Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

MESH MONOFILAMENT POLY 0112660

Facility

$523.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$261.50
Max. Negotiated Rate	$507.31
Rate for Payer: AlohaCare Medicaid	$261.50
Rate for Payer: AlohaCare Medicare	$397.48
Rate for Payer: Cash Price	$313.80
Rate for Payer: Devoted Health Medicare	$439.32
Rate for Payer: Hawaii Medical Service Association Medicare	$397.48
Rate for Payer: Hawaii Western Management Group Commercial	$366.10
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Humana Medicare	$397.48
Rate for Payer: Kaiser Permanente Commercial	$470.70
Rate for Payer: Kaiser Permanente Medicaid	$266.73
Rate for Payer: Kaiser Permanente Medicare	$397.48
Rate for Payer: MDX Hawaii PPO	$507.31
Rate for Payer: Ohana Health Plan Medicaid	$397.48
Rate for Payer: Ohana Health Plan Medicare	$397.48
Rate for Payer: UnitedHealthcare Medicare	$397.48
Rate for Payer: University Health Alliance Commercial	$292.88

MESH MONOFILAMENT POLY 0112660

Facility

$523.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$292.88
Max. Negotiated Rate	$507.31
Rate for Payer: Cash Price	$313.80
Rate for Payer: Hawaii Western Management Group Commercial	$366.10
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Kaiser Permanente Commercial	$470.70
Rate for Payer: MDX Hawaii PPO	$507.31
Rate for Payer: University Health Alliance Commercial	$292.88

MESH PARIETEX HERNIA PCO20X

Facility

$2,828.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,414.00
Max. Negotiated Rate	$2,743.16
Rate for Payer: AlohaCare Medicaid	$1,414.00
Rate for Payer: AlohaCare Medicare	$2,149.28
Rate for Payer: Cash Price	$1,696.80
Rate for Payer: Devoted Health Medicare	$2,375.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,149.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,979.60
Rate for Payer: Health Management Network Commercial	$2,403.80
Rate for Payer: Humana Medicare	$2,149.28
Rate for Payer: Kaiser Permanente Commercial	$2,545.20
Rate for Payer: Kaiser Permanente Medicaid	$1,442.28
Rate for Payer: Kaiser Permanente Medicare	$2,149.28
Rate for Payer: MDX Hawaii PPO	$2,743.16
Rate for Payer: Ohana Health Plan Medicaid	$2,149.28
Rate for Payer: Ohana Health Plan Medicare	$2,149.28
Rate for Payer: UnitedHealthcare Medicare	$2,149.28
Rate for Payer: University Health Alliance Commercial	$1,583.68

MESH PARIETEX HERNIA PCO20X

Facility

$2,828.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,583.68
Max. Negotiated Rate	$2,743.16
Rate for Payer: Cash Price	$1,696.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,979.60
Rate for Payer: Health Management Network Commercial	$2,403.80
Rate for Payer: Kaiser Permanente Commercial	$2,545.20
Rate for Payer: MDX Hawaii PPO	$2,743.16
Rate for Payer: University Health Alliance Commercial	$1,583.68

MESH PERFIX PLUG, LG 0112970

Facility

$1,025.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$512.50
Max. Negotiated Rate	$994.25
Rate for Payer: AlohaCare Medicaid	$512.50
Rate for Payer: AlohaCare Medicare	$779.00
Rate for Payer: Cash Price	$615.00
Rate for Payer: Devoted Health Medicare	$861.00
Rate for Payer: Hawaii Medical Service Association Medicare	$779.00
Rate for Payer: Hawaii Western Management Group Commercial	$717.50
Rate for Payer: Health Management Network Commercial	$871.25
Rate for Payer: Humana Medicare	$779.00
Rate for Payer: Kaiser Permanente Commercial	$922.50
Rate for Payer: Kaiser Permanente Medicaid	$522.75
Rate for Payer: Kaiser Permanente Medicare	$779.00
Rate for Payer: MDX Hawaii PPO	$994.25
Rate for Payer: Ohana Health Plan Medicaid	$779.00
Rate for Payer: Ohana Health Plan Medicare	$779.00
Rate for Payer: UnitedHealthcare Medicare	$779.00
Rate for Payer: University Health Alliance Commercial	$574.00

MESH PERFIX PLUG, LG 0112970

Facility

$1,025.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$574.00
Max. Negotiated Rate	$994.25
Rate for Payer: Cash Price	$615.00
Rate for Payer: Hawaii Western Management Group Commercial	$717.50
Rate for Payer: Health Management Network Commercial	$871.25
Rate for Payer: Kaiser Permanente Commercial	$922.50
Rate for Payer: MDX Hawaii PPO	$994.25
Rate for Payer: University Health Alliance Commercial	$574.00

