Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MESH 3DMAX X-LGE 0116312

Facility

$1,633.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$914.48
Max. Negotiated Rate	$1,584.01
Rate for Payer: Cash Price	$979.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.10
Rate for Payer: Health Management Network Commercial	$1,388.05
Rate for Payer: Kaiser Permanente Commercial	$1,469.70
Rate for Payer: MDX Hawaii PPO	$1,584.01
Rate for Payer: University Health Alliance Commercial	$914.48

MESH 3DMAX X-LGE RT 0116322

Facility

$1,442.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$721.00
Max. Negotiated Rate	$1,398.74
Rate for Payer: AlohaCare Medicaid	$721.00
Rate for Payer: AlohaCare Medicare	$1,095.92
Rate for Payer: Cash Price	$865.20
Rate for Payer: Devoted Health Medicare	$1,211.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,095.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,009.40
Rate for Payer: Health Management Network Commercial	$1,225.70
Rate for Payer: Humana Medicare	$1,095.92
Rate for Payer: Kaiser Permanente Commercial	$1,297.80
Rate for Payer: Kaiser Permanente Medicaid	$735.42
Rate for Payer: Kaiser Permanente Medicare	$1,095.92
Rate for Payer: MDX Hawaii PPO	$1,398.74
Rate for Payer: Ohana Health Plan Medicaid	$1,095.92
Rate for Payer: Ohana Health Plan Medicare	$1,095.92
Rate for Payer: UnitedHealthcare Medicare	$1,095.92
Rate for Payer: University Health Alliance Commercial	$807.52

MESH 3DMAX X-LGE RT 0116322

Facility

$1,442.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$807.52
Max. Negotiated Rate	$1,398.74
Rate for Payer: Cash Price	$865.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,009.40
Rate for Payer: Health Management Network Commercial	$1,225.70
Rate for Payer: Kaiser Permanente Commercial	$1,297.80
Rate for Payer: MDX Hawaii PPO	$1,398.74
Rate for Payer: University Health Alliance Commercial	$807.52

MESH BIOLOGIC 5X8CM XI0508-S+

Facility

$2,760.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,380.00
Max. Negotiated Rate	$2,677.20
Rate for Payer: AlohaCare Medicaid	$1,380.00
Rate for Payer: AlohaCare Medicare	$2,097.60
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Devoted Health Medicare	$2,318.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,097.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,932.00
Rate for Payer: Health Management Network Commercial	$2,346.00
Rate for Payer: Humana Medicare	$2,097.60
Rate for Payer: Kaiser Permanente Commercial	$2,484.00
Rate for Payer: Kaiser Permanente Medicaid	$1,407.60
Rate for Payer: Kaiser Permanente Medicare	$2,097.60
Rate for Payer: MDX Hawaii PPO	$2,677.20
Rate for Payer: Ohana Health Plan Medicaid	$2,097.60
Rate for Payer: Ohana Health Plan Medicare	$2,097.60
Rate for Payer: UnitedHealthcare Medicare	$2,097.60
Rate for Payer: University Health Alliance Commercial	$1,545.60

MESH BIOLOGIC 5X8CM XI0508-S+

Facility

$2,760.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,545.60
Max. Negotiated Rate	$2,677.20
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,932.00
Rate for Payer: Health Management Network Commercial	$2,346.00
Rate for Payer: Kaiser Permanente Commercial	$2,484.00
Rate for Payer: MDX Hawaii PPO	$2,677.20
Rate for Payer: University Health Alliance Commercial	$1,545.60

MESHED BILAYER 2X2 MWM2021

Facility

$5,993.00

Service Code	HCPCS Q4104
Hospital Revenue Code	636
Min. Negotiated Rate	$5,094.05
Max. Negotiated Rate	$5,813.21
Rate for Payer: Cash Price	$3,595.80
Rate for Payer: Health Management Network Commercial	$5,094.05
Rate for Payer: Kaiser Permanente Commercial	$5,393.70
Rate for Payer: MDX Hawaii PPO	$5,813.21

