Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SUTURE ANCHOR 4.75 72203704

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 4.75 72203705

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$831.50
Max. Negotiated Rate	$1,613.11
Rate for Payer: AlohaCare Medicaid	$831.50
Rate for Payer: AlohaCare Medicare	$1,263.88
Rate for Payer: Cash Price	$997.80
Rate for Payer: Devoted Health Medicare	$1,396.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,263.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Humana Medicare	$1,263.88
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: Kaiser Permanente Medicare	$1,263.88
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: Ohana Health Plan Medicaid	$1,263.88
Rate for Payer: Ohana Health Plan Medicare	$1,263.88
Rate for Payer: UnitedHealthcare Medicare	$1,263.88
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 4.75 72203705

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 4.75M 3910847021

Facility

$1,835.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.60
Max. Negotiated Rate	$1,779.95
Rate for Payer: Cash Price	$1,101.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,284.50
Rate for Payer: Health Management Network Commercial	$1,559.75
Rate for Payer: Kaiser Permanente Commercial	$1,651.50
Rate for Payer: MDX Hawaii PPO	$1,779.95
Rate for Payer: University Health Alliance Commercial	$1,027.60

SUTURE ANCHOR 4.75M 3910847021

Facility

$1,835.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$917.50
Max. Negotiated Rate	$1,779.95
Rate for Payer: AlohaCare Medicaid	$917.50
Rate for Payer: AlohaCare Medicare	$1,394.60
Rate for Payer: Cash Price	$1,101.00
Rate for Payer: Devoted Health Medicare	$1,541.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,394.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,284.50
Rate for Payer: Health Management Network Commercial	$1,559.75
Rate for Payer: Humana Medicare	$1,394.60
Rate for Payer: Kaiser Permanente Commercial	$1,651.50
Rate for Payer: Kaiser Permanente Medicaid	$935.85
Rate for Payer: Kaiser Permanente Medicare	$1,394.60
Rate for Payer: MDX Hawaii PPO	$1,779.95
Rate for Payer: Ohana Health Plan Medicaid	$1,394.60
Rate for Payer: Ohana Health Plan Medicare	$1,394.60
Rate for Payer: UnitedHealthcare Medicare	$1,394.60
Rate for Payer: University Health Alliance Commercial	$1,027.60

SUTURE ANCHOR 5.5 72203708

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$831.50
Max. Negotiated Rate	$1,613.11
Rate for Payer: AlohaCare Medicaid	$831.50
Rate for Payer: AlohaCare Medicare	$1,263.88
Rate for Payer: Cash Price	$997.80
Rate for Payer: Devoted Health Medicare	$1,396.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,263.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Humana Medicare	$1,263.88
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: Kaiser Permanente Medicare	$1,263.88
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: Ohana Health Plan Medicaid	$1,263.88
Rate for Payer: Ohana Health Plan Medicare	$1,263.88
Rate for Payer: UnitedHealthcare Medicare	$1,263.88
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72203708

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72203801

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72203801

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$831.50
Max. Negotiated Rate	$1,613.11
Rate for Payer: AlohaCare Medicaid	$831.50
Rate for Payer: AlohaCare Medicare	$1,263.88
Rate for Payer: Cash Price	$997.80
Rate for Payer: Devoted Health Medicare	$1,396.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,263.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Humana Medicare	$1,263.88
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: Kaiser Permanente Medicare	$1,263.88
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: Ohana Health Plan Medicaid	$1,263.88
Rate for Payer: Ohana Health Plan Medicare	$1,263.88
Rate for Payer: UnitedHealthcare Medicare	$1,263.88
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72205135

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$831.50
Max. Negotiated Rate	$1,613.11
Rate for Payer: AlohaCare Medicaid	$831.50
Rate for Payer: AlohaCare Medicare	$1,263.88
Rate for Payer: Cash Price	$997.80
Rate for Payer: Devoted Health Medicare	$1,396.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,263.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Humana Medicare	$1,263.88
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: Kaiser Permanente Medicare	$1,263.88
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: Ohana Health Plan Medicaid	$1,263.88
Rate for Payer: Ohana Health Plan Medicare	$1,263.88
Rate for Payer: UnitedHealthcare Medicare	$1,263.88
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72205135

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR #AR-1662BC

Facility

$1,435.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$803.60
Max. Negotiated Rate	$1,391.95
Rate for Payer: Cash Price	$861.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,004.50
Rate for Payer: Health Management Network Commercial	$1,219.75
Rate for Payer: Kaiser Permanente Commercial	$1,291.50
Rate for Payer: MDX Hawaii PPO	$1,391.95
Rate for Payer: University Health Alliance Commercial	$803.60

