Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

ACCOLADE C 127 DEG 6057-0637D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.00
Max. Negotiated Rate	$3,003.12
Rate for Payer: AlohaCare Medicaid	$1,548.00
Rate for Payer: AlohaCare Medicare	$2,352.96
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Devoted Health Medicare	$2,600.64
Rate for Payer: Hawaii Medical Service Association Medicare	$2,352.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Humana Medicare	$2,352.96
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: Kaiser Permanente Medicare	$2,352.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: Ohana Health Plan Medicaid	$2,352.96
Rate for Payer: Ohana Health Plan Medicare	$2,352.96
Rate for Payer: UnitedHealthcare Medicare	$2,352.96
Rate for Payer: University Health Alliance Commercial	$1,733.76

ACCOLADE C HIP STEM 6057-0435D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

ACCOLADE C HIP STEM 6057-0435D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.00
Max. Negotiated Rate	$3,003.12
Rate for Payer: AlohaCare Medicaid	$1,548.00
Rate for Payer: AlohaCare Medicare	$2,352.96
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Devoted Health Medicare	$2,600.64
Rate for Payer: Hawaii Medical Service Association Medicare	$2,352.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Humana Medicare	$2,352.96
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: Kaiser Permanente Medicare	$2,352.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: Ohana Health Plan Medicaid	$2,352.96
Rate for Payer: Ohana Health Plan Medicare	$2,352.96
Rate for Payer: UnitedHealthcare Medicare	$2,352.96
Rate for Payer: University Health Alliance Commercial	$1,733.76

ACCOLADE DR EL MRI/2 LEAD 9H52

Facility

$10,336.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$5,788.16
Max. Negotiated Rate	$10,025.92
Rate for Payer: Cash Price	$6,201.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,235.20
Rate for Payer: Health Management Network Commercial	$8,785.60
Rate for Payer: Kaiser Permanente Commercial	$9,302.40
Rate for Payer: MDX Hawaii PPO	$10,025.92
Rate for Payer: University Health Alliance Commercial	$5,788.16

ACCOLADE DR EL MRI/2 LEAD 9H52

Facility

$10,336.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$5,168.00
Max. Negotiated Rate	$10,025.92
Rate for Payer: AlohaCare Medicaid	$5,168.00
Rate for Payer: AlohaCare Medicare	$7,855.36
Rate for Payer: Cash Price	$6,201.60
Rate for Payer: Devoted Health Medicare	$8,682.24
Rate for Payer: Hawaii Medical Service Association Medicare	$7,855.36
Rate for Payer: Hawaii Western Management Group Commercial	$7,235.20
Rate for Payer: Health Management Network Commercial	$8,785.60
Rate for Payer: Humana Medicare	$7,855.36
Rate for Payer: Kaiser Permanente Commercial	$9,302.40
Rate for Payer: Kaiser Permanente Medicaid	$5,271.36
Rate for Payer: Kaiser Permanente Medicare	$7,855.36
Rate for Payer: MDX Hawaii PPO	$10,025.92
Rate for Payer: Ohana Health Plan Medicaid	$7,855.36
Rate for Payer: Ohana Health Plan Medicare	$7,855.36
Rate for Payer: UnitedHealthcare Medicare	$7,855.36
Rate for Payer: University Health Alliance Commercial	$5,788.16

ACCOLADE GNRTR DR L301

Facility

$8,100.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$4,536.00
Max. Negotiated Rate	$7,857.00
Rate for Payer: Cash Price	$4,860.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,670.00
Rate for Payer: Health Management Network Commercial	$6,885.00
Rate for Payer: Kaiser Permanente Commercial	$7,290.00
Rate for Payer: MDX Hawaii PPO	$7,857.00
Rate for Payer: University Health Alliance Commercial	$4,536.00

ACCOLADE GNRTR DR L301

Facility

$8,100.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$4,050.00
Max. Negotiated Rate	$7,857.00
Rate for Payer: AlohaCare Medicaid	$4,050.00
Rate for Payer: AlohaCare Medicare	$6,156.00
Rate for Payer: Cash Price	$4,860.00
Rate for Payer: Devoted Health Medicare	$6,804.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,156.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,670.00
Rate for Payer: Health Management Network Commercial	$6,885.00
Rate for Payer: Humana Medicare	$6,156.00
Rate for Payer: Kaiser Permanente Commercial	$7,290.00
Rate for Payer: Kaiser Permanente Medicaid	$4,131.00
Rate for Payer: Kaiser Permanente Medicare	$6,156.00
Rate for Payer: MDX Hawaii PPO	$7,857.00
Rate for Payer: Ohana Health Plan Medicaid	$6,156.00
Rate for Payer: Ohana Health Plan Medicare	$6,156.00
Rate for Payer: UnitedHealthcare Medicare	$6,156.00
Rate for Payer: University Health Alliance Commercial	$4,536.00

ACCOLADE GNRTR EL DR L321

Facility

$8,100.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$4,536.00
Max. Negotiated Rate	$7,857.00
Rate for Payer: Cash Price	$4,860.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,670.00
Rate for Payer: Health Management Network Commercial	$6,885.00
Rate for Payer: Kaiser Permanente Commercial	$7,290.00
Rate for Payer: MDX Hawaii PPO	$7,857.00
Rate for Payer: University Health Alliance Commercial	$4,536.00