MESHED BILAYER 2X2 MWM2021

Facility

$5,993.00

Service Code	HCPCS Q4104
Hospital Revenue Code	636
Min. Negotiated Rate	$53.76
Max. Negotiated Rate	$5,813.21
Rate for Payer: AlohaCare Medicaid	$2,996.50
Rate for Payer: AlohaCare Medicare	$4,554.68
Rate for Payer: Cash Price	$3,595.80
Rate for Payer: Cash Price	$3,595.80
Rate for Payer: Devoted Health Medicare	$5,034.12
Rate for Payer: Hawaii Medical Service Association ABD	$53.76
Rate for Payer: Hawaii Medical Service Association Commercial	$158.93
Rate for Payer: Hawaii Medical Service Association Medicare	$4,554.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53.76
Rate for Payer: Hawaii Western Management Group Commercial	$5,693.35
Rate for Payer: Health Management Network Commercial	$5,094.05
Rate for Payer: Humana Medicare	$4,554.68
Rate for Payer: Kaiser Permanente Commercial	$5,393.70
Rate for Payer: Kaiser Permanente Medicaid	$3,056.43
Rate for Payer: Kaiser Permanente Medicare	$4,554.68
Rate for Payer: MDX Hawaii PPO	$5,813.21
Rate for Payer: Ohana Health Plan Medicaid	$4,554.68
Rate for Payer: Ohana Health Plan Medicare	$4,554.68
Rate for Payer: UnitedHealthcare Medicaid	$3,595.80
Rate for Payer: UnitedHealthcare Medicare	$4,554.68
Rate for Payer: University Health Alliance Commercial	$4,368.30

MESHED BILAYER 4X5 MWM4051

Facility

$10,451.00

Service Code	HCPCS Q4104
Hospital Revenue Code	636
Min. Negotiated Rate	$8,883.35
Max. Negotiated Rate	$10,137.47
Rate for Payer: Cash Price	$6,270.60
Rate for Payer: Health Management Network Commercial	$8,883.35
Rate for Payer: Kaiser Permanente Commercial	$9,405.90
Rate for Payer: MDX Hawaii PPO	$10,137.47

MESHED BILAYER 4X5 MWM4051

Facility

$10,451.00

Service Code	HCPCS Q4104
Hospital Revenue Code	636
Min. Negotiated Rate	$53.76
Max. Negotiated Rate	$10,137.47
Rate for Payer: AlohaCare Medicaid	$5,225.50
Rate for Payer: AlohaCare Medicare	$7,942.76
Rate for Payer: Cash Price	$6,270.60
Rate for Payer: Cash Price	$6,270.60
Rate for Payer: Devoted Health Medicare	$8,778.84
Rate for Payer: Hawaii Medical Service Association ABD	$53.76
Rate for Payer: Hawaii Medical Service Association Commercial	$158.93
Rate for Payer: Hawaii Medical Service Association Medicare	$7,942.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53.76
Rate for Payer: Hawaii Western Management Group Commercial	$9,928.45
Rate for Payer: Health Management Network Commercial	$8,883.35
Rate for Payer: Humana Medicare	$7,942.76
Rate for Payer: Kaiser Permanente Commercial	$9,405.90
Rate for Payer: Kaiser Permanente Medicaid	$5,330.01
Rate for Payer: Kaiser Permanente Medicare	$7,942.76
Rate for Payer: MDX Hawaii PPO	$10,137.47
Rate for Payer: Ohana Health Plan Medicaid	$7,942.76
Rate for Payer: Ohana Health Plan Medicare	$7,942.76
Rate for Payer: UnitedHealthcare Medicaid	$6,270.60
Rate for Payer: UnitedHealthcare Medicare	$7,942.76
Rate for Payer: University Health Alliance Commercial	$7,617.73

MESHED DERMAL 5CMX5CM MDRT2021

Facility

$7,560.00

Service Code	HCPCS Q4105
Hospital Revenue Code	636
Min. Negotiated Rate	$6,426.00
Max. Negotiated Rate	$7,333.20
Rate for Payer: Cash Price	$4,536.00
Rate for Payer: Health Management Network Commercial	$6,426.00
Rate for Payer: Kaiser Permanente Commercial	$6,804.00
Rate for Payer: MDX Hawaii PPO	$7,333.20

