Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NAIL 011X400 125° 3525-1400S

Facility

$6,402.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,201.00
Max. Negotiated Rate	$6,209.94
Rate for Payer: AlohaCare Medicaid	$3,201.00
Rate for Payer: AlohaCare Medicare	$4,865.52
Rate for Payer: Cash Price	$3,841.20
Rate for Payer: Devoted Health Medicare	$5,377.68
Rate for Payer: Hawaii Medical Service Association Medicare	$4,865.52
Rate for Payer: Hawaii Western Management Group Commercial	$4,481.40
Rate for Payer: Health Management Network Commercial	$5,441.70
Rate for Payer: Humana Medicare	$4,865.52
Rate for Payer: Kaiser Permanente Commercial	$5,761.80
Rate for Payer: Kaiser Permanente Medicaid	$3,265.02
Rate for Payer: Kaiser Permanente Medicare	$4,865.52
Rate for Payer: MDX Hawaii PPO	$6,209.94
Rate for Payer: Ohana Health Plan Medicaid	$4,865.52
Rate for Payer: Ohana Health Plan Medicare	$4,865.52
Rate for Payer: UnitedHealthcare Medicare	$4,865.52
Rate for Payer: University Health Alliance Commercial	$3,585.12

NAIL 011X400 125° 3525-1400S

Facility

$6,402.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,585.12
Max. Negotiated Rate	$6,209.94
Rate for Payer: Cash Price	$3,841.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,481.40
Rate for Payer: Health Management Network Commercial	$5,441.70
Rate for Payer: Kaiser Permanente Commercial	$5,761.80
Rate for Payer: MDX Hawaii PPO	$6,209.94
Rate for Payer: University Health Alliance Commercial	$3,585.12

NAIL 10MM CANN LF 04.033.067S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

NAIL 10MM CANN LF 04.033.067S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,501.00
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$3,801.52
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$4,201.68
Rate for Payer: Hawaii Medical Service Association Medicare	$3,801.52
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$3,801.52
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$3,801.52
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$3,801.52
Rate for Payer: Ohana Health Plan Medicare	$3,801.52
Rate for Payer: UnitedHealthcare Medicare	$3,801.52
Rate for Payer: University Health Alliance Commercial	$2,801.12

NAIL 10MM TI CANN 04.008.066S

Facility

$3,860.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,161.60
Max. Negotiated Rate	$3,744.20
Rate for Payer: Cash Price	$2,316.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,702.00
Rate for Payer: Health Management Network Commercial	$3,281.00
Rate for Payer: Kaiser Permanente Commercial	$3,474.00
Rate for Payer: MDX Hawaii PPO	$3,744.20
Rate for Payer: University Health Alliance Commercial	$2,161.60

NAIL 10MM TI CANN 04.008.066S

Facility

$3,860.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,930.00
Max. Negotiated Rate	$3,744.20
Rate for Payer: AlohaCare Medicaid	$1,930.00
Rate for Payer: AlohaCare Medicare	$2,933.60
Rate for Payer: Cash Price	$2,316.00
Rate for Payer: Devoted Health Medicare	$3,242.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,933.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,702.00
Rate for Payer: Health Management Network Commercial	$3,281.00
Rate for Payer: Humana Medicare	$2,933.60
Rate for Payer: Kaiser Permanente Commercial	$3,474.00
Rate for Payer: Kaiser Permanente Medicaid	$1,968.60
Rate for Payer: Kaiser Permanente Medicare	$2,933.60
Rate for Payer: MDX Hawaii PPO	$3,744.20
Rate for Payer: Ohana Health Plan Medicaid	$2,933.60
Rate for Payer: Ohana Health Plan Medicare	$2,933.60
Rate for Payer: UnitedHealthcare Medicare	$2,933.60
Rate for Payer: University Health Alliance Commercial	$2,161.60

