Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CR FLEX FEM G-RT 5956-017-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$3,800.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$4,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$3,800.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$3,800.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$3,800.00
Rate for Payer: Ohana Health Plan Medicare	$3,800.00
Rate for Payer: UnitedHealthcare Medicare	$3,800.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

CR FLX FEM COMPNT #5750-017-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$3,800.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$4,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$3,800.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$3,800.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$3,800.00
Rate for Payer: Ohana Health Plan Medicare	$3,800.00
Rate for Payer: UnitedHealthcare Medicare	$3,800.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

CR FLX FEM COMPNT #5750-017-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

CRTD COBALT XT HF MRI IS1 HF

Facility

$52,098.00

Service Code	HCPCS C1882
Hospital Revenue Code	275
Min. Negotiated Rate	$29,174.88
Max. Negotiated Rate	$50,535.06
Rate for Payer: Cash Price	$31,258.80
Rate for Payer: Hawaii Western Management Group Commercial	$36,468.60
Rate for Payer: Health Management Network Commercial	$44,283.30
Rate for Payer: Kaiser Permanente Commercial	$46,888.20
Rate for Payer: MDX Hawaii PPO	$50,535.06
Rate for Payer: University Health Alliance Commercial	$29,174.88

CRTD COBALT XT HF MRI IS1 HF

Facility

$52,098.00

Service Code	HCPCS C1882
Hospital Revenue Code	275
Min. Negotiated Rate	$26,049.00
Max. Negotiated Rate	$50,535.06
Rate for Payer: AlohaCare Medicaid	$26,049.00
Rate for Payer: AlohaCare Medicare	$39,594.48
Rate for Payer: Cash Price	$31,258.80
Rate for Payer: Devoted Health Medicare	$43,762.32
Rate for Payer: Hawaii Medical Service Association Medicare	$39,594.48
Rate for Payer: Hawaii Western Management Group Commercial	$36,468.60
Rate for Payer: Health Management Network Commercial	$44,283.30
Rate for Payer: Humana Medicare	$39,594.48
Rate for Payer: Kaiser Permanente Commercial	$46,888.20
Rate for Payer: Kaiser Permanente Medicaid	$26,569.98
Rate for Payer: Kaiser Permanente Medicare	$39,594.48
Rate for Payer: MDX Hawaii PPO	$50,535.06
Rate for Payer: Ohana Health Plan Medicaid	$39,594.48
Rate for Payer: Ohana Health Plan Medicare	$39,594.48
Rate for Payer: UnitedHealthcare Medicare	$39,594.48
Rate for Payer: University Health Alliance Commercial	$29,174.88

CRUCIATE RETAINING 5510-F-202

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

CRUCIATE RETAINING 5510-F-202

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

CRUCIATE RETAINING 5517-F-502

Facility

$5,947.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,973.50
Max. Negotiated Rate	$5,768.59
Rate for Payer: AlohaCare Medicaid	$2,973.50
Rate for Payer: AlohaCare Medicare	$4,519.72
Rate for Payer: Cash Price	$3,568.20
Rate for Payer: Devoted Health Medicare	$4,995.48
Rate for Payer: Hawaii Medical Service Association Medicare	$4,519.72
Rate for Payer: Hawaii Western Management Group Commercial	$4,162.90
Rate for Payer: Health Management Network Commercial	$5,054.95
Rate for Payer: Humana Medicare	$4,519.72
Rate for Payer: Kaiser Permanente Commercial	$5,352.30
Rate for Payer: Kaiser Permanente Medicaid	$3,032.97
Rate for Payer: Kaiser Permanente Medicare	$4,519.72
Rate for Payer: MDX Hawaii PPO	$5,768.59
Rate for Payer: Ohana Health Plan Medicaid	$4,519.72
Rate for Payer: Ohana Health Plan Medicare	$4,519.72
Rate for Payer: UnitedHealthcare Medicare	$4,519.72
Rate for Payer: University Health Alliance Commercial	$3,330.32

CRUCIATE RETAINING 5517-F-502

Facility

$5,947.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,330.32
Max. Negotiated Rate	$5,768.59
Rate for Payer: Cash Price	$3,568.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,162.90
Rate for Payer: Health Management Network Commercial	$5,054.95
Rate for Payer: Kaiser Permanente Commercial	$5,352.30
Rate for Payer: MDX Hawaii PPO	$5,768.59
Rate for Payer: University Health Alliance Commercial	$3,330.32

CRYSTAL CANNULA 5.75 AR-6564

Facility

$131.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.50
Max. Negotiated Rate	$127.07
Rate for Payer: AlohaCare Medicaid	$65.50
Rate for Payer: AlohaCare Medicare	$99.56
Rate for Payer: Cash Price	$78.60
Rate for Payer: Devoted Health Medicare	$110.04
Rate for Payer: Hawaii Medical Service Association Medicare	$99.56
Rate for Payer: Hawaii Western Management Group Commercial	$124.45
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$99.56
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$99.56
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$99.56
Rate for Payer: Ohana Health Plan Medicare	$99.56
Rate for Payer: UnitedHealthcare Medicare	$99.56
Rate for Payer: University Health Alliance Commercial	$95.49