MESHED DERMAL 5CMX5CM MDRT2021

Facility

$7,560.00

Service Code	HCPCS Q4105
Hospital Revenue Code	636
Min. Negotiated Rate	$26.09
Max. Negotiated Rate	$7,333.20
Rate for Payer: AlohaCare Medicaid	$3,780.00
Rate for Payer: AlohaCare Medicare	$5,745.60
Rate for Payer: Cash Price	$4,536.00
Rate for Payer: Cash Price	$4,536.00
Rate for Payer: Devoted Health Medicare	$6,350.40
Rate for Payer: Hawaii Medical Service Association ABD	$26.09
Rate for Payer: Hawaii Medical Service Association Commercial	$158.93
Rate for Payer: Hawaii Medical Service Association Medicare	$5,745.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.09
Rate for Payer: Hawaii Western Management Group Commercial	$7,182.00
Rate for Payer: Health Management Network Commercial	$6,426.00
Rate for Payer: Humana Medicare	$5,745.60
Rate for Payer: Kaiser Permanente Commercial	$6,804.00
Rate for Payer: Kaiser Permanente Medicaid	$3,855.60
Rate for Payer: Kaiser Permanente Medicare	$5,745.60
Rate for Payer: MDX Hawaii PPO	$7,333.20
Rate for Payer: Ohana Health Plan Medicaid	$5,745.60
Rate for Payer: Ohana Health Plan Medicare	$5,745.60
Rate for Payer: UnitedHealthcare Medicaid	$4,536.00
Rate for Payer: UnitedHealthcare Medicare	$5,745.60
Rate for Payer: University Health Alliance Commercial	$5,510.48

MESH FLEX HD 6X16 PF2616

Facility

$8,106.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$4,539.36
Max. Negotiated Rate	$7,862.82
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: University Health Alliance Commercial	$4,539.36

MESH FLEX HD 6X16 PF2616

Facility

$8,106.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$4,053.00
Max. Negotiated Rate	$7,862.82
Rate for Payer: AlohaCare Medicaid	$4,053.00
Rate for Payer: AlohaCare Medicare	$6,160.56
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Devoted Health Medicare	$6,809.04
Rate for Payer: Hawaii Medical Service Association Medicare	$6,160.56
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Humana Medicare	$6,160.56
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: Kaiser Permanente Medicaid	$4,134.06
Rate for Payer: Kaiser Permanente Medicare	$6,160.56
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: Ohana Health Plan Medicaid	$6,160.56
Rate for Payer: Ohana Health Plan Medicare	$6,160.56
Rate for Payer: UnitedHealthcare Medicare	$6,160.56
Rate for Payer: University Health Alliance Commercial	$4,539.36

MESH FLEX HD 8X16 PF2618

Facility

$11,412.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$6,390.72
Max. Negotiated Rate	$11,069.64
Rate for Payer: Cash Price	$6,847.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,988.40
Rate for Payer: Health Management Network Commercial	$9,700.20
Rate for Payer: Kaiser Permanente Commercial	$10,270.80
Rate for Payer: MDX Hawaii PPO	$11,069.64
Rate for Payer: University Health Alliance Commercial	$6,390.72

MESH FLEX HD 8X16 PF2618

Facility

$11,412.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$5,706.00
Max. Negotiated Rate	$11,069.64
Rate for Payer: AlohaCare Medicaid	$5,706.00
Rate for Payer: AlohaCare Medicare	$8,673.12
Rate for Payer: Cash Price	$6,847.20
Rate for Payer: Devoted Health Medicare	$9,586.08
Rate for Payer: Hawaii Medical Service Association Medicare	$8,673.12
Rate for Payer: Hawaii Western Management Group Commercial	$7,988.40
Rate for Payer: Health Management Network Commercial	$9,700.20
Rate for Payer: Humana Medicare	$8,673.12
Rate for Payer: Kaiser Permanente Commercial	$10,270.80
Rate for Payer: Kaiser Permanente Medicaid	$5,820.12
Rate for Payer: Kaiser Permanente Medicare	$8,673.12
Rate for Payer: MDX Hawaii PPO	$11,069.64
Rate for Payer: Ohana Health Plan Medicaid	$8,673.12
Rate for Payer: Ohana Health Plan Medicare	$8,673.12
Rate for Payer: UnitedHealthcare Medicare	$8,673.12
Rate for Payer: University Health Alliance Commercial	$6,390.72

