Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

UHR BIPOLAR 28X46MM UH1-46-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X47MM UH1-47-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X47MM UH1-47-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X48MM UH1-48-28

Facility

$2,433.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,216.50
Max. Negotiated Rate	$2,360.01
Rate for Payer: AlohaCare Medicaid	$1,216.50
Rate for Payer: AlohaCare Medicare	$1,849.08
Rate for Payer: Cash Price	$1,459.80
Rate for Payer: Devoted Health Medicare	$2,043.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,849.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,703.10
Rate for Payer: Health Management Network Commercial	$2,068.05
Rate for Payer: Humana Medicare	$1,849.08
Rate for Payer: Kaiser Permanente Commercial	$2,189.70
Rate for Payer: Kaiser Permanente Medicaid	$1,240.83
Rate for Payer: Kaiser Permanente Medicare	$1,849.08
Rate for Payer: MDX Hawaii PPO	$2,360.01
Rate for Payer: Ohana Health Plan Medicaid	$1,849.08
Rate for Payer: Ohana Health Plan Medicare	$1,849.08
Rate for Payer: UnitedHealthcare Medicare	$1,849.08
Rate for Payer: University Health Alliance Commercial	$1,362.48

UHR BIPOLAR 28X48MM UH1-48-28

Facility

$2,433.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.48
Max. Negotiated Rate	$2,360.01
Rate for Payer: Cash Price	$1,459.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,703.10
Rate for Payer: Health Management Network Commercial	$2,068.05
Rate for Payer: Kaiser Permanente Commercial	$2,189.70
Rate for Payer: MDX Hawaii PPO	$2,360.01
Rate for Payer: University Health Alliance Commercial	$1,362.48

UHR BIPOLAR 28X49MM UH1-49-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X49MM UH1-49-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X50MM UH1-50-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X50MM UH1-50-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X51MM UH1-51-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X51MM UH1-51-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X52MM UH1-52-28

Facility

$2,433.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.48
Max. Negotiated Rate	$2,360.01
Rate for Payer: Cash Price	$1,459.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,703.10
Rate for Payer: Health Management Network Commercial	$2,068.05
Rate for Payer: Kaiser Permanente Commercial	$2,189.70
Rate for Payer: MDX Hawaii PPO	$2,360.01
Rate for Payer: University Health Alliance Commercial	$1,362.48

UHR BIPOLAR 28X52MM UH1-52-28

Facility

$2,433.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,216.50
Max. Negotiated Rate	$2,360.01
Rate for Payer: AlohaCare Medicaid	$1,216.50
Rate for Payer: AlohaCare Medicare	$1,849.08
Rate for Payer: Cash Price	$1,459.80
Rate for Payer: Devoted Health Medicare	$2,043.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,849.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,703.10
Rate for Payer: Health Management Network Commercial	$2,068.05
Rate for Payer: Humana Medicare	$1,849.08
Rate for Payer: Kaiser Permanente Commercial	$2,189.70
Rate for Payer: Kaiser Permanente Medicaid	$1,240.83
Rate for Payer: Kaiser Permanente Medicare	$1,849.08
Rate for Payer: MDX Hawaii PPO	$2,360.01
Rate for Payer: Ohana Health Plan Medicaid	$1,849.08
Rate for Payer: Ohana Health Plan Medicare	$1,849.08
Rate for Payer: UnitedHealthcare Medicare	$1,849.08
Rate for Payer: University Health Alliance Commercial	$1,362.48

UHR BIPOLAR 28X53MM UH1-53-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X53MM UH1-53-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X54MM UH1-54-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X54MM UH1-54-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X55MM UH1-55-28

Facility

$2,433.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,216.50
Max. Negotiated Rate	$2,360.01
Rate for Payer: AlohaCare Medicaid	$1,216.50
Rate for Payer: AlohaCare Medicare	$1,849.08
Rate for Payer: Cash Price	$1,459.80
Rate for Payer: Devoted Health Medicare	$2,043.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,849.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,703.10
Rate for Payer: Health Management Network Commercial	$2,068.05
Rate for Payer: Humana Medicare	$1,849.08
Rate for Payer: Kaiser Permanente Commercial	$2,189.70
Rate for Payer: Kaiser Permanente Medicaid	$1,240.83
Rate for Payer: Kaiser Permanente Medicare	$1,849.08
Rate for Payer: MDX Hawaii PPO	$2,360.01
Rate for Payer: Ohana Health Plan Medicaid	$1,849.08
Rate for Payer: Ohana Health Plan Medicare	$1,849.08
Rate for Payer: UnitedHealthcare Medicare	$1,849.08
Rate for Payer: University Health Alliance Commercial	$1,362.48

UHR BIPOLAR 28X55MM UH1-55-28

Facility

$2,433.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.48
Max. Negotiated Rate	$2,360.01
Rate for Payer: Cash Price	$1,459.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,703.10
Rate for Payer: Health Management Network Commercial	$2,068.05
Rate for Payer: Kaiser Permanente Commercial	$2,189.70
Rate for Payer: MDX Hawaii PPO	$2,360.01
Rate for Payer: University Health Alliance Commercial	$1,362.48

UHR BIPOLAR 28X56MM UH1-56-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X56MM UH1-56-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X58MM UH1-58-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X58MM UH1-58-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X61MM UH1-61-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X61MM UH1-61-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$1,830.08
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$2,022.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$1,830.08
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$1,830.08
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$1,830.08
Rate for Payer: Ohana Health Plan Medicare	$1,830.08
Rate for Payer: UnitedHealthcare Medicare	$1,830.08
Rate for Payer: University Health Alliance Commercial	$1,348.48

Know your out-of-pocket cost for care.

All Charges