SUTURE ANCHOR #AR-1662BC

Facility

$1,435.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$717.50
Max. Negotiated Rate	$1,391.95
Rate for Payer: AlohaCare Medicaid	$717.50
Rate for Payer: AlohaCare Medicare	$1,090.60
Rate for Payer: Cash Price	$861.00
Rate for Payer: Devoted Health Medicare	$1,205.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,090.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,004.50
Rate for Payer: Health Management Network Commercial	$1,219.75
Rate for Payer: Humana Medicare	$1,090.60
Rate for Payer: Kaiser Permanente Commercial	$1,291.50
Rate for Payer: Kaiser Permanente Medicaid	$731.85
Rate for Payer: Kaiser Permanente Medicare	$1,090.60
Rate for Payer: MDX Hawaii PPO	$1,391.95
Rate for Payer: Ohana Health Plan Medicaid	$1,090.60
Rate for Payer: Ohana Health Plan Medicare	$1,090.60
Rate for Payer: UnitedHealthcare Medicare	$1,090.60
Rate for Payer: University Health Alliance Commercial	$803.60

SUTURE ANCHOR #AR-1927BCFT-45

Facility

$1,208.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$604.00
Max. Negotiated Rate	$1,171.76
Rate for Payer: AlohaCare Medicaid	$604.00
Rate for Payer: AlohaCare Medicare	$918.08
Rate for Payer: Cash Price	$724.80
Rate for Payer: Devoted Health Medicare	$1,014.72
Rate for Payer: Hawaii Medical Service Association Medicare	$918.08
Rate for Payer: Hawaii Western Management Group Commercial	$845.60
Rate for Payer: Health Management Network Commercial	$1,026.80
Rate for Payer: Humana Medicare	$918.08
Rate for Payer: Kaiser Permanente Commercial	$1,087.20
Rate for Payer: Kaiser Permanente Medicaid	$616.08
Rate for Payer: Kaiser Permanente Medicare	$918.08
Rate for Payer: MDX Hawaii PPO	$1,171.76
Rate for Payer: Ohana Health Plan Medicaid	$918.08
Rate for Payer: Ohana Health Plan Medicare	$918.08
Rate for Payer: UnitedHealthcare Medicare	$918.08
Rate for Payer: University Health Alliance Commercial	$676.48

SUTURE ANCHOR #AR-1927BCFT-45

Facility

$1,208.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$676.48
Max. Negotiated Rate	$1,171.76
Rate for Payer: Cash Price	$724.80
Rate for Payer: Hawaii Western Management Group Commercial	$845.60
Rate for Payer: Health Management Network Commercial	$1,026.80
Rate for Payer: Kaiser Permanente Commercial	$1,087.20
Rate for Payer: MDX Hawaii PPO	$1,171.76
Rate for Payer: University Health Alliance Commercial	$676.48

SUTURE ANCHOR #AR-1928SF-45

Facility

$1,152.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$645.12
Max. Negotiated Rate	$1,117.44
Rate for Payer: Cash Price	$691.20
Rate for Payer: Hawaii Western Management Group Commercial	$806.40
Rate for Payer: Health Management Network Commercial	$979.20
Rate for Payer: Kaiser Permanente Commercial	$1,036.80
Rate for Payer: MDX Hawaii PPO	$1,117.44
Rate for Payer: University Health Alliance Commercial	$645.12

SUTURE ANCHOR #AR-1928SF-45

Facility

$1,152.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$576.00
Max. Negotiated Rate	$1,117.44
Rate for Payer: AlohaCare Medicaid	$576.00
Rate for Payer: AlohaCare Medicare	$875.52
Rate for Payer: Cash Price	$691.20
Rate for Payer: Devoted Health Medicare	$967.68
Rate for Payer: Hawaii Medical Service Association Medicare	$875.52
Rate for Payer: Hawaii Western Management Group Commercial	$806.40
Rate for Payer: Health Management Network Commercial	$979.20
Rate for Payer: Humana Medicare	$875.52
Rate for Payer: Kaiser Permanente Commercial	$1,036.80
Rate for Payer: Kaiser Permanente Medicaid	$587.52
Rate for Payer: Kaiser Permanente Medicare	$875.52
Rate for Payer: MDX Hawaii PPO	$1,117.44
Rate for Payer: Ohana Health Plan Medicaid	$875.52
Rate for Payer: Ohana Health Plan Medicare	$875.52
Rate for Payer: UnitedHealthcare Medicare	$875.52
Rate for Payer: University Health Alliance Commercial	$645.12