NAIL 10MMX285 ST 04.004.437S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL 10MMX285 ST 04.004.437S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,817.50
Max. Negotiated Rate	$3,525.95
Rate for Payer: AlohaCare Medicaid	$1,817.50
Rate for Payer: AlohaCare Medicare	$2,762.60
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Devoted Health Medicare	$3,053.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,762.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Humana Medicare	$2,762.60
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: Kaiser Permanente Medicare	$2,762.60
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: Ohana Health Plan Medicaid	$2,762.60
Rate for Payer: Ohana Health Plan Medicare	$2,762.60
Rate for Payer: UnitedHealthcare Medicare	$2,762.60
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL 10X170 125 DEG 8125-0170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.36
Max. Negotiated Rate	$4,637.57
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: Kaiser Permanente Commercial	$4,302.90
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL 10X170 125 DEG 8125-0170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,390.50
Max. Negotiated Rate	$4,637.57
Rate for Payer: AlohaCare Medicaid	$2,390.50
Rate for Payer: AlohaCare Medicare	$3,633.56
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Devoted Health Medicare	$4,016.04
Rate for Payer: Hawaii Medical Service Association Medicare	$3,633.56
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: Humana Medicare	$3,633.56
Rate for Payer: Kaiser Permanente Commercial	$4,302.90
Rate for Payer: Kaiser Permanente Medicaid	$2,438.31
Rate for Payer: Kaiser Permanente Medicare	$3,633.56
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: Ohana Health Plan Medicaid	$3,633.56
Rate for Payer: Ohana Health Plan Medicare	$3,633.56
Rate for Payer: UnitedHealthcare Medicare	$3,633.56
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL 10X170MM 130° 04.037.042S

Facility

$4,045.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,022.50
Max. Negotiated Rate	$3,923.65
Rate for Payer: AlohaCare Medicaid	$2,022.50
Rate for Payer: AlohaCare Medicare	$3,074.20
Rate for Payer: Cash Price	$2,427.00
Rate for Payer: Devoted Health Medicare	$3,397.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,074.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,831.50
Rate for Payer: Health Management Network Commercial	$3,438.25
Rate for Payer: Humana Medicare	$3,074.20
Rate for Payer: Kaiser Permanente Commercial	$3,640.50
Rate for Payer: Kaiser Permanente Medicaid	$2,062.95
Rate for Payer: Kaiser Permanente Medicare	$3,074.20
Rate for Payer: MDX Hawaii PPO	$3,923.65
Rate for Payer: Ohana Health Plan Medicaid	$3,074.20
Rate for Payer: Ohana Health Plan Medicare	$3,074.20
Rate for Payer: UnitedHealthcare Medicare	$3,074.20
Rate for Payer: University Health Alliance Commercial	$2,265.20

NAIL 10X170MM 130° 04.037.042S

Facility

$4,045.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,265.20
Max. Negotiated Rate	$3,923.65
Rate for Payer: Cash Price	$2,427.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,831.50
Rate for Payer: Health Management Network Commercial	$3,438.25
Rate for Payer: Kaiser Permanente Commercial	$3,640.50
Rate for Payer: MDX Hawaii PPO	$3,923.65
Rate for Payer: University Health Alliance Commercial	$2,265.20

NAIL 10X300MM CANN 04.013.440S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,985.00
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$3,017.20
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$3,334.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,017.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$3,017.20
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$3,017.20
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$3,017.20
Rate for Payer: Ohana Health Plan Medicare	$3,017.20
Rate for Payer: UnitedHealthcare Medicare	$3,017.20
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL 10X300MM CANN 04.013.440S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL 10X300MM LEFT 04.037.051S

Facility

$5,665.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,172.40
Max. Negotiated Rate	$5,495.05
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,965.50
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Kaiser Permanente Commercial	$5,098.50
Rate for Payer: MDX Hawaii PPO	$5,495.05
Rate for Payer: University Health Alliance Commercial	$3,172.40

NAIL 10X300MM LEFT 04.037.051S

Facility

$5,665.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,832.50
Max. Negotiated Rate	$5,495.05
Rate for Payer: AlohaCare Medicaid	$2,832.50
Rate for Payer: AlohaCare Medicare	$4,305.40
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Devoted Health Medicare	$4,758.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4,305.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,965.50
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Humana Medicare	$4,305.40
Rate for Payer: Kaiser Permanente Commercial	$5,098.50
Rate for Payer: Kaiser Permanente Medicaid	$2,889.15
Rate for Payer: Kaiser Permanente Medicare	$4,305.40
Rate for Payer: MDX Hawaii PPO	$5,495.05
Rate for Payer: Ohana Health Plan Medicaid	$4,305.40
Rate for Payer: Ohana Health Plan Medicare	$4,305.40
Rate for Payer: UnitedHealthcare Medicare	$4,305.40
Rate for Payer: University Health Alliance Commercial	$3,172.40

NAIL 10X300MM RT 04.037.050S

Facility

$5,665.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,172.40
Max. Negotiated Rate	$5,495.05
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,965.50
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Kaiser Permanente Commercial	$5,098.50
Rate for Payer: MDX Hawaii PPO	$5,495.05
Rate for Payer: University Health Alliance Commercial	$3,172.40

