Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MESH 10X15CM PROLENE GPSL

Facility

$2,528.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,415.68
Max. Negotiated Rate	$2,452.16
Rate for Payer: Cash Price	$1,516.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,769.60
Rate for Payer: Health Management Network Commercial	$2,148.80
Rate for Payer: Kaiser Permanente Commercial	$2,275.20
Rate for Payer: MDX Hawaii PPO	$2,452.16
Rate for Payer: University Health Alliance Commercial	$1,415.68

MESH 10X15CM PROLENE GPSL

Facility

$2,528.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,264.00
Max. Negotiated Rate	$2,452.16
Rate for Payer: AlohaCare Medicaid	$1,264.00
Rate for Payer: AlohaCare Medicare	$1,921.28
Rate for Payer: Cash Price	$1,516.80
Rate for Payer: Devoted Health Medicare	$2,123.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,921.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,769.60
Rate for Payer: Health Management Network Commercial	$2,148.80
Rate for Payer: Humana Medicare	$1,921.28
Rate for Payer: Kaiser Permanente Commercial	$2,275.20
Rate for Payer: Kaiser Permanente Medicaid	$1,289.28
Rate for Payer: Kaiser Permanente Medicare	$1,921.28
Rate for Payer: MDX Hawaii PPO	$2,452.16
Rate for Payer: Ohana Health Plan Medicaid	$1,921.28
Rate for Payer: Ohana Health Plan Medicare	$1,921.28
Rate for Payer: UnitedHealthcare Medicare	$1,921.28
Rate for Payer: University Health Alliance Commercial	$1,415.68

MESH 15X10CM

Facility

$1,509.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$754.50
Max. Negotiated Rate	$1,463.73
Rate for Payer: AlohaCare Medicaid	$754.50
Rate for Payer: AlohaCare Medicare	$1,146.84
Rate for Payer: Cash Price	$905.40
Rate for Payer: Devoted Health Medicare	$1,267.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,146.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,056.30
Rate for Payer: Health Management Network Commercial	$1,282.65
Rate for Payer: Humana Medicare	$1,146.84
Rate for Payer: Kaiser Permanente Commercial	$1,358.10
Rate for Payer: Kaiser Permanente Medicaid	$769.59
Rate for Payer: Kaiser Permanente Medicare	$1,146.84
Rate for Payer: MDX Hawaii PPO	$1,463.73
Rate for Payer: Ohana Health Plan Medicaid	$1,146.84
Rate for Payer: Ohana Health Plan Medicare	$1,146.84
Rate for Payer: UnitedHealthcare Medicare	$1,146.84
Rate for Payer: University Health Alliance Commercial	$845.04

MESH 15X10CM

Facility

$1,509.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$845.04
Max. Negotiated Rate	$1,463.73
Rate for Payer: Cash Price	$905.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,056.30
Rate for Payer: Health Management Network Commercial	$1,282.65
Rate for Payer: Kaiser Permanente Commercial	$1,358.10
Rate for Payer: MDX Hawaii PPO	$1,463.73
Rate for Payer: University Health Alliance Commercial	$845.04

MESH 25X20CM

Facility

$2,102.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,177.12
Max. Negotiated Rate	$2,038.94
Rate for Payer: Cash Price	$1,261.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.40
Rate for Payer: Health Management Network Commercial	$1,786.70
Rate for Payer: Kaiser Permanente Commercial	$1,891.80
Rate for Payer: MDX Hawaii PPO	$2,038.94
Rate for Payer: University Health Alliance Commercial	$1,177.12

MESH 25X20CM

Facility

$2,102.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,051.00
Max. Negotiated Rate	$2,038.94
Rate for Payer: AlohaCare Medicaid	$1,051.00
Rate for Payer: AlohaCare Medicare	$1,597.52
Rate for Payer: Cash Price	$1,261.20
Rate for Payer: Devoted Health Medicare	$1,765.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,597.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.40
Rate for Payer: Health Management Network Commercial	$1,786.70
Rate for Payer: Humana Medicare	$1,597.52
Rate for Payer: Kaiser Permanente Commercial	$1,891.80
Rate for Payer: Kaiser Permanente Medicaid	$1,072.02
Rate for Payer: Kaiser Permanente Medicare	$1,597.52
Rate for Payer: MDX Hawaii PPO	$2,038.94
Rate for Payer: Ohana Health Plan Medicaid	$1,597.52
Rate for Payer: Ohana Health Plan Medicare	$1,597.52
Rate for Payer: UnitedHealthcare Medicare	$1,597.52
Rate for Payer: University Health Alliance Commercial	$1,177.12