MESH PHASIX 20X25 1202025

Facility

$28,644.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$16,040.64
Max. Negotiated Rate	$27,784.68
Rate for Payer: Cash Price	$17,186.40
Rate for Payer: Hawaii Western Management Group Commercial	$20,050.80
Rate for Payer: Health Management Network Commercial	$24,347.40
Rate for Payer: Kaiser Permanente Commercial	$25,779.60
Rate for Payer: MDX Hawaii PPO	$27,784.68
Rate for Payer: University Health Alliance Commercial	$16,040.64

MESH PHASIX 20X25 1202025

Facility

$28,644.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$14,322.00
Max. Negotiated Rate	$27,784.68
Rate for Payer: AlohaCare Medicaid	$14,322.00
Rate for Payer: AlohaCare Medicare	$21,769.44
Rate for Payer: Cash Price	$17,186.40
Rate for Payer: Devoted Health Medicare	$24,060.96
Rate for Payer: Hawaii Medical Service Association Medicare	$21,769.44
Rate for Payer: Hawaii Western Management Group Commercial	$20,050.80
Rate for Payer: Health Management Network Commercial	$24,347.40
Rate for Payer: Humana Medicare	$21,769.44
Rate for Payer: Kaiser Permanente Commercial	$25,779.60
Rate for Payer: Kaiser Permanente Medicaid	$14,608.44
Rate for Payer: Kaiser Permanente Medicare	$21,769.44
Rate for Payer: MDX Hawaii PPO	$27,784.68
Rate for Payer: Ohana Health Plan Medicaid	$21,769.44
Rate for Payer: Ohana Health Plan Medicare	$21,769.44
Rate for Payer: UnitedHealthcare Medicare	$21,769.44
Rate for Payer: University Health Alliance Commercial	$16,040.64

MESH PHSM SYNTHETIC NON AB

Facility

$1,842.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,786.74
Rate for Payer: AlohaCare Medicaid	$921.00
Rate for Payer: AlohaCare Medicare	$1,399.92
Rate for Payer: Cash Price	$1,105.20
Rate for Payer: Devoted Health Medicare	$1,547.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,399.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,289.40
Rate for Payer: Health Management Network Commercial	$1,565.70
Rate for Payer: Humana Medicare	$1,399.92
Rate for Payer: Kaiser Permanente Commercial	$1,657.80
Rate for Payer: Kaiser Permanente Medicaid	$939.42
Rate for Payer: Kaiser Permanente Medicare	$1,399.92
Rate for Payer: MDX Hawaii PPO	$1,786.74
Rate for Payer: Ohana Health Plan Medicaid	$1,399.92
Rate for Payer: Ohana Health Plan Medicare	$1,399.92
Rate for Payer: UnitedHealthcare Medicare	$1,399.92
Rate for Payer: University Health Alliance Commercial	$1,031.52

MESH PHSM SYNTHETIC NON AB

Facility

$1,842.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.52
Max. Negotiated Rate	$1,786.74
Rate for Payer: Cash Price	$1,105.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,289.40
Rate for Payer: Health Management Network Commercial	$1,565.70
Rate for Payer: Kaiser Permanente Commercial	$1,657.80
Rate for Payer: MDX Hawaii PPO	$1,786.74
Rate for Payer: University Health Alliance Commercial	$1,031.52

MESH POLY 15CM W/COLLAGEN

Facility

$2,884.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.04
Max. Negotiated Rate	$2,797.48
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Kaiser Permanente Commercial	$2,595.60
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: University Health Alliance Commercial	$1,615.04

MESH POLY 15CM W/COLLAGEN

Facility

$2,884.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,442.00
Max. Negotiated Rate	$2,797.48
Rate for Payer: AlohaCare Medicaid	$1,442.00
Rate for Payer: AlohaCare Medicare	$2,191.84
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Devoted Health Medicare	$2,422.56
Rate for Payer: Hawaii Medical Service Association Medicare	$2,191.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Humana Medicare	$2,191.84
Rate for Payer: Kaiser Permanente Commercial	$2,595.60
Rate for Payer: Kaiser Permanente Medicaid	$1,470.84
Rate for Payer: Kaiser Permanente Medicare	$2,191.84
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: Ohana Health Plan Medicaid	$2,191.84
Rate for Payer: Ohana Health Plan Medicare	$2,191.84
Rate for Payer: UnitedHealthcare Medicare	$2,191.84
Rate for Payer: University Health Alliance Commercial	$1,615.04

