Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PERSONA FEM PS CMT STD SZ7 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 PS CMT STD SZ7 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 PS CMT STD SZ8 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 PS CMT STD SZ8 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 PS CMT STD SZ8 R

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,016.00
Max. Negotiated Rate	$3,492.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,520.00
Rate for Payer: Health Management Network Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Commercial	$3,240.00
Rate for Payer: MDX Hawaii PPO	$3,492.00
Rate for Payer: University Health Alliance Commercial	$2,016.00

PERSONA FEM PS CMT STD SZ8 R

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$3,492.00
Rate for Payer: AlohaCare Medicaid	$1,800.00
Rate for Payer: AlohaCare Medicare	$2,736.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Devoted Health Medicare	$3,024.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,736.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,520.00
Rate for Payer: Health Management Network Commercial	$3,060.00
Rate for Payer: Humana Medicare	$2,736.00
Rate for Payer: Kaiser Permanente Commercial	$3,240.00
Rate for Payer: Kaiser Permanente Medicaid	$1,836.00
Rate for Payer: Kaiser Permanente Medicare	$2,736.00
Rate for Payer: MDX Hawaii PPO	$3,492.00
Rate for Payer: Ohana Health Plan Medicaid	$2,736.00
Rate for Payer: Ohana Health Plan Medicare	$2,736.00
Rate for Payer: UnitedHealthcare Medicare	$2,736.00
Rate for Payer: University Health Alliance Commercial	$2,016.00

PERSONA FEM PS CMT STD SZ9 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 PS CMT STD SZ9 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 PS POR NRW SZ10 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,987.00
Max. Negotiated Rate	$19,374.78
Rate for Payer: AlohaCare Medicaid	$9,987.00
Rate for Payer: AlohaCare Medicare	$15,180.24
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Devoted Health Medicare	$16,778.16
Rate for Payer: Hawaii Medical Service Association Medicare	$15,180.24
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Humana Medicare	$15,180.24
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicare	$15,180.24
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: Ohana Health Plan Medicaid	$15,180.24
Rate for Payer: Ohana Health Plan Medicare	$15,180.24
Rate for Payer: UnitedHealthcare Medicare	$15,180.24
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ10 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ10 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,987.00
Max. Negotiated Rate	$19,374.78
Rate for Payer: AlohaCare Medicaid	$9,987.00
Rate for Payer: AlohaCare Medicaid	$4,655.00
Rate for Payer: AlohaCare Medicare	$15,180.24
Rate for Payer: AlohaCare Medicare	$7,075.60
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Cash Price	$5,586.00
Rate for Payer: Devoted Health Medicare	$16,778.16
Rate for Payer: Devoted Health Medicare	$7,820.40
Rate for Payer: Hawaii Medical Service Association Medicare	$7,075.60
Rate for Payer: Hawaii Medical Service Association Medicare	$15,180.24
Rate for Payer: Hawaii Western Management Group Commercial	$6,517.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$7,913.50
Rate for Payer: Humana Medicare	$15,180.24
Rate for Payer: Humana Medicare	$7,075.60
Rate for Payer: Kaiser Permanente Commercial	$8,379.00
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicaid	$4,748.10
Rate for Payer: Kaiser Permanente Medicare	$15,180.24
Rate for Payer: Kaiser Permanente Medicare	$7,075.60
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$9,030.70
Rate for Payer: Ohana Health Plan Medicaid	$15,180.24
Rate for Payer: Ohana Health Plan Medicaid	$7,075.60
Rate for Payer: Ohana Health Plan Medicare	$7,075.60
Rate for Payer: Ohana Health Plan Medicare	$15,180.24
Rate for Payer: UnitedHealthcare Medicare	$15,180.24
Rate for Payer: UnitedHealthcare Medicare	$7,075.60
Rate for Payer: University Health Alliance Commercial	$11,185.44
Rate for Payer: University Health Alliance Commercial	$5,213.60

