEGREE 6721-0127

Facility

$5,839.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,269.84
Max. Negotiated Rate	$5,663.83
Rate for Payer: Cash Price	$3,503.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,087.30
Rate for Payer: Health Management Network Commercial	$4,963.15
Rate for Payer: Kaiser Permanente Commercial	$5,255.10
Rate for Payer: MDX Hawaii PPO	$5,663.83
Rate for Payer: University Health Alliance Commercial	$3,269.84

HIP STEM 13.5 00-7711-013-00

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 13.5 00-7711-013-00

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,600.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: AlohaCare Medicaid	$2,600.00
Rate for Payer: AlohaCare Medicare	$3,952.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Devoted Health Medicare	$4,368.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Humana Medicare	$3,952.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: Kaiser Permanente Medicaid	$2,652.00
Rate for Payer: Kaiser Permanente Medicare	$3,952.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: Ohana Health Plan Medicaid	$3,952.00
Rate for Payer: Ohana Health Plan Medicare	$3,952.00
Rate for Payer: UnitedHealthcare Medicare	$3,952.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 14/225MM 01-00102-214

Facility

$13,867.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,933.50
Max. Negotiated Rate	$13,450.99
Rate for Payer: AlohaCare Medicaid	$6,933.50
Rate for Payer: AlohaCare Medicare	$10,538.92
Rate for Payer: Cash Price	$8,320.20
Rate for Payer: Devoted Health Medicare	$11,648.28
Rate for Payer: Hawaii Medical Service Association Medicare	$10,538.92
Rate for Payer: Hawaii Western Management Group Commercial	$9,706.90
Rate for Payer: Health Management Network Commercial	$11,786.95
Rate for Payer: Humana Medicare	$10,538.92
Rate for Payer: Kaiser Permanente Commercial	$12,480.30
Rate for Payer: Kaiser Permanente Medicaid	$7,072.17
Rate for Payer: Kaiser Permanente Medicare	$10,538.92
Rate for Payer: MDX Hawaii PPO	$13,450.99
Rate for Payer: Ohana Health Plan Medicaid	$10,538.92
Rate for Payer: Ohana Health Plan Medicare	$10,538.92
Rate for Payer: UnitedHealthcare Medicare	$10,538.92
Rate for Payer: University Health Alliance Commercial	$7,765.52

HIP STEM 14/225MM 01-00102-214

Facility

$13,867.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,765.52
Max. Negotiated Rate	$13,450.99
Rate for Payer: Cash Price	$8,320.20
Rate for Payer: Hawaii Western Management Group Commercial	$9,706.90
Rate for Payer: Health Management Network Commercial	$11,786.95
Rate for Payer: Kaiser Permanente Commercial	$12,480.30
Rate for Payer: MDX Hawaii PPO	$13,450.99
Rate for Payer: University Health Alliance Commercial	$7,765.52

HIP STEM 15 STD 00-7711-015-00

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,600.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: AlohaCare Medicaid	$2,600.00
Rate for Payer: AlohaCare Medicare	$3,952.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Devoted Health Medicare	$4,368.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Humana Medicare	$3,952.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: Kaiser Permanente Medicaid	$2,652.00
Rate for Payer: Kaiser Permanente Medicare	$3,952.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: Ohana Health Plan Medicaid	$3,952.00
Rate for Payer: Ohana Health Plan Medicare	$3,952.00
Rate for Payer: UnitedHealthcare Medicare	$3,952.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 15 STD 00-7711-015-00

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 17.5 00-7711-017-00

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,686.24
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 17.5 00-7711-017-00

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,077.00
Max. Negotiated Rate	$9,849.38
Rate for Payer: AlohaCare Medicaid	$5,077.00
Rate for Payer: AlohaCare Medicare	$7,717.04
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Devoted Health Medicare	$8,529.36
Rate for Payer: Hawaii Medical Service Association Medicare	$7,717.04
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Humana Medicare	$7,717.04
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: Kaiser Permanente Medicaid	$5,178.54
Rate for Payer: Kaiser Permanente Medicare	$7,717.04
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: Ohana Health Plan Medicaid	$7,717.04
Rate for Payer: Ohana Health Plan Medicare	$7,717.04
Rate for Payer: UnitedHealthcare Medicare	$7,717.04
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 18/225MM 01-00102-218

Facility

$13,867.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,765.52
Max. Negotiated Rate	$13,450.99
Rate for Payer: Cash Price	$8,320.20
Rate for Payer: Hawaii Western Management Group Commercial	$9,706.90
Rate for Payer: Health Management Network Commercial	$11,786.95
Rate for Payer: Kaiser Permanente Commercial	$12,480.30
Rate for Payer: MDX Hawaii PPO	$13,450.99
Rate for Payer: University Health Alliance Commercial	$7,765.52

