Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

KNE FEM SZ:E/LT 00-5956-015-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$3,800.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$4,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$3,800.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$3,800.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$3,800.00
Rate for Payer: Ohana Health Plan Medicare	$3,800.00
Rate for Payer: UnitedHealthcare Medicare	$3,800.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/LT 00-5964-015-51

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/LT 00-5964-015-51

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$3,800.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$4,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$3,800.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$3,800.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$3,800.00
Rate for Payer: Ohana Health Plan Medicare	$3,800.00
Rate for Payer: UnitedHealthcare Medicare	$3,800.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/RT 00-5750-015-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/RT 00-5750-015-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$3,800.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$4,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$3,800.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$3,800.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$3,800.00
Rate for Payer: Ohana Health Plan Medicare	$3,800.00
Rate for Payer: UnitedHealthcare Medicare	$3,800.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:F/LT 00-5956-016-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$3,800.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$4,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$3,800.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$3,800.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$3,800.00
Rate for Payer: Ohana Health Plan Medicare	$3,800.00
Rate for Payer: UnitedHealthcare Medicare	$3,800.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:F/LT 00-5956-016-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:F/RT 00-5750-016-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:F/RT 00-5750-016-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$3,800.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$4,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$3,800.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$3,800.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$3,800.00
Rate for Payer: Ohana Health Plan Medicare	$3,800.00
Rate for Payer: UnitedHealthcare Medicare	$3,800.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:G/LT 00-5956-017-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$3,800.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$4,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$3,800.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$3,800.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$3,800.00
Rate for Payer: Ohana Health Plan Medicare	$3,800.00
Rate for Payer: UnitedHealthcare Medicare	$3,800.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:G/LT 00-5956-017-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:G/LT 00-5956-017-02

Facility

$7,308.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,654.00
Max. Negotiated Rate	$7,088.76
Rate for Payer: AlohaCare Medicaid	$3,654.00
Rate for Payer: AlohaCare Medicare	$5,554.08
Rate for Payer: Cash Price	$4,384.80
Rate for Payer: Devoted Health Medicare	$6,138.72
Rate for Payer: Hawaii Medical Service Association Medicare	$5,554.08
Rate for Payer: Hawaii Western Management Group Commercial	$5,115.60
Rate for Payer: Health Management Network Commercial	$6,211.80
Rate for Payer: Humana Medicare	$5,554.08
Rate for Payer: Kaiser Permanente Commercial	$6,577.20
Rate for Payer: Kaiser Permanente Medicaid	$3,727.08
Rate for Payer: Kaiser Permanente Medicare	$5,554.08
Rate for Payer: MDX Hawaii PPO	$7,088.76
Rate for Payer: Ohana Health Plan Medicaid	$5,554.08
Rate for Payer: Ohana Health Plan Medicare	$5,554.08
Rate for Payer: UnitedHealthcare Medicare	$5,554.08
Rate for Payer: University Health Alliance Commercial	$4,092.48

KNE FEM SZ:G/LT 00-5956-017-02

Facility

$7,308.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,092.48
Max. Negotiated Rate	$7,088.76
Rate for Payer: Cash Price	$4,384.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,115.60
Rate for Payer: Health Management Network Commercial	$6,211.80
Rate for Payer: Kaiser Permanente Commercial	$6,577.20
Rate for Payer: MDX Hawaii PPO	$7,088.76
Rate for Payer: University Health Alliance Commercial	$4,092.48

KNE FEM SZ:G/LT 00-5964-017-51

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$3,800.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$4,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$3,800.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$3,800.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$3,800.00
Rate for Payer: Ohana Health Plan Medicare	$3,800.00
Rate for Payer: UnitedHealthcare Medicare	$3,800.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:G/LT 00-5964-017-51

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNIFE RX NEEDLE KNIFE XL

Facility

$720.00

Hospital Revenue Code	272
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$698.40
Rate for Payer: AlohaCare Medicaid	$360.00
Rate for Payer: AlohaCare Medicare	$547.20
Rate for Payer: Cash Price	$432.00
Rate for Payer: Devoted Health Medicare	$604.80
Rate for Payer: Hawaii Medical Service Association Medicare	$547.20
Rate for Payer: Hawaii Western Management Group Commercial	$684.00
Rate for Payer: Health Management Network Commercial	$612.00
Rate for Payer: Humana Medicare	$547.20
Rate for Payer: Kaiser Permanente Commercial	$648.00
Rate for Payer: Kaiser Permanente Medicaid	$367.20
Rate for Payer: Kaiser Permanente Medicare	$547.20
Rate for Payer: MDX Hawaii PPO	$698.40
Rate for Payer: Ohana Health Plan Medicaid	$547.20
Rate for Payer: Ohana Health Plan Medicare	$547.20
Rate for Payer: UnitedHealthcare Medicare	$547.20
Rate for Payer: University Health Alliance Commercial	$524.81

KNIFE RX NEEDLE KNIFE XL

Facility

$720.00

Hospital Revenue Code	272
Min. Negotiated Rate	$612.00
Max. Negotiated Rate	$698.40
Rate for Payer: Cash Price	$432.00
Rate for Payer: Health Management Network Commercial	$612.00
Rate for Payer: Kaiser Permanente Commercial	$648.00
Rate for Payer: MDX Hawaii PPO	$698.40

KNIFE SLIT ANG 2.75

Facility

$134.00

Hospital Revenue Code	272
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$80.40
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: MDX Hawaii PPO	$129.98