MESH POLY 20X15 W/COLLAGEN

Facility

$2,074.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,161.44
Max. Negotiated Rate	$2,011.78
Rate for Payer: Cash Price	$1,244.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.80
Rate for Payer: Health Management Network Commercial	$1,762.90
Rate for Payer: Kaiser Permanente Commercial	$1,866.60
Rate for Payer: MDX Hawaii PPO	$2,011.78
Rate for Payer: University Health Alliance Commercial	$1,161.44

MESH POLY 20X15 W/COLLAGEN

Facility

$2,074.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,037.00
Max. Negotiated Rate	$2,011.78
Rate for Payer: AlohaCare Medicaid	$1,037.00
Rate for Payer: AlohaCare Medicare	$1,576.24
Rate for Payer: Cash Price	$1,244.40
Rate for Payer: Devoted Health Medicare	$1,742.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,576.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.80
Rate for Payer: Health Management Network Commercial	$1,762.90
Rate for Payer: Humana Medicare	$1,576.24
Rate for Payer: Kaiser Permanente Commercial	$1,866.60
Rate for Payer: Kaiser Permanente Medicaid	$1,057.74
Rate for Payer: Kaiser Permanente Medicare	$1,576.24
Rate for Payer: MDX Hawaii PPO	$2,011.78
Rate for Payer: Ohana Health Plan Medicaid	$1,576.24
Rate for Payer: Ohana Health Plan Medicare	$1,576.24
Rate for Payer: UnitedHealthcare Medicare	$1,576.24
Rate for Payer: University Health Alliance Commercial	$1,161.44

MESH POLY 9CM DIA W/COLLAGEN

Facility

$1,100.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$550.00
Max. Negotiated Rate	$1,067.00
Rate for Payer: AlohaCare Medicaid	$550.00
Rate for Payer: AlohaCare Medicare	$836.00
Rate for Payer: Cash Price	$660.00
Rate for Payer: Devoted Health Medicare	$924.00
Rate for Payer: Hawaii Medical Service Association Medicare	$836.00
Rate for Payer: Hawaii Western Management Group Commercial	$770.00
Rate for Payer: Health Management Network Commercial	$935.00
Rate for Payer: Humana Medicare	$836.00
Rate for Payer: Kaiser Permanente Commercial	$990.00
Rate for Payer: Kaiser Permanente Medicaid	$561.00
Rate for Payer: Kaiser Permanente Medicare	$836.00
Rate for Payer: MDX Hawaii PPO	$1,067.00
Rate for Payer: Ohana Health Plan Medicaid	$836.00
Rate for Payer: Ohana Health Plan Medicare	$836.00
Rate for Payer: UnitedHealthcare Medicare	$836.00
Rate for Payer: University Health Alliance Commercial	$616.00

MESH POLY 9CM DIA W/COLLAGEN

Facility

$1,100.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$616.00
Max. Negotiated Rate	$1,067.00
Rate for Payer: Cash Price	$660.00
Rate for Payer: Hawaii Western Management Group Commercial	$770.00
Rate for Payer: Health Management Network Commercial	$935.00
Rate for Payer: Kaiser Permanente Commercial	$990.00
Rate for Payer: MDX Hawaii PPO	$1,067.00
Rate for Payer: University Health Alliance Commercial	$616.00

MESH POLYESTER 30X20CM PCO3020

Facility

$2,874.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,609.44
Max. Negotiated Rate	$2,787.78
Rate for Payer: Cash Price	$1,724.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,011.80
Rate for Payer: Health Management Network Commercial	$2,442.90
Rate for Payer: Kaiser Permanente Commercial	$2,586.60
Rate for Payer: MDX Hawaii PPO	$2,787.78
Rate for Payer: University Health Alliance Commercial	$1,609.44

MESH POLYESTER 30X20CM PCO3020

Facility

$2,874.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,437.00
Max. Negotiated Rate	$2,787.78
Rate for Payer: AlohaCare Medicaid	$1,437.00
Rate for Payer: AlohaCare Medicare	$2,184.24
Rate for Payer: Cash Price	$1,724.40
Rate for Payer: Devoted Health Medicare	$2,414.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,184.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,011.80
Rate for Payer: Health Management Network Commercial	$2,442.90
Rate for Payer: Humana Medicare	$2,184.24
Rate for Payer: Kaiser Permanente Commercial	$2,586.60
Rate for Payer: Kaiser Permanente Medicaid	$1,465.74
Rate for Payer: Kaiser Permanente Medicare	$2,184.24
Rate for Payer: MDX Hawaii PPO	$2,787.78
Rate for Payer: Ohana Health Plan Medicaid	$2,184.24
Rate for Payer: Ohana Health Plan Medicare	$2,184.24
Rate for Payer: UnitedHealthcare Medicare	$2,184.24
Rate for Payer: University Health Alliance Commercial	$1,609.44