CRYSTAL CANNULA 5.75 AR-6564

Facility

$131.00

Hospital Revenue Code	272
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$78.60
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: MDX Hawaii PPO	$127.07

C-TAPER +0 HEAD 06-2600

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$995.00
Max. Negotiated Rate	$1,930.30
Rate for Payer: AlohaCare Medicaid	$995.00
Rate for Payer: AlohaCare Medicare	$1,512.40
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Devoted Health Medicare	$1,671.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,512.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Humana Medicare	$1,512.40
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: Kaiser Permanente Medicaid	$1,014.90
Rate for Payer: Kaiser Permanente Medicare	$1,512.40
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: Ohana Health Plan Medicaid	$1,512.40
Rate for Payer: Ohana Health Plan Medicare	$1,512.40
Rate for Payer: UnitedHealthcare Medicare	$1,512.40
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER +0 HEAD 06-2600

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.40
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

C-TAPER BIOLOX HEAD 18-3600

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.00
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$2,033.76
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$2,247.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,033.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$2,033.76
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$2,033.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$2,033.76
Rate for Payer: Ohana Health Plan Medicare	$2,033.76
Rate for Payer: UnitedHealthcare Medicare	$2,033.76
Rate for Payer: University Health Alliance Commercial	$1,498.56

C-TAPER BIOLOX HEAD 18-3600

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

C-TAPER BIOLOX HEAD 18-3625

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.00
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$2,033.76
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$2,247.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,033.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$2,033.76
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$2,033.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$2,033.76
Rate for Payer: Ohana Health Plan Medicare	$2,033.76
Rate for Payer: UnitedHealthcare Medicare	$2,033.76
Rate for Payer: University Health Alliance Commercial	$1,498.56

C-TAPER BIOLOX HEAD 18-3625

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

C-TAPER BIOLOX HEAD 18-36-5

Facility

$6,442.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,607.52
Max. Negotiated Rate	$6,248.74
Rate for Payer: Cash Price	$3,865.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,509.40
Rate for Payer: Health Management Network Commercial	$5,475.70
Rate for Payer: Kaiser Permanente Commercial	$5,797.80
Rate for Payer: MDX Hawaii PPO	$6,248.74
Rate for Payer: University Health Alliance Commercial	$3,607.52

C-TAPER BIOLOX HEAD 18-36-5

Facility

$6,442.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,221.00
Max. Negotiated Rate	$6,248.74
Rate for Payer: AlohaCare Medicaid	$3,221.00
Rate for Payer: AlohaCare Medicare	$4,895.92
Rate for Payer: Cash Price	$3,865.20
Rate for Payer: Devoted Health Medicare	$5,411.28
Rate for Payer: Hawaii Medical Service Association Medicare	$4,895.92
Rate for Payer: Hawaii Western Management Group Commercial	$4,509.40
Rate for Payer: Health Management Network Commercial	$5,475.70
Rate for Payer: Humana Medicare	$4,895.92
Rate for Payer: Kaiser Permanente Commercial	$5,797.80
Rate for Payer: Kaiser Permanente Medicaid	$3,285.42
Rate for Payer: Kaiser Permanente Medicare	$4,895.92
Rate for Payer: MDX Hawaii PPO	$6,248.74
Rate for Payer: Ohana Health Plan Medicaid	$4,895.92
Rate for Payer: Ohana Health Plan Medicare	$4,895.92
Rate for Payer: UnitedHealthcare Medicare	$4,895.92
Rate for Payer: University Health Alliance Commercial	$3,607.52

C-TAPER COCR LFIT HEAD 06-2810

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$985.50
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$1,497.96
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$1,655.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,497.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$1,497.96
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$1,497.96
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$1,497.96
Rate for Payer: Ohana Health Plan Medicare	$1,497.96
Rate for Payer: UnitedHealthcare Medicare	$1,497.96
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER COCR LFIT HEAD 06-2810

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER COCR LFIT HEAD 06-2898

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER COCR LFIT HEAD 06-2898

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$985.50
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$1,497.96
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$1,655.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,497.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$1,497.96
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$1,497.96
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$1,497.96
Rate for Payer: Ohana Health Plan Medicare	$1,497.96
Rate for Payer: UnitedHealthcare Medicare	$1,497.96
Rate for Payer: University Health Alliance Commercial	$1,103.76

C-TAPER FEMORAL HEAD 15-2825

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

C-TAPER FEMORAL HEAD 15-2825

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.00
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$2,033.76
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$2,247.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,033.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$2,033.76
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$2,033.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$2,033.76
Rate for Payer: Ohana Health Plan Medicare	$2,033.76
Rate for Payer: UnitedHealthcare Medicare	$2,033.76
Rate for Payer: University Health Alliance Commercial	$1,498.56

Know your out-of-pocket cost for care.

All Charges