MESH HERNIA PLUG AND PATCH

Facility

$391.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$218.96
Max. Negotiated Rate	$379.27
Rate for Payer: Cash Price	$234.60
Rate for Payer: Hawaii Western Management Group Commercial	$273.70
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: Kaiser Permanente Commercial	$351.90
Rate for Payer: MDX Hawaii PPO	$379.27
Rate for Payer: University Health Alliance Commercial	$218.96

MESH HERNIA PLUG AND PATCH

Facility

$391.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$379.27
Rate for Payer: AlohaCare Medicaid	$195.50
Rate for Payer: AlohaCare Medicare	$297.16
Rate for Payer: Cash Price	$234.60
Rate for Payer: Devoted Health Medicare	$328.44
Rate for Payer: Hawaii Medical Service Association Medicare	$297.16
Rate for Payer: Hawaii Western Management Group Commercial	$273.70
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: Humana Medicare	$297.16
Rate for Payer: Kaiser Permanente Commercial	$351.90
Rate for Payer: Kaiser Permanente Medicaid	$199.41
Rate for Payer: Kaiser Permanente Medicare	$297.16
Rate for Payer: MDX Hawaii PPO	$379.27
Rate for Payer: Ohana Health Plan Medicaid	$297.16
Rate for Payer: Ohana Health Plan Medicare	$297.16
Rate for Payer: UnitedHealthcare Medicare	$297.16
Rate for Payer: University Health Alliance Commercial	$218.96

MESH HERNIA SYNECOR 12C GKFC12

Facility

$1,863.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$931.50
Max. Negotiated Rate	$1,807.11
Rate for Payer: AlohaCare Medicaid	$931.50
Rate for Payer: AlohaCare Medicare	$1,415.88
Rate for Payer: Cash Price	$1,117.80
Rate for Payer: Devoted Health Medicare	$1,564.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,415.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,304.10
Rate for Payer: Health Management Network Commercial	$1,583.55
Rate for Payer: Humana Medicare	$1,415.88
Rate for Payer: Kaiser Permanente Commercial	$1,676.70
Rate for Payer: Kaiser Permanente Medicaid	$950.13
Rate for Payer: Kaiser Permanente Medicare	$1,415.88
Rate for Payer: MDX Hawaii PPO	$1,807.11
Rate for Payer: Ohana Health Plan Medicaid	$1,415.88
Rate for Payer: Ohana Health Plan Medicare	$1,415.88
Rate for Payer: UnitedHealthcare Medicare	$1,415.88
Rate for Payer: University Health Alliance Commercial	$1,043.28

MESH HERNIA SYNECOR 12C GKFC12

Facility

$1,863.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,043.28
Max. Negotiated Rate	$1,807.11
Rate for Payer: Cash Price	$1,117.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,304.10
Rate for Payer: Health Management Network Commercial	$1,583.55
Rate for Payer: Kaiser Permanente Commercial	$1,676.70
Rate for Payer: MDX Hawaii PPO	$1,807.11
Rate for Payer: University Health Alliance Commercial	$1,043.28