SUTURE ANCHOR #AR-1929SF-3

Facility

$919.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$459.50
Max. Negotiated Rate	$891.43
Rate for Payer: AlohaCare Medicaid	$459.50
Rate for Payer: AlohaCare Medicare	$698.44
Rate for Payer: Cash Price	$551.40
Rate for Payer: Devoted Health Medicare	$771.96
Rate for Payer: Hawaii Medical Service Association Medicare	$698.44
Rate for Payer: Hawaii Western Management Group Commercial	$643.30
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Humana Medicare	$698.44
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: Kaiser Permanente Medicare	$698.44
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: Ohana Health Plan Medicaid	$698.44
Rate for Payer: Ohana Health Plan Medicare	$698.44
Rate for Payer: UnitedHealthcare Medicare	$698.44
Rate for Payer: University Health Alliance Commercial	$514.64

SUTURE ANCHOR #AR-1929SF-3

Facility

$919.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$514.64
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Hawaii Western Management Group Commercial	$643.30
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: University Health Alliance Commercial	$514.64

SUTURE ANCHOR #AR-1938BC

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$874.72
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

SUTURE ANCHOR #AR-1938BC

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$781.00
Max. Negotiated Rate	$1,515.14
Rate for Payer: AlohaCare Medicaid	$781.00
Rate for Payer: AlohaCare Medicare	$1,187.12
Rate for Payer: Cash Price	$937.20
Rate for Payer: Devoted Health Medicare	$1,312.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,187.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Humana Medicare	$1,187.12
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: Kaiser Permanente Medicaid	$796.62
Rate for Payer: Kaiser Permanente Medicare	$1,187.12
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: Ohana Health Plan Medicaid	$1,187.12
Rate for Payer: Ohana Health Plan Medicare	$1,187.12
Rate for Payer: UnitedHealthcare Medicare	$1,187.12
Rate for Payer: University Health Alliance Commercial	$874.72

SUTURE ANCHOR #AR-2324BCC-2

Facility

$1,788.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,001.28
Max. Negotiated Rate	$1,734.36
Rate for Payer: Cash Price	$1,072.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,251.60
Rate for Payer: Health Management Network Commercial	$1,519.80
Rate for Payer: Kaiser Permanente Commercial	$1,609.20
Rate for Payer: MDX Hawaii PPO	$1,734.36
Rate for Payer: University Health Alliance Commercial	$1,001.28

SUTURE ANCHOR #AR-2324BCC-2

Facility

$1,788.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$894.00
Max. Negotiated Rate	$1,734.36
Rate for Payer: AlohaCare Medicaid	$894.00
Rate for Payer: AlohaCare Medicare	$1,358.88
Rate for Payer: Cash Price	$1,072.80
Rate for Payer: Devoted Health Medicare	$1,501.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,358.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,251.60
Rate for Payer: Health Management Network Commercial	$1,519.80
Rate for Payer: Humana Medicare	$1,358.88
Rate for Payer: Kaiser Permanente Commercial	$1,609.20
Rate for Payer: Kaiser Permanente Medicaid	$911.88
Rate for Payer: Kaiser Permanente Medicare	$1,358.88
Rate for Payer: MDX Hawaii PPO	$1,734.36
Rate for Payer: Ohana Health Plan Medicaid	$1,358.88
Rate for Payer: Ohana Health Plan Medicare	$1,358.88
Rate for Payer: UnitedHealthcare Medicare	$1,358.88
Rate for Payer: University Health Alliance Commercial	$1,001.28

SUTURE ANCHOR #AR-2325PSLC

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$762.00
Max. Negotiated Rate	$1,478.28
Rate for Payer: AlohaCare Medicaid	$762.00
Rate for Payer: AlohaCare Medicare	$1,158.24
Rate for Payer: Cash Price	$914.40
Rate for Payer: Devoted Health Medicare	$1,280.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,158.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,066.80
Rate for Payer: Health Management Network Commercial	$1,295.40
Rate for Payer: Humana Medicare	$1,158.24
Rate for Payer: Kaiser Permanente Commercial	$1,371.60
Rate for Payer: Kaiser Permanente Medicaid	$777.24
Rate for Payer: Kaiser Permanente Medicare	$1,158.24
Rate for Payer: MDX Hawaii PPO	$1,478.28
Rate for Payer: Ohana Health Plan Medicaid	$1,158.24
Rate for Payer: Ohana Health Plan Medicare	$1,158.24
Rate for Payer: UnitedHealthcare Medicare	$1,158.24
Rate for Payer: University Health Alliance Commercial	$853.44

SUTURE ANCHOR #AR-2325PSLC

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$853.44
Max. Negotiated Rate	$1,478.28
Rate for Payer: Cash Price	$914.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,066.80
Rate for Payer: Health Management Network Commercial	$1,295.40
Rate for Payer: Kaiser Permanente Commercial	$1,371.60
Rate for Payer: MDX Hawaii PPO	$1,478.28
Rate for Payer: University Health Alliance Commercial	$853.44

Know your out-of-pocket cost for care.

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