Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NAIL 11X300MM RT 04.037.150S

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 11X300MM RT 04.037.150S

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 11X320MM RT 04.037.152S

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 11X320MM RT 04.037.152S

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 11X340 3525-1340S

Facility

$6,789.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,801.84
Max. Negotiated Rate	$6,585.33
Rate for Payer: Cash Price	$4,073.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,752.30
Rate for Payer: Health Management Network Commercial	$5,770.65
Rate for Payer: Kaiser Permanente Commercial	$6,110.10
Rate for Payer: MDX Hawaii PPO	$6,585.33
Rate for Payer: University Health Alliance Commercial	$3,801.84

NAIL 11X340 3525-1340S

Facility

$6,789.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,394.50
Max. Negotiated Rate	$6,585.33
Rate for Payer: AlohaCare Medicaid	$3,394.50
Rate for Payer: AlohaCare Medicare	$5,159.64
Rate for Payer: Cash Price	$4,073.40
Rate for Payer: Devoted Health Medicare	$5,702.76
Rate for Payer: Hawaii Medical Service Association Medicare	$5,159.64
Rate for Payer: Hawaii Western Management Group Commercial	$4,752.30
Rate for Payer: Health Management Network Commercial	$5,770.65
Rate for Payer: Humana Medicare	$5,159.64
Rate for Payer: Kaiser Permanente Commercial	$6,110.10
Rate for Payer: Kaiser Permanente Medicaid	$3,462.39
Rate for Payer: Kaiser Permanente Medicare	$5,159.64
Rate for Payer: MDX Hawaii PPO	$6,585.33
Rate for Payer: Ohana Health Plan Medicaid	$5,159.64
Rate for Payer: Ohana Health Plan Medicare	$5,159.64
Rate for Payer: UnitedHealthcare Medicare	$5,159.64
Rate for Payer: University Health Alliance Commercial	$3,801.84

NAIL 11X340MM LEFT 04.037.155S

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 11X340MM LEFT 04.037.155S

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 11X340MM RT 04.037.154S

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 11X340MM RT 04.037.154S

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 11X360MM LEFT 04.037.157S

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 11X360MM LEFT 04.037.157S

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 11X360MM RT 04.037.156S

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 11X360MM RT 04.037.156S

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 11X380MM LEFT 04.037.159S

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 11X380MM LEFT 04.037.159S

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 11X380MM RT 04.037.158S

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 11X380MM RT 04.037.158S

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 11X400MM RT 04.037.160S

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 11X400MM RT 04.037.160S

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 11X420MM LEFT 04.037.163S

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 11X420MM LEFT 04.037.163S

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 125 DEG 12MM DIA 40CM

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,433.50
Max. Negotiated Rate	$4,720.99
Rate for Payer: AlohaCare Medicaid	$2,433.50
Rate for Payer: AlohaCare Medicare	$3,698.92
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Devoted Health Medicare	$4,088.28
Rate for Payer: Hawaii Medical Service Association Medicare	$3,698.92
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Humana Medicare	$3,698.92
Rate for Payer: Kaiser Permanente Commercial	$4,380.30
Rate for Payer: Kaiser Permanente Medicaid	$2,482.17
Rate for Payer: Kaiser Permanente Medicare	$3,698.92
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: Ohana Health Plan Medicaid	$3,698.92
Rate for Payer: Ohana Health Plan Medicare	$3,698.92
Rate for Payer: UnitedHealthcare Medicare	$3,698.92
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL 125 DEG 12MM DIA 40CM

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.52
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Kaiser Permanente Commercial	$4,380.30
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL 12MM/340MM LF 04.033.265S

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

Know your out-of-pocket cost for care.

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