HIP STEM 18/225MM 01-00102-218

Facility

$13,867.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,933.50
Max. Negotiated Rate	$13,450.99
Rate for Payer: AlohaCare Medicaid	$6,933.50
Rate for Payer: AlohaCare Medicare	$10,538.92
Rate for Payer: Cash Price	$8,320.20
Rate for Payer: Devoted Health Medicare	$11,648.28
Rate for Payer: Hawaii Medical Service Association Medicare	$10,538.92
Rate for Payer: Hawaii Western Management Group Commercial	$9,706.90
Rate for Payer: Health Management Network Commercial	$11,786.95
Rate for Payer: Humana Medicare	$10,538.92
Rate for Payer: Kaiser Permanente Commercial	$12,480.30
Rate for Payer: Kaiser Permanente Medicaid	$7,072.17
Rate for Payer: Kaiser Permanente Medicare	$10,538.92
Rate for Payer: MDX Hawaii PPO	$13,450.99
Rate for Payer: Ohana Health Plan Medicaid	$10,538.92
Rate for Payer: Ohana Health Plan Medicare	$10,538.92
Rate for Payer: UnitedHealthcare Medicare	$10,538.92
Rate for Payer: University Health Alliance Commercial	$7,765.52

HIP STEM #3 30X102MM 6721-0330

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$5,606.60
Rate for Payer: AlohaCare Medicaid	$2,890.00
Rate for Payer: AlohaCare Medicare	$4,392.80
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Devoted Health Medicare	$4,855.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4,392.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Humana Medicare	$4,392.80
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: Kaiser Permanente Medicare	$4,392.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: Ohana Health Plan Medicaid	$4,392.80
Rate for Payer: Ohana Health Plan Medicare	$4,392.80
Rate for Payer: UnitedHealthcare Medicare	$4,392.80
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM #3 30X102MM 6721-0330

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM 6051-0730S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$5,606.60
Rate for Payer: AlohaCare Medicaid	$2,890.00
Rate for Payer: AlohaCare Medicare	$4,392.80
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Devoted Health Medicare	$4,855.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4,392.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Humana Medicare	$4,392.80
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: Kaiser Permanente Medicare	$4,392.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: Ohana Health Plan Medicaid	$4,392.80
Rate for Payer: Ohana Health Plan Medicare	$4,392.80
Rate for Payer: UnitedHealthcare Medicare	$4,392.80
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM 6051-0730S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM 6 EXT 00-7711-006-40

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,077.00
Max. Negotiated Rate	$9,849.38
Rate for Payer: AlohaCare Medicaid	$5,077.00
Rate for Payer: AlohaCare Medicare	$7,717.04
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Devoted Health Medicare	$8,529.36
Rate for Payer: Hawaii Medical Service Association Medicare	$7,717.04
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Humana Medicare	$7,717.04
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: Kaiser Permanente Medicaid	$5,178.54
Rate for Payer: Kaiser Permanente Medicare	$7,717.04
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: Ohana Health Plan Medicaid	$7,717.04
Rate for Payer: Ohana Health Plan Medicare	$7,717.04
Rate for Payer: UnitedHealthcare Medicare	$7,717.04
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 6 EXT 00-7711-006-40

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,686.24
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 7.5 00-7711-007-00

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,686.24
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 7.5 00-7711-007-00

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,077.00
Max. Negotiated Rate	$9,849.38
Rate for Payer: AlohaCare Medicaid	$5,077.00
Rate for Payer: AlohaCare Medicare	$7,717.04
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Devoted Health Medicare	$8,529.36
Rate for Payer: Hawaii Medical Service Association Medicare	$7,717.04
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Humana Medicare	$7,717.04
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: Kaiser Permanente Medicaid	$5,178.54
Rate for Payer: Kaiser Permanente Medicare	$7,717.04
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: Ohana Health Plan Medicaid	$7,717.04
Rate for Payer: Ohana Health Plan Medicare	$7,717.04
Rate for Payer: UnitedHealthcare Medicare	$7,717.04
Rate for Payer: University Health Alliance Commercial	$5,686.24

HIP STEM 7.5 00-7711-007-10

Facility

$7,220.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,043.20
Max. Negotiated Rate	$7,003.40
Rate for Payer: Cash Price	$4,332.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,054.00
Rate for Payer: Health Management Network Commercial	$6,137.00
Rate for Payer: Kaiser Permanente Commercial	$6,498.00
Rate for Payer: MDX Hawaii PPO	$7,003.40
Rate for Payer: University Health Alliance Commercial	$4,043.20

Know your out-of-pocket cost for care.

All Charges