KNIFE SLIT ANG 2.75

Facility

$134.00

Hospital Revenue Code	272
Min. Negotiated Rate	$67.00
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$67.00
Rate for Payer: AlohaCare Medicare	$101.84
Rate for Payer: Cash Price	$80.40
Rate for Payer: Devoted Health Medicare	$112.56
Rate for Payer: Hawaii Medical Service Association Medicare	$101.84
Rate for Payer: Hawaii Western Management Group Commercial	$127.30
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$101.84
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$101.84
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$101.84
Rate for Payer: Ohana Health Plan Medicare	$101.84
Rate for Payer: UnitedHealthcare Medicare	$101.84
Rate for Payer: University Health Alliance Commercial	$97.67

KNOTLESS FIBERTAK AR-2600FSB-2

Facility

$9,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$4,625.00
Max. Negotiated Rate	$8,972.50
Rate for Payer: AlohaCare Medicaid	$4,625.00
Rate for Payer: AlohaCare Medicare	$7,030.00
Rate for Payer: Cash Price	$5,550.00
Rate for Payer: Devoted Health Medicare	$7,770.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,030.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,475.00
Rate for Payer: Health Management Network Commercial	$7,862.50
Rate for Payer: Humana Medicare	$7,030.00
Rate for Payer: Kaiser Permanente Commercial	$8,325.00
Rate for Payer: Kaiser Permanente Medicaid	$4,717.50
Rate for Payer: Kaiser Permanente Medicare	$7,030.00
Rate for Payer: MDX Hawaii PPO	$8,972.50
Rate for Payer: Ohana Health Plan Medicaid	$7,030.00
Rate for Payer: Ohana Health Plan Medicare	$7,030.00
Rate for Payer: UnitedHealthcare Medicare	$7,030.00
Rate for Payer: University Health Alliance Commercial	$5,180.00

KNOTLESS FIBERTAK AR-2600FSB-2

Facility

$9,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$5,180.00
Max. Negotiated Rate	$8,972.50
Rate for Payer: Cash Price	$5,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,475.00
Rate for Payer: Health Management Network Commercial	$7,862.50
Rate for Payer: Kaiser Permanente Commercial	$8,325.00
Rate for Payer: MDX Hawaii PPO	$8,972.50
Rate for Payer: University Health Alliance Commercial	$5,180.00

KNOTLESS TIGHTROPE AR-8925SS

Facility

$2,990.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.40
Max. Negotiated Rate	$2,900.30
Rate for Payer: Cash Price	$1,794.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,093.00
Rate for Payer: Health Management Network Commercial	$2,541.50
Rate for Payer: Kaiser Permanente Commercial	$2,691.00
Rate for Payer: MDX Hawaii PPO	$2,900.30
Rate for Payer: University Health Alliance Commercial	$1,674.40

KNOTLESS TIGHTROPE AR-8925SS

Facility

$2,990.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,495.00
Max. Negotiated Rate	$2,900.30
Rate for Payer: AlohaCare Medicaid	$1,495.00
Rate for Payer: AlohaCare Medicare	$2,272.40
Rate for Payer: Cash Price	$1,794.00
Rate for Payer: Devoted Health Medicare	$2,511.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,272.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,093.00
Rate for Payer: Health Management Network Commercial	$2,541.50
Rate for Payer: Humana Medicare	$2,272.40
Rate for Payer: Kaiser Permanente Commercial	$2,691.00
Rate for Payer: Kaiser Permanente Medicaid	$1,524.90
Rate for Payer: Kaiser Permanente Medicare	$2,272.40
Rate for Payer: MDX Hawaii PPO	$2,900.30
Rate for Payer: Ohana Health Plan Medicaid	$2,272.40
Rate for Payer: Ohana Health Plan Medicare	$2,272.40
Rate for Payer: UnitedHealthcare Medicare	$2,272.40
Rate for Payer: University Health Alliance Commercial	$1,674.40

KNOTLESS TIGHTROPE #AR-8926SSK

Facility

$2,516.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,408.96
Max. Negotiated Rate	$2,440.52
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.20
Rate for Payer: Health Management Network Commercial	$2,138.60
Rate for Payer: Kaiser Permanente Commercial	$2,264.40
Rate for Payer: MDX Hawaii PPO	$2,440.52
Rate for Payer: University Health Alliance Commercial	$1,408.96

KNOTLESS TIGHTROPE #AR-8926SSK

Facility

$2,516.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,258.00
Max. Negotiated Rate	$2,440.52
Rate for Payer: AlohaCare Medicaid	$1,258.00
Rate for Payer: AlohaCare Medicare	$1,912.16
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Devoted Health Medicare	$2,113.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,912.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.20
Rate for Payer: Health Management Network Commercial	$2,138.60
Rate for Payer: Humana Medicare	$1,912.16
Rate for Payer: Kaiser Permanente Commercial	$2,264.40
Rate for Payer: Kaiser Permanente Medicaid	$1,283.16
Rate for Payer: Kaiser Permanente Medicare	$1,912.16
Rate for Payer: MDX Hawaii PPO	$2,440.52
Rate for Payer: Ohana Health Plan Medicaid	$1,912.16
Rate for Payer: Ohana Health Plan Medicare	$1,912.16
Rate for Payer: UnitedHealthcare Medicare	$1,912.16
Rate for Payer: University Health Alliance Commercial	$1,408.96

Know your out-of-pocket cost for care.

All Charges