NAIL 10X300MM RT 04.037.050S

Facility

$5,665.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,832.50
Max. Negotiated Rate	$5,495.05
Rate for Payer: AlohaCare Medicaid	$2,832.50
Rate for Payer: AlohaCare Medicare	$4,305.40
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Devoted Health Medicare	$4,758.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4,305.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,965.50
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Humana Medicare	$4,305.40
Rate for Payer: Kaiser Permanente Commercial	$5,098.50
Rate for Payer: Kaiser Permanente Medicaid	$2,889.15
Rate for Payer: Kaiser Permanente Medicare	$4,305.40
Rate for Payer: MDX Hawaii PPO	$5,495.05
Rate for Payer: Ohana Health Plan Medicaid	$4,305.40
Rate for Payer: Ohana Health Plan Medicare	$4,305.40
Rate for Payer: UnitedHealthcare Medicare	$4,305.40
Rate for Payer: University Health Alliance Commercial	$3,172.40

NAIL 10X320 LF ST 04.033.063S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

NAIL 10X320 LF ST 04.033.063S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,501.00
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$3,801.52
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$4,201.68
Rate for Payer: Hawaii Medical Service Association Medicare	$3,801.52
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$3,801.52
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$3,801.52
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$3,801.52
Rate for Payer: Ohana Health Plan Medicare	$3,801.52
Rate for Payer: UnitedHealthcare Medicare	$3,801.52
Rate for Payer: University Health Alliance Commercial	$2,801.12

NAIL 10X320MM LEFT 04.037.053S

Facility

$5,665.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,832.50
Max. Negotiated Rate	$5,495.05
Rate for Payer: AlohaCare Medicaid	$2,832.50
Rate for Payer: AlohaCare Medicare	$4,305.40
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Devoted Health Medicare	$4,758.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4,305.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,965.50
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Humana Medicare	$4,305.40
Rate for Payer: Kaiser Permanente Commercial	$5,098.50
Rate for Payer: Kaiser Permanente Medicaid	$2,889.15
Rate for Payer: Kaiser Permanente Medicare	$4,305.40
Rate for Payer: MDX Hawaii PPO	$5,495.05
Rate for Payer: Ohana Health Plan Medicaid	$4,305.40
Rate for Payer: Ohana Health Plan Medicare	$4,305.40
Rate for Payer: UnitedHealthcare Medicare	$4,305.40
Rate for Payer: University Health Alliance Commercial	$3,172.40

NAIL 10X320MM LEFT 04.037.053S

Facility

$5,665.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,172.40
Max. Negotiated Rate	$5,495.05
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,965.50
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Kaiser Permanente Commercial	$5,098.50
Rate for Payer: MDX Hawaii PPO	$5,495.05
Rate for Payer: University Health Alliance Commercial	$3,172.40

NAIL 10X320MM RT 04.037.052S

Facility

$5,665.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,832.50
Max. Negotiated Rate	$5,495.05
Rate for Payer: AlohaCare Medicaid	$2,832.50
Rate for Payer: AlohaCare Medicare	$4,305.40
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Devoted Health Medicare	$4,758.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4,305.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,965.50
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Humana Medicare	$4,305.40
Rate for Payer: Kaiser Permanente Commercial	$5,098.50
Rate for Payer: Kaiser Permanente Medicaid	$2,889.15
Rate for Payer: Kaiser Permanente Medicare	$4,305.40
Rate for Payer: MDX Hawaii PPO	$5,495.05
Rate for Payer: Ohana Health Plan Medicaid	$4,305.40
Rate for Payer: Ohana Health Plan Medicare	$4,305.40
Rate for Payer: UnitedHealthcare Medicare	$4,305.40
Rate for Payer: University Health Alliance Commercial	$3,172.40

NAIL 10X320MM RT 04.037.052S

Facility

$5,665.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,172.40
Max. Negotiated Rate	$5,495.05
Rate for Payer: Cash Price	$3,399.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,965.50
Rate for Payer: Health Management Network Commercial	$4,815.25
Rate for Payer: Kaiser Permanente Commercial	$5,098.50
Rate for Payer: MDX Hawaii PPO	$5,495.05
Rate for Payer: University Health Alliance Commercial	$3,172.40

NAIL 10X340 LF 04.033.065S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

Know your out-of-pocket cost for care.

All Charges