ACCOLADE GNRTR EL DR L321

Facility

$8,100.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$4,050.00
Max. Negotiated Rate	$7,857.00
Rate for Payer: AlohaCare Medicaid	$4,050.00
Rate for Payer: AlohaCare Medicare	$6,156.00
Rate for Payer: Cash Price	$4,860.00
Rate for Payer: Devoted Health Medicare	$6,804.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,156.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,670.00
Rate for Payer: Health Management Network Commercial	$6,885.00
Rate for Payer: Humana Medicare	$6,156.00
Rate for Payer: Kaiser Permanente Commercial	$7,290.00
Rate for Payer: Kaiser Permanente Medicaid	$4,131.00
Rate for Payer: Kaiser Permanente Medicare	$6,156.00
Rate for Payer: MDX Hawaii PPO	$7,857.00
Rate for Payer: Ohana Health Plan Medicaid	$6,156.00
Rate for Payer: Ohana Health Plan Medicare	$6,156.00
Rate for Payer: UnitedHealthcare Medicare	$6,156.00
Rate for Payer: University Health Alliance Commercial	$4,536.00

ACCOLADE GNRTR MRI EL DR L331

Facility

$13,810.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$6,905.00
Max. Negotiated Rate	$13,395.70
Rate for Payer: AlohaCare Medicaid	$6,905.00
Rate for Payer: AlohaCare Medicare	$10,495.60
Rate for Payer: Cash Price	$8,286.00
Rate for Payer: Devoted Health Medicare	$11,600.40
Rate for Payer: Hawaii Medical Service Association Medicare	$10,495.60
Rate for Payer: Hawaii Western Management Group Commercial	$9,667.00
Rate for Payer: Health Management Network Commercial	$11,738.50
Rate for Payer: Humana Medicare	$10,495.60
Rate for Payer: Kaiser Permanente Commercial	$12,429.00
Rate for Payer: Kaiser Permanente Medicaid	$7,043.10
Rate for Payer: Kaiser Permanente Medicare	$10,495.60
Rate for Payer: MDX Hawaii PPO	$13,395.70
Rate for Payer: Ohana Health Plan Medicaid	$10,495.60
Rate for Payer: Ohana Health Plan Medicare	$10,495.60
Rate for Payer: UnitedHealthcare Medicare	$10,495.60
Rate for Payer: University Health Alliance Commercial	$7,733.60

ACCOLADE GNRTR MRI EL DR L331

Facility

$13,810.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$7,733.60
Max. Negotiated Rate	$13,395.70
Rate for Payer: Cash Price	$8,286.00
Rate for Payer: Hawaii Western Management Group Commercial	$9,667.00
Rate for Payer: Health Management Network Commercial	$11,738.50
Rate for Payer: Kaiser Permanente Commercial	$12,429.00
Rate for Payer: MDX Hawaii PPO	$13,395.70
Rate for Payer: University Health Alliance Commercial	$7,733.60

ACCOLADE GNRTR SR L300

Facility

$10,886.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$6,096.16
Max. Negotiated Rate	$10,559.42
Rate for Payer: Cash Price	$6,531.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,620.20
Rate for Payer: Health Management Network Commercial	$9,253.10
Rate for Payer: Kaiser Permanente Commercial	$9,797.40
Rate for Payer: MDX Hawaii PPO	$10,559.42
Rate for Payer: University Health Alliance Commercial	$6,096.16

ACCOLADE GNRTR SR L300

Facility

$10,886.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,443.00
Max. Negotiated Rate	$10,559.42
Rate for Payer: AlohaCare Medicaid	$5,443.00
Rate for Payer: AlohaCare Medicare	$8,273.36
Rate for Payer: Cash Price	$6,531.60
Rate for Payer: Devoted Health Medicare	$9,144.24
Rate for Payer: Hawaii Medical Service Association Medicare	$8,273.36
Rate for Payer: Hawaii Western Management Group Commercial	$7,620.20
Rate for Payer: Health Management Network Commercial	$9,253.10
Rate for Payer: Humana Medicare	$8,273.36
Rate for Payer: Kaiser Permanente Commercial	$9,797.40
Rate for Payer: Kaiser Permanente Medicaid	$5,551.86
Rate for Payer: Kaiser Permanente Medicare	$8,273.36
Rate for Payer: MDX Hawaii PPO	$10,559.42
Rate for Payer: Ohana Health Plan Medicaid	$8,273.36
Rate for Payer: Ohana Health Plan Medicare	$8,273.36
Rate for Payer: UnitedHealthcare Medicare	$8,273.36
Rate for Payer: University Health Alliance Commercial	$6,096.16

ACCOLADE II #9 6721-0937

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

ACCOLADE II #9 6721-0937

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

ACCOLADE II SIZE 1 6720-0127

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

ACCOLADE II SIZE 1 6720-0127

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

ACCOLADE II SIZE 2 6720-0230

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

ACCOLADE II SIZE 2 6720-0230

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

ACCOLADE II SIZE 3 6720-0330

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

ACCOLADE II SIZE 3 6720-0330

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

ACCOLADE II SIZE 6 6720-0635

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

ACCOLADE II SIZE 6 6720-0635

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

ACCOLADE II SIZE 7 6720-0737

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

ACCOLADE II SIZE 7 6720-0737

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

Know your out-of-pocket cost for care.

All Charges