MESH 3.2X3.2 CIRCLE 5950009

Facility

$2,520.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,444.40
Rate for Payer: AlohaCare Medicaid	$1,260.00
Rate for Payer: AlohaCare Medicare	$1,915.20
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Devoted Health Medicare	$2,116.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,915.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Humana Medicare	$1,915.20
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: Kaiser Permanente Medicaid	$1,285.20
Rate for Payer: Kaiser Permanente Medicare	$1,915.20
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: Ohana Health Plan Medicaid	$1,915.20
Rate for Payer: Ohana Health Plan Medicare	$1,915.20
Rate for Payer: UnitedHealthcare Medicare	$1,915.20
Rate for Payer: University Health Alliance Commercial	$1,411.20

MESH 3.2X3.2 CIRCLE 5950009

Facility

$2,520.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,411.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: University Health Alliance Commercial	$1,411.20

MESH 3D EXTRA LARGE #0117322

Facility

$1,389.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$694.50
Max. Negotiated Rate	$1,347.33
Rate for Payer: AlohaCare Medicaid	$694.50
Rate for Payer: AlohaCare Medicare	$1,055.64
Rate for Payer: Cash Price	$833.40
Rate for Payer: Devoted Health Medicare	$1,166.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,055.64
Rate for Payer: Hawaii Western Management Group Commercial	$972.30
Rate for Payer: Health Management Network Commercial	$1,180.65
Rate for Payer: Humana Medicare	$1,055.64
Rate for Payer: Kaiser Permanente Commercial	$1,250.10
Rate for Payer: Kaiser Permanente Medicaid	$708.39
Rate for Payer: Kaiser Permanente Medicare	$1,055.64
Rate for Payer: MDX Hawaii PPO	$1,347.33
Rate for Payer: Ohana Health Plan Medicaid	$1,055.64
Rate for Payer: Ohana Health Plan Medicare	$1,055.64
Rate for Payer: UnitedHealthcare Medicare	$1,055.64
Rate for Payer: University Health Alliance Commercial	$777.84

MESH 3D EXTRA LARGE #0117322

Facility

$1,389.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$777.84
Max. Negotiated Rate	$1,347.33
Rate for Payer: Cash Price	$833.40
Rate for Payer: Hawaii Western Management Group Commercial	$972.30
Rate for Payer: Health Management Network Commercial	$1,180.65
Rate for Payer: Kaiser Permanente Commercial	$1,250.10
Rate for Payer: MDX Hawaii PPO	$1,347.33
Rate for Payer: University Health Alliance Commercial	$777.84

MESH 3D MAX LARGE LT 0117311

Facility

$1,302.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$989.52
Rate for Payer: Cash Price	$781.20
Rate for Payer: Devoted Health Medicare	$1,093.68
Rate for Payer: Hawaii Medical Service Association Medicare	$989.52
Rate for Payer: Hawaii Western Management Group Commercial	$911.40
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$989.52
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$989.52
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$989.52
Rate for Payer: Ohana Health Plan Medicare	$989.52
Rate for Payer: UnitedHealthcare Medicare	$989.52
Rate for Payer: University Health Alliance Commercial	$729.12

MESH 3D MAX LARGE LT 0117311

Facility

$1,302.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$729.12
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$781.20
Rate for Payer: Hawaii Western Management Group Commercial	$911.40
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: University Health Alliance Commercial	$729.12

MESH 3D MAX LARGE RT 0117321

Facility

$1,314.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$735.84
Max. Negotiated Rate	$1,274.58
Rate for Payer: Cash Price	$788.40
Rate for Payer: Hawaii Western Management Group Commercial	$919.80
Rate for Payer: Health Management Network Commercial	$1,116.90
Rate for Payer: Kaiser Permanente Commercial	$1,182.60
Rate for Payer: MDX Hawaii PPO	$1,274.58
Rate for Payer: University Health Alliance Commercial	$735.84

MESH 3D MAX LARGE RT 0117321

Facility

$1,314.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$657.00
Max. Negotiated Rate	$1,274.58
Rate for Payer: AlohaCare Medicaid	$657.00
Rate for Payer: AlohaCare Medicare	$998.64
Rate for Payer: Cash Price	$788.40
Rate for Payer: Devoted Health Medicare	$1,103.76
Rate for Payer: Hawaii Medical Service Association Medicare	$998.64
Rate for Payer: Hawaii Western Management Group Commercial	$919.80
Rate for Payer: Health Management Network Commercial	$1,116.90
Rate for Payer: Humana Medicare	$998.64
Rate for Payer: Kaiser Permanente Commercial	$1,182.60
Rate for Payer: Kaiser Permanente Medicaid	$670.14
Rate for Payer: Kaiser Permanente Medicare	$998.64
Rate for Payer: MDX Hawaii PPO	$1,274.58
Rate for Payer: Ohana Health Plan Medicaid	$998.64
Rate for Payer: Ohana Health Plan Medicare	$998.64
Rate for Payer: UnitedHealthcare Medicare	$998.64
Rate for Payer: University Health Alliance Commercial	$735.84