MESH PTEX PCOX ROUND 12CM

Facility

$1,584.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,536.48
Rate for Payer: AlohaCare Medicaid	$792.00
Rate for Payer: AlohaCare Medicare	$1,203.84
Rate for Payer: Cash Price	$950.40
Rate for Payer: Devoted Health Medicare	$1,330.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,203.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,108.80
Rate for Payer: Health Management Network Commercial	$1,346.40
Rate for Payer: Humana Medicare	$1,203.84
Rate for Payer: Kaiser Permanente Commercial	$1,425.60
Rate for Payer: Kaiser Permanente Medicaid	$807.84
Rate for Payer: Kaiser Permanente Medicare	$1,203.84
Rate for Payer: MDX Hawaii PPO	$1,536.48
Rate for Payer: Ohana Health Plan Medicaid	$1,203.84
Rate for Payer: Ohana Health Plan Medicare	$1,203.84
Rate for Payer: UnitedHealthcare Medicare	$1,203.84
Rate for Payer: University Health Alliance Commercial	$887.04

MESH PTEX PCOX ROUND 12CM

Facility

$1,584.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$887.04
Max. Negotiated Rate	$1,536.48
Rate for Payer: Cash Price	$950.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,108.80
Rate for Payer: Health Management Network Commercial	$1,346.40
Rate for Payer: Kaiser Permanente Commercial	$1,425.60
Rate for Payer: MDX Hawaii PPO	$1,536.48
Rate for Payer: University Health Alliance Commercial	$887.04

MESH RT NON ABS 0115321

Facility

$1,106.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$619.36
Max. Negotiated Rate	$1,072.82
Rate for Payer: Cash Price	$663.60
Rate for Payer: Hawaii Western Management Group Commercial	$774.20
Rate for Payer: Health Management Network Commercial	$940.10
Rate for Payer: Kaiser Permanente Commercial	$995.40
Rate for Payer: MDX Hawaii PPO	$1,072.82
Rate for Payer: University Health Alliance Commercial	$619.36

MESH RT NON ABS 0115321

Facility

$1,106.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$553.00
Max. Negotiated Rate	$1,072.82
Rate for Payer: AlohaCare Medicaid	$553.00
Rate for Payer: AlohaCare Medicare	$840.56
Rate for Payer: Cash Price	$663.60
Rate for Payer: Devoted Health Medicare	$929.04
Rate for Payer: Hawaii Medical Service Association Medicare	$840.56
Rate for Payer: Hawaii Western Management Group Commercial	$774.20
Rate for Payer: Health Management Network Commercial	$940.10
Rate for Payer: Humana Medicare	$840.56
Rate for Payer: Kaiser Permanente Commercial	$995.40
Rate for Payer: Kaiser Permanente Medicaid	$564.06
Rate for Payer: Kaiser Permanente Medicare	$840.56
Rate for Payer: MDX Hawaii PPO	$1,072.82
Rate for Payer: Ohana Health Plan Medicaid	$840.56
Rate for Payer: Ohana Health Plan Medicare	$840.56
Rate for Payer: UnitedHealthcare Medicare	$840.56
Rate for Payer: University Health Alliance Commercial	$619.36

MESH RT NON ABS 0115322

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 RT NON ABS 0115322

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 SELF GRIPPING LT 12X8

Facility

$981.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$490.50
Max. Negotiated Rate	$951.57
Rate for Payer: AlohaCare Medicaid	$490.50
Rate for Payer: AlohaCare Medicare	$745.56
Rate for Payer: Cash Price	$588.60
Rate for Payer: Devoted Health Medicare	$824.04
Rate for Payer: Hawaii Medical Service Association Medicare	$745.56
Rate for Payer: Hawaii Western Management Group Commercial	$686.70
Rate for Payer: Health Management Network Commercial	$833.85
Rate for Payer: Humana Medicare	$745.56
Rate for Payer: Kaiser Permanente Commercial	$882.90
Rate for Payer: Kaiser Permanente Medicaid	$500.31
Rate for Payer: Kaiser Permanente Medicare	$745.56
Rate for Payer: MDX Hawaii PPO	$951.57
Rate for Payer: Ohana Health Plan Medicaid	$745.56
Rate for Payer: Ohana Health Plan Medicare	$745.56
Rate for Payer: UnitedHealthcare Medicare	$745.56
Rate for Payer: University Health Alliance Commercial	$549.36

Know your out-of-pocket cost for care.

All Charges