MESH LF NON ABS 0115311

Facility

$910.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$882.70
Rate for Payer: AlohaCare Medicaid	$455.00
Rate for Payer: AlohaCare Medicare	$691.60
Rate for Payer: Cash Price	$546.00
Rate for Payer: Devoted Health Medicare	$764.40
Rate for Payer: Hawaii Medical Service Association Medicare	$691.60
Rate for Payer: Hawaii Western Management Group Commercial	$637.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Humana Medicare	$691.60
Rate for Payer: Kaiser Permanente Commercial	$819.00
Rate for Payer: Kaiser Permanente Medicaid	$464.10
Rate for Payer: Kaiser Permanente Medicare	$691.60
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: Ohana Health Plan Medicaid	$691.60
Rate for Payer: Ohana Health Plan Medicare	$691.60
Rate for Payer: UnitedHealthcare Medicare	$691.60
Rate for Payer: University Health Alliance Commercial	$509.60

MESH LF NON ABS 0115311

Facility

$910.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$509.60
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Hawaii Western Management Group Commercial	$637.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Kaiser Permanente Commercial	$819.00
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: University Health Alliance Commercial	$509.60

MESH LF NON ABS 0115312

Facility

$1,220.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$610.00
Max. Negotiated Rate	$1,183.40
Rate for Payer: AlohaCare Medicaid	$610.00
Rate for Payer: AlohaCare Medicare	$927.20
Rate for Payer: Cash Price	$732.00
Rate for Payer: Devoted Health Medicare	$1,024.80
Rate for Payer: Hawaii Medical Service Association Medicare	$927.20
Rate for Payer: Hawaii Western Management Group Commercial	$854.00
Rate for Payer: Health Management Network Commercial	$1,037.00
Rate for Payer: Humana Medicare	$927.20
Rate for Payer: Kaiser Permanente Commercial	$1,098.00
Rate for Payer: Kaiser Permanente Medicaid	$622.20
Rate for Payer: Kaiser Permanente Medicare	$927.20
Rate for Payer: MDX Hawaii PPO	$1,183.40
Rate for Payer: Ohana Health Plan Medicaid	$927.20
Rate for Payer: Ohana Health Plan Medicare	$927.20
Rate for Payer: UnitedHealthcare Medicare	$927.20
Rate for Payer: University Health Alliance Commercial	$683.20

MESH LF NON ABS 0115312

Facility

$1,220.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$683.20
Max. Negotiated Rate	$1,183.40
Rate for Payer: Cash Price	$732.00
Rate for Payer: Hawaii Western Management Group Commercial	$854.00
Rate for Payer: Health Management Network Commercial	$1,037.00
Rate for Payer: Kaiser Permanente Commercial	$1,098.00
Rate for Payer: MDX Hawaii PPO	$1,183.40
Rate for Payer: University Health Alliance Commercial	$683.20

MESH M FLAT 15X10 501320

Facility

$2,076.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.56
Max. Negotiated Rate	$2,013.72
Rate for Payer: Cash Price	$1,245.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,453.20
Rate for Payer: Health Management Network Commercial	$1,764.60
Rate for Payer: Kaiser Permanente Commercial	$1,868.40
Rate for Payer: MDX Hawaii PPO	$2,013.72
Rate for Payer: University Health Alliance Commercial	$1,162.56

MESH M FLAT 15X10 501320

Facility

$2,076.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.00
Max. Negotiated Rate	$2,013.72
Rate for Payer: AlohaCare Medicaid	$1,038.00
Rate for Payer: AlohaCare Medicare	$1,577.76
Rate for Payer: Cash Price	$1,245.60
Rate for Payer: Devoted Health Medicare	$1,743.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,577.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,453.20
Rate for Payer: Health Management Network Commercial	$1,764.60
Rate for Payer: Humana Medicare	$1,577.76
Rate for Payer: Kaiser Permanente Commercial	$1,868.40
Rate for Payer: Kaiser Permanente Medicaid	$1,058.76
Rate for Payer: Kaiser Permanente Medicare	$1,577.76
Rate for Payer: MDX Hawaii PPO	$2,013.72
Rate for Payer: Ohana Health Plan Medicaid	$1,577.76
Rate for Payer: Ohana Health Plan Medicare	$1,577.76
Rate for Payer: UnitedHealthcare Medicare	$1,577.76
Rate for Payer: University Health Alliance Commercial	$1,162.56

Know your out-of-pocket cost for care.

All Charges