MESH 3D MAX LEFT XL #0117312

Facility

$1,455.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$814.80
Max. Negotiated Rate	$1,411.35
Rate for Payer: Cash Price	$873.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,018.50
Rate for Payer: Health Management Network Commercial	$1,236.75
Rate for Payer: Kaiser Permanente Commercial	$1,309.50
Rate for Payer: MDX Hawaii PPO	$1,411.35
Rate for Payer: University Health Alliance Commercial	$814.80

MESH 3D MAX LEFT XL #0117312

Facility

$1,455.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$727.50
Max. Negotiated Rate	$1,411.35
Rate for Payer: AlohaCare Medicaid	$727.50
Rate for Payer: AlohaCare Medicare	$1,105.80
Rate for Payer: Cash Price	$873.00
Rate for Payer: Devoted Health Medicare	$1,222.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,105.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,018.50
Rate for Payer: Health Management Network Commercial	$1,236.75
Rate for Payer: Humana Medicare	$1,105.80
Rate for Payer: Kaiser Permanente Commercial	$1,309.50
Rate for Payer: Kaiser Permanente Medicaid	$742.05
Rate for Payer: Kaiser Permanente Medicare	$1,105.80
Rate for Payer: MDX Hawaii PPO	$1,411.35
Rate for Payer: Ohana Health Plan Medicaid	$1,105.80
Rate for Payer: Ohana Health Plan Medicare	$1,105.80
Rate for Payer: UnitedHealthcare Medicare	$1,105.80
Rate for Payer: University Health Alliance Commercial	$814.80

MESH 3DMAX LGE LF 0116311

Facility

$1,507.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$843.92
Max. Negotiated Rate	$1,461.79
Rate for Payer: Cash Price	$904.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,054.90
Rate for Payer: Health Management Network Commercial	$1,280.95
Rate for Payer: Kaiser Permanente Commercial	$1,356.30
Rate for Payer: MDX Hawaii PPO	$1,461.79
Rate for Payer: University Health Alliance Commercial	$843.92

MESH 3DMAX LGE LF 0116311

Facility

$1,507.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$753.50
Max. Negotiated Rate	$1,461.79
Rate for Payer: AlohaCare Medicaid	$753.50
Rate for Payer: AlohaCare Medicare	$1,145.32
Rate for Payer: Cash Price	$904.20
Rate for Payer: Devoted Health Medicare	$1,265.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,145.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,054.90
Rate for Payer: Health Management Network Commercial	$1,280.95
Rate for Payer: Humana Medicare	$1,145.32
Rate for Payer: Kaiser Permanente Commercial	$1,356.30
Rate for Payer: Kaiser Permanente Medicaid	$768.57
Rate for Payer: Kaiser Permanente Medicare	$1,145.32
Rate for Payer: MDX Hawaii PPO	$1,461.79
Rate for Payer: Ohana Health Plan Medicaid	$1,145.32
Rate for Payer: Ohana Health Plan Medicare	$1,145.32
Rate for Payer: UnitedHealthcare Medicare	$1,145.32
Rate for Payer: University Health Alliance Commercial	$843.92

MESH 3DMAX LGE RT 0116321

Facility

$1,367.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$765.52
Max. Negotiated Rate	$1,325.99
Rate for Payer: Cash Price	$820.20
Rate for Payer: Hawaii Western Management Group Commercial	$956.90
Rate for Payer: Health Management Network Commercial	$1,161.95
Rate for Payer: Kaiser Permanente Commercial	$1,230.30
Rate for Payer: MDX Hawaii PPO	$1,325.99
Rate for Payer: University Health Alliance Commercial	$765.52

MESH 3DMAX LGE RT 0116321

Facility

$1,367.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$683.50
Max. Negotiated Rate	$1,325.99
Rate for Payer: AlohaCare Medicaid	$683.50
Rate for Payer: AlohaCare Medicare	$1,038.92
Rate for Payer: Cash Price	$820.20
Rate for Payer: Devoted Health Medicare	$1,148.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,038.92
Rate for Payer: Hawaii Western Management Group Commercial	$956.90
Rate for Payer: Health Management Network Commercial	$1,161.95
Rate for Payer: Humana Medicare	$1,038.92
Rate for Payer: Kaiser Permanente Commercial	$1,230.30
Rate for Payer: Kaiser Permanente Medicaid	$697.17
Rate for Payer: Kaiser Permanente Medicare	$1,038.92
Rate for Payer: MDX Hawaii PPO	$1,325.99
Rate for Payer: Ohana Health Plan Medicaid	$1,038.92
Rate for Payer: Ohana Health Plan Medicare	$1,038.92
Rate for Payer: UnitedHealthcare Medicare	$1,038.92
Rate for Payer: University Health Alliance Commercial	$765.52