PERSONA FEM PS POR NRW SZ10 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Cash Price	$5,586.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,517.00
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Health Management Network Commercial	$7,913.50
Rate for Payer: Kaiser Permanente Commercial	$8,379.00
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: MDX Hawaii PPO	$9,030.70
Rate for Payer: University Health Alliance Commercial	$5,213.60
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ11 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ11 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,987.00
Max. Negotiated Rate	$19,374.78
Rate for Payer: AlohaCare Medicaid	$9,987.00
Rate for Payer: AlohaCare Medicare	$15,180.24
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Devoted Health Medicare	$16,778.16
Rate for Payer: Hawaii Medical Service Association Medicare	$15,180.24
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Humana Medicare	$15,180.24
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicare	$15,180.24
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: Ohana Health Plan Medicaid	$15,180.24
Rate for Payer: Ohana Health Plan Medicare	$15,180.24
Rate for Payer: UnitedHealthcare Medicare	$15,180.24
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ11 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,987.00
Max. Negotiated Rate	$19,374.78
Rate for Payer: AlohaCare Medicaid	$9,987.00
Rate for Payer: AlohaCare Medicare	$15,180.24
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Devoted Health Medicare	$16,778.16
Rate for Payer: Hawaii Medical Service Association Medicare	$15,180.24
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Humana Medicare	$15,180.24
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicare	$15,180.24
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: Ohana Health Plan Medicaid	$15,180.24
Rate for Payer: Ohana Health Plan Medicare	$15,180.24
Rate for Payer: UnitedHealthcare Medicare	$15,180.24
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ11 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ1 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ1 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,987.00
Max. Negotiated Rate	$19,374.78
Rate for Payer: AlohaCare Medicaid	$9,987.00
Rate for Payer: AlohaCare Medicare	$15,180.24
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Devoted Health Medicare	$16,778.16
Rate for Payer: Hawaii Medical Service Association Medicare	$15,180.24
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Humana Medicare	$15,180.24
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicare	$15,180.24
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: Ohana Health Plan Medicaid	$15,180.24
Rate for Payer: Ohana Health Plan Medicare	$15,180.24
Rate for Payer: UnitedHealthcare Medicare	$15,180.24
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ1 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,987.00
Max. Negotiated Rate	$19,374.78
Rate for Payer: AlohaCare Medicaid	$9,987.00
Rate for Payer: AlohaCare Medicare	$15,180.24
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Devoted Health Medicare	$16,778.16
Rate for Payer: Hawaii Medical Service Association Medicare	$15,180.24
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Humana Medicare	$15,180.24
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicare	$15,180.24
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: Ohana Health Plan Medicaid	$15,180.24
Rate for Payer: Ohana Health Plan Medicare	$15,180.24
Rate for Payer: UnitedHealthcare Medicare	$15,180.24
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ1 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ2 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ2 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,987.00
Max. Negotiated Rate	$19,374.78
Rate for Payer: AlohaCare Medicaid	$9,987.00
Rate for Payer: AlohaCare Medicare	$15,180.24
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Devoted Health Medicare	$16,778.16
Rate for Payer: Hawaii Medical Service Association Medicare	$15,180.24
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Humana Medicare	$15,180.24
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicare	$15,180.24
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: Ohana Health Plan Medicaid	$15,180.24
Rate for Payer: Ohana Health Plan Medicare	$15,180.24
Rate for Payer: UnitedHealthcare Medicare	$15,180.24
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ2 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,987.00
Max. Negotiated Rate	$19,374.78
Rate for Payer: AlohaCare Medicaid	$9,987.00
Rate for Payer: AlohaCare Medicare	$15,180.24
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Devoted Health Medicare	$16,778.16
Rate for Payer: Hawaii Medical Service Association Medicare	$15,180.24
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Humana Medicare	$15,180.24
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: Kaiser Permanente Medicaid	$10,186.74
Rate for Payer: Kaiser Permanente Medicare	$15,180.24
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: Ohana Health Plan Medicaid	$15,180.24
Rate for Payer: Ohana Health Plan Medicare	$15,180.24
Rate for Payer: UnitedHealthcare Medicare	$15,180.24
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ2 R

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

PERSONA FEM PS POR NRW SZ3 L

Facility

$19,974.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$11,185.44
Max. Negotiated Rate	$19,374.78
Rate for Payer: Cash Price	$11,984.40
Rate for Payer: Hawaii Western Management Group Commercial	$13,981.80
Rate for Payer: Health Management Network Commercial	$16,977.90
Rate for Payer: Kaiser Permanente Commercial	$17,976.60
Rate for Payer: MDX Hawaii PPO	$19,374.78
Rate for Payer: University Health Alliance Commercial	$11,185.44

Know your out-of-pocket cost for care.

All Charges