Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PERSONA FEM CMT CCR NRW SZ10 R

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ11 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ11 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ11 R

Facility

$7,410.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,149.60
Max. Negotiated Rate	$7,187.70
Rate for Payer: Cash Price	$4,446.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,187.00
Rate for Payer: Health Management Network Commercial	$6,298.50
Rate for Payer: Kaiser Permanente Commercial	$6,669.00
Rate for Payer: MDX Hawaii PPO	$7,187.70
Rate for Payer: University Health Alliance Commercial	$4,149.60

PERSONA FEM CMT CCR NRW SZ11 R

Facility

$7,410.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,705.00
Max. Negotiated Rate	$7,187.70
Rate for Payer: AlohaCare Medicaid	$3,705.00
Rate for Payer: AlohaCare Medicare	$5,631.60
Rate for Payer: Cash Price	$4,446.00
Rate for Payer: Devoted Health Medicare	$6,224.40
Rate for Payer: Hawaii Medical Service Association Medicare	$5,631.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,187.00
Rate for Payer: Health Management Network Commercial	$6,298.50
Rate for Payer: Humana Medicare	$5,631.60
Rate for Payer: Kaiser Permanente Commercial	$6,669.00
Rate for Payer: Kaiser Permanente Medicaid	$3,779.10
Rate for Payer: Kaiser Permanente Medicare	$5,631.60
Rate for Payer: MDX Hawaii PPO	$7,187.70
Rate for Payer: Ohana Health Plan Medicaid	$5,631.60
Rate for Payer: Ohana Health Plan Medicare	$5,631.60
Rate for Payer: UnitedHealthcare Medicare	$5,631.60
Rate for Payer: University Health Alliance Commercial	$4,149.60

PERSONA FEM CMT CCR NRW SZ1 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ1 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ1 R

Facility

$15,814.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,855.84
Max. Negotiated Rate	$15,339.58
Rate for Payer: Cash Price	$9,488.40
Rate for Payer: Hawaii Western Management Group Commercial	$11,069.80
Rate for Payer: Health Management Network Commercial	$13,441.90
Rate for Payer: Kaiser Permanente Commercial	$14,232.60
Rate for Payer: MDX Hawaii PPO	$15,339.58
Rate for Payer: University Health Alliance Commercial	$8,855.84

PERSONA FEM CMT CCR NRW SZ1 R

Facility

$15,814.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,907.00
Max. Negotiated Rate	$15,339.58
Rate for Payer: AlohaCare Medicaid	$7,907.00
Rate for Payer: AlohaCare Medicare	$12,018.64
Rate for Payer: Cash Price	$9,488.40
Rate for Payer: Devoted Health Medicare	$13,283.76
Rate for Payer: Hawaii Medical Service Association Medicare	$12,018.64
Rate for Payer: Hawaii Western Management Group Commercial	$11,069.80
Rate for Payer: Health Management Network Commercial	$13,441.90
Rate for Payer: Humana Medicare	$12,018.64
Rate for Payer: Kaiser Permanente Commercial	$14,232.60
Rate for Payer: Kaiser Permanente Medicaid	$8,065.14
Rate for Payer: Kaiser Permanente Medicare	$12,018.64
Rate for Payer: MDX Hawaii PPO	$15,339.58
Rate for Payer: Ohana Health Plan Medicaid	$12,018.64
Rate for Payer: Ohana Health Plan Medicare	$12,018.64
Rate for Payer: UnitedHealthcare Medicare	$12,018.64
Rate for Payer: University Health Alliance Commercial	$8,855.84

PERSONA FEM CMT CCR NRW SZ2 L

Facility

$15,814.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,907.00
Max. Negotiated Rate	$15,339.58
Rate for Payer: AlohaCare Medicaid	$7,907.00
Rate for Payer: AlohaCare Medicare	$12,018.64
Rate for Payer: Cash Price	$9,488.40
Rate for Payer: Devoted Health Medicare	$13,283.76
Rate for Payer: Hawaii Medical Service Association Medicare	$12,018.64
Rate for Payer: Hawaii Western Management Group Commercial	$11,069.80
Rate for Payer: Health Management Network Commercial	$13,441.90
Rate for Payer: Humana Medicare	$12,018.64
Rate for Payer: Kaiser Permanente Commercial	$14,232.60
Rate for Payer: Kaiser Permanente Medicaid	$8,065.14
Rate for Payer: Kaiser Permanente Medicare	$12,018.64
Rate for Payer: MDX Hawaii PPO	$15,339.58
Rate for Payer: Ohana Health Plan Medicaid	$12,018.64
Rate for Payer: Ohana Health Plan Medicare	$12,018.64
Rate for Payer: UnitedHealthcare Medicare	$12,018.64
Rate for Payer: University Health Alliance Commercial	$8,855.84

PERSONA FEM CMT CCR NRW SZ2 L

Facility

$15,814.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,855.84
Max. Negotiated Rate	$15,339.58
Rate for Payer: Cash Price	$9,488.40
Rate for Payer: Hawaii Western Management Group Commercial	$11,069.80
Rate for Payer: Health Management Network Commercial	$13,441.90
Rate for Payer: Kaiser Permanente Commercial	$14,232.60
Rate for Payer: MDX Hawaii PPO	$15,339.58
Rate for Payer: University Health Alliance Commercial	$8,855.84

PERSONA FEM CMT CCR NRW SZ2 R

Facility

$15,814.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,855.84
Max. Negotiated Rate	$15,339.58
Rate for Payer: Cash Price	$9,488.40
Rate for Payer: Hawaii Western Management Group Commercial	$11,069.80
Rate for Payer: Health Management Network Commercial	$13,441.90
Rate for Payer: Kaiser Permanente Commercial	$14,232.60
Rate for Payer: MDX Hawaii PPO	$15,339.58
Rate for Payer: University Health Alliance Commercial	$8,855.84

PERSONA FEM CMT CCR NRW SZ2 R

Facility

$15,814.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,907.00
Max. Negotiated Rate	$15,339.58
Rate for Payer: AlohaCare Medicaid	$7,907.00
Rate for Payer: AlohaCare Medicare	$12,018.64
Rate for Payer: Cash Price	$9,488.40
Rate for Payer: Devoted Health Medicare	$13,283.76
Rate for Payer: Hawaii Medical Service Association Medicare	$12,018.64
Rate for Payer: Hawaii Western Management Group Commercial	$11,069.80
Rate for Payer: Health Management Network Commercial	$13,441.90
Rate for Payer: Humana Medicare	$12,018.64
Rate for Payer: Kaiser Permanente Commercial	$14,232.60
Rate for Payer: Kaiser Permanente Medicaid	$8,065.14
Rate for Payer: Kaiser Permanente Medicare	$12,018.64
Rate for Payer: MDX Hawaii PPO	$15,339.58
Rate for Payer: Ohana Health Plan Medicaid	$12,018.64
Rate for Payer: Ohana Health Plan Medicare	$12,018.64
Rate for Payer: UnitedHealthcare Medicare	$12,018.64
Rate for Payer: University Health Alliance Commercial	$8,855.84

PERSONA FEM CMT CCR NRW SZ3 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ3 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ3 R

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ3 R

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ4 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ4 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ4 R

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ4 R

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ5 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ5 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ5 R

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ5 R

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

Know your out-of-pocket cost for care.

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