MESH 3DMAX MED LF 0116310

Facility

$1,316.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$658.00
Max. Negotiated Rate	$1,276.52
Rate for Payer: AlohaCare Medicaid	$658.00
Rate for Payer: AlohaCare Medicare	$1,000.16
Rate for Payer: Cash Price	$789.60
Rate for Payer: Devoted Health Medicare	$1,105.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,000.16
Rate for Payer: Hawaii Western Management Group Commercial	$921.20
Rate for Payer: Health Management Network Commercial	$1,118.60
Rate for Payer: Humana Medicare	$1,000.16
Rate for Payer: Kaiser Permanente Commercial	$1,184.40
Rate for Payer: Kaiser Permanente Medicaid	$671.16
Rate for Payer: Kaiser Permanente Medicare	$1,000.16
Rate for Payer: MDX Hawaii PPO	$1,276.52
Rate for Payer: Ohana Health Plan Medicaid	$1,000.16
Rate for Payer: Ohana Health Plan Medicare	$1,000.16
Rate for Payer: UnitedHealthcare Medicare	$1,000.16
Rate for Payer: University Health Alliance Commercial	$736.96

MESH 3DMAX MED LF 0116310

Facility

$1,316.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$736.96
Max. Negotiated Rate	$1,276.52
Rate for Payer: Cash Price	$789.60
Rate for Payer: Hawaii Western Management Group Commercial	$921.20
Rate for Payer: Health Management Network Commercial	$1,118.60
Rate for Payer: Kaiser Permanente Commercial	$1,184.40
Rate for Payer: MDX Hawaii PPO	$1,276.52
Rate for Payer: University Health Alliance Commercial	$736.96

MESH 3DMAX MED RT 0116320

Facility

$1,382.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$691.00
Max. Negotiated Rate	$1,340.54
Rate for Payer: AlohaCare Medicaid	$691.00
Rate for Payer: AlohaCare Medicare	$1,050.32
Rate for Payer: Cash Price	$829.20
Rate for Payer: Devoted Health Medicare	$1,160.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,050.32
Rate for Payer: Hawaii Western Management Group Commercial	$967.40
Rate for Payer: Health Management Network Commercial	$1,174.70
Rate for Payer: Humana Medicare	$1,050.32
Rate for Payer: Kaiser Permanente Commercial	$1,243.80
Rate for Payer: Kaiser Permanente Medicaid	$704.82
Rate for Payer: Kaiser Permanente Medicare	$1,050.32
Rate for Payer: MDX Hawaii PPO	$1,340.54
Rate for Payer: Ohana Health Plan Medicaid	$1,050.32
Rate for Payer: Ohana Health Plan Medicare	$1,050.32
Rate for Payer: UnitedHealthcare Medicare	$1,050.32
Rate for Payer: University Health Alliance Commercial	$773.92

MESH 3DMAX MED RT 0116320

Facility

$1,382.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$773.92
Max. Negotiated Rate	$1,340.54
Rate for Payer: MDX Hawaii PPO	$1,340.54
Rate for Payer: Cash Price	$829.20
Rate for Payer: Hawaii Western Management Group Commercial	$967.40
Rate for Payer: Health Management Network Commercial	$1,174.70
Rate for Payer: Kaiser Permanente Commercial	$1,243.80
Rate for Payer: University Health Alliance Commercial	$773.92

MESH 3DMAX X-LGE 0116312

Facility

$1,633.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$816.50
Max. Negotiated Rate	$1,584.01
Rate for Payer: AlohaCare Medicaid	$816.50
Rate for Payer: AlohaCare Medicare	$1,241.08
Rate for Payer: Cash Price	$979.80
Rate for Payer: Devoted Health Medicare	$1,371.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,241.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.10
Rate for Payer: Health Management Network Commercial	$1,388.05
Rate for Payer: Humana Medicare	$1,241.08
Rate for Payer: Kaiser Permanente Commercial	$1,469.70
Rate for Payer: Kaiser Permanente Medicaid	$832.83
Rate for Payer: Kaiser Permanente Medicare	$1,241.08
Rate for Payer: MDX Hawaii PPO	$1,584.01
Rate for Payer: Ohana Health Plan Medicaid	$1,241.08
Rate for Payer: Ohana Health Plan Medicare	$1,241.08
Rate for Payer: UnitedHealthcare Medicare	$1,241.08
Rate for Payer: University Health Alliance Commercial	$914.48

Know your out-of-pocket cost for care.

All Charges